SCAD重组腺病毒对自发性高血压大鼠血管重构的影响

目的探究尾静脉注射短链酰基辅酶A脱氢酶(SCAD)重组腺病毒能否改善自发性高血压大鼠(SHR)血管重构。方法实验分为6组:Wistar+NS组、Wistar+GFP组、Wistar+Ad-SCAD组、SHR+NS组、SHR+GFP组和SHR+Ad-SCAD组。腺病毒包装的SCAD和GFP纯化后,以尾静脉方式注射给药8周。采用超声心动图检测大鼠心功能情况;采用无创血压仪检测大鼠的血压变化;主动脉HE染色、天狼星红染色、DHE染色、TUNEL染色、EVG染色,观察血管重构。采用实时荧光定量PCR检测相关基因mRNA表达变化、Western blot检测相关蛋白表达变化,观察游离脂肪酸、一氧化氮(NO)和ATP含量变化。结果 (1)尾静脉注射SCAD重组腺病毒,大鼠主动脉中SCAD蛋白出现过表达,mRNA水平增高,SCAD酶活性增加;(2)在病理状态下,增加主动脉中SCAD表达,可以降低血压,改善心功能,改善血管管腔大小,减少胶原沉积,减少血管活性氧(ROS)的生成和细胞凋亡;(3)在病理状态下,SCAD的表达增加可减少血清和主动脉中游离脂肪酸的含量,增加组织中的ATP水平,激活内皮型一氧化氮合酶(eNOS)磷酸化,增加主动脉NO的生成。结论自发性高血压大鼠主动脉SCAD的表达增加能逆转高血压血管重构,可能与其减少血清中游离脂肪酸的含量、增加NO水平、减少活性氧生成、消除氧化应激有关。     

勿动蛋白及其信号通路分子Rho A与Rho相关蛋白激酶在高血压心肌肥厚与纤维化中的作用

目的探讨勿动蛋白(Nogo)/Rho相关蛋白激酶(ROCK)-去甲肾上腺素转运蛋白(NET)信号通路对自发性高血压大鼠心肌肥厚与纤维化的调节作用。方法选择7周龄SPF级同源同系雄性自发性高血压大鼠20只,随机分为4组:对照组、Nogo受体拮抗剂(NEP1-40)组、ROCK抑制剂(法舒地尔)组和NET抑制剂(氟西汀)组,每组5只,饲养7周。分离称量左心室质量,计算左心室质量指数。实时定量PCR检测心肌肥厚标志物心钠肽、脑钠肽、β肌球蛋白重链(β-MHC)基因表达,以及心肌纤维化标志物结缔组织生长因子(CTGF)、心肌胶原组织Ⅰ型(CollagenⅠ)、心肌胶原组织Ⅲ型(CollagenⅢ)和NET基因表达水平。结果与对照组比较,NEP1-40组左心室质量指数、心钠肽、脑钠肽、β-MHC表达明显增高,法舒地尔组左心室质量指数、心钠肽、脑钠肽、β-MHC表达明显降低(P0.05)。与对照组比较,NEP1-40组CTGF、CollagenⅠ、CollagenⅢ表达明显增高,法舒地尔组NET表达明显升高,CTGF、CollagenⅠ、CollagenⅢ和NET表达明显降低(P0.05)。与对照组比较,氟西汀组心钠肽、脑钠肽、β-MHC、CTGF和CollagenⅠ表达明显增高[(1.37±0.05)%vs (1.26±0.03)%,(1.27±0.04)%vs (1.18±0.07)%,(1.26±0.04)%vs (1.22±0.03)%,2.05±0.01 vs 1.44±0.11,1.86±0.06 vs 1.29±0.05,P0.05]。结论Nogo/ROCK-NET信号通路参与自发性高血压大鼠心肌肥厚与纤维化的调节。     

