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PI3K/Akt signaling mediates protection effects of polydatin on myocardial ischemia/reperfusion injury
Fu-lin YU, Yan GAO, Li WANG, Hai-qiang WANG
2022, 34(4): 373-377, 388. doi: 10.12125/j.chj.202201073
Abstract:
  AIM  To explore the effects of polydatin (PD) preconditioning on myocardial ischemia/reperfusion (I/R) injury.   METHODS  Myocardial I/R injury was produced in mice via 30 min of left descending coronary artery occlusion, followed by 24 h reperfusion. Male C57/BL6J mice were randomly divided into five groups (n=18): Sham group, I/R group, I/R+PD group, I/R+PD+LY294002 group and I/R+LY294002 group. Echocardiography was employed to evaluate the cardiac functions. The area of myocardial infarction was determined by TTC staining and the levels of plasma CK and LDH were measured by ELISA. The fibrosis degree was detected by Masson staining, cardiac apoptosis was evaluated by the Tunnel assay and the expressions of p-Akt and Akt were determined by Western blot.   RESULTS  Compared with those in sham group, the cardiac functions were decreased significantly (P<0.05), with enhanced CVF and apoptosis index (P<0.05) and increased levels of plasma CK and LDH (P<0.05), as well as enhanced infarct size, and the expressions of p-Akt were increased (P<0.05) in I/R group. Compared with those in I/R group, the cardiac functions were improved significantly (P<0.05), with decreased CVF and apoptosis index (P<0.05) and decreased levels of plasma CK and LDH (P<0.05), as well as decreased infarct size, and the expressions of p-Akt were further increased (P<0.05) in I/R+PD group. Compared with those in I/R+PD group, the cardiac functions were decreased (P<0.05), with enhanced CVF and apoptosis index (P<0.05) and increased levels of plasma CK and LDH (P<0.05), as well as enhanced infarct size, and the level of p-Akt was decreased (P<0.05) in I/R+PD+LY294002 group.   CONCLUSION  polydatin attenuates myocardial I/R injury by activating PI3K/Akt signaling.
Effects of salidroside on AMPK in myocardial autophagy related pathway under simulated high altitude hypoxia
Li DU, Ling MA, Nan WANG
2022, 34(4): 378-382. doi: 10.12125/j.chj.202009073
Abstract:
  AIM  To investigate the molecular pharmacological mechanism of Salidroside in protecting rat heart injury induced by high altitude hypoxia.   METHODS  Wistar rats were randomly divided into 5 groups: blank control group (1 500 m), hypoxic saline group (6 500 m+NS), hypoxia compound C group (6 500 m+comC), hypoxia salidroside group(6 500 m+Sal), hypoxia salidroside+ compound C group (6 500 m+comC+Sal).   RESULTS  After exposure to hypoxic environment, myocardial structure was changed and myocardial apoptosis was aggravated(P<0.05). Salidroside treatment could improve the pathological damage of myocardial cells and reduce the degree of myocardial apoptosis(P<0.05); At the same time, the level of phosphorylated AMPK increased and the level of phosphorylated mTOR decreased(P<0.05). The expression levels of AMPK and mTOR were between compound C group and salidroside group, but the expression of autophagy protein Beclin-1 was higher than that of compound C group(P<0.05).   CONCLUSION   salidroside can positively regulate AMPK signaling pathway, activate autophagy and protect myocardium from hypoxia injury.
Role and molecular mechanism of Notch signaling pathway in the process of myocardial fibrosis mediated by polycystic ovary syndrome
Nan-nan REN, Shan ZHOU, Hai-xia DUAN
2022, 34(4): 383-388. doi: 10.12125/j.chj.202107075
Abstract:
  AIM  To investigate the role and mechanism of Notch signaling pathway in myocardial fibrosis induced by polycystic ovary syndrome.   METHODS  Rats were given letrozole by gavage to establish PCOS model. The experiment was divided into: negative control group, letrozoleintervention group 200 μg/d, Notch1 agonist Jagged1 treatment group, Notch1 agonist Jagged1+ letrozole intervention group (200 μg/d). The changes of serum levels of estradiol (E2) and follicle-stimulating growth hormone (FSH) in each group were observed after successful modeling on 21 d. HE staining was used to detect the morphological changes of ovary in each group. Changes of molecules related to Notch signaling pathway in heart tissues of each group were detected by Western blot.   RESULTS  PCOS model was successfully established by gavage of letrozole. Compared with the control group, TG, TC, HDL and LDL in serum were significantly increased in the PCOS model group (P<0.05). Heart coefficient of PCOS model group was significantly higher than that of the control group (P<0.05). In the PCOS group, the myocardial cells showed fibrotic changes, collagen increased, and molecules related to Notch signaling pathway were inhibited. The agonist intervention of Notch signaling pathway had no effect on the serum content and inhibited letrozole-induced increased collagen expression in rat cardiomyocytes.   CONCLUSION  Notch signaling pathway can inhibit the process of myocardial fibrosis mediated by PCOS and has a protective effect on the occurrence of cardiovascular diseases caused by PCOS.
