Objective: High-dose intravenous immunoglobulin (IVIG) decreases the risk for development of coronary arterial lesions (CAL) in Kawasaki disease (KD) while patients resistant to IVIG have higher risk. This study is ai...Objective: High-dose intravenous immunoglobulin (IVIG) decreases the risk for development of coronary arterial lesions (CAL) in Kawasaki disease (KD) while patients resistant to IVIG have higher risk. This study is aimed to investigate an additional therapy affects the risk for CAL in IVIG resistant KD. Design: The information from 11,510 children with KD was collected by the nationwide survey (2003-2004) in Japan. The secondary therapeutic strategies for IVIG resistant KD were an additional IVIG dose, steroids or both. The incidence of CAL was compared among 4 groups: G1, children responded to initial IVIG;G2, IVIG resistant patients receiving an additional IVIG dose;G3, IVIG resistant patients receiving additional steroids;G4, IVIG resistant patients receiving an additional IVIG dose plus steroids. CAL was assessed at 30th day of illness using ultrasound echocardiography. Results: 2229 patients (19.4%) were resistant to initial IVIG. Incidence of CAL was significantly lower in children responding to initial IVIG than in IVIG resistant patients (1.9% and 11.0%, respectively;odd’s ratio 6.3). The incidences of CAL in an each additional therapy group were as follows: G2: 6.7%, G3: 9.7%, G4: 22.2%. The risk for CAL was significantly higher in G4 as compared with G2 and G3. Giant aneurysmal formation (GA) was more frequently developed in G3 and G4 consisting of the patients receiving steroids (G1: 0.03%, G2: 0.63%, G3: 4.3%, G4: 3.7%). Conclusion: The incidence of CAL was considerably high in IVIG resistant KD and an additional therapy by steroids may increase the risk for GA.展开更多
Objective:To explore the effect of nicorandil on the coronary artery microcirculation and hemodynamics in patients with coronary slow flow (CSF).Methods: A total of 86 patients with CSF who were admitted in our hospit...Objective:To explore the effect of nicorandil on the coronary artery microcirculation and hemodynamics in patients with coronary slow flow (CSF).Methods: A total of 86 patients with CSF who were admitted in our hospital were included in the study and randomized into the treatment group and the control group with 43 cases in each group. The patients in the control group were given aspirin, HMG-CoA reductase inhibitor, and ACEI. On this basis, the patients in the treatment group were given nicorandil. The patients in the two groups were continuously treated for 6 months. The coronary artery microcirculation and hemodynamic indicators before and after treatment in the two groups were detected and compared.Results:TAT, ET-1, and hs-CRP levels, LAD, LCX, RCA, TIMI average blood flow frame count value, and IMR after treatment in the two groups were significantly reduced when compared with before treatment (P<0.05). The above indicators after treatment in the treatment group were significantly lower than those in the control group (P<0.05). FMD after treatment in the two groups was significantly elevated when compared with before treatment (P<0.05). FMD after treatment in the treatment group was significantly higher than that in the control group (P<0.05). Conclusions: Nicorandil in the treatment of CSF can effectively improve the coronary artery microcirculation and hemodynamics, with a significant efficacy.展开更多
Objective To examine insulin resistance and high sensitivity C-reactive protein (hsCRP) association with clinical and angiographic severity of coronary artery disease (CAD) in patients with normal glucose tolerance. M...Objective To examine insulin resistance and high sensitivity C-reactive protein (hsCRP) association with clinical and angiographic severity of coronary artery disease (CAD) in patients with normal glucose tolerance. Methods In 638 consecutive patients with normal glucose tolerance, 221 had atypical chest pain and normal coronary artery (control group), 279 had stable angina and CAD (SAP group), and 138 suffered acute myocardial infarction (MI group). The degree of CAD was further divided into borderline lesion (lumen diameter narrowing 50%-69%), significant 1-, 2- or 3-vessel disease (luminal diameter narrowing ≥70%). Fasting serum glucose, insulin and hsCRP levels and lipid profiles were measured, and homeostasis model assessment for insulin resistance (HOMA-IR) was calculated. Multivariate analysis was performed to assess risk factors for 3-vessel disease or acute MI. Results Serum hsCRP, lipoprotein (a) levels, and insulin resistance index (IRI) were higher in AMI group than those in SAP and control groups. Serum hsCRP level and IRI were also higher in 3-vessel disease than those in other groups. Multivariate regression analysis revealed that insulin resistance, cigarette smoking, serum hsCRP, and lipoprotein (a) levels were independent risk factors for acute MI. Lipoprotein (a) elevation was an independent risk factor for 3-vessel disease. Conclusion Insulin resistance and high serum hsCRP level were associated with occurrence of acute MI and angiographic severity of coronary disease in patients with normal glucose tolerance.展开更多
