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ABSTRACT: To evaluate the feasibility and imaging quality of double prospectively ECG-triggered high-pitch spiral acquisition mode (double flash mode) for coronary computed tomography angiography (CTCA) in patients with atrial fibrillation (AF). 47 patients (11 women, 36 men; mean age 64.5 ± 12.1 years) were enrolled for CTCA examinations using a dual-source CT with 2 × 128 × 0.6 mm collimation, 0.28 s rotation time and a pitch of 3.4. Double flash mode was prospectively triggered first at 60 % and later at 30 % of the R-R interval within two cardiac cycles. Image quality was evaluated using a four-point scale (1 = excellent, 4 = non-assessable). From 672 coronary artery segments, 77.5 % (521/672) was rated as score of 1, 20.8 % (140/672) as score of 2, 1.2 % (8/672) as score of 3 and 0.4 % (3/672) was rated as 'non-assessable'. The average image quality score was 1.25 ± 0.38 on a per segment basis. Mean dose-length product for CTCA was 92.6 ± 28.2 mGy cm, the effective dose was 1.30 ± 0.39 mSv (0.64-1.97 mSv). In patients with AF, double prospectively ECG-triggered high-pitch spiral acquisition mode could be a feasible and valuable scan mode for CTCA with a consistent dose below 2 mSv as well as diagnostic imaging quality.
The international journal of cardiovascular imaging 03/2013; · 2.15 Impact Factor
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ABSTRACT: Objective: The 'no-reflow' phenomenon after a primary percutaneous coronary intervention (pPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) is a strong predictor of both short- and long-term mortality. We therefore developed and prospectively validated a risk score system in order to identify STEMI patients at high risk in terms of no-reflow after primary PCI. Methods: The first part of our study used data from 1,615 STEMI patients who underwent primary PCI within 12 h from symptom onset. Using logistic regression, we derived a risk score to predict angiographic no-reflow using baseline clinical variables. From this score, we developed a simplified fast-track screen that can be used before reperfusion. In the second part of our study, we prospectively validated the score system using receiver-operating characteristic (ROC) curves with data from 692 STEMI patients. Results: The model included six clinical items: age, neutrophil count, admission plasma glucose, β-blocker treatment, time-to-hospital admission and Killip classes. The risk score system demonstrated a good risk prediction with a c-statistic of 0.757 (95% CI 0.732-0.781) based on ROC analysis. Conclusion: A simple risk score system based on clinical variables is useful to predict the risk of developing no-reflow after pPCI in patients with STEMI.
Cardiology 03/2013; 124(3):153-160. · 1.71 Impact Factor
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Jun Guo, Yun-Dai Chen,
Feng Tian,
Hong-Bin Liu,
Lian Chen,
Zhi-Jun Sun,
Yi-Hong Ren,
Qin-Hua Jin,
Chang-Fu Liu,
Bao-Shi Han,
Lu-Yue Gai,
Ting-Shu Yang
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ABSTRACT: BACKGROUND: Thrombosis following plaque rupture is the main cause of acute coronary syndrome, but not all plaque ruptures lead to thrombosis. There are limited in vivo data on the relationship between the morphology of ruptured plaque and thrombosis. METHODS: We used optical coherence tomography (OCT) to investigate the morphology of plaque rupture and its relation to coronary artery thrombosis in patients with coronary heart disease. Forty-two patients with coronary artery plaque rupture detected by OCT were divided into two groups (with or without thrombus) and the morphological characteristics of ruptured plaque, including fibrous cap thickness and broken cap site, were recorded. RESULTS: The fibrous cap of ruptured plaque with thrombus was significantly thinner compared to caps without thrombus ((57.00 ± 17.00) µm vs. (96.00 ± 48.00) µm; P = 0.0076). CONCLUSIONS: Plaque rupture associated with thrombosis occurs primarily in plaque covered by a thin fibrous cap. Thick fibrous caps are associated with greater stability of ruptured plaque.
