Effects of Danhong Injection (丹红注射液) on Peri-Procedural Myocardial Injury and Microcirculatory Resistance in Patients with Unstable Angina Undergoing Elective Percutaneous Coronary Intervention: A Pilot Randomized Study

Objective To evaluate the effect of Danhong Injection(丹红注射液,DH)on the index of microcirculatory resistance(IMR)and myocardial injury in patients with unstable angina undergoing elective percutaneous coronary intervention(PCI).Methods Seventy-eight patients with unstable angina were randomly divided into DH group(39 cases)and the control group(39 cases)during elective PCI.Randomization was performed using a random-number table.The DH group received DH at a dosage of 40 mL(mixed with 250 mL saline,covered by a light-proof bag,intravenous drip)during PCI and daily for 7 consecutive days,while the control group only received the same dosage of saline.Both groups received standardized treatment.The IMR and fractional flow reserve(FFR)were measured at maximal hyperemia before and after PCI.Myocardial markers,including myoglobin,creatine kinase(CK),creatine kinase MB(CK-MB),and coronary troponin T(cTnT)values were measured at baseline and 24 h after PCI.Results Among the 78 patients enrolled,the baseline and procedural characteristics were similar between the two groups.There was no significant difference in pre-PCI myocardial markers and coronary physiological indexes between the two groups.However,post-PCI CK and CK-MB levels in the DH group were significantly lower than those in the control group(111.97±80.97 vs.165.47±102.99,P=0.013;13.08±6.90 vs.19.75±15.49,P=0.016).Post-PCI myoglobin and cTNT-positive tend to be lower in the DH group than in the control group but did not reach statistical significance(88.07±52.36 vs.108.13±90.94,P=0.52;2.56%vs.7.69%,P=0.065).Compared with the control group,the post-IMR levels of the DH group tended to decrease,but there was no statistical difference(20.73±13.15 vs.26.37±12.31,P=0.05).There were no statistical differences in post-FFR in both groups.The peri-procedural myocardial injury of the DH group was significantly lower than that of the control group(2.56%vs.15.38%,P=0.025).During the 30-d follow-up period,no major adverse cardiovascular events occurred in either group.Conclusion This study demonstrated benefit of DH in reducing myocardial injury and potential preserving microvascular function in patients with unstable angina undergoing elective PCI.

Index of microcirculatory resistance: state-of-the-art and potential applications in computational simulation of coronary artery disease

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.

Predictive value and impact analysis for the index of microcirculatory resistance in MI patients with elective percutaneous coronary intervention

Objective To evaluate the predictive value and impact for the index of microcirculatory resistance(IMR)in myocardial infarction(MI)patients with elective percutaneous coronary intervention(PCI)for treating coronary artery occlusion.Methods A total of 34 patients with STEMI or non-STEMI treated after 12h time window

Coronary physiology assessment in the catheterization laboratory

Physicians cannot rely solely on the angiographic appearance of epicardial coronary artery stenosis when evaluating patients with myocardial ischemia. Instead, sound knowledge of coronary vascular physiology and of the methods currently available for its characterization can improve the diagnostic and prognostic accuracy of invasive assessment of the coronary circulation, and help improve clinical decision-making. In this article we summarize the current methods available for a thorough assessment of coronary physiology.