The exploration of coronary microcirculatory dysfunction in diabetes has accelerated in recent years.Cardiac function is compromised in diabetes.Diabetic patients manifest accelerated atherosclerosis in coronary arter...The exploration of coronary microcirculatory dysfunction in diabetes has accelerated in recent years.Cardiac function is compromised in diabetes.Diabetic patients manifest accelerated atherosclerosis in coronary arteries.These data are confirmed in diabetic animal mod-els,where lesions of small coronary arteries have been described.These concepts are epitomized in the classic microvascular complications of diabetes,i.e.blindness,kidney failure and distal dry gangrene.Most importantly,accumulating data indicate that insights gained from the link between inflammation and diabetes can yield predictive and prognostic information of considerable clinical utility.This review summarizes the evidence for the predisposing factors and the mechanisms involved in diabetes,and assesses the current state of knowledge regarding the triggers for inflammation in this disease.We evaluate the roles of hyperglycemia,oxidative stress,polyol pathway,protein kinase C,advanced glycation end products,insulin resistance,peroxisome proliferator-activated receptor-γ,inflammation,and diabetic cardiomyopathy as a "stem cell disease".Furthermore,we discuss the mechanisms responsible for impaired coronary arteriole function.Finally,we consider how new insights in diabetes may provide innovative therapeutic strategies.展开更多
AIM:To investigate whether nonalcoholic fatty liver disease(NAFLD)affects coronary artery disease(CAD)and identify candidate mediators.METHODS:Patients who underwent coronary angiography were consecutively recruited.T...AIM:To investigate whether nonalcoholic fatty liver disease(NAFLD)affects coronary artery disease(CAD)and identify candidate mediators.METHODS:Patients who underwent coronary angiography were consecutively recruited.The patients were classified into four groups by coronary artery stenosis:A,insignificant;B,one-vessel disease;C,two-vessel disease;and D,three-vessel disease.Abdominal ultrasonography was performed to determine the presence of a fatty liver and categorize by grade:0,no evidence;1,mild;2,moderate;and 3,severe.We measured not only known CAD risk factors,but also serum insulin,HOMA-index,adiponectin,interleukin-6,tumor necrosis factor-αand high-sensitivity C-reactive protein levels.RESULTS:Of the 134 patients who met the inclusion criteria,82(61.2%)had ultrasonographically diagnosed NAFLD.Among the 46 patients with CAD,37(80.4%)had evidence of a fatty liver.The two groups(A vs B-D)were significantly different in terms of age,total cholesterol,triglycerides,low-density lipoprotein levels and fatty liver.Coronary artery stenosis was strongly associated with fatty liver in a grade-dependent manner(P=0.025).In binary logistic regression,NAFLD was a significant independent predictor of CAD(P=0.03,OR=1.685;95%CI:1.051-2.702).Among the candidate mediators,the serum adiponectin level showed a trend toward lowering based on CAD progression(P=0.071).CONCLUSION:NAFLD is an independent risk factor for CAD in a grade-dependent manner.Moreover,adiponectin might be related to the pathogenesis of NAFLD.展开更多
We sought to assess the incidence of aspirin resistance after off-pump coronary artery bypass (OPCAB) surgery, and investigate whether clopidogrel can improve aspirin response and be safely applied early after OPCAB...We sought to assess the incidence of aspirin resistance after off-pump coronary artery bypass (OPCAB) surgery, and investigate whether clopidogrel can improve aspirin response and be safely applied early after OPCAB surgery. Sixty patients who underwent standard OPCAB surgery were randomized into two groups. One group (30 patients) received mono-antiplatelet treatment (MAPT) with aspirin 100 mg daily and the other group received dual anfiplatelet treatment (DAPT) with aspirin 100 mg daily plus clopidogrel 75 mg daily. Platelet aggregations