Treatment of Coronary Heart Disease from the Perspective of Liver Controlling Dispersion

The liver is in charge of distributing and regulating the movement of qi throughout the whole body,coordinating the transportation and transformation of the internal organs in the middle part of the body,promoting the biochemical circulation of qi,blood,and body fluids,and regulating emotions.Liver dysfunction can disrupt the transportation and transformation of qi,blood,and body fluids,causing phlegm turbidity,blood stasis,and other unwanted symptoms.Poor regulation of emotion further aggravates the accumulation of pathological substances,resulting in the obstruction of heart vessels,and ultimately coronary heart disease(CHD).Through regulating lipid metabolism,inflammatory reaction,vasoactive substances,platelet function,neuroendocrine,and other factors,liver controlling dispersing qi plays a comprehensive role in the prognosis of atherosclerosis,the primary cause of CHD.Therefore,it is recommended to treat CHD from the perspective of liver-controlling dispersion.

Coronary heart disease-related fatigue:risk factors,assessment and treatments

Coronary atherosclerotic heart disease is a disease of myocardial ischemia and hypoxia,which often presents as chest pain,dyspnea,cold sweat and fatigue.Fatigue is the subjective experience of patients,which is easy to be ignored,and will lead to the decline of patients’quality of life and physical activity level,etc.,with a high incidence and great harm.The purpose of this paper was to review the concept,risk factors,assessment tools and intervention measures of coronary atherosclerotic heart disease fatigue in order to provide a reference for identifying and improving the fatigue of coronary atherosclerotic heart disease.

The Study on the Correlation Between Plasma Adiponectin Level and Coronary Heart Disease

Objectives To investigate the relationship between plasma adiponectin level and coronary heart disease （CHD）, and some established cardiovascular risk factors and to probe its probable pathogenesis which adiponectin results in CHD. Methods The levels of plasma adiponectin, fasting plasma insulin （FINS）, C-reactive protein （CRP） and P-selectin were measured by ELISA, plasma ET-1 was measured by radioimmunoassay （RIA） in 75 male patients with CHD and 30 healthy male people. Body mass index （BMI）, waist / hip ratio （WHR） and insulin resistance index （Homa-IR） were calculated respectively. Results （1）The plasma adiponectin levels in CHD group were lower compared with control group[（5.18±2.57）mg / L vs（8.94±2.59）mg / L, P〈 0.001 ], there was no significant difference of plasma adiponectin levels in CHD sub-groups （P 〉 0.05）.（2） Based on multinominal stepwise logistic regression analysis, adiponectin was one of significant and independent risk factors for CHD. （3） Multivariate liner stepwise regression analysis showed that adiponectin had significant correlation with BMI and TG, BMI and TG were independent factors influencing on plasma adiponectin levels. （4） Pearson correlation analysis indicated plasma adiponectin levels were inversely related to FINS levels , Homa-IR, CRP, P-selectin and ET-1. Conclusions （ 1 ）Plasma adiponectin levels are lower in CHD patients compared the control subjects, there are no significant difference of plasma adiponectin levels in patients with SAP, UAP and AMI. （2） Plasma adiponectin levels are relative with CHD. Hypoadiponectinemia is an independent risk factor for CHD. （3）Established cardiovascular risk factors such as BMI and TG have an obvious influence on adiponectin. （4）The probable pathogenesis by which adiponectin involves in CHD is suggested that adiponectin relates to insulin resistance, inflammatory reaction and dysfunction of vessel endothelium.

Atherosclerotic aortic plaques detected by transesophageal echocardiography

Objective To evaluate the predictive value of atherosclerotic aortic plaques in coronary artery disease (CAD). Methods In 50 patients with suspected coronary artery disease, transesophageal echocardiography was performed to examine their thoracic aortas 2 weeks before or after coronary angiography. In the cases of coronary angiography studied, stenosis of the coronary artery ≥50%was considered to be due to coronary artery disease, whereas the thickness of the intima ≥1.3 mm was taken to be the criteria for the presence of an atherosclerotic aortic plaque on the transesophageal echocardiographic test. Results Among the 50 patients, 37 cases were diagnosed as CAD and 13 cases were considered to be normal. The plaques of the thoracic aorta were observed in 34 cases in the CAD group and 3 cases in the normal group. The sensitivity and specificity of aortic plaques for CAD were 91.9%and 76.9%, respectively. The positive and negative predictive values of the aortic plaques for CAD were 91.9%and 76.9%, respectively. The accuracy was 88.0%. 80 percent of the patients with single-vessel disease had thoracic aortic plaques, 92 percent of the patients with two vessel disease and 100 percent of the patients with three vessel disease had thoracic aortic plaques. There was a significant difference in the thickness of aortic intimas between the normal group and the CAD group. Conclusions Detecting atherosclerotic plaques in the thoracic aorta with transesophageal echocardiography may be of great value in predicting the presence and extent of coronary artery disease.

Early outcomes and analysis of factors influencing in-hospital mortality after concomitant heart valve replacement and coronary artery bypass grafting

Background Objective:To investigate the perioperative precautions,surgical methods and early clinical efficacy of patients with valvular heart disease complicated by coronary atherosclerotic heart disease treated with coronary artery bypass grafting at the same time as heart valve replacement and to analyze the relevant factors affecting the death of patients during hospitalization after surgery.Methods:Between January 2020 and September 2021,a total of 103 patients who underwent simultaneous heart valve replacement and coronary artery bypass grafting for heart valve disease in conjunction with coronary atherosclerotic heart disease at the Department of cardiac surgery,Guangdong Cardiovascular Institute were retrospectively evaluated for clinical data,and a systematic review and summary of all preoperative data,surgical methods,intraoperative data,and major complications were performed.The variations in each cardiotocography indicator were examined before and after surgery to determine surgical effectiveness and statistical perioperative patient mortality.After integrating the Sino SCORE risk assessment system and analyzing the case features included in this data,12 alternative risk variables for mortality were identified and submitted to univariate and multivariate analysis using logistic regression.After performing a univariate analysis of the alternative risk factors,the option of P<0.05 was considered a risk factor and included in the multivariate analysis,followed by a multivariate logistic regression analysis in which the factors were determined to be independent risk factors with P<0.05,and their OR values and 95 percent confidence intervals(CIs)were calculated to analyze the associated factors affecting patients’early prognosis systematically.Results:Of the 103 patients,91 were successfully discharged from the hospital,12 died,11.7%of the deaths were due to the following causes:postoperative low cardiac output syndrome,multiple organ failure,and severe infection;Among all the 103 patients,7 patients underwent rebleeding and hemostasis after surgery,6 patients required dialysis after surgery,28 patients underwent IABP supportive care after surgery because of the occurrence of low cardiac output syndrome,1 patient assisted by ECMO after surgery,and patients discharged successfully had significantly less LVEDD and LVESD in the early postoperative period,compared with those before surgery(P=0.000;P=0.000).Age>70 years,preoperative combined hyperlipidemia,and history of the cerebrovascular accident were the three independent risk factors that may have contributed to in-hospital mortality in patients undergoing CABG valve replacement.Conclusions:1.The diastolic function of the majority of patients with valvular heart disease and coronary atherosclerotic heart disease improved significantly in the early stages after coronary artery bypass grafting and heart valve replacement.2.Age>70 years,preoperative combined hyperlipidemia,and a history of the cerebrovascular accident were three independent risk factors for in-hospital death in patients receiving CABG valve replacement.