Tricuspid regurgitation (TR) is frequently associated with severe mitral stenosis (MS), the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of this study was to investigate the efficacy and safety of percutaneous balloon mitral valvuloplasty (PBMV) procedure in rheumatic heart disease patients with mitral valve (MV) stenosis and tricuspid valve regurgitation.Two hundred and twenty patients were enrolled in this study due to rheumatic heart disease with MS combined with TR. Mitral balloon catheter made in China was used to expand MV. The following parameters were measured before and after PBMV: MV area (MVA), TR area (TRA), atrial pressure and diameter, and pulmonary artery pressure (PAP). The patients were followed for 6 months to 9 years.After PBMV, the MVAs increased significantly (1.7 ± 0.3 cm 2 vs. 0.9 ± 0.3 cm 2 , P < 0.01); TRA significantly decreased (6.3 ± 1.7 cm 2 vs. 14.2 ± 6.5 cm 2 , P < 0.01), right atrial area (RAA) decreased significantly (21.5 ± 4.5 cm 2 vs. 25.4 ± 4.3 cm 2 , P < 0.05), TRA/RAA (%) decreased significantly (29.3 ± 3.2% vs. 44.2 ± 3.6%, P < 0.01). TR velocity (TRV) and TR continue time (TRT) as well as TRV × TRT decreased significantly (183.4 ± 9.4 cm/s vs. 254.5 ± 10.7 cm/s, P < 0.01; 185.7 ± 13.6 ms vs. 238.6 ± 11.3 ms, P < 0.01; 34.2 ± 5.6 cm vs. 60.7 ± 8.5 cm, P < 0.01, respectively). The postoperative left atrial diameter (LAD) significantly reduced (41.3 ± 6.2 mm vs. 49.8 ± 6.8 mm, P < 0.01) and the postoperative right atrial diameter (RAD) significantly reduced (28.7 ± 5.6 mm vs. 46.5 ± 6.3 mm, P < 0.01); the postoperative left atrium pressure significantly reduced (15.6 ± 6.1 mmHg vs. 26.5 ± 6.6 mmHg, P < 0.01), the postoperative right atrial pressure decreased significantly (13.2 ± 2.4 mmHg vs. 18.5 ± 4.3 mmHg, P < 0.01). The pulmonary arterial pressure decreased significantly after PBMV (48.2 ± 10.3 mmHg vs. 60.6 ± 15.5 mmHg, P < 0.01). The symptom of chest tightness and short of breath obviously alleviated. All cases followed-up for 6 months to 9 years (average 75 ± 32 months), 2 patients with severe regurgitation died (1 case of massive cerebral infarction, and 1 case of heart failure after 6 years and 8 years, respectively), 2 cases lost access. At the end of follow-up, MVA has been reduced compared with the postoperative (1.4 ± 0.4 cm 2 vs. 1.7 ± 0.3 cm 2 , P < 0.05); LAD slightly increased compared with the postoperative (45.2 ± 5.7 mm vs. 41.4 ± 6.3 mm, P < 0.05), RAD slightly also increased compared with the postoperative (36.1 ± 6.3 mm vs. 28.6 ± 5.5 mm, P < 0.05), but did not recover to the preoperative level. TRA slightly increased compared with the postoperative, but the difference was not statistically significant (P > 0.05). The PAP and left ventricular ejection fraction appeared no statistical difference compared with the postoperative (P > 0.05), the remaining patients without serious complications.PBMV is a safe and effective procedure for MS combined with TR in patients of rheumatic heart disease. It can alleviate the symptoms and reduce the size of TR. It can also improve the quality-of-life and prognosis. Its recent and mid-term efficacy is certain. While its long-term efficacy remains to be observed.