in response to arachi- donic acid (PLAA) and adenosine diphosphate (ADP) (PLADP) were measured preoperatively and on days 1 to 6, 8 and 10 after the antiplatelet agents were administered. A PLAA level above 20% was defined as aspirin resistance. Postoperative bleeding and other perioperative variables were also recorded. There were no significant differences between the two groups in baseline characteristics, average number of distal anastomosis, operation time, postoperative bleeding, ventilation time and postoperative hospital stay. However, the incidence of aspirin resistance was significantly lower in the DAPT group than that in the MAPT group on the first and second day after antiplatelet agents were given (62.1% vs, 32.1%, 34.5% vs. 10.7%, respectively, both P 〈 0.05). There was no significant difference in postoperative complication between the two groups. DAPT with aspirin and clopidogrel can be safely applied to OPCAB patients early after the procedure. Moreover, clopidogrel reduces the incidence of OPCAB-related aspirin resistance.展开更多
Insulin resistance (IR) is recognized to be of critical importance in a variety of metabolic diseases and coronary artery disease (CAD). Impaired skeletal muscle glucose utilization (SMGU) plays an important role in t...Insulin resistance (IR) is recognized to be of critical importance in a variety of metabolic diseases and coronary artery disease (CAD). Impaired skeletal muscle glucose utilization (SMGU) plays an important role in the pathogenesis of IR, whereas it is controversial whether myocardial IR is similar in this respect. Methods: Twenty-two studies of myocardial IR and skeletal muscle IR using positron emission tomography (PET) and/or whole body IR were reviewed. Heart and skeletal muscle IR were measured with PET and18F-FDG under hyperinsulinemic euglycemic insulin clamp technique. Whole body IR was also determined at the time of PET under hyperinsulinemic euglycemic insulin clamp technique. Results: One study reported that heart and skeletal muscle IR is present in untreated type 2 diabetes mellitus (T2DM), hypertension and CAD (as reflected in a myocardial glucose utiliation rate (MGU) in T2DM vs control [p -0.665, p -0.60, p -0.74, p -0.74, p 18F-FDG Uptake (MFU) in hypertriglyc-eridemics was (p = ns) despite findings of reduced skeletal muscle18F-FDG uptake (SMFU in hyper-triglyceridemia展开更多
The dysfunction of coronary microcirculation is an important cause of coronary artery disease(CAD).The index of microcirculatory resistance(IMR)is a quantitative evaluation of coronary microcirculatory function,which ...The dysfunction of coronary microcirculation is an important cause of coronary artery disease(CAD).The index of microcirculatory resistance(IMR)is a quantitative evaluation of coronary microcirculatory function,which provides a significant reference for the prediction,diagnosis,treatment,and prognosis of CAD.IMR also plays a key role in investigating the interaction between epicardial and microcirculatory dysfunctions,and is closely associated with coronary hemodynamic parameters such as flow rate,distal coronary pressure,and aortic pressure,which have been widely applied in computational studies of CAD.However,there is currently a lack of consensus across studies on the normal and pathological ranges of IMR.The relationships between IMR and coronary hemodynamic parameters have not been accurately quantified,which limits the application of IMR in computational CAD studies.In this paper,we discuss the research gaps between IMR and its potential applications in the computational simulation of CAD.Computational simulation based on the combination of IMR and other hemodynamic parameters is a promising technology to improve the diagnosis and guide clinical trials of CAD.展开更多
Background Currently,there are no reliable indicators for predicting intravenous immunoglobulin resistance and coronary artery lesions in the early stage of Kawasaki disease.Methods A total of 300 patients with Kawasa...Background Currently,there are no reliable indicators for predicting intravenous immunoglobulin resistance and coronary artery lesions in the early stage of Kawasaki disease.Methods A total of 300 patients with Kawasaki disease were studied retrospectively.Laboratory data were compared between the intravenous immunoglobulin resistant (29 patients) and responsive groups,and between the groups with coronary artery lesions (48 patients) and without coronary artery lesions.Results The intravenous immunoglobulin resistant group had significantly higher D-dimer,globulin,interleukin-6 and serum ferritin levels in comparison