Calculation of Coronary Angiographic Total Blush in Patients with Coronary Artery Disease and its Prognostic Implication / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Myocardial perfusion grade (MPG) is an accepted method of evaluating myocardial perfusion. However, it does not take into the account, the extent of the perfusion. We hypothesized that myocardial blush area times MPG (total blush) would be more accurate than simple MPG, and yield better prognostic information.</p><p><b>METHODS</b>About 34 patients were recruited after they had consented to both coronary angiography (CAG) and single photon emission computed tomography (SPECT), and divided into two groups. A special dedicated computer was employed to calculate the total blush. The CAG was performed as a conventional way. Scintigraphic technetium 99m methoxyisobutyl-isonitrile rest and stress images were evaluated quantitatively. The comparison was made between stenosis versus chronic total occlusion (CTO), MPG 1, 2 versus MPG 3, percutaneous intervention (PCI) successful versus failure. A correlation was made between ejection fraction (EF) and myocardial perfusion by MPG, total blush, SPECT, and syntax score.</p><p><b>RESULTS</b>The perfusion indices of total blush, summed difference score (SDS) and syntax score were insignificant between the two groups (P > 0.05). However, the left ventricular end diastolic volume was significantly larger in CTO (P < 0.05). The patients with stenosis had better MPG than with CTO (P < 0.05). The increased MPG was associated with increased total blush, higher syntax score, and EF (P < 0.05). Successful PCI resulted in better perfusion indicated by increased total blush, and MPG (P < 0.05) but successful PCI did not change syntax score, EF and SDS significantly. Multivariate linear analysis with EF as the dependent factor and syntax score, SDS, total blush, blush area, and MPG as the independent factors showed a significantly higher degree of correlation (R = 0.87, P < 0.05).</p><p><b>CONCLUSION</b>After PCI the total blush and EF improved significantly indicating its potential application in the future.</p>

Long-term outcome of patients undergoing recanalization procedures for chronic total coronary occlusion / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the long-term outcomes of patients receiving percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy for treatment of chronic total coronary occlusion (CTO).</p><p><b>METHODS</b>The patients with CTO were selected from a consecutive cohort of patients who underwent coronary angiography (CAG) between 2008 and 2009. The patients with multiple CAG were excluded. The patients received treatments with PCI, CABG, or conservative medication therapy and were followed for major adverse cardiovascular events (MACE) within 5 years.</p><p><b>RESULTS</b>A total of 253 patients were enrolled in this study, including 192 receiving PCI, 48 receiving CABG, and 13 treated conservatively with medications. The baseline clinical characteristics were similar among the 3 groups except for increased low-density lipoprotein (LDL) and total cholesterol (TC) in the medication group, and increased Syndax score in CABG group. During the follow-up, the incidences of MACE, AMI, death, stroke or heart failure did not differ significantly among the 3 groups (P>0.05). However, CABG group showed a higher incidence of the stroke than the other two groups although this difference did not reach a statistically significantly level (P=0.06).</p><p><b>CONCLUSION</b>Our study did not demonstrate that recanalization offers greater long-term benefits than medications for treatment of CTO, and the patients receiving CABG appeared to have a higher incidence of stroke.</p>

Four-year clinical outcome in asymptomatic patients undergoing coronary computed tomography angiography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Percutaneous coronary intervention (PCI) is indicated for angina with coronary stenosis. However, PCI for asymptomatic coronary stenosis remains controversial. We prospectively followed a group of patients for four years who underwent coronary computed tomography angiography (CCTA) for major adverse cardiac events (MACE). We hypothesized that the results of this trial would reliably reflect the natural outcome of the coronary disease.</p><p><b>METHODS</b>Consecutive patients who underwent CCTA from June 2008 to May 2009 were selected. Those who could not be reached by telephone, had significant angina, had CT images that were not interpretable, or poor kidney and left ventricular (LV) function were excluded. The patients were divided into five groups: group A normal CCTA without stenosis, group B mild stenosis (1% - 49%), group C moderate stenosis (50% - 74%), group D severe stenosis (= 75%) and they were treated with optimal medical therapy (OMT) or PCI. The group E had PCI before the CCTA examination. The patients were then followed for MACE after different treatments. MACE included acute myocardial infarction (MI), heart failure (HF) and death.</p><p><b>RESULTS</b>The patient population consisted of 419 patients. The follow-up time was (51 ± 5) months. The age was (60 ± 31) years. Male made up 67.78% of the population (n = 284). A total of 51 cases of MACE occurred including 25 MI, eight HF and 18 all-cause deaths. There was no MACE in group A. Although MACE occurred in two patients in group B, they were not attributed to cardiac death. We further compared the MACE in groups C-E and no significant difference was found (P > 0.05). However, a difference was detected among patients with unstable angina pectoris (UAP), stable angina pectoris (SAP), re-hospitalization, and cerebrovascular events from groups A-E (P < 0.05). The plaque scores were used to predict MACE. The scores progressively increased significantly with lesion severity (P < 0.05). Receiver operating curve (ROC) was performed to determine the sensitivity and specificity in predicting MACE. Our scores predicted MI with area of 0.76, predicted HF with area of 0.77, and predicted death with area of 0.70.</p><p><b>CONCLUSIONS</b>Normal and mild lesions had very few events. With increased stenosis the MACE rate increased progressively. PCI did not significantly reduce the MACE in comparison with OMT in asymptomatic patients. Furthermore, UAP, re-hospitalization, and re-PCI were significantly increased in patients who were treated with PCI.</p>

