Comparison of myocardial microcirculatory perfusion after catheter-administered intracoronary thrombolysis with anisodamine versus standard thrombus aspiration in patients with ST-elevation myocardial infarction.

OBJECTIVE: To evaluate efficacy, safety and feasibility of targeted intracoronary injection using pro-urokinase combined with anisodamine (TCA) versus thrombus aspiration (TA) in ST-elevation myocardial infarction (STEMI) patients with high thrombus loads. BACKGROUND: The best method of avoiding thrombus detachment and stroke in PCI patients with high thrombus loads has not yet been established. METHODS: STEMI patients receiving coronary artery angiography or percutaneous coronary intervention (CAG/PCI) with thrombus grade ≥ 3 from January 1, 2017 to June 30, 2018 were randomly assigned to targeted intracoronary thrombolysis (pro-urokinase and anisodamine via catheter (TCA) group), or the TA group which followed the standard thrombus aspiration procedure. Parameters compared included thrombus grade, index of microcirculatory resistance (IMR), postoperative myocardial SPECT, thrombosis in myocardial infarction (TIMI) scores including flow grade, corrected TIMI frame counts (CTFCs), and TIMI myocardial perfusion grade (TMPG). Adverse events were followed up within 3 months. RESULTS: Thirty-nine patients were finally enrolled. In primary CAG/PCI, the TCA group had higher percentages of TIMI 3 flow and lower IMR values compared with the TA group. The ratio of TMPG 3 grade in the TCA group was higher in repeat CAG, and the perfusion descending area (PDA) presented by SPECT was lower than in the TA group. No significant difference was seen in major adverse coronary events (MACEs) or bleeding events at follow-up. CONCLUSIONS: TCA appears to be effective, safe, and feasible for repatency and reduction of high thrombus burden in primary PCI and may protect myocardial microcirculation with improved outcomes.

Effects of Levosimendan on Right Ventricular Function in Patients with Acute Decompensated Heart Failure.

BACKGROUND: To investigate the effects of levosimendan on right ventricular (RV) function in patients with acute decompensated heart failure (ADHF). METHODS: Patients with ADHF admitted from January 2017 to October 2017 were enrolled in this study. The patients were randomized to receive 24-h intravenous levosimendan or placebo. Echocardiographic examinations were performed and the parameters were compared. Epidemiological data were recorded and compared before and after treatment. Major adverse cardiac events during hospitalization and during 1-month follow-up were compared. RESULTS: The baseline characteristics were comparable. After 24-h infusion of levosimendan and placebo, the left ventricular ejection fraction and S' were significantly increased in the levosimendan group compared with the control group (both p < 0.05). The E value in the levosimendan group significantly decreased (75.38 ± 8.32 vs. 88.21 ± 10.36, p < 0.0001), and E/e' significantly increased in the control group (19.61 ± 6.52 vs. 27.58 ± 8.22, p < 0.0001). The levels of right ventricular fractional area change (24 ± 3 vs. 20 ± 2, p < 0.0001) and tricuspid annular plane systolic excursion (1.56 ± 0.36 vs. 1.38 ± 0.21, p < 0.0001) were significantly higher in the levosimendan group than in the control group. After treatment, the values of systolic pulmonary artery pressure (SPAP) decreased in both groups (both p < 0.05), and the value of SPAP in the levosimendan group was lower than that in the control group (47.22 ± 5.6 vs. 55.85 ± 7.41, p < 0.0001). After 1-month follow-up, there was no significance in readmissions due to recurrent heart failure. CONCLUSIONS: Levosimendan seems to provide more beneficial effects among patients with ADHF to improve RV function, along with a decrease in pulmonary pressure.

A comparative study of transulnar and transradial artery access for percutaneous coronary intervention in patients with acute coronary syndrome.

OBJECTIVES: Transradial access has become commonly used for elective evaluation of patients with coronary artery disease, but it has some disadvantages and has had limited use in the acute coronary syndrome (ACS). Because the diameter of the ulnar artery is usually larger than that of the radial artery, we hypothesized that the ulnar artery could be used as an access for percutaneous coronary intervention (PCI). The present study compares the feasibility, safety, and outcome of transulnar artery and transradial artery access for PCI in patients with ACS. METHODS: We reviewed 636 patients who had PCI for ACS from May 2006 to May 2009. The patients were randomly assigned to transulnar intervention (TUI; 317) or transradial intervention (TRI; 319). RESULTS: Several outcomes were similar in the TUI and TRI groups: success rate of first puncture, duration of guiding catheter engagement, puncture-to-balloon inflation time, final thrombolysis in myocardial grade 3 flow, complications at the vascular access site, and postprocedure complications. The incidence of severe arterial spasm and forearm hematoma in the TUI groups was significantly less than that in the TRI group. At 1-year follow-up, the level of blood oxygen saturation at the middle finger and Doppler ultrasonographic characteristics of the ulnar artery did not significantly change from pre-PCI values for these criteria in either group. CONCLUSION: The TUI approach has results and access complications similar to the TRI approach and is a safe and feasible alternative for ACS patients.

Thrombolysis Followed by Early Percutaneous Coronary Intervention via Transradial Artery Approach in Patients with ST-Segment Elevation Infarction.

