coronary artery disease

摘要： BACKGROUND The results of previous animal experiments and clinical studies have shown that there is a correlation between expression of betatrophin and blood lipid levels.However,there are still differences studies on the correlation and interaction mechanism between betatrophin,angiogenin-likeprotein3(ANGPTL3)and lipoprotein lipase(LPL).In our previous studies,we found an increase in serum ANGPTL3 Levels in Chinese patients with coronary heart disease(CHD).Therefore,we retrospectively studied Kazakh CHD patients.AIM To explore the correlation between the betatrophin/ANGPTL3/LPL pathway and severity of coronary artery disease(CAD)in patients with CHD.METHODS Nondiabetic patients diagnosed with CHD were selected as the case group;79 were of Kazakh descent and 72 were of Han descent.The control groups comprised of 61 Kazakh and 65 Han individuals.The serum levels of betatrophin and LPL were detected by enzyme-linked immunosorbent assay(ELISA),and the double antibody sandwich ELISA was used to detect serum level of ANGPTL3.The levels of triglycerides,total cholesterol,and fasting blood glucose in each group were determined by an automatic biochemical analyzer.At the same time,the clinical baseline data of patients in each group were included.RESULTS Betatrophin,ANGPTL3 and LPL levels of Kazakh patients were significantly higher than those of Han patients(P=0.031,0.038,0.021 respectively).There was a positive correlation between the Gensini score and total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),betatrophin,and LPL in Kazakh patients(r=0.204,0.453,0.352,0.471,and 0.382 respectively),(P=0.043,0.009,0.048,0.001,and P<0.001 respectively).A positive correlation was found between the Gensini score and body mass index(BMI),TC,TG,LDL-C,LPL,betatrophin in Han patients(r=0.438,0.195,0.296,0.357,0.328,and 0.446 respectively),(P=0.044,0.026,0.003,0.20,0.004,and P<0.001).TG and betatrophin were the risk factors of coronary artery disease in Kazakh patients,while BMI and betatrophin were the risk factors in Han patients.CONCLUSION There was a correlation between the betatrophin/ANGPTL3/LPL pathway and severity of CAD in patients with CHD.

摘要： BACKGROUND Severe stenotic myocardial bridges(MBs)have been reported to lead to intracoronary ischaemia,but the physiological evaluation of MBs using intracoronary function evaluation indicators after intraoperative drug treatment has not been fully established.CASE SUMMARY We performed through snuff fossa for coronary angiography in a patient with chest tightness after repeated exercise,and the results showed that the middle part of the anterior descending branch was a MB with 100%systolic compression.The intracoronary function evaluation(defined as the ratio of distal coronary pressure to aortic pressure with zero microcirculation resistance)was instantaneous wave-free ratio(IFR)without drug and fractional flow reserve(FFR)with adenosine.The IFR was 0.73,and the FFR was 0.66.Then esmolol 0.02μg/kg/min was intravenously injected.The IFR and FFR were measured again when the heart rate dropped to 60 beats/min.The IFR was 0.83,and the FFR 0.65.CONCLUSION This case report is a case of isolated MB with severe stenosis.After intraoperative drug treatment decreased the ventricular rate,an increase in the coronary function evaluation index was immediately observed to confirm the effective improvement of coronary blood flow.

摘要： Objective:To investigate health literacy,behavioral and psychosocial characteristics in coronary artery patients.Methods:Between March 2019 and 2020 years,275 coronary artery patients aged≥50 years were included in the study.Turkish Health Literacy Scale-32 and Beck Depression Inventory were used to collect the data.Results:General health literacy index score was 31.7 and the prevalence of limited health literacy was 59.3%.Adequate health literacy was 2.8 fold higher in the 50-64 age group,3.1 fold higher among men,3.4 fold higher among married and 5.3 fold higher among those who believed in the necessity of individual protective practices(P<0.05).Significant differences were also found in different working status,living places,perceived economic situation,perceived general health status,comorbidities,family history of coronary artery disease,angiography history,material skills on reading and understanding,level of depressive syptom,commitment to individual protective practices health check-ups,utilizing health services,cigarette and alcohol use,and exercise and nutrition between limited and adequate health literacy(P<0.05).Logistic regression analysis showed that adequate health literacy was significantly higher among younger patients(OR:2.81;95%CI:1.46-5.62),male gender(OR:3.10;95%CI:1.46-6.58),married(OR:3.42;95%CI:1.39-8.44)and those with belief in individual protective practices(OR:5.3;95%CI:1.93-14.96).Conclusions:Health literacy is poor among coronary artery patients and behavioral and psychosocial variables differ with health literacy levels.To keep cardiovascular health among these patients,health literacy-based interventions should be adopted in coronary artery clinics,especially for risky population.

