Iodixanol is associated with lower rates of contrast-induced acute kidney injury (CI-AKI). However, the effects of high volumes of iodixanol on renal function after percutaneous coronary intervention (PCI) have not been fully elucidated. This study evaluates the effects of high-dose (>300 mL) iodixanol on renal function within 72 hours of PCI. We retrospectively reviewed 676 consecutive patients who received high-dose (>300 mL) iodixanol during PCI between October 2015 and December 2017 in 4 centers. Logistic regression analysis was used to identify significant independent predictors for CI-AKI. The incidence of CI-AKI was 3.5% (23/651). In patients administered 300 to 500 mL and >500 mL iodixanol, the incidence of CI-AKI was 3.9% and 1.7%, respectively. In patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, the incidence of CI-AKI was 2.6%. In high-risk and very high-risk patients, stratified by the Mehran risk score, the incidence of CI-AKI was 3.3% and 4.3%, respectively. In patients received high-dose iodixanol (>300 mL), logistic regression analysis demonstrated that female sex, chronic kidney disease, and eGFR were independent risk factors for CI-AKI, but contrast volume was not. The administration of high (300-500 mL) and very high (>500 mL) dose of iodixanol is associated with low rates of CI-AKI.

1 病例简介 患者男性,69岁,因"反复胸闷1年,加重伴胸痛2d"入院.入院1年前患者在劳累后反复出现胸闷不适,每次持续3～5 min ,休息后可缓解,无心悸、气促等伴随症状,未行特殊处理.入院2d前,患者胸闷症状加重,持续时间延长,约0.5 h,伴心前区压榨性疼痛,放射至背部,伴心悸、出汗,当地医院心电图示Ⅱ、Ⅲ、aVF导联ST段弓背抬高,药物保守治疗后至我院.入院检查:血压 126/76 m m H g ,心率70次/min ,心律齐,未闻及早搏,心脏各瓣膜听诊区未闻及病理性杂音.胸片示双肺未见实质性病变.心电图示窦性心律,Ⅱ、Ⅲ、aV F导联病理性 Q 波,胸导联T波低平、倒置.腹部超声示肝、胆、脾、双肾未见异常.

目的 评估大剂量碘克沙醇(>300 mL)对糖尿病患者经皮冠状动脉介入治疗(PCI)术后72 h内肾功能的影响.方法 顺序筛选2015年10月一2017年12月4个中心的987例冠状动脉介入治疗术中使用大剂量(>300 mL)碘克沙醇的患者,最终204例合并糖尿病患者被纳入,进一步评价术后72 h内对比剂诱导的急性肾损伤(CI-AKI)的发生情况.结果 204例糖尿病患者使用大剂量碘克沙醇(>300 mL)对比剂诱导的急性肾损伤总发生率为3. 9％ (8/204).其中碘克沙醇300～500 mL亚组和 >500 mL亚组对比剂诱导的急性肾损伤发生率分别为4.3％ (7/161)和2. 3％ (1/43);基线eGFR<60 miy(min - 1.73 m2)的患者对比剂诱导的急性肾损伤发生率为6.9％ (2/29).多因素Logistic回归分析显示,合并慢性肾功能不全、贫血、行急诊冠状动脉介入治疗术以及高Me-hran评分是对比剂诱导的急性肾损伤的独立危险因素.对比剂诱导的急性肾损伤发生率与对比剂剂量的增加似乎无关.结论 合并糖尿病患者使用大剂量(>300 mL)碘克沙醇后对比剂诱导的急性肾损伤发生率不高.