BACKGROUND: The purpose of this study was to investigate the safety and efficacy of thrombolysis followed by early percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 161 patients were enrolled in the study. Fifty-three of them who underwent thrombolysis in non-PCI hospital and immediately transferred to receive early PCI were assigned to the early PCI group (E-PCI); the rest of the patients were assigned to the primary PCI group (P-PCI). Coronary angiography and PCI were performed via the transradial artery approach for patients in both groups. Angiographic parameters, bleeding complications and total hospital stay were compared between the two groups. All patients were followed-up for 30 days to evaluate major adverse cardiac events (MACE). RESULTS: Before PCI procedure, the thrombus score of IRA in the E-PCI group was lower, and the percentage of TIMI flow grade (TFG) 3 was higher (both p < 0.05) compared to those in the P-PCI group. The myocardial reperfusion in the E-PCI group was better than that in the P-PCI group. There was a trend towards a lower peak value of serum creatine kinase MB in the E-PCI group, and left ventricular ejection fraction (LVEF) before discharge in E-PCI was higher than that in the P-PCI group (54.38 ± 5.29% vs. 52.19 ± 7.00%, respectively, p = 0.028). No significant differences were found in the incidences of bleeding complications and hospital stay between the two groups. There was no significant difference in the 30-day MACE between the two groups (p = 0.863), and no significance of cumulative MACE-free survival rates were found between the two groups as well (p = 0.522). Variables predicting MACE upon patient follow-up according to univariable Cox regression analyses showed that a history of hyperlipidemia, smokers, TFG of infarction related artery before PCI < 2, and low levels of LVEF were associated with poor clinical outcomes (all p < 0.05). CONCLUSIONS: It is safe and efficacious for STEMI patients to receive thrombolysis followed by early PCI via the transradial artery approach. KEY WORDS: Major adverse cardiac event; Percutaneous coronary intervention; Radial artery; ST-segment elevation myocardial infarction; Thrombolysis.

[Prevalence and related factors of injury caused by agricultural machinery in the 3 provinces Shandong, Henan and Hebei of China].

OBJECTIVE: To study the prevalent characteristics and related factors of injuries caused by agricultural machinery in 3 provinces Shandong, Henan and Hebei in China. METHODS: A total of 1621 agricultural machinery operators aged between 18 and 60 years old from Shandong, Henan and Hebei provinces were selected by purposive-cluster sampling method in 2009. Demographic characteristics, injury history caused by agricultural machinery in the last year and the related social and psychological factors were collected by self-designed questionnaire. We used statistical description to report the injury prevalence, and adopted the univariate and multivariate analysis to explore the risk factors. RESULTS: The average incidence of injuries caused by agricultural machinery was 13.44% (213/1585) in the three provinces, of which 14.46% (202/1397) in males and 5.85% (11/188) in females (χ(2) = 10.56, P < 0.01). Most of injuries (155 cases, 72.77%) occurred between April and August. Being stuck by rolling starting handles (45 cases, 21.13%), being crushed by running or dropping machineries (32 cases, 15.02%), fall from machines (28 cases, 13.15%) ranked the top three causes of injuries. The main related machines were tractors and motor tricycles (133 cases, 62.44%). The leading types of injuries were scratch (115 cases, 53.99%), strain (68 cases, 31.92%) and fracture (37 cases, 17.37%). RESULTS: of multivariate logistic regression analysis showed that being male (OR = 3.18, 95%CI:1.65-6.15), educational level above high school(OR = 1.69, 95%CI:1.21-2.34), annual family income <2000 yuan (OR = 1.94, 95%CI:1.13-3.32), operating experience ≤ 5 years (OR = 1.70, 95%CI:1.13-2.55), daytime sleepiness (OR = 2.89, 95%CI:1.66-5.01), smoking during machinery operation (OR = 1.43, 95%CI:1.05-1.96), bearing debts (OR = 1.88, 95%CI:1.35-2.63) and suffering from other diseases (OR = 1.42, 95%CI:1.02-1.98) were risk factors of agricultural machinery injuries. CONCLUSION: The average incidence of injuries caused by agricultural machinery in the three provinces Shandong, Henan and Hebei, was rather high among agricultural machinery operators, especially in the males. Agricultural machinery injury has been an important issue endangering the health of rural labor force in recent years.

Equilibrium radionuclide angiography for evaluating the effect of facilitated percutaneous coronary intervention on ventricular synchrony in patients with acute myocardial infarction.

BACKGROUND: It is unclear whether facilitated percutaneous coronary intervention (PCI) via a transradial approach therapy is preferable to primary PCI, with improved ventricular synchrony performance (VS), in Chinese patients. METHODS AND RESULTS: The 152 patients with their first anterior acute myocardial infarction (AMI) were randomized to a primary PCI group or facilitated PCI group. In the 1(st) week and 6(th) month after AMI onset, the parameters of VS were measured by equilibrium radionuclide angiography with ventricular phase analysis. The rate of TIMI grade-3 flow in the infarct-related artery pre-PCI in the facilitated PCI group was higher than that in the primary PCI group (30.56% vs. 8.45%, P=0.001). At the 6(th) month post-AMI, the parameters of time to peak ejection rate, phase shift and peak phase standard deviation were lower than in the primary PCI group (P<0.05, respectively). The incidence of recurrent ischemia and new or worsening congestive heart failure post-AMI in the facilitated PCI group was significantly lower than that in the primary PCI group (2.78% vs. 9.86%, P=0.043; 2.78% vs. 12.68%, P=0.028). CONCLUSIONS: Facilitated PCI via a transradial approach might significantly inhibit left ventricular remodeling and improve left ventricular function because of the complete, persistent patency of the infarct-related artery with few complications of vessel access and bleeding.

[The use of recombinant human B-type natriuretic peptide for the protection of cardiac and renal functions in heart failure patients with acute anterior myocardial infarction in peri-operative period of primary percutaneous coronary intervention].