Comparison of safety and efficacy of ticagrelor and clopidogrel in treatment of elderly patients with acute coronary syndrome
Zi-wei WANG, Sui-ning XU, Jia-yi WANG, Qin WANG, Wen-tao HU, Yi-ming ZOU, Shuai ZHAO, Gen-rui CHEN, Bo-da ZHU, Cheng-xiang LI, Kun LIAN
2022, 34(4): 389-393. doi: 10.12125/j.chj.202110074
Abstract:
  AIM  To explore the efficacy and safety of ticagrelor and clopidogrel in the treatment of acute coronary ayndrome (ACS) in Chinese elderly patients without revascularization.   METHODS  Continuously enrolled for this study were 106 Chinese elderly ACS patients (≥75 years old) who were not treated with interventional therapy in our department from May 2012 to September 2020. According to antiplatelet drugs, the enrolled patients were divided into clopidogrel group (n=65) and ticagrelor group (n=41) and the follow-up was 12 months. The effective end point was the major adverse cardiovascular event (MACE), which was composed of all-cause death, nonfatal myocardial infarction and clinically-driven revascularization. The safety endpoint is BARC bleeding event.   RESULTS  There were more patients with chronic kidney disease in the clopidogrel group (P<0.05) and there was no significant difference between the two groups in baseline data such as basic data, past medical history and laboratory data. The incidence of MACE in the ticagrelor group was lower than that in the clopidogrel group (4.9% vs. 18.5%) and the difference was statistically significant (P<0.05). The incidence of bleeding events in the ticagrelor group was higher than that in the clopidogrel group (7.3% vs. 3.1%) and the difference was not statistically significant.   CONCLUSION  Compared with clopidogrel, ticagrelor reduces the incidence of MACE in elderly ACS patients without interventional therapy, and it does not significantly increase bleeding events.
Safety and efficacy of dabigatran (110mg) in cryoballoon ablation
Dong ZHANG, Yi-bo MA, Hua-ni PANG, Fu YI
2022, 34(4): 394-398, 407. doi: 10.12125/j.chj.202111089
Abstract:
  AIM  To explore the safety and efficacy of dabigatran 110 mg in the periprocedural period and 1 year follow-up after cryoballoon ablation procedure for atrial fibrillation.   METHODS  We performed a prospective study involving patients with drug-refractory, paroxysmal or persistent atrial fibrillation who underwent cryoballoon ablation procedure in the Department of Cardiology, the First Affiliated Hospital of Air Force Medical University from January 2018 to June 2019. All patients received 110 mg of darigatran bid during the periprocedural period. Subsequent outpatient follow-up was conducted for 1 year and relevant clinical data were collected. Thromboembolic and hemorrhagic events associated with drug use were analyzed, and multivariate logistic regression analysis was used to identify possible relevant factors.   RESULTS  A total of 148 patients who underwent cryoballoon ablation met the criteria and were included in this study, none of whom experienced clinical thromboembolism or massive bleeding events within the one-year follow-up. The overall success rate of cryoballoon ablation was 77.70%. Mild bleeding events occurred in 22 patients (14.9%) in the blanking period (3 months) and no complications related to drug application were found after 12 weeks. Acute pericardial tamponade occurred in 1 patient during the periprocedural period. Multivariate logistic regression analysis showed that a history of hypertension was the only risk factor for mild bleeding events (P<0.05).   CONCLUSION  Dabigatran given at a dose of 110 mg bid is safe and effective during perioperative period and one-year follow-up after cryoballoon ablation for atrial fibrillation. No thromboembolism or drug-related major bleeding events are observed in this study. Mild bleeding is common, especially in patients with a history of hypertension, but these events occur in the blanking period.
Relationship between ventricular remodeling and sacubitril and valsartan combined with rosuvastatin in treatment of patients with atrial fibrillation and heart failure with preserved ejection fraction
Qian FENG, Dong-po ZHAO, Miao SHI, Ze-yang WU
2022, 34(4): 399-403. doi: 10.12125/j.chj.202108096
Abstract:
  AIM   To investigate the therapeutic effect of sacubitril-valsartan combined with rosuvastatin on atrial fibrillation (AF) complicated with heart failure with preserved ejection fraction (HFpEP).  METHODS  A total of 114 patients with AF combined with HFpEP in our hospital from October 2019 to October 2020 were selected and grouped by random number table, with 57 cases in each group. The control group received oral rosuvastatin and the study group was given oral sacubitril and valsartan based on the treatment of the control group. Both were treated for 1 month. Clinical efficacy, adverse reactions and effective rate of maintaining sinus rhythm were observed. Comparison between the two groups were made in ventricular remodeling indexes before and one month after treatment [left atrial volume index (LAVI), left ventricular mass index (LVMI), left ventricular end-diastole Inner diameter (LVEDD), left ventricular ejection fraction (LVEF)], ECG indicators (QRS wave duration, QTc interval, planar QRS-T angle), chitinase 3-like protein 1 (CH1L1), N-terminal type B Pre-brain natriuretic peptide (NT-proBNP) and Apelin levels. Spearman correlation analysis was performed to determine the correlation between clinical efficacy and ventricular remodeling indicators.   RESULTS  One month after treatment, the total effective rate of treatment in the study group higher than that in the control group (P<0.05). Compared with those in the control group, the LVEF in the study group was bigger, the time limit of LVEDD, LAVI, LVMI, QRS wave and the QTc interval and the plane QRS-T angle were smaller (P<0.01), the serum NT-proBNP and CH1L1 levels were lower, and the Apelin level was higher (P<0.01). There was no statistically significant difference in the incidence of adverse reactions such as hypotension, headache and pharyngitis between the two groups . Three months after treatment, there was no loss to follow-up in the two groups. There was no statistically significant difference in the effective rate of maintaining sinus rhythm between the two groups . Spearman correlation analysis showed that the clinical efficacy of patients with AF combined with HFpEP was positively correlated with LVEF, and negatively correlated with LVEDD, LAVI, and LVMI (P<0.05).   CONCLUSION  Sacubitril-valsartan combined with rosuvastatin is effective in the treatment of AF complicated with HFpEP, and the treatment effect is closely related to the improvement of ventricular remodeling-related indicators.