Objective To compare the safety and efficacy of 3 kinds of permanent, biodegradable and polymer free drug eluting stents in the treatment of unprotected left main coronary artery disease (UPLM). Methods A total of 259 UPLM patients diagnosed by coronary angiography and underwent percutaneous coronary intervention (PCI) in our institute from January 2013 to June 2017 were recruited in this study. These cases were divided into 3 groups according to stent-type of left main implantation: permanent (PP-DES, n=153), biodegradable (BP-DES, n=54) and polymer free (PF-DES, n=52) groups. All the patients were followed up for 12 months. The target vessel failure (TVF), including cardiac death (CD), target vessel myocardial infarction (TVMI), target vessel revascularization (TVR), and major adverse cardiovascular events (MACE), including CD, nonfatal myocardial infarction (NFMI) and revascularization at 12 months after PCI were observed. Results There were no significant differences in sex, age, complicated high risk factors, lesions, stenting procedures, ratio of bifurcation lesions among the 3 groups (P>0.05). And no significant difference was seen in the incidences of TVF (P=0.596) and MACE (P=0.210) according to stent-type of left main implantation. Multivariate COX regression analysis showed that after 12-month follow-up, the risk of TVF and MACE had no significant correlation with stent-type of left main implantation (P>0.05). Conclusion Biodegradable and polymer free drug eluting stents have similar effects on the incidences of TVF and MACE in the treatment of UPLM when compared with permanent polymer drug eluting stent, and they are safe and effective for left main implantation.

冠状动脉旁路移植术(coronary artery bypass grafting,CABG)是20世纪人类医学史上的重大应用之一[1-2].目前严重冠状动脉粥样硬化病变行CABG取得了良好的疗效,但是对搭桥手术后桥血管再狭窄及闭塞病变再处理提出了更高要求[3].CABG术后10％～20％患者因心绞痛复发而复查冠状动脉造影[4].继续外科搭桥手术对钙化病变冠脉难以实行,本文探索CABG术后桥血管闭塞重新对病变冠脉行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的疗效以及安全性,现报告如下.

目的 观察冠状动脉分叉病变合并糖尿病患者接受紫杉醇药物洗脱球囊(drug eluted balloon,DEB)扩张术后的疗效.方法 本研究纳入了2016年5月-2017年7月于陆军军医大学(第三军医大学)第二附属医院心血管内科诊断为冠状动脉分叉病变,分支血管行DEB扩张术患者共105例.按照是否合并糖尿病分组,两组患者术后随访第6、9、12个月主要不良心血管事件(包括心绞痛、急性心肌梗死、靶器官血运重建及心源性死亡)的发生情况;术后第12个月复查选择性冠状动脉造影.结果 两组患者在性别、年龄及冠心病危险因素等临床资料差异均无统计学意义(P＞0.05).多因素COX回归模型分析表明:经过1年随访,合并糖尿病与发生主要不良心血管事件(major adverse cardiac events,MACE)之间差异无统计学意义(P =0.235).两组患者复查选择性冠状动脉造影出现分支血管狭窄数目差异无统计学意义(P＞0.05).结论 合并糖尿病不会增加冠状动脉分叉病变患者行紫杉醇药物洗脱球囊扩张术后出现主要不良心血管事件和血管再狭窄的发生率,该类患者行紫杉醇药物洗脱球囊扩张术安全有效.

The prognostic role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the general population remains controversial. We conducted this meta-analysis to investigate the association between baseline NT-proBNP concentrations and cardiovascular or all-cause mortality in the general population. PubMed and Embase databases were systematically searched from their inception to August 2016. Prospective observational studies that investigated the association between baseline NT-proBNP concentrations and cardiovascular or all-cause mortality in the general population were eligible. A summary of the hazard ratio (HR) and 95% confidence interval (CI) of mortality were calculated by the highest versus the lowest category of NT-proBNP concentrations. Eleven studies with a total of 25,715 individuals were included. Compared individuals in the highest with those in the lowest category of NT-proBNP, the pooled HR was 2.44 (95% CI 2.11-2.83) for all-cause mortality, 3.77 (95% CI 2.85-5.00) for cardiovascular mortality, and 2.35 (95% CI 1.45-3.82) for coronary heart disease mortality, respectively. Subgroup analyses indicated that the effects of NT-proBNP on the risk of cardiovascular mortality (RR 2.27) and all-cause mortality (RR 3.00) appeared to be slightly lower among men. Elevated NT-proBNP concentrations appeared to be independently associated with increased risk of cardiovascular and all-cause mortality in the general population.

