老年慢性心力衰竭患者血清瘦素水平变化及其与血压的关系

该文探讨慢性心力衰竭（CHF）患者血清瘦素水平变化及其与血压的关系。方法：观察慢性心力衰竭患者35例及健康对照组30例血清瘦素、左心室射血分数（LVEF）及血压水平，分析瘦素水平与血压及LVEF之间的关系。结果：CHF组与对照组比较，血清瘦素水平分别为（11．4±5．8）、（7．3±3．1）μg／L，收缩压分别为（142．1±19．7）、（127．0±17．6）mmHg，舒张压分别为（85．0±12．9）、（78．4±9．7）mmHg，两组比较，差异有统计学意义（P〈0．05和P〈0．01）。CHF患者按LVEF程度分为2组，LVEF〈30％组瘦素水平为（12．4±7．8）μg／L，30％～40％组瘦素水平为（10．8±1．8）μg／L，两组间比较差异有统计学意义（P〈0．05），表明LVEF水平越低，瘦素水平越高。多元回归分析显示，CHF患者血清瘦素水平分别与体重指数（r=0．910，P〈0．01）、收缩压（r=0．859，P〈0．01）、舒张压（r=0．680，P〈0．05）呈正相关，与LVEF呈负相关（r=-0．729，P〈0．01）。结论：老年CHF患者血清瘦素水平较健康对照组高。并与LVEF程度呈负相关；CHF患者血压明显高于健康对照组。且瘦素水平与血压呈正相关。提示血清瘦素水平与高血压之间存在密切联系。共同促进CHF发展。     

急诊冠状动脉支架术联合国产替罗非班治疗急性ST段抬高性心肌梗死的临床疗效和安全性

目的前瞻性评价急性ST段抬高性心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）联合应用国产替罗非班治疗的临床疗效及安全性。方法入选连续160例接受急诊PCI治疗的急性STEMI患者,随机分为替罗非班组（80例）和对照组（80例）。比较两组基础临床情况、介入治疗结果、术后即刻疗效、术后30天和180天主要心脏不良事件（MACE,包括死亡、再梗死、再次靶血管重建）发生率及左室射血分数（LVEF）。结果两组基础临床情况、介入治疗结果差异均无统计学意义。与对照组相比,替罗非班组术后即刻心肌梗死溶栓试验（TIMI）3级复流血流差异无统计学意义（95．0％比87．5％,P〉0．05）,但即刻心肌组织灌注（TMP）3级（75．0％比56．3％,P〈0．05）、校正TIMI帧数[（23．56±5．19）帧比（31．05±6．92）帧,P〈0．01）]、ST段抬高总和回落[（6．51±3．56）mm比（4．53±2．47）mm,P〈0．01]、肌酸激酶同工酶（CK—MB）峰值[（225．02±105．81）μg／L比（269．20±110．88）μg／L,P〈0．05）、肌钙蛋白Ⅰ（TnⅠ）峰值[（45．25±33．00）μg／L比（56．46±29．48）μg／L,P〈0．05]及平均住院天数[（11．38±4．63）天比（14．68±6．90）天,P〈0．01]均显著优于对照组。替罗非班组术后MACE发生率30天（5．0％比16．3％,P〈0．05）和180天（7．5％比18．8％,P〈0．05）明显降低,LVEF（术后30天：53％±7％比49％±9％,P〈0．01;术后180天：59％±8％比53％±9％,P〈0．01）显著提高。多因素logistic回归分析表明,年龄〉65岁[比值比（OR）=3．42,P〈0．01]、替罗非班治疗（OR=0．56,P〈0．05）、住院期LVEF〈0．5（OR=2．56,P〈0．01）是术后180天MACE发生率的主要决定因素。替罗非班组术后出血并发症发生率高于对照组（16．3％和7．5％）,但差异无统计学意义（P〉0．05）。结论急诊冠状动脉支架术联合应用国产替罗非班治疗STEMI能显著提高相关梗死区域再灌注水平,明显改善术后即刻、术后30天及180天临床预后和左心室收缩功能。     

