Restrictive Cardiomyopathy Resulting from a Troponin I Type 3 Mutation in a Chinese Family.

Objective To identify the pathogenic variant responsible for restrictive cardiomyopathy (RCM) in a Chinese family.Methods Next generation sequencing was used for detecting the mutation and Results verified by sequencing. We used restriction enzyme digestion to test the mutation in the family members and 200 unrelated normal subjects without any cardiac inherited diseases when the mutation was identified.Results Five individuals died from cardiac diseases, two of whom suffered from sudden cardiac death. Two individuals have suffered from chronic cardiac disorders. Mutation analysis revealed a novel missense mutation in exon 7 of troponin I type 3 (TNNI3), resulting in substitution of serine (S) with proline (P) at amino acid position 150, which cosegregated with the disease in the family, which is predicted to be probably damaging using PolyPhen-2. The mutation was not detected in the 200 unrelated subjects we tested.Conclusion Using next generation sequencing, which has very recently been shown to be successful in identifying novel causative mutations of rare Mendelian disorders, we found a novel mutation of TNNI3 in a Chinese family with RCM.

[Prevalence and risk factors of atherosclerotic renal artery stenosis].

OBJECTIVE: To explore the prevalence and risk factors of atherosclerotic renal artery stenosis (ARAS) in patients undergoing coronary angiography. METHODS: A total of 2506 patients with suspected and known coronary heart disease (CAD) at our hospital underwent simultaneous coronary and renal angiography. Renal artery stenosis was defined as at least one of renal artery stenosis ≥ 50% narrowing of luminal diameter. The prevalence of ARAS was summarized from the results of angiography. And single- and multi-variable logistic regression analysis was used to assess the relationship between clinical characteristics and ARAS. RESULTS: Among them, there were 1479 males and 1027 females with a mean age of 62.7 ± 11.4 years. ARAS was detected in 409 patients (16.3%), including 214 (8.5%) with significant stenosis (≥ 75%); Bilateral ARAS was detected in 98 patients (3.9%), including 27 (1.1%) with significant stenosis (≥ 75%). Left and right ARAS were detected in 162 patients (6.5%) and 148 patients (5.9%) respectively, including 84 patients (3.4%) with significant stenosis (≥ 75%) in left ARAS and 72 patients (2.9%) in right ARAS. Univariate analysis indicated that age, females, diabetes, hypertension, stroke, peripheral artery disease, coronary heart disease, renal insufficiency, dyslipidemia and hyperuricemia were the predictor for ARAS (P < 0.05 or 0.01). Multivariate regression analysis demonstrated that age ≥ 65 years (P = 0.025, OR = 1.358), females (P < 0.01, OR = 1.678), hypertension (P < 0.01, OR = 1.650), peripheral artery disease (P < 0.01, OR = 14.678), renal insufficiency (P < 0.01, OR = 1.835), coronary heart disease including 3-vessel (P < 0.01, OR = 1.746) and left main coronary (P < 0.01, OR = 3.416)disease were independent risk factors for ARAS. CONCLUSION: Renal angiography should be routinely performed in female patients aged ≥ 65 years with hypertension, peripheral artery disease, elevated creatinine and coronary heart disease, especially for 3-vessel and left main coronary disease to identify ARAS in time.

[Risk factors and coronary angiography characteristics of female patients with acute coronary syndrome].

OBJECTIVE: To assess the risk factors and coronary angiography characteristics of female patients with acute coronary syndrome (ACS). METHODS: A total of consecutive 986 inpatients with ACS who had undergone coronary angiography from March 2009 to August 2010 in our hospital were enrolled in this study. There were 303 female patients and 683 male patients. Clinical data were collected by physicians and the severity of coronary artery stenosis was analyzed via the international Gensini Score system. RESULTS: Incidence of ACS under the age of 60 years [8.6% (26/303) vs. 16.5% (113/683), P < 0.05], family history of coronary artery disease [15.8% (48/303) vs. 23.0% (157/683), P < 0.05], and smokers [19.1% (58/303) vs. 71.7% (490/683), P < 0.001] were significantly less while hypertension [81.5% (247/303) vs. 64.0% (437/536), P < 0.001] and diabetes rate [51.8% (157/303) vs. 44.0% (298/683), P < 0.05] were significantly higher in female patients than in male patients. The comorbidities of dyslipidemia, adiposity, hyper-C-reaction protein and hyperfibrinogenemia were similar between male and female patients (P > 0.05). Unstable angina and non-ST-segment elevation myocardial infarction were more often [86.1% (261/303) vs. 78.5% (536/683)], while ST-segment elevation myocardial infarction was less [13.9% (42/303) vs. 21.5% (147/683), P = 0.005] in female patients than in male patients. There were significantly more incidence of mild coronary artery stenosis [15.0% (47/303) vs. 10.0% (68/683), P = 0.012] and less severely stenotic lesions [84.2% (255/303) vs. 89.8% (613/683), P = 0.013] in female patients than in male patients. Gensini score, percutaneous intervention rate and in-hospital mortality rate were similar between male and female patients with ACS (P > 0.05). CONCLUSIONS: Prevalence rates of diabetes mellitus and hypertension are higher while positive family history on coronary artery disease and smoking rate are lower in female patients with ACS than in male ACS patients. Female ACS patients are often presented with unstable angina or non-ST-segment elevation myocardial infarction and with mild coronary artery stenosis compared to male ACS patients.