Objective To observe the prognosis value of thyroid-stimulating hormone (TSH) within reference range in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI) and its clinical significance.Methods One thousand and two patients with CHD,who received PCI and had TSH in the normal range (0.3 ～ 4.2 μIU/mL),were enrolled.The patients were divided into 3 groups:Lownormal TSH group (0.30 ～ 1.60 μIU/ml,n =387),the middle-normal TSH group (1.61 ～ 2.90 μIU/mL,n =413),and the high-normal TSH group (2.91 ～4.20 μIU/mL,n =202).All of them were followed up for 1 year,and primary end point was all-cause mortality.Peri-PCI bleeding and readmission were also recorded.Results The low-normal group experienced an all-cause mortality rate of 1.55％,a peri-PCI bleeding rate of 3.36％,and a readmission rate of 9.82％.The middle-normal group had an all-cause mortality rate of 1.94％,a peri-PCI bleeding rate of 3.39％,and a readmission rate of 6.54％.The highnormal group experienced an all-cause mortality rate of 4.95％,a peri-PCI bleeding rate of 7.92％,and a readmission rate of 7.43％.There were significant differences in one-year all-cause mortality and peri-PCI bleeding among the 3 groups (all P ＜ 0.05),and there was no significant difference in the readmission among them (P ＞ 0.05).Logistic regression analysis showed that TSH in the upper reference range was a risk factor in one-year all-cause mortality (OR =1.48,P ＜0.05) and peri-PCI bleeding (OR =1.47,P ＜0.05).Survival analysis also showed that TSH in the upper reference Limit was a risk factor in one-year all-cause mortality (RR =1.566,P ＜ 0.05).Conclusion TSH in the upper reference Limit is an independence risk factor in one-year all-cause mortality and peri-PCI bleeding in the patients with CHD after PCI.

Objective To investigate the role of inflammasome of nucleotide binding oligomerization domain-like receptor protein 3 (NLRP3) in the occurrence of coronary heart disease (CHD) in patients with type 2 diabetes mellitus (T2DM).Methods One hundred and thirty patients hospitalized in the Department of Cardiology,Xinqiao Hospital between March and August 2016 were enrolled in this study,including 40 with CHD,20 with T2DM group,and 40 with T2DM complicated by CHD,with 30 individuals without T2DM or CHD serving as the control group.Peripheral blood monocytes (HPBMCs) and plasma were collected from the subjects to detect the transcription and protein levels of NLRP3,apoptosis-associated speck-hike protein (ASC) and caspase-1 using real-time qPCR and Western blotting;the plasma level of IL-1 β was detected with enzyme-linked immunosorbent assay (ELISA).Results Both the mRNA and protein levels of NLRP3,ASC and caspase-1 in the HPBMCs were significantly increased in patients with CHD,T2DM and T2DM complicated by CHD groups as compared with the control group (P ＜ 0.05).HPBMCs from diabetic patients with CHD patients showed significantly higher ASC and caspase-1 mRNA levels and NLRP3 protein level than those from CHD or T2DM patients (P ＜ 0.05).The mean plasma levels of IL-1β were 24.05 ± 1.00,22.86 ± 1.66,and 26.85 ± 1.45 ng/L in CHD,T2DM and T2DM complicated by CHD groups,respectively,all significantly higher than the level in the control group (12.53 ± 2.79 ng/L,P ＜ 0.05).Conclusion The aberrant activation of NLRP3 inflammasome promotes the occurrence of CHD in patients with T2DM and may serve as a new target for prevention and treatment of the CHD in diabetic patients.