Clinical effects of dabigatran etexilate and rivaroxaban in anticoagulation in patients with non-valvular atrial fibrillation
Gui-mei ZHAO, Li-hua LI, Yi-xuan DING
2022, 34(4): 404-407. doi: 10.12125/j.chj.202105053
Abstract:
  AIM  To analyze and compare the clinical effects and safety of different anticoagulant drugs in the clinical treatment of non-valvular atrial fibrillation (NAVF).   METHODS  A total of 136 NVAF patients who received anticoagulant therapy from April 2018 to April 2021 were selected. Among them, 76 patients were treated with rivaroxaban anticoagulant therapy in group L and 60 patients were treated with dabigatran etexilate in group D. Coagulation, improvement of blood routine indexes, bleeding and adverse events were analyzed and compared between the two groups after three months of medication.   RESULTS  Three months after the treatment, the platelets of the two groups increased significantly compared with those before the treatment (P<0.05). The red blood cell and prothrombin time in L group after treatment was significantly higher than those of that before treatment (P<0.05). After the medication, there was no significant difference between group L and group D. The total incidence of bleeding during medication in group L was 34.21%, which was significantly higher than that of the rate of 11.67% in group D (P<0.01). The total incidence of adverse events in group L was 22.37 % compared with 21.67 % in group D, and there was no statistical difference in both of those.   CONCLUSION  Both rivaroxaban and dabigatran etexilate achieve ideal clinical efficacy in patients with NVAF, but the lsafety factor of dabigatran etexilate is higher.
Effect of early rehabilitation exercise on cardiopulmonary function and deep vein thrombosis after cardiac pacemaker implantation in the elderly
Meng-jie PAN, Fang LIU, Liu ZHANG, Ya-nan GUO, Zhi-ping XU
2022, 34(4): 408-412. doi: 10.12125/j.chj.202108122
Abstract:
  AIM   To explore the effects of early rehabilitation exercises on the heart and lung function and deep vein thrombosis after cardiac pacemaker implantation in the elderly.   METHODS  A total of 106 patients undergoing cardiac pacemaker implantation who were diagnosed and treated in our hospital from January 2017 to December 2018 were selected as the research subjects. According to different rehabilitation programs, the patients were divided into study group and control group, with 53 cases in each group. Routine rehabilitation nursing was implemented in control group and early rehabilitation exercise nursing was implemented in study group. Operation time, normal activity time out of bed, hospitalization time, changes in cardiopulmonary function, complications, quality of life and treatment satisfaction were analyzed and compared between the two groups.   RESULTS  The activity time out of bed and hospital stay time in the study group were significantly less than those in the control group (P<0.01). The LVEF and FEV1/FVC in the two groups of were significantly increased at 1 week and 1 month after the operation, and the recovery at 1 month after the operation was better than that at the 1 week after the operation. The recovery of the patients in the study group was better than that in the control group (P<0.01). The incidence of deep vein thrombosis in the study group was 3.77%, which was significantly lower than that in the control group and the incidence of complications in the study group was also significantly lower than that in the control group (P<0.01). The quality of life in the two groups improved significantly at 1 week and 1 month after operation and the improvement in the study group was significantly better than that in the control group (P<0.01). The rehabilitation exercise satisfaction in the study group was significantly higher than that in the control group (P<0.01).   CONCLUSION   Scientific and reasonable early rehabilitation exercise not only effectively improves the cardiopulmonary function of patients undergoing cardiac pacemaker implantation, shortens the hospital stay time and the activity time out of bed, but also reduces the occurrence of complications such as deep vein thrombosis. Personalized early rehabilitation exercises improves the quality of life and treatment satisfaction of patients, thereby improving the rehabilitation effect and is worthy of clinical promotion.
Efficacy and safety of bivalirudin in treatment of acute coronary syndrome patients during perioperative period of percutaneous coronary intervention
Chang LIU, En-rui XIE, Yi-xuan DUAN, Ya-juan NI, Qing LI, Deng-feng GAO, Jie DENG
2022, 34(4): 413-416, 421. doi: 10.12125/j.chj.202108035
Abstract:
  AIM  To investigate the efficacy and safety of bivalirudin in acute coronary syndrome (ACS) patients during the perioperative period of percutaneous coronary intervention (PCI).   METHODS  A retrospective analysis was conducted in 309 PCI patients who received aspirin plus ticagrelor as antiplatelet pretreatment from January 2018 to June 2020 in the First and Second Affiliated Hospital of Xi’an Jiaotong University. According to antithrombotic therapy during perioperative period of PCI, the patients were divided into two groups: the bivalirudin group and the heparin plus Gp IIb/IIIa inhibitor (GPI) group. Based on the clinical and demographic variables, 1∶1 propensity score matching was conducted and the patients were followed up by phone. The primary endpoint was 30-day net adverse clinical event (NACE), defined by any bleeding as defined by the Bleeding Academic Research Consortium (BARC) and a composite of major adverse cardiac or cerebral events (MACCE), including all-cause death, urgent ischemia-driven target vessel revascularization (uTVR), reinfarction and stroke. The secondary endpoints were 30-day and 6-month MACCE and any bleeding, as well as 6-month NACE.   RESULTS  Among the 309 patients who underwent PCI, 58 patients were assigned to the bivalirudin group and 251 patients to heparin plus GpⅡb/Ⅲa inhibitor group. After propensity score matching, each of the two groups included 50 patients respectively. No statistical difference was found between the two groups in the incidence of 30-day NACE, MACCE, any bleeding and 6-month NACE, MACCE and all bleeding. Nor was the difference found in the incidence of 30-day BARC3-5 . However, the risk of 30-day NACE was found to have reduced in bivalirudin-treated medium-to-high bleeding risk ACS patients with >30 scores ranked by the CRUSADE bleeding score (Bivalirudin vs. Heparin plus GPI, 0 vs. 6.0%, P<0.05).   CONCLUSION  Bivalirudin is efficacious and safe in ACS patients after asprin plus ticagrelor combination therapy during the perioperative period of PCI. Bivalirudin reduces the risk of 30-day NACE in ACS patients with medium to high bleeding risk.