to the intravenous immunoglobulin responder group.D-dimer level had a sensitivity of 87.0% and a specificity of 56.3% for predicting intravenous immunoglobulin resistance at a cutoff point of 1.09 mg/L.Globulin had a sensitivity of 62.1% and a specificity of 82.3% for predicting intravenous immunoglobulin resistance at a cutoff point of 34.7 g/L.Serum ferritin level had a sensitivity of 42.9% and a specificity of 88.8% for predicting intravenous immunoglobulin resistance at a cutoff point of 269.7 ng/mL.The patients with coronary artery lesions had higher D-dimer and tumor necrosis factor-α level.D-dimer level had a sensitivity of 50% and a specificity of 78.6% for predicting coronary artery lesions at a cutoff point of 1.84 mg/L.Based on analysis by multivariate logistic regression,serum ferritin and globulin were independent risks for intravenous immunoglobulin resistance,D-dimer was independent risk for coronary artery lesions.Conclusions Elevated serum ferritin,globulin and D-dimer levels are significantly associated with intravenous immunoglobulin resistance in Kawasaki disease.Moreover,serum D-dimer is significantly increased in Kawasaki disease with coronary artery lesions.展开更多
Background Insulin resistance(IR)is significantly associated with coronary artery disease and cardiovascular events in patients with or without type 2 diabetes mellitus.This study aimed to evaluate the influence of ...Background Insulin resistance(IR)is significantly associated with coronary artery disease and cardiovascular events in patients with or without type 2 diabetes mellitus.This study aimed to evaluate the influence of IR on long-term outcomes of patients undergoing percutaneous coronary intervention(PCI)with sirolimus-eluting stent(SES)implantation.Methods A total of 467 consecutive patients undergoing SES-based PCI were divided into lR group(n=104)and non-IR group(n=363).The patients were followed up for one year.The rate of major adverse cardiac events(MACEs) including death, non-fatal myocardial infarction and recurrent angina pectoris was compared by the log-rank test,and the independent risk factors were identified by the Cox regression analysis.Results MACEs occurred more frequently,and cumulative survival rate was lower in the IR group than in the non-IR group during the follow-up (all P〈0.05).IR was an independent risk factor for the occurrence of cardiac death and non-fatal myocardial infarction(OR=2176,95% CI=1.35-5.47,P=0.034).Old age,diabetes,and multi-vessel disease were determinants for recurrent angina pectoris after PCI(P〈0.05).Subgroup analysis revealed that IR(OR=3.35,95% CI=1.07-13.59,P=0.013)and multi-vessel disease(OR=2.19,95%CI=1.01-5.14,P=0.044)were independent risk predictors for recurrent angina pectoris in patients with diabetes after PCI.Conclusions IR is associated with reduced MACE-free survival and remains an independent predictor for recurrent angina pectoris after PCI with SES implantation.展开更多
Objective:To explore the effectiveness of Danhong Injection(丹红注射液)on improving microcirculatory injury after percutaneous coronary intervention(PCI)in patients with coronary heart disease(CHD).Methods:A randomize...Objective:To explore the effectiveness of Danhong Injection(丹红注射液)on improving microcirculatory injury after percutaneous coronary intervention(PCI)in patients with coronary heart disease(CHD).Methods:A randomized controlled trial was conducted and 90 patients were enrolled.A random sequence was generated using statistical analysis software.Patients with microcirculatory injuries after PCI were randomly divided into 3 groups for treatment(30 subjects in each group):Danhong Injection group:after PCI,Danghong Injections were given with intravenous administration with 40 mL twice a day for a week;statins intensive group:after PCI,atorvastatin calcium tablets were given oral medication with 80 mg once,and then atorvastatin 40 mg daily for 1 week;the control group:after PCI,atorvastatin calcium tablets were given oral medication with 10–20 mg daily for 1 week.The index of microcirculation resistance(IMR)was used to assess microcirculatory injury during PCI.The IMR of the target vessel was reexamined after 1 week of drug treatment.Results:After one week's drug treatment,IMR was significantly decreased in both statins intensive group and Danhong Injection group compared with the control group(P<0.01),but no difference was found between statins intensive group and Danhong injection group(14.03±2.54 vs.16.03±5.72 U,P=0.080).Conclusions:The efficacy of Danhong Injection is non-inferior to statin.Early use of Danhong Injection after PCI can effectively improve coronary microcirculation injury after PCI.展开更多