Objective: To evaluate the feasibility of a novel technique for achieving distal SB access and improve strut apposition during provisional stenting. Background: While distal rewiring and stent expansion toward the side branch (SB) are associated with better results during provisional stenting of coronary artery bifurcation lesions, these techniques are technically challenging and often leave unopposed struts near the carina. Methods: The "Jail Escape Technique" (JET) is performed by passing the proximal tip of the SB wire between the main vessel (MV) stent struts and balloon before implantation, allowing the MV stent to push the SB wire against the distal part of the carina. The MV stent can then be deployed without jailing the SB wire. Distal SB access and strut distribution at the carina were tested in phantom and swine models. Stent distortion, dislodgement forces, and material damage were evaluated with tensile testing. Human feasibility was then tested on 32 patients. Results: Preclinical testing demonstrated that the SB wire was located at the most distal part of the carina and no strut malapposition at the carina was present after balloon inflation. Stent distortion, dislodgement forces, or material damage were not affected. JET was successfully performed in 30 of 32 patients. No major adverse cardiovascular events occurred in any patient at 6-month follow-up. Conclusion: The "JET" enables distal SB access and eliminates strut malapposition at the carina. Further studies with larger numbers of patients are needed to further investigate this technique.

Background:Recrossing the compromised side branch (SB) with a balloon is sometimes technically challenging. The aim of this study was to evaluate whether in-stent anchoring (ISA) is safe and effective to facilitate SB balloon delivery for final kissing. Methods:One hundred and fifty-nine consecutive patients were included (166 bifurcation lesions) in this prospective, single-center registry. ISA was used as a bailout method after unsuccessful SB crossing using conventional techniques, including low-profile balloons. Technique success was defined as SB balloon delivery and final kissing. Results:Kissing-balloon delivery was successfully performed with conventional strategies in 149 of 166 lesions (89.8%). In the remaining 17 lesions (10.2%), recrossing of the main vessel stent strut was not successful; therefore, ISA was attempted. The balloon successfully crossed the stent struts, and final kissing was achieved in 15 of 17 lesions (88.2%). Total final kissing was achieved in 164 of 166 lesions (98.8%), with success rates of 100% in the single-stent group and 97.6% in the two-stent group. Two cases without balloon delivery had complex bifurcation lesions with severe calcification. There was no vessel dissection in the anchoring zone. Conclusions:ISA is safe and effective for recrossing stent struts when conventional low-profile balloons have failed. However, large-scale trials are warranted for further evaluation.

目的 探讨不稳定性心绞痛患者超敏肌钙蛋白T(hs-cTnT)水平与冠状动脉病变SYNTAX评分之间的关系.方法 将157例不稳定性心绞痛患者根据冠状动脉造影结果SYNTAX评分分为低分组(评分＜22分,97例)和中高分组(评分≥22分,60例),对比分析两组患者的临床资料和血清hs-cTnT表达水平,应用双变量相关分析、多元线性回归和Logistic回归分析hs-cTnT与冠状动脉SYNTAX评分之间的相关性.结果 (1)中高分组血清中hs-cTnT水平明显高于低分组,差异有统计学意义(P＜0.01);(2)患者血清中hs-cTnT水平与冠状动脉SYNTAX评分有相关性(r=0.661,P＜0.01);(3)多元线性回归分析显示hs-cTnT水平与冠状动脉SYNTAX评分独立相关(β=0.077,P＜0.01);(4) Logistic回归分析显示hs-cTnT是冠状动脉SYNTAX评分的独立预测因子(OR=1.148,95％CI:1.087～1.212;P=0.001).结论 在不稳定性心绞痛患者中,hs-cTnT水平升高可能提示患者冠状动脉病变严重程度.

