Virtual reality-based cognitive-behavioural therapy for the treatment of anxiety in patients with acute myocardial infarction:a randomised clinical trial

Background The presence of mental health conditions is pervasive in patients who experienced acute myocardial infarction(AMI),significantly disrupting their recovery.Providing timely and easily accessible psychological interventions using virtual reality-based cognitive-behavioural therapy(VR-CBT)could potentially improve both acute and long-term symptoms affecting their mental health.Aims We aim to examine the effectiveness of VR-CBT on anxiety symptoms in patients with AMI who were admitted to the intensive care unit(ICU)during the acute stage of their illness.Methods In this single-blind randomised clinical trial,participants with anxiety symptoms who were admitted to the ICU due to AMI were continuously recruited from December 2022 to February 2023.Patients who were Han Chinese aged 18-75 years were randomly assigned(1:1)via block randomisation to either the VR-CBT group to receive VR-CBT in addition to standard mental health support,or the control group to receive standard mental health support only.VR-CBT consisted of four modules and was delivered at the bedside over a 1-week period.Assessments were done at baseline,immediately after treatment and at 3-month follow-up.The intention-to-treat analysis began in June 2023.The primary outcome measure was the changes in anxiety symptoms as assessed by the Hamilton Anxiety Rating Scale(HAM-A).Results Among 148 randomised participants,70 were assigned to the VR-CBT group and 78 to the control group.The 1-week VR-CBT intervention plus standard mental health support significantly reduced the anxiety symptoms compared with standard mental health support alone in terms of HAM-A scores at both post intervention(Cohen’s d=−1.27(95%confidence interval(CI):−1.64 to−0.90,p<0.001)and 3-month follow-up(Cohen’s d=−0.37(95%CI:−0.72 to−0.01,p=0.024).Of the 70 participants who received VR-CBT,62(88.6%)completed the entire intervention.Cybersickness was the main reported adverse event(n=5).Conclusions Our results indicate that VR-CBT can significantly reduce post-AMI anxiety at the acute stage of the illness;the improvement was maintained at the 3-month follow-up.Trial registration number The trial was registered at www.chictr.org.cn with the identifier:ChiCTR2200066435.

A Chinese Multi-Specialty Delphi Consensus to Optimize RAASi Usage and Hyperkalaemia Management in Patients with Chronic Kidney Disease and Heart Failure

Objective Variations are present in common clinical practices regarding best practice in managing hyperkalaemia(HK),there is therefore a need to establish a multi-specialty approach to optimal renin angiotension-aldosterone system inhibitors(RAASi)usage and HK management in patients with chronic kidney disease(CKD)&heart failure(HF).This study aimed to establish a multi-speciality approach to the optimal use of RAASi and the management of HK in patients with CKD and HF.Methods A steering expert group of cardiology and nephrology experts across China were convened to discuss challenges to HK management through a nominal group technique.The group then created a list of 41 statements for a consensus questionnaire,which was distributed for a further survey in extended panel group of cardiologists and nephrologists across China.Consensus was assessed using a modified Delphi technique,with agreement defined as"strong"(≥75%and<90%)and"very strong"(≥90%).The steering group,data collection,and analysis were aided by an independent facilitator.Results A total of 150 responses from 21 provinces across China were recruited in the survey.Respondents were comprised of an even split(n=75,50%)between cardiologists and nephrologists.All 41 statements achieved the 75%consensus agreement threshold,of which 27 statements attained very strong consensus(≥90%agreement)and 14 attained strong consensus(agreement between 75%and 90%).Conclusion Based on the agreement levels from respondents,the steering group agreed a set of recommendations intended to improve patient outcomes in the use of RAASi therapy and HK management in China.

Nonhypertensive male with multiple paragangliomas of the heart and neck:A case report