文摘Objective: High-dose intravenous immunoglobulin (IVIG) decreases the risk for development of coronary arterial lesions (CAL) in Kawasaki disease (KD) while patients resistant to IVIG have higher risk. This study is aimed to investigate an additional therapy affects the risk for CAL in IVIG resistant KD. Design: The information from 11,510 children with KD was collected by the nationwide survey (2003-2004) in Japan. The secondary therapeutic strategies for IVIG resistant KD were an additional IVIG dose, steroids or both. The incidence of CAL was compared among 4 groups: G1, children responded to initial IVIG;G2, IVIG resistant patients receiving an additional IVIG dose;G3, IVIG resistant patients receiving additional steroids;G4, IVIG resistant patients receiving an additional IVIG dose plus steroids. CAL was assessed at 30th day of illness using ultrasound echocardiography. Results: 2229 patients (19.4%) were resistant to initial IVIG. Incidence of CAL was significantly lower in children responding to initial IVIG than in IVIG resistant patients (1.9% and 11.0%, respectively;odd’s ratio 6.3). The incidences of CAL in an each additional therapy group were as follows: G2: 6.7%, G3: 9.7%, G4: 22.2%. The risk for CAL was significantly higher in G4 as compared with G2 and G3. Giant aneurysmal formation (GA) was more frequently developed in G3 and G4 consisting of the patients receiving steroids (G1: 0.03%, G2: 0.63%, G3: 4.3%, G4: 3.7%). Conclusion: The incidence of CAL was considerably high in IVIG resistant KD and an additional therapy by steroids may increase the risk for GA.
文摘Objective:To explore the effect of nicorandil on the coronary artery microcirculation and hemodynamics in patients with coronary slow flow (CSF).Methods: A total of 86 patients with CSF who were admitted in our hospital were included in the study and randomized into the treatment group and the control group with 43 cases in each group. The patients in the control group were given aspirin, HMG-CoA reductase inhibitor, and ACEI. On this basis, the patients in the treatment group were given nicorandil. The patients in the two groups were continuously treated for 6 months. The coronary artery microcirculation and hemodynamic indicators before and after treatment in the two groups were detected and compared.Results:TAT, ET-1, and hs-CRP levels, LAD, LCX, RCA, TIMI average blood flow frame count value, and IMR after treatment in the two groups were significantly reduced when compared with before treatment (P<0.05). The above indicators after treatment in the treatment group were significantly lower than those in the control group (P<0.05). FMD after treatment in the two groups was significantly elevated when compared with before treatment (P<0.05). FMD after treatment in the treatment group was significantly higher than that in the control group (P<0.05). Conclusions: Nicorandil in the treatment of CSF can effectively improve the coronary artery microcirculation and hemodynamics, with a significant efficacy.
文摘Objective To examine insulin resistance and high sensitivity C-reactive protein (hsCRP) association with clinical and angiographic severity of coronary artery disease (CAD) in patients with normal glucose tolerance. Methods In 638 consecutive patients with normal glucose tolerance, 221 had atypical chest pain and normal coronary artery (control group), 279 had stable angina and CAD (SAP group), and 138 suffered acute myocardial infarction (MI group). The degree of CAD was further divided into borderline lesion (lumen diameter narrowing 50%-69%), significant 1-, 2- or 3-vessel disease (luminal diameter narrowing ≥70%). Fasting serum glucose, insulin and hsCRP levels and lipid profiles were measured, and homeostasis model assessment for insulin resistance (HOMA-IR) was calculated. Multivariate analysis was performed to assess risk factors for 3-vessel disease or acute MI. Results Serum hsCRP, lipoprotein (a) levels, and insulin resistance index (IRI) were higher in AMI group than those in SAP and control groups. Serum hsCRP level and IRI were also higher in 3-vessel disease than those in other groups. Multivariate regression analysis revealed that insulin resistance, cigarette smoking, serum hsCRP, and lipoprotein (a) levels were independent risk factors for acute MI. Lipoprotein (a) elevation was an independent risk factor for 3-vessel disease. Conclusion Insulin resistance and high serum hsCRP level were associated with occurrence of acute MI and angiographic severity of coronary disease in patients with normal glucose tolerance.
