Relationship between resistin level in serum and acute coronary syndrome or stable angina pectoris

Objective： To investigate the relationship between serum resistin level and acute coronary syndrome （ACS） or stable angina pectoris （SAP）. Methods： Sixty-five patients, with coronary artery disease, were enrolled and divided into three subgroups： acute myocardial infarction （AMI）, unstable angina pectoris （UAP） and SAP, and 26 healthy people were recruited as controls in the cross-sectional study. Serum resistin levels were determined by ELISA （enzyme-linked immunosorbent assay）, and WBC （white blood cell count）, hsCRP （high sensitive C-reaction protein）, CKmax （maximum of creatinkinase）, CK-MBmax （maximum of isozyme of creatinkinase） and cTnImax （maximum of troponin） were measured by standard laboratory methods. Results： The serum resistin levels were 4 folds higher in AMI patients, 2.43 folds in UAP patients and I. 12 folds in SAP patients than in the healthy controls （P〈0.05）. The resistin levels were also significantly different between AMI [（8.16±0.79） ng/ml], UAP [（5.59±0.75） ng/ml] and SAP [（3.45±0.56） ng/ml] groups （P〈0.01）; WBC, hsCRP, CK CK-MBmax and cTnlmax were significantly increased in AMI patients over UAP and SAP patients. Spearman analysis showed that serum resistin levels were positively correlated with WBC （r=0.412, P=0.046）, hsCRP （r=0.427,p=0.037）, CK CK-MBmax and cTnImax （r=0.731, 0.678, 0.656; P〈0.01）. Conclusion： Serum resistin levels increased with inflammatory factors and myocardial impairment. The results suggest that human resistin might play an important role in the pathogenesis of atherosclerosis and AMI as an inflammatory factor.

Core outcome set for stable angina pectoris in traditional Chinese medicine(COS-SAP-TCM)

Objective:This study aimed to develop a core outcome set(COS)for use in future studies of stable angina pectoris(SAP)in traditional Chinese medicine(TCM).Methods:Systematic literature reviews and qualitative interviews with cardiologists and patients with SAP treated using TCM were conducted to generate a set of outcomes.Outcomes were prioritized by stakeholders via two rounds of an online Delphi survey and face-to-face consensus meetings.Following the final consensus meeting,a final COS was generated.Results:An initial set of 324 outcomes was identified.A preliminary list of 65 outcomes was employed in the Delphi study.In total,223 participants from seven stakeholder groups were invited to score outcomes in the first Delphi round:87 completed round 1 and 47 completed round 2.Thirty-one participants attended the consensus meeting and agreed on a final core set of outcomes comprising six items across four domains:frequency of angina attack,duration of angina attack,Seattle angina questionnaire,total exercise duration in the exercise treadmill test,cardiovascular events,and QT interval on electrocardiography.Conclusions:The COS developed in this study provides the minimum requirements for measurement and reporting in future TCM clinical trials for the treatment of SAP.The employment of this COS may reduce heterogeneity across trials and facilitate evidencebased decision-making for stakeholders.

A Meta-analysis of Ginseng combined with conventional therapy for stable angina pectoris

Objective:To evaluate the efficacy of Ginseng combined with conventional therapy for stable angina pectoris(SAP).Methods:From the Cochrane Library,Pubmed,Embase,Web of Science,CNKI(China National Knowledge Infrastructure),Wanfang Datebase,VIP(Chinese Scientific Journals Database),CBM(Chinese Biomedicine Database),we reviewed the clinical randomized controlled trial(RCT),after screening and assessing the risk of bias,used RevMan 5.3 and Stata 15.0 software to make the Meta-analysis.Results:Thirteen studies were included with 1176 cases,involving 606 cases in the experimental group and 570 in the control group.The results of Meta-analysis showed that Ginseng combined with conventional therapy significantly has obvious effect on clinical effective rate(RR=1.29,95%CI[1.21,1.36],P<0.00001);ECG effective rate(RR=1.35,95%CI[1.22,1.50],P<0.00001);number of angina attacks(MD=-1.77,95%CI[-2.64,-0.91],P<0.00001);duration of angina pectoris(MD=-2.16,95%CI[-2.54,-1.78],P<0.00001);nitroglycerin dosage(MD=-1.52,95%CI[-1.81,-1.23],P<0.00001),and it is better than using conventional therapy alone.Conclusion:Ginseng combined with conventional therapy for SAP can significantly improve clinical effective rate and ECG effective rate,reduce the number of angina attacks,shorten the duration of angina pectoris,and reduce nitroglycerin dosage.The development of ginseng-related proprietary Chinese medicines has good prospects.But due to the quality of studies is medium and low,it still needs to be confirmed by conducting high-quality RCTs.