SHR心肌组织内血管紧张素转换酶活性的变化及西拉普利的作用

目的 探讨心肌组织内血管紧张素转换酶活性在自发性高血压大鼠不同发病阶段的变化及其与左室肥厚及心肌纤维化的关系以及西拉普利的作用。方法 用荧光测定法检测自发性高血压大鼠不同发病阶段心肌组织内血管紧张素转换酶的活性;应用大体及组织病理学检查结合图象分析等方法检测自发性高血压大鼠心肌肥厚和心肌纤维化的动态改变。结果 SHR心肌组织内血管紧张素转换酶活性在第6周和第14周时无明显改变,24周则为明显增高,与代表间质纤维化的参数CVF同步变化;代表血管周围时纤维化的参数PVCA则从第6周开始增高,第14和24周持续增加,代表左室肥厚的参数LV、LVI及CA从14周开始增加,24周更为明显;这些变化均与ACE的变化不同步,而与收缩压变化基本同步;西拉普利可使心肌组织内血管紧张素转换酶活性、代表左室肥厚及心肌纤维化的参数恢复至对照组的水平。结论 SHR心肌组织内血管紧张素转换酶活性在高血压的中晚期增高,与代表间质纤维化的参数CVF呈同步变化,提示心肌间质纤维化的发生可能与ACE的增高有关;西拉普利可有效地降低SHR心肌组织内血管紧张素转换酶活性并预防和逆转左室肥厚及心肌纤维化。     

SHR心肌组织内血管紧张素转换酶活性的变化及西拉普利的作用

目的探讨心肌组织内血管紧张素转换酶活性在自发性高血压大鼠不同发病阶段的变化及其与左室肥厚及心肌纤维化的关系以及西拉普利的作用。方法用荧光测定法检测自发性高血压大鼠不同发病阶段心肌组织内血管紧张素转换酶的活性;应用大体及组织病理学检查结合图象分析等方法检测自发性高血压大鼠心肌肥厚和心肌纤维化的动态改变。结果SHR心肌组织内血管紧张素转换酶活性在第6周和第14周时无明显改变,24周则为明显增高,与代表间质纤维化的参数CVF同步变化;代表血管周围时纤维化的参数PVCA则从第6周开始增高,第14和24周持续增加,代表左室肥厚的参数LV、LVI及CA从14周开始增加,24周更为明显;这些变化均与ACE的变化不同步,而与收缩压变化基本同步;西拉普利可使心肌组织内血管紧张素转换酶活性、代表左室肥厚及心肌纤维化的参数恢复至对照组的水平。结论SHR心肌组织内血管紧张素转换酶活性在高血压的中晚期增高,与代表间质纤维化的参数CVF呈同步变化,提示心肌间质纤维化的发生可能与ACE的增高有关;西拉普利可有效地降低SHR心肌组织内血管紧张素转换酶活性并预防和逆转左室肥厚及心肌纤维化。     

大鼠左室肥厚心肌PPARα信号通路失活及其意义

目的 :观察压力超负荷左室肥厚心肌过氧化物酶体增殖剂活化受体α(PPARα)mRNA和蛋白的表达变化 ,探讨PPARα信号通路失活与左室肥厚心肌能量底物转换的关系。方法 :检测大鼠腹主动脉缩窄术后 2周、4周和 8周血流动力学参数、心室重塑指标、血清和心肌游离脂肪酸的含量及PPARαmRNA和蛋白的表达变化。结果 :术后 2周左室已出现肥厚 ,伴有PPARαmRNA表达下调 ;术后 8周PPARα蛋白水平开始下调 :随着肥厚程度的增加 ,血清和心肌游离脂肪酸蓄积增加 ,左室心肌PPARαmRNA和蛋白的表达进行性下调。结论 :病理性肥厚心肌PPARα活性下调与能量底物的利用变化相一致 ,预示PPARα信号通路是病理性心室重塑防治新策略的一个有效靶点     

尼群地平预防自发性高血压大鼠心肌纤维化的实验研究

实验研究观察尼群地平对于自发性高血压大鼠心肌纤维化的作用。结果表明：二氢吡啶类钙拮抗剂尼群地平３０ｍｇ／ｋｇ／ｄ治疗１４周龄自发性高血压大鼠１２周，不但可以有效地降压，逆转左室肥厚，还能预防左、右心室心肌纤维化的发生。该实验心肌纤维化由心肌胶原蛋白浓度及含量来衡量     

ERK表达及活化在自发性高血压大鼠心肌肥厚中作用的研究

目的　以SHR大鼠作为自发性高血压动物模型 ,研究ERK表达及活化在高血压并发左心室肥厚 (LVH)中的作用。方法　SHR大鼠按年龄分为 8周、16周和 2 4周三组 ,以Wistar大鼠作为对照。ERK表达及活性定量测定采用WesternBlot方法。结果　SHR左室质量指数与磷酸化ERK水平正相关。 2 4周龄SHR大鼠基础ERK表达水平较 8周龄和 16周龄减少 ,亦明显低于同龄Wistar大鼠 (P =0 0 0 3) ;SHR大鼠ERK活化程度高于同龄Wistar大鼠 ,随年龄增加 ,SHR磷酸化ERK表达量增加。结论　ERK的活化参与高血压心肌肥厚的发病。     

