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Objective:To investigate the efficacy of trimetazidine in the treatment of atrial arrhythmias in patients with ischemic cardiomyopathy and heart failure and analyze the effect of trimetazidine on cardiac function and atrial arrhythmias.Methods:A total of 79 patients with ischemic cardiomyopathy and heart failure who received treatment at the Second Hospital of Jiaxing from December 2018 to June 2020 were included in this study. These patients were randomly divided into an observation group ( n = 41) and a control group ( n = 38). Patients in the control group received conventional drugs, while those in the observation group received trimetazidine sustained-release tablets twice daily, each time taking 35 mg in addition to conventional drugs. The treatment lasted for 24 weeks. Before and after treatment, cardiac function indicators (left ventricular ejection fraction, B-type brain natriuretic peptide, 6-minute walking distance), cardiac color Doppler ultrasound indicators [ratio of early to late peak filling rate (E/A ratio)], left ventricular fractional shortening), electrocardiogram parameters (maximum P-wave duration, minimum P-wave duration, and P-wave dispersion), dynamic electrocardiogram parameters [number of single atrial premature beats, total number and duration of paroxysmal atrial tachycardia episodes, total number and duration of paroxysmal atrial flutter/fibrillation attacks, standard deviation of RR intervals, root mean square of successive differences between normal heartbeats, proportion of successive RR intervals that differ by more than 50 ms divided by the total number of NN intervals (PNN50), standard deviation of average NN intervals, high frequency and low frequency], as well as changes in high sensitivity C-reactive protein were analyzed in each group. Results:After treatment, left ventricular ejection fraction, B-type brain natriuretic peptide, 6-minute walking distance, maximum P-wave duration, P-wave dispersion, total number of atrial flutter/atrial fibrillation attacks, and duration of atrial flutter/atrial fibrillation in the observation group were (51.05 ± 7.68)%, (1 615.59 ± 1 129.78) ng/L, (350.02 ± 62.99) m, (99.73 ± 11.60) ms, (22.44 ± 12.03) ms, (0.22 ± 0.61), and (4.59 ± 12.30) minutes, respectively, which were significantly superior to (46.82 ± 7.34)%, (2 267.47 ± 1 539.03) ng/L, (294.16 ± 58.20) m, (111.71 ± 10.00) ms, (36.77 ± 15.07) ms, (0.76 ± 1.13), (15.66 ± 22.30) minutes in the control group, t = -2.95, 2.16, -4.08, 4.89, 4.68, 2.69, 2.76, all P < 0.01). Conclusion:Trimetazidine can effectively reduce atrial arrhythmias and improve the prognosis of patients with ischemic cardiomyopathy and heart failure, which warrants clinical promotion.
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Objective:To evaluate the correlation and consistency between quantitative coronary flow fraction (QFR) and cardiac magnetic resonance imaging (CMR) in assessing myocardial ischemia in patients with coronary heart disease (CAD).Methods:A retrospective analysis was conducted on the data of coronary heart disease patients who underwent load CMR examination and coronary angiography at the Beijing Anzhen Hospital, Capital Medical University from August 2017 to March 2022. CMR examination includes cardiac cine, load/rest myocardial perfusion imaging, and delayed enhancement sequence. According to the results of CMR examination, the patient′s left ventricular myocardial segments were divided into normal segment group and abnormal segment group (further divided into ischemic segment group and infarcted segment group). On the basis of coronary angiography, an artificial intelligence based platform (AngioPlus system) was applied to calculate the preoperative coronary artery QFR value of patients undergoing percutaneous coronary intervention treatment. Kappa test was used to evaluate the consistency of QFR and CMR in diagnosing abnormal myocardium; Mann Whitney U test was used to compare the differences in QFR between groups; The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of QFR in diagnosing abnormal myocardium; Spearman correlation analysis was used to clarify the relationship between myocardial infarction area and QFR value of the supplying coronary artery in patients.Results:Among the 70 CAD patients enrolled, there were 60 males and 10 females, aged (54.1±11.1)years. At the vascular level, the consistency between QFR and CMR in diagnosing myocardial injury (including ischemia and infarction) is moderate (Kappa value=0.514). The sensitivity and specificity of detecting abnormal myocardial segments in CAD patients were 57% and 91%, respectively. The area under the curve (AUC) value of QFR predicting abnormal myocardium in CAD patients was 0.769, and the optimal cutoff value was QFR=0.865. At this time, the sensitivity and specificity of QFR predicting myocardial injury in CAD patients were 67.2% and 84.3%, respectively. The difference in vascular QFR between the normal segment group, ischemic segment group, and infarcted segment group was statistically significant ( P<0.001), with the infarcted segment group having significantly lower QFR values than the other two groups (all P<0.01). The range of myocardial infarction was negatively correlated with the QFR value of the supplying coronary artery ( r=-0.45, P<0.001). At the patient level, the consistency between QFR and CMR in diagnosing myocardial injury (including ischemia and infarction) was moderate (Kappa value=0.445), with a sensitivity of 74% and a specificity of 81% for diagnosing myocardial injury in CAD patients. Conclusions:Compared with CMR, QFR has better specificity in detecting myocardial injury in CAD patients. The QFR value of the infarcted segment group is significantly lower than that of the ischemic group and the normal group. The area of myocardial infarction is negatively correlated with the QFR value of the supplying coronary artery.