Chinese medical journal 03/2013; 126(6):1092-1095. · 0.86 Impact Factor
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ABSTRACT: Coronary artery ectasia (CAE) refers to abnormal dilation of coronary artery segments to 1.5 times of adjacent normal ones. Epicardial fat is associated with cardiovascular risk factors. The relationship between CAE and epicardial fat has not yet been investigated. This study aimed to assess the relationship between CAE and epicardial fat volume (EFV) in older people by dual-source computed tomography coronary angiography (CTCA).
We prospectively enrolled 1400 older adults who were scheduled for dual-source CTCA. Under reconstruction protocols, patients with abnormal segments 1.5 times larger than the adjacent segments were accepted as CAE. EFV was measured by semi-automated software. Traditional risk factors in CAE patients, as well as the extent of EFV, were analyzed and compared to non-CAE group.
A total of 885 male and 515 female older patients were enrolled. CAE was identified by univariable analysis in 131 patients and significantly correlated to hypertension, smoking, hyperlipidemia, prior percutaneous coronary intervention and ascending aorta aneurysm. EFV was shown to be significantly higher in CAE patients than patients without ectasia. In multivariable analyses, EFV (P = 0.018), hypertension (P < 0.001) and hyperlipidemia (P < 0.001) were significantly correlated to CAE. There was a significant negative correlation between EFV and Markis classification.
CAE can be reliably recognized by dual-source CTCA. Epicardial fat might play a role in etiopathogenesis and progression of CAE, providing a new target for treating ectasia.
Journal of Geriatric Cardiology 03/2013; 10(1):10-5.
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ABSTRACT: To investigate the effect of monocyte chemotactic protein-3 (MCP-3) on the expressions of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), tissue factor (TF, and tissue factor pathway inhibitor (TFPI) and cell apoptosis in human umbilical vein endothelial cells (HUVECs).
Cultured HUVECs were treated with MCP-3 at the optimal concentration determined previously 1 h after treatments with or without MCP-3 antibody (20 ng/ml), PI3K inhibitor, or LY-294002 (5 mmol/ml). The expressions of ICAM-1, VCAM-1, TF and TFPI were analyzed using RT-PCR and Western blot after the treatments. MCP-3 mRNA and protein expressions were detected in HUVECs exposed to 50 µg/ml ox-LDL for 24 h. The cell apoptosis and caspase-3 protein production in HUVECs treated with MCP-3 or with MCP-3 plus CCR2 antagonist for 24 h and 48 h were evaluated by flow cytometry and Western blotting.
At the optimal concentration of 0.3 ng/ml, MCP-3 treatment for 24 h caused significantly increased ICAM-1, VCAM-1, and TF expressions with lowered expression of TFPI in HUVECs (P<0.05), and such effects were significantly inhibited by the application of MCP-3 antibody, PI3K inhibitor, or LY-294002 (P<0.05). Ox-LDL exposure significantly increased the expression of MCP-3 in HUVECs (P<0.05). HUVECs showed a significantly increased apoptosis rate after treatment with MCP-3 or with MCP-3 plus CCR2 antagonist (P<0.05), and the apoptosis rate increased significantly as the treatment time prolonged (P<0.05); caspase-3 protein expression in the cells showed a similar pattern of alterations following the treatments.
ox-LDL can induce MCP-3 expression in HUVECs. MCP-3 induces apoptosis of HUVECs and significantly affects the cellular function partially through the PI3K signaling pathway.
Nan fang yi ke da xue xue bao = Journal of Southern Medical University 01/2013; 33(1):86-92.