Preductive application of three detection in poor prognosis after emergency PCI in patients with acute myocardial infarction
Shun-lin TAN, Sheng ZHANG, Li CHEN, Lei HUANG
2022, 34(4): 417-421. doi: 10.12125/j.chj.202110079
Abstract:
  AIM   To explore the predictive value of homocysteine (Hcy), secreted frizzled related protein 5 (SFRP5) and uric acid (UA) three detection in poor prognosis after emergency PCI in patients with acute myocardial infarction.   METHODS  Ninety-six patients with acute myocardial infarction treated in Ziyang First People's Hospital from January 2017 to December 2018 were selected, according to 2-year follow-up data, they were divided into the control group (n=63) and the observation group (n=33). The levels of Hcy, SFRP5 and UA in patients with different prognosis were analyzed; Logistic regression was used to analyze the related factors that affected the poor prognosis in the patients; ROC curve was drawn to analyze the predictive value of the three combined (Hcy, SFRP5 and UA) detection for the poor prognosis after PCI.   RESULTS  ① There was no significant difference in gender, age, body weight, history of hypertension, and history of diabetes between the two groups; there were significant differences in the family history of cardiovascular and cerebrovascular diseases, smoking history, drinking history and coronary artery disease number between the two groups (all P<0.01). ② The levels of Hcy and UA in the observation group were significantly higher than those in the control group and the level of SFRP5 was lower than that in the control group (all P<0.01). ③ Cardiovascular and cerebrovascular family genetic history, smoking history, drinking history, coronary artery disease branch number, Hcy, SFRP5, UA were related risk factors for poor prognosis after PCI in patients with acute myocardial infarction (all P<0.01). The AUC of Hcy, SFRP5 and UA and combined detection of the three was 0.948, 0.894, 0.823 and 0.991,respectively, the sensitivities were 87.56, 85.12, 83.65 and 91.56, respectively, and the specificities were 89.45, 87.26, 84.19 and 92.14, respectively, the AUC, sensitivity and specificity of combined detection were the best.   CONCLUSION  Hcy, SFRP5 and UA are closely related to the prognosis of patients with acute myocardial infarction after PCI,, and the early combined detection of the three indicators in patients with acute myocardial infarction after PCI is helpful to evaluate the prognosis.
Predictive value of inflammatory factors for in-hospital major adverse cardiovascular events in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention
Su-na SHI, Wei-na HOU, Zhen-lian LI, Xiang-ke JIA, Zhen-fang REN
2022, 34(4): 422-427. doi: 10.12125/j.chj.202110010
Abstract:
  AIM  To investigate the prognostic value of inflammatory factors for in-hospital major adverse cardiac events (MACE) in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI).   METHODS  A total of 500 STEMI patients admitted to our hospital from June 2015 to June 2019 were selected as the study subjects, and clinical data of the patients were collected. Fasting venous blood was taken for inflammatory factor detection on the next day after PCI, and patients were divided into MACE group (85 cases) and non-MACE group (415 cases) according to the occurrence of MACE in hospital. Univariate analysis and multivariate logistic regression were used to analyze the independent influencing factors of nosocomial MACE after PCI in STEMI patients. ROC curve was used to evaluate the predictive value of inflammatory indicators on nosocomial MACE in STEMI patients and a nomogram prediction model for nosocomial MACE in STEMI patients after PCI was constructed. The receiver operating characteristic (ROC) curve, Hosmer-Lemeshow goodness-of-fit test and Calibration curve were used to evaluate the differentiation, accuracy and consistency of the model.   RESULTS  Age, prevalence of diabetes mellitus and D-dimer (DD) index in MACE group were significantly higher than those in MACE group (all P<0.05), LVEF index was significantly lower than those in MACE group (P<0.05). Smoking rate, serum creatinine (Scr), creatine kinase isoenzyme (CK-MB), cardiac calcium protein I (cTnI), white blood cell count (WBC), hypersensitive C-reactive protein (hs-CRP), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), procalcitonin (PCT) and interleukin-6 (IL-6) were significantly higher than those in MACE group (ALL P<0.01). Multivariate regression analysis showed that age (P<0.05), diabetes mellitus (P<0.05), Scr (P<0.05), CK-MB (P<0.05), inflammatory factors hs-CRP, NLR, PLR, PCT and IL-6 (all P<0.01) were the only factors of MACE in STEMI patients after PCI LVEF (P<0.05) was a protective factor for nosocomial MACE. Inflammatory factors hs-CRP, NLR, PLR, PCT and IL-6 all had certain predictive value. The fitting effect of the line graph model based on independent prognostic factors was good, and the area under ROC curve was 0.761 (95% CI was 0.680~0.839), indicating that the model had good predictive ability.   CONCLUSION   Inflammatory factors hs-CRP, NLR, PLR, PCT and IL-6 are independent risk factors for nosocomial MACE after PCI in STEMI patients and they have good predictive value for the short-term prognosis of patients. The nomogram model constructed in this study can be used as a quantitative tool to predict the risk of in-hospital MACE for STEMI patients after PCI, which can help formulate postoperative care for STEMI patients and reduce the risk of complications.