急性心肌梗死患者肌酸激酶同工酶、心型脂肪酸结合蛋白与预后

目的探讨CK．MB、心型脂肪酸结合蛋白（H—FABP）与急性心肌梗死（AMI）患者近期预后的关系。方法正常对照组20例，急性心肌梗死组40例，随访平均（12．3±3．4）（6～18）个月，观察CK-MB、H-FABP在心血管事件发生组与未发生组间的差异。结果血清CK—MB、H—FABP对照组分别为（14．1±5．6）u／L、（3．8±2．1）μg／L，AMI组为（85．2±12．3）、（16．1±6．3）μg／L（均P〈0．001）。心血管事件发生组为（126．3±23．4）、（21．58±6．2）μg／L，未发生组为（65．7±10．8）、（13．6±4．8）μg/L（均P〈0．001）。结论CK-MB、H—FABP可预测AMI患者近期预后。     

支气管哮喘和慢性阻塞性肺疾病患者诱导痰中基质金属蛋白酶及其抑制剂与气道炎症及气流受限

目的探讨支气管哮喘（简称哮喘）和慢性阻塞性肺疾病（COPD）患者诱导痰中基质金属蛋白酶9（MMP-9）和基质金属蛋白酶抑制剂1（TIMP-1）的水平及其与炎性细胞数、肺功能的关系。方法分别选择14例缓解期哮喘患者（哮喘组）、12例稳定期COPD患者（COPD组）和10名健康对照者（健康对照组）进行肺功能测定和用诱导痰检查方法对痰炎性细胞进行分类计数，并用酶联免疫吸附试验（ELISA）法测定诱导痰上清液中自细胞介素4（IL-4）、MMP-9和TIMP-1浓度。结果哮喘组患者诱导痰中嗜酸粒细胞、中性粒细胞分别为0．181±0．067、0．30±0．07，健康对照组为0．007±0．005、0．26±0．06，COPD组为0．042±0．017、0．50±0．10，3组细胞间比较差异有统计学意义（F值分别为4．32、4．13，P均〈0．05）。哮喘组、COPD组、健康对照组间诱导痰中IL-4浓度分别为（19±7）×10^-3／L、（14±6）×10^-3g／L、（11±4）×10^-3g／L，3组诱导痰中IL-4浓度比较差异无统计学意义（F=1．56，P均〉0．05），且分别与嗜酸粒细胞、中性粒细胞和第一秒用力呼气容积占预计值百分比（FEV1占预计值％）无相关（r分别为0．33、0．11、0．19、0．25、0．39、0．40、0．21、0．35、0．17，P均〉0．05）。哮喘组和COPD组诱导痰中MMP-9、TIMP-1浓度分别为（15．9±6．0）g／L、（13．4±5．1）g／L、（19．8±8．5）g／L、（16．7±7．6）g／L，健康对照组分别为（1．8±1．1）g／L、（1．3±0．9）g／L，两组MMP-9、TIMP-1浓度比较差异有统计学意义（F值分别为2．99、4．22，P均〈0．05）。哮喘组MMP-9浓度与嗜酸粒细胞呈正相关（r=0．71，P〈0．05）；COPD组MMP-9浓度与中性粒细胞呈正相关（r=0．59，P〈0．05），但与FEV。占预计值％和第一秒用力呼气容秽用力肺活量（FEV1／FVC）无相关（r分别为0．22、0．16、0．25、0．30，P均〉0．05）。哮喘组和COPD组TIMP．1浓度均与嗜酸粒细胞和中性粒细胞无相关（r分别为0．27、0．31、0．20、0．35，P均〉0．05），但与FEV。占预计值％呈负相关（r分别为-0．58、-0．62，P均〈0．05）。哮喘组和COPD组诱导痰中MMP-9／TIMP-1比值分别为0．8±0．7、0．8±0．6，两组比较差异无统计学意义（F=1．78，P〉0．05），但与健康对照组（1．5±0．6）比较差异有统计学意义（F=3．70，P〈0．05），且与FEV1占预计值％呈正相关（r分别为0．56、0．61，P均〈0．05）。结论哮喘组和COPD组患者诱导痰中MMP-9／TIMP-1比值的失衡与气道炎症和气流受限有关，这种失衡在哮喘和COPD细胞外基质的重塑和气流受限的发病机制中发挥重要作用。     