BACKGROUND Paraganglioma is a rare disease that can be lethal if undiagnosed.Thus,quick recognition is very important.Cardiac paragangliomas are found in patients who have hypertension.The classic symptoms are the triad of headaches,palpitations,and profuse sweating.We describe a very rare case of multiple paragangliomas of the heart and bilateral carotid artery without hypertension and outline the management strategies for this disease.CASE SUMMARY A 46-year-old man presented with the chief complaint of recently recurrent chest pain with a history of hemangioma of the bilateral carotid artery that had been surgically removed.He was found to have an intracardiac mass in the right atrioventricular groove and underwent successful excision.The final pathology demonstrated that the intracardiac mass was a cardiac paraganglioma,and the patient had an increased level of normetanephrine in the blood.The pathology and immunohistochemistry results showed that the bilateral carotid masses were also paragangliomas.During the 3 mo follow-up period,the patient did not experience recurrence of chest pain.CONCLUSION To our knowledge,this is the first case of multiple paragangliomas of the heart and neck without hypertension.This rare disease can be lethal if left undiagnosed.Thus,quick recognition is very important.The key to the diagnosis of cardiac paraganglioma is the presence of typical symptoms,including headaches,palpitations,profuse sweating,hypertension,and chest pain.Radiology can demonstrate the intracardiac mass.It is important to determine the levels of normetanephrine in the blood.The detection of genetic mutations is also recommended.Surgical resection is necessary to treat the disease and obtain pathological evidence.

The gender difference of utilization of cardiac implantable electronic device in China： data from Arrhythmia Interventional Therapy Data Registry

BackgroundCardiac 可植入的电子设备(CIED ) 极大地改进病人的幸存和生活质量。然而，关于这些设备的利用和利益有性差别。在这张未来的 CIED 注册表，我们试图在中国从 14 个省在 China.MethodsTwenty 中心在 CIED 利用估价性差别在我们的登记学习被包括。在在 2015 年 1 月和 2016 年 12 月之间的这二十个中心经历了 CIED 培植的所有病人是 8570 个病人全部的 included.ResultsA 在基线队被注册，包括 7203 心律调整器， 664 个可植入的心脏的使用高压脉冲来消减心脏(ICD ) 植入并且 703 心脏的再同步治疗设备(CRT/D ) 。完全， 4117 (48.0%) CIED 病人是女性的，并且超过 59% 心律调整器病人是女性的，但是女人们仅仅说明在这张注册表的三分之一 ICD 或 CRT/D 培植。在心律调整器和 ICD 指示的性之间有重要差别。女性是更可能的由于病了的湾穴症候群(SSS ) 收到了一个心律调整器(63.9% 对 51.0% ， P < 0.001 ) 。收到 ICD 的女病人由于心脏的离子隧道疾病是更可能的(29.2% 对 4.2% ， P < 0.001 ) 。在女病人的双房间的心律调整器的利用的百分比比男性显著地高(85.3% 对 81.1% ， P < 0.001 ) 。但是男病人更多半被接待心脏的再同步治疗有使用高压脉冲来消减心脏的设备比女性(56.5% 对 41.9% ， P = 0.001 ) 。在心律调整器病人，男性是更可能的有结构心疾病(31.3% 对 28.0% ， P = 0.002 ) 。在 ICD 病人，男病人是更可能的有 ischemic 心疾病(48.2% 对 29.2% ， P < 0.001 ) 。女人的吝啬的年龄在 CRT/D 培植的时候比男人旧(P = 0.014 ) 。 Nonischemic 心肌症(70.9%)是在经历了 CRT/D 的治疗的病人的最普通的病原学，不管男性或 female.ConclusionsIn 真实世界的背景，女性确实有不同传染病学， pathophysiology 和许多心脏的节奏混乱的临床的表示什么时候与相比男性，并且所有这些因素可以影响 CIED 培植的利用。但是它另外文化、社会经济的特征可以在这明显的辨别起一个作用的可能性。

Long-term follow-up of antithrombotic management patterns in patients with acute coronary syndrome in China

Objective To describe the long-term antithrombotic management patterns(AMPs)and clinical outcomes of Chinese patients with acute coronary syndrome(ACS).Methods This was an observational,multicenter,longitudinal cohort extension study of Chinese patients who had completed the EPICOR Asia 2-year follow-up study post-hospitalization for an ACS event.Changes in AMP and clinical outcomes for up to 5 years post-ACS event were evaluated.Results Overall,2334 patients with ACS were enrolled at 49 sites.The mean age was 61.6 years and 76.3%were men.By study end,2093 patients completed the 3-year follow-up.At baseline(2 years post-ACS event),72.4%of patents received one antiplatelet(AP)medication,with aspirin being the preferred one.A small proportion of patients(21.5%)was treated with two or more APs(2+AP),and even fewer patients(6.1%)did not receive any AP medication at baseline.Upon study completion,the proportion of patients without AP therapy increased to 13.6%,while the percentage of patients on one AP and 2+AP decreased to 69.3%and 17.1%,respectively.Numerically,a higher incidence of clinical events(composite of all-cause mortality,myocardial infarction,stroke)was observed for the 2+AP(13.2%)subgroup than for the no AP(10.5%)and one AP(8.6%)subgroups.Furthermore,the 2+AP subgroup exhibited the greatest number of bleeding events,outpatient visits,and hospitalization rates.Unlike myocardial infarction or stroke,bleeding events prompted an adjustment in AMP.Conclusion Most patients in China received at least one AP medication up to 5 years after an ACS event.