摘要： Exercise stress echocardiography(ESE)is a widely used diagnostic test in cardiology departments.ESE is mainly used to study patients with coronary artery disease;however,it has increasingly been used in other clinical scenarios including valve pathology,congenital heart disease,hypertrophic and dilated cardiomyopathies,athlete evaluations,diastolic function evaluation,and pulmonary circulation study.In our laboratories,we use an established methodology in which cardiac function is evaluated while exercising on a treadmill.After completing the exercise regimen,patients remain in a standing position or lie down on the left lateral decubitus,depending on the clinical questions to be answered for further evaluation.This method increases the quality and quantity of information obtained.Here,we present the various methods of exercise stress echocardiography and our experience in many clinical arenas in detail.We also present alternatives to ESE that may be used and their advantages and disadvantages.We review recent advances in ESE and future directions for this established method in the study of cardiac patients and underline the advantage of using a diagnostic tool that is radiation-free.

摘要： Background:Measuring glycosylated hemoglobin(HbA1c)is a simple way to assess patients with prediabetes or diabetes mellitus.It has been shown that HbA1c level predicts prognosis in patients with coronary artery disease(CAD)and the incidence of diabetes mellitus.However,the prognostic significance of HbA1c level in Asian patients with prediabetes and CAD is not yet clear.Our study aimed to determine the relationship between HbA1c level and major adverse cardiovascular events(MACE)in patients with prediabetes and CAD.Methods:We enrolled 1367 patients with prediabetes and CAD in the final analysis,and grouped them according to the HbA1c level.Primary end points included nonfatal myocardial infarction,hospitalization for unstable angina,and ischemia-driven revascularization.Cox proportional-hazards regression analysis was used to determine the relation-ship between HbA1c level and MACE after our accounting for confounding factors.Results:A total of 1367 patients(age 58.8±10.3 years;71.6%men)were included.During 43 months of follow-up,197 patients experienced at least one primary end point event.Multivariate Cox proportional-hazards regression analy-sis showed in comparison of HbA1c levels that the hazard ratio for primary end points was 4.110,with a 95%confidence interval of 2.097-6.011(P<0.001).Conclusions:HbA1c level positively correlated with MACE,demonstrating it is a valuable indicator for indepen-dently predicting MACE in Asian patients with prediabetes and CAD.

摘要： Clopidogrel is a pro-drug which needs two-step metabolism to produce the active thiol metabolite.This study aimed to explore an efficient method to simultaneously determine the plasma clopidogrel,2-oxo-clopidogrel(2-Oxo-CLP),and the clopidogrel active metabolite(CAM).A high-throughput liquid chromatography tandem mass spectrometry(LC-MS/MS)was therefore developed.The analytes were extracted from plasma by using methyl tert-butyl ether(MTBE).Chromatographic separation was performed on a C18 column under an isocratic elution,accompanied with acetonitrile and deionized water containing 0.1%formic acid.After optimizing the condition of LC-MS/MS,a stable linearity was observed in the standard curves over the concentration ranges of 0.05 to 50.0 ng/mL for clopidogrel,0.5 to 50.0 ng/mL for 2-Oxo-CLP,and 0.5 to 100 ng/mL for clopidogrel active metabolite derivative(CAMD).The retention time was 4.78 minutes,3.79 minutes,3.59 minutes,and 4.82 minutes for clopidogrel,2-Oxo-CLP,CAMD,and internal standard,respectively.Both the relative standard deviation and the relative error were within the requirement of operating criteria.No significant degradation of clopidogrel,2-Oxo-CLP,and CAMD occurred under different storage conditions.This method was successfully validated in 3 patients with coronary artery disease.The results showed that the current LC-MS/MS method was efficient for simultaneously detecting clopidogrel,2-Oxo-CLP,and CAM with fine linearity,accuracy,precision,and stability.