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Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 12/2012; · 0.44 Impact Factor
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ABSTRACT: OBJECTIVE: To analyze the risk factors related to in-hospital bleeding for patients with acute coronary syndrome (ACS). METHODS: Clinical and therapeutic data of 3807 patients who were registered with acute coronary syndrome in SINO-GRACE in China from March 2001 to December 2007 were reviewed. A total of 57 patients were grouped to bleeding group and 234 out of the remaining 3750 patients without bleeding were randomly chosen and served as non-bleeding group. Hemorrhage-related factors were screened and compared between the two groups. Unitary logistic regression analysis was performed to detect the possible factors related to hemorrhage. Factors with P < 0.1 were further analyzed by stepwise regression method and multivariate conditional logistic regression analyses. RESULTS: (1) Age, history of coronary artery bypass graft (CABG), previous hemorrhage, renal failure and heart failure as well incidence of acute coronary syndrome were significantly higher in bleeding group than in non-bleeding group (all P ≤ 0.05). Patients were more often treated with clopidogrel and glycoprotein (GP) IIb/IIIa receptor antagonist in bleeding group than in non-bleeding group. (2) Single factor logistic regression analysis showed that age > 70 years, history of previous bleeding, renal failure, heart failure, clopidogrel and GP IIb/IIIa receptor antagonists use, non-ST-segment elevation myocardial infarction, inferior wall, lateral myocardial infarction, CABG were risk factors for bleeding (all P < 0.05). (3) Multivariate logistic regression analysis showed that history of renal failure (OR = 19.77, 95%CI 4.38 - 89.18, P < 0.01) and clopidogrel (OR = 19.77, 95%CI 4.38 - 89.18, P < 0.01) and GPIIb/IIIa receptor antagonist (OR = 343.57, 95%CI 40.39 - 999.99, P < 0.01) use were the independent risk factors for bleeding. CONCLUSION: Our results show that renal failure history and clopidogrel and GPIIb/IIIa receptor antagonist use are independent risk factors for in-hospital bleeding in patients with acute coronary syndrome.
Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases] 11/2012; 40(11):902-907.
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ABSTRACT: To explore the value of prospectively ECG-triggered high-pitch spiral mode CT coronary angiography (CTCA) in the follow-up of patients with prior coronary stent implantation.
According to the different scan modes, ninety-six patients with heart rate below 75 beat per minute, sinus rhythm and weight below 100 kg and previous coronary stent implantation who underwent 128-slice dual-source Flash spiral CT coronary angiography were randomly divided into two groups according to the randomly numbers in the envelopes: group A(the prospective electrocardiography gated group, 50 cases) and group B(the prospectively ECG-triggered high-pitch spiral mode group, 46 cases). The image quality was evaluated with a four-point grading scale (1 = excellent, 2 = good, 3 = poor, 4 = very poor or non-diagnostic). The total effective dose and the total dose length product between the two groups were recorded respectively. The CTCA enhanced effective dose, dose length product, and the CT volume dosage index (CTDIvol) between the two groups were recorded respectively.
A total of 157 stents were implanted, there were 78 stents in group A and 79 stents in group B, and the value of the image quality was (1.3 ± 0.6) scores in group A and (1.4 ± 0.6) scores in group B (P > 0.05). The total effective dose [(7.6 ± 1.8) mSv vs. (1.6 ± 0.3) mSv] and dose length product [(545.8 ± 131.5) mGy×cm vs. (111.4 ± 19.8) mGy×cm]of the entire scan process were significantly higher in group A than in group B (all P < 0.01). The CTCA enhanced effective dose [(6.7 ± 1.7) mSv vs. (1.2 ± 0.2) mSv], dose length product [(480.8 ± 121.9) mGy×cm vs. (84.2 ± 17.5) mGy×cm] and the CTDIvol [(35.7 ± 8.6) mGy vs. (4.5 ± 0.9) mGy] of group A were also significantly higher than those in group B (all P < 0.01).
It is clinically feasible to use the dual-source Flash spiral CT coronary angiography for the follow-up of the patients with previous coronary stent implantation. This new process can substantially reduce the radiation dose while preserving good imaging quality.
Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases] 11/2012; 40(11):933-8.
