ISSN 1671-5411 CN 11-5329/R

2016 Vol. 13, No. 10

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Aggressive therapy with statins in elderly and malnourished patients with acute myocardial infarction: is the right time to change?
Annamaria Mazzone, Umberto Paradossi, Sergio Berti, Giuseppina Basta
2016, 13(10): 815-816. doi: 10.11909/j.issn.1671-5411.2016.10.011
Baicalin and geniposide inhibit the development of atherosclerosis by increasing Wnt1 and inhibiting dickkopf-related protein-1 expression
Bin WANG, Ping-Ping LIAO, Li-Hua LIU, Xin FANG, Wei LI, Si-Ming GUAN
2016, 13(10): 846-854. doi: 10.11909/j.issn.1671-5411.2016.10.013
Background Our previous study showed that the combined Chinese herbs containing scutellaria baicalensis georgi and gardenia jasminoids ellis inhibited atherosclerosis. In this study, we sought to determine if baicalin and geniposide could inhibit atherosclerosis through Wnt1 and dickkopf-related protein-1 (DKK1). Methods The wild-type and ApoE-/- mice were treated with baicalin, geniposide, and baicalin plus geniposide daily by gavage for 12 weeks. Blood lipid levels were measured with an automatic biochemistry analyzer. Aortic atherosclerotic lesion areas were analyzed with Image-ProPlus software. The mRNA and protein expression of DKK1, Wnt1 and nuclear factor-κB (NF-κB) were measured with RT-PCR and Western Blot. Serum levels of interleukin-12 (IL-12) were quantified with ELISA. Results The baicalin or geniposide monotherapy as well as combination therapy inhibited the development of atherosclerotic lesions, increased Wnt1 and decreased DKK1 expression and elevated the ratio of Wnt1/DKK1 compared with high-lipid diet group. However, only baicalin or geniposide monotherapy decreased NF-κB expression. Moreover, baicalin and geniposide mono- or combination therapy lowered IL-12 levels. Geniposide reduced both serum total cholesterol and low density lipoprotein levels, while baicalin either alone or in combination with geniposide did not affect serum lipid levels. In human, umbilical vein endothelial cells stimulated by oxidized low density lipoprotein, baicalin and geniposide also increased Wnt1 and decreased DKK1 expression and elevated the ratio of Wnt1/DKK1. Conclusions Baicalin and geniposide exert inflammation-regulatory effects and may prevent atherosclerotic lesions through enhancing Wnt1 and inhibiting DKK1 expression.
Multi-phase post-mortem CT-angiography: a pathologic correlation study on cardiovascular sudden death
Emanuela Turillazzi, Paola Frati, Natascha Pascale, Cristoforo Pomara, Giampaolo Grilli, Rocco Valerio Viola, Vittorio Fineschi
2016, 13(10): 855-865. doi: 10.11909/j.issn.1671-5411.2016.10.003
Multi-phase post-mortem CT-angiography (MPMCTA) has the great potential to increase the quality of the post-mortem investigation, especially in the area of sudden death; however, its role as routine complement to the pathology toolbox is still questioned as it needs to be further standardized. The aim of this study is to investigate the contribution of MPMCTA in cases of sudden unexplained death in adults and in particular in sudden cardiovascular death. Sixty-eight sudden unexpected deaths of adults were investigated at our institution between 2012 and 2013. Ten cases underwent MPMCTA and autopsy and were included in the study. Before the angiographic step by complete filling of the vascular system, prior to any manipulation of the body, a non-contrast CT-scan was carried out. Image reconstructions were performed on a CT workstation (Vitrea) and two radiologists experienced with post mortem imaging interpreted the MPMCTA findings. In all 10 cases, we could state a good correlation between combination of post-mortem CT and MPMCTA and autopsy procedures, confirming a high diagnostic sensitivity. With this case series we want to illustrate the advantages offered by performing MPMCTA when facing a sudden death, regardless of specific suspicion for acute coronary syndrome or other vascular or ischemic disease.