OBJECTIVE: To evaluate the protective effect of recombinant human B-type natriuretic peptide (rhBNP) on cardiac and renal functions in heart failure (HF) patients as a result of acute anterior myocardial infarction (AAMI) in peri-operative period of primary percutaneous coronary intervention (pPCI). METHODS: One hundred and twenty-six patients with AAMI-HF were enrolled into this study. All patients undertaken pPCI were randomly assigned to the rhBNP group (n=62) or the control group (n=64). rhBNP or nitroglycerin was intravenously administered on the basis of conventional treatment from first day of admission to 24 hours after pPCI in both groups. Heart rate (HR), systolic blood pressure (SBP), B-type natriuretic peptide (BNP), estimated glomerular filtration rate (eGFR) and heart function were observed. All patients were followed up for 30 days for the observation of main adverse cardiac events (MACE). RESULTS: The HR was significantly decreased compared with that at admission in rhBNP group, but such condition was not found in the control group. The SBP was reduced obviously in both groups. The plasma level of BNP, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension (LVEDD) were improved significantly at different time points compared with those before administration in both groups. The improvement of above parameters in rhBNP group was more significant than that in the control group [BNP (ng/L) 30 hours after pPCI: 303.5±128.4 vs. 354.0±133.6, 14 days after pPCI: 157.8±78.6 vs. 201.1±91.7; LVEF 1 day after pPCI: 0.420±0.052 vs. 0.378±0.055, 14 days after pPCI : 0.444±0.050 vs. 0.393±0.055, 30 days after pPCI: 0.469±0.053 vs. 0.413±0.052; LVEDD (mm) 1 day after pPCI: 53.5±4.4 vs. 57.6±4.4, 14 days after pPCI : 49.6±5.1 vs. 53.4±4.6, 30 days after pPCI: 46.5±4.4 vs. 50.2±4.8, P<0.05 or P<0.01]. The eGFR was reduced obviously 1 day after pPCI than that at admission in both groups, and eGFR recovered to baseline 3 days after pPCI. The level of eGFR was significantly increased 7 days and 14 days after pPCI than that at admission, but there was no difference between rhBNP group and control group. The incidence of contrast-induced nephropathy showed a lowering tendency in the rhBNP group than that in the control group [19.4% (12/62) vs. 29.7% (19/64), P=0.178]. The incidence of ventricular arrhythmias was obviously lowered 7 days after pPCI in the rhBNP group than that in the control group [48.4% (30/62) vs. 75.0% (48/64), P<0.01]. The rate of MACE was lower in rhBNP group than that in control group in 30 days [12.9% (8/62) vs. 26.6% (17/64), P<0.05]. CONCLUSION: Administration of rhBNP can effectively improve the heart function in AAMI-HF patients undergoing pPCI, and it lowered the incidence of MACE in 30 days, without influence on renal function, and it can reduce the incidence of contrast-induced nephropathy.

[Warm-up angina and the application of a KATP channel blocker].

OBJECTIVE: To explore the protection for ischemic myocardium with warm-up phenomenon and KATP channel blocker interventional effect on it. METHODS: Patients with chronic stable angina who came into the study were divided into three groups according to the presence of diabetes and its treatment ways: 25 patients without diabetes came into a NDM group, 22 patients with diabetes treated with glibenclamide came into a DMG group and 25 patients with diabetes but on diet only came into a DMD group. All the patients underwent sequential bicycle ergometer exercise test twice (EX1, EX2) with a time interval of 15 min. Parameters including exercise duration (ED), time for 1 mm ST-segment depression (T-STD), maximum STD (mm) and corresponding heart-rate systolic blood pressure product (RPP) were observed respectively. The parameters obtained during EX2 were compared with those obtained during EX1. RESULTS: In the group NDM, ED and T-STD were prolonged [(546.04 +/- 103.78) s vs (617.52 +/- 106.96) s, P < 0.05 and (378.64 +/- 92.34) s vs (436.84 +/- 91.25) s, P < 0.05], STDmax was shortened [(2.06 +/- 0.37) mm vs (1.75 +/- 0.41) mm, P < 0.01] and RPP was increased [(173.77 +/- 34.73) beatsxmin(-1)xmm Hg(-2) vs (199.23 +/- 37.07 beatsxmin(-1)xmm Hg(-2), P < 0.05] as the parameters during EX2 were compared with those during EX1. In the group DMG, there was no difference in these analysed parameters except that T-STD was prolonged [(328.45 +/- 64.66) s vs (363.00 +/- 81.48) s, P < 0.01] when those of EX2 and EX1 were compared. In the group DMD, all the analysed parameters improved significantly during the second test (EX2) in comparison with the first test (EX1) as the results in the group NDM. CONCLUSIONS: Exercise test can induce warm-up phenomenon in patients with chronic stable angina pectoris. The KATP channel blocker glibenclamide can block the warm-up phenomenon.

[Changes of the characteristics of sleep apnea in heart failure patients and the associated factors].