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ABSTRACT: OBJECTIVE: To explore the association of the uric acid levels and coronary blood flow in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS: A total of 276 STEMI patients undergoing primary PCI were enrolled and divided into 2 groups based upon the Thrombolysis in Myocardial Infarction (TIMI) flow grade. No-reflow was defined as TIMI Grade 0, 1 and 2 flows. The association of uric acid levels on admission with TIMI flow grade after PCI was assessed by multivariate Logistic regression. Major adverse cardiac events (MACE) were defined as death, non-fatal myocardial infarction and need for repeat percutaneous revascularization or coronary artery bypass grafting. RESULTS: The uric acid level was significantly higher in the no-reflow group (n = 57) than that of the normal-flow group (n = 219, 372 ± 111 vs 303 ± 102, P < 0.01). In-hospital MACEs were significantly higher in the patients with no reflow (8.8% vs 1.8%, P = 0.016). A uric acid level ≥ 345 mmol/L measured on admission had a 61.2% sensitivity and 77.5% specificity in predicting no-reflow at ROC curve analysis. At multivariate analyses, high plasma uric acid (OR 1.01, 95%CI 1.01 - 1.01, P < 0.01), neutrophil count (OR 1.02, 95%CI 1.00 - 1.06, P < 0.01), admission plasma glucose (OR 1.14, 95%CI 1.08 - 1.21, P < 0.01), time from pain to PCI (OR 1.67, 95%CI 0.46 - 5.97, P = 0.012), pre PCI thrombus score ≥ 4 (OR 2.67, 95%CI 1.29 - 5.13, P = 0.008), collateral circulation grade ≤ 1 (OR 1.86, 95%CI 1.27 - 2.73, P = 0.008), and Killip classes (OR 2.01, 95%CI 1.01 - 3.94, P = 0.042) were independent predictors of no-reflow post primary PCI. CONCLUSIONS: The plasma level of uric acid on admission is a strong and independent predictor of poor coronary blood flow following at post-primary PCI among STEMI patients. Uric acid levels may be a useful biomarker of risk stratification.
Zhonghua yi xue za zhi 11/2012; 92(44):3100-3103.
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ABSTRACT: OBJECTIVE: To investigate the clinical characteristics of patients with acute coronary syndrome suffering hemorrhage during hospitalization. METHODS: The clinical symptoms, diagnostic and therapeutic characteristics and in-hospital outcome of 3807 inpatients who were recruited into SINO-GRACE study in China due to acute coronary syndrome from March, 2001 to December, 2007 were collected. Statistical methods were adopted to compare the differences in clinical data between hemorrhage group and non-hemorrhage group. RESULTS: Hemorrhage had happened in 57 out of 3807 inpatients with the incidence of 1.50%. Five patients, which accounted for 9.6% of the overall hemorrhage cases, were fatal hemorrhage. Nine patients were intracranial hemorrhage with the incidence of 0.24%. There were 155 deaths among the 3807 patients, with an overall mortality rate of 4.1%. The mortality of hemorrhage accounted for 3.2% in overall mortality. Patients with one of the following factors were more apt to hemorrhage: > 70 years old, previous hemorrhage history, renal failure history, heart failure history and clopidogrel and glycoprotein (GP) IIb/IIIa receptor antagonist administration for coronary artery bypass grafting. Patients who developed hemorrhage might need prolonged hospitalization and were liable to develop heart-related adverse events, including re-infarction and sustained ventricular tachycardia/fibrillation after they were admitted in hospital over 24 hours. CONCLUSION: Patients with acute coronary syndrome who underwent coronary artery bypass grafting, with advanced age, previous hemorrhage history, renal failure history, heart failure history or treated with clopidogrel and GP IIb/IIIa receptor antagonist are more vulnerable to hemorrhage.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 09/2012; 51(9):670-673.
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ABSTRACT: In-stent restenosis is a common complication after stent implantation. However, the assessment of stent lumen in computed tomography (CT) coronary angiography is limited by multiple factors. Our study aimed to evaluate the accuracy and the suspected affecting factors in diagnosing coronary in-stent restenosis by dual-source CT (DSCT) compared with coronary angiography.
One hundred and fifteen stents in 50 patients were evaluated with DSCT before coronary angiography for the detection of coronary in-stent restenosis (≥ 50% luminal narrowing). Patency of each stent was analyzed by two independent expert radiologists blinded to the results of coronary angiography. The relationship between diagnostic accuracy and the suspected factors including age, body mass index (BMI), heart rate, variation of heart rate, radiation dose, image quality, location and stent characteristics (type, material, diameter, length and strut thickness) was assessed with both univariate and multivariate analysis. The fitting of a Logistic regression model was evaluated using a receiver operating characteristic (ROC) curve.