The value of serum metabolomics analysis in predicting the response to cardiac resynchronization therapy

Objective To construct a prediction model based on metabolic profiling for predicting the response to cardiac resynchronization therapy(CRT).Methods Peripheral venous(PV)and coronary sinus(CS)blood samples were collected from 25 patients with heart failure(HF)at the time of CRT implantation,and PV blood samples were obtained from ten healthy controls.The serum samples were analyzed by liquid chromatography-mass spectrometry(LC-MS).As per the clinical and echocardiographic assessment at the 6-month follow-up,the HF patients were categorized as CRT responders and non-responders.Results HF patients had altered serum metabolomic profiles that were significantly different from those of the healthy controls.Differential metabolites were also observed between CRT responders and non-responders.A prediction model for CRT response(CRT-Re)was constructed using the concentration levels of the differential metabolites,L-arginine and taurine.The optimal cutoff value of the CRT-Re model was found to be 0.343 by ROC analysis(sensitivity,88.2%;specificity,87.5%;Area under curve(AUC)=0.897,P=0.002).The concentration levels of the differential metabolites,L-arginine and lysyl-gamma-glutamate,in PV serum were significantly correlated with that in CS serum(r=0.945 and 0.680,respectively,all P<0.001).Conclusions Our results suggest that serum-based metabolic profiling may be a potential complementary screening tool for predicting the outcome of CRT.

Analysis of risk factors for early stent thrombosis in the Chinese population:A multicenter restrospective study

BACKGROUND:The predictive scoring systems for early stent thrombosis(EST)remains blank in China.The study aims to evaluate the risk factors and conduct a prediction model of EST in the Chinese population.METHODS:EST was defined as thrombosis that occurs within the first 30 days after primary percutaneous coronary intervention(PCI).Patients from ten Chinese hospitals diagnosed as stent thrombosis(ST)from January 2010 to December 2016 were retrospectively included as the study group.A control group(1 case:2 controls)was created by including patients without ST,major adverse cardiovascular events,or cerebrovascular events during follow-up.The present study evaluated 426 patients with single-vessel lesions and ultimately included 40 patients with EST and 80 control patients,who were included to identify factors that predicted EST and to develop a prediction scoring system.The other 171 patients without integrated 1:2 pair were used for external validation.RESULTS:EST was independently associated with a low hemoglobin concentration(adjusted odds ratio[OR]0.946,95%confi dence interval[95%CI]0.901-0.993,P=0.026),a high pre-PCI Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score(OR 1.166,95%CI 1.049-1.297,P=0.004),and a DAPT(DAPT)duration of<30 days(OR 28.033,95%CI 5.302-272.834,P<0.001).The simple EST prediction score provided an area under the curve(AUC)of 0.854(95%CI 0.777-0.932,P<0.001)with 70.0%sensitivity and 90.0%specifi city,and 0.742(95%CI 0.649-0.835,P<0.001)with 54.5%sensitivity and 81.0%specifi city for external validation dataset.CONCLUSIONS:EST may be independently associated with DAPT discontinuation within 30 days,a low hemoglobin concentration,and a high SYNTAX score.The scoring system also has a good ability to predict the risk of EST and may be useful in the clinical setting.

Intravascular ultrasound assessment of the incidence and predictors of edge dissections and intramural hematomas after drug-eluting stent implantation

