Reduced peripheral vascular reactivity in refractory angina pectoris:Effect of enhanced external counterpulsation

Objective To examine if the skin microvascular bed is altered and can be modified by enhanced external counterpulsation(EECP)in patients with chronic refractory angina.Methods Twenty patients diagnosed with refractory angina were divided into EECP(n=10)or no EECP(n=10)groups.The data were compared to matched healthy subjects(n=20).The cutaneous forearm microvascular blood flow was measured by Laser-Doppler flowmetry.The vascular responsiveness to iontophoretic administration of acetylcholine(ACh),sodium nitroprusside(SNP)and local skin warming were studied.Measurements of Canadian Cardiovascular Society(CCS)-class,blood pressure and plasma samples were registered.Results EECP patients showed reduced CCS-class compared to no EECP(P<0.05).Both EECP and no EECP(P<0.05)groups had decreased systolic blood pressure(SBP)as compared to SBP at baseline(P<0.05).There was no difference in resting blood flow between the two refractory groups at baseline as well as after EECP and seven weeks of follow-up.Responses to heating,the responses to ACh and SNP in the cutaneous microcirculation were lower in both groups of refractory angina patients as compared to healthy subjects(P<0.05).EECP patients corresponded positively to the treatment shown by reduced plasma level of soluble interleukin-2 receptor and CCS-class.Conclusions Refractory angina patients have reduced responsiveness in their cutaneous microcirculation to ACh,SNP and heat compared to healthy subjects.Although EECP reduced the CCS-class,this effect was not associated with improvements in responsiveness of the cutaneous microcirculation.

Summary of Zhang Hongxing's Experience in Treating Refractory Angina Pectoris with Traditional Chinese Medicine

As a famous traditional Chinese medicine(TCM)expert in Shandong province and a famous veteran TCM expert in Dezhou city,Zhang Hongxing has been engaged in cardiovascular clinical work for more than 30 years.He has unique experience in the treatment of refractory angina pectoris.This paper comprehensively explains from the aspects of etiology and pathogenesis.His treatment is mostly based on syndrome differentiation,combined with the basic pharmacology of modem Chinese medicine to formulate prescriptions and drugs,and at the same time values the use of insect drugs.We hereby attach the clinical records,hoping to provide reference for clinical workers,which is conducive to the inheritance and development of famous Chinese medical academic experience.

Transplantation of CD34+cells for myocardial ischemia

CD34+cells are multipotent hematopoietic stem cells also known as endothelial progenitor cells and are useful in regenerative medicine.Naturally,these cells are mobilized from the bone marrow into peripheral circulation in response to ischemic tissue injury.CD34+cells are known for their high proliferative and differentiation capacities that play a crucial role in the repair process of myocardial damage.They have an important paracrine activity in secreting factors to stimulate vasculogenesis,reduce endothelial cells and cardiomyocytes apoptosis,remodel extracellular matrix and activate additional progenitor cells.Once they migrate to the target site,they enhance angiogenesis,neovascularization and tissue regeneration.Several trials have demonstrated the safety and efficacy of CD34+cell therapy in different settings,such as peripheral limb ischemia,stroke and cardiovascular disease.Herein,we review the potential utility of CD34+cell transplantation in acute myocardial infarction,refractory angina and ischemic heart failure.