简介：ObjectivesEndothelialdysfunctionistheearliestmarkerforatherosclerosisandplayskeyroleinthepathogenesisofcardiovasculardiseases.Thepresentstudywasperformedtoevaluateeffectofagingonarterialelasticitybyusingpulsewaveformanalysisandinvestigatewhetherthechangesinarterialelasticitycanbeusedasanon-invasivemeasureforearlydetectionofendothelialdysfunction.MethodsUsingmodifiedWindkesselmodelofthecirculationandpulsewaveformanalysis,C1largearteryandC2smallarteryelasticityindicesof204normalhealthysubjects(age15-80years)weremeasured.Amongthemtwenty-fourmalehealthysubjectsweredividedintoboththeyoung(age20-30years,n=12)andelderly(age60-70years,n=12)groups.Wedeliveredacethycholine(Ach),anendotheliumdependentvasodilator,andsodiumnitroprusside(SNP),anendothelium-independentvasodilator,todermalvesselsoftheforearmusingiontophoresis,respectively,andmeasuredbasalandpeakbloodflowusinglaserdopplerfluximetry.ResultsC1largearteryandC2smallarteryelasticityindiceswerereducedwithadvancingage.C1largearteryandC2smallarteryelasticityindiceswerenegativelycorrelatedwithage(r=-0.628,p＜0.001;r=-0.595,p＜0.001).Basalbloodflowwassimilarbetweentheyoungandelderlygroups(14.58±3.4vs13.52±3.41PU,p=NS).PeakbloodflowinducedbyAchwassignificantlyreducedintheelderlygroupcomparedwiththeyounggroup(83.4±11.9vs93.75±10.87PU,p＜0.05).However,peakbloodflowinducedbySNPwassimilarinthetwogroups(119.17±16.76vs128.33±21.29PU,p=NS).Ach-inducedpeakbloodflowcorrelatedpositivelywithC1largearteryandC2smallarteryelasticityindices(r=0.56,p＜0.01;r=0.53,p＜0.01).ConclusionsAdvancingageleadstoimpairedarteryelasticityandendothelialdysfunction.Reducedarterialelasticityis,inparallel,associatedwithdiminishedendothelium-dependentvasodilation.Itisconcludedthata

简介：BackgroundHybridcoronaryrevascularization(HCR)isanalternativecoronaryrevascularizationstrategythatcombinesaminimallyinvasive,survivaladvantageoftheleftinternalmammaryartery(LIMA)-leftanteriordescending(LAD)coronaryarterybypasswithless-invasivepercutaneouscoronaryintervention(PCI)tonon-LADcoronarylesionsbyusingdrug-elutingstents.Wereportourexperienceofhybridminimallyinvasiveapproachin15patients.MethodsFromDecember2012toOctober2013,15patientsunderwentrevascularizationoftheleftanteriordescendingarterythroughminimallyinvasivecoronaryarterybypassgrafting(MIDCAB).Allpatientsbyendoscopicassistbeatingheartcoronaryarterybypassgrafting.Sevenpatientswerescheduledforahybridprocedure.Percutaneouscoronaryinterventionofnon-LADwasperformed3to5dayspreoperatively.Demographicdata,perioperativeoutcome,andannualfollow-upwereobtainedfromallthepatients.ResultsIn-hospitalmortalitywas6.67%.Therateofconversiontofullmediansternotomywas13.3%.Ventilationtimewas6.9±5.1h.Bloodlossvolumewas241±67.8mL.ICUstaywas21.3±10.8h.Hospitalpostoperativestaylastedfor7.5±1.3days.PriortoPCIpatientsshowed100%patentLIMA(Tables3and4).Ameanfollow-upwas8.5months.Oneyeargraftpatencyratewas100%(8/8patientsfor254-slicetomography).Twopatientsrequiredreintervention.ConclusionsMinimallyinvasivehybridcoronaryrevascularizationisasafe,feasibleandefficaciousapproachwithgoodresultsandshouldbeperformedinselectedpatientsbysurgeonswithexperienceinminimallyinvasivebypasssurgerypluscollaborationwithcardiologists.elutingstents.