Objective We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections and intramural hematomas after drug-eluting stent (DES) implantation. Methods We studied 887 patients with 1 045 non-in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging, and compared the dissected stent end to the non-dissected stent end. Results Eighty-two dissections were detected; 51.2% (42/82) involved the proximal and 48.8% (40/82) the distal stent edge. When compared to the non-dissected stent end, residual plaque area [(8.0±4.3) mm2 vs (5.2±3.0) mm2, P【0.01], plaque burden [(52±12)% vs (36±15)%, P【0.01], plaque eccentricity (8.4±5.5 vs 4.0±3.4, P【0.01), and stent edge symmetry (1.17±0.11 vs 1.14±0.08, P=0.02) were larger; plaque burden≥50% was more frequent (62% vs 17%, P【0.01) and calcium deposits (52.5% vs 35.6%, P=0.03) more common; and the lumen/stent area (0.86±0.16 vs 1.02±0.18, P【0.01) was smaller in the stent dissected end. Independent predictors of stent edge dissection were residual plaque eccentricity (OR=1.3, P【0.01) and residual plaque burden≥50% (OR=7.3, P【0.01). Intramural hematomas occurred in 34.1% (28/82) of dissections.Independent predictors of intramural hematomas were plaque eccentricity (OR=1.4, P=0.005), plaque burden≥50% (OR=7.1, P=0.02), and mean lumen diameter to stent diameter ratio (OR=0.37, P=0.04).Concluslon IVUS identified edge dissections after 9.4% of DES implantations. Residual plaque eccentricity and significant plaque burden predicted coronary stent edge dissections. Dissections in less diseased reference segments with an arc of normal vessel wall (greater plaque eccentricity) more often evolved into an intramural hematoma.

Assessment of inconclusive left main coronary lesions: lessons from an intravascular ultrasound study

Objective Angiographic assessment of a left main coronary artery (LMCA) stenosis is often difficult and unreliable. Intravascular ultrasound (IVUS) assessment of absolute lumen dimensions has been shown to correlate with fractional flow reserve (FFR) and to predict clinical outcome in patients with a LMCA stenosis. Methods During 21 months period (October, 2004 to July, 2006), 153 patients (Ostial lesions, n=47; Non-ostial lesion, n=106) underwent IVUS evaluation specifically to assess the severity of an angiographically inconclusive LMCA narrowing. IVUS analysis included plaque morphology; external elastic membrane (EEM), lumen, plaque cross-sectional areas (CSA), plaque burden (plaque CSA/ EEM) and remodeling index (lesion EEM CSA/reference EEM CSA). Results Overall, minimum lumen area (MLA) and diameter (MLD) and plaque burden measured 8.2 mm2, 2.6 mm, and 59.3 %, respectively. An MLA【6.0 mm2 (which has been shown to correlate with a FFR 【0.75) was seen 41.5% in ostial lesions and 44.5% in non-ostial lesions. In particular, ostial LMCA lesions had a larger MLA and a smaller plaque burden than non-ostial lesions (Table). Conclusions Patients referred for LMCA evaluation commonly have insignificant narrowing. Negative remodeling was prominent at the LMCA ostium. These patients deserve IVUS assessment before revascularization.

An unexpected electrocardiogram sign of subacute left ventricular free wall rupture: Its early awareness may be lifesaving

BACKGROUND:Post-infarct left ventricular free wall rupture(LVFWR)is not always an immediately catastrophic complication.The rupture can be subacute,allowing time for diagnosis and intervention.Accordingly,early recognition of the entity may be lifesaving.METHODS:We present an electrocardiogram(ECG)change pattern in two cases,which was erroneously attributed to ischemia.Two women in their 80s were admitted to our institute after experiencing the sudden onset of chest pain.They were managed as anterior ST-segment elevation myocardial infarction without reperfusion treatment.Unfortunately,they experienced a recurrence of severe chest pain with cardiogenic shock during hospitalisation.The ECG recorded at that time showed a ST-segment re-elevation in infract-related leads.RESULTS:The two cases were regrettably received a misjudgement of reinfarction at first,and one of the patients even was administrated with tirofi ban.Afterwards the diagnosis of subacute LVFWR was made through antemortem echocardiography.CONCLUSION:New ST-segment elevation(STE)in infarct-associated leads,coupled with recurrence of chest pain and new-onset hypotension,may constitute the premonitory signs of a subacute LVFWR.

