Clinical value of left ventricular strain analysis by cardiovascular magnetic resonance in patients with coronary chronic total occlusion / 中华心血管病杂志

Objective: To explore the clinical value of quantitatively assessment of left ventricular strain in patients with coronary chronic total occlusion (CTO) by cardiac magnetic resonance imaging (CMR)-feature tracking (CMR-FT) technique. Methods: In this retrospective and observation study, patients with single CTO, who underwent CMR examination in Beijing Anzhen Hospital from November 2014 to January 2019, were selected as case group (CTO group), and those without cardiovascular diseases defined by echocardiography, electrocardiogram (ECG) and clinical history and with normal CMR results were selected as healthy control group (control group). General clinical data including age, gender, discharge diagnosis, and the examination results of echocardiography and ECG were obtained from the electronic medical record system. Two-dimensional CMR-FT was applied to measure left ventricle (LV) global peak radial, circumferential, and longitudinal strains (GPRS, GPCS and GPLS, respectively), and the regional myocardial strain in the target vessel area of CTO was analyzed. Grayscale thresholds of 5 standard deviations (SDs) were used to quantify late gadolinium enhancement (LGE). Patients with CTOs were divided into infract size>10% group and infarct size≤10% group, and left ventricular ejection fraction (LVEF)≥50% group and LVEF<50% group, respectively. The differences between various groups were compared. Results: There were 52 patients in CTO group (34 males, age (54.1±11.7) years, body mass index (BMI) (26.2±2.5)kg/m2) and 30 patients in control group (14 males, age(51.6±12.3)years, BMI (25.6±3.3)kg/m2). There was no significant difference in age, gender, and BMI between the two groups (all P>0.05). LVEF, GPRS, GPCS and GPLS were significantly lower in CTO group than in control group (all P<0.05), left ventricular volume (LVEDV) was similar between the two groups (P>0.05). Among the patients with CTO, there were 26 patients with infarct size>10% and 26 patients with infarct size≤10%. GPRS, GPCS and GPLS were significantly lower (all P<0.05), while LVEF and LVEDV were similar in CTO patients with infarct size≤10% as compared to control group (both P>0.05). LVEF, GPRS, GPCS and GPLS were significantly lower (all P<0.05), while LVEDV was similar in CTO patients with infarct size>10% (P>0.05) as compared to control group. GPRS and GPCS were significantly lower (both P<0.05), while LVEF, LVEDV and GPLS were similar in CTO patients with infarct size>10% as compared to infarct size≤10% group. There were 40 subjects in LVEF≥50% group and 12 subjects in LVEF<50% group. Compared with the control group, GPCS and GPLS of CTO patients were significantly lower in LVEF≥50% group and LVEF<50% group (all P<0.01), LVEF and LVEDV was similar in CTO patients with LVEF≥50% (both P>0.05), but LVEF was lower and LVEDV was larger in LVEF<50% group (both P<0.05). The GPRS, GPCS, GPLS and LVEF of CTO patients in LVEF ≥ 50% group were higher than those in LVEF<50% group (all P<0.0l), and the myocardial infarction size was smaller than that in LVEF reduced group (P<0.0l), but there was no significant difference in LVEDV between the two groups (P=0.07). In the CTO group, there were 21 patients with left anterior descending artery (LAD) occlusion and 126 segments supplied by the target vessels. The peak radial strain (PRS), circumferential strain (PCS) and longitudinal strain (PLS) in the blood supply area were lower than those in the control group (all P<0 01). In 7 patients with left circumflex artery (LCX) occlusion, the number of myocardial segments supplied by the target vessels was 35, and the PRS, PCS and PLS in the target vessel supply area were lower than those in the control group (all P<0 05). In 24 patients with right coronary artery (RCA) occlusion, the number of myocardial segments supplied by the target vessels was 120, and the PRS, PCS and PLS in the target vessel supply area were lower than those in the control group (all P<0.01). Among the 126 segments in 21 patients with LAD CTO, 91 (72.2%) segments had infarct size≤25%, 17 (13.5%) segments had infarct size between 26%-50%, 11 segments (8.7%) had infarct size between 51%-75%, and 7 (5.6%) segments had infarct size between 76%-100%. Among the 35 segments in 7 patients with LCX CTO, 31 (88.6%) segments had infarct size≤25%, and 4 (11.4%) segments had infarct size between 26%-75%. Among the 120 segments in 24 patients with RCA CTO, 96 (80.0%) segments had infarct size≤25%, 11 (9.2%) segments had infarct size between 26%-50%, 8 (6.7%) segments had infarct size between 51%-75%, and 5 segments (4.2%) had infarct size between 76%-100%. Conclusions: In this study with single CTO, although the LVEF is preserved in the majority of the patients, the left ventricular global and regional strain values are significantly decreased. The larger the infarct size, the greater the impact on radial and circumferential motion, reflecting the early impairment of left ventricular function in these patients.

