Objective: To investigate the outcome and inlfuencing factors of graft vessels including saphenous vein graft (SVG) and left internal mammary artery graft (LIMAG) in patients after coronary artery bypass grafting (CABG). Methods: A total of 92 patients with post-CABG symptom recurrence from 2010 to 2015 were analyzed by angiography and clinical features for their native coronary vessel and graft vessel. There were 83 male and 9 female patients with the mean age of (62.6±10.8) years. The outcomes of graft vessel were assessed; correlation study was conducted between SVG, LIMAG lesions and traditional atherosclerosis risk factors like age, gender, hypertension, hyperlipidemia, diabetic mellitus, smoking, family history of coronary artery disease (CAD) with other clinical factors such as the time of angina recurrence, thetime from coronary angiography (CAG) to CABG, type of SVG (sequential graft or individual graft), the features of native target vessel lesions prior grafting. Results: The average time from CABG to symptom recurrence was (35.10±24.7) months. There were 146 grafts including 52 LIMAG and 94 SVG (60 individual and 34 sequential grafts), the patency rate of LIMAG was higher than SVG (63.5% vs 44.7%),P=0.030. SVG lesion was positively related to symptom recurrence (OR=1.119, 95% CI 1.002-1.249,P=0.046) and trended to female gender (P=0.065), while not related to other clinical factors; LIMGA lesion was not related to any clinical factors. The patency rate of sequential SVG was higher than individual SVG (58.9% vs. 36.7%,P=0.038). The native target vessel lesion (deifned by pre-operative occlusion/stenosis) was similar between individual SVG group (24/14) and no-lesion SVG group (17/5),P=0.388; while the native target vessel lesion in LIMAG group (7/12) was lower than no-lesion LIMAG group (23/10),P=0.04. Conclusion: Post-CABG lesion was not obviously related to traditional risk factors of CAD, post-SVG lesion was positively related to the time of post-CABG angina recurrence. SVG mid-and long-term patency in sequential graft vessel was higher than that in individual graft vessel. Pre-CABG native coronary blood lfow would affect the outcome of individual LIMAG but not SVG.

OBJECTIVETo investigate the triaging pathways of patients after coronary computed tomography angiography (CCTA).

METHODSThe patients undergoing CCTA were enrolled consecutively during the period from March 3, 2008 to June 23, 2009. The rate of coronary angiography (CAG) examinations after CCTA was calculated. The rates of normal CAG, medication, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) were compared between CCTA and direct CAG cohorts.

RESULTSA total of 8030 cases receiving CCTA and 3260 receiving direct CAG were included in the study. The CCTA patients had significantly fewer risk factors than those having direct CAG. Of the 8030 patients undergoing CCTA, 953 (12.03%) received further CAG and 6977 (87.97%) did not. Of the patients who received CAG after CCTA, 35 (3.7%) had normal CAG findings, 604 (63.4%) underwent PCI, 108 (11.3%) received conservative treatment with medications, and 206 (21.6%) underwent CABG. In the 3260 patients directly undergoing CAG, 706 (52.3%) underwent subsequent PCI, 142(4.4%) underwent CABG, 815(25.1%) received medications, and 579 (17.9%) had normal CAG findings. Comparison between the cases receiving direct CAG and CAG after CCTA showed that CCTA resulted in a significant increase in the revascularization rate (P<0.0001).

CONCLUSIONCCTA can help prevent unnecessary CAG and allows more accurate patient triage.

Coronary Angiography ; methods ; Coronary Artery Disease ; diagnostic imaging ; therapy ; Female ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed

Objective To investigate the triaging pathways of patients after coronary computed tomography angiography (CCTA). Methods The patients undergoing CCTA were enrolled consecutively during the period from March 3, 2008 to June 23, 2009. The rate of coronary angiography (CAG) examinations after CCTA was calculated. The rates of normal CAG, medication, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) were compared between CCTA and direct CAG cohorts. Results A total of 8030 cases receiving CCTA and 3260 receiving direct CAG were included in the study. The CCTA patients had significantly fewer risk factors than those having direct CAG. Of the 8030 patients undergoing CCTA, 953 (12.03%) received further CAG and 6977 (87.97%) did not. Of the patients who received CAG after CCTA, 35 (3.7%) had normal CAG findings, 604 (63.4%) underwent PCI, 108 (11.3%) received conservative treatment with medications, and 206 (21.6%) underwent CABG. In the 3260 patients directly undergoing CAG, 706 (52.3%) underwent subsequent PCI, 142(4.4%) underwent CABG, 815(25.1%) received medications, and 579 (17.9%) had normal CAG findings. Comparison between the cases receiving direct CAG and CAG after CCTA showed that CCTA resulted in a significant increase in the revascularization rate (P<0.0001). Conclusion CCTA can help prevent unnecessary CAG and allows more accurate patient triage.