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Objective:To explore the relationship between changes in levels of thrombomodulin (TM) and non high-density lipoprotein cholesterol (non-HDL-C) with ascending aortic elastic function and degree of coronary artery disease (CHD) in patients with coronary heart disease (CHD).Methods:A total of 147 patients with coronary heart disease diagnosed through coronary angiography at Yulin First Hospital from January 2018 to December 2022 were selected as the CHD group. In addition, 90 volunteers who underwent health examinations at our hospital and did not experience coronary artery disease were selected as the control group. Two groups were compared in terms of blood lipids [triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)], ascending aortic elastic function parameters [arterial dilation (AD), arterial stiffness index (ASI)], TM, non HDL-C levels, and other indicators, and stratified analysis was conducted according to the number of coronary lesions. The linear correlation analysis method was used to analyze the relationship between TM, non-HDL-C, Gensini score, and ascending aortic elastic function parameters.Results:The serum levels of TG, TC, LDL-C, TM, and non HDL-C in the CHD group were significantly higher than those in the control group, while the HDL-C levels were lower than those in the control group, with statistical significance (all P<0.05). The ASI of the ascending aorta in the CHD group was significantly higher than that in the control group, while the AD was lower than that in the control group, and the differences were statistically significant (all P<0.05). The serum levels of TG, TC, LDL-C, TM, and non HDL-C in CHD patients with multiple coronary artery lesions were significantly higher than those in patients with dual or single coronary artery lesions, and the HDL-C levels were lower than those in patients with dual or single coronary artery lesions, with statistical significance (all P<0.05); The serum levels of TM and non HDL-C in CHD patients with dual coronary artery disease were significantly higher than those in single coronary artery disease patients, and the HDL-C levels were lower than those in single coronary artery disease patients, with statistical significance (all P<0.05). The ASI of CHD patients with multiple coronary artery lesions was significantly higher than that of patients with dual or single coronary artery lesions, and the AD was lower than that of patients with dual or single coronary artery lesions, with statistical significance (all P<0.05); The ASI of CHD patients with dual coronary artery disease was significantly higher than that of patients with single coronary artery disease, and the AD was lower than that of patients with single coronary artery disease, with statistical significance (all P<0.05). The TM, non HDL-C levels in CHD patients were significantly negatively correlated with AD (all P<0.05), and positively correlated with ASI and Gensini scores (all P<0.05). Conclusions:The levels of TM and non HDL-C in CHD patients significantly increase, and the ascending aortic elasticity function was decreased. TM and non HDL-C are related to coronary elasticity function and the severity of coronary artery disease.
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Objective To observe characteristics of atherosclerotic plaque of coronary heart disease(CHD)with different traditional Chinese medicine(TCM)syndrome type based on intravenous ultrasound(IVUS).Methods Data of 116 CHD patients were retrospectively analyzed.The patients were divided into syndrome of blood stasis due to qi deficiency(n=33),syndrome of blockade of phlegm-turbidity(n=42)as well as syndrome of intermin-gled phlegm and blood stasis(n=41)according to TCM syndrome differentiation.IVUS was performed to compare lesion vessel and plaque characteristics among different syndromic types of CHD.Results The lipid pool area,extravascular elastic membrane area,remodeling index,plaque eccentricity index of CHD with syndrome of blood stasis due to qi deficiency were all larger than those of syndrome of blockade of phlegm-turbidity as well as syndrome of intermin-gled phlegm and blood stasis(all P＜0.05).The proportion of fibrous-fatty within plaques of syndrome of blood stasis due to qi deficiency was bigger than that of syndrome of intermin-gled phlegm and blood stasis(P＜0.05).The lipid pool area,extravascular elastic membrane area and plaque eccentricity index of CHD of syndrome of blockade of phlegm-turbidity were smaller than,while the proportion of necrotic core within plaques was bigger than those of syndrome of intermin-gled phlegm and blood stasis(all P＜0.05).Conclusion Atherosclerotic plaque characteristics in CHD with different TCM syndrome types were different,and the plaque stability of syndrome of blood stasis due to qi deficiency was the worst.
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Objective:To investigate the clinical value of multiparametric myocardial imaging using a dual-layer detector spectral CT in the non-invasive preoperative assessment of patients with coronary atherosclerotic heart disease (CHD) undergoing percutaneous coronary intervention (PCI).Methods:The clinical and imaging data of 90 patients who underwent coronary CT angiography (CCTA) with dual-layer spectral detector CT and invasive coronary angiography (ICA) within 30 days at the Affiliated Changshu Hospital of Nantong University from January 2021 to October 2022 were retrospectively analyzed. A total of 189 coronary arteries were included in the study cohort. The patients were divided into PCI ( n=44) and non-PCI groups ( n=46) according to whether they received PCI after evaluation with ICA. The diameter stenosis rate of the coronary arteries, myocardial iodine concentration (IC) and effective atomic number (Z eff) values were obtained from CCTA conventional and spectral images. The IC values and Z eff values of the myocardium in the areas with abnormal perfusion were compared with those in the areas with normal perfusion. The diagnostic performance of these parameters, as well as their combined model, was evaluated and compared using receiver operating characteristic (ROC) curve and area under the curve (AUC) in the pre-PCI assessment of patients with CHD. Results:Baseline patient data did not show statistically significant differences between the PCI and non-PCI groups (all P>0.05). There were statistically significant differences in IC values [(0.42±0.28) and (2.26±0.48) mg/ml] and Z eff values (7.39±0.33 and 8.50±0.25) between the myocardium areas with abnormal perfusion and the myocardium areas with normal perfusion in all patients (all P<0.001). The AUC for assessing whether patients with CHD need PCI treatment using myocardial IC and Z eff values were 0.865 and 0.853, respectively, which were significantly higher than assessment based only on lumen diameter stenosis rate (AUC=0.726, P<0.001). Conclusions:The IC and Z eff derived from myocardial spectral images can be used to diagnose myocardial perfusion abnormalities in patients with CHD. The spectral myocardial multi-parameters imaging shows promising potentials in pre-PCI assessment of patients with CHD, which can improve the efficiency of evaluation and may help to avoid unnecessarily invasive procedures.
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Objective To investigate the protective and treatment role of ulinastatin(UTI)on con-trast-induced acute kidney injury(CIAKI)in the elderly with coronary heart disease(CHD)and chronic kidney diseases(CKD).Methods A total of 321 elderly CHD inpatients complicated with CKD undergoing coronary angiography admitted in the First Medical Center of Chinese PLA Gen-eral Hospital from November 2021 to November 2022 were enrolled consecutively and then divid-ed into UTI group(n=161)and hydration group(n=160).Their cardiac and renal function pa-rameters were collected and analyzed before and 2 d after intervention.The changes in above pa-rameters and incidence of CIAK were observed and compared between the two groups.Results In 2 d after intervention,the UTI group had significantly lower Scr,urea,CysC,homocysteine and NT-proBNP,but higher eGFR than the hydration group(P＜0.01).There were 62 patients(62/321,19.3％)developing CIAKI,including 17 from the UTI group and 45 from the hydration group,and statistical difference was observed in the incidence(10.6％vs 28.1％,P＜0.01).For the patients with comorbidities of hypertension,diabetes,hyperlipidemia and hyperuricemia,the incidence of CIAKI was obviously lower in the UTI group than the hydration group(P＜0.01).Multivariate logistic regression analysis showed that UTI was an independent protective factor for occurrence of CIAKI(OR=0.348,95％CI:0.180-0.673,P=0.001).Conclusion UTI can im-prove renal function and reduce the risk of CIAKI in elderly CHD patients with CKD.
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Objective To explore the efficacy and safety of enhanced external counterpulsation(EECP)in elderly patients with acute ischemic stroke(AIS)complicated by coronary heart dis-ease(CHD).Methods A total of 65 AIS patients with CHD admitted in our hospital from Janu-ary to June 2023 were recruited and randomly divided into a control group(drug secondary pre-vention,n=32)and a treatment group(drug combined with EECP therapy,n=33).Their NIHSS score,mRS score and Canadian Cardiovascular Society(CCS)angina grade were evaluated before and after treatment and compared between the two groups.The incidences of recurrent ischemic stroke,new hemorrhagic stroke and major adverse cardiovascular events(MACE)were also recor-ded during treatment.Results The NIHSS score and mRS score were significantly decreased in both groups after treatment(P＜0.01).After treatment,the NIHSS score(2.67±1.63 vs 3.56± 1.83),mRS score[1.0(0.0,1.0)vs 2.0(1.0,2.0)]and CCS grade[1.0(1.0,2.0)vs 2.0(1.0,2.0)]were obviously lower in the treatment group than the control group(P＜0.05,P＜0.01).There were no statistical differences in the incidence rates of recurrent ischemic stroke,new-onset hem-orrhagic stroke,and MACE between the control group and the treatment group(9.4％vs 6.1％,6.3％vs 3.0％,12.5％vs 6.1％,P＞0.0 5).Conclusion EECP is a safe and effective treatment option for elderly AIS patients with CHD.
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Objective To investigate the levels of soluble tyrosine kinase-1(sFlt-1)and chemokine C-C ligand 3(CCL3)in serum of patients with coronary heart disease(CHD)and their correlation with the severity of the disease.Methods A total of 230 elderly CHD patients admitted to the De-partment of Cardiovascular Medicine of Xinxiang Central Hospital from November 2020 to No-vember 2022 were collected as the study subjects(CHD group),and according to their Gensini score,they were divided into mild(n=89),moderate(n=95),and severe(n=46)CHD sub-groups.Another 230 healthy individuals who taking physical examination during the same period served as the control group.ELISA was applied to measure serum levels of sFlt-1 and CCL3.ROC curve was plotted to analyze the diagnostic values of serum sFlt-1 and CCL3 levels for CHD.Pear-son correlation analysis was employed to analyze the relationship between serum sFlt-1 and CCL3 levels and the CHD severity.Results The serum levels of sFlt-1 and CCL3 were obviously higher in the CHD group than the control group(121.71±29.80 ng/L vs 98.70±17.57 ng/L,18.22± 5.41 ng/L vs 13.68±3.89 ng/L,P＜0.01).ROC curve analysis showed that the AUC value of the two indicators combined together was significantly greater than that of them alone in diagnosis of CHD(0.886 vs 0.791,0.775,P＜0.01).The serum levels of sFlt-1 and CCL3 were increased along with the severity of the disease and Gensini score when the levels and the score were compared among the mild,moderate and severe subgroups(P＜0.05).Pearson correlation analysis indicated that the serum levels of sFlt-1 and CCL3 were positively correlated with the Gensini score(r=0.420,r=0.479,P＜0.01).Conclusion The levels of serum sFlt-1 and CCL3 are obviously ele-vated in CHD patients,and closely associated with the severity of coronary lesions.
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Objective:To predict Chinese materia medica that may prevent and treat coronary microvascular dysfunction (CMD) by identifying disease core targets.Methods:CMD- related targets were obtained through GeneCards and OMIM databases. Subnetworks were extracted by using MCODE plugin in Cytoscape 3.9.1. Core targets of subnetworks were obtained by using cytoNCA plugin. GO function and KEGG pathway enrichment analysis for core targets were performed by using Metascape. Coremine Medical database was used to match targets with Chinese materia medica. Obtained Chinese materia medica was screened, and their properties and tastes, meridians and efficacy categories were under statistics.Results:Totally 3 859 disease-related targets were screened and five subnetworks were obtained. An in-depth study of MCODE1 yielded ten core targets, including IL-1β, IL6, TNF, STAT3, AKT1, ACTB, VEGFA, GAPDH, TP53, and ALB. GO functional enrichment analysis showed that these core targets were mainly involved in biological processes, such as positive regulation of gene expression, positive regulation of transcription, DNA template, and negative regulation of gene expression. KEGG pathway enrichment analysis identified 67 signaling pathways, including the AGEs-RAGE signaling pathway, HIF-1 signaling pathway, adipocytokine signaling pathway, fluid shear stress, and atherosclerosis. The researchers identified 36 kinds of Chinese materia medica associated with the ten core targets, including Salviea Miltiorrhizae Radix et Rhizoma, Chuanxiaong Rhizoma, Carthami Flos, Paeoniae Radix Rubra, Coptidis Rhizoma, Ginseng Radix et Rhizoma, Ophiopogonis Radix, Schisandrae Chinensis Fructus, Cinnamomi Cortex, Nelumbinis Semen, and Valerianae Jatamansi Rhizoma et Radix among 880 herbs.Conclusion:This study predicts 36 kinds of Chinese materia medica that have the effect of preventing and treating CMD, which can provide research ideas for the development of new drugs.
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Objective:With the help of SWOT(S: internal strengths, W: internal weaknesses, O: external opportunities, T: external threats)analysis, to explore the internal and external conditions of internet-based cognitive behavioral therapy applied to improve the negative emotions of patients with coronary heart disease, and to propose development strategies.Methods:SWOT analysis was used to analyze and sort out the internal strengths and internal weaknesses, external opportunities and external threats of internet-based cognitive behavioral therapy in improving the negative emotions of patients with coronary heart disease.Results:The internal strengths of internet-based cognitive behavioral therapy in improving the negative emotions of patients with coronary heart disease were significant therapeutic effect, strong operability and high cost-effectiveness. The internal weaknesses included excessive dependence on patients′ treatment enthusiasm, and a lack of psychological training among nurses. The external opportunities included demand support, technical support, and theoretical support. The external threats were the lack of large-scale empirical research and the risk of patient personal information leakage.Conclusions:In the clinical application of internet-based cognitive behavioral therapy to improve the negative emotions of patients with coronary heart disease, both strengths and weaknesses coexist, and opportunities and threats coexist. Only by taking strengths of opportunities to overcome weaknesses, improve the autonomy and enthusiasm of patients in treatment, and increase the psychological training of medical staff, can internet-based cognitive behavioral therapy be further promoted in the clinical application of improving the negative emotions of patients with coronary heart disease.
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Objective:To study influence of exercise rehabilitation based on psycho-cardiology medical model on pa-tients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods:A total of 164 CHD patients undergoing PCI in our hospital were randomly and equally divided into routine nursing group and exer-cise rehabilitation group(received exercise rehabilitation based on psycho-cardiology medical model based on rou-tine nursing group).Both groups were intervened for six months.General clinical data,score of somatic symptoms scale(SSS),cardiac function indexes:LVEF and LVEDV,6min walking distance(6MWD)and score of 36-item short-form heath survey(SF-36)were compared between two groups.Results:During follow-up,there were three cases lost in routine nursing group,and two cases lost and four cases stopped follow-up in exercise rehabilita-tion group.Compared with routine nursing group,six months after intervention,there were significant reductions in SSS score[(33.97±5.76)scores vs.(25.76±4.79)scores]and LVEDV[(125.33±16.14)ml vs.(119.53± 16.82)ml],and significant rise in LVEF[(56.28±4.46)％vs.(59.28±4.90)％],6MWD[(410.42±20.08)m vs.(439.69±20.66)m],scores of physical functioning[(19.20±4.22)scores vs.(23.76±3.98)scores],bodily pain[(7.42±1.99)scores vs.(8.84±1.94)scores],general health[(16.42±4.73)scores vs.(19.09±4.37)scores],vitality[16.0(7.0)scores vs.19.0(6.8)scores],role-emotional[(4.86±1.10)scores vs.(5.18± 0.86)scores],mental health[20.0(5.0)scores vs.24.0(8.8)scores]of SF-36 in exercise rehabilitation group(P＜0.05 or＜0.01).Conclusion:Exercise rehabilitation based on psycho-cardiology medical model can signifi-cantly improve cardiac function and psychological status,and improve quality of life in patients with coronary heart disease after PCI.
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Objective:To explore the application value of posture adaptation training combined with continuous pas-sive exercise rehabilitation for patients after coronary artery bypass grafting(CABG).Methods:A total of 100 pa-tients with coronary heart disease(CHD)undergoing CABG in our hospital were enrolled,divided into single group(n=50,received single continuous passive exercise rehabilitation intervention)and combined group(n=50,re-ceived posture adaptation training based on single group)according to color grouping method.Both groups were in-tervened for two months.Clinical indexes,cardiac function indexes,cognitive function,exercise endurance,serum levels of neuron specific enolase(NSE),S-100β protein and satisfaction were analyzed and compared between two groups.Results:Compared with single group after intervention,there were significant reductions in first out of bed time,first anal exhaust time and length of hospital stay,and significant rise in left ventricular ejection fraction(LVEF),cardiac index(CI),left ventricular fractional shortening(LVFS),score of Montreal cognitive assessment(MoCA)scale,6min walking distance,and significant reductions in serum levels of NSE[(19.93±1.90)μg/L vs.(16.59±2.25)μg/L]and S-100β protein[(6.72±0.34)μg/L vs.(3.96±0.19)μg/L]in combined group,P=0.001 all.Satisfaction in combined group was significantly higher than that of single group(94.00％vs.80.00％,P=0.037).Conclusion:Posture adaptation training combined with continuous passive exercise rehabilitation can sig-nificantly improve the clinical indexes,promote cardiopulmonary function and cognitive function recovery in pa-tients undergoing coronary artery bypass grafting after operation.
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Objective:To observe the effect of Zhibitai capsule combined with pitavastatin on blood lipid levels in pa-tients with coronary heart disease(CHD).Methods:A total of 180 CHD patients who were treated in our hospital from Mar 2018 to Feb 2021 were selected.According to random number table method,they were divided into pita-vastatin group(n=90)and combined treatment group(n=90,received Zhibitai capsule combined with pitavasta-tin),and both groups were treated for eight weeks.Clinical therapeutic effect,levels of blood lipids and inflamma-tory factors before and after treatment,and incidence of adverse reactions were observed and compared between two groups.Results:Total effective rate of combined treatment group was significantly higher than that of pitavas-tatin group(94.44％vs.80.00％,P=0.001).Compared with pitavastatin group after treatment,there were signif-icant reductions in serum levels of total cholesterol(TC)[(4.39±0.71)mmol/L vs.(2.86±0.56)mmol/L],tri-glyceride(TG)[(2.28±0.43)mmol/L vs.(1.46±0.39)mmol/L],low density lipoprotein cholesterol(LDL-C)[(2.93±0.50)mmol/L vs.(1.84±0.52)mmol/L],lipoprotein(a)[(124.57±11.37)mmol/L vs.(85.83± 11.96)mmol/L],interleukin-6(IL-6)[(21.28±3.64)pg/mlvs.(12.39±2.08)pg/ml],high mobility group box-1 protein B1(HMGB1)[(3.84±0.98)μg/L vs.(1.28±0.79)μg/L],tumor necrosis factor-α(TNF-α)[(4.06±0.62)ng/ml vs.(2.39±0.48)ng/ml],and significant rise in level of high density lipoprotein cholesterol(HDL-C)[(1.89±0.26)mmol/L vs.(2.63±0.31)mmol/L]in combined treatment group,P=0.001 all.There was no significant difference in incidence rate of adverse reactions between two groups,P=0.600.Conclu-sion:Zhibitai capsule combined with pitavastatin can effectively regulate blood lipids,reduce the levels of inflamma-tory factors in patients with coronary heart disease,which is safe and effective.
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Objective:To study influence of curcumin(Cur)on platelet activity in coronary heart disease.Methods:A total of 40 Wistar male rats were randomly and equally divided into normal group,model group(high-fat diet),as-pirin group(received aspirin based on model group)and Cur group(received Cur based on model group).Platelet aggregation rate,fluorescence intensity and positive rate of CD62p and PAC-1,plasma levels of β-thromboglobu-lin(β-TG)and platelet factor 4(PF4),expression levels of p-p38MAPK and p-JNK were compared among all groups.Results:Compared with normal group,there were significant rise in AA,ADP-induced platelet aggrega-tion rates,fluorescence intensity and positive rate of CD62p and PAC-1,plasma levels of β-TG and PF4,protein expression levels of p-p38MAPK and p-JNK in model group(P＜0.05 or＜0.01).Compared with normal group and model group,there were significant reductions in above indexes except CD62p positive rate in aspirin group and Cur group and CD26p positive rate in Cur group(P＜0.05 or＜0.01).Compared with model group,there were sig-nificant reductions in positive rates of CD26p in aspirin group and Cur group(P=0.001 both).Compared with as-pirin group,there were significant reductions in AA[(51.03±7.39)％vs.(38.43±4.04)％],ADP-induced platelet aggregation rates[(52.32±6.43)％vs.(40.81±5.52)％],fluorescence intensity[CD62p:(53.87±7.42)vs.(43.92±5.45),PAC-1:(59.39±8.01)vs.(42.43±7.39)]and positive rate[CD62p:(49.67±5.93)％vs.(40.36±5.83)％,PAC-1:(50.37±5.83)％vs.(41.44±6.29)％]of CD62p and PAC-1,protein expression levels of p-p38MAPK[(1.01±0.05)vs.(0.79±0.01)]and p-JNK[(1.07±0.03)vs.(0.74±0.02)]in Cur group(P＜0.05 or＜0.01).Conclusion:Cur can decrease platelet activity and inhibit p38MAPK and JNK signal ac-tivation.
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Objective:To study influence of seamless management concept intervention on patients with coronary heart dis-ease(CHD).Methods:A total of 98 CHD patients treated in our hospital were randomly and equally divided into routine intervention group(received routine follow-up management based on routine treatment)and seamless management group(received seamless management intervention based on routine treatment)according to random number table method.Both groups were intervened for one year.General clinical data,levels of total cholesterol(TC),triglyceride(TG),high densi-ty lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and homocysteine(Hcy)before and after intervention and incidence rate of major adverse cardiovascular events(MACE)within one-year follow-up were compared between two groups.Results:Compared with routine intervention group,after intervention,there were signifi-cant reductions in levels of TC[(3.39±0.54)mmol/L vs.(2.95±0.59)mmol/L],LDL-C[(2.02±0.54)mmol/L vs.(1.74±0.53)mmol/L]and Hcy[(15.69±5.09)mmol/L vs.(13.41±4.96)mmol/L],and significant rise in HDL-Clevel[(1.33±0.40)mmol/L vs.(1.57±0.27)mmol/L]in seamless management group(P＜0.05 or＜0.01).Incidence rate of MACE during one-year follow-up in seamless management group was significantly lower than that of routine intervention group(8.16％vs.26.53％,P=0.014).Conclusion:Seamless management concept intervention can significantly improve blood lipid levels,reduce homocysteine level and incidence rate of major adverse cardiovascular events in patients with coronary heart disease.
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Objective:To investigate the value of peripheral blood platelet to gamma-glutamyl transferase ratio (PLT/GGT) in evaluating plaque stability recognized by virtual histology-intravascular ultrasound (VH-IVUS) in patients with coronary heart disease.Methods:This study was a prospective study. A total of 100 patients with coronary heart disease admitted in Zhejiang Veteran Hospital/the Third Affiliated Hospital of Jiaxing University from June 2020 to December 2022 were included. They were divided into vulnerable plaque group (42 cases) and stable plaque group (58 cases) based on the stability of the plaque examined by VH-IVUS. The general data, PLT/GGT and other laboratory indexes were compared between the two groups. The relationship between PLT/GGT and plaque stability in peripheral blood of patients with coronary heart disease and the evaluation value of PLT/GGT on plaque stability were analyzed.Results:The levels of C-reactive protein (CRP) and gamma-glutamyl transferase (GGT) in the vulnerable plaque group were higher than those in the stable plaque group: (8.07 ± 1.85) mg/L vs. (7.23 ± 1.57) mg/L, (72.39 ± 10.85) U/L vs. (67.13 ± 8.57) U/L, and PLT, PLT/GGT levels were lower than those in the stable plaque group: (180.76 ± 11.75) × 10 9/L vs. (187.36 ± 12.47) × 10 9/L, 2.55 ± 0.42 vs. 2.84 ± 0.41, the differences were statistically significant ( P<0.05). Point two column correlation found that the plaque stability recognized by VH-IVUS in patients with coronary heart disease was related to CRP, GGT, PLT, PLT/GGT ( P<0.05). Receiver operating characteristic curve analysis showed that the area under the curve (AUC) for assessing plaque stability using the peripheral blood PLT/GGT in patients with coronary heart disease was 0.71, which had certain evaluation value. Conclusions:The peripheral blood PLT/GGT in patients with coronary heart disease is closely related to the plaque stability recognized by VH-IVUS, and can be used as an effective indicator for evaluating plaque stability in patients.