Spontaneous dissection of proximal left main coronary artery in a healthy adolescent presenting with syncope:A case report

BACKGROUND Spontaneous coronary artery dissection(SCAD)is a frequent cause of acute coronary syndrome in young to middle-aged women with few or no traditional cardiovascular risk factors.Chest pain is the most frequently described presenting symptom,but syncope is extremely rare.Herein,we report on a 16-year-old girl who presented with an episode of syncope occurring during a race.Despite significantly elevated troponin level,the diagnosis of the left main coronary artery SCAD with cardiogenic shock was delayed.CASE SUMMARY A 16-year-old girl presented with an episode of syncope.Myocardial injury markers were positive.Echocardiography showed a mildly reduced left ventricular ejection fraction(50%).Although initially stable,she later experienced recurrent chest pain accompanying precordial ST segment elevation with dynamic changes and developed cardiogenic shock,necessitating emergent revascularization.Coronary angiography demonstrated almost total occlusion at the ostium and proximal segment of the left main trunk coronary artery(LMT).Intravascular ultrasound confirmed a false lumen with prominent dissection in the LMT.Percutaneous coronary intervention assisted by intra-aortic balloon pump was conducted in the LMT.A 3.5 mm×24 mm everolimus-eluting stent was deployed to the focal lesions of the LMT.A postprocedural electrocardiogram showed alleviation of the precordial ST-segment elevation.The diagnosis of SCAD was confirmed.Transthoracic echocardiography showed an improved left ventricular ejection fraction(57%).The patient was asymptomatic during the 24-mo.follow-up period.CONCLUSION SCAD should always be considered in the differential diagnosis of acute coronary syndrome presentations in low-risk patients,regardless of age.

Clinical importance of intravascular ultrasound in coronary interventions

Since the introduction of coronary angiography in 1959, 1 a new "gold standard" examination became available for the evaluation of coronary artery disease.

Activation of histamine/H R signaling pathway promotes cardiac differentiation and maturation of human induced pluripotent stem cells

The efficiency and quality of human induced pluripotent stem cell-derived cardiomyocytes(hiPSC CMs)is crucial for regenerative medicine,disease modeling,drug screening and the study of the development events during cardiac specification.However,their applications have been hampered by the differentiation efficiency,poor maturation and high interline variability.Recent studies have reported that histamine plays important roles in hema topoietic stem cell proliferation and neutrophil maturation.However,its roles in cardiovascular tissue regeneration have not been thoroughly investigated.In the current study,we identified a novel physiological function of the histamine/histamine 1 receptor(H,R)signal in regulating the differentiation of hiPSC-CMs and heart development.

Gut Microbiota Community Shift with Severity of Coronary Artery Disease

Gut microbiota community shift with coronary artery disease(CAD)has been reported in several limited cohorts during the past several years.However,whether the enriched or decreased microbiota taxa with CAD can be reproducible deserves further investigation and validation.In this study,78 human subjects were recruited.Of these,19 were diagnosed without stenosis in coronary artery(control group,referred to herein as Ctrl),14 with stenosis less than 50%(LT50),and 45 with stenosis greater than 50%(GT50).Fecal samples were collected and DNA was extracted to perform 16S ribosomal RNA(rRNA)gene sequencing.The operational taxonomic units(OTUs)were analyzed to identify taxa specific to different groups;next,multivariate logistic regression was employed to test whether the defined taxa could independently predict CAD risk.We found that Deltaproteobacteria,Fusobacterium,Bilophila,Actinomyces,and Clostridium XIX were enriched in Ctrl;Prevotellaceae,Parabacteriodes,and Butyricicoccus were enriched in LT50;and Roseburia and Butyricimonas were enriched in GT50.Further analysis revealed that increased populations of Deltaproteobacteria,Fusobacterium,Bilophila,and Desulfovibrionaceae were associated with a 0.26-fold,0.21-fold,0.18-fold,and 0.26-fold decreased risk of CAD,respectively(p<0.05),and an increased Prevotellaceae population was associated with a 5.63-fold increased risk of CAD(p<0.01).A combination of the 20 microbial taxa achieved an area under the receiver operating characteristic(ROC)curve of higher than 0.88 for all discriminations between LT50 vs Ctrl,GT50 vs Ctrl,LT50+GT50 vs Ctrl,and GT50 vs Ctrl+LT50.However,the microbial taxa previously reported as enriched in CAD patients or healthy controls could not be observed in our cohort except for Bacteroides.In conclusion,CAD patients showed a different microbial taxa signature than the healthy controls.However,the non-reproducibility of the microbiota taxa enriched in CAD across different cohorts limits the use of this signature in early diagnosis and prevention.Only decreased Bacteroides abundance was found to be a reliable marker to indicate CAD progression.