不同类型心绞痛患者低密度脂蛋白及氧化型低密度脂蛋白的比较研究

目的探讨血浆低密度脂蛋白胆固醇（LDL-C）和氧化型低密度脂蛋白（ox-LDL）与冠状动脉粥样硬化病变严重程度的关系。方法病例选择：冠状动脉痉挛组（CAS,n=31）,临床上具有胸痛表现、冠状动脉造影无显著狭窄并经过乙酰胆碱试验确诊的患者,根据痉挛血管形态分为节段性痉挛组和弥漫性痉挛组;稳定性心绞痛组（SAP,n=35）,为稳定的劳力型心绞痛患者,根据冠状动脉造影结果分为单支病变组和多支病变组;对照组（n=24）,为健康体检患者。各组于清晨空腹采取静脉血,采用全自动生化分析仪测定血浆LDL-C,用ELISA法检测血浆ox-LDL含量,分组比较其LDL．C及ox-LDL水平。结果血浆LDL-C水平SAP亚组[单支病变组（2．6±0．9）mmol／L,多支病变组（2．8±0．9）mmol／L]和CAS亚组[弥漫性痉挛组（3．2±0．5）mmol／L,节段性痉挛组（2．9±0．8）mmol／L]间差异无统计学意义,但均高于对照组[（2．2±0．5）mmol／L,P〈0．05];SAP组血浆ox-LDL含量[（575±219）μg/L]高于对照组[（218±35）μg/L,P〈0．01]和CAS组[（299±117）μg/L,P〈0．01],CAS组与对照组比较,差异无统计学意义（P〉0．05）;弥漫性痉挛组[（225±63）μg／L]、节段性痉挛组[（328±123）μg／L]、单支血管病组[（462±72）μg／L]、多支血管病变组[（672±92）μg／L]的血浆ox—LDL浓度逐步上升,各组间差异有统计学意义（P〈0．05）,与冠状动脉硬化程度呈一致趋势,而血浆LDL水平组间差异无统计学意义。结论血浆ox-LDL比LDL—C更能准确地预测冠状动脉粥样硬化的严重程度,调脂治疗应该更为重视降低ox-LDL,而不应单纯控制LDL水平。     

慢性心力衰竭病人血清尿酸水平与心功能的关系

目的探讨慢性心力衰竭病人血清尿酸水平与心功能的关系。方法对167例慢性充血性心力衰竭病人根据血尿酸水平分为尿酸升高组和尿酸正常组，比较两组血尿酸水平、房室大小、心功能、肾功能等指标的差异，对血清尿酸水平与房室大小、心功能、肾功能指标进行相关性分析。对167例慢性充血性心力衰竭痛人依NYHA分级法分为Ⅱ级、Ⅲ级、Ⅳ级3组，比较3组间左室舒张末内径（LVEDD）、左室射血分数（LVEF）、短轴缩短率（FS）、血尿酸（UA）水平。结果尿酸正常组UA为（339.10±66．50）μmol／L、LVEDD为（55．15±7．22）mm、尿素氮（BUN）为（4．75±1．37）mmol／L、肌酐（Cr）为（68．98±27．59）μmol／L、LVEF为（45．94±14．70）％；尿酸升高组UA为（479．89±65．43）μmol／L、LVEDD为（65．27±9．34）mm、BUN为（6．33±1．64）mmol／L、Cr为（96．24±19．60）“mol／L、LVEF为（35．46±10．36）％，两组比较差异有统计学意义（P〈0．01）。而两组左房内径（LAD）、心排血量（CO）、每搏量（SV）比较差异无统计学意义（P〉0．05）。相关分析表明UA与LVEDD呈正相关（r=0．486，P〈0．01），与LVEF呈负相关（r=-0．519，P〈0．01），与FS呈负相关（r=-0．533，P〈0．01）。结论慢性心力衰竭痛人血清尿酸水平升高是心脏扩大、心脏射血功能下降及心功能恶化的一项预测指标。     

氯沙坦和氨氯地平对肥胖高血压患者瘦素、脂联素及胰岛素敏感性的影响

目的观察血管紧张素Ⅱ受体拮抗剂氯沙坦和钙离子通道拮抗剂氨氯地平对肥胖高血压患者血浆瘦素、脂联素、去甲肾上腺素（NE）水平和胰岛素敏感性的影响。方法采用放射免疫法测定血浆瘦素及脂联素水平、采用稳态模型评价胰岛素抵抗指数（HOMA-IR），以高效液相色谱检测血浆NE水平。结果氯沙坦组血浆瘦素、脂联素、HOMA—IR、体重指数（BMI）治疗16周前后差异有统计学意义[分别为（35．6±18．5vs32．0±17．1）μg／L，P〈0．05；（9．34±3．12vs12．45±4．52）mg／L，P〈0．01；8．6±2．7vs6．1±2．1，P〈0．05；（28．9±3．8vs27．3±3．2）kg／m^2，P〈0．05]，氨氯地平组在治疗前后差异均无统计学意义[分别为（35．2±18．3vs35．4±18．9）μg/L；（9．32±3．23vs9．39±3．41）mg／L；8．3±2．5vs8．7±2．9；（28．8±3．8vs28．7±3．6）kg／m^2]；血浆NE水平在氨氯地平组治疗后明显增加[（324±112vs449±122）ng／L，P〈0．01]，氯沙坦组治疗前后差异无统计学意义[（322±115vs325±121）ng／L]，两治疗组之间的疗效差异有统计学意义（P〈0．01）。结论虽然氯沙坦和氨氯地平有等同的降压效应，但氯沙坦尚能改善与肥胖相关的代谢紊乱，因此肥胖高血压患者用氯沙坦比氨氯地平治疗可能会获得更多益处。     

