Alprostadil vs. isosorbide dinitrate in ameliorating angina episodes in patients with coronary slow flow phenomenon: A randomized controlled trial.

Background: The optimum therapy for coronary slow flow phenomenon (CSFP) stays debatable. This study compared the effectiveness of alprostadil with isosorbide dinitrate in alleviating angina episodes in CSFP patients. Methods: In this prospective, randomized controlled study, 102 patients with CSFP without severe coronary artery stenosis that exhibited stable angina were allocated randomly in a ratio of 1:1 to either the alprostadil group (40 µg, three times per day, n = 51) or the isosorbide dinitrate group (5 mg, three times per day, n = 51). Frequency of angina events, intensity of suffering, and the Canadian Cardiovascular Society (CCS) grading of angina pectoris were evaluated at baseline and one month after. Additionally, the Seattle Angina Questionnaire (SAQ) was assessed. Results: Baseline characteristics were comparable between the two groups. At 1-month follow-up, patients administered with alprostadil experienced fewer angina episodes [episodes per week, 1 (2) vs. 2 (2), P < 0.001] and less pain intensity [self-evaluated pain score, 2 (3) vs. 3 (4), P < 0.001] than those with isosorbide dinitrate. In the alprostadil group, 78.4% of patients were classified as CCS class I, significantly higher than the 47.1% seen in the isosorbide dinitrate group (P = 0.001). Furthermore, treatment of alprostadil led to a significant improvement in the SAQ score (7.09 U, 95% CI: 4.22-9.96, P < 0.001) compared to isosorbide dinitrate. Additionally, fewer patients suffered headaches when receiving alprostadil (7.8% vs. 19.6%, P = 0.084). Conclusion: Alprostadil was more effective in ameliorating angina symptoms in CSFP patients than isosorbide dinitrate. Clinical trial registration: [www.chictr.org.cn], identifier [ChiCTR2000033233].

Development of a Nomogram for Predicting Surgical Site Infection in Patients with Resected Lung Neoplasm Undergoing Minimally Invasive Surgery.

Background: Predictive models are necessary to target high-risk populations and provide precision interventions for patients with lung neoplasm who suffer from surgical site infections (SSI). Patients and Methods: This case control study included patients with lung neoplasm who underwent minimally invasive surgeries (MIS). Logistic regression was used to generate the prediction model of SSI, and a nomogram was created. A receiver operator characteristic (ROC) curve was used to examine the predictive value of the model. Results: A total of 151 patients with SSI were included, and 604 patients were randomly selected among the patients without SSI (ratio 4:1). Male gender (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.57-4.15; p < 0.001), age >60 years (OR, 2.10; 95% CI, 1.29-3.44, p = 0.003), operation time >60 minutes (all categories, p < 0.05), treatments for diabetes mellitus (OR, 2.96; 95% CI, 1.75-4.98l; p < 0.001), and best forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC; OR, 0.96; 95% CI, 0.94-0.99; p = 0.008) were independently associated with SSI. The model based on these variables showed an area under the curve (AUC) of 0.813 for predicting SSI. Conclusions: A nomogram predictive model was successfully established for predicting SSI in patients receiving MIS, with good predictive value.

Myocardial protective effect of intracoronary administration of nicorandil and alprostadil via targeted perfusion microcatheter in patients undergoing elective percutaneous coronary intervention: A randomized controlled trial.

BACKGROUND: The aim of the study was to evaluate the efficacy of nicorandil and alprostadil on myocardial protection in patients undergoing elective percutaneous coronary intervention (PCI). METHODS: In this prospective, single-blinded, randomized controlled study, 90 consecutive patients scheduled for elective PCI for de novo coronary lesions were assigned to the nicorandil, alprostadil, and nitroglycerin groups in a 1:1:1 ratio. Drugs were administered intracoronary via a targeted perfusion microcatheter. The primary endpoint was the thrombolysis in myocardial infarction (TIMI) myocardial perfusion frame count (TMPFC). Additionally, the corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG), and incidence of periprocedural myocardial injury (PMI) were assessed. RESULTS: Both nicorandil and alprostadil were significantly effective in reducing TMPFC (114.6 ±â€Š33.7 vs 93.4 ±â€Š30.9, P = .016; 114.3 ±â€Š34.3 vs 94.7 ±â€Š33.3, P = .029, respectively). Similar findings were observed in the improvement of cTFC (20.3 ±â€Š10.5 vs 13.5 ±â€Š5.0, P = .003; 20.2 ±â€Š7.4 vs 15.2 ±â€Š5.2, P = .003, respectively) and percentage of TMPG 3 (100% vs 82.8%, P = .052; 83.3% vs 96.7%, P = .196, respectively); whereas, nitroglycerin produced a limited effect on TMPFC (114.4 ±â€Š30.9 vs 112.1 ±â€Š31.9, P = .739), cTFC (19.4 ±â€Š7.2 vs 19.3 ±â€Š7.2, P = .936), and percentage of TMPG 3 (86.7% vs 86.7%, P = 1.000). No significant difference was found in the incidence of PMI (16.7% vs 16.0% vs 27.6%, P = .537), though it was comparatively lower in the nicorandil and alprostadil groups. Furthermore, the intracoronary administration of nicorandil and alprostadil had a mild effect on blood pressure and heart rate. CONCLUSIONS: The intracoronary administration of nicorandil and alprostadil via a targeted perfusion microcatheter was more effective in improving myocardial perfusion in patients undergoing elective PCI than nitroglycerin.