OBJECTIVE: To investigate the changes of the characteristics of sleep apnea in heart failure patients with periodic breathing disorder and to explore the influencing factors. METHODS: According to the characteristics of sleep apnea after polysomnography (PSG) for 2 nights, 54 patients with heart failure were divided into 3 groups: obstructive sleep apnea (OSA), central sleep apnea (CSA) and OSA-CSA switching groups, with 18 patients each. t test was used for comparison between the first and the second PSG data, left ventricular ejection fraction (LVEF), periodic breathing cycle length (PBCL) and lung to finger circulation time (LFCT) in the same patient. Analysis of variance was performed for comparison within groups and Pearson correlation test was used for correlation analysis between 2 variables. RESULTS: When the events of sleep apnea changed from OSA to CSA, the mean wake and sleep stage II (S2) PtcCO(2) decreased significantly [(41.0 +/- 1.3) cm H(2)O vs (34.9 +/- 1.0) cm H(2)O, 1 cm H(2)O = 0.098 kPa, P < 0.01;(42.1 +/- 1.2) cm H(2)O vs (36.3 +/- 1.1) cm H(2)O, P < 0.01], while PBCL and LCFT increased significantly [(51.9 +/- 2.1) s vs (62.3 +/- 1.9) s, P < 0.01, (54.4 +/- 1.8) s vs (65.3 +/- 1.6) s, P < 0.01]. Furthermore, there was a significant decrease in LVEF [(32.1 +/- 2.5)% vs (19.9 +/- 3.5)%, P < 0.05], and LVEF was negatively correlated with PBCL and LFCT (r = 0.687, P < 0.05;r = -0.591, P < 0.05). When sleep apnea changed from CSA to OSA, the mean wake and S2 PtcCO(2) increased significantly [(39.2 +/- 0.5) cm H(2)O vs (42.7 +/- 1.0) cm H(2)O, P < 0.05], while PBCL and LFCT decreased significantly [(61.5 +/- 3.4) s vs (49.7 +/- 2.8) s, P < 0.05, (66.1 +/- 2.1) s vs (52.1 +/- 1.6) s, P < 0.01)]. In addition, there was a negative correlation between PtcCO(2) and PBCL (r = -0.586, P < 0.05). However, PtcCO(2) showed no significant correlation with LFCT (r = -0.381, P > 0.05). There were no statistical differences between the first and the second mean wake and S2 PtcCO(2), PBCL and LFCT in the OSA and the CSA group, but AHI showed a significant correlation with LVEF in the CSA group (r = -0.474, P < 0.05). CONCLUSIONS: The characteristics of sleep apnea can change when periodic breathing happens in heart failure patients with OSA or CSA. The change can be affected by wake and sleep PtcCO(2), PBCL and LFCT, and possibly by heart function.

Cardioprotective effects of simvastatin on reversing electrical remodeling induced by myocardial ischemia-reperfusion in normocholesterolemic rabbits.

BACKGROUND: Recent studies have revealed that pretreatment with statin is effective in preventing arrhythmia, but its electrophysiological mechanism is unclear. This study was conducted to investigate the cardioprotective effects of simvastatin on reversing electrical remodeling in left ventricular myocytes of rabbit heart undergoing ischemia-reperfusion, so as to explore the ionic mechanism responsible for the anti-arrhythmic effect of statin. METHODS: Forty-five rabbits were randomly divided into three groups: ischemic-reperfusion group (I-R), simvastatin intervention group (Statin) and sham-operated control group (CON). Anesthetized rabbits were subjected to 30-minute ischemia by ligation of the left anterior descending coronary artery and a 60-minute reperfusion after a 3-day administration of oral simvastatin of 5 mg x kg(-1) x d(-1) in the Statin group or a placebo in the I-R group. Single ventricular myocytes were isolated enzymatically from the epicardial zone of the infracted region derived from the hearts in the I-R and Statin group and the same anatomical region in the CON animals. The whole cell patch-clamp technique was used to record membrane ionic currents, including sodium current (I(Na)), L-type calcium current (I(Ca-L)) and transient outward potassium current (I(to)). Simultaneously, the level of serum cholesterol was examined. RESULTS: There was no significant difference in the serum cholesterol concentration among the three groups. The peak I(Na) current density (at -30 mV) was significantly decreased in I-R ((-22.46+/-5.32) pA/pF, n=12) compared with CON ((-42.78+/-5.48) pA/pF, n=16, P<0.01) and Statin ((-40.66+/-5.89) pA/pF, n=15, P<0.01), while the peak I(Na) current density in the Statin group was not different from CON (P>0.05). The peak I(Ca-L) current density (at 0 mV) was significantly increased in I-R ((-4.34+/-0.92) pA/pF, n=15) compared with CON ((-3.13+/-1.22) pA/pF, n=13, P<0.05) and Statin ((-3.46+/-0.85) pA/pF, n=16, P<0.05), while the Peak I(Ca-L) current density in Statin was not different from CON (P>0.05). The I(to) current density (at +60 mV) was significantly decreased in I-R ((9.49+/-1.91) pA/pF, n=11) compared with CON ((17.41+/-3.13) pA/pF, n=15, P<0.01) and Statin ((14.54+/-2.41) pA/pF, n=11, P<0.01), although there was a slight reduction in the Statin group compared with CON (P<0.05). CONCLUSIONS: It is implied that ischemia-reperfusion induces significant down-regulation of I(Na) and I(to) and up-regulation of I(Ca-L), which may underlie the altered electrical activity and long abnormal transmembrane action potential duration of the surviving ventricular myocytes, thus contributing to ventricular arrhythmias during acute ischemia-reperfusion period. Pretreatment with simvastatin could attenuate these changes and reverse this electrical remodeling without lowering the serum cholesterol level, contributing to the ionic mechanism of statin in treatment of arrhythmia independent of a decrease in cholesterol.

Effect of tirofiban plus clopidogrel and aspirin on primary percutaneous coronary intervention via transradial approach in patients with acute myocardial infarction.

BACKGROUND: Aspirin and clopidogrel can improve myocardial reperfusion and alleviate myocardial injury during percutaneous coronary intervention (PCI). Whether the addition of intravenous tirofiban during this procedure produces further benefit has not been clarified in ST segment elevation myocardial infarction (STEMI) patients. We evaluated this on STEMI patients who underwent primary PCI (p-PCI) via transradial artery approach. METHODS: Consecutive patients were randomized into tirofiban group (n=72) or placebo group (n=78). Angiographic analysis included initial and final thrombolysis in myocardial infarction (TIMI) flow grade (TFG), corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) of the thrombotic vessel. Platelet aggregation rate (PAR), creatine phosphokinase (CPK), CPK isoenzyme MB (CPK-MB) and troponin I levels were measured and TIMI definitions were used to assess bleeding complications. Left ventricular performance parameters were investigated with equilibrium radionuclide ventriculography. Major adverse cardiac events (MACE) were followed up for 6 months. RESULTS: The cases of TFG 0 and 1 before PCI, TFG 0 when first crossing of guide wire were less, and the cases of TFG 3 after PCI was more in tirofiban group than those in placebo group. The final CTFC was fewer and the incidence of no reflow phenomenon was lower, as well the percentage of final TFG 3 was higher in tirofiban group than those in placebo group (all P<0.05). Mean peak CPK-MB was significantly lower, while the left ventricular performance parameters 1 week after PCI were much more improved in tirofiban group than those in the placebo group. PAR was significantly decreased shortly after tirofiban infusion. The incidence of 6-month MACE in tirofiban group was obviously lower than that in the placebo group. No statistical difference was noted between the two groups with regard to bleeding complications. CONCLUSIONS: Intravenous tirofiban infusion, in addition to aspirin and clopidogrel in STEMI patients with p-PCI via transradial artery access, can quickly inhibit platelet aggregation, loosen occlusive thrombus, improve myocardial reperfusion and reduce incidence of MACE with few complications of vessel access and bleeding.