Mean stent diameter was (2.9 ± 0.4) mm. Sensitivity, specificity, positive and negative predictive values and accuracy of DSCT in detection of in-stent restenosis were 69.2%, 91.2%, 50.0%, 95.9%, and 88.7%, respectively. In a subgroup of stents with a diameter ≥ 3.0 mm, sensitivity, specificity, positive and negative predictive values and accuracy were 100.0%, 96.5%, 75.0%, 100.0%, and 96.8%, respectively. Stent diameter < 3.0 mm and poor image quality were associated with poor diagnostic accuracy (P < 0.05). The area under curve of ROC was 0.79.
DSCT can provide high accuracy for the assessment of in-stent restenosis in stents with a diameter = 3.0 mm, and can play an important role in ruling out in-stent restenosis.
Chinese medical journal 06/2012; 125(11):1936-40. · 0.86 Impact Factor
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ABSTRACT: To analyze the clinical characteristics of patients with systemic lupus erythematosus (SLE) and coronary artery disease (CAD).
Clinical data of 3911 SLE patients were retrospectively analyzed and CAD was diagnosed by coronary angiography in 26 (0.7%) SLE patients (10 stable angina pectoris, 5 unstable angina pectoris, 8 STEMI and 3 non-STEMI). The tradition risk factors, first onset of cardiac events, blood biochemistry index, treatment and activity of SLE, coronary angiographic features were compared with 552 CAD patients without SLE.
Compared with CAD patients without SLE, CAD patients with SLE were younger [(50.4 ± 15.2) years vs. (60.6 ± 11.6) years, P < 0.01], the mean number per patient of Framingham tradition risk factors was less (1.11 ± 1.18 vs. 2.50 ± 1.28, P < 0.05). CAD patients with SLE were prone to premature coronary artery disease [76.9% (20/26)], and ACS was the most common manifestation in SLE patients with premature coronary artery disease [65.0% (13/20)], the duration of steroid use was significantly longer [24.00 (3.75, 57.00) months vs. 1.00 (0.00, 2.00) months, P < 0.05] and 24 hours total urine protein [(1.93 ± 1.97) g vs. (0.76 ± 0.75) g, P < 0.05] was significantly higher in the ACS patients with SLE than non-ACS patients with SLE. Coronary stenosis was evidenced in most of the SLE patients with CAD [76.9% (20/26)] and incidence of coronary thrombotic occlusion was significantly higher in SLE patients with CAD than CAD patients without SLE [30.8% (8/26) vs. 11.8% (65/552), P < 0.05].
The incidence of CAD in SLE patients is low and the major form of CAD in SLE patients is premature coronary artery disease and mostly induced by coronary thrombotic occlusion.
Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases] 05/2012; 40(5):378-81.
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Jun Guo,
Lu Sun, Yun-dai Chen,
Feng Tian,
Hong-bin Liu,
Lian Chen,
Zhi-jun Sun,
Yi-hong Ren,
Qin-hua Jin,
Chang-fu Liu,
Bao-shi Han,
Lu-yue Gai,
Ting-shu Yang
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ABSTRACT: To explore the diagnostic accuracy of optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in the detection of ex vivo coronary plaques with different compositions compared with histology results.
OCT and IVUS were performed in 15 autopsied heart specimens and the isolated coronary artery was assessed by routine histological processing thereafter. Coronary plaques were classified into 3 types (lipid-rich plaque, calcified plaque and fibrous plaque) according to standard criteria respectively. Sensitivity and specificity for detection of different types of plaque by OCT and IVUS were calculated according histology results.
Seventy seven coronary plaques were analyzed. OCT demonstrated a sensitivity and specificity of 69% and 88% for lipid-rich plaque, 93% and 92% for calcified plaque, 88% and 98% for fibrous plaque. IVUS demonstrated a sensitivity and specificity of 61% and 92%, 98% and 97%, 68% and 90% respectively. The agreement between OCT and IVUS in assessment of coronary plaque was 0.831 (Kappa = 0.72, P < 0.01).
