[Association between collateral circulation and myocardial viability evaluated by cardiac magnetic resonance imaging in patients with coronary artery chronic total occlusion].

Objective: Late gadolinium enhancement(LGE) cardiac magnetic resonance imaging(CMR) was used to evaluate the myocardial viability of chronic total occlusion(CTO) in patients with coronary heart disease and to observe the relationship between collateral circulation and myocardium viability in these patients. Methods: This retrospective study included 40 patients with CTO diagnosed by invasive coronary angiography (CAG) from September 2015 to June 2016 in our department, all patients performed CMR examination within one week after CAG.The collateral circulation of CTO was graded with Rentrop classification as follows: poor or no collateral circulation group, moderate collateral circulation group and good collateral circulation group.According to CMR images, the delayed enhancement transmural extent of myocardial segments were scored, the ventricular wall motion of the myocardial segment were graded, and the wall motion score index (WMSI) was calculated.Spearman correlation analysis was used to analyze the relationship between the delayed enhancement transmural extent of myocardial segments and WMSI. Results: In the no or poor collateral group of 6 myocardial regions, 1 myocardial region had viable myocardium and 3 myocardial regions had no viable myocardium; in the moderate collateral group of 16 myocardial regions, 11 myocardial regions had viable myocardium and 5 myocardial regions had no viable myocardium; in the good collateral group of 24 myocardial regions, 21 myocardial regions had viable myocardium and 3 myocardial regions had no viable myocardium, there was significant difference between the groups (P=0.002). The WMSI of poor or no collateral circulation group, moderate collateral circulation group and good collateral circulation group were 1.54±0.50, 1.21±0.34 and 1.26±0.40, respectively, there was no significant difference between the groups (P=0.063). Spearman correlation analysis showed that the extent of delayed enhancement transmural extent of myocardial segment was significantly associated with WMSI (r=0.638, P<0.01). Conclusion: Collateral circulation in patients with chronic total occlusion can predict myocardial viability.Increase of Rentrop grade is linked with higher possibility of the presence of viable myocardium.

[Comparison on the long-term outcomes post percutaneous coronary intervention or coronary artery bypass grafting for bifurcation lesions in unprotected left main coronary artery].

Objective: To compare the long-term clinical outcomes of consecutive patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention(PCI) with drug-eluting stents (DES) for bifurcation lesions in unprotected left main coronary artery (ULMCA). Methods: A total of 663 consecutively patients with unprotected left main bifurcation disease (defined as stenosis≥50%) who received either drug-eluting stents (DES) implantation (n=316) or underwent CABG (n=347) between January 2003 and July 2009 in Beijing Anzhen Hospital were enrolled retrospectively in this study.The endpoints of the study were death, repeat revascularization, myocardial infarction (MI), stroke, the composite of cardiac death, MI or stroke and MACCE (major adverse cardiac and cerebrovascular events, the composite of cardiac death, MI, stroke or repeat revascularization). To reduce the bias between two compared groups , our study applid propensity score matching by logistic regression.Cumulative survival rate was calculated by Kaplan-Meier method.Multiple regression analyses, hazard ratio(HR) and 95%CI were tested by Cox proportional hazard models with the CABG group as the reference category. Results: The median follow-up was 7.2 years (interquartile range 5.1 to 8.3 years) in the overall patients.Unadjusted analysis showed that MACCE rate (PCI 44.5% vs. CABG 45.7%, P=0.036), the rate of repeat revascularization (PCI 33.7% vs. CABG 19.5%, P<0.001), the composite rate of serious outcomes (cardiac death, MI or stroke) (PCI 20.4% vs. CABG 34.3%, P=0.032), stroke rate (PCI 3.7% vs. CABG 23.5%, P<0.001) were significantly different for patients undergoing PCI or CABG. Death rate (PCI 13.0% vs. CABG 18.9%, P=0.12) and MI rate (PCI 11.3% vs. CABG 6.1%, P=0.108) were similar between PCI and CABG group.After adjusting covariates with multivariate Cox hazard regression model, there was no significant difference in rates of death (P=0.286), MI(P=0.165) and the composite rate of serious outcomes (cardiac death, MI or stroke) (P=0.305) between the two groups. Patients in PCI group suffered significant higher rates of MACCE(P=0.011), mainly driven by the significant higher rates of repeat revascularization(HR=2.46, 95%CI 1.662-3.642, P<0.001). However, stroke rate was still significantly higher in CABG group than in PCI group(P=0.001)after multivariate adjusting. After propensity score matching (PSM), there was no more significant difference for all covariates in the matched cohorts (202 pairs). Further PSM analysis showed that overall findings were consistent with multivariate Cox hazard regression model except for MI (PCI 12.7% vs. CABG 3.8%, P=0.039). Conclusions: During a follow-up up to 8.3 years, the survival rate is similar between the PCI and the CABG group in patients with unprotected left main bifurcation disease.The rate of repeat revascularization is significantly higher whereas stroke rate is significantly lower in the PCI group compared to CABG group.After propensity score matching, PCI group not only had a significant higher rate of repeat revascularization, but also had significantly higher risk of MI in the matched cohorts; while they did not seem to translate into any disparity of mortality in ULMCA bifurcation disease patients.Accordingly, PCI for ULMCA disease can be used as a reasonable treatment option alternative to CABG.