[Effect of intra-coronary injection of anisodamine on the slow-reflow phenomenon in patients with acute myocardial infarction after percutaneous coronary intervention].

OBJECTIVE: To assess the effect and safety of intra-coronary administration of anisodamine on "slow-reflow" phenomenon of infarct related artery (IRA) following primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). METHODS: Twenty-five patients with slow-reflow phenomenon screened out from 153 AMI patient with post-PCI reflow IRA were enrolled. They were 17 males and 8 females; aged (62.3 +/- 9.3) years; 10 with focal artery at left anterior descendens, 5 in circumflux and 10 in right coronary artery; PCI was successfully performed on them about 7.11 +/- 2.31 h after the onset of angina pectoris and the post-operation mean TIMI flow was 1.75 +/- 0.42 grade. Nitroglycerin (200 microg) was injected into coronary previously for confirming the slow-reflow phenomenon as control, then the injection of anisodamine 500 microg 10 min later. Coronary arteriography (CAG) was performed at the 1 st, 3 rd and 10 th min after the medication. Gibson's TIMI frame count method and quantitative computer angiography (QCA) system was used to quantitatively detect the frames of blood flow and the diameter of arterial lumen at different time points after nitroglycerin or anisodamine administration. Hemodynamics and changes of electrocardiogram were determined. RESULTS: (1) No significant change in frames of blood flow was found between before and 1 min after intra-coronary administration of nitroglycerin (82.79 +/- 9.30 frames vs 78.43 +/- 9.37 frames, P >0. 05) after operation; but 1, 3 and 10 min after injection of anisodamine, it was decreased 46.25 +/- 4.55, 44.52 +/- 4.52 and 43.09 +/- 4.18, respectively, all P <0. 01, and the average coronary blood flow increased from TIMI grade 1.75 +/- 0.42 to grade 2.70 +/- 0.45 (t = 0. 34, P < 0.05). (2) The diameter of middle segment of reopened coronary artery slightly increased from 3.2 +/- 0.3 mm to 3.3 +/- 0.4 mm 3 min after anisodamine injection, but without statistical significance (P >0. 05). (3) Successive monitoring at 10 min after anisodamine injection showed that all the parameters, including intra-coronary pressure, peripheral blood pressure, P-R interval, Q-T interval and QRS duration were not changed significantly (P > 0.05), only the heart rate increased for 15-19 beats/min, but did not induce tachycardia or other malignant arrhythmia. CONCLUSION: Intra-coronary administration of anisodamine 500 microg could improve the post-PCI slow-reflow phenomenon, it is safe and convenient, and may be taken as an effective approach for treatment of the illness.

[Effect of urapidil on heart function and ventricular systolic synchrony in acute myocardial infarction patients with no-reflow phenomenon after percutaneous coronary intervention].

OBJECTIVE: To evaluate the influence of intracoronary administration of urapidil on myocardial blush grade (MBG) and left ventricular systolic function and synchrony in the acute myocardial infarction (AMI) patients with no-reflow phenomenon after percutaneous coronary intervention (PCI) identified by MBG. METHODS: Forty-three patients with AMI, in whom primary PCI was successfully performed (6.25+/-2.37) hours after the onset of angina pectoris,were found to have no-reflow phenomenon. They were randomized into two groups: urapidil group (n=22) and no-reflow control group (n=21). Nitroglycerin (200 microg) was injected into coronary artery. Urapidil (5 mg) was injected into coronary artery after 10 minutes in the urapidil group, and 0.9% NaCl (5 ml, weight percentage) was injected into coronary artery in the no-reflow control group. All the patients received same standard therapy afterwards. The left ventriculography (LVG) was performed immediately and 6 months after PCI to measure the ventricular volume, left ventricular end-diastolic pressure (LVEDP), and wall motion score (WMS). Equilibrium radionuclide angiography (ERNA) was performed 1 week and 6 months after PCI to determine the parameters of left ventricular systolic function and systolic synchrony. RESULTS: The MBG of urapidil group and control group was grade 0.77+/-0.31 and grade 0.77+/-0.28 after PCI, respectively. The MBG remained unchanged in control group and significantly increased from grade 0.77+/-0.31 to grade 2.37+/-0.27 10 minutes in urapidil group (P<0.05). Follow-up at 6 months after AMI-PCI, left ventricular end-systolic volume index (LVESVI), left ventricular end-diastolic volume index (LVEDVI), WMS and LVEDP were significantly lower in urapidil group compared with those in control group respectively (all P<0.05). The values of left ventricular ejection fraction (LVEF), peak ejection rate (PER), peak filling rate (PFR) of the ERNA as measured by ERNA were significantly increased in urapidil group compared with that in control group (all P<0.05). Phase analysis showed that the left ventricular systolic synchrony parameters phase shift (PS), full width at half maximum (FWHM) and peak phase standard deviation (PSD) were also significantly lower in urapidil group than those in control group (all P<0.05). CONCLUSION: Intracoronary administration of urapidil can attenuate the no-reflow phenomenon, improve the left ventricular systolic function and synchrony in patients with no-reflow phenomenon after AMI-PCI.

