Protection Mechanism of Addition and Subtraction Therapy of Danshenyin Combined with Wendantang for Myocardial Ischemia in Patients with Stable Angina / 中国实验方剂学杂志

Objective:To observe the efficacy of addition and subtraction therapy of Danshenyin combined with Wendantang in the treatment to stable angina pectoris （SAP） with stagnation of phlegm and blood stasis， and to explore its protection mechanism for myocardial ischemia. Method:One hundred and thirty-two patients were randomly divided into control group and observation group equally. Finished the 63 cases study both in control group and observation group after dropout， loss of follow-up and withdrawal. Patients in control group and observation group got antianginal drugs and the treatment of drug therapy to control the risk factors. All patients were treated with anti-angina drugs and risk factors control drugs. Patients in control group got Danlou Tablets by oral administration， 5 tablets/time， 3 times/day. Patients in observation group got dispensing decoction pieces of Danshenyin and Wendantang 1 dose/day. The treatment continued for 3 months in both groups. Scores of angina attack were graded every week. Before and after treatment， electrocardiogram treadmill exercise test was made to evaluate myocardial ischemia of coronary heart disease， and scores of phlegm stasis block syndrome and Seattle Angina questionnaire （SAQ） were graded for TCM symptoms and quality of life. Levels of hemorheology index， interleukin-6 （IL-6）， tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>）， intercellular adhesion molecule-1 （ICAM-1）， Cystatin C （CysC）， homocysteine （Hcy）， ischemic modified albumin （IMA） and macrophage migration inhibitory factor were detected. In addition， safety was evaluated. Result:After treatment， scores of times， duration， degree of angina pectoris， nitroglycerin dosage of angina pectoris and nitroglycerin dosage in the observation group were lower than those in the control group （<italic>P</italic><0.01）. Total exercise time， duration of ST depression for 1.0 mm， occurrence time of stable angina pectoris， metabolic equivalent and scores of Duke in the observation group were more than those in the control group （<italic>P</italic><0.01）. Score of stagnation of phlegm and blood stasis in the observation group was lower than that in the control group （<italic>P</italic><0.01）， while score of SAQ was higher than that in the control group （<italic>P</italic><0.01）. Levels of IL-6， TNF-<italic>α</italic>， ICAM-1， CysC， IMA， Hcy， MIF， whole blood viscosity （low cut， high cut）， whole blood reducing viscosity， plasma viscosity， platelet aggregation rate and fibrinogen （FIB） in the observation group were lower than those in the control group （<italic>P</italic><0.01）. Effect of angina pectoris in observation group was superior to that in control group （<italic>Z</italic>=2.091， <italic>P</italic><0.01）. No adverse reactions related to Danshenyin combined with Wendantang were found. Conclusion:Addition and subtraction therapy of Danshenyin combined with Wendantang based on the routine western medicine treatment can control the attack of angina pectoris， relieve the symptoms of phlegm and stasis block syndrome， and improve the quality of life for patients with SAP， showing superior clinical efficacy and safety. In addition， it can improve the hemorheology of patients， inhibit the inflammatory reaction， reduce the stenosis or obstruction of lumen in order to improve the degree of myocardial ischemia.

ECG characteristics ,preventive and therapeutic strategy of ventricular arrhythmias induced by second-ary hypokalemia / 心血管康复医学杂志

