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Dynamic Evaluation of Left Ventricular Function and Remodeling by Gated SPECT Perfusion and Gated FDG PET Metabolic Imaging During Ventricular Aneurysm Formation in Experimental Pigs

Yutong KE ; Congna TIAN ; Hongxing WEI ; Yi TIAN ; Weixue WANG ; Yijian YANG ; Zongyao ZHANG ; Qinghai GENG ; Qi WANG ; Hongyue WANG ; Xiaoli ZHANG ; Yue TANG

Chinese Circulation Journal.2015;(6):580-584. doi:10.3969/j.issn.1000-3614.2015.06.018

Objective: To dynamically evaluate left ventricular perfusion, global and local functional changes during left ventricular aneurysm (LVA) formation and to explore the relationship between the size of LVA and LVEF, LVESV, LVEDV by gated99mTc-MIBI SPECT (GSPECT) and gated18F-FDG PET metabolic (GPET) imaging in experimental pigs. Methods: LVA model was established by occlusion of left circumlfex artery (LCX) and placing an Ameroid constrictor at the proximal end of left anterior descending artery (LAD) in a total of 16 Chinese mini-pigs. At the 1st, 4th and 8th weeks of surgery, the changes of total perfusion defect (TPD), LVA formation and LVEF, LVESV, LVEDV were dynamically evaluated by GSPECT and GPET; the relationships between the size of LVA and LVEF, LVESV, LVEDV were analyzed respectively.Results: There were 5 pigs died in surgery and 2 died at the 1st week of modeling. According to golden (pathological) standard, 9 animals successfully ifnished the dynamic imaging study. At the 1st week of (basic) modeling, 4 animals formed large LVA, 2 formed small LVA at the apex and 3 without LVA formation. At the 4th and 8th weeks of modeling, dynamic imaging presented that the animals with large LVA had gradually increased range and degree of perfusion defect, LVEDV, LVESV, while gradually decreased LVEF; the above indexes were relatively stable in animals with small or none LVA. In addition, the size of LVA was related to LVEF (r=-7.26), LVEDV (r=0.855) and LVESV (r=0.825), allP<0.05. Conclusion: In experimental pigs, at the beginning of LVA formation, large range and severe perfusion defect may cause large aneurysm, the LV functional damage and remodeling may gradually increase and the prognosis is poor; in contrast, the animals with small or none LVA have better prognosis and usually without ventricular remodeling; which implies that in acute phase of LVA formation, the size of aneurysm may predict the trend of global LV systolic function and remodeling at the early stage.

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Clinical Efficacy of Transcatheter Induced Closure in Patients With Small Patent Ductus Arteriosus

Ling LIU ; Jun LIU ; Lei GAO ; Zhen WANG ; Milin ZHANG

Chinese Circulation Journal.2015;(6):570-572. doi:10.3969/j.issn.1000-3614.2015.06.015

Objective: To explore the methodology and efifcacy of transcatheter induced closure in patients with small patent ductus arteriosus (PDA). Methods: A total of 717 PDA patients treated in our hospital from 2005-11 to 2014-08 were summarized and there were 8 patients with small PDA were treated by transcatheter induced closure method including 3 male and 5 female from (1-6) years of age at the mean of (3.9±1.4) years with the body weight of (10-21) kg at the mean of (15.2±3.7) kg. The procedures were performed under local or general anesthesia with right cardiac catheterization and descending aortic arch angiography to observe PDA morphology and to measure PDA diameter at aortic and pulmonary aterial lateral and ductus length. Right catheter along the guide wear was pushed to the narrowest part of PDA and the motion was repeated for several times to stimulate the local area and then, the catheter was kept at PDA aortic lateral about 20 minutes thereafter. Results: Descending aortic arch angiography indicated that no residual shunt at 20 min after catheter partial blockage in all 8 patients, the immediate closure rate was 100%. No patient suffering from re-canalization by 1 year follow-up examination. Conclusion: Transcatheter induced closure of small PDA has minor trauma, no foreign material implantation, with low cost and good effect. It provides a new method for treating such particular type of PDA patients in clinical practice.