Value of cardiac color Doppler ultrasound parameters combined with serum NT proBNP in predicting heart failure after PCI in AMI patients
Yin-chun LI, Yi YAN, Yong HUANG
2022, 34(4): 428-434, 443. doi: 10.12125/j.chj.202107067
Abstract:
  AIM  To investigate the predictive value of cardiac color Doppler ultrasound parameters combined with serum N-terminal pro-B-type natriuretic peptide (NT−proBNP) in predicting heart failure after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).   METHODS  One hundred and sixty-nine AMI patients treated by emergency PCI admitted to our hospital from March 2018 to January 2020 were selected as the study group and 144 healthy people in the same period were selected as the control group, in whom color Doppler echocardiography was performed and serum NT-proBNP levels were detected. The patients in the study group were followed up for 6 months and they were divided into heart failure group and non heart failure group according to the complications of heart failure. The relationship between the parameters of cardiac color Doppler ultrasound and serum NT-proBNP level and heart failure in AMI patients after PCI was examined by multivariate logistic regression analysis method and the predictive value of cardiac color Doppler ultrasound parameters combined with serum NT-proBNP level in AMI patients with heart failure after PCI was analyzed by receiver operating characteristic (ROC) curve.   RESULTS  Left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD) and Tei indexes in the study group were significantly higher than those in the control group (P<0.01), and left ventricular ejection fraction (LVEF) and the ratio of peak velocity of mitral flow in early diastolic phase (E) to peak velocity of mitral flow in late diastolic phase (A) (E/A) were significantly lower than those in the control group (P<0.01), and the serum NT proBNP level was significantly higher than that in the control group (P<0.01). Throughout the 6-month followed up, the complication rate of heart failure in the study group was 18.34% (31/169). The proportions of age ≥ 60 years(P<0.05), multiple infarction sites, hypertension, diabetes(P<0.05), hyperlipidemia(P<0.05), slow/no reflow after PCI in the heart failure group were higher than those in the non heart failure group (P<0.01) and the time from onset to admission in the heart failure group was longer than that in the non heart failure group (P<0.01). The number of coronary artery lesions, and LVEDD, LVESD and Tei index in the heart group were higher and LVEF and E/A were lower than those in the non heart failure group (P<0.01). Gensini score of coronary artery disease, cardiac troponin T (cTnT), creatine kinase MB (CK-MB), systolic blood pressure (SBP), diastolic blood pressure (DBP) and NT-proBNP levels in the heart failure group were higher than those in the non heart failure group (P<0.01). Multivariate analysis showed that the above indicators were the influencing factors of heart failure 6 months after PCI in AMI patients (P<0.01). ROC curve analysis showed that the sensitivity of LVEDD, LVESD, LVEF, E/A and Tei index, single and combined, to predict heart failure within 24 hours after PCI in AMI patients were 83.87%, 80.65%, 80.65%, 80.65%, 83.87% and 80.65% respectively, and the specificity were 75.36%, 76.09%, 78.26%, 76.81%, 76.09% and 94.20% respectively. The sensitivity of serum NT-proBNP level within 24 hours after PCI and its combination with whole heart color Doppler ultrasound parameters to predict heart failure after PCI in AMI patients were 83.87% and 96.77% respectively, and the specificity were 91.30% and 91.30% respectively.   CONCLUSION  LVEDD, LVESD and Tei index of cardiac color Doppler ultrasound parameters are increased and LVEF and E/A are decreased within 24 hours after PCI in AMI patients, and the serum NT-proBNP level is abnormally increased, which all have the certain influences on the occurrence of heart failure in AMI patients after PCI and have the certain predictive values for the complicated heart failure. The combination of overall cardiac color Doppler parameters and serum NT-proBNP level has higher value. Age, time from onset to admission, numbers of coronary artery lesions, Gensini score, cTnT, CK-MB, blood pressure, infarct location, hypertension, diabetes, hyperlipidemia and postoperative reflux are also risk factors of heart failure in AMI patients after PCI.
Imaging diagnosis of cryptic ischemic stroke caused by patent foramen ovale
Li-li MENG, Qi-guang WANG, Xian-yang ZHU, Jian-ming WANG, Ming ZHAO
2022, 34(4): 435-438. doi: 10.12125/j.chj.202110097
Abstract:
  AIM  To investigate the imaging diagnosis of cryptic ischemic stroke (CS) caused by patent foramen ovale (PFO).   METHODS  Sixty-four PFO patients combined with CS in the General Hospital of the Northern Theater Command from May 2017 to June 2020 were selected as the study group, and 64 CS patients without PFO at the same period were selected as the control group. Brain imaging examinations were performed and the types of cerebral infarction lesions and vascular distribution of infarction lesions in both groups were statistically analyzed.   RESULTS  The fusion rate of small infarcts in the same vascular distribution area in the study group was lower than that in the control group (14% vs. 30%, P<0.05) and the rate of multiple infarcts in different vascular distribution areas was higher than that in the control group (31% vs. 14%, P<0.05). The proportions in the study group distributed in the vertebrobasilar artery system and the specific involved vessel, posterior cerebral artery, were higher than those in the control group (34% vs. 14% and 36% vs. 12%, P<0.01). The percentage of infarction lesions in the right internal carotid artery system in the study group was lower than that in the control group (11% vs. 34%, P<0.01).   CONCLUSION  The multiple infarcts in the multi-vessel distribution area are imaging features of PFO-induced CS , and moreover, posterior circulation infarction is dominant.
