Prevalence and predictors of bridging of coronary arteries in a large Indonesian population, as detected by 64-slice computed tomography scan

Background

Multislice computed tomography (MSCT) can be used to detect myocardial bridging (MB) of coronary arteries. However, most published studies included small cohorts and did not collect data about predictors. We investigated prevalence and predictors of MB in an Indonesian population.

Methods

All patients who had MSCT at Cinere Hospital, Jakarta, Indonesia between 2006 and 2009 were included in a prospective registry. MB was defined when at least half of the coronary artery was imbedded within the myocardium with a normal epicardial course of the proximal and distal portion.

Results

Of the 934 patients (mean age 53 years, 37.8 % female), MB could be observed in 152 patients (16.3 %). Patients with MB were younger compared with those without MB. Coronary risk factors were not different between the two groups. Coronary calcifications and moderate to severe coronary stenoses were less prevalent in patients with MB, also after adjusting for differences in age. At the time of diagnosis, only a few patients with MB were treated with beta-blockers (35 %) or calcium channel blockers (13 %).

Conclusions

Prevalence of myocardial bridging as detected by MSCT is relatively high. Patients with MB were younger and had a lower prevalence of coronary sclerosis. MB could be the cause of their unexplained symptoms. Follow-up studies are necessary to assess the symptoms of these patients, their response to treatment and the incidence of (coronary) events. MSCT can be used to identify patients for potential new treatment strategies.     

Levels and trends in cardiovascular risk factors and drug treatment in 4837 elderly Dutch myocardial infarction patients between 2002 and 2006

Background

It is important to gain insight into opportunities for secondary prevention of cardiovascular disease. Our aim was to investigate levels and trends in cardiovascular risk factors and drug treatment in Dutch post-myocardial infarction (MI) patients between 2002 and 2006 and to make comparisons with the EUROASPIRE surveys (1999–2007).

Methods

We analysed data from 4837 post-MI patients (aged 69 years, 78% men) from 32 Dutch hospitals, using baseline cross-sectional data from the Alpha Omega Trial.

Results

Between 2002 and 2006, significant declines were found in the prevalence of smoking (23% to 16%, p < 0.001), hypercholesterolaemia (≥5 mmol/l; 54% to 27%, p < 0.0001) and hypertension (≥140/90 mmHg; 58% to 48%, p < 0.001). The prevalence of antithrombotic drugs was high (97%). The prevalence of lipid-modifying drugs and antihypertensives was high, and increased (74% to 90%, p < 0.0001 and 82% to 93%, p < 0.001, respectively). The prevalence of obesity (27%) was high in 2002 and decreased to 24% in 2006, albeit not significantly. Diabetes prevalence was high and increased between 2002 and 2006 (18% to 22%, p = 0.02). In comparison with EUROASPIRE patients, who were on average 8–10 years younger, our study in 2006 included patients with lower levels of obesity, hypertension, hypercholesterolaemia, diabetes and lower use of antiplatelets and β-blockers, but similar levels of lipid-modifying drugs.

Conclusions

This study showed that older Dutch post-MI patients were adequately treated with drugs, and that risk factors reached lower levels than in the younger EUROASPIRE patients. However, there is room for improvement in diet and lifestyle, given the high prevalence of smoking, obesity, and diabetes.

Electronic supplementary material

The online version of this article (doi:10.1007/s12471-012-0248-z) contains supplementary material, which is available to authorized users.     

心肌造影负荷超声心动图评价存活心肌的临床研究

目的:研究心肌造影负荷超声心动图(MCSE)定量心肌血流判断存活心肌的可行性与可靠性。方法:对20例冠心病患者行持续静脉滴注法MCSE,按1:4的比例于收缩末期触发的方式提取图像,采集图像后脱机分析及彩色编码。计算灌注正常区域和灌注缺损区域的A.β值,根据A.β值确定心肌存活与否,将判定结果正电子断层显像(PET)进行对照。结果:17例病人(85%)获得满意图像,灌注正常区和灌注缺损区的A.β值分别为59.32±11.54和5.69±1.78;灌注正常区在Dob 5μg、10μg时的A.β均值分别为69.57±8.13和76.65±13.61,且均高于静息时A.β值,与PET判定坏死的心肌节段一致。结论:MCSE能从血流定量水平判断存活心肌。     