Apelin-13在自发性高血压大鼠心肌组织的表达及其与心肌肥厚和心功能的关系

目的观察Apelin-13在自发性高血压大鼠(SHR)心肌组织的表达改变,探讨其与心肌肥厚和心功能的关系。方法选取清洁级4周龄和20周龄雄性自发性高血压大鼠和WKY(Wistar-Kyoto)大鼠,按周龄及种属分为4组,每组8只。分别测定无创尾动脉血压及心脏质量指数;超声心动图和血流动力学系统评估心室重构和心功能;HE染色评价心肌细胞及排列情况。Western blot法检测心肌组织Apelin-13、APJ的蛋白表达。结果 1Apelin-13、APJ在SHR心肌组织中呈低表达(P0.05),20周龄SHR较4周龄SHR更明显(P0.05)。2 SHR的收缩压(SBP)、左心室舒张期末压(LVEDP)、心脏质量指数(HW/BW)、心室质量指数(LVW/BW)、舒张期室间隔厚度(IVSD)和左心室舒张期末后壁厚度(LVWPd)明显升高(P0.05),左心室舒张期末内径(LVEDd)、左心室射血分数(EF)、左心室短轴缩短率(FS)和左心室压力最大下降速率(-dp/dtmax)明显降低(P0.05);心肌细胞明显肥大、排列紊乱。20周龄SHR与4周龄SHR相比,上述指标改变更加明显(P0.05)。3心肌组织Apelin-13与IVSD、HW/BW、LVW/BW以及LVEDd、LVEDP呈负相关(P0.05),与EF、FS和-dp/dtmax呈正相关(P0.05)。结论 Apelin-13在SHR心肌组织中呈低表达,其与心肌肥厚指标呈负相关,与心功能呈正相关,提示其可能影响高血压的左心室心肌肥厚和心功能。     

ERK表达及活化在自发性高血压大鼠心肌肥厚中作用的研究

目的以SHR大鼠作为自发性高血压动物模型,研究ERK表达及活化在高血压并发左心室肥厚(LVH)中的作用.方法 SHR大鼠按年龄分为8周、16周和24周三组,以Wistar大鼠作为对照.ERK表达及活性定量测定采用Western Blot方法.结果 SHR左室质量指数与磷酸化ERK水平正相关.24周龄SHR大鼠基础ERK 表达水平较8周龄和16周龄减少,亦明显低于同龄Wistar大鼠(P=0.003);SHR大鼠ERK活化程度高于同龄Wistar大鼠,随年龄增加,SHR磷酸化ERK表达量增加.结论 ERK的活化参与高血压心肌肥厚的发病.     

辛伐他汀对SHR心肌组织SOD、MDA、NOS、NO及心肌间质胶原含量的影响

目的　观察辛伐他汀对自发性高血压大鼠 (SHR)心肌纤维化的影响。方法 2 0只 16周龄雄性SHR大鼠 ,随机分成 2组 :( 1)辛伐他汀组 (n =10辛伐他汀 2mg/kg·d) ;( 2 )SHR空白对照组 (n =10 ) ;( 3)同龄雄性正常血压WKY大鼠对照组 (n =10 )。给药 12周后称量大鼠左室重量并计算大鼠左室重量指数 ;测定心肌组织丙二醛、超氧歧化酶、一氧化氮及一氧化氮合酶 ;用改良VG染色法使胶原特殊染色 ,计算机图像分析测量心肌间质及心肌小动脉周围胶原的胶原容积分数对心肌纤维化程度进行比较。结果辛伐他汀组与SHR组相比心肌超氧歧化酶无明显改变、丙二醛明显减少而心肌一氧化氮及结构型一氧化氮合酶 (cNOS)活性明显升高 ;辛伐他汀组均未能有效降低SHR血压和左心室肥厚 (P <0 0 5 )但能使心室内、外膜及心肌小动脉周围的胶原减少。结论一氧化氮 /活性氧平衡失调可能是导致高血压心肌纤维化的又一个重要因素 ;辛伐他汀抗纤维化作用可能与其抗氧化作用及改善心肌cNOS活性密切相关     

Cardiac perforation with tamponade during cardiac catheterization

Among 6,675 adult patients undergoing cardiac catheterization in our institution, three patients developed cardiac perforation and tamponade (incidence 0.04%). Two perforations involved the left atrium, and one the right atrium. Tamponade developed in the three patients. Hemodynamic confirmation of tamponade was available in two patients. Pericardiocentesis was performed in all three patients. Two patients required emergency surgery. All patients recovered.     