Comparative study on transit-time flow measurement of graft conduits with 7-0 or 8-0 prolene suture applied for off-pump coronary artery bypass grafting
Dian-cai ZHAO, Kai-jie WANG, Peng-fei JI, Xiao-chao DONG, Wei YI, Wei-xun DUAN, Jie SU, Jin-cheng LIU, Shi-qiang YU, Hong-liang LIANG
2022, 34(4): 439-443. doi: 10.12125/j.chj.202111072
Abstract:
  AIM  To compare the transit-time flow measurement results of graft conduits with 7-0 prolene suture and 8-0 prolene suture in off-pump coronary artery bypass grafting (OPCABG).   METHODS  OPCABG cases completed by a single surgeon in the Department of Cardiovascular Surgery in Xijing Hospital were analyzed retrospectively. 7-0 prolene suture was used for distal graft conduit anastomosis from July 2019 to June 2020 and 8-0 prolene suture was used for distal graft conduit anastomosis from July 2020 to June 2021. 421 anastomoses were included in the 7-0 Prolene suture group and 397 anastomoses were included in the 8-0 Prolene suture group. Transit-time flow measurement indexes of graft conduits, including mean blood flow (MFV), pulsatility index (PI) and diastolic filling percentage (DF%), were compared between the use of 7-0 prolene suture and 8-0 prolene suture.   RESULTS  Compared with 7-0 Prolene suture group (n=421), MFV (ml/min) of graft vessels in 8-0 Prolene suture group increased significantly (36±13 vs. 46±16, P<0.05), and PI decreased significantly (2.7±0.65 vs. 2.2±0.5, P<0.05); In subgroup analysis with different target vessels, there was no significant difference in PL or PDA between the two groups. In lad, the value of 8-0 Prolene suture group (increased) was better than that of 7-0 Prolene suture group (P<0.01). In the other six subgroups, the MFV and PI of 8-0 Prolene suture group were better than that of 7-0 Prolene suture group (all P<0.05). Using different graft vascular materials for subgroup analysis, the MFV of 8-0 Prolene suture group was better than that of 7-0 Prolene suture group (all P<0.05), and the ima or RA (P<0.01) and SVG (P<0.05) of PI were better than that of 7-0 Prolene suture group. There was no significant difference in DF (%) between the two groups (71±7 vs. 72±12).   CONCLUSION  The use of 8-0 prolene sutures in distal anastomosis of OPCABG resulted in better anastomotic quality. 8-0 prolene suture should be used to improve the quality of anastomosis if the patient’s vascular conditions and the surgeon’s technical competence allow.
Effect of transversus thoracic muscle plane block on perioperative neurocognitive disorders in patients with valve replacement under cardiopulmonary bypass
Zeng-lang GU, Xiao-jun WANG, Lian-sheng XU
2022, 34(4): 444-448. doi: 10.12125/j.chj.202108016
Abstract:
  AIM  To explore the effect of transversus thoracic muscle plane block on perioperative neurocognitive disorders (PND) in patients with valve replacement under cardiopulmonary bypass (CPB).   METHODS  One hundred and fifty-six patients with valve replacement under CPB were selected and randomly divided into group A and group B, 78 cases in each group. The patients in group A received general anesthesia and the patients in group B received transversus thoracic muscle plane block before general anesthesia. The total amount of sufentanil in the operation and the pressing times of analgesic pump within 24 hours after operation were compared between the two groups. The VAS scores at rest and at cough at 6h, 12h and 24h after operation were compared between the two groups. Serum TNF-α, IL-6, NSE and S-100β were compared between the two groups before anesthesia (T1), at the end of operation (T2), 6 hours after operation (T3) and 24 hours after operation (T4). The scores of Mini Mental State Examination (MMSE) were compared between the two groups at 1d day before operation and at 1d, 3 d and 7d after operation. The incidence of PND at 1d, 3d and 7d after operation was compared between the two groups.   RESULTS  The total amount of sufentanil in the operation and the pressing times of analgesic pump within 24 hours after operation in group A were less than those in group B (P<0.05). The VAS scores at rest and at cough in group A were lower than those in group B at 6h, 12h and 24h after operation (P<0.05). At T2, T3 and T4, the serum levels of TNF-α and IL-6 in group A were lower than those in group B (P<0.05). The serum levels of NSE and S-100β in group A were lower than those in group B (P<0.05). The MMSE scores in group A were higher than those in group B at 1, 3 and 7 days after operation (P<0.05). The incidence of PND in group A was lower than that in group B at 1d, 3d and 7d days after operation (P<0.05).   CONCLUSION  Transversus thoracic muscle plane block effectively inhibits the release of inflammatory cytokines, reduces nerve injury and improves postoperative cognitive function, thus reducing the occurrence of PND for patients with valve replacement under CPB.