基金Supported by Grants from Pfizer Atorvastatin Research Award,No. 2004-37American Heart Association SDG,No. 110350047ANIH Grants,No. RO1 HL077566 and RO1 HL085119 to Zhang C
文摘The exploration of coronary microcirculatory dysfunction in diabetes has accelerated in recent years.Cardiac function is compromised in diabetes.Diabetic patients manifest accelerated atherosclerosis in coronary arteries.These data are confirmed in diabetic animal mod-els,where lesions of small coronary arteries have been described.These concepts are epitomized in the classic microvascular complications of diabetes,i.e.blindness,kidney failure and distal dry gangrene.Most importantly,accumulating data indicate that insights gained from the link between inflammation and diabetes can yield predictive and prognostic information of considerable clinical utility.This review summarizes the evidence for the predisposing factors and the mechanisms involved in diabetes,and assesses the current state of knowledge regarding the triggers for inflammation in this disease.We evaluate the roles of hyperglycemia,oxidative stress,polyol pathway,protein kinase C,advanced glycation end products,insulin resistance,peroxisome proliferator-activated receptor-γ,inflammation,and diabetic cardiomyopathy as a "stem cell disease".Furthermore,we discuss the mechanisms responsible for impaired coronary arteriole function.Finally,we consider how new insights in diabetes may provide innovative therapeutic strategies.
基金Supported by A 2009 Research Grant from Kangwon National University
文摘AIM:To investigate whether nonalcoholic fatty liver disease(NAFLD)affects coronary artery disease(CAD)and identify candidate mediators.METHODS:Patients who underwent coronary angiography were consecutively recruited.The patients were classified into four groups by coronary artery stenosis:A,insignificant;B,one-vessel disease;C,two-vessel disease;and D,three-vessel disease.Abdominal ultrasonography was performed to determine the presence of a fatty liver and categorize by grade:0,no evidence;1,mild;2,moderate;and 3,severe.We measured not only known CAD risk factors,but also serum insulin,HOMA-index,adiponectin,interleukin-6,tumor necrosis factor-αand high-sensitivity C-reactive protein levels.RESULTS:Of the 134 patients who met the inclusion criteria,82(61.2%)had ultrasonographically diagnosed NAFLD.Among the 46 patients with CAD,37(80.4%)had evidence of a fatty liver.The two groups(A vs B-D)were significantly different in terms of age,total cholesterol,triglycerides,low-density lipoprotein levels and fatty liver.Coronary artery stenosis was strongly associated with fatty liver in a grade-dependent manner(P=0.025).In binary logistic regression,NAFLD was a significant independent predictor of CAD(P=0.03,OR=1.685;95%CI:1.051-2.702).Among the candidate mediators,the serum adiponectin level showed a trend toward lowering based on CAD progression(P=0.071).CONCLUSION:NAFLD is an independent risk factor for CAD in a grade-dependent manner.Moreover,adiponectin might be related to the pathogenesis of NAFLD.