Coronary Angiography: Indications, Results and Cost-Effectiveness in the Diagnosis of Stable Angina Pectoris in Two Hospitals in Senegal

Background: The current gold standard for the diagnosis of stable coronary artery disease (CAD) is invasive coronary angiography. But a large proportion of patients undergoing coronary angiography don’t have obstructive coronary artery disease. Objective: The aim of the present study was to evaluate the diagnostic performance of invasive coronary angiography for patients without known coronary artery disease presenting with stable chest pain syndrome at two hospitals structures in Senegal. Method: We conducted a prospective, descriptive, and analytical study from March 1, 2019, to December 31, 2020 in the Cardiology Departments of General Hospital Idrissa Pouye (HOGIP) and Aristide Le Dantec Hospital (HALD). During the study period a cohort of patients referred to angiography coronary for diagnostic CAD because of suspected stable angina were enrolled. Demographic characteristics, risk factors, symptoms, and noninvasive test results were correlated with the presence of obstructive coronary artery disease. Results: A total of 143 patients were included in our study with a median age of 60.91 ± 10.58 years;men were 96 (67.13%) and women 47 (32.87%). The prevalence of hypertension was 60.84%;diabetes was 34.27%;dyslipidemia was 32.17% and sedentary was 26.57% in our study population. Typical and atypical angina symptoms were present in 37.76% (n = 54) and 49.65% (n = 71) respectively, while 10.49% had dyspnea. Coronary angiography revealed 59 (41.26%) patients with no CAD as well as 27 (18.88%) with one-vessel;28 (19.58%) with two-vessel, and 29 (20.28%) with three-vessel disease. Independent predictive factors for stable angina with the presence of obstructive lesion were: patient age (OR, 2.36;95% CI, 1.05 - 5.29;p = 0.036);male gender (OR, 1.6;95% CI, 0.72 - 3.57;p = 0.24);diabetes (OR, 2.14;95% CI, 0.96 - 4.75;p = 0.06) and necrosis Q waves (4.75;CI, 0.98 - 23.09;p = 0.05). Conclusion: In our study, more than half of the patients (58.74%) referred for coronary angiography had a confirmed diagnosis. A better clinical and non-invasive assessment is needed to improve the efficiency of patient selection for coronary angiography.

Effects of auricular point pressing + Danshen Dropping Pill on platelet function, inflammatory response and protease expression in patients with stable angina pectoris

Objective:To investigate the effects of auricular point pressing plus Danshen Dropping Pill on platelet function, inflammatory response and protease expression in patients with stable angina pectoris.Methods:A total of 92 patients with stable angina pectoris who were treated in this hospital between November 2014 and November 2017 were divided into the auricular point pressing group (n=46) and routine group (n=46) by random number table method. Routine group were treated with routine western medicine plus Danshen Dropping Pill, auricular point pressing group were treated with auricular point pressing on the basis of the therapy of routine group, and both groups had been continuously treated for 1 month. The differences in platelet function, inflammatory response and protease expression were compared between the two groups before and after treatment.Results:Before treatment, there was no statistically significant difference in the platelet activation index levels, serum inflammatory factor contents or protease expression between the two groups. After 1 month of treatment, peripheral blood platelet activation index CD42b level of auricular point pressing group was higher than that of routine group whereas CD63 and PAC-1 levels were lower than those of routine group;serum inflammatory factors IL-6, IL-10, IL-18 and hs-CRP contents were lower than those of routine group;serum proteases MMP-1, MMP-2 and MMP-9 contents were lower than those of routine group.Conclusion:Compound Danshen Dropping Pill combined with auricular point pressing can further optimize the platelet function and improve the systemic inflammatory state and protease expression in patients with stable angina pectoris.