Visual analysis of paroxysmal atrial fibrillation literature in recent 6 years based on CiteSpace
Ting CHEN, Yu-guang CHU, Yuan-hui HU
2022, 34(4): 449-454. doi: 10.12125/j.chj.202008028
Abstract:
  AIM   To perform visualization analysis on paroxysmal atrial fibrillation (PAF) and to assess the advantages and disadvantages of traditional ECG monitoring techniques (pulse palpation, electrocardiogram, etc.) and the new wearable dynamic ECG monitoring recorder in detecting PAF patients.   METHODS   CiteSpace software was used for co-occurrence analysis of authors, countries, institutions and keywords, and relevant visualization maps were drawn. The relevant literature from 2014 to 2020 included in the Science Citation Index Expanded (SCI-X) in Web of Science (WOS) was used as the data basis.   RESULTS   A total of 1679 documents were retrieved, with an average annual volume of more than 239 articles. The high-yielding countries were the United States, Japan and Germany, of which the United States had a dominant advantage in this field. The most productive institutions were Tokyo Medical University, Askepios Klin St Georg and Shanghai Jiaotong University. KARLHEUINZ KUCK, the author with highest volume of articles, had an important influence. Hot keywords were atrial fibrillation, catheter ablation, pulmonary vein isolation, and paroxysmal atrial fibrillation, etc. The predicted development trend may focus on the increase in the diagnosis rate of PAF, the best treatment strategy for patients, the complications before and after treatment, and the quality of life in later stages.   CONCLUSION   The application of CiteSpace for PAF measurement analysis is still relatively popular, which reveals countries and institutions for cooperation and provides topics for further research. By comparison, the traditional ECG monitoring technology has more defects for PAF detection and the new wearable dynamic ECG monitoring recorder has certain potentials.
Effects of vestibular stimulation on cardiovascular function and cognitive ability
Shu-han LI, Ying ZHANG, Yi-kai PAN, Ting-ting WEI, Zhuo LI, Xi-qing SUN
2022, 34(4): 455-460. doi: 10.12125/j.chj.202201004
Abstract:
  AIM  To observe the changes of BP, HR, HRV and cognitive ability of the subjects after vestibular stimulation, so as to provide experimental basis for establishing the training program of pilots’ vestibular illusion simulation experience.   METHODS  Twenty healthy young male subjects were trained by vestibular illusion simulation training system for 3 minutes, in which the acceleration phase lasted for 50 seconds, the uniform rotation compound turning phase lasted for 2 minutes, and the deceleration phase lasted for 10 seconds. HR, BP, HRV, cognitive function score, SO2, vestibular symptoms and illusion were recorded after training.   RESULTS   Compared with those before the experiment, DBP, HR and R of the subjects during vestibular stimulation were significantly increased (P<0.05). After vestibular stimulation, NAI in the task of attention allocation of subjects decreased significantly (P<0.05), and the vestibular symptom score increased significantly (P<0.05). The vestibular function stability was rated from 0 degree to degree III, and the 20 subjects fell into 4 (0 degree), 16 (I degree), 0 (II degree) and 0 (III degree), and the vestibular illusion induced rate was 100%.   CONCLUSION  Using vestibular illusion simulation training system to stimulate subjects’ vestibule can cause moderate vestibular response, induce vestibular illusion and have certain influence on cardiovascular function and distributed attention. This study provides reference for the formulation of training program of pilots’ vestibular illusion simulation experience.
Intermittent hypoxic adaptation attenuates myocardial ischemia/reperfusion injury by improving ability of plasma membrane repair
Yan-qi LIU, Lin-xia LI, Yun-gang BAI, Bo JIAO, Jin MA, Zhi-bin YU, Yun-ying WANG
2022, 34(4): 461-466. doi: 10.12125/j.chj.202203001
Abstract:
  AIM  To investigate whether intermittent hypoxic adaptation (IHA) can attenuate myocardial ischemia/reperfusion (I/R) injury by improving the ability of plasma membrane repair.  METHODS  Small animal hypobaric chamber was used to simulate different barometric heights. Male Sprague Dawley rats were randomly divided into four groups: Sham, Sham+IHA, I/R, I/R+IHA. After 7 days of IHA, different treatments were used in each group. In I/R group, LAD was ligated for 30 minutes and then reperfusion for 12 hours. The myocardial ischemia/reperfusion injury was assessed with HE staining, echocardiography. The fluorescence intensity of mg-53 in myocardial tissue was detected by immunofluorescence assay. The levels of serum lactate dehydrogenase isoenzyme-1 (LDH-1) and creatine kinase isoenzyme-MB (CK-MB) were detected by enzyme-linked immunosorbent assay (ELISA). The expression of dysferlin, caveolin-3 and MG-53 proteinwere detected by Western Blot.   RESULTS  There was no significant difference in all indexes between Sham and Sham+IHA. Compared with those in I/R group, the myocardial injury in I/R+IHA group was lighter, and the systolic function were significantly increased (P<0.01). Compared with those in IR group, the fluorescence intensity of MG-53 in I/R+IHA group was significantly increased (P<0.05), and the expression levels of dysfelin, MG-53 and caveolin-3 protein were significantly increased (P<0.05).   CONCLUSION   IHA treatment can reduce myocardial I/R injury by improving the ability of plasma membrane repair in adult SD rats.
Progress in caveolae and caveolae-mediated endocytosis in cardiovascular disease
Xing-long SONG, Wan-rong MAN, De-xi WU, Dong-dong SUN
2022, 34(4): 467-472, 478. doi: 10.12125/j.chj.202104003
Abstract:
Caveolae are mainly composed of caveolins and cavins. Caveolae are involved in many cellular functions including mechanosensing, signaling, endocytosis, lipid storage and trafficking, cell metabolism and membrane homeostasis. Caveolae-mediated endocytosis plays an important role in many pathophysiological processes and is associated with a variety of diseases. In this review, the composition of caveolae, caveolae-mediated endocytosis and caveolae-related cardiovascular diseases will be introduced.