[Clinical and coronary features of systemic lupus erythematosus patients with coronary artery disease].

OBJECTIVES: To observe the clinical and coronary features of patients with systemic lupus erythematosus (SLE) and coronary artery disease (CAD). METHODS: Among 2877 SLE inpatients (age ≥ 18 years, male 363, female 2514) admitted in the Peking Union Medical College Hospital between January 1999 to October 2009, 33 patients [mean age (50.7 ± 12.8) years] were diagnosed with CAD and coronary angiogram was available in 20 out of these 33 patients. Clinical and coronary features of these patients were retrospectively reviewed. RESULTS: The incidence of CAD was significantly higher in male SLE patients than in female patients [2.48% (9/363) vs. 0.95% (24/2514), P = 0.022]. Patients with secondary antiphospholipid syndrome were more likely to suffer from CAD [5.76% (8/139) vs. 0.91% (25/2738), P < 0.001]. Myocardial infarction was the major form of CAD (24/33). Coronary artery angiographic changes included coronary stenosis and occlusions, coronary aneurysms and acute thrombosis and multi-vessel lesions was found in 75.0% (15/20) patients with SLE and CAD. CONCLUSIONS: Male SLE patients and patients with secondary antiphospholipid syndrome are at higher risk for CAD. Myocardial infarction and multi-vessel lesions are common in SLE patients with CAD.

[ST segment deviation in acute myocardial infarction with isolated disease of left anterior descending artery].

OBJECTIVE: To analyze the characteristics of the electrocardiogram (ECG) of left anterior descending coronary artery (LAD) occlusion in patients with acute ST elevation myocardial infarction (STEMI). METHODS: Patients included were those diagnosed with STEMI in Peking Union Medical College Hospital from January 1996 to March 2009, and underwent coronary angiography (CAG). The infarction related artery (IRA) was LAD, and there were no significant stenosis in left circumflex artery and right coronary artery. A total of 170 cases were consecutively enrolled. They were divided into 2 groups according to occlusive sites of the LAD: LAD proximal (n = 77), LAD medius distal group (n = 93). Standard 18 leads ECG within 12 hours from the onset of STEMI were recorded and ST segment deviation was analyzed quantitatively. RESULTS: Proximal LAD occlusion as IRA was diagnosed with aVL ≥ 0.1 mV, ST aVL > aVR, sum of II, III and aVF STsegment depression ≥ 0.1 mV, in which sensitivity was 39.0%, 37.7% and 50.6%, specificity was 78.5%, 77.4% and 74.2% respectively. Statisticully significance (P < 0.05). Medius-distal LAD occlusion as IRA was diagnosed with no II ST depression, aVF ST depression and sum of II, III and aVF ST segment depression > 0.1 mV, In which sensitivity were 86.0%, 81.7% and 74.2% and the were 31.2%, 48.1% and 50.6% respectively. Statisticully significance (P < 0.05). CONCLUSION: In STEMI patients with isolated LAD occlusion, ECG can be useful to predict the occlusion site.

[Deviation of ST-segment and detection of infarction related artery in patients with acute inferior wall infarction].