重组人可溶性补体受体1型SCR15-18片段对心肌缺血再灌注损伤的保护作用

目的探讨重组人可溶性补体受体1型SCR15-18片段（sCR1-SCR15-18）对心肌缺血再灌注的保护作用。方法36只SD大鼠随机分为假手术（SO）组,缺血再灌注（I／R）组和sCR1-SCR15-18（sCR1）保护组。建立急性心肌缺血再灌注模型,结扎冠状动脉前立即注射磷酸盐缓冲液（0.1mL／100g）或sCR1-SCR15-18蛋白（15mg／kg）。测定心肌梗塞面积,血清中乳酸脱氢酶（LDH）和肌酸激酶（CK）,心肌组织髓过氧化物酶（MPO）活性,HE染色观察心肌病理改变和免疫组织化学法检测C3c。结果（1）心肌梗死面积：I／R组为（22．9±3．0）％,sCR1保护组为（16．1±3．3）％（P〈0．05）。（2）血清心肌酶CK（U／L）：I／R组为3400．9±534．9,sCR1保护组为2532．5±597．1（P〈0．05）。LDH（U／L）：I／R组为6572．0±476．3,sCR1保护组为5436．2±611．3（P〈0．05）。（3）心肌组织MPO活性（U／g）：I／R组为1．12±0．13,sCR1保护组为0．81±0．14（P〈0．05）。（4）心肌病理改变：I／R组心肌有断裂、坏死,间质肿胀,出血及中性粒细胞浸润,sCR1保护组心肌的以上病理变化明显较I／R组减轻。（5）与I／R组比sCR1保护组梗死区心肌组织C3c的沉积减少。结论sCR1-SCR15-18蛋白对大鼠急性心肌缺血再灌注损伤具有保护作用。     

衰老大鼠心肌对缺血再灌注损伤的敏感性研究

目的观察衰老大鼠心肌对缺血再灌注损伤的敏感性,并探讨其可能的机制。方法成年和老年雄性Wistar大鼠各12只,分为4组：成年假手术组、成年缺血再灌注组、老年假手术组和老年缺血再灌注组,每组6只,进行缺血30 min再灌注3 h。脱氧核糖核苷酸末端转移酶介导的缺口末端标记(TUNEL)法检测心肌细胞凋亡,比色法检测心肌组织半胱胺酸蛋白酶蛋白-3 (caspase-3)活性,化学发光法测定心肌组织总一氧化氮(NOx)含量,ELISA法检测心肌过氧亚硝基(ONOO~-)含量。结果老年组缺血再灌注引起心肌细胞凋亡的程度明显高于成年组,凋亡指数分别为(14．6±1.7)%、(19．0±2．1)%,差异有统计学意义(P＜0．05)；caspase-3活性：成年组为(340±32)μmol/mg,老年组为(436±35)μmol/mg,差异有统计学意义(P＜0．05)；心肌组织中NOx含量：成年缺血再灌注组、老年缺血再灌注组分别为成年假手术组的(2．1±0．2)、(4．4±0．5)倍,差异有统计学意义(P＜0．05)；ONOO~-含量：成年缺血再灌注组和老年缺血再灌注组分别为(4．68±0．15)nmol/g、(7．25±0．18)nmol/g,差异有统计学意义(P＜0．05)。结论老年大鼠对心肌缺血再灌注损伤的敏感性增加,可能的原因是老年鼠心脏中NO的毒性衍生物ONOO~-含量增加,从而导致功能蛋白的硝基化。     

卡维地洛治疗扩张型心肌病心力衰竭的疗效及对血浆细胞凋亡抑制因子的影响

目的 :观察卡维地洛治疗国人扩张型心肌病 ( DCM)心力衰竭 ( HF)的临床疗效 ,以及对血浆细胞凋亡抑制因子 ( APO- 1/ Fas)的反应。方法 :2 4例 DCM HF患者在洋地黄、利尿剂、血管紧张素转换酶抑制剂和硝酸盐类扩血管药物治疗基础上 ,随机分为卡维地洛组和常规组 (加用安慰剂 )。治疗前与治疗 3个月后应用超声心动图测量左室短轴缩短分数 ( FS) ,射血分数 ( EF) ,左室舒张末内径 ( L VDD) ,室间隔厚度 ( IVS)和左室后壁厚度( L VPW) ;以 EL ISA法测定患者血浆 APO- 1/ Fas浓度。结果 :治疗 3个月后 ,两组心功能均有显著改善 ,但卡维地洛组 L VDD[( 60 .5± 6.7)∶ ( 66.3± 6.3 ) m m,P<0 .0 5 ],[EF( 4 9.4± 9.8) %∶ ( 4 1.3± 6.2 ) % ,P<0 .0 5 ],D/T( 3 .0 8± 0 .62∶ 3 .69± 0 .79,P <0 .0 5 )改善比常规组更明显。治疗前两组 CHF患者血浆 APO- 1/ Fas水平均显著高于正常水平 ,且与 EF负相关 ( r =- 0 .73 ,P <0 .0 0 1) ,治疗 3个月后卡维地洛组 APO- 1/ Fas显著低于常规组 [( 0 .94± 0 .2 6)∶ ( 1.18± 0 .3 2 ) μg/ L,P <0 .0 5 ]。结论 :卡维地洛对 CHF心肌的保护作用可能与抑制心肌细胞凋亡有关。     

Prediction of remote left ventricular volumes and functions after acute myocardial infarction with successful coronary intervention.

BACKGROUND: The scintigraphic perfusion defect size (DS) at 1 week after acute myocardial infarction (AMI) predicts remote left ventricular (LV) volumes and LV ejection fraction (LVEF). The present study examined whether LV volumes and LVEF 6 months after AMI may be better predicted by the combination of LV volumes and LVEF just after reperfusion, and DS at 1 week, after AMI in patients with Thrombolysis In Myocardial Infarction (TIMI) grade III reperfusion by percutaneous coronary intervention. METHODS AND RESULTS: In 48 patients with AMI and TIMI grade III reperfusion, quantitative gated SPECT (QGS) was performed just after reperfusion, and at 1 week and 6 months after AMI. LV end-diastolic volume index decreased (108+/-8 to 93+/-6 ml/m(2), p<0.05) and LVEF increased (44+/-3 to 50+/-2%, p<0.05) 6 months after AMI. In addition, they were better predicted by a combination of LV volumes and LVEF just after reperfusion and DS at 1 week after AMI. CONCLUSIONS: In AMI with TIMI grade III reperfusion, LV volumes and LVEF at 6 months after MI correlate with the values obtained just after reperfusion. Myocardial perfusion imaging combined with QGS at reperfusion may predict these late-phase parameters.     

Effects of reperfusion on left ventricular ejection fraction and volume after acute myocardial infarction.

The effects of reperfusion on left ventricular (LV) function and volume were studied in patients with evolving acute myocardial infarction (AMI). We analyzed the LV ejection fraction and volume in patients who had been admitted within 24 h of the onset of their first AMI with culprit lesion of #6, #7 and #1 (American Heart Association classification). Sixty-five patients (Re group) received successful reperfusion therapy within 6 h after the AMI. The other 60 patients (Oc group), who were admitted from 6 to 24 h after the AMI, received conservative therapy. Patients with re-obstruction of the culprit lesion after reperfusion therapy were excluded from the Re group. Patients with spontaneous recanalization following conservative therapy were excluded from the Oc group. The LV ejection fraction (LVEF), LV end-systolic volume index (LVESVI), and LV end-diastolic volume index (LVEDVI) were measured using a modified Dodge's formula by left ventriculography performed 4 weeks after the AMI. LVEF in the Re group was significantly greater than in the Oc group (57 +/- 12 vs 49 +/- 11%) (mean +/- SD, p less than 0.01). LVESVI in the Re group was significantly smaller than in the Oc group (30 +/- 13 vs 38 +/- 16 ml/m2, p less than 0.01). Although LVEDVI was not significantly different between the 2 groups, in patients with a responsible coronary lesion of segment #6, LVEDVI in the Re group was significantly smaller than in the Oc group (67 +/- 14 vs 77 +/- 18 ml/m2, p less than 0.05). Although LVEF and LV volume correlated in both groups, the correlation was weak (r = 0.40-0.42), suggesting that LV volume was not dependent solely on LV functional recovery. The incidence of ventricular aneurysm in the Re group was significantly lower than in the Oc group (15.4 vs 45.0%, p less than 0.01). Multivariate analysis selected reperfusion of the responsible coronary artery as one of the factors significantly associated with a reduction of LVEDVI, LVESVI, an improvement of LVEF, and a decrease in the rate of aneurysm formation. In summary, our results indicated that reperfusion improved EF, reduced LV volume, and decreased the rate of aneurysm formation as compared to non-reperfusion, which suggests that reperfusion therapy is beneficial for both functional recovery and ventricular remodeling.     

Evaluation of transmural myocardial perfusion by ultra-harmonic myocardial contrast echocardiography in reperfused acute myocardial infarction.

BACKGROUND: The transmural distribution of myocardial perfusion is important for predicting the contractile reverse of an infarcted wall in reperfused acute myocardial infarction (AMI). Evaluating transmural myocardial perfusion by myocardial contrast echocardiography (MCE) could predict the long-term recovery of left ventricular (LV) function. METHODS AND RESULTS: The study group comprised 20 consecutive patients with a first-episode anterior AMI with total occlusion of the proximal left anterior descending artery, who underwent successful percutaneous coronary intervention within 24 h of onset. MCE was performed on the 15th day after the onset, using ultraharmonic gray-scale imaging with intermittent end-systolic triggering every 4 beats or every 6 beats. Regions of interest were placed over both the endocardial and epicardial region at the mid-septal level. Regional wall motion (RWM) of the infarcted anterior wall and global LV function were assessed by 2-dimensional echocardiography and left ventriculography in both the acute and chronic phase. The transmural distribution of myocardial perfusion by MCE demonstrated a significant relation with RWM score index (r = 0.75, p = 0.0004). Recovery of RWM and LV ejection fraction (LVEF) at 6 months after reperfusion was significantly greater in the group with good perfusion of the epicardium according to MCE than in the poor perfusion group [RWM (SD/cord); -1.23+/-0.91 vs -3.51+/-0.84, p = 0.001, LVEF (%); 63.8+/-10.4 vs 47.0+/-3.4, p = 0.04]. CONCLUSIONS: Assessing the transmural distribution of myocardial perfusion by MCE can predict the long-term recovery of LV function after a reperfused AMI.     

Cardioprotective effects of magnesium sulfate in patients undergoing primary coronary angioplasty for acute myocardial infarction.

BACKGROUND: Experimental evidence indicates that magnesium sulfate may have potential cardioprotective properties as an adjunct to coronary reperfusion. The present study was designed to examine the hypothesis that magnesium might have beneficial effects on left ventricular (LV) function and coronary microvascular function in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: The study population of 180 consecutive patients with a first AMI (anterior or inferior) underwent successful primary coronary intervention. Patients were randomized to treatment with either intravenous magnesium (magnesium group, n=89) or normal saline (control group, n=91). Pre-discharge left ventriculograms were used to assess LV ejection fraction (LVEF), regional wall motion (RWM) within the infarct-zone and LV end-diastolic volume index. The Doppler guidewire was used to assess coronary flow velocity reserve (CFVR) as an index of coronary microvascular function. Magnesium group subjects showed significantly better LV systolic function (LVEF 63+/-9% vs 55+/-13%, p<0.001; RWM: -1.01+/-1.29 SD/chord vs -1.65+/-1.11 SD/chord, p=0.004), significantly smaller LV end-diastolic volume index (63+/-17 ml/m(2) vs 76+/-20 ml/m(2), p<0.001), and significantly higher CFVR (2.95+/-0.76 vs 2.50+/-0.99, p=0.023) than controls. CONCLUSION: Magnesium sulfate as an adjunct to primary coronary intervention shows favorable functional outcomes in patients with AMI.     

Clinical significance of acute-phase endothelin-1 in acute myocardial infarction patients treated with direct coronary angioplasty.