Research progress of Chinese and Western medicine in cardiac rehabilitation drug prescriptions
Huang-yu XU, Xiao-yan LU
2022, 34(4): 473-478. doi: 10.12125/j.chj.202110094
Abstract:
At present, cardiac rehabilitation at home and abroad is mainly based on exercise training, which has definite curative effect and sufficient evidence in improving patients’ cardiac functions, exercise tolerance and quality of life. Up till now, a scientific and systematic consensus guide for cardiac rehabilitation has been formed. Drug prescription, as the main factor to control the disease, relieve symptoms and improve prognosis, cardiac functions and quality of life, is also indispensable. There is evidence that some drugs, such as traditional Chinese medicine preparations, are supplements to exercise training. According to the domestic guidelines, this paper categorizes the drug prescriptions into the five prescriptions of cardiac rehabilitation, aiming to summarize the drug prescriptions in the guidelines at home and abroad, sort out the latest research progress of traditional Chinese medicine prescriptions for cardiac rehabilitation, analyze the current situation and problems, and point out the direction of future research and development for cardiac rehabilitation prescriptions, so as to preliminarily explore the guidelines of integrated Chinese and Western medicine for cardiac rehabilitation.
Research progress of matrine in atherosclerosis related diseases
Yi-nan HUANG, Song ZHANG, Shu-ya YANG, Kun YANG
2022, 34(4): 479-483. doi: 10.12125/j.chj.202111114
Abstract:
Matrine is a kind of quinazine alkaloid extracted from the root of the traditional Chinese herb Sophora flavescens. Atherosclerosis is a pathological disease characterized by fibrous proliferation of the vascular wall, chronic inflammation, lipid accumulation and immune disorder. In recent years, matrine in the treatment of atherosclerosis and its related diseases have attracted wide attention. Studies have shown that matrine plays an important role in atherosclerotic diseases by reducing blood lipids, slowing down obesity, inhibiting inflammation and protecting endothelial cells. In this paper, the action mechanism of matrine in the treatment of atherosclerosis and its related diseases is further elaborated to lay a foundation for the application of matrine in clinical treatment in the future.
Application of multimodality imaging and 3d printing technique in transcatheter mitral valve edge-to-edge repair
Guo-lei ZHOU, Meng-en ZHAI, Chen-nian XU, Yan-yan MA, Ping JIN, Kang YI, Yang LIU, Tao YOU, Jian YANG
2022, 34(4): 484-488. doi: 10.12125/j.chj.202103089
Abstract:
Multimodality imaging refers to a comprehensive imaging mode that combines the image information of different modes of a variety of imaging techniques, complementary advantages of various disciplines, and cross-validation in disease diagnosis and treatment. Transcatheter mitral valve edge-to-edge repair(TEER) has been developed as an alternative to surgical repair for patients with high-risk mitral regurgitation. In order to ensure the safety and success rate of surgery, TEER is more and more dependent on multimodality imaging. In this paper, the applications of transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), multidetector row computed tomography (MDCT), cardiac magnetic resonance (CMR) and mitral valve 3D printing model in TEER were reviewed.
Application of standardized training combined with objective management teaching method in clinical teaching of cardiac surgery
Xiao-chen WU, Jian WANG, Jian LIU, Yuan-zhang LIU, Qin YUE, Xia LI, Sheng DING, Jin-bao ZHANG
2022, 34(4): 489-491, 495. doi: 10.12125/j.chj.202112031
Abstract:
  AIM  To explore the significance of standardized training combined with objective management teaching method in clinical teaching of cardiac surgery.   METHODS  Twenty residents who received standardized training in cardiac surgery in our hospital from January 2020 to January 2021 were randomly divided into control group and study group. The residents were taught by traditional teaching and standardized training combined with objective management teaching method, and the learning effects of the two groups were compared.   RESULTS  The mastery of cardiac surgery knowledge and satisfaction with teaching methods in the study group were significantly better than those in the control group, and the difference between the groups was statistically significant (P<0.05).   CONCLUSION  The application effect of standardized training combined with objective management teaching method in clinical teaching of cardiac surgery is good, which can effectively improve the learning effect of standardized training residents.
Application of situational simulation teaching of acute ST segment elevation myocardial infarction in 5-year-program clinical medical students
Jun CHEN, Juan LI, Xu-wu SHAO, Xue-zhong WANG, Xue-bin DONG, Jin-fa XIA, Shao-jun WANG, Li-li E, Xiao-jun TONG, Yue-song WANG
2022, 34(4): 492-495. doi: 10.12125/j.chj.202201095
Abstract:
  AIM   To explore the feasibility of situational simulation teaching of acute ST segment elevation myocardial infarction (STEMI) in 5-year-program clinical students.   METHODS   Fifty-six five-year-program clinical students from Wannan Medical College who were interns in Ma’anshan People’s Hospital from 2020 to 2021 were randomly divided into traditional teaching group and situational simulation teaching group. The traditional teaching group used the traditional clinical teaching methods. The situational simulation teaching group conducted teaching through three scenarios, including "diagnosis and treatment of acute chest pain", "identification and treatment of STEMI" and "rescue of cardiac arrest". After the course, the two groups of students were tested and evaluated.   RESULTS   The average test score of STEMI theoretical knowledge in situational simulation teaching group (83.0 ± 5.7) was significantly higher than that in traditional teaching group (74.7 ± 9.8). The average test scores of the above three scenarios in situational simulation teaching group were also significantly higher than those in the traditional teaching group [(7.8±0.7) vs. (6.7±1.9), P<0.01; (7.8±0.9) vs. (7.1±1.5), P<0.05; (8.3±0.8) vs. (7.3±1.6), P<0.01].   CONCLUSION   In the teaching of STEMI, the situational simulation teaching mode is superior to the traditional teaching mode and is worthy of wide application and promotion.
A rare case of child fraternal twins with mirror image dextrocardia
Liu YANG, Hui-chao WANG, Tian-hua LI
2022, 34(4): 496-498. doi: 10.12125/j.chj.202104090
Abstract: