Instant and short-term effects of acupuncture for depression and anxiety in unstable angina pectoris patients with percutaneous coronary interventions.

Aim: Patients with unstable angina pectoris (UAP) usually present anxiety or depression during percutaneous coronary intervention (PCI). This study sought to investigate the instant and short-term effects of acupuncture for anxiety and depression in UAP patients with PCI. Methods: A total of 210 UAP patients who underwent PCI were recruited and randomly assigned (1:1:1) to acupuncture, placebo, or control groups. Enzyme-linked immunosorbent assay was used to detect the levels of fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), interleukin-6 (IL-6), high-sensitivity C-reactive protein (Hs-CRP), advanced oxidation protein products (AoPPs), and oxidized low-density lipoprotein (OX-LDL). Serial questionnaires with the Hamilton Anxiety (HAMA) scale and the Pittsburgh Sleep Quality Index were evaluated, and heart rate variability indicators were obtained. Results: Primary end-point: low frequency/high frequency (HF) was lower in the electroacupuncture group (p = 0.014), while standard deviation of normal-to-normal intervals, average standard deviation of normal-to-normal intervals, percentage of successive intervals that differ more than 50 ms, and HF were increased with acupuncture (p = 0.018, p = 0.043, p = 0.016, and p = 0.002, respectively). Secondary end-point: significant improvements in anxiety levels (HAMA) were observed in the three groups (p < 0.001). The fasting insulin and HOMA-IR levels were similar between the control group and the acupuncture group (p = 0.285 and p = 0.165, respectively). The levels of IL-6 and AoPPs differed among the three groups (p = 0.021 and p < 0.001, respectively). However, no significant differences were found in fasting plasma glucose, fasting c-peptide, Hs-CRP, and OX-LDL levels among the three groups (p = 0.585, p = 0.611, p = 0.902, and p = 0.756, respectively). Conclusions: In this study, short-term acupuncture may potentially relieve clinical symptoms before PCI treatment. Clinical Trial Registration: ClinicalTrials.gov, identifier (NCT03789344).

[The limitation of MB isoenzyme of creatine kinase mass in assess myocardial injury with muscular disease].

OBJECTIVE: To examine the changes in serum MB isoenzyme of creatine kinase mass (CK-MB mass), cardiac troponin I (cTnI), and myoglobulin (Mb) in children with myocarditis and muscular disease in order to evaluate the significance of index CK-MB mass for the diagnosis of myocardium injury in these diseases. METHODS: Blood samples were collected from 40 children with myocarditis, 38 children with muscular diseases, and 10 healthy children, for the measurement of creatine kinase (CK), CK-MB activity, CK-MB mass, cTnI, and Mb. Myocarditis patients also received electrocardiogram and pulse Doppler electrocardiogram examination while muscular diseases patients were subjected to electro-myographic examination, inherit-metabolic diseases screening and related gene analysis. The data were analyzed for differences between groups, and differences between values before and after the treatment. RESULTS: In comparison with healthy controls [CK (U/L): 95.0 ± 27.0, CK-MB activity (U/L): 22.6 ± 1.3, CK-MB mass (µg/L): 2.4 ± 0.3, cTnI (µg/L): 0.012 ± 0.001], the patients with myocarditis had significantly (all P < 0.01) higher mean values in CK (1033.0 ± 408.0), CK-MB activity (101.2 ± 31.5), CK-MB mass (38.2 ± 13.2) and cTnI (5.544 ± 1.554) before the treatment. After 2 weeks of treatment these indexes returned to the level of controls, with cTnI responded the last (CK: 59.3 ± 25.1, CK-MB activity: 24.6 ± 13.2, CK-MB mass: 3.3 ± 2.9, cTnI: 0.125 ± 0.128). One week after treatment, the incidences of CK and CK-MB mass elevation were significantly lower than the values before the treatment [CK: 5.9% (1/17) vs. 56.4% (22/39); CK-MB mass: 8.3% (1/12) vs. 61.1% (22/36), both P < 0.01], with the change in CK-MB mass appeared significantly earlier than cTnI [8.3% (1/12) vs. 73.7% (14/19), P < 0.05]. The patients with muscular disease also had significantly elevated mean value in CK (10193.0 ± 1447.0), CK-MB activity (311.7 ± 44.4), and CK-MB mass (229.2 ± 47.9) in comparison with healthy controls before the treatment (all P < 0.01). But their cTnI (0.021 ± 0.002) was not significantly different from the control at this time. Two weeks after treatment, the elevated indexes were still significantly higher than the control (CK: 5735.6 ± 6187.8, CK-MB activity: 170.7 ± 143.0, CK-MB mass: 207.4 ± 136.6), while the level of cTnI (0.230 ± 0.150) remained at the level of the control group. The incidence of index elevation was not significantly different from the values before the treatment for all the indexes tested [CK: 85.7% (6/7) vs. 97.4% (37/38); CK-MB activity: 85.7% (6/7) vs. 97.4% (37/38); CK-MB mass: 100.0% (2/2) vs. 94.1% (32/34); cTnI: 0(0/1) vs. 6.4% (2/31), all P > 0.05]. CONCLUSIONS: In patients with myocarditis, CK-MB mass and cTnI both follow a consistent pattern of change: elevated in the acute stage of the disease but return to normal after recovery. In patients with muscular diseases, these 2 indexes have different pattern of change. CK-MB mass is significantly higher than control even after the treatment, while cTnI value remain unchanged. Therefore, CK-MB mass has very limited value as an index for myocardial injury in these patients.