Effectiveness of Integrative Medicine Therapy on Coronary Artery Disease Prognosis: A Real-World Study / 中国结合医学杂志

OBJECTIVE@#To evaluate the effectiveness of integrative medicine (IM) on patients with coronary artery disease (CAD) and investigate the prognostic factors of CAD in a real-world setting.@*METHODS@#A total of 1,087 hospitalized patients with CAD from four hospitals in Beijing, China were consecutively selected between August 2011 and February 2012. The patients were assigned to two groups based on the treatment: Chinese medicine (CM) plus conventional treatment, i.e., IM therapy (IM group); or conventional treatment alone (CT group). The endpoint was major adverse cardiac events [MACE; including cardiac death, myocardial infarction (MI), and revascularization].@*RESULTS@#A total of 1,040 patients finished the 2-year follow-up. Of them, 49.4% (514/1,040) received IM therapy. During the 2-year follow-up, the total incidence of MACE was 11.3%. Most of the events involved revascularization (9.3%). Cardiac death/MI occurred in 3.0% of cases. For revascularization, logistic stepwise regression analysis revealed that age ⩾ 65 years [odds ratio (OR), 2.224], MI (OR, 2.561), diabetes mellitus (OR, 1.650), multi-vessel lesions (OR, 2.554), baseline high sensitivity C-reactive protein level ⩾ 3 mg/L (OR, 1.678), and moderate or severe anxiety/depression (OR, 1.849) were negative predictors (P<0.05); while anti-platelet agents (OR, 0.422), β-blockers (OR, 0.626), statins (OR, 0.318), and IM therapy (OR, 0.583) were protective predictors (P<0.05). For cardiac death/MI, age ⩾ 65 years (OR, 6.389) and heart failure (OR, 7.969) were negative predictors (P<0.05), while statin use (OR, 0.323) was a protective predictor (P<0.05) and IM therapy showed a beneficial tendency (OR, 0.587), although the difference was not statistically significant (P=0.218).@*CONCLUSION@#In a real-world setting, for patients with CAD, IM therapy was associated with a decreased incidence of revascularization and showed a potential benefit in reducing the incidence of cardiac death or MI.

Effect and mechanism of recombinant hirudin on atherosclerotic plaques in apolipoprotein E knockout (ApoE(-/-)) mice / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the effect and mechanism of hirudin on atherosclerotic plaques in apolipoprotein E knockout (ApoE(-/-)) mice.</p><p><b>METHODS</b>Totally 24 ApoE(-/-) mice, 7-8 weeks old were fed with high fat diets. They were randomly divided into the recombinant hirudin treatment group (drug group) and the model group according to body weight and different dens, 12 in each group. Twelve C57BL/6J mice, 7-8 weeks old fed with high fat diet were recruited as the normal control group. Recombinant hirudin (0.25 mg/kg) was intraperitoneally injected to mice in the drug group from the 10th week old once every other day for five successive weeks. Equal volume of normal saline was injected to mice in the model group. Mice in the normal control group received no treatment. All mice were sacrificed after fed with high fat diet until they were 20 weeks old. Serum levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), high-sensitive C-reactive protein (hs-CRP), E-selectin, interleukin-6 (IL-6), and stromal metalloproteinase-2 (MMP-2) were detected. The plaque/lumen area and extracellular lipid composition/ plaque area were analyzed by HE staining and morphometry. Changes of signaling molecules in store-operated calcium channels, including stromal interacting molecule 1 (STIM1), Orail protein, and transient receptor potential channel 1 (TRPC1) were determined by Western blot. Results Lipid plaque formed in the aorta vessel wall of 20-week old mice in the model group. Compared with the normal control group, serum levels of TC, TG and LDL increased (P<0.01), hs-CRP, E-selction, IL-6, and MMP-2 obviously increased (P<0.01, P<0.05) in the model group; expression levels of STIM1, TRPC1, and Orail significantly increased (P<0.01). Compared with the model group, the plaque/lumen area and the extracellular lipid composition/plaque area significantly decreased in the drug group (P<0.05, P<0.01); serum levels of TC and LDL, hs-CRP, E-selction, IL-6, and MMP-2 obviously decreased (P<0.05, P<0.01); expression levels of STIM1, TRPC1, and Orail were significantly down-regulated (P<0.05, P<0.01).</p><p><b>CONCLUSION</b>Hirudin could significantly improve lipids and endothelial functions of ApoE(-/-) mice, down-regulate expression levels of STIM1, Orai1, and TRPC1, and thus delaying the occurrence and development of atherosclerosis.</p>