OBJECTIVE: To explore the characteristics of ST-segment deviation in patients with acute ST elevation myocardial infarction(STEMI)having only one vessel lesion in either left circumflex artery (LCX) or right coronary artery (RCA). METHODS: All AMI (acute myocardial infarction) patients were admitted into Peking Union Medical College Hospital from January 1996 to March 2009. They underwent coronary angiography (CAG). And the IRA (infarction-related artery) was either LCX or RCA without other coronary artery stenosis. Their ST-segments deviations on electrocardiogram (ECG) were analyzed quantitatively. RESULTS: Among 2503 AMI cases undergoing CAG during hospitalization, 75 cases had LCX (n = 16) or RCA (n = 59)-related STEMI. The RCA group was further divided into the proximal subgroup (n = 21) and the distal subgroup (n = 38). RCA as IRA was diagnosed when ST I depression < 0, ST V(1) elevation ≥ 0 or ST I and aVL depression < 0 with the sensitivities of 55.9%, 74.6% and 54.2% and the specificities of 81.3%, 62.5% and 81.3% respectively. LCX as IRA was diagnosed when ST aVR depression ≥ 0.1 mv, ST I elevation ≥ 0 or ST V(5) and V(6) elevation ≥ 0 with the sensitivities of 68.8%, 81.3% and 31.3% and the specificities of 76.3%, 59.3% and 91.5% respectively. Proximal occlusion of RCA was diagnosed when there was no ST depression in V(1) and depression in V(2), Max precordial ST depression in V(1)-V(3) with the sensitivities of 47.6% and 52.4% and the specificities of 78.9% and 84.2%. CONCLUSION: While discriminating IRA in STEMI patients with single LCX or RCA lesion, it is necessary to assess all ST-segments deviations on ECG.

[Effects of hemoglobin levels on long-term prognosis in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention].

OBJECTIVE: To evaluate the effects of hemoglobin (Hb) levels on long-term prognosis in the patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. METHODS: A total of 150 patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention between January 2005 to December 2007 were enrolled. They were divided into 2 groups: Hb < 120 g/L group (n = 21) and Hb ≥ 120 g/L group (n = 129). The mean clinical follow-up period was 3 years (range: 41.4 ± 16.1 months). The differences of major adverse cardiac events (MACE), including death, acute myocardial infarction, stent thrombosis & stent restenosis), were observed between two groups. RESULTS: The parameters of infarction site, infarction relative artery, 2-vessel disease, 3-vessel disease, Killip class ≥ II, drug-eluting stent, TIMI grade 3 flow, hypertension, hyperlipidemia, smoking, obesity, aspirin and clopidogrel use were not different between two groups (all P > 0.05). The rate of diabetes was significantly higher in Hb < 120 g/L group than that in Hb ≥ 120 g/L group (47.62% vs 18.60%, P = 0.0032). The mean age and symptom-onset-to balloon-time (SOTB) were significantly higher in Hb < 120 g/L group than that in Hb ≥ 120 g/L group (68.5 ± 9.2 vs 61.2 ± 12.2 years, P < 0.0001; 8.8 ± 10.5 vs 6.3 ± 5.0 h, P < 0.0001). The mean LVEF (left ventricular ejection fraction)(%) and rate of complete revascularization were significantly lower in Hb < 120 g/L group than that in Hb ≥ 120 g/L group (51.25 ± 11.34 vs 58.79 ± 10.38, P < 0.0001; 61.9% vs 86.8%, P = 0.0045). Logistic regression analysis showed that LVEF was an independent predictor of MACE during the follow-up period (P = 0.0140). During a 3-year follow-up, MACE occurred in 16 patients. The incidence of MACE was significantly higher in Hb < 120 g/L group than that in Hb ≥ 120 g/L group (33.33% vs 6.98%, P = 0.0003); Moreover the all-cause mortality and cardiac mortality were significantly higher in Hb < 120 g/L group than those in Hb ≥ 120 g/L group (28.57% vs 3.10%, P < 0.0001; 23.81% vs 2.33%, P < 0.0001). CONCLUSION: In the patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, hemoglobin level < 120 g/L at baseline is markedly associated with adverse outcomes and an elevated incidence of MACE and mortality during the follow-up period.

[Long-term outcome analysis of patients underwent percutaneous coronary intervention with prior ischemic stroke].

OBJECTIVE: To analyze the clinical characteristics and long-term outcomes of patients underwent percutaneous coronary intervention (PCI) with prior ischemic stroke. METHODS: A total of 2053 patients underwent PCI in Peking union medical college hospital from January 2003 to December 2007 were included in this analysis and patients were followed up to December 2009. End-point included all-cause mortality, cardiac death, stent thrombosis, target-lesion revascularization, myocardial infarction, re-cerebral infarction. Major bleeding events were recorded during follow-up. RESULTS: There are 1945 coronary heart disease patients were followed up and 222 patients with prior ischemic stroke. Compared patients without prior ischemic stroke, patients with prior ischemic stroke were older (P = 0.000), had higher hypertension morbidity (P = 0.000), higher diabetes mellitus morbidity (P = 0.005), higher incidence of multi-vessels disease (P = 0.000). During the follow-up of (35.0 ± 19.6) months, cardiac death rate (8.5% vs. 3.9%, P = 0.002) and re-cerebral infarction rate (5.8% vs. 1.4%, P = 0.000) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke. Dual antiplatelet therapy treatment time [(13.77 ± 11.33) months vs. (13.94 ± 11.33) months, P = 0.986] and major bleeding events (5.8% vs. 3.6%, P = 0.100) were similar between the two groups and cerebral hemorrhage rate (1.8% vs. 0.5%, P = 0.028) were higher in patients with prior ischemic stroke than patients without prior ischemic stroke. CONCLUSION: Patients with prior ischemic stroke were associated with increased rate of risk factors, multiple coronary artery disease, cardiac death and re-cerebral infarction and higher cerebral hemorrhage rate during follow-up despite similar dual-anti platelet therapy time.

[Clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease].

OBJECTIVE: To evaluate the clinical and coronary angiographic features of patients with systemic vasculitis and coronary artery disease. METHOD: Fifteen patients (11 male) with systemic vasculitis and coronary artery diseases admitted to our hospital from January 1999 to October 2009 were reviewed. RESULTS: There were 6 patients with Behcet's disease, 3 patients with Churg-Strauss syndrome, 2 patients with Takayasu arteritis, 1 patient with polyarteritis nodosa, 1 patient with microscopic polyangiitis, 1 patient with Wegner's granulomatosis and 1 patient with Kawasaki disease. Mean age of this cohort was (39.3 ± 11.9) years. Adverse coronary events occurred in 4 patients during the inactive phase of systemic vasculitis and in 9 patients during the active phase of systemic vasculitis. Twelve patients were hospitalized with acute myocardial infarction, 2 with angina pectoris and 1 with cardiac tamponade. There were 3 patients with acute left ventricular dysfunction and 3 patients with severe arrhythmias. Compared to patients in the inactive phase, patients in the active phase were younger [(32.4 ± 8.1) years vs. (47.0 ± 10.2) years], had less risk factors for atherosclerosis (1.2 ± 1.5 to 2.8 ± 1.7) and the time intervals between coronary artery disease and systemic vasculitis was shorter [0 - 7 years (average 1.6 years) to 3 - 30 years (average 17.7 years)]. Coronary angiography evidenced coronary stenosis or occlusions in 11 patients, coronary aneurysm and acute thrombosis in 1 patient, coronary aneurysms and occlusions in 1 patient and coronary spasm in 2 patients. LVEF measured by echocardiography was less than 50% in 8 patients. CONCLUSION: Patients with various systemic vasculitis could develop severe coronary artery disease due to coronary stenosis/occlusion, aneurysma, thrombosis and coronary spasm.

[Effect of duration of clopidogrel use on clinical follow-up outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention].

OBJECTIVE: To evaluate effect of duration of clopidogrel use on clinical follow-up outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. METHODS: A total of 214 patients with acute myocardial infarction undergoing primary percutaneous coronary intervention between January 2005 to December 2007 were enrolled. All patients were divided into two groups by duration of clopidogrel use: <1 year group (n=59) and > or =1 years group (n=155). Baseline characteristics [age, gender, angiographic characteristics, Killip classification, LVEF (left ventricular ejection fraction) , CK (creatine kinase), CK-MB, CTnI (cardiac troponin-I), hemoglobin levels and history of hypertension, diabetes, hyperlipidemia, obesity and smoking] of two groups were collected. Clinical follow-up end-point was major adverse cardiac event (MACE) including death, acute myocardial infarction, stent thrombosis and stent restenosis. Clinical follow-up duration was 41.6 +/- 16.3 months. MACE occurred in 28 patients. RESULTS: Rates of male, infarction site, infarction relative artery, multivessel disease, Killip classification (class I), aspirin use and history of smoking, obesity, hypertension and hyperlipidemia were not different (P > 0.05) in duration of clopidogrel use <1 year group and > or =1 years group. Average LVEF, hemoglobin levels and rate of drug-eluting stents were significantly lower in duration of clopidogrel use <1 year group than that in duration of clopidogrel use > or =1 years group (P < 0.0001, P < 0.0001, P = 0.0065). Average CK, CK-MB, CTnI were significantly higher in duration of clopidogrel use > or =1 years group than that in duration of clopidogrel use <1 year group (P < 0.0001). Rate of diabetes and average age were significantly higher in duration of clopidogrel use <1 year group than that in duration of clopidogrel use > or =1 years group (P = 0.0190, P < 0.0001). Incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use > or =1 years group than that in duration of clopidogrel use < 1 year group (6.45% vs. 30.51%, P < 0.01). After stopping clopidogrel use, incidence of MACE in followup period was significantly lower in duration of clopidogrel use > or =1 years group than that in duration of clopidogrel use <1 year group (2.58% vs. 20. 34%, P < 0.01). CONCLUSION: Primary percutaneous coronary intervention is an effective therapeutic method. Incidence of MACE in follow-up period was significantly lower in duration of clopidogrel use > or =1 years group than that in duration of clopidogrel use <1 year group. Duration of clopidogrel use may influence clinical outcomes in follow-up period in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

[Clinical and coronary characteristics of young patients (< 30 years old) with acute myocardial infarction].