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Analysis for Combined Use of Low Molecular Weight Heparin and Statins Causing Transaminase Elevation in 32 Patients

Xu YANG ; Xiaoqing HUANG ; Yun ZHANG ; Hui SUN ; Haihua ZHANG ; Wei ZHANG ; Li WANG ; Huimin PANG ; Lu HUA ; Yishi LI

Chinese Circulation Journal.2015;(6):567-569. doi:10.3969/j.issn.1000-3614.2015.06.014

Objective: To analyze the relevant factors for combined use of low molecular weight heparin (LMWH) and statins causing transaminase elevation and to provide the reference for medication safety in clinical practice. Methods: There were 45 patients who received the combination of LMWH and statins treatment, then having ALT elevation in our ward from 2011-01 to 2012-12 were collected, by exclusion of patients with the history of high ALT at admission, interrupted treatment and incomplete record of liver function tests, a total of 32 patients were ifnally enrolled for investigation. The conditions for using LMWH and statins together, type of LMWH, timing of ALT elevation after medication and clinical outcomes were retrospectively analyzed. Results: All patients received statins including simvastatin, atorvastatin, rosuvastatin and pravastatin, and 15 patients took statins before using LMWH including enoxaparin, nadroparin and dalteparin. There were 18 patients had ALT increased below 3 times of the upper limit and 14 patients had ALT level ≥ 3 times of the upper limit, and ALT elevation occurred at the average of (3 ± 3.8) days after taking LMWH. All patients stopped using LMWH upon ALT elevation and 16 of them stopped taking statins. The ALT level gradually decreased to normal by application of hepatic-protective treatment in all patients.Conclusion: Combined using LMWH and statins could cause ALT elevation, LMWH and statins may have synergistic effect, and therefore, the enhanced monitor of liver function is necessary when using the combined medication.

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Comparative Study of Rivaroxaban and Warfarin for Treating the Patients With Left Ventricular Thrombus

Xiufen LI ; Zhenrong GE

Chinese Circulation Journal.2015;(6):559-561. doi:10.3969/j.issn.1000-3614.2015.06.012

Objective: To compare the safety and efifcacy of rivaroxaban and warfarin for treating the patients with left ventricular thrombus. Methods: A total of 31 patients with left ventricular thrombus were studied, the patients were randomly divided into 2 groups:Warfarin group, n=16, the patients initially received oral warfarin and low molecular weight heparin at (2.5-3) mg/day, when the INR value reached 2.0-3.0, heparin was stopped and warfarin was continued, the INR value was monitored every 3 days for 3 times, when INR value was stably kept at 2.0-3.0, it was then monitored for every 2 weeks. Rivaroxaban group,n=15, the patients received oral rivaroxaban at 10 mg twice a day. All patients were followed-up for 3 months, the thrombus remission time, new onset of thrombosis, embolism and bleeding events during treatment period were compared between 2 groups. Results: The patients’ age, gender, complication, size of thrombus and medication were similar between 2 groups. Compared with Warfarin group, Rivaroxaban group had the shorter thrombus remission time, (60.00±5.50)d vs (71.00±8.50) d,P<0.01, while the new onset of thrombosis and embolism events as cerebral embolism and systemic embolism were similar between 2 groups, Warfarin group had slightly higher bleeding events, allP>0.05. Conclusion: Rivaroxaban had better effect than warfarin for treating the patients with left ventricular thrombus without increasing the risk of bleeding.

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Comparative Study of Thymosin α1 Combining Anti-coagulation Medication and Simple Anti-coagulation Medication for Treating the Patients With Deep Venous Thrombosis Formation

Hongzhi SUN ; Xinjun LI

Chinese Circulation Journal.2015;(6):556-558. doi:10.3969/j.issn.1000-3614.2015.06.011

Objective: To compare the therapeutic effect of thymosin α1 combining anti-coagulation medication and simple anti-coagulation mediation in treating the patients with deep venous thrombosis (DVT) formation. Methods: A total of 92 patients with lower extremity vascular ultrasound conifrmed diagnosis of DVT were studied. The patients were randomly divided into 2 groups for treatment: Combination group, the patients received thymosin α1 combining anti-coagulation medication,n=45 and Simple group, the patients received only anti-coagulation medication,n=47. The changes of their deep venous thrombosis condition after treatment were compared between 2 groups. Results: By 4 weeks treatment, the proportion of completely dissolved thrombus in Combination group and in Simple group were 67 branches (49.26%) and 54 branches (37.24%); the thrombus progression and recurrence condition were 6 branches (4.41%) and 16 branches (11.03%), allP<0.05. Conclusion: Thymosin α1 combining anti-coagulation medication has the better effect than simple anti-coagulation medication for treating DVT patients.

