冠心病患者静息心率与血小板活性相关研究

目的:探讨冠心病患者静息心率与血小板活性的相关研究。方法:选择2013年1月至2014年9月于我院住院患者474例,按静息心率快慢分为三组,心率70 bmp为第一组(Q1)150例,心率位于70~85 bmp为第二组(Q2)265例,心率85 bmp为第三组(Q3)59例,三组患者均于病情稳定时行血栓弹力图(TEG)中MA值检测,同时随访3个月,观察和比较三组患者MA值变化及预后。结果:三组患者MA值分别为61.16±7.29 mm、62.02±7.46 mm、65.32±6.56 mm,第三组患者MA值与第一组或第二组患者MA值比较差异均存在统计学意义(P0.05),通过血栓弹力图检测三组经花生四烯酸(AA)途径的血小板抑制率和经二磷酸腺苷(ADP)途径的血小板抑制率发现,静息心率高低与抗血小板药物作用疗效无相关关系(P0.05)。随访3个月,三组患者心绞痛、再住院、脑血管病及死亡的总发生率分别为28%、28.68%、40.67%。结论:冠心病患者静息心率越快,MA值越大即血小板活性越高,静息心率的高低与抗血小板药物作用疗效无关。     

肌钙蛋白I水平检测对急诊房颤患者的临床意义

目的:探讨房颤患者急诊入院时检测肌钙蛋白I(Tn I)水平的临床作用及预测价值。方法:回顾性分析我院523例房颤患者的临床资料,将资料中数据进行统计学分析处理。患者分为三组:1组患者Tn I轻度升高;2组患者Tn I正常;3组患者未检测Tn I,分别就三组患者的基线特征以及就诊时的症状展开数据比较,并且单变量及多变量分析Tn I升高的预测因子。设置主要终点为1年内所有原因导致的死亡及心肌梗死(MI),患者从入院时起随访1年,记录期间的MI发生情况及死亡情况。结果:173例患者(33%)Tn I轻度升高(均值0.56 ng/m L),225例患者(43%)Tn I正常,125例患者(24%)未检测Tn I。住院期间1组患者(50%)的心功能检查异常明显高于组2和组3(28%和29%,P≤0.001),1组患者(22%)主要终点发生率明显高于2组(10%)和3组患者(15%)(P=0.002),有统计学意义。结论:肌钙蛋白I轻度升高与冠脉疾病(CAD)发生率增加及MI发生率增加有关,但对于总体死亡率无影响。     

序贯旁路移植同期行内膜剥脱治疗严重弥漫性冠状动脉病变的临床研究

目的:探讨严重弥漫性冠状动脉病变患者在非体外循环下行序贯旁路移植手术联合内膜剥脱的临床效果及安全性。方法:按照随机数字表法将2011年3月~2013年3月我院收治的110例严重弥漫性冠状动脉病变患者分为治疗组54例和对照组56例。治疗组在非体外循环下行序贯旁路移植结合内膜剥脱治疗,对照组在非体外循环下行冠状动脉旁路移植结合内膜剥脱治疗,比较两组的临床效果及围手术期并发症。结果:治疗组围手术期死亡2例(3.70%),对照组死亡4例(7.14%),两组死亡率比较差异无统计学意义(x2=0.631,P=0.427)。围手术期内治疗组心肌梗死、严重心脑血管不良事件以及新发房颤的发生率低于对照组,差异有统计学意义(P0.05)。治疗组术后1年吻合口通畅程度和桥血管通畅程度均优于对照组,差异均有统计学意义(Z=-2.416,-2.456;P=0.016,0.014)。结论:在非体外循环下序贯旁路移植同期行内膜剥脱治疗严重弥漫冠状动脉病变具有并发症少、安全性高且疗效好的特点,值得临床推广使用。     

Association of male pattern baldness with angiographic coronary artery disease severity and collateral development

Objective

We aimed to investigate whether there is an association between male pattern baldness and angiographic coronary artery disease (CAD) severity and collateral development, which has not been reported previously.

Methods

Coronary arteriograms, CAD risk factors, lipid parameters and presence and severity of baldness in 511 male patients were prospectively evaluated. Baldness was classified into five groups. Severity of CAD was evaluated with the Gensini scoring system and collateral development with Rentrop scores.

Results

Although subjects with a higher Gensini score had more frequent and severe baldness, they were older than the group with lower Gensini scores. Bald patients had a higher Gensini score when compared with their non-bald counterparts. In univariate analysis, age more than 60, body mass index more than 30, smoking and baldness were predictors of high Gensini scores. In multivariate analysis, only age more than 60, body mass index more than 30 and smoking were independent predictors of a high Gensini score. There were no differences in terms of presence and severity of baldness in subjects with and without adequate collateral development.

Conclusions

There was no relation between presence, severity and age of occurrence of male pattern baldness and Gensini and Rentrop scores, which are important measures of presence and severity of CAD.     

Peripheral arterial tonometry cannot detect patients at low risk of coronary artery disease

Background

Endothelial dysfunction precedes coronary artery disease (CAD) and can be measured by peripheral arterial tonometry (PAT). We examined the applicability of PAT to detect a low risk of CAD in a chest pain clinic.

Methods

In 93 patients, PAT was performed resulting in reactive hyperaemia (RHI) and augmentation (AIx) indices. Patients were risk classified according to HeartScore, Diamond and Forrester pretest probability (DF), exercise testing (X-ECG), and computed tomography calcium scoring (CCS) and angiography (CTA). Correlations, risk group differences and prediction of revascularisation within 1 year were calculated.

Results

RHI correlated with HeartScore (r = − 0.21, p = 0.05), AIx with DF (r = 0.26, p = 0.01). However, both were not significantly different between normal and ischaemic X-ECG groups. In addition RHI and AIx were similar between low risk as compared with intermediate-to-high risk, based on risk algorithms (RHI: 1.98 (0.67) vs 1.94 (0.78); AIx: 0.0 (21) vs 5.0 (25); p = NS), or CCS and CTA (RHI: 1.99 (0.58) vs 1.89 (0.82); AIx: − 2.0 (24) vs 4.0 (25); p = NS). Finally, RHI and AIx failed to predict revascularisation (RHI: OR 1.42, CI 0.65–3.1; AIx: OR 1.02, CI 0.98–1.05).

Conclusions

PAT cannot detect a low risk of CAD, possibly because RHI and AIx versus X-ECG, CCS and CTA represent independent processes.     

Characterization of the contractile P2Y14 receptor in mouse coronary and cerebral arteries

Extracellular UDP-glucose can activate the purinergic P2Y14 receptor. The aim of the present study was to examine the physiological importance of P2Y14 receptors in the vasculature. The data presented herein show that UDP-glucose causes contraction in mouse coronary and basilar arteries. The EC₅₀ values and immunohistochemistry illustrated the strongest P2Y14 receptor expression in the basilar artery. In the presence of pertussis toxin, UDP-glucose inhibited contraction in coronary arteries and in the basilar artery it surprisingly caused relaxation. After organ culture of the coronary artery, the EC₅₀ value decreased and an increased staining for the P2Y14 receptor was observed, showing receptor plasticity.