Objective To compare the different impacts of right ventricular apex, right ventricular outflow tract septum and left ventricular outflow tract septum region on interventricular electro-mechanical synchronization and assess the ideal pacing sites for maintaining the interventricular electro-mechanical synchronization. Methods A total of 30 patients without organic heart disease were operated with radiofrequency ablation at our hospital. The mapping electrodes were implanted post-operatively on the left ventricular posterior wall (LVPLW) and right ventricular anterior lateral wall (RVALW) respectively. And the ablation electrodes were placed subsequently in right ventricular apex, right ventricular outflow tract septum region and left ventricular outflow tract septum. The difference values were measured between transmission time from pacemaker to LVPLW, from pacemaker to RVALW and between aortic pre-ejection interval (APEI) and pulmonary artery pre-ejection interval (PPEI). Then their correlations were compared. Results When pacing at right ventricular apex, the difference value between transmission time from pacemaker to LNPLW and from pacemaker to RVALW was (34±7)ms. And it was (18 ±4)ms while pacing at right ventricular outflow tract septum region and ( 12 ± 4)ms at left ventricular outflow tract septum region. There was significant difference (P＜0.01). The absolute value of APEI-PPEI was (25 ±5) ms at right ventricular apex, (13±4) ms at right ventricular outflow tract septum region and (11±3) ms at left ventricular outflow tract septum region. And there was significant difference (P ＜0. 01 ). The absolute value of APEI-PPEI was positively correlated with the change of LNPLW-RVALW (r= 0. 993, P ＜ 0. 01 ). Left ventricular outflow tract septum pacing showed ABp and left ventricle end-systolic pressure significantly increased [(127±23) mm Hg, (142±22) mm Hg,P ＜0.05], left ventricular end-diastolic pressure was significantly lower [(9±3) mm Hg, P ＜ 0. 05]. Conclusion Compared with right ventricular apical pacing and right ventricular outflow tract ventricular septal pacing, left ventricular outflow tract septum has a smaller impact on the electro-mechanical synchronization. It conforms more closely to the physiological pacing so that there is a higher synchronization of electrical and mechanical ventricular contractions.
Key words:
Cardiac pacing, artificial; Catheter ablation; Electrical excitement; Contraction
At present the number of patients with heart failure is annually increasing,cardiac resynchronization therapy is attracting more and more attention.Along with the progressive development of tissue Doppler imaging,it is expected to become the most important criterion to the selection of patients for cardiac resynchronization theraphy.
OBJECTIVE To observe the effects of Tongxinluo capsule on platelet activity and function of vascular endothelium at different stages after percutaneous coronary intervention(PCI) in patients with acute coronary syndrome.METHODS One hundred and sixty patients with acute coronary syndrome were randomly divided into Tongxinluo(TXL) treatment group(TXL group,80 patients) and conventional treatment group(conventional group,80 patients).Fifty healthy people were enrolled as control group.The blood levels of CD62p,CD63,glucose protein(GP)Ⅱb/Ⅲa and endothelium 1(ET-1),vWF,nitric oxide(NO),and flow-mediated dilatation(FMD) in brachial artery were examined before PCI and the second day after PCI in both groups.Then the patients in TXL group received TXL treatment for 6 months(4 capsule tid),and the above parameters were compared with those of conventional treatment group.RESULTS The ACS patients′ blood levels ofCD62p,CD63,GPⅡb/Ⅲa,vWF and ET-1 increased significantly(P0.01),NO and FMD decreased significantly(P0.01),compared with control group.The ACS patients′ plasma levels of vWF increased significantly(P0.05),CD62p,CD63,GPⅡb/Ⅲa and FMD decreased significantly(P0.05) after PCI compared with baseline levels.In both TXL group and conventional group,the patients′ plasma levels of CD62p,CD63,GPⅡb/Ⅲa,vWF and ET-1 decreased significantly(P0.05,P0.01),FMD increased significantly(P0.05,P0.01) compared with baseline levels,meanwhile there were significant differences in all the parameters between TXL group and conventional group(P0.01,P0.05).In addition,the parameters showed significant differences between 6 months and 2 months after TXL treatment(P0.01,P0.05).CONCLUSION TXL can inhibit platelet activity and protect the vascular endothelium function after PCI.