OBJECTIVE: To explore the clinical characteristics and angiographic features of acute myocardial infarction in patients aged 30 years or younger. METHODS: Data of 360 consecutive patients referred to Peking Union Medical College Hospital for evaluation of chest pain or discomfort from January 2007 to December 2009, diagnosed as acute myocardial infarction and underwent emergent coronary angiography were analyzed. Seven patients (1.9%) with age ≤ 30 years [4 male, (25 ± 5) years] were included in this study, patients were followed up for (12 ± 9) months. RESULTS: There were 6 cases of ST-segment elevated myocardial infarction and 1 non-ST-segment elevated myocardial infarction. The culprit vessels were as follows: 5 left anterior descending artery, 1 left main and 1 right coronary artery. All 3 female patients were complicated with congenital coronary malformation or autoimmune disease, including 1 coronary artery aneurismal dilation of left anterior descending, 1 Takayasu's arteritis and 1 systemic lupus erythematosus. Three of the 4 male patients were smokers. Two patients underwent percutaneous coronary intervention. There was no death or cardiovascular re-admission during the follow-up. CONCLUSIONS: The majority of acute myocardial infarction in patients aged 30 years or younger were presented with ST-segment elevated myocardial infarction and single vessel non-obstructive lesion. The most common culprit vessel was left anterior descending artery. All female patients were complicated with congenital coronary malformation or autoimmune disease. The short-term prognosis in patients of this cohort was good.

[Assessment of life quality in patients with chronic heart failure].

OBJECTIVE: Using Kansas city cardiomyopathy questionnaire (KCCQ) to evaluate the quality of life (QOL) of the patients with chronic heart failure. METHODS: A total of 271 hospitalized patients with heart failure symptoms in cardiology department, Peking Union Medical College Hospital, who undergone coronary angiography from December 2007 to December 2008, were included in this study. QOL of the subjects was measured, and their demographic and clinical data were collected. Patients were divided into 2 groups according to heart function and they were compared by QOL.Multiple linear regression analysis was conducted to identify the variables associated with the quality of life. RESULTS: KCCQ physical limitation scores of the patients of left ventricular elective fraction (LVEF) < 50% (n = 50) and LVEF > or = 50% (n = 221) were (66 +/- 22) points and (73 +/- 22) points (P < 0.05). In the patients of NYHA I/II (n = 227) vs NYHA III/IV (n = 44), KCCQ scores of physical limitation, symptoms and QOL were (74 +/- 20) vs (60 +/- 27) points, (62 +/- 22) vs (49 +/- 25) points and (61 +/- 16) vs (53 +/- 18) points (all P < 0.05). In the patients of heart failure grade A/B (n = 197) vs grade C/D (n = 74), KCCQ scores of physical limitation, symptoms and QOL were (75 +/- 19) vs (61 +/- 26) points, (63 +/- 22) vs (52 +/- 24) points, (61 +/- 16) vs (56 +/- 18) points (all P < 0.05). Multiple linear regression analysis of QOL KCCQ showed that, age, NYHA cardiac function classification, gender and Judkins score were the risk factors of patients' physical limitation (P < 0.01); gender and stages of heart failure were the risk factors of patients'symptoms (P < 0.01); gender was the risk factors of patients'social function (P < 0.01). CONCLUSION: The patients with poor cardiac function have a poor QOL. KCCQ is more sensitive for the evaluation of heart function. Age, NYHA, gender, Judkins score and stages of heart failure can change QOL for the patients with chronic heart failure.

[Assessment of quality of life in patients with coronary artery disease with Seattle angina questionnaire].