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Efficacy and Safety of Coronary Artery Bypass Grafting Without Stopping Pre-operative Aspirin Administration：A Meta Analysis

Junhong LI

Chinese Circulation Journal.2015;(6):547-551. doi:10.3969/j.issn.1000-3614.2015.06.009

Objective: To systemically evaluate the efifcacy and safety of coronary artery bypass grafting (CABG) without stopping pre-operative aspirin administration for anti-platelet therapy in relevant patients. Methods: The computer searching including Cochrane Library (Issue 2, 2014), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP was conducted to collect the randomized controlled trial (RCT) for CABG without stopping pre-operative aspirin administration from the data base establishment until 2014-07. There were 2 reviewers identiifed the literatures independently according to inclusion, exclusion criteria, and extracted the information, evaluated the quality of assessment methods, then meta-analysis was performed by RevMan 5.2 software. Results: A total of 8 RCT studies including 1945 patients were enrolled. The meta analysis showed that compared with stopping pre-operative aspirin administration, the patients without stopping pre-operative aspirin had obviously increased post-operative bleeding drainage as MD=235.97,P=0.01, re-operation for bleeding as OR=2.4,P=0.0005 and fresh frozen plasma transfusion requirement as MD=0.79,P<0.0001. While the packed red blood cell (PRBC) transfusion requirement as MD=0.66, P=0.05, platelet transfusion requirement as MD=0.99,P=0.25, the incidence rate of post-operative myocardial infarction as OR=1.03,P=0.90 and post-operative mortality (OR=1.24,P=0.56) were similar between two conditions. Conclusion: CABG without stopping pre-operative aspirin administration may increase the post-operative bleeding,transfusion and re-operation for bleeding; low dose aspirin administration before CABG needs further investigation to solve the above problems in clinical practice.

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The Prognostic Effect of Left Ventricular End-diastolic Pressure During Primary Percutaneous Coronary Intervention in Patients With Acute ST-segment Elevation Myocardial Infarction

Jingjing JIA ; Pingshuan DONG ; Laijing DU ; Zhijuan LI ; Ximei FAN ; Honglei WANG ; Xishan YANG ; Xuming YANG

Chinese Circulation Journal.2015;(6):543-546. doi:10.3969/j.issn.1000-3614.2015.06.008

Objective: To evaluate the post-operative mortality of left ventricular end-diastolic pressure (LVEDP) during primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: We retrospectively analyzed 255 patients with new onset of STEMI who received primary PCI in our hospital and all patients received LVEDP measurement before coronary artery opening. According to LVEDP value, the patients were divided into 2 groups: LVEDP≤14 mmHg group,n=155 and LVEDP>14 mmHg group,n=100. The post-operative mortality up to 6 months was observed, and the effect of LVEDP on death rate was studied by Cox regression analysis. Results: Compared with LVEDP≤14 mmHg group, the patients in LVEDP>14 mmHg group had the 6 months mortality at HR=4.26, 95% CI (1.13-16.08),P=0.03. Relevant study presented that LVEDP was slightly related to LVEF (r=-0.267, P=0.001) and BNP (r=-0.154,P=0.041). Multi-regression analysis indicated that with adjusted LVEF and BNP, LVEDP was the independent predictor for post-operative mortality up to 6 months in acute STEMI patients after PCI. Conclusion: The LVEDP value measured during PCI procedure is the independent predictor for mortality after PCI in patients with new onset of STEMI.

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Expression of Connective Tissue Growth Factor in Patients With ST-segment Elevation Myocardial Infarction

Yong LI ; Li LI ; Chunmei QI ; Jun DIAO ; Weiheng WU ; Jianqi FENG

Chinese Circulation Journal.2015;(6):540-542. doi:10.3969/j.issn.1000-3614.2015.06.007

Objective: To detect the changes of serum level of connective tissue growth factor (CTGF) in patients with ST-segment elevation myocardial infarction (STEMI) and to study the correlation between CTGF level and the maximal activity of creatine kinase-MB (CK-MB). Methods: Our research included 2 groups of patients: STEMI group and unstable angina (UA) group. All patients were treated in our hospital from 2013-07 to 2014-06,n=50 in each group. In STEMI group, the serum levels of CTGF were examined by ELISA at 24h, 2, 7, 14 days of onset, and in UA group, CTGF level was examined at 24h of onset. The CK-MB activity levels were measured in STEMI group at the same time points by immunosuppression method. Results: The serum level of CTGF in UA patients at 24 h of onset was (10.34 ± 2.00) ng/mL, and in STEMI patients were (16.76 ± 3.17) ng/mL at 24h, (29.87 ± 4.90) ng/mL at 2d, (45.02 ± 8.35) ng/mL at 7d and (31.61 ± 4.40) at 14d. The CTGF levels in STEMI group at different time points were all higher than UA group at 24h of onset,P<0.01. In STEMI group, the CTGF levels were increasing from 24h to 7d, then decreasing at 14d, allP<0.01. In STEMI group, the highest protein concentration of CTGF was positively related to the maximal activity of CK-MB at 7 days of onset (r=0.859,P=0.000). Conclusion: CTGF expression has been up-regulated in STEMI patients which might be related to myocardial ifbrosis. The protein level of CTGF is related to MI size, it shows certain predictive value in relevant patients.

