Association of Uric Acid and C-reactive Protein with the Severity of Coronary Artery Disease Using SYNTAX Score and Clinical SYNTAX Score.

BACKGROUND: The SYNTAX score (SXscore), an anatomical-based scoring tool reflecting the complexity of coronary anatomy, has been associated with the mortality and prognosis of coronary artery disease (CAD). Clinical SYNTAX score (CSS), incorporating clinical factors further augmented the utility of the SXscore to longer-term risk. C-reactive protein (CRP) is related to SXscore. Serum uric acid (UA) is associated with atherosclerosis and CAD. However, serum uric acid combined with CRP may better predict the SXscore and CSS. METHODS: A total of 208 patients (mean age 57.82 ± 9.39 years) with chest pain were included in this study. All selected subjects underwent coronary artery angiography and blood test. The relationship between serum UA, CRP and SXscore, and CSS were analyzed. RESULTS: Age and CRP had a positive correlation with SXs and CSS. DM and fasting glucose correlated with SXscore and CSS respectively. In multivariate regression, serum UA, age, fasting glucose, and body mass index (BMI) were significant discriminant factors of high CSS. The predictive accuracy of CRP for SXscore >0 and high CSS using receiver operator characteristic curves was set at the cut off point of 0.205 mg/dL and 0.145 mg/dL respectively, (sensitivity 70.9% and 98%, specialty 48% and 23.2%). CONCLUSION: Serum CRP is correlated with SXscore and CSS, serum UA is independently associated with CSS. CRP predicts high CSS at a lower level than it predicts SXscore. Thus, serum CRP combined with serum UA may be useful to predict SXscore and CSS.

[An initial study on the feasibility of diagnosing myocardial ischemia with CT first-pass myocardial perfusion imaging at rest].

OBJECTIVE: To assess the feasibility and accuracy of CT first-pass myocardial perfusion imaging (CT first-pass MPI) at rest for diagnosis of myocardial ischemia. Results of adenosine-induced myocardial perfusion scintigraphy (MPS) were used as gold standard. METHODS: Twenty-two patients with suspected or diagnosed coronary artery disease (CAD) were included and CT coronary angiography (CTCA) and MPS were performed within 2 weeks. CT first-pass MPI detected myocardial ischemia results through analyzing the raw date of CTCA were compared with MPS results. RESULTS: The sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CT first-pass MPI at rest for detecting myocardial ischemia were 92% (12/13), 78% (7/9), 86% (12/14), 88% (7/8) and 86% (19/22), respectively. CONCLUSION: CT first-pass MPI at rest could detect myocardial ischemia with an accuracy similar to that of MPS.

[Ex vivo assessment of coronary lesions by optical coherence tomography and intravascular ultrasound in comparison with histology results].

OBJECTIVE: To explore the diagnostic accuracy of optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in the detection of ex vivo coronary plaques with different compositions compared with histology results. METHODS: OCT and IVUS were performed in 15 autopsied heart specimens and the isolated coronary artery was assessed by routine histological processing thereafter. Coronary plaques were classified into 3 types (lipid-rich plaque, calcified plaque and fibrous plaque) according to standard criteria respectively. Sensitivity and specificity for detection of different types of plaque by OCT and IVUS were calculated according histology results. RESULTS: Seventy seven coronary plaques were analyzed. OCT demonstrated a sensitivity and specificity of 69% and 88% for lipid-rich plaque, 93% and 92% for calcified plaque, 88% and 98% for fibrous plaque. IVUS demonstrated a sensitivity and specificity of 61% and 92%, 98% and 97%, 68% and 90% respectively. The agreement between OCT and IVUS in assessment of coronary plaque was 0.831 (Kappa = 0.72, P < 0.01). CONCLUSIONS: Both OCT and IVUS correctly detected ex vivo coronary plaques and there was a good agreement in assessment of coronary plaques between OCT and IVUS. OCT is superior to IVUS in assessment of fibrous plaque and is similar as IVUS in assessment of calcified plaque.

Incidence, predictors, and clinical impact of tissue prolapse after coronary intervention: an intravascular optical coherence tomography study.