OBJECTIVE: To evaluate quality of life (QOL) of patients with different severity of coronary artery disease using Seattle angina questionnaire (SAQ). METHODS: A total of 513 hospitalized patients undergoing coronary angiography from December 2007 to December 2008 were included. QOL of these patients was measured with SAQ and their demographic and clinical data were collected. Patients were divided into 3 groups according to the severity of coronary artery disease by coronary angiography. And comparisons of traditional risk factors and QOL were made among these groups. Multiple linear regression analysis was conducted to identify the variables associated with QOL. RESULTS: The scores of physical limitation were significantly different among 3 groups according to the severity of coronary artery disease by coronary angiography (80 +/- 16, 79 +/- 19 and 71 +/- 22, P < 0.01). Multiple linear regression analysis showed that physical limitation of the patients was affected by age (P < 0.01), gender (P < 0.01) and severity of coronary artery disease (P < 0.01). Angina stability was affected by the history of myocardial infarction (P = 0.03). Angina frequency was affected by the history of myocardial infarction (P = 0.01) and gender (P = 0.04). Treatment satisfaction was affected by the severity of coronary artery disease (P = 0.03) and disease perception by the history of DM (P = 0.03). CONCLUSION: Age, gender, history of myocardial infarction, history of DM and severity of coronary artery disease are independent predictors of QOL in patients with coronary artery disease.

[Characteristics of angina in patients with coronary artery disease complicated by diabetes mellitus].

OBJECTIVE: To improve the understanding of chest pain and angina pectoris in patients with diabetes mellitus (DM). METHODS: The clinical features and angina characteristics of 4873 patients undergoing coronary angiography (CAG) were recorded. The characteristics of angina pectoris of 1431 patients with coronary artery diseases (CAD) complicated by DM were analyzed. For detecting coronary artery disease, the sensitivity, specificity, positive predictive value, and negative predictive value were analyzed according to chest pain and coronary angiography. RESULTS: Of the 1431 CAD patients with DM 187 only presented non-cardiac chest pain, 492 presented atypical angina, and 752 presented typical angina. Of the CAD 2056 patients without DM 297 only presented non-cardiac chest pain, 735 presented atypical angina, and 1024 presented typical angina. In detecting coronary artery disease, no matter with what type of chest pain, the positive predictive values of the DM group were all remarkably higher than those of the non-DM group, and the negative predictive values of the DM group were all remarkably lower than those of the non-DM group, however, there were not significant differences in the sensitivity and specificity between the DM group and non-DM group. In the non-DM group the number of stenotic branches of coronary artery was closely associated with the angina characteristics (P < 0.01), however, in the DM group the number of stenotic branches of coronary artery was not associated with the angina characteristics (P = 0.333). CONCLUSION: Typical angina pectoris is a clinical manifestation with high accuracy in diagnosis of CAD. In the non-DM patients, the characteristics of chest pain reflect the severity of coronary artery stenosis.

[Factors associated with reduced renal function post primary percutaneous coronary intervention in acute myocardial infarction patients with normal baseline serum creatinine level].

OBJECTIVE: To analyze factors associated with reduced renal function post primary percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients with normal baseline serum creatinine level. METHOD: The clinical and angiographic data of 216 consecutive AMI patients undergoing primary PCI with normal baseline serum creatinine level (< 1.5 mg/dl) were obtained and compared between patients with (n = 32) and without (n = 184) renal function deterioration (increase in serum creatinine > or = 25% from baseline level within 72 hours of primary PCI) post PCI. RESULTS: The incidence of renal function deterioration was 14.8% (32/216). Patients with age > 75 years (28.1% vs. 14.1%, P = 0.047), congestive heart failure (25.0% vs. 9.2%, P = 0.017), less use of low-molecular weight heparins (84.4% vs. 95.1%, P = 0.039) and beta-blockers (75.0% vs. 95.6%, P = 0.001) as well as angiotensin converting enzyme inhibitors/angiotensin receptor blockers (81.3% vs. 93.5%, P = 0.025) and statins (84.4% vs. 97.3%, P = 0.008) were risk factors for developing renal dysfunction post PCI. Renal function deterioration post PCI was also associated with increased in-hospital mortality (25.0% vs. 2.2%, P < 0.001). Multivariate analysis showed that congestive heart failure was the single independent predictor of renal function deterioration (odds ratio = 3.275, 95% confidence interval 1.275 - 8.408, P = 0.014), while renal function deterioration was the strongest independent predictor of in-hospital death (odds ratio = 10.313, 95% confidence interval 2.569 - 41.402, P = 0.001). CONCLUSION: Renal function deterioration is a common complication post primary PCI and is associated with higher risk of in-hospital death in AMI patients with normal baseline serum creatinine level.

[Clinical characteristics of angina pectoris in patients of coronary artery disease complicated with renal stenosis and the diagnostic value thereof: analysis of 2820 cases].