The Complementary Relationship Between Echocardiography and Multi-Slice Spiral CT Coronary Angiography in the Diagnosis of Coronary Artery Thrombosis in Children With Kawasaki Disease.

Aim: To compare the diagnostic values by using transthoracic echocardiography (ECHO) and multi-slice spiral CT coronary angiography (CTCA) for identifying coronary artery thrombosis in children with Kawasaki disease (KD). Methods: Total 97 KD children with coronary artery dilation complications in our hospital from June 2012 to December 2020 were included in the study. CTCA and ECHO were performed after over 1 month of illness. Results: Coronary artery thrombosis was found in 14 out of 97 patients. Among them, 10 were identified as positive by CTCA, 9 were identified as positive by ECHO, and 5 were identified as positive by both CTCA and ECHO. Conclusion: Both CTCA and ECHO can be used to diagnose coronary artery thrombosis. ECHO has advantage in identifying low-density thrombus, and CTCA is better for the clot in distal coronary artery. They can complement each other.

Correlation Between Arrhythmia and the Prognosis in Children With EFE/LVNC/DCM.

Aim: To explore the correlation between different phenotypes of arrhythmia and the prognosis in children with EFE/LVNC/DCM. Methods: A total of 167 children with cardiomyopathy diagnosed and treated in Shengjing Hospital between January 2010 and May 2019 were evaluated. After patient screening, 31 patients with endomyocardial fibroelastosis (EFE), left ventricular non-compaction, or dilated cardiomyopathy with significant arrhythmias were selected. In addition, 42 children with primary EFE were selected to evaluate the prognosis with or without arrhythmia. Follow-up was undertaken 0, 1, 3, 6, 9, and 12 months after treatment. Results: We revealed the outcomes for five types of cardiomyopathy: EFE patients with Wolff-Parkinson-White syndrome B and supraventricular tachycardia, intraventricular block and complete left bundle branch block recovered slower than EFE patients with atrial flutter and atrial fibrillation, even slower than EFE with ventricular tachycardia. The average recovering time for LVEF and LVED in EFE patients without arrythmia was 10 months after diagnosis, while 76.9% (3/13 cases) of those with significant arrythmia hadn't recovered until 24 months after diagnosis. Three of patients died at 6, 7, and 6 and half years after diagnosis. Conclusion: The long-term prognosis in children with cardiomyopathy is associated with the type of arrhythmia and time of intervention. The prognosis of EFE patients with arrhythmia is worse than EFE patients without arrhythmia. Patients with Wolff-Parkinson-White syndrome B, especially a significantly widen QRS complex, carry a poor prognosis if radiofrequency ablation is not undertaken. CLBBB patients have similar poor prognosis if proper pacemaker is not implanted timely.

[Value of multislice spiral computed tomography in finding coronary artery lesion in children with Kawasaki disease].

OBJECTIVE: Kawasaki disease is an acute systemic vasculitis syndrome primarily affecting small and medium-sized arteries, with development of severe coronary artery lesion (CAL). CAL may induce myocardial infarction and sudden death. So it is very important to find CAL early. In this study the value of multislice spirral computed tomography (MSCT) was investigated to find CAL in patients with Kawasaki disease. METHODS: Thirty-four patients with Kawasaki disease were examined respectively by using MSCT and two dimensional echocardiography (TDE), then the findings were analyzed. RESULTS: MSCT showed CAL in 12 of 34 patients involving 16 coronary arteries, including 9 (26%) dilated left coronary arteries (LCA), 1 constricted, 1 calcified and 1 LCA which had both stenosis and 4 (12%) dilated right coronary artery. TDE showed that 10 patients had 13 dilated coronary arteries, including 7 (21%) left coronary arteries and 6 (18%) right coronary arteries. TDE failed to show the abnormalities in 3 patients with coronary artery stenosis or calcification and in 2 patients with left descending artery dilation demonstrated by MSCT. However, no significant difference was found between the two methods (P > 0.05) in the rates of positive findings. The correlation between TDE and MSCT, in left as well as right coronary artery, was significantly positive (r = 0.90, r = 0.82, respectively, P < 0.01). However, compared with TDE, MSCT was significantly better in finding coronary artery stenosis and calcification (chi(2) = 24.3, P < 0.01). CONCLUSIONS: Use of MSCT may help better find the lesions of coronary artery, especially those in middle and distant sections as compared to TDE. MSCT is better than TDE in exploring coronary wall calcification and coronary artery stenosis. MSCT could be a helpful new addition to the current CAL monitoring method in long-term follow-up of patients with Kawasaki disease.