Objective :To explore related clinical manifestations ,ECG characteristics and therapeutic strategy of ven-tricular arrhythmias induced by secondary hypokalemia .Methods :Clinical data of 184 patients ,who were diagnosed as ventricular arrhythmias induced by secondary hypokalemia in our hospital from Jan 2013 to Nov 2015 ,were retro-spectively analyzed .ECG characteristics and clinical manifestations were analyzed ,blood potassium concentration and incidence of ventricular arrhythmia were compared between before and after treatment .According to blood po-tassium concentration ,patients were divided into mild hypokalemia group (n＝91 ,3.01～3.5mmol/L ,mild group) , medium hypokalemia group (n＝78 ,2.51～3.00mmol/L ,medium group) and severe hypokalemia group (n＝15 ,＜2.5mmol/L ,severe group).ECG condition was compared among these groups .Results : Main clinical manifesta-tions included palpitations ,chest tightness ,fatigue ,hypotension and short of breath etc .,and severe patients can present as coma ,intestinal paralysis and syncope etc .Among ECG manifestations ,premature ventricular systole was the most frequent [75 (40.8%)] ,and the second was frequent premature atrial systole [69 (37.5%)].Compared with mild group ,there were significant rise in percentage of positive ECG changes (50.5% vs.79.5%,100%) in medium group and severe group (P＝0.001 both) ,but there was no significant difference between medium and se-vere group , P＝0.120. Compared with before treatment ,after treatment ,there was significant rise in blood potas-sium concentration [ (2.5 ± 1.1) mmol/L vs.(4.4 ± 1.7) mmol/L] ,and significant reductions in percentages of ventricular premature contraction (86.96% vs .25.00%) and persistent ventricular tachycardia (8.70% vs.0) in these patients ,P＝0.001 all .Conclusion :Along with blood potassium level reduces ,percentage of patients with ven-tricular arrhythmias induced by secondary hypokalemia and abnormal ECG rises .Timely ECG and blood potassium examinations should be performed in these patients for timely treatment .

Effects of Ang Ⅱ perfusion on transmural heterogeneous of Cx43 in acute myocardial ischemia reperfusion

OBJECTIVE@#To observe the effects of angiotensin Ⅱ(Ang Ⅱ) perfusion on transmural heterogeneity of Cx43 expression in the rabbit model with acute myocardial ischemia reperfusion (MIR), and investigate the role of rennin-angiotensin system in malignant ventricular arrhythmia induced by MIR.@*METHODS@#Twenty rabbits were randomly divided into MIR group (n = 10) and Ang Ⅱ group (n = 10). MIR model was produced with traditional ligation and opening of the anterior descending coronary artery in all animal. The hearts in vitro in the MIR group and the Ang Ⅱ group were perfused with simply improved Tyrode's solution and containing Ang Ⅱ Tyrode's solution respectively. 90% monophasic action potential repolarization duration, transmural dispersion of repolarization, Cx43 protein (Cx43-pro) and mRNA (Cx43-Cq) expression in subepicardial, midmyocardial and subendocardial myocardium were measured in both groups. The greatest differences of Cx43-pro and Cx43-Cq among three myocardial layers were calculated and shown with ΔCx43-pro and ΔCx43-Cq respectively.@*RESULTS@#After Ang Ⅱ perfusion, 90% monophasic action potential repolarization duration among three myocardial layer were significantly prolonged (P < 0.05 and P < 0.01), and transmural dispersion of repolarization also significantly increased compared with the MIR group (P < 0.05). Compare with the MIR group, three myocardial Cx43-pro and Cx43-Cq expression in the Ang Ⅱ group were significantly decreased (P < 0.05 and P < 0.01), but ΔCx43-pro and ΔCx43-Cq were significant increased.@*CONCLUSIONS@#Renin-angiotensin system increases transmural heterogeneity of Cx43 expression in the rabbit model with MIR by Ang Ⅱ, and enlarge transmural dispersion of repolarization among three myocardial layers of left ventricular which induces malignant ventricular arrhythmia.

Effects of Ang II perfusion on transmural heterogeneous of Cx43 in acute myocardial ischemia reperfusion

Objective: To observe the effects of angiotensin II(Ang II) perfusion on transmural heterogeneity of Cx43 expression in the rabbit model with acute myocardial ischemia reperfusion (MIR), and investigate the role of rennin-angiotensin system in malignant ventricular arrhythmia induced by MIR. Methods: Twenty rabbits were randomly divided into MIR group (n = 10) and Ang II group (n = 10). MIR model was produced with traditional ligation and opening of the anterior descending coronary artery in all animal. The hearts in vitro in the MIR group and the Ang II group were perfused with simply improved Tyrode's solution and containing Ang II Tyrode's solution respectively. 90% monophasic action potential repolarization duration, transmural dispersion of repolarization, Cx43 protein (Cx43-pro) and mRNA (Cx43-Cq) expression in subepicardial, midmyocardial and subendocardial myocardium were measured in both groups. The greatest differences of Cx43-pro and Cx43-Cq among three myocardial layers were calculated and shown with ΔCx43-pro and ΔCx43-Cq respectively. Results: After Ang II perfusion, 90% monophasic action potential repolarization duration among three myocardial layer were significantly prolonged (P < 0.05 and P < 0.01), and transmural dispersion of repolarization also significantly increased compared with the MIR group (P < 0.05). Compare with the MIR group, three myocardial Cx43-pro and Cx43-Cq expression in the Ang II group were significantly decreased (P < 0.05 and P < 0.01), but ΔCx43-pro and ΔCx43-Cq were significant increased. Conclusions: Renin-angiotensin system increases transmural heterogeneity of Cx43 expression in the rabbit model with MIR by Ang II, and enlarge transmural dispersion of repolarization among three myocardial layers of left ventricular which induces malignant ventricular arrhythmia.