Chinese patent medicine for stable angina pectoris:protocol for a systematic review and network meta-analysis

Stable angina pectoris is a common condition that affects a wide group of patients with coronary artery diseases.A number of Chinese patent drugs based on classic herbal formulations are available for angina management.A network meta-analysis is proposed to assess the relative efficacy and safety of commonly used drugs for stable angina and generate a clinically meaningful ranking for each important outcome.We composed a list of 24 widely-used oral blood-quickening Chinese patent drugs from literature review and expert consultation.Three English and five Chinese electronic databases will be searched up to July 2021 for randomised clinical trials comparing between drugs on the list or with nitrates or placebo for stable angina.Unpublished data or grey literature will be sought through trial registries and correspondence to the report authors.Two reviewers independently screen literature,extract data and assess clinical and methodological features of included studies.The WinBUGS software will be used to perform network meta-analysis and the Stata 13.0 software to generate graphic demonstrations of the results.Primary outcomes are the incidence of cardiovascular events and changes in angina frequency,duration and intensity.We will use the surface under the cumulative ranking curve and the mean value for the numeric presentation of efficacy and safety ranking probabilities of multiple treatments.Heterogeneity and inconsistency will be assessed using appropriate statistical tests,and subgroup analysis and network meta-regression will be resorted when necessary.The quality of evidence for each outcome will be graded with the web-based GRADEpro GDT.

Effect of action research-based exercise training guidance on exercise endurance and readmission rate in patients with stable angina pectoris due to coronary heart disease

Background Stable angina pectoris is a common subtype of coronary heart disease.Patients suffer from chest tightness,chest pain and crushing pain under the inducement of fatigue and emotional agitation.This study aims to investigate the effect of exercise training guidance based on action research on exercise endurance and readmission rate of patients with stable angina pectoris.Methods A retrospective study was conducted on 60 patients with stable angina pectoris due to coronary heart disease admitted to our hospital from February 2020 to November 2023.Patients were divided into a control group of 29 cases(receiving conventional exercise training guidance)and a guidance group of 31 cases(receiving action research-based exercise training guidance).Both groups received continuous training for one month.A comparison was made between the exercise endurance indicators[6-minute walk test distance(6MWT),peak oxygen consumption(peak VO2),anaerobic threshold(AT),exercise duration(ED)],quality of life,and readmission rate within 6 months after intervention in both groups.Results After 1 month of intervention,6MWT,peak VO2,AT and ED were increased in both groups,and those in the guidance group were higher than those in the conventional group(P<0.05).The score of quality of life(The 36-item shot-form health status survey,SF-36)in both groups was increased,and the guidance group scored higher than the conventional group(P<0.05).The readmission rate of patients in the guidance group was 6.45%,which was lower than that in the conventional group(27.59%)(P<0.05).Conclusions The application of action research-based exercise training guidance in patients with stable angina pectoris due to coronary heart disease has significant effects,improving exercise endurance,significantly improving quality of life,and reducing readmission rate,thus having practical value.[S Chin J Cardiol 2024;25(3):162-168]

Left atrial area index predicts adverse cardiovascular events in patients with unstable angina pectoris