Effect of intracoronary administration of anisodamine on slow reflow phenomenon following primary percutaneous coronary intervention in patients with acute myocardial infarction.

BACKGROUND: Many basic and clinical studies have proved that anisodamine can produce significant effect on relieving microvascular spasm, improving and dredging the coronary microcirculation. It may be beneficial to the improvement of slow-reflow phenomenon (SRP) following percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). So we investigated the effect of intracoronary administration of anisodamine on SRP of infarct related artery (IRA) following primary PCI in patients with ST segment elevated acute myocardial infarction (STEAMI). METHODS: Twenty-one patients with SRP from a total of 148 STEAMI patients accepted primary PCI were enrolled into this study from September 2004 to December 2005. When SRP happened, nitroglycerin (200 microg) was "bolus" injected firstly into IRA to exclude the spasm of epicardial artery and identify SRP as well as a baseline and self-control agent following PCI. Ten minutes later, 1000 microg of anisodamine was injected into IRA with SRP at 200 microg/s, while the coronary angiography (CAG) was taken before and at 1st, 3rd and 10th minute after administration of nitroglycerin or anisodamine, respectively. The corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG) and the diameter of IRA were calculated and analyzed by Gibson's TIMI frame count method using quantitative computer angiography (QCA) system to evaluate the influence of anisodamine on coronary flow and vessel lumen. In the meantime the invasive hemodynamic parameters of intracoronary and systemic artery (systolic, diastolic and mean pressure) and electrocardiogram (ECG) were measured and monitored. The changes of ventricular performance parameters and the adverse reaction were evaluated and followed-up at 1 month post-PCI. RESULTS: No significant changes in cTFCs and TMPGs were found at 1st, 3rd and 10th minute after intracoronary administration of nitroglycerin as compared with the baseline control (P > 0.05). cTFCs were decreased by 58.3%, 56.2%, and 54.6%, respectively (P < 0.001), and TMPGs were increased from 1.13 +/- 0.21 grade to 2.03 +/- 0.32, 2.65 +/- 0.45 and 2.51 +/- 0.57 grades (P < 0.05) at 1st, 3rd and 10th minute after intracoronary administration of anisodamine as compared with those after intracoronary administration of nitroglycerine, respectively. The average coronary blood flow of TIMI grade was improved from 1.76 +/- 0.43 to 2.71 +/- 0.46 (P < 0.05) while the diameter of middle segment in re-patented coronary artery was slightly increased from (3.20 +/- 0.40) mm to (3.40 +/- 0.50) mm at the 3rd minute after intracoronary administration of anisodamine (P > 0.05) as compared with those of nitroglycerine control. The systolic, diastolic and mean pressures of intracoronary artery after intracoronary administration of anisodamine increased from 115 to 123, 75 to 84, 88 to 95 mmHg (P < 0.05), respectively, along with the rise of heart rate from 68 to 84 beats per minute (P < 0.05). There were no significant changes in intervals of PR, QT and QRS (P > 0.05) and no any severe fast arrhythmia after intracoronary administration of anisodamine. The ventricular performance parameters were significantly improved and no major adverse cardiovascular events (MACE) were found during follow-up at 1 month post-PCI. CONCLUSIONS: Intracoronary administration of 1000 microg anisodamine is effictive in reversing SRP following PCI in STEAMI patients, especially it is suitable for SRP patients with bradycardia or hypotension.

[Incidence and risk factors of acute radial artery occlusion following transradial percutaneous coronary intervention].

OBJECTIVE: To elucidate the incidence and risk factors of acute radial artery occlusion (RAO) following transradial percutaneous coronary intervention (TRI). METHODS: A total of 7215 patients who underwent TRI were divided into normal group and RAO group, according to whether the patient without and with RAO. Risk factors of RAO were analyzed by logistic regression model. RESULTS: Acute RAO occurred in 68 patients (0.94%). As compared to the patients in normal group, there were more female and diabetes mellitus patients in RAO group. The dosage of heparin used in the operational procedure in RAO group were significantly less than normal group (3723 IU +/- 556 IU vs 7603 IU +/- 1533 IU, P < 0.01). The post-procedure duration of high-pressure compression hemostasis were longer in RAO patients than normal patients (103.8 min +/- 23.3 min vs 87.7 min +/- 31.2 min, P = 0.02). Logistic regression analyses showed that the dosage of heparin used in the procedure, the category and size of sheath and the post-procedure compression time were independent risk factors for RAO. CONCLUSION: The incidence of RAO can be minimized by appropriate anticoagulation, proper sheath selection, and avoiding prolonged duration of high-pressure compression hemostasis following the procedure.

[Influence of intracoronary administration of anisodamine on no-reflow, ventricular function and systolic synchrony in acute myocardial infarction patients undergoing percutaneous coronary intervention].