The Effect of Renal Sympathetic Denervation (RSD) in Atrial Fibrillation (AF) Inducibility

Objective: The purpose of this study is to investigate the effects of renal sympathetic nerve stimulation (RSN-S) and ablation (RSN-A) on atrial effective refractory period (ERP) and AF in normal canine heart. Atrial Fibrillation (AF) is a complex disease and one of the most frequent arrhythmias, especially in elderly patients. Multiple mechanisms are involved including interaction between the autonomic nervous system (ANS), electrophysiological properties of the atria, and vulnerability for AF. Cardiac overload increases the incidence of AF. In lone AF the triggers are in the pulmonary veins. AF caused by underlying disease has different mechanism. Atrial fibrillation (AF) is associated with activity of renin-angiotensin-aldosterone system (RAAS). Reduction in renal nor-adrenaline spillover could be achieved after renal sympathetic denervation (RSD). Methods: 1) Establish of atrial fibrillation model;2) Ventricular rate analysis of AF;3) Statistical analysis. Results: 1) The establishment of atrial fibrillation model;2) Inducibility and duration of AF;3) The changes of AERP dispersion. Conclusion: Left RSN-S shortened left atrial ERP, increased ERP dispersion, but did not change right atrial ERP. Bilateral RSN-A produced significant prolongation in both atrial ERP, but did not affect ERP dispersion. The on time of RD effect is at 4 hrs after RD procedure and the RD effect on AF will last for 20 hrs after RD procedure.

Successful left-sided accessory pathway ablation without reference catheter in patient with atresia of coronary sinus and thin persistent left superior vena cava

We report a case of atrioventricular reentrant tachycardia (AVRT) with ostial atresia of the coronary sinus (CS). Without the anatomic angiography, radiofrequency (RF) energy was applied at the mitral valve annulus and the bypass tract was eliminated. After the therapy procedure, by CS angiography, we knew the persistent left superior vena cava (PLSVC), and the coronary sinus was connected with vena cava superior, very thin in a diameter. The therapy procedure was successful. The patient has remained completely symptom free.

心肌桥的检出率及其临床意义

目的探讨冠状动脉(冠脉)造影时心肌桥的检出率及临床意义。方法回顾性分析2165例冠脉造影中检出的66例心肌桥患者的临床资料。结果心肌桥检出率为3·0%,分布在左前降支62例。孤立性心肌桥患者58例,其中24例无明显临床症状,34例表现为心绞痛等临床症状;根据冠脉管腔收缩期狭窄程度分成A、B、C3组,结果显示心肌桥下血管管腔狭窄程度与临床表现有显著相关性(P<0·05)。结论提高心肌桥的检出率有助于减少误诊,正确治疗。

Neuregulin-1 therapy improved cardiac function and reduced ANPmRNA expression in post myocardial infarction rats with cardiac dysfunction

To observe the influence of neuregulin-1 on the cardiac function of post-myocardial infarction rats. Methods Left ventricular MI was created in Sprague-Dawley rats by ligation of the left anterior descending coronary. Six months after the operation, rats were evaluated with echocardiology methods. 36 rats that had an infarct area and a EF around 60% were randomized into 3 groups: MI group(n=12) were injected a blank vehicle fluid intravenously for 5 days, after which they continued to be raised on standard food and water for 30 days. MI+NRG group(n=12), received NRG-110μg·kg-1 intravenously for 5 days, after which they continued to be raised on standard food and water for 30 days. MI+Capt group (n=12) received captopril orally (dissolved in their drinking water 2g/L) for 30days, after which tap water substituted the solution for 5 days. Final echocardiographic and hemodynamic measurements were made at the end of 1 month of therapy. Total RNA was extracted from frozen left ventricular tissues, and was reverse transcribed into firststrand PCR was performed with primers for BNP、 ANP. Results Rats treated with neuregulin had a smaller LVDs (P=0.014), a betterLVEF (P=0.004),and a tendency towards less lung perfusion than untreated rats. Neuregulin decreased the expression of ANP mRNA in the ventricle (P=0.025).Conclusion Neuregulin markedly improved the cardiac function of rats that survived myocardial infarction,and decreased the expression of ANP mRNA in the ventricle.

Sirolimus-eluting stent fractures associated with aneurysm and very late stent thrombosis in the right coronary artery

Although the occurrence of coronary stent fracture is rare, recent reports showed that stent fracture after sirolimus-eluting stent (SES) implantation may be associated with neointimal hyperplasia and restenosis. We report two cases of stent fracture that occurred late after elective SES implantation into the right coronary artery (RCA) that were related to the aneurysm, restenosis, thrombosis, and vessel occlusion.