Background The left atrial size has been considered as a useful marker of adverse cardiovascular outcomes. However, it is not well known whether left atrial area index （LAAI） has predictive value for prognosis in patients with unstable angina pectoris （UAP）. This study was aimed to assess the association between LAAI and outcomes in UAP patients. Methods We enrolled a total of 391 in-hospital patients diag- nosed as UAP. Clinical and echocardiographic data at baseline were collected. The patients were followed for the development of ad- verse cardiovascular （CV） events, including hospital readmission for angina pectoris, acute myocardial infarction （AMI）, congestive heart failure （CHF）, stroke and all-cause mortality. Results During a mean follow-up time of 26.3±8.6 months, 98 adverse CV events occurred （84 hospital readmission for angina pectoris, four AMI, four CHF, one stroke and five all-cause mortality）. In a multivariate Cox model, LAAI [OR： 1.140, 95% CI： 1.01±1.279, P = 0.026], diastolic blood pressure （OR： 0.976, 95% CI： 0.956-0.996, P = 0.020） and pulse pressure （OR 1.020, 95% CI： 1.007-1.034, P = 0.004） were independent predictors for adverse CV events in UAP patients. Conclusions LAAI is a predictor of adverse CV events independent of clinical and other echocardiographic parameters in UAP patients.

Efficacy and prognostic impact of Pericarpium Trichosanthis injection combined with nicorandil for intractable angina pectoris in elderly patients: A retrospective study

BACKGROUND Coronary artery disease(CAD)is a leading cause of global cardiovascular morta-lity.Refractory angina pectoris,a manifestation of CAD,requires effective drug treatments.Pericarpium Trichosanthis injection,a traditional Chinese medicine,improves cardiovascular symptoms,while nicorandil alleviates spasms and angina.Both have potential in treating CAD.AIM To investigate the therapeutic effects of combining Pericarpium Trichosanthis injection and nicorandil in elderly patients suffering from refractory angina caused by coronary heart disease.METHODS A retrospective analysis was conducted on the data of 130 patients diagnosed with refractory coronary heart disease.Based on the different treatment regimens administered during hospitalization,the patients were divided into a control group(58 cases)and a study group(72 cases).The control group received conven-tional treatment,which included aspirin,statins,and nitrate vasodilators.In addition to the conventional medication,the study group received a combination treatment of Pericarpium Trichosanthis injection and nicorandil.RESULTS After treatment,the study group showed significantly higher left ventricular ejection fraction and cardiac output,and lower brain natriuretic peptide and C-reactive protein levels compared to the control group.The study group also exhibited improvements in angina,quality of life,exercise endurance,and lipid profiles.Multivariate logistic regression analysis revealed a relationship of lipid levels and heart function with the combined treatment.Some patients in the study group experienced headaches during treatment,but no significant adverse reactions were observed.Follow-up showed that the treatment was well-tolerated,with no drug-related adverse reactions detected.CONCLUSION Combination of Pericarpium Trichosanthis injection and nicorandil is more effective than conventional treatment in improving symptoms and heart function in elderly patients with refractory angina pectoris.

Advances in Research of Treatment of Angina Pectoris in Coronary Heart Disease from the Method of Dredging Collaterals with Pungent

The angina pectoris in coronary heart disease belongs to the category of"chest impediment"in traditional Chinese medicine,and belongs to the syndrome of root deficiency with tip excess.Its main pathogenesis is obstruction of the heart collaterals,and treatment mainly adopts dredging collaterals and relieving pain.Based on the treatment principles of dredging collaterals with pungent,aiming at the etiology,pathogenesis and disease characteristics of angina pectoris in coronary heart disease,this article systematically analyzes the Method of Dredging Collaterals with Pungent including the methods of dredging collaterals with pungent moisture,dredging collaterals with pungent warm,dredging collaterals with pungent aroma,and dredging collaterals with insect type drugs,to provide ideas for the treatment of angina pectoris in coronary heart disease.