OBJECTIVE: To evaluate the influence of intracoronary administration of anisodamine on myocardial blush grade (MBG) and left ventricular regional and global systolic function and synchrony in the acute myocardial infarction (AMI) patients with no-reflow phenomenon post percutaneous coronary intervention (PCI). METHODS: Forty-seven AMI patients who underwent PCI within 12 hours of onset and MBG was 0 - 1 were randomized to receive standard therapy [group B, n = 23, 18 males, mean age (62.72 +/- 11.48) years] or standard therapy plus intracoronary administration of anisodamine [200 microg/ml, group A, n = 24, 18 males, mean age (64.23 +/- 12.27) years]. The left ventriculography (LVG) was performed immediately and 6 months after PCI to measure the ventricular volume, LVEDP and wall motion score (WMS). Equilibrium radionuclide angiography (ERNA) was performed 1 week and 6 months after PCI to determine the parameters of left ventricular regional, global systolic function and systolic synchrony. Incidence of major adverse cardiac events (MACE) during the follow-up was analyzed. RESULTS: Anisodamine [(2530 +/- 340) microg/person)] was well tolerated by patients. The MBG remained unchanged in group B and significantly increased from grade 0.74 +/- 0.32 to grade 2.33 +/- 0.28 10 min after anisodamine injection in group B. Six months post PCI, LVESVI [(40.53 +/- 8.12) ml/m(2) vs. (50.32 +/- 8.26) ml/m(2)], LVEDVI [(80.13 +/- 9.74) ml/m(2) vs. (87.17 +/- 10.25) ml/m(2)], WMS [(8.24 +/- 1.31) vs. (10.23 +/- 1.82)] and LVEDP [(13.36 +/- 4.21) vs. (16.38 +/- 3.21) mm Hg, 1 mm Hg = 0.133 kPa] were significantly lower in group A compared with that in group B (all P < 0.05) while LVEF [(44.02 +/- 5.86)% vs. (38.52 +/- 5.18)%], PER [(1.86 +/- 0.09) EDV/s vs. (1.61 +/- 0.09) EDV/s] and PFR [(2.19 +/- 0.32) EDV/s vs. (1.78 +/- 0.17) EDV/s] measured by ERNA were significantly increased in group A compared with that in group B (all P < 0.05). (2) LrEF(2)-LrEF(8) in group A were higher by 13.96%, 25.02%, 30.36%, 22.86%, 27.67%, 22.07% and 18.71% respectively compared with that in group B. (3) Phase analysis showed that the left ventricular systolic synchrony parameters PS [(46.04 +/- 8.93) degrees vs. (53.19 +/- 162) degrees ], FWHM [(23.02 +/- 6.27) degrees vs. (25.02 +/- 5.31) degrees ] and PSD [(7.92 +/- 4.12) degrees vs. (11.76 +/- 4.11) degrees ] were also significantly lower in group A than that in group B (all P < 0.05). (4) During the 6 months of follow-up, the incidence of MACE in group A was significantly lower than that in group B (P < 0.05). CONCLUSION: Intracoronary administration of anisodamine is safe and could partly attenuate the no-reflow phenomenon, improve the left ventricular systolic function and synchrony and reduce the incidence of MACE in patients with no-reflow phenomenon post AMI-PCI.

Effects of intensive pitavastatin therapy on glucose control in patients with non-ST elevation acute coronary syndrome.

Objective: This study aimed to investigate the effects of intensive pitavastatin therapy on glucose control in patients with non-ST elevation acute coronary syndrome (ACS). Methods: Patients who had ACS with significant stenosis on initial coronary angiography and received successful percutaneous coronary intervention (PCI) in the Second Hospital of Hebei Medical University, Shijiazhuang, China from August 2015 to January 2016 were enrolled in this study. The patients were randomized to receive pitavastatin (4 mg daily) or atorvastatin (20 mg daily). PCI was performed within 72 hours after admission according to the current clinical practice at the physician's discretion. The examinations of blood lipid levels and blood markers of glucose metabolism were performed at baseline and after 6-month follow-up using standard techniques. The inflammatory markers, including white blood cell, high-sensitivity C-reactive protein (hs-CRP) and fibrinogen, were also assessed before PCI and 24 hours after PCI. An independent adverse event assessment committee evaluated major adverse cardiovascular events (MACE) and any other adverse events. Results: A total of 132 patients were enrolled and randomly divided into the pitavastatin group (n = 65) or the atorvastatin group (n = 67), which had similar baseline characteristics and PCI procedural characteristics. For the inflammatory biomarkers at 24 hours after PCI, the fibrinogen level was significantly increased in the atorvastatin group; the hs-CRP levels were significantly increased in both groups, however, the hs-CRP level in the pitavastatin group was lower than that in the atorvastatin group. In addition, the blood lipid parameters (e.g., TC, LDL-C, TG, non-HDL-C and Apo B) were significantly decreased in both groups after 6-month follow-up (P < 0.01), but these parameters between the two groups had no significant difference. After 6-month follow-up, the FPG, IRI, HOMA-IR and HbA1c levels were significantly decreased in the pitavastatin group (P < 0.05) but slightly increased in the atorvastatin group, indicating that the glucose homeostasis was improved in patients in the pitavastatin group but not in the atorvastatin group. Furthermore, the incidence of MACE was not significantly different between the two groups (P > 0.05). After 6-month antiplatelet treatment, the PAR value was significantly decreased in both groups (P < 0.01), but the PAR value in the pitavastatin group was lower than that in the atorvastatin group. Conclusion: Pitavastatin therapy may improve the glucose homeostasis for patients with ACS undergoing PCI and has more favorable outcomes than atorvastatin therapy.

[Experimental research on establishing chronic ischemic heart failure model of minipig with intracoronary perfusion of plastic microspheres by catheterization].