Neovascularization in the carotid atherosclerotic plaque is not associated with inflammatory cell aggregation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Monocytes and macrophages in atherosclerotic plaque lead to plaque instability. The aim of the study was to determine if plaque neovascularization led to inflammation.</p><p><b>METHODS</b>Patients were consecutively enrolled if their carotid intimal media thickness was > 2 mm, as revealed by duplex ultrasound. The patients then underwent dynamic contrast enhanced magnetic resonance imaging (DCE MRI) and fluorine-18 fluorodeoxyglucose ((18)F-FDG) positron emission tomography combined with computed tomography (PET CT). A target to background ratio (TBR) of ≥ 1.25 or < 1.25 served as the cutoff point for the presence and absence of inflammation, respectively.</p><p><b>RESULTS</b>Twenty-six patients underwent bilateral carotid DCE MRI and 24 patients also underwent PET CT. One hundred and fifty-five plaques were evaluated by both DCE MRI and PET CT. There was no significant difference in plaque morphology between the TBR ≥ 1.25 (n = 61) and TBR < 1.25 (n = 94) groups. No significant differences were found in plasma volume and transfer constant between the TBR ≥ 1.25 and TBR < 1.25 groups.</p><p><b>CONCLUSION</b>Our study did not find a significant correlation between plaque neovascularization and the aggregation of inflammatory cells.</p>

Correlation between acute coronary syndrome classification and multi-detector CT characterization of plaque / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To determine if multi-detector CT (MDCT) characterization of plaque is correlated with the classification of acute coronary syndrome (ACS).</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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).</p><p><b>CONCLUSIONS</b>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.</p>

Correlation of heart and kidney biomarkers to the pathogenesis of cardiorenal syndrome / 南方医科大学学报

<p><b>OBJECTIVE</b>The analyze the correlation of heart and kidney biomarkers to different heart and kidney diseases and explore the pathogenesis and classification of cardiorenal syndrome.</p><p><b>METHODS</b>This study involved 841 consecutive patients (600 males and 241 females) admitted between January, 2008 and May, 2008, who underwent NT-ProBNP and creatinine tests during hospitalization. The patients were classified according to the clinical diagnosis at the admission and to the status of the heart and kidney biomarkers.</p><p><b>RESULTS</b>The heart and kidney biomarkers were significantly different between genders. NT-proBNP showed slight elevations in patients with atrial fibrillation, mild non-heart disease, hypertension and angina, but significant elevation in patients with severe non-heart disease. In patients with renal artery stenosis, the heart and kidney biomarkers were moderately increased, which was also seen in patients with diabetes mellitus, myocardial infarction and coronary artery bypass grafting. In dilated cardiomyopathy and rheumatic heart disease, NT-proBNP showed marked increase with only slight increase of creatinine. Patients with chronic kidney disease had the highest NT-proBNP and creatinine levels and the lowest eGFR. The heart and kidneys index increased with the severity of the disease. From Ronco type I to type IV, NT-proBNP rose gradually, but the difference was not statistically significant (P>0.05), and the type I and IV patients had the highest creatinine level; type III involved mainly acute coronary syndrome, heart failure and renal stenosis. According to a modified classification, cardiarenal syndrome was characterized mainly by a marked increase of NT-proBNP, while renalcardiac syndrome by creatinine increases (P<0.05). Acute coronary syndrome, heart failure and renal artery stenosis represented a special entity of cardiorenal syndrome.</p><p><b>CONCLUSIONS</b>Heart and kidney biomarkers and clinical diagnosis are closely related. The heart and kidneys index more accurately reflects the severity of the cardiorenal syndrome. The heart and kidney biomarkers can be used in Ronco classification. The simplified classification is convenient to use and facilitates the clinical decisions of the treatment.</p>