Objective To investigate the triaging pathways of patients after coronary computed tomography angiography (CCTA). Methods The patients undergoing CCTA were enrolled consecutively during the period from March 3, 2008 to June 23, 2009. The rate of coronary angiography (CAG) examinations after CCTA was calculated. The rates of normal CAG, medication, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) were compared between CCTA and direct CAG cohorts. Results A total of 8030 cases receiving CCTA and 3260 receiving direct CAG were included in the study. The CCTA patients had significantly fewer risk factors than those having direct CAG. Of the 8030 patients undergoing CCTA, 953 (12.03%) received further CAG and 6977 (87.97%) did not. Of the patients who received CAG after CCTA, 35 (3.7%) had normal CAG findings, 604 (63.4%) underwent PCI, 108 (11.3%) received conservative treatment with medications, and 206 (21.6%) underwent CABG. In the 3260 patients directly undergoing CAG, 706 (52.3%) underwent subsequent PCI, 142(4.4%) underwent CABG, 815(25.1%) received medications, and 579 (17.9%) had normal CAG findings. Comparison between the cases receiving direct CAG and CAG after CCTA showed that CCTA resulted in a significant increase in the revascularization rate (P<0.0001). Conclusion CCTA can help prevent unnecessary CAG and allows more accurate patient triage.

Objective To discuss the influence of coronary computed tomography angiography(CCTA)on correctness of assessing revascularization in patients with coronary artery disease. Methods A retrospective study method was conducted,605 cases underwent CCTA before coronary angiography(CAG)from 2008 to 2009 in Chinese PLA General Hospital were selected as CCTA before CAG group,and meanwhile 616 cases examined by CAG directly were selected as direct CAG group. Patients with multiple procedures of CAG were excluded. The proportions of various treatment strategies were compared,including per-cutaneous coronary intervention(PCI),coronary artery bypass grafting(CABG),medical therapy(MT),normal rate of CAG and the correctness of assessing revascularization between the two groups. Results The comparison between the baseline of the two groups showed that in the CCTA before CAG group,there were more severe lesions than those in the direct CAG group,such as Syntax score(11.31±8.90 vs. 10.23±9.73,P<0.05). Compared with direct CAG group,the triage of PCI and CABG in the CCTA before CAG group was significantly increased〔PCI:65.3%(395/605)vs. 57.1%(352/616),CABG:16.5%(100/605)vs. 3.4%(21/616)〕,while the percentages of medical treatment and normal CAG were obviously reduced〔medical treatment:11.7%(71/605)vs. 19.3%(119/616),normal rate of CAG:6.4%(39/605)vs. 20.1%(124/616),all P<0.01〕. With the guidance of CCTA,the correctness of assessing revascularization was increased〔81.8%(495/605)vs. 60.6%(373/616),P<0.01〕. Conclusion Compared with the direct induction by CAG,the CCTA examination carried out before CAG is capable of increasing the rate of correctness in the determination of revascularization in coronary heart diseases.

Objective:To investigate the effect of angiotensin II (ang II), aldosterone (ald) and their receptor antagonists losartan (los) and spironolactone (spi) on the proliferation and collagen production of cardiac ifbroblasts (CFs) in rats.
Methods:CFs were isolated from neonatal SD rats by collagenase II method and puriifed with differential attachment and detachment method. The 3 or 4 passages of the CFs were divided into the following groups:angiotensin II, angiotensin II+aldosterone, aldosterone, angiotensin II+losartan, and aldosterone+spironolactone. The cell viability of the CFs was assessed by Cell Counting Kit-8 (CCK-8) after the drug administration. The mRNA and protein expression levels of COL1A1, COL3A1, MMP1 and TIMP1 were detected by reverse transcription polymerase chain reaction (RT-PCR) and Western blot respectively.
Results:Ang II and Ald facilitated the proliferation rate of the CFs independently compared with that in the control group (38.5%vs 28.5%;P<0.05), and the proliferation rate in the ang II+ald group was higher than that in the ang II group and ald group alone (54.4%, P<0.05). Los and spi inhibited the effect induced by ang II and ald respectively (P<0.05). Compared with the control group, ang II and ald signiifcantly enhanced COL1A1, COL3A1 and MMP1 expression both at the mRNA and protein levels (P<0.05), but the TIMP1 expression was inhibited (P<0.05), which could be abolished by corresponding receptor antagonists los and spi (P<0.05).
Conclusion:Ang II and ald can promote the proliferation of CFs, and the COL1A1 and COL3A1 expression is enhanced both at mRNA and protein levels. Ang II and ald have synergistic effect when they are used together, while los and spi may restrain the effect. The mechanism is probably linked with the balance of MMPs/TIMPs.