A polysaccharide (SMP1) was isolated from the roots of Salvia miltiorrhiza. This study is designed to investigate whether SMP1 prevents H9c2 cells from hydrogen peroxide (H2O2)-induced apoptosis. The present study showed that exposure of H9c2 cells to 100mM H2O2 for 24h caused a significant increase in cell death and apoptosis, but pretreatment with SMP1 eliminated H2O2-induced apoptotic cell death. Furthermore, pretreatment with SMP1 significantly prevented the mitochondria disruption, cytochrome c release, the rise of the ratio between proapoptotic Bax and antiapoptotic Bcl-2 protein expression, and caspase-3 activation in H9c2 cells upon H2O2 stimulation. Moreover, the decline of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities together with the elevation of malondialdehyde (MDA) in PC12 cells exposed to H2O2 were remarkably reversed to normal levels by pretreatment with SMP1. These results suggest that SMP1 protects H9c2 cells from H2O2-induced apoptosis through inhibition of mitochondrial dysfunction, inactivation of caspase-3 cascade and enhancement of antioxidant capacity.

In this study, we investigated the cardioprotective effect of one purified polysaccharide (SMP1) from Salvia miltiorrhiza on isoproterenol (ISO)-induced myocardial infarction (MI) in rats. ISO-treated rats showed severe myocardial damage and high lipid peroxidation level, as well as decreased endogenous myocardial antioxidant function. Pretreatment with SMP1 (100 and 400mg/kg) for 30 days significantly increased the body weight, decreased the heart weight, attenuated the serum levels of creatine kinase (CK), creatine phospokinase-MB (CK-MB), dehydrogenase (LDH), alkaline phosphate (ALP), aspartate transaminase (AST), alanine transaminase (ALT), total cholesterol, triglyceride, and LDL-cholesterol (LDL-C), along with the increased concentration of HDL-cholesterol (HDL-C). In addition, SMP1 also enhanced myocardial superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPX) activities and elevated myocardial reduced glutathione (GSH) level, along with a decrease in thiobarbituric acid reactive substances (TBARS) concentration. Collectively, our results indicated that long-term oral administration of SMP1 offered significant protection against the damage induced by ISO in rat heart through enhancement of endogenous antioxidants and antihyperlipidemic activity.

目的：检测心绞痛患者冠状动脉内皮的损伤情况，以定性、定量分析的方式，利用经冠状动脉超声心肌声学造影（MCE）检测心肌组织微循环灌注情况，探讨冠状动脉内皮损伤与心肌组织微循环灌注状况的相关性极其临床意义。<br>　　方法：30例心绞痛患者均经冠状动脉造影证实有明显冠状动脉狭窄；18例对照组患者经临床检查和选择性冠状动脉造影排除冠心病。在介入手术中采集冠状窦血液标本，测定一氧化氮（NO）、内皮素（ET）含量和循环内皮细胞（CEC）数量，以此反映冠状动脉内皮损伤情况。冠状动脉造影后超声声学造影剂由冠状动脉直接注入，完成MCE。采用视觉评分法对心肌灌注进行定性分析，并由心肌灌注时间-强度曲线得到以下参数进行定量分析：造影剂峰值密度（A）、达峰时间（TP）及曲线下面积（AUC），分别反映心肌血容量、灌注速度及心肌血流量。

目的：研究白细胞介素-1β经血管外膜给药导致动脉平滑肌细胞发生的改变及其与JAK2-STAT3信号通路的关系，明确JAK2-STAT3信号通路在血管增殖性病变中的作用。