A systematic review and meta-analysis of Dengzhanxixin injection for coronary heart disease with angina pectoris patients

Background:Dengzhanxixin Injection(DZXXI)has been widely used to treat Coronary heart disease with angina pectoris patients.Therefore,the study aimed to evaluate the therapeutic efficacy and safety of DZXXI in treating Coronary heart disease with angina pectoris.Methods:The Cochrane Library,the China National Knowledge Infrastructure database,the Wanfang database,the VIP database,the PubMed database,the Medline database,the EMBASE database,and Clinical Trial were used to search literatures up to August 2022.Results:The results showed that DZXXI combined with conventional therapy were significant in clinical efficacy(relative risk(RR)=1.23,95%cerebral infarction(CI):1.18,1.29;P<0.01)and electrocardiogram curative effect(RR=1.35,95%CI:1.24-1.47;P<0.01),even the subgroup of the DZXXI≤20 ml showed the largest difference.In addition,DZXXI combined with conventional therapy could lower the level of triacylglycerol(mean difference(MD)=−0.63,95%CI:−0.72,−0.55;P<0.01),total cholesterol(MD=−1.18,95%CI:−1.28,−1.09;P<0.01)and low density lipoprotein-cholesterol(MD=−0.98,95%CI:−1.08,−0.88;P<0.01),improve the level of high density lipoprotein-cholesterol(MD=0.41,95%CI:0.33,0.49;P<0.01),blood viscosity(MD=−1.09,95%CI:−1.32,−1.86,P<0.01),plasma viscosity(MD=−0.11,95%CI:−0.11,−0.11,P<0.01)and fibrin(MD=−1.50,95%CI:−1.53,−1.47,P<0.01).Conclusion:These findings revealed that there was more efficacious in DZXXI combined with conventional therapy than that in conventional therapy for the Coronary heart disease with angina pectoris and low dose of DZXXI might be suggested.

Effects of Ginkgo Leaf Extract on Function of Dendritic Cells and Th1/Th2 Cytokines in Patients with Unstable Angina Pectoris

Objective： To investigate the effects of Ginkgo leaf extract （GLE） on function of dendritic cells （DO） and Th1/Th2 cytokines in patients with unstable angina pectoris（UAP）. Methods： Fifty-four patients with UAP were equally assigned into two groups, the treated group and the control group, both treated with conventional Western medicine, but with GLE given additionally to the treated group. Blood of all patients was taken before and 4 weeks after treatment to prepare the peripheral mononuclear cells, then which were incubated in the completed medium containing granulocyte-macrophage colony stimulatory factor （GMCSF） and interleukin-4 （IL-4） to induce mature DO. The expression of co-stimulating factor CD86 （B7-2） on the surface of DC was detected by flow cytometry, and the stimulating capacity of DC was determined by mixed lymphocyte reaction （MLR）. The blood levels of cytokines, interferon-γ （IFN-γ）, and IL-4, were analyzed by ELISA, and blood C-reactive protein （CRP） level by turbidimetry. Moreover, the direct effect of Ginkgolide B on CD86 expression on DO were also tested in vitro. Results： After treatment, CD86 expression on DO, the stimulating capacity of DO as well as levels of IFN-γ and ORP were lowered in both groups （P〈0.05 or P〈0.01）, but the changes were much more significant in the treated group than those in the control group. Ginkgolide B showed a direct inhibitory effect on the CD86 expression on DO. Conclusion： The inhibition of GLE on DO and thereby the suppression on inflammatory reaction may be one of the mechanisms of GLE in treating patients with UAP.

Comparative Study on the Effects of Small Dose of Aspirin Combined with Ginkgo-damole Injection(银杏达莫注射液) and the Effects of Conventional Dose of Aspirin in Treating Senile Unstable Angina Pectoris