Performance of dual-source CT with high pitch spiral mode for coronary stent patency compared with invasive coronary angiography
Xia YANG, Qiang YU, Wei DONG, Zhen-Hong FU, Jun-Jue YANG, Jun GUO, Yun-Dai CHEN
2016, 13(10): 817-823. doi: 10.11909/j.issn.1671-5411.2016.10.002
Objective To investigate the performance of dual-source computed tomography (DSCT) using high-pitch spiral (HPS) mode for coronary stents patency. Methods We conducted a prospective study on 120 patients with 260 previous stents implanted due to recurred suspicious symptoms of angina scheduled for invasive coronary angiography (ICA), while DSCT were conducted using HPS mode. Results There was no significant impact of age, body mass index or heat rate (HR) on image quality (P > 0.05), while HR variability had a slight impact on that (P P P Conclusion DSCT using HPS mode provides good diagnostic performance on stent patency with lower effective dose in patients with HR < 65 beats/min.
Impact of old age on clinical and angiographic characteristics of coronary artery spasm as assessed by acetylcholine provocation test
Woong Gil Choi, , Seung-Woon Rha, Kang-Yin CHEN, Yong-Jian LI, Byoung Geol Choi, Se Yeon Choi, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh
2016, 13(10): 824-829. doi: 10.11909/j.issn.1671-5411.2016.10.005
Background Smoking and other risk factors have been well known as important factors of variant angina or coronary artery spasm (CAS). However, clinical features related to age on coronary artery spasm have been rarely evaluated. Methods We evaluated 3155 consecutive patients with insignificant coronary artery lesion. Patients underwent Acetylcholine (Ach) provocation test for induction of CAS. CAS was defined as > 70% luminal narrowing of coronary arteries during Ach provocation test. The results of Ach provocation test were compared among age groups; Results Older patients had higher incidence of hypertension, diabetes, but lower incidence rate of current smoking, male sex compared with younger patients. Positive Ach provocation test finding was frequently showed with aging (47.36% vs. 58.3% vs. 62.6% vs. 61.5%, P Conclusion Our present study showed that old age was independent predictor for Ach-induced significant coronary artery spasm.
Clinical outcomes of elderly South-East Asian patients in primary percutaneous coronary intervention for ST-elevation myocardial infarction
Jieli Tong, Wen Wei Xiang, An Shing Ang, Wen Jun Sim, Kien Hong Quah, David Foo, Paul Jau Lueng Ong, Hee Hwa Ho
2016, 13(10): 830-835. doi: 10.11909/j.issn.1671-5411.2016.10.001
Objective To evaluate the clinical characteristics and in-hospital outcomes of elderly South-East Asian patients undergoing primary percutaneous coronary intervention (PPCI). Methods From January 2009 to December 2012, 1268 patients (86.4% male, mean age of 58.4 ± 12.2 years) presented to our hospital for ST-elevation myocardial infarction (STEMI) and underwent PPCI. They were divided into two groups: elderly group defined as age > 70 years and non-elderly group defined as age Results The elderly group constituted 19% of the study population with mean age 76.6 ± 5.0 years. There was a higher proportion of female gender and ethnic Chinese patients in the elderly group when compared with the non-elderly group. The former was less likely to be smokers and have a significantly higher prevalence of hypertension. The mean D2B time was significantly longer in the elderly group. They also had a significantly higher incidence of triple vessel disease and obstructive left main disease. The use of radial artery access, glycoprotein 2b/3a inhibitors and drug-eluting stents during PPCI were also significantly lower. In-hospital mortality was significantly higher in the elderly group. The rate of cardiogenic shock and inhospital complications were also significantly higher. Conclusions Our registry showed that in-hospital mortality rate in elderly South-East Asian patients undergoing PPCI for STEMI was high. Further studies into the optimal STEMI management strategy for these elderly patients are warranted.
Predictors and in-hospital prognosis of recurrent acute myocardial infarction
Cheng-Fu CAO, Su-Fang LI, Hong CHEN, Jun-Xian SONG
2016, 13(10): 836-839. doi: 10.11909/j.issn.1671-5411.2016.10.008
Objective To investigate the contributing factors and in-hospital prognosis of patients with or without recurrent acute myocardial infarction (AMI). Methods A total of 1686 consecutive AMI patients admitted to Peking University People’s Hospital from January 2010 to December 2015 were recruited. Their clinical characteristics were retrospectively compared between patients with or without a recurrent AMI. Then multivariable logistic regression was used to estimate the predictors of recurrent myocardial infarction. Results Recurrent AMI patients were older (69.3 ± 11.5 vs. 64.7 ± 12.8 years, P vs. 35.0%, P P P P vs. 7.8%, P = 0.039) than incident AMI patients. Conclusions Recurrent AMI patients presented with more severe coronary artery conditions. Age, DM and reperfusion therapy were independent risk factors for recurrent AMI, and recurrent AMI was related with a high risk of in-hospital death.