الملخص
As doenças cardiovasculares, com destaque para a síndrome coronariana aguda (SCA), representam a principal causa de mortalidade mundial. Essa síndrome é a manifestação clínica mais comum da doença arterial coronariana (DAC). O intervalo de tempo entre o início dos sintomas e a reperfusão do miocárdio é crucial para a sobrevivência dos pacientes. Contudo, a falta de conhecimento e a demora para reconhecer os sintomas isquêmicos são os principais fatores que influenciam no atraso do atendimento pré-hospitalar. Programas educativos e instrumentos de avaliação são importantes estratégias para educar a população e reduzir eventos recorrentes da SCA. Nossa revisão de literatura demonstrou que, no Brasil, não dispomos de um instrumento validado para avaliar o conhecimento dos indivíduos sobre esta síndrome. O Acute Coronary Syndrome (ACS) Response Index avalia a resposta do indivíduo à SCA, por meio de seu conhecimento, atitudes e crenças. Dessa forma, o objetivo deste estudo metodológico foi adaptar culturalmente e verificar as propriedades de medida da versão adaptada para o Brasil do ACS Response Index, em pacientes com 18 anos ou mais, de ambos os sexos e diagnosticados com DAC. O processo de adaptação cultural transcorreu de acordo com as seguintes etapas: tradução inicial; obtenção do consenso das versões em português; comitê de especialistas; retrotradução; obtenção do consenso das versões em inglês; avaliação pelo autor da versão original; análise semântica; e pré-teste. As seguintes propriedades de medida foram avaliadas: consistência interna, validade de face e de conteúdo, validade de construto entre grupos conhecidos, validade de constructo convergente, validade estrutural e presença de efeitos teto e chão. O nível de significância adotado foi de 0,05. Participaram do estudo 244 indivíduos com DAC. As pontuações médias para as subescalas de conhecimento, atitudes e crenças foram, respectivamente: 12,75 (DP=2,6), 13,48 (DP=3,39) e 22,40 (DP=3,16). A consistência interna da subescala de conhecimento foi avaliada pelo KR-20, cujo valor foi de 0,399. Os resultados dos alfas de Cronbach para as subescalas de atitudes e de crenças foram 0,735 e 0,577, respectivamente. A estrutura original do instrumento foi testada mediante análise fatorial confirmatória, para a qual obteve-se índices de ajuste satisfatórios para as subescalas de conhecimento (SRMR=0,065; RMSEA=0,058; CFI=0,792; TLI=0,761), atitudes (SRMR=0,027; RMSEA=0,053; CFI=0,988; TLI=0,970) e crenças (SRMR=0,047; RMSEA=0,048; CFI=0,971; TLI=0,952). As hipóteses prévias sobre a validade de constructo por grupos conhecidos foram testadas para comparar os valores das três subescalas segundo a faixa etária, presença de orientação prévia sobre sua doença cardíaca e nível escolaridade. Apenas as seguintes hipóteses foram confirmadas: na subescala de conhecimento, os indivíduos com até 59 anos apresentaram melhores níveis de conhecimento quando comparados aos indivíduos com 60 anos ou mais (p=0,003); na subescala de crenças, maiores valores foram obtidos no grupo que relatou orientação prévia sobre sua doença (p=0,008) e naqueles com maior escolaridade (p=0,022). A avaliação da validade de constructo convergente mostrou correlação fraca e positiva entre as subescalas de conhecimento e crenças (r=0,217; p<0,05), e de conhecimento e atitudes (r=0,128; p<0,05). Não encontramos correlação entre os valores das demais subescalas. Constatamos a presença do efeito teto em todos os itens das subescalas de atitudes e de crenças. Os resultados mostraram que o ACS Response Index-BR manteve as equivalências, validade de face e de conteúdo, validade de constructo entre grupos conhecidos nas subescalas de conhecimentos e crenças, ajuste adequado ao modelo estrutural original e confiabilidade satisfatória para a subescala de atitudes. Entretanto, dadas as particularidades da amostra, sugerimos a realização de estudos adicionais com a versão adaptada em diferentes instituições de saúde, assim como, em amostras com características sociodemográficas distintas.