BACKGROUND: The aim of the present study was to investigate the relationship between plasma concentrations of endothelin (ET)-1 and clinical outcome (including mortality) and left ventricular (LV) systolic function in acute myocardial infarction (AMI). METHODS AND RESULTS: The study group comprised 110 consecutive first-AMI patients who were successfully reperfused by primary coronary intervention. Plasma ET-1 concentrations were evaluated 24 h from onset and the patients were divided into 2 groups according to the median value, either a high group (H group: > or = 2.90 pg/ml plasma ET-1; n = 55) or low group (L group: < 2.90 pg/ml plasma ET-1; n = 55). Major complications and LV systolic function were monitored in the 2 groups. Both highly sensitive C-reactive protein (hs-CRP) and brain natriuretic peptide (BNP) showed a significant positive correlation with ET-1 (BNP: r = 048, p < 0.0001, hs-CRP: r = 0.43, p < 0.001). Chronic stage left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume index (LVEDVI) were significantly poorer in the H group (LVEF: 51+/-15% vs 60+/-13%, p = 0.003, LVEDVI: 74+/-19 ml/m2 vs 66+/-14 ml/m2, p < 0.05). There were significantly more major complications in the H group than in the L group (cardiogenic shock: 18% vs 5%, p = 0.04; cardiac death: 13% vs 0%, p < 0.01). CONCLUSIONS: In the setting of AMI, plasma ET-1 concentrations may be closely related to LV systolic dysfunction and poor patient outcome, including mortality.     

Impact of the magnitude of the initial ST-segment elevation on left ventricular function in patients with anterior acute myocardial infarction.

BACKGROUND: In the percutaneous coronary intervention (PCI) era, the impact of initial ST-segment elevation magnitude on left ventricular (LV) function in patients with acute myocardial infarction (AMI) remains unclear. METHODS AND RESULTS: In the present study, 239 patients with total occlusion and 81 patients with spontaneous reperfusion within 12 h of their first anterior AMI were evaluated. The sum of ST-segment elevation (SigmaST) was measured in leads I, aV(L) and V(1-6) shortly before angiography. Predischarge LV ejection fraction (LVEF) was obtained at 15+/-5 days. In total occlusion, the predischarge LVEF was significantly lower in patients with SigmaST >/=10 mm than in those with SigmaST <10 mm (51+/-14% vs 57+/-14%, p<0.01). However, in spontaneous reperfusion, there was no significant difference between patients with ST >/=10 mm and those with SigmaST <10 mm (61+/-13 vs 62+/-14 %, p=NS). Predischarge LVEF significantly correlated with SigmaST in total occlusion (r=-0.25, p<0.01), but not in spontaneous reperfusion (r=0.03, p=NS). CONCLUSION: The results suggest that initial SigmaST is an important predictor of LV function in patients with total occlusion, but not in those with spontaneous reperfusion.     

Impact of prodromal angina pectoris and white blood cell count on outcome of patients with acute myocardial infarction

BACKGROUND: Elevation of white blood cell (WBC) count at admission is associated with adverse outcome after acute myocardial infarction (AMI). Prodromal angina, by the mechanism of ischemic preconditioning, improves left ventricular (LV) function and survival after reperfusion therapy in patients with AMI. Recent experimental studies have reported that preconditioning has anti-inflammatory effect. METHODS: This study consisted of 598 patients with first anterior wall AMI who underwent coronary angiography within 12 h after symptom onset. WBC count was measured at the time of hospital admission. Prodromal angina was defined as angina occurring within 24 h before the onset of AMI. Serial measurements of LV ejection fraction (EF) were obtained before reperfusion therapy and before discharge in 421 patients (71%). RESULTS: High WBC count (>10.2 x 103/mm3, n=297) was associated with higher 30-day mortality (8% vs. 4%, p=0.02) and lower predischarge LVEF (51+/-15% vs. 57+/-14%, p<0.001), although there was no significant difference in acute LVEF (47+/-10% vs. 49+/-11%, p=0.07). High WBC count was an independent predictor of 30-day mortality (p=0.009) and predischarge LVEF (p=0.002). Prodromal angina was associated with lower 30-day mortality (3% vs. 7%, p=0.02) and preserved predischarge LVEF (57+/-15% vs. 53+/-14%, p=0.006). Patients with prodromal angina had lower WBC count (10.0+/-3.3 x 10(3)/mm3 vs. 11.0+/-3.9 x 10(3)/mm3, p=0.001) and prodromal angina was an independent predictor of WBC count (p<0.001). CONCLUSIONS: Elevation of WBC count and lack of prodromal angina were associated with impaired LV function and mortality after reperfusion in patients with AMI. Prodromal angina might have contributed to favorable outcome after AMI through its anti-inflammatory effect.     