A real-world analysis of cardiac rupture on incidence, risk factors and in-hospital outcomes in 4190 ST-elevation myocardial infarction patients from 2004 to 2015.

BACKGROUND: Cardiac rupture is a disastrous but uncommon complication of acute ST-elevation myocardial infarction (STEMI). The incidence, risk factors and in-hospital outcomes related to cardiac rupture in the current era are unknown. METHODS: This study consecutively collected all acute STEMI patients admitted to a single tertiary center in China from January 2004 to December 2015. Characteristics of each cardiac rupture were collected and analyzed. RESULTS: Among 4190 patients, 75 (1.8%) patients had cardiac rupture, including 33 at the ventricular septum and 42 at the left ventricle free wall (LVFW). Patients with cardiac rupture were more likely to be female, with more advanced age, lower rate of primary percutaneous coronary intervention (PPCI), and higher in-hospital mortality. Compared with survivors, the death cases were older, had a higher white blood cell count, higher rate of delayed admission (>12 h from symptom onset to door), earlier occurrence of cardiac rupture, higher percentage of LVFW rupture and lower rate of surgical repair. Logistic regression analysis showed that surgical repair served as the most valuable factor affecting survival. Moreover, elevated white blood cell count and advanced age might be related to an increased in-hospital death due to cardiac rupture. CONCLUSIONS: In this contemporary cohort, female sex, advanced age and low rate of PPCI post-STEMI are associated with an increased risk of cardiac rupture. Advanced age and elevated white blood cell count might be related to an increased in-hospital mortality after cardiac rupture, whereas surgical repair served as the most valuable factor affecting survival.

Five-year outcomes after catheter ablation for atrial fibrillation in patients with hypertrophic cardiomyopathy.

BACKGROUND: Catheter ablation (CA) is a promising option in most patients with refractory atrial fibrillation (AF). However, data on over 5 years' outcomes with larger numbers in hypertrophic cardiomyopathy (HCM) patients with AF have not been reported. We assessed the outcome of 120 HCM patients following CA compared with a non-CA group and general patients without AF matched by HCM type with a 61.9 ± 31.6-month follow-up. METHODS AND RESULTS: A total of 120 patients (age 61 ± 9.8 years, female n = 43, 35.8%) with paroxysmal AF (n = 60, 50%) and persistent AF (n = 60, 50%) were enrolled. Of the 120 patients, 48 (40%) required redo procedures, and 82 (68.3%) were in sinus rhythm at the last evaluation. The composite clinical events rate following the initial CA was lower than that in the non-CA group (P = .023) and was also comparable to that in general patients without AF matched by HCM type (P = .729). Female (HR 2.358, 95% CI, 1.151-4.831; P = .019), NYHA functional class III-IV (HR 2.422, 95% CI, 1.032-5.685; P = .042) and left atrial diameter ≥50 mm (HR 3.319, 95% CI, 1.469-7.499; P = .004) were predictors of AF recurrence after multiple procedures. CONCLUSIONS: CA was successful in restoring long-term sinus rhythm and improving symptomatic status in most HCM patients with refractory AF especially for those patients with small atrial size and mild symptoms. In addition, CA may contribute to the prevention of major clinical adverse events in the long-term clinical course.

Targeting AMPK signalling pathway with natural medicines for atherosclerosis therapy: an integration of in silico screening and in vitro assay.

An integration of virtual screening and kinase assay was reported to identify AMPK kinase inhibitors from various natural medicines.The activation of AMP-activated protein kinase (AMPK) signalling pathway plays a central role in the pathologic progression of atherosclerosis (AS). Targeting the AMPK is thus considered as a potential therapeutics to attenuate AS. Here, we report the establishment of a synthetic pipeline that integrates in silico virtual screening and in vitro kinase assay to discover new lead compounds of AMPK inhibitors. The screening is performed against a large-size pool of structurally diverse natural products, from which a number of compounds are inferred as promising candidates, and few of them are further tested in vitro by using a standard kinase assay protocol to determine their inhibitory potency against AMPK. With this scheme we successfully identify five potent AMPK inhibitors with IC50 values at micromolar level. We also examine the structural basis and molecular mechanism of nonbonded interaction network across the modelled complex interface of AMPK kinase domain with a newly identified natural medicine.