OBJECTIVE: To establish a stable chronic ischemic heart failure (CIHF) model of minipig caused by gradual myocardial ischemia and necrosis that was achieved with repetitive microspheres perfusion in left anterior descending artery (LAD). METHODS: A total of fifteen Wuzhishan minipigs original in Hainan China (8 to 11 months old with body weight of 20 to 30 kg) were used. The 4F angiographic catheter was superselectively engaged in LAD, and 1 ml of suspending plastic microspheres fluid were given repeatedly at ten-minute intervals, which include microspheres 1.0 x 10(5)/ml, until LVEDP raising and maintaining from 15 mm Hg to 18 mm Hg and TIMI flow was less than or equal to grade 2. Electrocardiography, hemodynamic parameters, CK-MB and cTnT were monitored during the procedure. LVEF was repeatedly measured with ultracardiography at 10 d, 20 d, 30 d, 40 d, 50 d, 60 d after establishing chronic ischemic heart failure model. Meanwhile, hemodynamic indices including mRAP, mRVP, mPAP, PCWP and CO (thermo-dilution method) were measured before and two months after procedure. The success rate, stability and repetition of chronic ischemic heart failure model were identified and evaluated. Finally, myocardial infarcted area was measured and myocardial pathologic examination was investigated. RESULTS: Eleven minipigs survived two months after procedure. There were ten minipigs accorded with the criteria (LVEDP > 18 mm Hg CO reduced by 30%) of the CIHF model and the success rate was 66.7% with a mean of 3.2 +/- 0.9 times of microspheres injections and total doses of (3.2 +/- 0.9) x 10(5) microspheres. This resulted in 38.5% reduction in LVEF, 197.8% elevation in LVEDP and 46.8% declining in CO from baseline values (P < 0.01), while mRAP, mRVP, mPAP and PCWP increased significantly as compared with those before procedure. Cross myocardium pathology showed the ratio of necrosis area to left ventricle (LV) area was 25.4% - 34.9% (mean 28.6%) and light microscopy examination of LV myocardium revealed that intravascular semitransparent plastic microspheres distributed throughout subendocardium of left ventricular anterior and apical parts, with more numerous focal myofiber necrosis, which characterized by pathologic founding of ischemic necrosis of myocardium with fibre proliferation. CONCLUSION: A stable CIHF model could be established in Chinese Wuzhishan minipigs with intra-coronary microspheres perfusion via superselectively engaging in LAD, which was prior to those of drug-induced, tachycardia-pacing induced or coronary artery ligation-induced, and had the advantages of stability, closed chest, mild trauma higher success rate and easy for repetition. It might be suitable for using the research of CIHF as large reliable experimental animal model.

[Acute hemodynamic effects of intravenous recombinant human brain natriuretic peptide in patients with acute myocardial infarction complicated with heart failure].

OBJECTIVE: To compare the acute hemodynamic effects and safety of intravenous injection of recombinant human brain natriuretic peptide (rhBNP) versus intravenous nitroglycerin (NIT) in acute myocardial infarction (AMI) patients with heart failure. METHODS: On top of standard therapy, 42 consecutive patients who suffered from anterior wall AMI with heart failure [pulmonary capillary wedge pressure (PCWP) > 16 mm Hg] within 12 to 24 hours from the onset of chest pain were randomized into rhBNP group (n = 21, 1.5 microg/kg bolus intravenous injection followed by 0.0075 microg.kg(-1).mn(-1) for the first 3 hours and 0.015-0.03 microg.kg(-1).mn(-1) infusion for following 21 hours) and NIT group (n = 21, 10 to 100 microg/mn intravenous infusion for 24 hours). The hemodynamic parameters were monitored by Swan-Ganz catheter at baseline, during drug infusion and 6 hours post infusion withdraw; total urine output was also obtained. The major adverse cardiac events (MACE) were observed up to 1 week after drug infusions. RESULTS: Central venous pressure and systolic blood pressure remained unchanged after rhBNP or NIT infusion. Compared to baseline level, PCWP was significantly reduced by 48.9% (P < 0.01) at 30 minutes after rhBNP infusion and this effect remained up to 6 hours post infusion withdraw; PCWP reduced by 28.7% (P < 0.05) at 2 hours after NIT infusion and this effect remained to 6 hours before infusion withdraw. Cardiac index (CI) was increased by 27.1% (P < 0.05) at 1 hour after rhBNP infusion and remained till 6 hours post infusion withdraw; CI was significantly increased at 3 hour after NIT infusion and this effect disappeared after infusion withdraw. The PCWP and CI values were significantly higher in rhBNP group than that of NIT group at 30 minutes and 2 hours (P < 0.05). Heart rate was significantly reduced at 30 minutes (95.3 +/- 7.4 vs. 118.0 +/- 8.2 bpm, P < 0.05) and at 2 hour (92.8 +/- 6.8 vs. 109.2 +/- 7.6 bpm, P < 0.05) in rhBNP and NIT group, respectively and heart rate remained reduced during the whole infusion period in both groups. The total urine output for 30 hours in rhBNP group (1870 +/- 535 ml) tended to be higher than that in NIT group (1538 +/- 620 ml, P > 0.05). There was no symptomatic hypotension or other adverse events during drug infusion in both groups and MACE up to 1 week post drug infusion was also similar between the two groups. CONCLUSION: Intravenous injection of rhBNP results in more rapid and long-lasting hemodynamic improvements than that of NIT in AMI patients with heart failure and it is also feasible and safe for clinic use in AMI patients with heart failure.

Influence of Puncture Site on Radial Artery Occlusion After Transradial Coronary Intervention.

BACKGROUND: The risk of radial artery occlusion (RAO) needs particular attention in transradial intervention (TRI). Therefore, reducing vascular occlusion has an important clinical significance. The aim of this study was to determine the appropriate puncture site during TRI through comparing the occurrence of RAO between the different puncture sites to reduce the occurrence of RAO after TRI. METHODS: We prospectively assessed the occurrence of RAO in 606 consecutive patients undergoing TRI. Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention. Risk factors for RAO were evaluated using a multivariate model analysis. RESULTS: Of the 606 patients, the RAO occurred in 56 patients. Compared with TRI at 2-5 cm away from the radius styloid process, the odds ratio (OR) for occlusion risk at 0 cm and 1 cm were 9.65 (P = 0.033) and 8.90 (P = 0.040), respectively. The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤1 (OR = 2.45, P = 0.004). CONCLUSION: Distal puncture sites (0-1 cm away from the radius styloid process) can lead to a higher rate of RAO. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01979627; https://clinicaltrials.gov/ct2/show/NCT01979627?term = NCT01979627 and rank = 1.