基金supported by a grant from the National Natural Science Foundation of China(81170181)a Program for Development of Innovative Research Team in the First Affiliated Hospital of Nanjing Medical Universitya Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutes(PAPD)
文摘We sought to assess the incidence of aspirin resistance after off-pump coronary artery bypass (OPCAB) surgery, and investigate whether clopidogrel can improve aspirin response and be safely applied early after OPCAB surgery. Sixty patients who underwent standard OPCAB surgery were randomized into two groups. One group (30 patients) received mono-antiplatelet treatment (MAPT) with aspirin 100 mg daily and the other group received dual anfiplatelet treatment (DAPT) with aspirin 100 mg daily plus clopidogrel 75 mg daily. Platelet aggregations in response to arachi- donic acid (PLAA) and adenosine diphosphate (ADP) (PLADP) were measured preoperatively and on days 1 to 6, 8 and 10 after the antiplatelet agents were administered. A PLAA level above 20% was defined as aspirin resistance. Postoperative bleeding and other perioperative variables were also recorded. There were no significant differences between the two groups in baseline characteristics, average number of distal anastomosis, operation time, postoperative bleeding, ventilation time and postoperative hospital stay. However, the incidence of aspirin resistance was significantly lower in the DAPT group than that in the MAPT group on the first and second day after antiplatelet agents were given (62.1% vs, 32.1%, 34.5% vs. 10.7%, respectively, both P 〈 0.05). There was no significant difference in postoperative complication between the two groups. DAPT with aspirin and clopidogrel can be safely applied to OPCAB patients early after the procedure. Moreover, clopidogrel reduces the incidence of OPCAB-related aspirin resistance.
文摘Insulin resistance (IR) is recognized to be of critical importance in a variety of metabolic diseases and coronary artery disease (CAD). Impaired skeletal muscle glucose utilization (SMGU) plays an important role in the pathogenesis of IR, whereas it is controversial whether myocardial IR is similar in this respect. Methods: Twenty-two studies of myocardial IR and skeletal muscle IR using positron emission tomography (PET) and/or whole body IR were reviewed. Heart and skeletal muscle IR were measured with PET and18F-FDG under hyperinsulinemic euglycemic insulin clamp technique. Whole body IR was also determined at the time of PET under hyperinsulinemic euglycemic insulin clamp technique. Results: One study reported that heart and skeletal muscle IR is present in untreated type 2 diabetes mellitus (T2DM), hypertension and CAD (as reflected in a myocardial glucose utiliation rate (MGU) in T2DM vs control [p -0.665, p -0.60, p -0.74, p -0.74, p 18F-FDG Uptake (MFU) in hypertriglyc-eridemics was (p = ns) despite findings of reduced skeletal muscle18F-FDG uptake (SMFU in hyper-triglyceridemia
基金supported by the Natural Science Foundation of China(Nos.61527811 and 61701435)the Key Research and Development Program of Zhejiang Province(No.2020C03016)+1 种基金the Zhejiang Provincial Natural Science Foundation of China(No.LY17H180003)the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission(No.2020RC094),China。
文摘The dysfunction of coronary microcirculation is an important cause of coronary artery disease(CAD).The index of microcirculatory resistance(IMR)is a quantitative evaluation of coronary microcirculatory function,which provides a significant reference for the prediction,diagnosis,treatment,and prognosis of CAD.IMR also plays a key role in investigating the interaction between epicardial and microcirculatory dysfunctions,and is closely associated with coronary hemodynamic parameters such as flow rate,distal coronary pressure,and aortic pressure,which have been widely applied in computational studies of CAD.However,there is currently a lack of consensus across studies on the normal and pathological ranges of IMR.The relationships between IMR and coronary hemodynamic parameters have not been accurately quantified,which limits the application of IMR in computational CAD studies.In this paper,we discuss the research gaps between IMR and its potential applications in the computational simulation of CAD.Computational simulation based on the combination of IMR and other hemodynamic parameters is a promising technology to improve the diagnosis and guide clinical trials of CAD.
基金This work was supported,in part,by grants from The National Natural Science Foundation of China(81670251).