OBJECTIVES: To evaluate the predictors of tissue prolapse after stenting and whether this phenomenon can affect the clinical outcome. METHODS: All consecutive patients who underwent optical coherence tomography (OCT) examination after stent implantation were included. Qualitative and quantitative assessment of tissue prolapse after stent implantation was performed. The lesions were classified into 4 groups according to the severity of tissue prolapse. We analyzed the clinical, procedural, and image-based predictors of severe tissue prolapse and evaluated the clinical impact of tissue prolapse. RESULTS: Tissue prolapse within the stented segment was visible in 102/104 (98.08%) cases. The frequency and severity of tissue prolapse was similar in acute coronary syndrome (ACS) and non-ACS lesions. The OCT-defined thin cap fibroatheroma (TCFA) was related with severe tissue prolapse (≥ grade III) (r = 17.722, p < 0.001). No difference in events was observed among different tissue prolapse groups during the hospitalization period and 1-year follow-up. CONCLUSIONS: The incidence of tissue prolapse after stent implantation was relatively high, irrespective of the clinical presentation. OCT-defined TCFA lesions were more likely with severe tissue prolapse (≥ grade III). Tissue prolapse was not associated with clinical events during the hospitalization period and 1-year clinical follow-up.

Correlation between acute coronary syndrome classification and multi-detector CT characterization of plaque.

OBJECTIVE: To determine if multi-detector CT (MDCT) characterization of plaque is correlated with the classification of acute coronary syndrome (ACS). METHODS: Altogether 1900 patients were examined by MDCT from December 2007 to May 2009, of whom 95 patients fulfilled the criteria of ACS. Those patients were divided into the discrete plaque group ( n=61) and diffuse plaque group ( n=34) based on the findings in MDCT. The clinical diagnosis of ACS and CT results were analyzed, including segment stenosis score, segment involvement score, 3-vessel plaque score, left main score, calcification score, and remodeling index. The incidences of major adverse cardiac events in follow-up period were also recorded. RESULTS: The patients of the diffuse plaque group were older than those of the discrete plaque group ( Pü0.0001). The diffuse plaque group presented more cases of hypertension, peripheral artery disease, diabetes, and heart failure than discrete plaque group (all P<0.05). All the 5 patients with ST-segment elevation myocardial infarction were found in discrete plaque group. The segment stenosis score of the discrete plaque group was lower than that of the diffuse plaque group(5.15±3.55 vs. 14.91±5.37, Pü0.001). The other four scores demonstrated significant inter-group difference as well (all P<0.05). The remodeling index of thediscrete plaque group was higher (1.12±0.16 vs.0.97±0.20, Pü0.05). Follow-up data showed that major adverse cardiac events occurred more frequently in diffuse plaque group than in discrete group (29.41% vs. 11.48%, P=0.0288). CONCLUSIONS: Characteristics of discrete and diffuse plaques may be significantly different among different classes of ACS. The diffuse plaque may present higher risk, correlated to higher mortality. The diagnosis of discrete and diffuse plaques by MDCT would provide a new insight into the prognosis and treatment of ACS.

[Value of combined CT coronary angiography and adenosine stress myocardial perfusion scintigraphy for diagnosis of coronary artery disease].

OBJECTIVE: To assess the accuracy and feasibility of combination of CT coronary angiography (CTCA) and adenosine stress myocardial perfusion scintigraphy (MPS) for diagnosis of coronary artery disease (CAD). METHODS: CTCA, MPS were performed in 105 patients with suspected or diagnosed CAD within 4 weeks before coronary angiography (CAG) examination. RESULTS: The sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were 97.1%, 75.0%, 88.2%, 93.1% and 89.5%, respectively, for CTCA; 79.7%, 63.9%, 80.9%, 62.2% and 74.3%, respectively, for MPS and 97.2%, 98.5%, 98.5%, 89.7% and 95.2%, respectively, for CTCA + MPS. CONCLUSION: Combination of CTCA and adenosine stress MPS, which provided both anatomical and functional information of coronary vessels, could significantly increase the specificity and PPV of diagnosing CAD with CTCA.

[Changes of vasoactive substances in myocardium of chronic renal ischemia rats].

OBJECTIVE: To investigate the relationship between the vasoactive substances including endothelin-1 (ET-1), calcitonin gene-related peptide (CGRP), and nitric oxide (NO) in myocardium and the cardiac functions in chronic renal ischemia rats. METHODS: Male Wistar rats weighting 180-200 g were randomly divided into 2 groups: operation group (n=30) and sham operation group (n=10). A ligation of abdominal aorta between right and left renal artery was made by silk suture in operation group and the necrosis degree of aorta was about 50%. Aorta was not ligated in sham operation group. Sixteen weeks after operation, invasive measurement of blood pressure and cardiac function were performed, and content of ET-1, CGRP, and NO in myocardium were determined. RESULTS: Compared with sham operation group, blood pressure significantly increased in the operation group after ligation, along with decreased cardiac systolic and diastolic function, increased left ventricular mass index. After 16 weeks, compared with sham operation group, the content of ET-1 in cardiac tissue were significantly elevated in operation group [(361.0+/-118.7) vs. (503.4+/-139.6 ) pg/ml, P<0.01), along with significantly decreased CGRP content [(74.4+/-24.8) vs. (45.4+/-15.1) pg/ml, P<0.01). The content of ET-1 in cardiac tissue was negatively correlated with the maximum pressure rise rate of left ventricular r=-0.37, P<0.05). CONCLUSIONS: Chronic kidney ischemia caused by abdominal aorta ligation may result in the increase of ET-1 content in cardiac tissue and decrease of CGRP decreased. The content of ET-1 in cardiac tissue is also negatively correlated with left ventricular systolic function.