OBJECTIVE: To analyze the characteristics of angina symptom complex of patients with coronary artery disease (CAD) complicated with renal stenosis, and to analyze their sensitivity and specificity of angina symptom complex for the diagnosis of CAD. METHODS: The medical records of 2820 in-hospital patients who underwent coronary angiography and renal angiography simultaneously during the period from Jan 1998 to May 2005 and could be diagnosed as with CAD or renal stenosis with the stenotic degree more than 50% of the coronary or renal artery in angiography, were analyzed. The diagnosis of CAD was based on the 3 groups of symptoms recommended by American College of Cardiology/American Heart Association: (1) substernal chest discomfort with a characteristic quality and duration, (2) chest pain provoked by exertion or emotional stress, and (3) chest pain that can be relieved by rest or nitroglycerin. RESULTS: 243 of the 2820 patients had renal stenosis and 2577 of the 2820 patient did not have renal stenosis. The prevalence rates of CAD and hypertension were higher in the renal stenosis group and in the patients without renal stenosis. To diagnose CAD with any one of the 3 groups of above mentioned angina symptom complex, the sensitivity rates were 94.2%, 69.7%, and 75.5% respectively, the specificity rates were 14.3%, 40.0%, and 25.7% respectively, the positive predictive values were 86.7%, 87.3%, and 85.8% respectively, and the negative predictive values were 29.4%, 18.2%, and 15.0% respectively. To diagnose CAD by the symptoms of groups (2) plus (3), (1) plus (2), and (1) plus (3) the sensitivity rates were 68.8%, 56.7%, and 72.6% respectively, specificity rate were 40.0%, 62.9%, and 45.7% respectively, positive predictive values were 87.2%, 90.1%, and 88.8% respectively, and negative predictive values were 17.7%, 19.6, and 21.9% respectively. To diagnose CAD based on all three groups of angina symptom complex, the sensitivity was 56.3%, specificity was 62.9%, positive predictive value was 90.0%, and negative predictive value was 19.5%. CONCLUSION: For detecting CAD based on one, two or three groups of angina symptom complex, there are not significant differences in the diagnostic sensitivity and specificity, however, the positive predictive value is greater and the negative predictive value is smaller in the patients with renal stenosis compared with those without renal stenosis.

[The application of adenosine stress myocardial perfusion tomographic imaging in detecting coronary artery disease].

OBJECTIVE: To analyze the sensitivity and specificity of adenosine stress myocardial perfusion tomographic imaging for the diagnosis of coronary artery disease (CAD). METHODS: Adenosine was infused intravenously at a rate of 140 microg.kg(-1).min(-1) for 6 minutes. 3 minutes after adenosine infusion, 925 MBq of (99m)Tc-MIBI were injected intravenously. SPECT myocardial imaging acquisition was obtained 1.5 hours after adenosine infusion. If the result was abnormal, rest myocardial perfusion imaging would be performed next day. Coronary angiography was performed in all patients within one week of myocardial imaging. RESULTS: Total 79 cases [(62 +/- 10) years old, 35 men, 44 women] were included in this study. In the 50 cases of CAD patients confirmed by coronary angiography, 44 patients have positive adenosine (99m)Tc-MIBI myocardial perfusion SPECT. Nineteen out of 29 cases without CAD have negative adenosine myocardial perfusion tomographic imaging. The sensitivity and specificity of adenosine myocardial perfusion tomographic imaging for the diagnosis of CAD were 88.0% and 65.5%. The sensitivity of adenosine myocardial perfusion tomographic imaging for diagnosing coronary stenosis in left anterior descending, left circumflex and right coronary artery are 32/40, 21/27 and 31/32. There was no severe adverse side effect during adenosine stress test. CONCLUSION: Adenosine stress myocardial perfusion tomographic imaging is an useful non-interventional method for detecting coronary artery disease.

[The long-term results percutaneous transluminal angioplasty and stenting in atherosclerotic renal artery stenosis].