Objective: To evaluate the therapeutic and adverse effect of small dose of aspirin (Asp) combined with Ginkgo-damole injection (GDI,银杏达莫注射液) in treating senile unstable angina pectoris (UA). Methods: One hundred and twenty old in-patients of coronary heart disease with UA were randomly divided into two groups. The 60 patients in the treated group were treated with oral administration of enteric soluble 50 mg Asp once a day and GDI 20 ml per day by intravenous dripping, with 14 days as one therapeutic course, while the other 60 in the control group were treated with enteric soluble Asp 100 mg alone once a day orally. Besides, isosorbide-5-mononitrate 20 mg twice a day was applied to both groups, and the β-ad-renoceptor blocker, blood lipids regulatory agents and nitroglycerin (10 mg by intravenous dripping) were given accordingly. The angina total improving rate, hemorrheologic indexes (whole blood viscosity, plasma viscosity, fibrinogen, platelet aggregation rate), comprehensive clinical terminal event and the total occurrence rate of adverse reaction in the two groups were observed. Results: After treatment, comparison between the two groups showed insignificant difference in aspects of angina total improving rate (75.00% vs 65.00%), hemorrheological indexes and comprehensive clinical terminal event rate (25.00% vs 31.67%), P>0.05, and the hemorrheological indexes were improved in both groups (P<0.05), but the total occurrence rate of adverse reaction in the treated group was lower than that in the control group (6. 67% vs 25.00%), showing significant difference (P<0.05). Conclusion: In treatment of senile UA, small dose of Asp combined with GDI showed therapeutic effect similar to that of conventional dose of Asp, but it has lower adverse reaction.

Effect of Chinese Herbs for Activating Blood Circulation,Removing Stasis and Supplementing Qi on the Circulating Endothelial Cells in Patients with Unstable Angina Pectoris

Objective: To observe the effect and clinical significance of circulating endothelial cells (CEC) in the pathogenesis of coronary heart disease with unstable angina pectoris (CHD-UAP), and to explore the protective effect of Chinese herbs for activating blood circulation, removing stasis and supplementing Qi (CH) on CHD-UAP patient's CEC. Methods: Sixty patients with diagnosis of CHD-UAP confirmed and differentiated to be Qi-deficiency and blood stasis by TCM were randomly divided into two groups and treated, on the basis of Western drug-therapy, with Tongxinluo capsule (通心络胶囊, TXL) and Huoxue Tongmai capsule (活血通脉胶囊, HXTM) respectively by way of oral taking three times a day, 3 capsules every time, with 1 month as one therapeutic course. The number of CEC in patients' blood circulation was counted before and after treatment. Besides, the number of CEC in 30 healthy persons was also counted for control. Results: The number of CEC in CHD-UAP patients was significantly higher than that in the healthy persons (P<0.01). After the patients were treated with CH, either TXL or HXTM, it significantly decreased (P<0.01)with insignificant difference between the two treated groups. Conclusion: CEC in CHD-UAP patients is severely damaged and endothelial function in disorder, Chinese herbs have protective effect on patients' CEC.

Effect of the platelet membrane GPⅠa gene polymorphism in the pathogenesis of unstable angina pectoris

Objective: To investigate the effect of platelet membrane glycoprotein(GP) Ⅰa gene polymorphism in the pathogenesis of unstable angina pectoris (UAP) in Chinese people. Methods: Collagen type Ⅰ-induced platelet aggregation was measured in 33 healthy subjects in vitro. Plasma level of α-granule membrane protein (GMP-140) was measured in both the above 33 healthy subjects during fasting and 35 patients with recent onset effort anina during rest onset within 24 h after hospitalization. Furthermore, the platelet membrane GP Ⅰa gene 807C/T polymorphism was checked in all subjects with polymerase chain reaction-sequence specific primers(PCR-SSP) technique. Results: The lag time before 30% platelet aggregation was significantly longer in healthy subjects with CC genotype than with TC genotype (P<0.01). However, there was no significant difference in the maximal platelet aggregation between healthy subjects with the above two genotypes. Plasma level of GMP-140 was significantly higher in TC genotypic patients with recent onset effort angina than in CC genotypic patients with the same type of UAP(P<0.05) and healthy subjects (P<0.01), furthermore, there was also significant difference between the latter two groups(P<0.05). Conclusion: The rapid initiation of collagen-induced platelet aggregation may be associated with platelet membrane GP Ⅰa T (807) allele, which may play an important role in the pathogenesis of UAP.