Objective To assess the relationship between coronary plaques and risk factor of coronary heart disease in a asymptomatic population.Methods A total of 604 in-patients who received coronary computerized tomography angiography (CCTA) during January 1 th,2010 and April 1 th,2011 were enrolled in this study and assigned to the non-lesion group (0),mild lesion group (0 ＜ score ≤ 5) andmoderate-severe lesion group (＞ 5) according to the third quartile of CCTA score.Clinical data including physical examination,laboratory test,ultrasound sonogram and discharge diagnoses were collected and compared between the groups.Multivariable linear regression and bivariate logistic regression were performed to find out the main risk factors of coronary heart disease.ROC curve was drawn to estimate the diagnostic value of coronary lesions.Results There were 240 individuals in the non-lesion group,271 in the mild lesion group,93 in the moderate-severe lesion group.Multivariable linear regression indicated Y =-6.56 +3.22 × mean carotid intima-media thickness (cIMT) + 1.106 × male + 0.597 × low-density lipoprotein cholesterol (LDL-C) + 0.116 × age-1.596 × high-density lipoprotein cholesterol (HDL-C).Bivariate logistic regression and ROC curve showed that mean cIMT was the main risk factor of coronary heart disease (odds ratio (OR) =7.19,ROC =0.730,P=0.00,95％ confidence interval (CI):0.68 to 0.78).Furthermore,major coronary lesions were located in the LAD (20.8％) and was soft plaque (42.5％).Conclusion In this investigation,60.2％ of the asymptomatic patients showed plaques in CCTA.Age,cIMT,LDL-C and HDL-C may be predictive to moderate to severe coronary artery lesions.

OBJECTIVETo assess the feasibility and accuracy of CT coronary angiography (CTCA) combined with CT first-pass myocardial perfusion imaging (CT first-pass MPI) at rest for diagnosis of obstructive coronary artery disease (CAD).

METHODSFifty-five patients, suspected or diagnosed as CAD, were performed with CTCA and CAG within 2 weeks. CT first-pass MPI detected myocardial ischemia through analyzing the raw date of CTCA.

RESULTSComparison with the results of CAG, the sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CT first-pass MPI at rest for detecting obstructive CAD were 84.6%, 68.8%, 86.8%, 64.7% and 80.0%, respectively; and 92.3%, 93.8%, 97.3%, 83.3%, 92.7% for CTCA combined with CT first-pass MPI, respectively.

CONCLUSIONCTCA combined with CT first-pass MPI at rest could detect obstructive CAD feasible and accurately.

Adult ; Aged ; Coronary Angiography ; Coronary Artery Disease ; diagnostic imaging ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Myocardial Perfusion Imaging ; Predictive Value of Tests ; Sensitivity and Specificity ; Tomography, Spiral Computed

OBJECTIVETo investigate the correlation between the findings by coronary computed tomography angiography (CCTA) and the risk factors for major adverse cardiac events (MACE).

METHODSThis cohort study involved 706 out-patients who received examination with CCTA between June, 2008 and April, 2011. The severity of coronary artery disease (CAD) was graded to normal, mild, moderate, severe, and revascularization. Pearson correlation analysis and ANOVA were used to evaluate the relationship between the risk factors for CAD and coronary plaques identified by CCTA, and the predictive accuracy was determined by the receiver-operating characteristic (ROC) curve.

RESULTSOf the 706 patients, 58.63% were found to have abnormal CCTA findings. A older age, hypertension, hyperlipidemia, diabetes mellitus, cerebral infarction, CAD, and myocardial infarction were associated with an significantly increased incidence of coronary plaques (P<0.01). The Framingham score, LDL, HCY, IMT, HDL and TC were also significantly correlated with the severity of the coronary plaques (P<0.05). The ROC curves showed that Framingham risk score (0.845), Cr (0.766), HCY (0.697), IMT (0.693) and HDL (0.316) had greater predictive value for the occurrence of coronary plaques (P<0.001).

CONCLUSIONThe Framingham risk score, Cr, HCY, IMT and HDL are validated by CCTA as the major coronary risk factors and can be used for screening of CAD.

Aged ; Coronary Angiography ; methods ; Coronary Artery Disease ; diagnostic imaging ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Tomography, Spiral Computed ; Tomography, X-Ray Computed ; methods

ObjectiveTo evaluate the feasibility and the value of videodensitometric scale (VDS) in assessing myocardial microperfusion. Methods11 Beagles were embolized small coronary artery with polystyrene microbubble (100 μm). Coronary angiography was performed after the embolization and the VDS was calculated. Single photon emission computerized tomography (SPECT) was also performed after embolization and SPECT scores were also calculated. ResultsVDS after embolization was (15.2±3.8); and SPECT score was (17.6±6.4). VDS correlated negatively with SPECT scores (r=－0.85, P<0.05).ConclusionVDS keeps a closely correlation with SPECT. It can be used to assess myocardial microcirculation in clinical.