[Relationship between computed tomography coronary angiography and adenosine stress myocardial perfusion imaging for the assessment of coronary artery disease].

OBJECTIVE: To compare the accuracy of computed tomography coronary angiography (CTCA) and adenosine stress myocardial perfusion imaging in the diagnosis of coronary artery disease (CAD) and discuss their relationship. METHODS: Fifty-six patients, suspected or diagnosed as CAD, were performed with CTCA, MPI and coronary angiography (CAG) within 3 weeks. They were divided into 3 groups: no CAD, no obstructive CAD (coronary artery stenosis < 70%) and obstructive CAD (coronary artery stenosis > or = 70%). RESULTS: 5 patients were diagnosed as no CAD. 19 patients were diagnosed as no obstructive CAD and 32 patients were diagnosed as obstructive CAD by CTCA. While adenosine stress MPI suggested 26 patients normal, 18 patients had IPD and 29 patients had RPD. The sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CTCA were 100%, 55.6%, 92.2% and 100% versus 78.6%, 71.4%, 73.3% and 76.9% respectively for adenosine stress MPI. CONCLUSION: CTCA and adenosine stress MPI provide different and complementary information on CAD, anatomical versus functional. As compared with CAG, CTCA has a high accuracy of detecting CAD.

[Differences between adipose-derived stem cells and mesenchymal stem cells in differentiation into cardiomyocytes].

Adipose-derived stem cells (ASCs) are similar to bone marrow mesenchymal stem cells (MSCs) in growth kinetics, antigen expression and multi-lineage differentiation capacity. The present study was designed to investigate the differences between ASCs and MSCs in in vitro culture and differentiation into cardiomyocytes. ASCs were isolated from the fat tissue of New Zealand white rabbits while MSCs were obtained from rat bone marrow. Both ASCs and MSCs were cultured in Iscove's modified Dulbecco's medium supplemented with 15% fetal bovine serum in the same incubator and treated with various concentrations of 5-azacytidine. A clonogenic assay was used to quantify ASCs in fat tissue and MSCs in bone marrow. The number of ASCs in the fat tissue was much higher than that of MSCs in the bone marrow quantified by clonogenic assay, and MSCs showed a remarkably slower proliferative rate compared with ASCs, especially at primary passage. ASCs began to attach to the bottom of the culture flask 12 h after seeding. The cells in culture assumed a short spindle shape under a phase-contrast microscope and did not form clusters. The phenotype was maintained through repeated subcultures under nonstimulating conditions. No other cell phenotype was observed. MSCs attached to the culture flask at 24-48 h after seeding and grew in clusters. The cells were fibroblast-like and prone to senescence or differentiation into adipose cells. Both ASCs and MSCs before treatment with 5-azacytidine were stained positively for CD29, CD44 and CD105 but negatively for CD34 and CD45, α-sarcromeric actin, cardiac troponin T and von Willebrand factor. ASCs differentiated into cardiomyocytes only after treatment with 6-9 µmol/L of 5-azacytidine, while MSCs differentiated into cardiomyocytes with 3-15 µmol/L of 5-azacytidine. After treatment with ideal dose of 5-azacytidine, ASCs began to change their morphology and showed multinucleation within the first week and formed a ball-like appearance thereafter, while MSCs showed multinucleation at the second week and formed a stick-like appearance at 3-4 weeks. The percentage of ASCs differentiated into cardiomyocytes after treatment with 5-azacytidine was significantly higher than that of MSCs. The age of animal had no significant influence on the tissue content, proliferation and differentiation rate of ASCs. However, the tissue content of MSCs in bone marrow decreased with increased age of animal and MSCs from old donor rats exhibited less myogenic cells than those from the young rats after exposure to 5-azacytidine. These results indicate that ASCs have advantages over MSCs in tissue content, homology, growth and differentiation rate, suggesting that ASCs are more suitable for cellular cardiomyoplasty than MSCs.