简介：BackgroundThroughaministernotomy'J'shapedapproach,leftinternalmammaryartery(LIMA)bypassgraftingtotheleftanteriordescendingartery(LAD)canbeperformedsafelyoff-pump.Toachieveacompleterevascularization,percutaneouscoronaryinterventions(PCI)withdrugelutingstentimplantationtoothercoronaryarterieswasused.Wereportedoutcomesofthetreatmentofmultivesselcoronaryarterydiseasewithminimallyinvasivecoronaryarterybypass(MICAB)andPCI.MethodsBetweenJanuary2009andDec2012,14patients(11males,3females,meanagewas64.8±10.1years.Two-vesseldiseaseaccountfor35.7%(5/14)ofthesepatients,three-vesseldisease64.2%(9/14)(Table1).Allpatientsunderwentaminimallyinvasivecoronaryarterybypassgraftingviamini-sternotomy'J'shapedapproach.SevenpatientswerefollowedbyPCI,7forobtusemarginalcircumflex,5forrightcoronaryartery(RCA).AngiographicassessmentofgraftpatencywasperformedinallpatientsduringthePCIprocedure.Theclinicalfollow-upperiodlastsfrom11-24months.ResultsThein-hospitalmortalitywas0%.Therewasneitherconversiontoafullmediansternotomynorintraoperativecomplications.Ventilationtimewas6.6±4.1h.Bloodlossranged341±78.8mL.ICUstayranged22.3±12.8h.Hospitalpostoperativestaylastedfor6.5±1.6days.PriortoPCIpatientsshowed100%patentleftinternalmammaryartery.Onepatienthadmediastinitis(Tables2-3).Rateoffreedomfromcardiacreinterventionduringthefollow-upperiodwas92.8%(13/14).ConclusionsTheinferiorJ-shapedsternotomyissimple,reproducible,andthesafesttechniqueforperformingminimallyinvasivecoronarybypasssurgery.MICAB+PCIisalsosafe,feasibleandefficacious.

简介：PatientswithAcuteCoronarySyndrome(ACS)areaclinicalcontinuum-withpatientspresentingwithunstableanginaononeend,withpatientswithSTelevationmyocardialinfarction(STEMI)attheotherendofthespectrum.Inbetweenarethosewithnon-ST

简介：BackgroundThoracoscopicminimallyinvasivepectusexcavatumrepair(Nussoperation)featuresitslittletrauma,simple,shortoperationtime,andgoodoutcomecomparedwithtraditionaltreatmentofpectusexcavatumsurgery-sternalelevation(Ravitchoperation)andsternalturnover.Theeffectoftheoperationonpatients’heartandheartfunctionremainsunclear.ThisstudyaimedtounderstandthechangesofelectrocardiogramandcardiacfunctionafterNussprocedure.MethodsFrom2008Januaryto2013July,thoracoscopicNussoperationwasperformedin217patientswithpectusexcavatum.Allthepatientsunderwentthepreoperative,postoperativedetectionofECGandcardiacfunctionin3monthsto1yearafteroperation.ResultsAfter3monthsto1yearfollow-up,arrhythmiaspersistedin46outof135patientswithpreoperativesymptoms(P<0.05);Strokevolumeandcardiacoutputsignificantlyincreased(P<0.05);Andcardiacparametersgreatlyimproved(P<0.05).ConclusionsMinimallyinvasiverepairofpectusexcavatumdeformitycancorrectthechestmalformation,alleviatearrhythmia,andimprovecardiacfunction.

简介：Furtherunderstandingofthepathphophisyology,advanceofthediagnosisinstrumentandrenovationoftheriskdelaminationstandardcanofferbettertherapyevidenceforthenon-ST-segmentelevationacutecoronarysyndrome(NSTE-ACS).Drugs,suchastrigeminyantiplateletdrug,prasugrel,fondaparinuxandbivalirudin,havebroughtgreatclinicaleffecttothehighriskpatients.SincetheresultoftheICTUStestannouncedandthedrugelutingballoondeveloped,wehavereachedthenewestrecognitionofhowtoselectachanceforinterventionandhowtopreventandcuretherestenosisofin-stent.