Both OCT and IVUS correctly detected ex vivo coronary plaques and there was a good agreement in assessment of coronary plaques between OCT and IVUS. OCT is superior to IVUS in assessment of fibrous plaque and is similar as IVUS in assessment of calcified plaque.
Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases] 04/2012; 40(4):302-6.
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ABSTRACT: This study aimed to determine the prevalence rates of conventional risk factors and to analyze the features of coronary lesions in patients with coronary heart disease (CHD).
3765 CHD cases were collected from the General Hospital of PLA in Beijing from 2009 to 2010 (2661 men, 1104 women). All the CHD patients enrolled in our study were diagnosed through angiography. Clinical and angiographic data of CHD patients were collected. After stratification on age and sex of the patients, logistic analysis method was used to evaluate the prevalence rates on conventional risk factors and to analyze the features of coronary lesions on CHD.
(1) More than two risk factors and advancing age of onset were commonly seen in female CHD patients. In those premature female CHD patients (age<45 years), there was a high proportion the habit of smoking. With the increase of age, proportions of patients with diabetes mellitus and hyperlipidemia also significantly increased. For male patients at different age, the proportions of smoking were high. (2) Data from logistic analysis suggested that diabetes mellitus could increase the prevalence of CHD on women (OR=2.05, 95%CI: 1.49-2.81, P<0.001), and smoking was a risk factor for men (OR=9.27, 95%CI: 7.68-11.19, P<0.001). (3) Along with the increase of age, female patients appeared to have more coronary vessel injures or severe coronary artery lesions. Different from the females, there was no change could seen on the characteristics of coronary lesions at different age for males.
Prevalence rates on risk factors and the characteristics of coronary lesions appeared to be different with age. Diabetes mellitus and hyperlipidemia seemed to impact more on women while smoking seemed to impact more on men.
Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi 04/2012; 33(4):423-7.
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Jun Guo, Yun-dai Chen,
Feng Tian,
Hong-bin Liu,
Lian Chen,
Zhi-jun Sun,
Yi-hong Ren,
Qin-hua Jin,
Chang-fu Liu,
Bao-shi Han,
Lu-yue Gai,
Ting-shu Yang
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ABSTRACT: Edge dissections after coronary stent implantation are associated with increased short-term risk of major adverse cardiovascular events. The incidence and outcome of edge dissections after coronary stent implantation were reportedly different using different imaging techniques. We used optical coherence tomography (OCT) to assess the incidence, morphological findings and related factors of edge dissections after drug-eluting stent (DES) implantation.
Totally 42 patients with 43 de novo lesions in 43 native arteries undergoing DES implantation with OCT imaging were enrolled in this study.
Nine edge dissections were detected in 43 arteries after DES implantation. There were four morphological patterns of stent edge dissections indentified in this study: (1) superficial intimal tears (n = 3), (2) subintimal dissections (n = 4), (3) split of media (n = 1), (4) disruption of the fibrotic cap of plaque (n = 1). Stent edge expansion and stent expansion were both higher in the group with dissections than those in the group without dissections (1.682 ± 0.425 vs. 1.229 ± 0.285, P = 0.0290; 1.507 ± 0.445 vs. 1.174 ± 0.265, P = 0.0072).
The incidence of stent edge dissections detected by OCT was 21%. Stent edge dissection is related with stent edge expansion and stent expansion.
Chinese medical journal 03/2012; 125(6):1047-50. · 0.86 Impact Factor
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ABSTRACT: To evaluate the safety and efficiency of local paclitaxel delivery using the double-balloon perfusion catheter to prevent restenosis in the canine coronary artery.