Comparative analysis of different cyclosporine A doses on protection after myocardial ischemia/reperfusion injury in rat

OBJECTIVE@#To investigate the protective effect of different cyclosporin A (CsA) doses on myocardial ischemia/reperfusion injury in rat models.@*METHODS@#A rat model of myocardial ischemia/reperfusion injury was established in vivo and the rats were randomly divided into four groups: placebo (PBS; T1), low-dose (CsA dose: 1.0 mg/kg; T2), medium-dose (CsA dose: 2.5 mg/kg; T3), and high-dose (CsA dose: 5.0 mg/kg; T4) groups. Heart function indexes were monitored at different time points, the extent of myocardial infarction was assessed by Evans Blue-TTC staining, and creatine kinase MB mass and cardiac troponin I values were measured by biochemical assays.@*RESULTS@#Compared with the T1 and T2 groups, both the creatine kinase MB mass and cardiac troponin I were significantly lower in the T3 and T4 groups (P<0.05). The mean arterial pressure (MAP) and left ventricular systolic pressure (LVSP) decreased sequentially in each group, with the extending reperfusion time. Significant decreases in LVSP and MAP were observed in the T3 and T4 groups as compared to the T1 and T2 group (P<0.05), and the T2 group showed a significantly lower LVSP and MAP decline than the T1 group (P<0.05). Compared with the T1 group, the rats from the T2, T3, and T4 groups suffered from a significantly lower extent of myocardial infarction (P<0.05). Also, the animals in the T3 and T4 groups had a significantly smaller extent of myocardial infarction than those in the T2 group (P<0.05).@*CONCLUSIONS@#Various CsA doses exert different degrees of protection against ischemia/reperfusion injury, and this protective effect peaks at approximately 2.5 mg/kg in rat models.

Effects of hypokalemia on transmural dispersion of ventricular repolarization in left ventricular myocardium

OBJECTIVE@#To observe effects of hypokalemia on transmural heterogeneity of ventricular repolarization in left ventricular myocardium of rabbit, and explore the role of hypokalemia in malignant ventricular arrhythmia (MVA).@*METHODS@#A total of 20 rabbits were randomly divided into control group and hypokalemic group. Isolated hearts in the control group were simply perfused with modified Tyrode's solution, and were perfused with hypokalemic Tyrode's solution in hypokalemic group. Ventricular fibrillation threshold (VFT), 90% monophasic action potential repolarization duration (APD90) of subepicardial, midmyocardial and subendocardial myocardium, transmural dispersion of repolarization (TDR) and C×43 protein expression in three layers of myocardium were measured in both groups.@*RESULTS@#VFT in the control group and the hypokalemic group were (13.40 ± 2.95) V, and (7.00 ± 1.49) V, respectively. There was a significant difference between two groups (P<0.01). APD90 of three myocardial layers in the hypokalemic group were significantly prolonged than those in the control group (P<0.01). ΔAPD90 in the hypokalemic group and the control group were (38.10 ± 10.29) ms and (23.70 ± 5.68) ms, and TDR were (52.90 ± 14.55) ms and (36.10 ± 12.44) ms, respectively. ΔAPD90 and TDR in the hypokalemic group were significantly higher than those in the control group (P<0.05), and the increase in APD90 of midmyocardium was more significant in the hypokalemic group. Cx43 protein expression of all three myocardial layers were decreased significantly in the hypokalemic group (P<0.01), and ΔCx43 was significantly increased (P<0.05). Reduction of Cx43 protein expression was more significant in the midmyocardium.@*CONCLUSIONS@#Hypokalemic can increase transmural heterogeneity of C×43 expression and repolarization in left ventricular myocardium of rabbit, and decrease VFT and can induce MVA more easily.