摘要： Coronary bifurcation lesions(CBLs)account for 15%-20%of all percutaneous coronary interventions.The complex nature of these lesions is responsible for poorer procedural,early and late outcomes.This complex lesion subset has received great attention in the interventional cardiac community,and multiple stenting techniques have been developed.Of these,the provisional stenting technique is most often the default strategy;however,the elective double stenting(EDS)technique is preferred in certain subsets of complex CBLs.The double kissing crush technique may be the preferred EDS technique because of its efficacy and safety in comparative trials;however,this technique consists of many steps and requires training.Many new methods have recently been added to the EDS techniques to provide better stent scaffolding and to reduce early and late adverse outcomes.Intravascular imaging is necessary to determine the interventional strategy and postinterventional results.This review discusses the basic concepts,contemporary percutaneous interventional technical approaches,new methods,and controversial treatment issues of CBLs.

摘要： A 58-year-old male patient with LAD diffuse had hyperlipidemia and hypertension. Preoperative angiography showed that he had triple-vessel disease with diffusely diseased LAD. In echocardiography, EF was detected as 60 % (52 - 70) and PAP 25 (12 - 25) mmHg and 2 degrees of tricuspid insufficiency. In this case report, we will present our LAD endarterectomy case. Surgical technique: after standard general anesthesia, cardiopulmonary bypass procedure and moderate hypothermia, cold cardioplegic arrest. Longitudinal long LAD endarterectomy was performed (approximately 10 cm long). A dissector was used to develop on the plane between media and atheroma. Gentle traction was made to light off the atheroplaque with the coronary artery branches, distal and proximal part of the LAD. We assumed that the distal part of the LAD was free from plaque. Then we made the same procedure to the proximal part of the LAD. Luckily, we observed that proximal atheroplaque was also harvested. After completing the endarterectomy, antegrade cardioplegia was administrated to wash and any debris is LAD; also we tried the distal part of the LAD. Via retrograde cardioplegia administrated, we did also observe the bolus return of cardioplegia via retrograde way. After making the same coronary end arteriotomy was successful, we used saphenous vein as a patch for LAD reconstruction. We made only patch plasty like a carotid endarterectomy. Posto- perative follow-up period was 120 months. According to 8 years angiography result, LAD patch plasty was working relatively well. The patient did not have any complaints. We made coronary angiography 10 years after the operation and observed that our patch plasty was occluded but the patient has still class II symptoms with an EF value of 40%.

摘要： Treatment of coronary chronic total occlusion(CTO)with percutaneous coronary intervention(PCI)has rapidly increased during the past decades.Different strategies and approach were developed in the recent past years leading to an increase in CTO-PCI procedural success.The goal to achieve an extended revascularization with a high rate of completeness is now supported by strong scientific evidences and consequently,has led to an exponential increase in the number of CTO-PCI procedures,even if are still underutilized.It has been widely demonstrated that complete coronary revascularization,achieved by either coronary artery bypass graft or PCI,is associated with prognostic improvement,in terms of increased survival and reduction of major adverse cardiovascular events.The application of“contemporary”strategies aimed to obtain a state-of-the-art revascularization by PCI allows to achieve long-term clinical benefit,even in highrisk patients or complex coronary anatomy with CTO.The increasing success of CTO-PCI,allowing a complete or reasonable incomplete coronary revascularization,is enabling to overcome the last great challenge of interventional cardiology,adding a“complex”piece to“complete”the puzzle.

摘要： Background: Long-term survival in acute coronary syndrome has increased steadily in the last decades. Follow-up studies developed in this patient clearly reveal that they are at risk of suffering a new event, placing them in a new stage, secondary prevention. Assuming this increased risk, the control target of their cardiovascular risk factors become more ambitious. In this field, control of Cholesterol levels, particularly LDL-C, has arisen as a priority objective in patients with coronary arterial disease. In this sense, management of dyslipidemia guidelines, recently recognises the role of functional food, highlighting among them is the Red Yeast Rice (RYR). The aim of the study is to establish the potential role of functional food, in secondary prevention, while determining its additional capacity to reduce LDL-C in patients that despite optimal classic treatment (maximum tolerated dose of stain plus Ezetimibe) is still out of control objectives. Results and Discussion: 88 patients were included and after 3 months of treatment with RYR, their lipid profiles were compared with the baseline. The variation of T-Col, LDL-C and Trig were statistically significant. A reduction in LDL-C was 10.73 mg/dL, which means a 10.93% of additional reduction over the standard therapy the patients were receiving. Concerning security, no relevant side effects were reported when adding RYR, even in a relevant percentage (35.4%), myalgia disappeared (especially when reducing the titrating dose of the statin). Conclusion: Adding RYR in secondary prevention patients in combination with the usual treatment, seems to be an effective alternative to optimize LDL levels and thus gets closer to the target set in the guidelines, without adding relevant side effects, and even improving tolerance to the statins.