Twenty domestic canines underwent bare-mental stent implantation after ballon injure of the left coronary artery. A novel double-balloon perfusion catheter was used to deliver the drug locally in the canine coronary artery. In the treatment group (n = 15), paclitaxel (10 ml, 20 micromol/L) was delivered using the double-balloon perfusion catheter before stent implantation. In the control group (n = 5), 10 ml saline was delivered using the double-balloon perfusion catheter before stent implantation. The perfusion time in both groups was (26.45 +/- 5.18) s. Animals underwent coronary angiography and optical coherence tomography (OCT) 90 days after stent implantation and were sacrificed. Vessels were perfusion-fixed and morphometric analysis was performed using conventional techniques.
Coronary angiography results showed restenosis rate in control group was significantly higher than that in treatment group (60% vs. 33.33%, P < 0.05). The parameters of OCT showed in treatment group and control group: the neointimal thickness was (0.19 +/- 0.08) mm and (0.38 +/- 0.03) mm, the neointimal area was (1.52 +/- 0.49) mm2 and (2.51 +/- 0.47) mm2, the lumen area was (3.50 +/- 0.66) mm2 and (2.78 +/- 0.57) mm2, the extent of stenosis was (30.13 +/- 8.56)% and (47.40 +/- 4.50)%, and all the variances above were significantly different between the two groups (P < 0.05). The histologic parameters showed in treatment group and control group: the neointimal thickness was (0.22 +/- 0.10) mm and (0.47 +/- 0.05) mm, the neointimal area was (1.85 +/- 0.78) mm2 and (3.43 +/- 0.25) mm2, the lumen area was (3.15 +/- 0.43) mm2 and (1.85 +/- 0.55) mm2, the extent of stenosis was (36.00 +/- 10.97)% and (65.40 +/- 8.23)%, and all the variances above were also significantly different between the two groups (P < 0.05). The stents of both the groups were fully endothelialized. No thrombus or aneurysm was found in stents.
Local delivery of paclitaxel with the double-balloon perfusion catheter to prevent restenosis in coronary stents is safe and efficient.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 02/2012; 34(1):8-13.
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ABSTRACT: The present study investigated the effects of intravenous adenosine on myocardial perfusion and segmental contractile function when used as an adjunct of primary percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI). Patients were randomly assigned to receive intravenous adenosine (n = 35) or saline (n = 34) within 12 h of STEMI. Myocardial contrast echocardiography (MCE) and velocity vector imaging (VVI) were performed 7 days after primary PCI. Serial echocardiography was performed on Days 7 and 30. Capillary blood volume (A; 6.34 ± 1.98 vs 5.64 ± 1.84 dB; P = 0.03) and myocardial blood velocity (β; 0.13 ± 0.04 vs 0.1 ± 0.04/s; P = 0.01) were higher in the adenosine group than in control patients. Myocardial blood flow (A × β) was 0.82 ± 0.37 dB/s with adenosine compared with 0.57 ± 0.4 dB/s in control patients (P < 0.01). Improvements were seen in the adenosine compared with the control group in terms of myocardial wall strain(-13.52 ± 5.61% vs -11.47 ± 5.25%, respectively; P = 0.03), strain rate (-1.08 ± 0.52 vs -0.90 ± 0.44/s, respectively; P = 0.03) and segmental ejection fraction (53.66 ± 12.04% vs 48.40 ± 14.99%, respectively; P = 0.03). There was a correlation between myocardial perfusion in apical anterior segments, peak systolic strain (P = 0.001), strain rate (P = 0.001) and segmental ejection (P < 0.001). Global contractile function was better in the adenosine-treated than control group. At the 1 month follow up, there were no significant differences between groups in terms of the incidence of recurrent angina or heart failure. The results of the present study suggest that periprocedural intravenous adenosine contributes to improvements in myocardial perfusion, segmental wall motion and global contractile function in patients with acute myocardial infarction undergoing primary PCI.
Clinical and Experimental Pharmacology and Physiology 01/2012; 39(3):247-52. · 1.85 Impact Factor
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ABSTRACT: To evaluate the accuracy of optical coherence tomography (OCT) in evaluating neointimal proliferation in canine coronary artery following stenting.
In 15 domestic dogs, a single bare-metal stent was implanted in the anterior descending or the circumflex branch of the left coronary artery. Ninety days after stenting, the dogs underwent coronary angiography and OCT, followed by quantitative histological assessment of neointimal proliferation in the target arterial segments. The parameters of OCT and the histological findings were analyzed comparatively.