Achieving timely percutaneous reperfusion for rural ST-elevation myocardial infarction patients by direct transport to an urban PCI-hospital
Charles-Lwanga K Bennin, Saif Ibrahim, Farah Al-Saffar, Lyndon C Box, Joel A Strom
2016, 13(10): 840-845. doi: 10.11909/j.issn.1671-5411.2016.10.012
Backgrounds ST-elevation myocardial infarction (STEMI) guidelines recommend reperfusion by primary percutaneous coronary intervention (PCI) ≤ 90 min from time of first medical contact (FMC). This strategy is challenging in rural areas lacking a nearby PCI-capable hospital. Recommended reperfusion times can be achieved for STEMI patients presenting in rural areas without a nearby PCI-capable hospital by ground transportation to a central PCI-capable hospital by use of protocol-driven emergency medical service (EMS) STEMI field triage protocol. Methods Sixty STEMI patients directly transported by EMS from three rural counties (Nassau, Camden and Charlton Counties) within a 50-mile radius of University of Florida Health-Jacksonville (UFHJ) from 01/01/2009 to 12/31/2013 were identified from its PCI registry. The STEMI field triage protocol incorporated three elements: (1) a cooperative agreement between each of the rural emergency medical service (EMS) agency and UFHJ; (2) performance of a pre-hospital ECG to facilitate STEMI identification and laboratory activation; and (3) direct transfer by ground transportation to the UFHJ cardiac catheterization laboratory. FMC-to-device (FMC2D), door-to-device (D2D), and transit times, the day of week, time of day, and EMS shift times were recorded, and odds ratio (OR) of achieving FMC2D times was calculated. Results FMC2D times were shorter for in-state STEMIs (81 ± 17 vs. 87 ± 19 min), but D2D times were similar (37 ± 18 vs. 39 ± 21 min). FMC2D ≤ 90 min were achieved in 82.7% in-state STEMIs compared to 52.2% for out-of-state STEMIs (OR = 4.4, 95% CI: 1.24–15.57; P = 0.018). FMC2D times were homogenous after adjusting for weekday vs. weekend, EMS shift times. Nine patients did not meet FMC2D ≤ 90 min. Six were within 10 min of target; all patient achieved FMC2D ≤ 120 min. Conclusions Guideline-compliant FMC2D ≤ 90 min is achievable for rural STEMI patients within a 50 mile radius of a PCI-capable hospital by use of protocol-driven EMS ground transportation. As all patients achieved a FMC2D time ≤ 120 min, bypass of non-PCI capable hospitals may be reasonable in this situation.
Percutaneous closure of paravalvular leak in the treatment of anemia of mixed etiology in a patient with diabetic complications and chronic inflammation
Magdalena Pelczarska, Maciej Lewandowski, Jaroslaw Goracy, Andrzej Wojtarowicz, Robert Sabiniewicz, Grzegorz Wojcik, Zdzislawa Kornacewicz-Jach
2016, 13(10): 866-868. doi: 10.11909/j.issn.1671-5411.2016.10.006
A centenarian transcatheter aortic valve implantation case
Abdullah Nabi Aslan, Huseyin Ayhan, Elcin Ozdemir, Engin Bozkurt
2016, 13(10): 869-871. doi: 10.11909/j.issn.1671-5411.2016.10.007
Delayed post-dilated stenting to treat an embolic myocardial infarction
Ming-Feng JIN, Zhuo XU
2016, 13(10): 872-874. doi: 10.11909/j.issn.1671-5411.2016.10.010
Minimally invasive surgical techniques in the era of hybrid coronary revascularization: additional benefits for the elderly patients?
Antonio Nenna, Mario Lusini, Salvatore Matteo Greco, Elvio Covino, Massimo Chello
2016, 13(10): 875-879. doi: 10.11909/j.issn.1671-5411.2016.10.009
Atrial fibrillation in older patients—reducing stroke risk is not only about anticoagulation
Nay Thu Win, Shyh Poh Teo
2016, 13(10): 880-882. doi: 10.11909/j.issn.1671-5411.2016.10.004