Traditional Chinese medicine for activating blood circulation and detoxifying in unstable angina pectoris:A systematic review and meta-analysis

Objective:The purpose of this review was to evaluate the effectiveness of traditional Chinese medicine for activating blood circulation and detoxifying(ABCD)in patients with unstable angina pectoris.Methods:We performed an electronic literature search of six medical databases for relevant articles published up to December 2014.Randomized controlled trials that compared ABCD Chinese medicine(alone or alongside conventional drugs)with conventional drugs or other Chinese medicines alone were included.A meta-analysis was performed for the following outcome measures:reduction of angina symptoms,electrocardiogram improvement,blood lipid levels,inflammatory factor levels,and plasma fibrinogen levels.Results:In total,11 moderate-to low-quality studies involving 686 patients were included.The evidence indicated that ABCD Chinese medicine exhibited superior effectiveness in relieving angina symptoms compared with conventional drugs[relative risk,1.23;95%confidence interval,1.05e1.44];however,electrocardiogram improvement was not very significant(relative risk,1.21;95%confidence interval,0.91e1.62).Moreover,ABCD Chinese medicine exhibited superior anti-inflammatory,anticoagulant,and lipid-lowering effects compared with other medicines.Conclusions:Within the methodological limitations of the included studies,our results suggest that ABCD Chinese medicine is beneficial for the treatment of unstable angina pectoris.

The Changes of Vasoactive Substances Originated Endotheiium in Patients with Unstable Angina Pectoris Treated by Improved Thrombolytic Therapy

Objectives To analyze the changes of vasoactive substances originated from endo- theiium in patients with unstable angina pectoris treated by modified thrombolytic therapy and explore the mech- anisms of the drug to treat unstable angina pectoris. Methods 120 patients with unstable angina pectoris who were not well responsed to common medication were studied. Their ECG stress tests were abnormal and there were ischemic changes in Holter. Urokinase 300,000 U was added in 100 ml normal saline and in- jected within 30 min once a day for 3 days. 300 mg as- pirin was administrated a day before and during uroki- nase applications. Before and after urokinase treat- ments , endothelin-1 , plasma tissue plasminogen activa- tor and its inhibitor-lwere determined. Results Compared with pretreatments, after treatments, the ac- tivities of tissue plasminogen activator increased, endo- thelin-1 and the inhibitor-1 decreased. The changes were significant. Conclusions Modified thrombolytic therapy can regulate the vasoactive substances origina- ted endotheiium in patients with unstable angina pecto- ris . The major substances include endothelin-1, plasma tissue plasminogen activator and inhibitor-1. This mechanism may suggest that urokinase can treat coro- nary heart disease effectively.

The Study of hemodynamics and coronary arteriography of Patients with Different Types of Unstable Angina Pectoris

Objectives To explore the basic heart functional state and cardiac reserve function of patients with different types of unstable angina pectoris (UAP) and observe the relations between the heart function and severity of coronary arterial disease. Methods 70 cases with UAP were enrolled including 25 patients with angina decubitus (AD), 23 patients with mixed angina (MA) , and 22 patients with accelerated effort angina (AEA). All patients underwent a series of examination such as UCG, ECT, hemodynamics and volume-loading test. The patients were divided into three groups in light of the results of the hemodynamic examination: ① diastolic dysfunction group ② systolic dysfunction group ③ normal heart function group. We assessed the basic heart function and cardiac reserve function of patients with different types of UAP and also observed the relations between coronary arteriography and heart function. Results ① Under basic conditions, patients with angina decubitus suffered from the systolic (36%) or diastolic dysfunction (48%). 43 percent of the patients with mixed angina had systolic dysfunction and other 43 percent of them had normal cardiac function. However, patients with accelerated effort angina (AEA) were characterized by diastolic dysfunction (31%) or normal heart function (60%). ② In hemodynamic examination, the pulmonary capillary wedge pressure of positive patients rose, at the same time cardiac index fell to the extreme instantaneously after loading in volume-loading test and then they restored to the basic level until 60 minutes. However, both PCWP and CI of the negative patients reach the peak momentarily after loading. They returned to the basic level within 30 minutes. ③ coronary arteriography show: there are 41% of patient with three-vessel disease, 50% with two-vessel disease, 9% single vessel disease and left main narrowing 22. 7% in AEA. There are separately 76%, 24%, 0% and 36% in AD; and 26.1% , 43.4% , 21.7% , 43.4% in MA. ④ Constituent ratio of the AEA and MA were separately compared with AD, AEA/AD: P < 0.05(P = 0.031); MA/AD: P < 0.01 (P = 0.000313). Conclusions Most of patients with the above three types of unstable angina pectoris suffered from the basic heart dysfunction and cardiac reserve dysfunction which might participate in the occurrence and development of unstable angina pectoris. In angiography, there are the most three-vessel diseases in AD that are, therefore, the most severe UAP.