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Prevalence of Hyponatremia and the Relationship Between Hyponatremia and Prognosis of Dilated Cardiomyopathy for In-hospital Patients

Xuefei WU ; Changhong ZOU ; Yan HUANG ; Qiong ZHOU ; Rong LV ; Yuhui ZHANG ; Jian ZHANG

Chinese Circulation Journal.2015;(6):529-533. doi:10.3969/j.issn.1000-3614.2015.06.005

Objective: To investigate the prevalence of hyponatremia and the relationship between hyponatremia and prognosis of dilated cardiomyopathy (DCM) for in-hospital patients. Methods: A total of 515 consecutive in-hospital DCM patients treated in HF center of Fu Wai Hospifal from 2008-10 to 2013-10 were retrospectively studied. Hyponatremia was deifned as the serum level of sodium < 135 mmol/L at ifrst admission. The prevalence of hyponatremia and the relationship between hyponatremia and DCM prognosis were studied including the risk of in-hospital time and mortality, the rates of all cause death and HF worsening death after discharge. Surviving patients were followed-up by clinical or telephone visit until 2014-11 or until the death. Results: There were 134/515 (26.0%) patients suffered from hyponatremia at admission, the serum level of sodium was related to HF symptom duration, NYHA functional classiifcation, systolic blood pressure (SBP), left atrial diameter and total bilirubin level, allP<0.01. Compared with non-hyponatremia, the patients with hyponatremia presented longer in-hospital time(14.8±11.1) days vs (11.2±5.8) days and higher in-hospital mortality (18.7% vs 1.8%), bothP< 0.01. There were 483 survivors discharged and were followed-up for (30.7 ± 19.5) months, during that period, the rates of all cause death and HF worsening death were 26.5% and 21.9% respectively. The patients with hyponatremia had the higher rates of all cause death (47.7% vs 20.3%) and HF worsening death (44.0% vs 15.5%), bothP<0.01. Multiple Cox regression analysis showed that with adjusted HF history (> 6 months vs≤ months ), NYHA functional classiifcation (Ⅱ-Ⅳ), SBP (per 10 mmHg elevation), total bilirubin level (per 1 mg/dl change) and LVEDD (per 5 mm change), the hyponatremia at admission is still one of the important independent predictors for all cause death (HR=1.836, 95% CI (1.248-2.702),P<0.01 and HF worsening death HR=2.139, 95% CI (1.406-3.253),P<0.01 in DCM patients after discharge. Conclusion: Hyponatremia is a common electrolyte disorder for in-hospital DCM patients, it is related to longer in-hospital time and higher mortality; higher rates of all cause death and HF worsening death after discharge in DCM patients.

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Characteristics of Arrhythmia With its Prognosis in Patients of Apical Hypertrophic Cardiomyopathy

Xiaoliang LUO ; Xiaojin GAO ; Xiao CUI ; Xiaoning LIU ; Lichao ZHAO ; Zhe LI ; Xinxin YAN ; Shubin QIAO

Chinese Circulation Journal.2015;(6):525-528. doi:10.3969/j.issn.1000-3614.2015.06.004

Objective: To summarize the characteristics of arrhythmia with the relevant factors affecting its prognosis in patients of apical hypertrophic cardiomyopathy (AHCM). Methods: A total 283 AHCM patients with echocardiography or cardiac magnetic resonance (CMR) conifrmed diagnosis in our hospital from 2005-01 to 2012-08 were summarized. The patients were divided into 2 groups: With arrhythmia group, n=103 and Without arrhythmia group,n=180. The endpoint event was followed-up by clinical and telephone visits in both groups and the relevant risk factors affecting AHCM prognosis were investigated by Cox regression analysis. Results: There were 269 patients ifnished the follow-up investigation, 98 in With arrhythmia group, 171 in Without arrhythmia group, and the death rate was 4.08% vs 1.17%, the occurrence of endpoint event was 18.37% vs 5.58%respectively. Cox regression analysis indicated that age (HR=23.051, 95% CI 1.08-1.068,P<0.005), left atrial diameter (HR=4.113, 95%CI 1.002-1.119,P=0.043) and NT-proBNP (HR= 18.653, 95% CI 3.433-26.650,P<0.005) were the independent risk factors affecting prognosis in AHCM patients. Conclusion: Arrhythmia is one of the common presentations of AHCM, it does not have much impact on survival, while it may cause ventricular ifbrillation and increase the occurrence of cardiovascular events.

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