[Association between genetic variants in the adiponectin gene and premature myocardial infarction].

OBJECTIVE: To investigate the relationship between adiponectin gene polymorphisms and premature myocardial infarction (PMI). METHODS: A total of 306 PMI patients of Beijing Anzhen Hospital were identified from March 2013 to January 2015 using the case-control method, 412 patients with normal coronary angiography results served as the control group. 17 single nucleotide polymorphisms (SNPs) in adiponectin gene were selected and genotyped using mass spectrometry. The Chi-squared test was used to compare allele and genotype frequencies between PMI and control groups. The plasma adiponectin concentrations were measured using enzyme-linked immunoassay, and the relationship was analyzed between adiponectin level and SNPs. RESULTS: There was no significant difference in allele frequencies and in genotype frequencies between PMI patients and controls (P>0.05). Multivariate logistic regression models were used to estimate the correlation in additive, dominant and recessive genetic models, respectively. Analysis showed that rs2241766T>G was significant associated with PMI risk in a addition model in Chinese Han population(OR=1.446, 95%CI 1.006-2.079, P=0.035), and rs12629945G>A was significant association with PMI risk in a dominant model in Chinese Han population(OR=1.609, 95%CI 1.006-2.573, P=0.041). Adiponectin levels in PMI group were significantly lower than in control group ((863.3±112.8)µg/L vs.(910.4±117.1)µg/L, P=0.042). Adiponectin levels were significantly lower in patients with the homozygous mutation genotype (GG) compared to patients with the heterozygote mutant and wild type genotypes (GT+ TT) in adiponectin gene rs2241766 T>G polymorphisms ((859.4±98.1)µg/L vs. (908.9±113.1)µg/L, P=0.032). CONCLUSION: The rs2241766T>G and rs12629945G>A polymorphisms in the adiponectin gene were associated with PMI in Chinese Han population. Rs2241766T>G polymorphisms is linked with lower plasma adiponectin levels, and increased risk of PMI.

[A comparison of clinical characteristics between non-erosive reflux disease and reflux esophagitis].

OBJECTIVE: To summarize the clinical symptoms of patients with non-erosive reflux disease(NERD) and reflux esophagitis(RE), which is helpful to the differential diagnosis. METHODS: Out-patients who met the criteria of NERD or RE according to the Montreal definition in Gastroenterology Department Wuhan Union Hospital from 2010-2014 were enrolled in our study. Clinical data were comprehensively collected. Incidence of disease, severity, frequency of esophageal and extraesophageal symptoms, and the rates of overlapping with functional dyspepsia (FD) or irritable bowel syndrome (IBS) were all studied. RESULTS: Totally 446 subjects were recruited, including 225 patients with NERD and 221 patients with RE. The occurrence rates of esophageal symptoms including heartburn [76.0%(171/225) vs 52.0%(115/221), P<0.01] and acid regurgitation [74.7%(168/225) vs 54.3%(120/221), P<0.05] in NERD group were significantly higher than those in RE patients, with more severe and frequent (P<0.05). Despite the rates of food regurgitation were similar, NERD patients behaved more severely and frequently (P<0.05). Extraesophageal symptoms including throat burning and foreign body sensation in NERD group [40.9%(92/225) vs 27.6%(61/221), 42.2%(95/225) vs 31.7%(70/221), all P<0.05] were also higher than those in RE group, the degree of which was more severe too (P<0.05). RE patients claimed a higher proportion of chronic cough. The incidences of overlapping with IBS in two groups were similar. But there were more patients with FD in NERD group [72.0%(162/225) vs 62.9%(139/221), P<0.05] than in RE group. CONCLUSIONS: The menifestations and degree of esophageal and extraesophageal symptoms in patients with NERD or RE are different, as well as comorbidities such as FD and IBS. These results suggest that NERD and RE are independent diseases.