OBJECTIVE: To evaluate the safety, as well as short term and long term effect of percutaneous angioplasty and stenting in atherosclerotic renal artery stenosis. METHODS: A total of 150 consecutive patients with atherosclerotic renal artery stenosis (ARAS) undergoing percutaneous transluminal renal angioplasty (PTRA) and stenting in a period of 6 years were followed up. Blood pressure, renal function before and after the procedure were monitored through-out the follow up years. Renal artery restenosis was tested with ultrasound and Doppler 6-9 months after the procedure. Clinically drive repeat angiogram was done in some patients. RESULTS: 96% of the patients had coronary artery disease and 54% triple vessel disease. A total of 174 renal arteries were found to have severe ARAS in these 150 patients. Procedure success rate was 99.3% with only 1 failure. 3 total occluded renal artery were not attempted, with a total of 170 renal arteries receiving PTRA and stenting. There was no immediate complication such as death, renal artery rupture or acute closure. 145 patients were clinically followed up, with a follow-up rate of 98.6%, and a follow up time between 7 months and 5 years. During follow-up, another 2 patients died in addition to the 3 died in the hospital. All of them died of cardiovascular disease. As to blood pressure, 66 patients among 101 with refractory hypertension and 20 among 42 with well controlled hypertension got improved in 6-9 months of follow up, with an improvement rate of 60.1%. These effects were kept throughout the follow up years. Most of the patient's renal function kept stable and a small number of patient's serum creatine level ameliorating. Renal artery restenosis was found in 10 among the 166 renal vessels undergoing ultrasound examination, with a restenosis rate of 6.0%. CONCLUSION: PTRA and stenting in ARAS patients with coronary artery disease are safe and effective, most of the patient's blood pressure can be controlled and renal function can be kept stable. Restenosis rate is quite low and acceptable.

[Diagnosis of coronary artery disease with 99Tcm-N-NOET myocardial perfusion imaging].

OBJECTIVE: To evaluate the sensitivity and specificity of (99)Tc(m)-N-NOET myocardial perfusion tomographic imaging (MPI) for the diagnosis of coronary artery disease (CAD). METHODS: Coronary angiography and (99)Tc(m)-N-NOET myocardial perfusion tomographic imaging were performed in the patients hospitalized in the Department of Cardiology, Peking Union Medical College Hospital, from June to December 2005 with known or suspected diagnosis of CAD. Adenosine was infused intravenously at a rate of 140 microg x kg(-1)min(-1) for 6 minutes. At the third minute of adenosine infusion, 740 MBq (20 mCi) (99)Tc(m)-N-NOET was injected intravenously. MPI was obtained 15 minutes after the (99)Tc(m)-N-NOET infusion. If the result was abnormal, rest myocardial perfusion imaging would be performed 2 hours later. Coronary angiography was performed in all patients within one week after the myocardial perfusion imaging. RESULTS: Myocardial perfusion imaging was performed in 53 cases, 36 males and 17 females, aged 56 +/- 10, who underwent coronary angiography, among which 31 had > or = 50% stenosis of coronary artery and 23 had normal coronary artery. All of the patients with stenosis of coronary artery had positive (99)Tc(m)-N-NOET adenosine stress myocardial perfusion imaging. Nineteen out of the 29 cases without stenosis of coronary artery had negative adenosine myocardial perfusion imaging. The sensitivity and specificity of (99)Tc(m)-N-NOET adenosine myocardial perfusion imaging were 100% and 73% respectively in the detection of stenosis of coronary arteries. Seven cases got percutaneous coronary intervention and 2 got coronary artery bypass graft. Six of the 9 patients undergoing revascularization had stenosis of stents or grafts, 5 of which had positive myocardial perfusion imaging. 3 cases hadn't restenosis and their results of myocardial perfusion imaging were negative. CONCLUSION: (99)Tc(m)-N-NOET myocardial perfusion imaging is a useful non-interventional method for detecting coronary artery stenosis.

[Early ST resolution after successful primary PCI is related to a favorable outcome in ST elevated AMI patients].

OBJECTIVE: To analyze the relationship between the early ST resolution magnitude and TIMI flow, MACE and the cardiac function in ST elevated AMI (STEMI) patients after successful primary PCI. METHODS: A total of 120 consecutive patients with STEMI underwent primary PCI within 12 hours after the onset of chest pain were enrolled in this study, the ST segment resolution was calculated and the patients were divided into group A (n = 81, Sigma STE resolved > or = 50%) and group B (n = 39, Sigma STE resolved < 50%). TIMI flow after PCI, clinical events up to 30 days post PCI and cardiac function 30 days post PCI were assessed. RESULTS: LVEF was higher in group A than that of group B (58.6% +/- 7.1% vs. 50.5% +/- 7.1%, P < 0.05). There are fewer patients with Killip III and IV in group A than in group B (1.2% vs. 12.8%, P < 0.05). The incidence of in-hospital MACE was also significantly less in group A than in group B (0 vs. 7.7%, P < 0.001). As expected, there were more patients with TIMI 3 flow (95.1% vs. 79.5%, P < 0.05) and fewer TIMI 2 (4.9% vs. 20.5%, P < 0.05) flow post PCI in group A than in group B and all 3 patients with MACE were group B patients with TIMI 2 flow. CONCLUSION: Early ST resolution post PCI represents improved myocardial perfusion and function and is related to a favorable clinical outcome in STEMI patients.