目的 研究白细胞介素-1β经血管外膜给药导致动脉平滑肌细胞发生的改变及其与JAK2-STAT3信号通路的关系,明确JAK2-STAT3信号通路在血管增殖性病变中的作用.方法 6～8周龄SD雄性大鼠24只,分离左侧颈总动脉,实验组(n=18)血管外膜包裹含白介素-1β2.5μg的琼脂缓释悬液,对照组(n=6)包裹不含白介素的琼脂悬液,术后2、8、24、48 h,1、2周分别处死实验组大鼠3只,对照组1只,血管标本经切片HE染色观察形态,Westernblot法检测JAK2、STAT3、磷酸化JAK2以及磷酸化STAT3的表达,免疫组化标记定位磷酸化JAK2及磷酸化STAT3；另取SD雄性大鼠9只,分离两侧颈总动脉,左侧滴加JAK2抑制剂AG490缓释凝胶,右侧滴加等量空白凝胶后两侧均包裹等量白介素-1β,术后8、48 h,1周处死动物分别行HE染色及Western blot检测.结果 白介素-1β包裹血管外膜后出现血管平滑肌细胞的增殖、迁移,通道蛋白JAK2、STAT3在不同时间点出现不同程度的磷酸化,经Western blot检测并行灰度分析,p-JAK2相对灰度值对照组(0.337 ±0.216),8h组(1.764±0.513),1周组(0.451±0.229)；p-STAT3相对灰度值对照组(0.125±0.870),24h组(1.909±0.309),2周组(0.448±0.516),各组间有明显差异(P＜0.05).加用抑制剂后,8h组p-JAK2相对灰度值实验侧(0.085±0.031),对照侧(1.416±0.468),48 h组p-STAT3相对灰度值实验侧(0.460±0.065),对照侧(2.425±0.638),提示JAK2、STAT3的磷酸化水平被明显抑制(P＜0.05),平滑肌细胞变化程度下降.结论 炎性因子白细胞介素-1β经动脉外膜给药可致动脉平滑肌细胞增殖、迁移,这种改变与JAK2-STAT3信号通路有直接关系.

<正>目的:分析有高血压阳性家族史但血压正常的健康子代,其内皮依赖性血管舒张功能和血清NO水平。方法:入选有高血压阳性家族史但本人血压正常的子代个体48例(男26例,女22例)作为家族史阳性组,取45例血压正常同时无高血压家族

[Objective] The evaluation of femoral artery PCI postoperative application Perclose ProGlide(Abbott,USA) suture bleeding vessels for the safety and reliability,analysis and common complications preventive measures.[Methods] In February 2007 to January 2011 in our hospital from 3109 patients via the artery PCI postoperative Perclose ProGlide blood vessels for application suture bleeding effect were retrospectively summarized,analyzed,and the reason for failure in complications,observe the recent complications.[Results] Hemostatic rate was 95.6%(2973/3109),stop bleeding time(2.9±0.8)min,postoperative braking time(4.3±1.5)h,a mean of the length of time(4.5±1.2)d.The overall incidence of complications in 1.6%(51/3109),including hematomas(19 cases),ooze blood in 16,10 cases of local infection,pseudo-aneurysms in 3 patients,the artery sandwich in 2 cases,retroperitoneal hematoma in 1.Among them is complications associated with suture bleeding 1.2%.By March 2012,a mean follow-up(12±2) months,follow-up rate 66.7%(2013/3109),follow-up complication rate 0.1%(3/2013),including 2 cases late-occurred femoral artery interlining,1 case of late femoral artery thrombosis.[Conclusion] The application Perclose ProGlide PCI suture bleeding vessels for is a safe and reliable hemostatic measures,is worth further promotion.

Objective: To investigate the effect of cilostazol on oxidative stress and neointimal hyperplasia after balloon injury in rat model.Methods: Twenty-four male SPF SD rats were randomly divided into three groups: sham-operation group,injury group and cilostazol group(n=8).Except shan-operation group,all Left common carotid artery of rats were injuried by a balloon catheter.14days later,the injured carotids were sliced,HE and immunohistochemistry stained.The level of reactive oxygen species(ROS) was examined by Dihydroethidium(DHE).Ratios of intima/media area,PCNA positive indexes and the level of ROS were compared.Results: The ratios of intima/media area,PCNA positive indexes and the level of ROS in injury group were significantly higher than that in sham-operation group(P0.05).Cilostazol can significantly decrease the ratios of intima/media area,PCNA positive indexes and the level of ROS(P0.05).Conclusion: Cilostazol reduces neointimal hyperplasia by inhibition superoxode production after balloon common arterial injury in a rat model.