A total of 15 OCT-histology matched frames acquired at the point with the most severe stenosis in every stent, and 60 pathological sections from all the stents were analyzed. The difference of the stent area assessed by OCT was comparable to that defined histologically (5.01∓0.79 mm(2) vs 4.99∓0.81 mm(2), P>0.05). Neointimal thickness and area were smaller with OCT assessment than with histological assessment (0.19∓0.08 mm vs 0.22∓0.10 mm, and 1.52∓0.49 mm(2) vs 1.85∓0.78 mm(2), respectively, P<0.05). The lumen area was larger by OCT assessment than by histological assessment (3.50∓0.66 mm(2) vs 3.15 ∓ 0.43 mm(2), P<0.05). Close correlations were found between OCT and histological evaluations of the neointimal thickness (R(2)=0.5280.767), neointimal area (R(2)=0.5280.537) and stent area (R(2)=0.528), but the correlation was poor for lumen area (R(2)=0.5280.307). All the stents showed full endothelialization without thrombus or aneurysm in the stents.
OCT allows precise and reproducible assessment of neointimal proliferation in the coronary artery following stenting, but for measurement of the lumen area, OCT shows a poor correlation to histological evaluation.
Nan fang yi ke da xue xue bao = Journal of Southern Medical University 11/2011; 31(11):1855-7.
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ABSTRACT: In general, percutaneous coronary intervention (PCI) relieves vessel stenosis by implantation of a stent, however, the relationship between plaque characteristics and response after stenting is not clear.
We enrolled 68 patients (68 vessels) with diagnosed unstable angina pectoris that prospectively underwent PCI and an optical coherence tomography (OCT) examination was done before and after stenting. Coronary plaques were classified as fibrous, lipid-rich and calcified plaque according to OCT examination, and fibrous cap thickness, lumen eccentricity, stent expansion, stent malapposition, tissue prolapse, thrombosis, dissection and stent symmetry were noted.
The frequency of prolapse was higher in lipid-rich plaques than fibrous plaques (85% vs. 40%, P < 0.001). Dissection most often occurred in fibrous plaque compared with lipid-rich and calcified plaques (60% vs. 32% vs. 29%, P < 0.001). The frequency of stent strut malapposition in calcified plaques was higher than firous and lipid-rich plaques (71% vs. 40% vs. 5%, P < 0.001). In-stent micro-thrombosis was detected only in lipid-rich plaques, with a frequency of 37% (15/41). The risk factors of micro-thrombosis after PCI were cap thickness (OR 0.903, 95%CI 0.829 - 0.985), lumen eccentricity (OR 1.147, 95%CI 1.012 - 1.30), and stent length (OR 1.495, 95%CI 1.032 - 2.166).
Plaque response after PCI is associated with its characteristics, and of those, micro-thrombosis after stenting in lipid-rich plaques was the most significant finding and can be predicted.
Chinese medical journal 11/2011; 124(22):3752-6. · 0.86 Impact Factor
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ABSTRACT: To analyze the clinical characteristics of patients with acute myocardial infarction (AMI) complicated by free wall rupture (FWR) and to define the independent risk factors for FWR.
Clinical and angiographic data of 6192 AMI patients admitted to our department between January 1995 and January 2010 were retrospectively reviewed, FWR was confirmed in 43 patients by post-mortem examination. Multivariate logistic regression analysis was performed to identify risk factors for FWR.
Rupture occurred at a median of 3.58 days after symptom onset. Risk factors associated with FWR were older age, female gender, delayed hospital admission, hypertension at admission and increased serum creatine level. Although patients with FWR had more single-vessel disease, their in-hospital mortality was very high (97.7%). Undue physical efforts were documented in 41.9% patients with FWR.
Old age, female gender and prolonged time from the onset of symptoms to hospital, hypertension and high level of serum creatine at admission are independent factors of FWR.
Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases] 09/2011; 39(9):812-5.