Ghrelin receptor deficiency aggravates atherosclerotic plaque instability

Ghrelin has been found to be associated with anti-inflammatory effects, inhibition of atherosclerotic plaque formation, and plaque stability in the cardiovascular system. We investigated whether ghrelin affected atherosclerotic plaque and inflammation found in atherosclerosis. We crossed ghrelin receptor knock out mice (growth hormone secretagogue receptor (GHSR)-/-) and low-density lipoprotein receptor-null (low-density lipoprotein receptor (LDLR)-/-) mice. In this model, atherosclerotic lesions were promoted by administering a high-fat, high-cholesterol, Western-type diet for 18 weeks. Serum lipid levels, atherosclerotic plaque on the aortic arches, and expression of intercellular cell adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1), T cells, macrophages, and smooth muscle cells of atherosclerotic plaque were observed. Although serum lipid levels and atherosclerotic plaque in aortic arches were not significantly different between GHSR+/+/LDLR-/- and GHSR -/-LDLR-/- mice, ICAM-1 and VCAM-1 protein expression in atherosclerotic plaques were increased in GHSR -/-LDLR-/- mice compared with GHSR+/+/LDLR-/- mice. T cells and macrophages were increased, while smooth muscle cells of atherosclerotic plaques were less in GHSR -/-LDLR-/- mice than that in GHSR+/+/LDLR-/- mice. In conclusion, ghrelin receptor deficiency aggravates atherosclerotic plaque instability and vascular inflammation but not the surface area of atherosclerotic plaque. This information will provide novel avenues for the treatment of patients with atherosclerosis.

Efficacy and safety of a novel multi-electrode radiofrequency ablation catheter for renal sympathetic denervation in pigs.

OBJECTIVE: To investigate the safety and efficacy of a self-developed novel multi-electrode radiofrequency ablation catheter (Spark) for catheter-based renal denervation (RDN). METHODS: A total of 14 experimental miniature pigs were randomly divided into four groups (55°& 5-watt, 55°& 8-watt, 65°& 5-watt, and 65° & 8-watt groups). Spark was used for left and right renal artery radiofrequency ablation. Blood samples collected from renal arteries and veins as well as renal arteriography were performed on all animals before, immediately after, and three months after procedure to evaluate the effects of Spark on the levels of plasma renin, aldosterone, angiotensin I, and angiotensin II as well as the pathological changes of renal arteries. RESULTS: One pig died of an anesthetic accident, 13 pigs successfully underwent the bilateral renal artery ablation. Compared with basic measurements, pigs in all the four groups had significantly decreased mean arterial pressure after procedure. Histopathological analysis showed that this procedure could result in intimal hyperplasia, significant peripheral sympathetic nerve damage in the renal arteries such as inflammatory cell infiltration and fibrosis in perineurium, uneven distribution of nerve fibers, tissue necrosis, severe vacuolization, fragmented and unclear nucleoli myelin degeneration, sparse axons, and interruption of continuity. In addition, the renal artery radiofrequency ablation could significantly reduce the levels of plasma renin, aldosterone, angiotensin I, and angiotensin II in pigs. CONCLUSIONS: The results suggest that this type of multi-electrode catheter-based radiofrequency ablation could effectively remove peripheral renal sympathetic nerves and reduce the activity of systemic renin-angiotensin system in pigs, thus facilitating the control of systemic blood pressure in pigs.

Meta-analysis of the effect of percutaneous coronary intervention on chronic total coronary occlusions.

BACKGROUND AND PURPOSE: Coronary chronic total occlusion (CTO) is the last stage of coronary artery atherosclerosis. Percutaneous coronary intervention (PCI) is a therapeutic procedure used to recanalize vessels with total occlusion. However, successful recanalization of CTO is still not optimal, and the key influence factors are still uncertainty. Therefore, a scientific evaluation on the effective of PCI for CTO treatment is necessary. METHODS: Relevant studies of PCI treatment for CTO were examined. Data were extracted and assessed by two independent clinical experts. Embase, PubMed and Medline et al. were used as database. The main research key words include "CTO", "PCI", "Stent", "Reopen", "long-term", "follow-up" and "outcome". Quality assessment was carried out according to the Cochrane Handbook. The selected data were pooled and analyzed using fixed-effect model and random-effect model. Heterogeneity was assessed using the I(2) test, Q test, L'abbe and Galbraith. Comprehensive Meta -Analysis 2.0 and Metanalysis 1.0 were used for statistics analysis in this research. RESULTS: A total of 16 articles involving 6695 cases in successful CTO recanalization (CTO success group) and 2370 cases in failed CTO recanalization(CTO failure group) were included in this research. Low CTO success was associated with elder age, previous coronary artery bypass graft surgery (CABG) history, multi-vessel diseases and right coronary artery disease lesion. Six follow-up variables including major adverse cardiac events (MACE), recurrent myocardial infarction (MI), all-cause death, incidence of angina, subsequent CABG and cumulative survival rate were found significantly reduced associated with CTO success. CONCLUSIONS: Clinical baseline characteristics such as age, previous CABG history and lesion baseline characteristics such as lesion length, multi-vessel diseases might be important factors influencing the successful rate of CTO recanalization. Compared to CTO failure patients, all six follow-up variables showed advantage for CTO success patients.