Impact of spontaneous anterograde flow of the infarct artery on left ventricular function in patients with a first anterior wall acute myocardial infarction

To assess the impact of spontaneous anterograde flow of the infarct artery on outcomes in patients with acute myocardial infarction (AMI), we studied 478 patients with a first anterior wall AMI who underwent coronary angiography within 12 hours after the onset of chest pain; Thrombolysis In Myocardial Infarction (TIMI) 3 flow was obtained after reperfusion therapy. Patients were divided into 3 groups: 119 patients with spontaneous anterograde flow (initial TIMI 2 or 3 flow) of the infarct artery, 118 patients with an initially occluded artery (TIMI 0 or 1 flow) and time to angiography or=55% (odds ratio 7.13, 95% confidence interval 3.10 to 16.4, p <0.001). In conclusion, although very early reperfusion improved LV function more than late reperfusion, spontaneous anterograde flow was associated with better acute and predischarge LV function after AMI compared with very early reperfusion of an initially occluded artery.     

ST-segment re-elevation unrelated to left ventricular ejection fraction or volume after anterior wall acute myocardial infarction treated with successful reperfusion

Ventricular remodeling is a major determinant of the long-term prognosis of patients with acute myocardial infarction (AMI). No previous study examined the relation of ST-segment re-elevation to left ventricular (LV) volume and function in patients with successful reperfusion. We examined the relation of ST-segment re-elevation to LV function and volume indices in 51 patients with anterior wall AMI who underwent successful reperfusion by direct coronary angioplasty. A 12-lead electrocardiogram was recorded once a day until 7 days after the onset of AMI. ST-segment shift was measured and Sigma ST was defined as the sum of ST-segment elevation obtained from leads V2, V3, and V4. ST-segment re-elevation was defined as present when the difference between maximal and minimal Sigma ST (Delta ST) was >0.3mV. LV indices were obtained from left ventriculography performed approximately 1 month after the onset of AMI. ST-segment re-elevation was observed in 15 patients (29%). No significant differences were observed between the ST- re-elevation group and non-ST-re-elevation group in LV ejection fraction (49.4+/-14.0 vs. 51.2+/-11.5%), LV end-systolic volume index (35.8+/-13.1 vs. 33.8+/-12.5 mL/m(2)) or LV end-diastolic volume index (69.7+/-12.8 vs. 68.3+/-14.4 mL/m(2)). The difference between maximal and minimal Sigma ST (Delta ST) was not significantly correlated with any LV index examined. In conclusion, the present study revealed that ST-segment re-elevation after successful reperfusion in anterior wall AMI patients was not related to LV volume or function, indicating that ST-re-elevation is not a clinically meaningful indicator of LV remodeling.     

急性心肌梗死后螺内酯干预对左室重构的影响

目的　探讨急性心肌梗死(AMI)患者应用螺内酯干预对于左室重构(LVRM)的影响。方法　4家医院共入选AMI患者88例,采用多中心、随机、对照的方法,对46例AMI患者在常规治疗的基础上加用螺内酯40mg/d(螺内酯组),对照组(n=42)常规治疗。在6个月干预期内检测两组血清Ⅲ型前胶原氨基端肽(PⅢNP)、脑钠肽(BNP)及超声心动图,以评价左室纤维化、左室功能和左室容积。结果　88例中,急性前壁心肌梗死患者43例,螺内酯组23例、对照组20例;急性下壁心肌梗死患者45例,螺内酯组23例、对照组22例。急性前壁心肌梗死组在治疗3、6个月时螺内酯组与对照组相比,血清PⅢNP和BNP明显降低[PⅢNP分别为( 260 .2±59. 9 )ng/L比( 328 .0±70 .3 )ng/L, P=0 .001, ( 197 .1±46 .3 )ng/L比( 266. 7±52 .4 )ng/L, P<0. 001 ,BNP分别为( 347 .4±84 .0)ng/L比(430 .1±62 .9)ng/L, P<0 .001, (243 .7±79. 7)ng/L比(334. 6±62. 8)ng/L, P<0. 001]。治疗6个月时螺内酯组较对照组左室舒张末期内径、左室收缩末期内径明显降低[分别为(51. 0±5 .5)mm比(55. 6±4 .5)mm, P=0 .005, (35 .7±4 .6)mm比(39 .1±5 .6)mm, P=0 .046]。急性下壁心肌梗死组在治疗6个月时螺内酯组与对照组相比血清PⅢNP、BNP水平无统计学意义,(P>0 05),并且左