Relationship Between Serum Creatine Kinase Isoenzyme MM Subbands and the Gradation of Coronary Stenosis in Patients with Unstable Angina Pectoris

Objective To observe the relationship between serum creatine kinase isoenzyme MM sub-bands (CKMM3/MM1 ratio) and the gradation of coronary stenosis and provide a simple, reliable, and economical method for identifying high-risk unstable angina pectoris (UAP). Mehtods Blood samples were drawn at different time after onset of chest pain in 21 patients with UAP and only once in 20 each volunteers for control. CKMM3/MM1 ratio was detected by nonserial buffer agarose gel electrophoresis. CKMB and CK were observed by velocity method. An emergent coronary arteriography was performed as soon as patients were admitted into hospital. Results Patients with UAP were divided into two subgroups: patients with elevated serum enzyme [P( + )] and patients with normal serum enzyme [P( - ) ] according to CKMM3/MM1 ratio < 0. 5. Patients with UAP( + ) had higher serum CKMM3/MM1 ratios from 0.5 to 12hrs and serum CKMB from 2 to 12 hrs than those with UAP( - ) and control ( P < 0. 05) . Serum enzyme concentrations of patients with UAP whose coronary lumen had 90% or more than 90% stenosis were significantly higher than those whose coronary lumen had less than 90% stenosis ( P <0. 01) . Any CK-MM3/MM1 ratio was less than 1. 0 and CK within the normal range in patients with UAP( + ) group. Conclusions CKMM3/MM1 ratios in patients with UAP can reflect severity of myocardial ischemia. SerumCKMM3/MM1 ratio provides a simple, reliable, and economical method for identifying high-risk UAP.

Effects of XUEZHIKANG on Oxidized Low Density Lipoprotein,C - Reactive Protein, Fibrinogen in Unstable Angina Pectoris Patients

Objectives To study the effects of XUEZHIKANG on lipid modulating and the level of oxidized low density lipoprotein(OX - LDL), C -reactive protein(CRP), fibrinogen(FIB) in serum. Methods XUEZHIKANG was given to patients with unstable angina pectoris and hyperlipidemia at a dose of 0. 6 gram bid for 2 months and with half -dose for another 2 months. Vitamin E was given to unstable angina pectoris patients with normal lipid at the dose of 0. 1 gram bid for 4 months respectively. Then compared the level of lipid and OX - LDfL, CRP, FIB in serum at beginning, first - month and second -month. Results XUEZHIKANG can reduce the serum level of total cholesterol, low density lipoprotein in 1 month , and gained better effect in 2 months. It can also reduce triglyceride and increase high density lipoprotein in 2 months. Compared with vitamin E XUEZHIKANG can reduce the level of OX - LDL, CRP, FIB significantly after treatment for 2 months. Conclusions XUEZHIKANG has significant effect in lipid modulating , and it can also inhibit the development of inflammation in coronary plaque.