Cardiovascular diseases, especially Acute Coronary Syndrome (ACS), represent the main cause of mortality worldwide. This syndrome is the most common clinical presentation of coronary artery disease (CAD). The time interval between the onset of symptoms and myocardial reperfusion is crucial for patient survival. However, lack of knowledge and delay in recognizing ischemic symptoms are the main factors that influence delays in pre-hospital care. Educational programs and assessment tools are important strategies to educate the population and reduce recurrent ACS events. Our literature review demonstrated that, in Brazil, we do not have a validated instrument to assess individuals' knowledge about this syndrome. The ACS Response Index assesses an individual's response to ACS, through their knowledge, attitudes and beliefs. Therefore, the objective of this methodological study was to culturally adapt and verify the measurement properties of the version adapted for Brazil of the ACS Response Index, in patients aged 18 or over, of both genders and diagnosed with CAD. The cultural adaptation process occurred according to the following stages: initial translation; obtaining consensus on the Portuguese versions; expert committee; back translation; obtaining consensus on English versions; evaluation by the author of the original version; semantic analysis; and pre-test. The following measurement properties were evaluated: internal consistency, face and content validity, construct validity by known groups, convergent construct validity, structural validity and ceiling and floor effects presence. The significance level adopted was 0.05. This study included 244 individuals with CAD. The mean scores for the knowledge, attitudes and beliefs subscales were, respectively: 12.75 (SD=2.6), 13.48 (SD=3.39) and 22.40 (SD=3.16). The internal consistency of the knowledge subscale was assessed using the KR-20, the value of which was 0.399. Cronbach's alpha results for the attitudes and beliefs subscales were 0.735 and 0.577, respectively. The original instrument's structure was tested using confirmatory factor analysis, for which satisfactory fit indices were obtained for the knowledge (SRMR=0.065; RMSEA=0.058; CFI=0.792; TLI=0.761), attitudes (SRMR=0.027; RMSEA =0.053; CFI=0.988; TLI=0.970) and beliefs subscales (SRMR=0.047; RMSEA=0.048; CFI=0.971; TLI=0.952). Previous hypotheses about construct validity by known groups were tested to compare the values of the three subscales according to age range, presence of previous guidance about heart disease and education level. Only the following hypotheses were confirmed: in the knowledge subscale, individuals aged 59 years or younger presented better levels of knowledge when compared to individuals aged 60 years or older (p=0.003); in the beliefs subscale, higher values were obtained in the group that reported previous guidance about their disease (p=0.008) and in those with higher education level (p=0.022). The evaluation of the convergent construct validity showed a weak and positive correlation between the knowledge and beliefs subscales (r=0.217; p<0.05), and knowledge and attitudes subscales (r=0,128; p<0,05). We did not find any correlation between the values of the other subscales. We found the presence of the ceiling effect in all items of the attitudes and beliefs subscales. The results showed that the ACS Response Index-BR maintained equivalences, face and content validity, construct validity by known groups in the knowledge and beliefs subscales, adequate fit to the original structural model, and satisfactory reliability for the attitudes subscale. However, given the particularities of the sample, we recommend conducting additional studies with the adapted version in different healthcare institutions, as well as in samples with different sociodemographic characteristics.
الموضوعات
Humans , Psychometrics , Health Knowledge, Attitudes, Practice , Validation Study , Acute Coronary Syndrome , Heart Diseasesالملخص
Objectives: To investigate the effect of exercise intensity on functional capacity in individuals with coronary artery disease, assess adherence to the heart rate training zone (HRTZ), and relationship between trained intensity and functional capacity. Methods: Retrospective study led with medical records of 54 outpatients with coronary artery disease in a public hospital. The prescribed intensity started at 50 60% of heart rate reserve, increasing monthly to 70 80% by the third month. Spearman's test was used to assess the correlation between improvement in distance in the incremental shuttle walk test (ISWT), exercise intensity, and rating of perceived exertion (BorgRPE). Adherence was classified as 'below' when HRTZ was not achieved in any phase of the program, 'intermediate' when HR was within the HRTZ for one or two months, and 'above' when HR was at or higher than HRTZ ï³two months. Improvement was tested with t-test and one-way ANOVA. Results: 51.9% of participants had an increase in ISWT of ≥70 m (p < 0.0001). In at least one month, 50.9% trained below HRTZ. Trained intensity did not go below 8.6% of the prescribed minimal threshold of HRTZ. Changes in ISWT were not significantly correlated with exercise intensity (p = 0.87) or BorgRPE (p = 0.16). Conclusion: While a significant increase in functional capacity was found, considerable heterogeneity in changes were observed. This may, in part, be related to adherence to HRTZ with progressive exercise intensity and to the variability in exercise volume incardiovascular rehabilitation programs.