RELATIONS OF ENDOTHELIAL FUNCTION AND BLOOD FLOW IN BRACHIAL ARTERY AND CORONARY ARTERY

Objective:To determine the relations between endothelium-dependent vasodilator function and blood flow in the brachial and coronary arteries in patients with suspected coronary artery disease.Methods:Twenty-eight patients with suspected coronary artery disease underwent brachial artery endothelial function test by using high-resolution B-mode ultrasound before coronary angiography(CAG)and coronary flow reserve(CFR)test by using intracoronary Doppler technique.The correlation of coronary artery dilatation induced by an increase in blood flow after intracoronary adenosine infusion and brachial artery flow-mediated dilatation(FMD) following reactive hyperemia was evaluated.The relation between the change of brachial artery blood flow and CFR was also studied.Results:There was a positive correlation between brachial FMD and percent change of coronary diameter after adenosine infusion(12.50%±9.35% vs 11.38%±7.55%,r=0.425,P=0.02).There was also a weak negative relation between brachial flow change following reactive hy-peremia and CFR(r=-0.397,P=0.04).Conclusion:There is a correlation between the coronary endo-thelial function and the CFR by ultrasonic determination of brachial flow changes following reactive hyperemia.

Effects of lornoxicam combining with fentanyl on postoperative arrhythmia and platelet function in patients with coronary artery disease after abdominal surgery

To investigate the effects of patient-controlled intravenous analgesia (PCIA) with lornoxicam and fentanyl on arrhythmia and the expression of platelet membrane glycoproteins in patients with coronary artery disease (CAD) after abdominal surgery.Methods Eighty ASA Ⅱ or Ⅲ patients with CAD aged 51～66 yrs weighing 59～68 kg presenting for abdominal surgery participated in this study.CAD was diagnosed by clinical symptoms and ischemic changes on ECG.The patients were premedicated with intramuscular henobarbital 0.1 g and scopolamine 0.3 mg.Anesthesia was induced with fentanyl,droperidol,propofol and vecuronium and maintained with propofol,fentanyl and vecuronium.The patients received PCIA after operation.The PCIA solution contained fentanyl 0.9 mg and droperidol 5 mg in 100 ml of normal saline (N.S.) in group A (n=40) or lornoxicam 56 mg,fentanyl 0.2 mg and droperidol 5 mg in 100 ml N.S. in group B (n=40).In group A the loading dose was fentanyl 0.05 mg and group B lornoxicam 4 mg.PCIA included a background infusion at 2 ml·h -1 and a bolus of 0.5 ml with a 15 min lock-out.VAS(0=no pain,10= worst pain) was used to measure pain intensity.In addition to BP,HR and SpO2 monitoring ECG was continuously monitored with a Holter monitor after operation.Blood samples were taken from peripheral vein before and 6 h after operation and on the 1st,2nd,7th and 8th postoperative days for determination of the expression of CD 62p ,CD 63 and CD 41 /CD 61 on the platelet membrane,platelet count,prothrombin time (PT) thrombin time (TT) and partial thromboplastin time (PTT).Results The two groups were comparable with respect to sex,age,body weight,severity of CAD,duration of operation and intraoperative blood loss.The patients received no blood transfusion during operation.There was no significant difference in VAS score,platelet count,PT,TT and PTT between the two groups.The incidence of atrial and ventricular premature beat on ECG and the expression of CD 41 /CD 61 ,CD 62p and CD 63 on the platelet membrane were significantly lower in group B than in group A on the 7th and 8th postoperative days(P<0.05 or 0.01).Conclusion Postoperative PCIA with lornoxicam and fentanyl can more effectively reduce the incidence of postoperative arrhythmia in patients with CAD.Suppression of activation of platelets by lornoxicam may contribute to the mechanism.10 refs,3 tabs.

Correlation between Diastolic Function and Mass and Geometry of Left Ventricle in Essential Hypertension

Object Diastolic function' s assessment is vital in order to produce information relevant to patients' functional class, management and prognosis. We sought to investigate diastolic dysfunction in essential hypertension (EH) with or without coronary heart disease (CAD) using color M - mode Doppler echocardiography and to study the relation between diastolic dysfunction and left ventricular mass index (LVMI) and geometry of LV, and to demonstrate partly the cause of increased cardiovascular risk of an echocardiographic pattern of LV geometry. Methods36 normal subjects (Group Ⅰ) and 107 patients with essential hypertension (Group II) were studied using color M - mode Doppler echocardiography. Four different LV anatomic adaptation to hypertension were i-dentified by categorizing patients according to values of end - diastolic relative wall thickness (RWT) and LVMI. We measured the rate of propagation of peak early filling flow velocity (Vp), time delay (TD) of the peak early filling flow velocity from mitral tips to the apex and Vp/E. Results The geometry of LV was classified into four types according to the LVMI and RWT. The normal limits of LVMI and RWT were obtained from the upper limits of the 95 % confidence interval from mean of LVMI and RWT in healthy control group respectively, which were 115.2 g/m2 and 0. 44. The definition of each type was as follows: Type I (normal group): LVMI≤115. 2 g/m2 and RWT≤ 0.44; Type Ⅱ (concentric remodeling): LVMI≤ 115. 2 g/m2 and RWT > 0. 44; Type III (eccentric hypertrophy): LVMI> 115.2 g/m2 and RWT≤0.44; Type Ⅳ (concentric hypertrophy): LVMI> 115.2 g/m2 and RWT>0.44. Most parameters of diastolic function in each geometry type differed significantly from those in the control group, but the difference among each geometry type was not significant. When compared with type Ⅰ, there was a tendency that TD was longer and Vp/E smaller in Type Ⅱ, Ⅲ and Ⅳ groups. The correlation between LVMI and Vp and TD had statistical significance ( P < 0. 01); the correlation coefficients were-0.21 and 0.29, respectively. Conclusions There is diastolic dysfunction in different LV geometry in patients with essential hypertension, even in patients with LV normal geometry there is diastolic dysfunction. LVMI has negative correlation to Vp, and positive correlation to TD. It may indicate that the greater the LVMI is, the worse the LV diastolic function.

Outcomes of anatomical versus functional testing for coronary artery disease

Background Many patients have symptoms suggestive of coronary artery disease （CAD） and are often eval- uated with the use of diagnostic testing, although there are limited data from randomized trials to guide care.