文摘Background Currently,there are no reliable indicators for predicting intravenous immunoglobulin resistance and coronary artery lesions in the early stage of Kawasaki disease.Methods A total of 300 patients with Kawasaki disease were studied retrospectively.Laboratory data were compared between the intravenous immunoglobulin resistant (29 patients) and responsive groups,and between the groups with coronary artery lesions (48 patients) and without coronary artery lesions.Results The intravenous immunoglobulin resistant group had significantly higher D-dimer,globulin,interleukin-6 and serum ferritin levels in comparison to the intravenous immunoglobulin responder group.D-dimer level had a sensitivity of 87.0% and a specificity of 56.3% for predicting intravenous immunoglobulin resistance at a cutoff point of 1.09 mg/L.Globulin had a sensitivity of 62.1% and a specificity of 82.3% for predicting intravenous immunoglobulin resistance at a cutoff point of 34.7 g/L.Serum ferritin level had a sensitivity of 42.9% and a specificity of 88.8% for predicting intravenous immunoglobulin resistance at a cutoff point of 269.7 ng/mL.The patients with coronary artery lesions had higher D-dimer and tumor necrosis factor-α level.D-dimer level had a sensitivity of 50% and a specificity of 78.6% for predicting coronary artery lesions at a cutoff point of 1.84 mg/L.Based on analysis by multivariate logistic regression,serum ferritin and globulin were independent risks for intravenous immunoglobulin resistance,D-dimer was independent risk for coronary artery lesions.Conclusions Elevated serum ferritin,globulin and D-dimer levels are significantly associated with intravenous immunoglobulin resistance in Kawasaki disease.Moreover,serum D-dimer is significantly increased in Kawasaki disease with coronary artery lesions.
文摘Background Insulin resistance(IR)is significantly associated with coronary artery disease and cardiovascular events in patients with or without type 2 diabetes mellitus.This study aimed to evaluate the influence of IR on long-term outcomes of patients undergoing percutaneous coronary intervention(PCI)with sirolimus-eluting stent(SES)implantation.Methods A total of 467 consecutive patients undergoing SES-based PCI were divided into lR group(n=104)and non-IR group(n=363).The patients were followed up for one year.The rate of major adverse cardiac events(MACEs) including death, non-fatal myocardial infarction and recurrent angina pectoris was compared by the log-rank test,and the independent risk factors were identified by the Cox regression analysis.Results MACEs occurred more frequently,and cumulative survival rate was lower in the IR group than in the non-IR group during the follow-up (all P〈0.05).IR was an independent risk factor for the occurrence of cardiac death and non-fatal myocardial infarction(OR=2176,95% CI=1.35-5.47,P=0.034).Old age,diabetes,and multi-vessel disease were determinants for recurrent angina pectoris after PCI(P〈0.05).Subgroup analysis revealed that IR(OR=3.35,95% CI=1.07-13.59,P=0.013)and multi-vessel disease(OR=2.19,95%CI=1.01-5.14,P=0.044)were independent risk predictors for recurrent angina pectoris in patients with diabetes after PCI.Conclusions IR is associated with reduced MACE-free survival and remains an independent predictor for recurrent angina pectoris after PCI with SES implantation.
基金Supported by Capital Health Development Research Project(No.2014-2-4032)。
文摘Objective:To explore the effectiveness of Danhong Injection(丹红注射液)on improving microcirculatory injury after percutaneous coronary intervention(PCI)in patients with coronary heart disease(CHD).Methods:A randomized controlled trial was conducted and 90 patients were enrolled.A random sequence was generated using statistical analysis software.Patients with microcirculatory injuries after PCI were randomly divided into 3 groups for treatment(30 subjects in each group):Danhong Injection group:after PCI,Danghong Injections were given with intravenous administration with 40 mL twice a day for a week;statins intensive group:after PCI,atorvastatin calcium tablets were given oral medication with 80 mg once,and then atorvastatin 40 mg daily for 1 week;the control group:after PCI,atorvastatin calcium tablets were given oral medication with 10–20 mg daily for 1 week.The index of microcirculation resistance(IMR)was used to assess microcirculatory injury during PCI.The IMR of the target vessel was reexamined after 1 week of drug treatment.Results:After one week's drug treatment,IMR was significantly decreased in both statins intensive group and Danhong Injection group compared with the control group(P<0.01),but no difference was found between statins intensive group and Danhong injection group(14.03±2.54 vs.16.03±5.72 U,P=0.080).Conclusions:The efficacy of Danhong Injection is non-inferior to statin.Early use of Danhong Injection after PCI can effectively improve coronary microcirculation injury after PCI.