非诺贝特通过FoxO1 抑制心肌肥大

目的:探讨非诺贝特(fenofibrate)对血管紧张素Ⅱ(AngⅡ)诱导的肥大心肌细胞的抑制作用及对FoxO1表达的影响。方法:首先采用AngⅡ诱导心肌细胞肥大,将细胞分为三组:对照组:未给予任何干预;心肌细胞肥大组:AngⅡ(10-7mol/L)刺激细胞;治疗组:先给予fenofibrate(10-5mol/L),30min后AngⅡ(10-7mol/L)刺激细胞。应用蛋白免疫印迹法(western-blotting)和实时定量PCR法(real time PCR)检测各组细胞中转录因子FoxO1的蛋白质及mRNA含量,心肌细胞肥大的判断使用脑钠肽(brain natriuret icpepide BNP)。结果:心肌细胞肥大组的FoxO1表达较对照组明显降低,而治疗组的FoxO1表达较心肌肥大组明显升高。结论:非诺贝特可能通过上调FoxO1表达,从而抑制心肌细胞肥大。     

Nur77 在缺氧/ 复氧诱导的心肌细胞凋亡中的作用及其机制的研究

目的:观察Nur77通过线粒体转位对缺氧/复氧(H/R)诱导的心肌细胞凋亡的影响。方法:原代培养l-2天SD大鼠心肌细胞,建立H/R模型。随机分为正常对照组、H/R组、Nur77组,采用免疫荧光检测横纹肌肌动蛋白(α-actin)鉴定心肌细胞;采用TUNEL染色法及Caspase-3酶活性检测心肌细胞凋亡情况;采用Western blot检测细胞核及线粒体Nur77蛋白表达、线粒体及胞浆Omi/HtrA2蛋白表达。结果:H/R组细胞核中Nur77蛋白表达明显低于正常对照组;而在线粒体中则相反。Nur77组线粒体中的Omi/HtrA2蛋白表达明显低于正常对照组;而在胞浆中则相反。结论:在心肌细胞H/R损伤时,Nur77线粒体转位促使Omi/HtrA2蛋白从线粒体释放入胞浆,从而导致心肌细胞凋亡。     

芪丹通脉片促进骨髓间充质干细胞向缺血心肌趋化迁移

目的:研究芪丹通脉片对骨髓间充质干细胞向缺血心肌趋化迁移的作用。方法:SD大鼠,随机分为单纯移植组,益气组,活血组。芪丹通脉片组,各组大鼠灌服中药14天后,采用冠状动脉左前降支结扎法建立心肌梗死模型。经尾静脉注入DIO标记的骨髓间充质干细胞,3天后取缺血部位的心肌,应用流式细胞仪分析计算出每克心肌所含有的DIO阳性细胞数;行冰冻切片,采用荧光显微镜观察DIO阳性细胞;4周后采用多导生理记录仪记录大鼠平均动脉压(MAP)、左心室收缩峰压(LVPSP)、左心室内压最大上升变化速率(+LVdp/dtmax)和最大下降速率(-LVdp/dtmax)。结果:芪丹通脉片组较益气组、活血组、单纯移植组,每克心肌所含有的DIO阳性细胞数增多,其差异有统计学意义;冰冻切片镜下观察,芪丹通脉片组阳性细胞数较益气组、活血组、单纯移植组增多,其差异有统计学意义;心功能检测示:芪丹通脉片组MAP、LVPSP、+LVdp/dtmax、-LVdp/dtmax较益气组、活血组、单纯移植组改善明显,差异有统计学意义。结论:芪丹通脉片具有促进骨髓间充质干细胞向缺血心肌趋化迁移的作用,益气与活血中药配伍应用优于单纯益气药或活血药。     

Recent improvements in the development of A<Subscript>2B</Subscript> adenosine receptor agonists