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简介：BackgroundThecombinationofglycoproteinⅡb/Ⅲainhibitorsandheparinhasnotbeencomparedwithbivalirudininstudiesspecificallyinvolvingpatientswithnon-ST-segmentelevationmyocardialinfarctionundergoingpercutaneouscoronaryintervention(PCI).Wecomparedthetwotreatmentsinthispatientpopulation.MethodsImmediatelybeforePCI,werandomlyassigned,inadouble-blindmanner,1721patientswithacutenon-ST-segmentelevationmyocardialinfarctiontoreceiveabciximabplusunfractionatedheparin(861patients)orbivalirudin(860patients).Thestudytestedthehypothesisthatabciximabandheparinwouldbesuperiortobivalirudinwithrespecttotheprimarycompositeendpointofdeath,largerecurrentmyocardialinfarction,urgenttarget-vesselrevascularization,ormajorbleedingwithin30days.Secondaryendpointsincludedthecompositeofdeath,anyrecurrentmyocardialinfarction,orurgenttarget-vesselrevascularization(efficacyendpoint)andmajorbleeding(safetyendpoint)within30days.ResultsTheprimaryendpointoccurredin10.9%ofthepatientsintheabciximabgroup(94patients)andin11.0%inthebivalirudingroup(95patients)(relativeriskwithabciximab,0.99;95%confidenceinterval[CI],0.74to1.32;P=0.94).Death,anyrecurrentmyocardialinfarction,orurgenttarget-vesselrevascularizationoccurredin12.8%ofthepatientsintheabciximabgroup(110patients)andin13.4%inthebivalirudingroup(115patients)(relativerisk,0.96;95%CI,0.74to1.25;P=0.76).Majorbleedingoccurredin4.6%ofthepatientsintheabciximabgroup(40patients)ascomparedwith2.6%inthebivalirudingroup(22patients)(relativerisk,1.84;95%CI,1.10to3.07;P=0.02).ConclusionsAbciximabandunfractionatedheparin,ascomparedwithbivalirudin,failedtoreducetherateoftheprimaryendpointandincreasedtheriskofbleedingamongpatientswithnon-ST-segmentelevationmyocardialinfarctionwhowereundergoingPCI.(FundedbyNycomedPharmaandothers;

简介：Toanalyzetheclinicalcharacteristicsof216patientswithnon-STsegmentelevationmyocardialinfarction(NSTEMI).MethodsAretrospectiveanalysiswasused.TwohundredandsixteenNSTEMIpatientsweredividedintotwogroups:①accordingtotheage:age<65yearsgroupandage≥65yearsgroup;②accordingtothrombolysisinmyocardialischemiatrial(TIMI)IIBriskstratificationscoringsystem:score<4groupand≥4group;③accordingtoserumcreatinine(sCr)level:sCrlevel≤178μmol·L-1groupand>178μmol·L-1group.Sevenhundredandeightysixacutemyocardialinfarction(AMI)patientsduringthesameperiodweredividedintoSTsegmentelevationmyocardialinfarction(STEMI)groupandNSTEMIgroup.Clinicalcharacteristicsofthepatientsinthetwogroupswerecompared.Results①ThenumberofNSTEMIpatientsinage≥65yearsgroupissignificantlygreaterthanthatinage<65yearsgroup.Studyrevealedthatthepatientsinage≥65yearsgroupwerewithoutchestpain,hadhypertension,dyslipidemia,atrialfibrillation,cardiacandrenaldysfunction(sCr>178μmol·L-1)andtriplevesseldisease.Fewerpatientsinthisgroupreceivedcoronaryarteryangiography(CAG),percutaneouscoronaryintervention(PCI)andcoronaryarterybypassgraft(CABG).Morenumberofdeathsinthisgroupcomparedwiththeage<65yearsgroup.②ThenumberofNSTEMIpatientsinTIMIscore>4groupissignificantlygreaterthanthatinTIMIscore<4group.Fourmajorcomplicationssuchasacuteleftventricularfailure,cardiogenicshock,seriousarrhythmiaanddeaths,increasedsignificantlyinTIMIscore>4groupcomparingwithTIMIscore≤4group.③Obviously,morenumberofelderlypatients,non-insulindependantdiabetesmellitus(NIDDM),patientswithcardiactroponinT(CTnT)>3.0ng·L-1anddeathsoccurredinsCr>178μmol·L-1group.④STEMIandNSTEMIpatientswerecomparedinsametimeframeasfollows:fewerNSTEMIpatientsandmoreelderlypatientshadnochestpain,NIDDM,hypert