Atherosclerosis is a chronic and progressive disease. Its morbidity and mortality rates have demonstrated an increase in recent years. The present study aimed to explore the role of sirtuin (SIRT) 4 in the development of atherosclerosis. Alterations in SIRT4 expression in response to oxidized low density lipoprotein (oxLDL) were quantified in human umbilical vein endothelial cells (HUVECs) using western blotting. Cell counting kit‑8 and flow cytometry assays were used in order to explore the effects of SIRT4 on HUVEC proliferation and apoptosis. The effect of SIRT4 on the expression of inflammatory factors in HUVECs was analyzed using ELISA. The expression and phosphorylation of proteins in the phosphoinositide 3‑kinase (PI3K)/protein kinase B (Akt)/nuclear factor (NF)‑κB pathway were comparatively analyzed using western blotting. Nuclear translocation of p65 NF‑κB was examined using immunofluorescence. The present study indicated that oxLDL treatment decreased the expression of SIRT4 in HUVECs in a dose‑ and time‑dependent manner. SIRT4 overexpression promoted oxLDL‑induced HUVEC proliferation and inhibited cell apoptosis. Furthermore, SIRT4 overexpression suppressed the PI3K/Akt/NF‑κB pathway by inhibiting PI3K phosphorylation and phosphorylated (p)‑Akt, p‑nuclear factor of kappa light polypeptide gene enhancer in B‑cells inhibitor α and p‑p65 NF‑κB expression; blocking p65 NF‑κB nuclear translocation and decreasing interleukin (IL)‑1β, IL‑6, and tumor necrosis factor α expression in oxLDL‑induced HUVECs. In conclusion, SIRT4 overexpression enhanced HUVEC survival, suppressed the PI3K/Akt/NF‑κB signaling pathway and inhibited the expression of inflammatory cytokines in oxLDL‑induced HUVECs.
Objective To investigate the safety and efficacy of percutaneous coronary intervention (PCI) in patients with low left ventricular ejection fraction (LVEF) and complex small coronary artery lesions. Methods Complete or partial post-PCI revascularization of coronary artery was employed in 16 patients with a low LVEF and complex small coronary artery lesions who were unsuitable for CABG ( coronary artery bypass grafting). All cases were observed with regards to immediate success rate of operation,complication, hospitalization duration, improvement of cardiac function and LVEF and major adverse cardiac events (including cardiac death, myocardial infarction and target lesion revascularization) at 12 months postoperation. Results All cases were successfully treated without death and severe complications while the hospitalization duration was (11 ± 5) days. The follow-up survey at 12 months post-operation showed that no major adverse cardiac event occurred, the post-operative improvement of cardiac function was from Ⅲ-Ⅳ grade toⅠ-Ⅱgrade, the improvement of LVEF was from 25%-45% [(29 ± 8)%] to 32%-48% [(37 ±7) % ], left ventricular end diastolic diameter ( LVDd ) was shortened from 52-79 (66 ± 11 )mm to 49.68(58±8)mm. The reexamination of 14 cases by coronary angiography at 12 months post-operation showed that there was no intra-stent thrombosis while 20%-40% intra-stent restenosis occurred in 2 cases. Conclusion For patients with a low LVEF and complex small coronary artery lesions, PCI is a safe and effective method to lower the mortality rate of CHD patients with heart failure and improve the long-term patient prognosis.
Key words:
Coronary artery disease; Heart failure; Stents
Diabetic cardiomyopathy (DCM), which is a complication of diabetes, poses a great threat to public health. Recent studies have confirmed the role of NLRP3 (NOD-like receptor protein 3) activation in DCM development through the inflammatory response. Teneligliptin is an oral hypoglycemic dipeptidyl peptidase-IV inhibitor used to treat diabetes. Teneligliptin has recently been reported to have anti-inflammatory and protective effects on myocardial cells.
Cardiovascular diseases have become the most common and most prevalent chronic diseases in the elderly.Smoking, hyperlipidemia, diabetes and other high-risk factors participate in the occurrence and development of atherosclerosis by impairing the structure and function of the vascular wall, resulting in the occurrence of arterial stiffness.Pulse wave conduction velocity(PWV) is the rate at which a pulse wave travels from one specific location of the artery to another specific location along the wall of the artery.It is a simple, effective and repeatable noninvasive index for evaluating arterial elasticity and vascular function.PWV is closely related to cardiovascular disease.In recent years, the relationship between PWV and cardiovascular disease has been deeply studied.The relationship between PWV and coronary heart disease, hypertension, cardiac function, atrial fibrillation and pulmonary hypertension is described in this paper.
Key words:
Pulse; Heart conduction system; Atherosclerosis; Coronary disease; Hypertension; Heart function tests; Atrial fibrillation; Hypertension, pulmonary; Review
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