Adenosine is known to exert most of its physiological functions by acting as local modulator at four receptor subtypes named A₁, A_2A, A_2B and A₃ (ARs). Principally as a result of the difficulty in identifying potent and selective agonists, the A_2B AR is the least extensively characterised of the adenosine receptors family. Despite these limitations, growing understanding of the physiological meaning of this target indicates promising therapeutic perspectives for specific ligands. As A_2B AR signalling seems to be associated with pre/postconditioning cardioprotective and anti-inflammatory mechanisms, selective agonists may represent a new therapeutic group for patients suffering from coronary artery disease. Herein we present an overview of the recent advancements in identifying potent and selective A_2B AR agonists reported in scientific and patent literature. These compounds can be classified into adenosine-like and nonadenosine ligands. Nucleoside-based agonists are the result of modifying adenosine by substitution at the N ⁶-, C²-positions of the purine heterocycle and/or at the 5′-position of the ribose moiety or combinations of these substitutions. Compounds 1-deoxy-1-{6-[N′-(furan-2-carbonyl)-hydrazino]-9H-purin-9-yl}-N-ethyl-β-D-ribofuranuronamide (19, hA₁ K _i = 1050 nM, hA_2A K _i = 1550 nM, hA_2B EC₅₀ = 82 nM, hA₃ K _i > 5 μM) and its 2-chloro analogue 23 (hA₁ K _i = 3500 nM, hA_2A K _i = 4950 nM, hA_2B EC₅₀ = 210 nM, hA₃ K _i > 5 μM) were confirmed to be potent and selective full agonists in a cyclic adenosine monophosphate (cAMP) functional assay in Chinese hamster ovary (CHO) cells expressing hA_2B AR. Nonribose ligands are represented by conveniently substituted dicarbonitrilepyridines, among which 2-[6-amino-3,5-dicyano-4-[4-(cyclopropylmethoxy)phenyl]pyridin-2-ylsulfanyl]acetamide (BAY-60–6583, hA₁, hA_2A, hA₃ EC₅₀ > 10 μM; hA_2B EC₅₀ = 3 nM) is currently under preclinical-phase investigation for treating coronary artery disorders and atherosclerosis.     

负荷剂量氯吡格雷治疗急性ST段抬高心肌梗死

目的:观察标准治疗基础上联合负荷剂量氯吡格雷治疗急性ST段抬高型心肌梗死(STEMI)的疗效及安全性。方法:106例12小时以内发病的ST段抬高型心肌梗死患者随机分为2组,2组均在入院后前3天给予阿司匹林300 mg.d~(-1),此后给予阿司匹林100 mg.d~(-1),A组不给予氯吡格雷治疗,B组入院即刻给予氯吡格雷300 mg,继之75 mg.d~(-1)治疗,平均随访30天。观察溶栓血管再通率、梗死后心绞痛发作、心力衰竭事件及死亡、再发心肌梗死或脑卒中的联合终点。结果:与A组相比,B组患者溶栓血管再通率显著提高、梗死后心绞痛发作明显减少;而在心力衰竭事件及死亡、再发心肌梗死、或脑卒中的联合终点的比较上差异无显著性意义。2组均无主要和次要出血事件发生,轻微出血发生率无统计学差异。结论:急性ST段抬高的急性心肌梗死患者,不论是否接受择期的冠脉介入治疗(PCI),在标准治疗的基础上早期加用氯吡格雷300mg负荷量,继之75 mg.d~(-1)口服,可显著提高溶栓成功率、降低梗死后心绞痛发作,且安全耐受性好。     

Myocardial mechanical dysfunction and calcium overload following rewarming from experimental hypothermia in vivo

Rewarming patients from accidental hypothermia are regularly complicated with cardiovascular instability ranging from minor depression of cardiac output to fatal circulatory collapse also termed “rewarming shock”. Since altered Ca²⁺ handling may play a role in hypothermia-induced heart failure, we studied changes in Ca²⁺ homeostasis in in situ hearts following hypothermia and rewarming. A rat model designed for studies of the intact heart in a non-arrested state during hypothermia and rewarming was used. Rats were core cooled to 15 °C, maintained at 15 °C for 4 h and thereafter rewarmed. As time-matched controls, one group of animals was kept at 37 °C for 5 h. Total intracellular myocardial Ca²⁺ content ([Ca²⁺]_i) was measured using ⁴⁵Ca²⁺. Following rewarming we found a significant reduction of stroke volume and cardiac output compared to prehypothermic control values as well as to time-matched controls. Likewise, we found that hypothermia and rewarming resulted in a more than six-fold increase in [Ca²⁺]_i to 3.01 ± 0.43 μmol/g dry weight compared to 0.44 ± 0.05 μmol/g dry weight in normothemia control. These findings indicate that hypothermia-induced alterations in the Ca²⁺-handling result in Ca²⁺ overload during hypothermia, which may contribute to myocardial failure during and after rewarming.     

冠脉结扎法制做大鼠心肌缺血模型

目的探讨大鼠心肌缺血动物模型的构建。方法缝扎大鼠冠脉左前降支,于左室前外侧壁形成缺血区域,约占左室壁面积的20%～50%。结果完成85例动物模型制作,存活74只,其中60只据术中所见、心电图、及病理检查证实有明确的心肌缺血,心功能下降。结论该方法制作简单可行,动物存活率满意;但模型欠稳定,需标本量较大以充分筛选。