简介：BackgroundInpatientswithacutecoronarysyndrome(ACS),loweradmissionsystolicbloodpressure(SBP)levelsinferaworseprognosis.However,thepredictivepotentialofadmissionSBPon1-yearmortalityhasnotfullyelucidatedinpatientswithnon-ST-segmentelevationACS(NSTEACS).MethodsWeenrolled1325patientstoinvestigatetheassociationbetweenadmissionSBPinpatientshospitalizedforNSTEACS.WeanalyzedtheassociationbetweenadmissionSBPand1-yearmortality.AdmissionSBPwascategorizedaslow(<110mmHg),normal(110-140mmHg),high(141-160mmHg),andveryhigh(>160mmHg).ResultsComparedwithpatientswithnormaladmissionSBP,thosewithlowSBPhadasignificantlyincreasedhazardratios(HRs)for1-yearmortalityof3.03(P<0.05),whilepatientswithhighandveryhighadmissionSBPhadnosignificantlyincreasedHRsfor1-yearmortality.ConclusionLowadmissionSBP,butnotelevatedadmissionSBP,isastrongindependentpredictorof1-yearmortalityinpatientswithNSTEACS.

简介：BackgroundNon-ST-segmentelevationacutecoronarysyndrome(NSTE-ACS)isanacuteheartdiseasecausedbyincompleteocclusionofrelatedcoronaryarterieswithunstableatheroscleroticplaques.LeadaVRSTsegmentelevationandcTnIpositivearecloselycorrelatedtotheprognosisofNSTE-ACSpatients.However,therearefewstudiesapplyingthetwopredictorstoearlyriskstratificationinNSTE-ACSpatients.MethodTwohundredandfivecasesofNSTE-ACSpatientsfollowedupfor6monthsafterdischargewerereviewed.Allpatientsweredividedintofourgroups:GroupA-cTnInegativecombinedwithaVR-non-ST-segmentelevationgroup(100cases);GroupB-cTnInegativecombinedwithaVR-ST-segmentelevationgroup(31cases);GroupC-cTnIpositivecombinedwithaVR-non-ST-segmentelevationgroup(43cases);GroupD-cTnIpositivecombinedwithaVR-ST-segmentelevationgroup(31cases).Therewasnosignificantdifferenceingender,age,oldmyocardialinfarction,previousPCIhistory,hypertension,anddiabetesbetweenaVR-STelevationgroupandnoaVR-STelevationgroup.Themorbidityofleftmainorthree-vesselcoronaryarterydiseaseaswellasadversecardiovasculareventsinthefourgroupswereobservedandanalyzed.Results(i)Themorbidityofleftmainorthree-vesselcoronaryarterydiseasewashighestinGroupD(87.1%),andwasmarkedlyhigherinGroupB(41.9%)thanthatinGroupA(7%)orGroupC(9.3%);(ii)TheincidenceofadversecardiovasculareventswashighestinGroupD(77.4%),andwasmuchhigherinB(35.5%)ascomparedwiththattinGroupA(1%)orgroupC(7%).ConclusionElectrocardiographicleadaVRST-segmentelevationcombinedwithcTnIpositivehasanimportantclinicalvalueinpredictingtheprognosisofthepatientswithNSTE-ACS.

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