Cardiac Involvement of Adult T Cell Leukemia/Lymphoma

Adult T-cell leukemia/lymphoma (ATL) is a refractory T-cell lymphoma with variable clinical profiles, commonly exhibiting extra-nodal involvement. The myocardial involvement of ATL is often detected at an autopsy; however, the development of a symptomatic cardiac mass due to ATL is extremely rare. We herein report a 65-year-old man with ATL who developed cardiac symptoms due to a rapidly enlarging left ventricular mass soon after the initiation of systemic chemotherapy. We also summarize previously reported cases of symptomatic ATL with cardiac involvement.     

Morphological observations of tumors in cardiac conduction system

Tumors of the cardiac conduction system(CCS) have rarely been reported. The CCS from 198 cardiac-related deaths(Group Ⅰ) ,and 838 deaths from non-cardiovascular diseases or trauma(Group Ⅱ) ,were studied. Sampling was done of the sinoatrial node(SAN) and atrio-ventricular node(AVN) along their long axis of each node as a single block and the His bundle(HB) perpendicular to its long axis in 2-4 blocks. Five-micron serial sections were made;tissue slices were taken intermittently,every 20th from the SAN,every 10th from the AVN,and every 30th from the HB and bundle branches(BB) ,by continuous slices three times. Tumors in the CCS were found in 12 cases(1.155 %) ,where 10(0.965%) were primary tumors,and 2(0.193%) were metastatic tumors. The primary tumors included 4 fibromata compressing the HB(0.386 %) ,4 hemangiomata(0.386%) ,1 AVN tumor(0.097 %) ,and 1 rhabdomyoma(0.097 %) . In 8 of the 10 cases,the tumors were located in the AVN or HB. The metastatic tumors originated from lymphocytic leukemia and malignant lymphoma(histiocytic type) in lung,and were all found in the SAN. Of the 12 cases,2 were from the group Ⅰ. Tumors in the CCS are the smallest tumors in different parts of the body,which can cause sudden death.     

Calcified mass in the right atrium extending into the inferior vena cava with pulmonary artery embolization. Typical or atypical myxoma?

Cardiac masses are divided into neoplastic and non-neoplastic. They usually represent a diagnostic challenge given their relative rarity, their infrequent symptoms, and the overall difficulty with dynamic imaging of the heart. While echocardiography is useful in the initial evaluation of a suspected mass, cardiac magnetic resonance (CMR) imaging is the best imaging modality to characterize cardiac tumors due to its superior tissue characterization and its higher contrast resolution. For neoplastic, primary cardiac tumors are rare (0.05%). Atrial myxoma is the most common cardiac (50%) mass. About 75%-80% of myxoma are seen in the left atrium. Atypical myxoma is a term describing myxoma arising in other nonleft atrial locations. 20%-25% myxomas arise from the right atrium and 5% or less from the ventricles. We present a case of a 59-year-old female patient presenting with severe dyspnea. Her chest noncontrast CT showed a calcified mass lesion in the right atrium extending into the inferior vena cava. She underwent cardiac MRI for better tissue characterization. The cardiac MRI revealed a very irregular, highly spiculated, heavily calcified, heterogeneous, and nonenhancing lesion within the right atrium extending into the inferior vena cava. Via dynamic imaging, no evidence of mobile components was present. Via T1, T2 along with pre- and postcontrast imaging, the mass was confirmed to be calcified without a fibrotic component or evidence of thrombus. The above findings raised the possibility of atypical myxoma.     

Cardiac chloroma or cardiac myeloid sarcoma: Case Report

Chloroma or myeloid sarcoma is rare extramedullary tumor composed of immature myeloid cells that may occur in association with or during or even before the course of adult myelodysplastic or myeloproliferative diseases. It may involve different organs including the orbit, skin, lymph nodes, bone, gastrointestinal tract, breast, central nervous system, and lung. Cardiac involvement with MS is an exceedingly rare finding. We report a very rare case of left ventricular cardiac chloroma accidentally discovered by transthoracic echocardiography (TTE) and confirmed by cardiac magnetic resonance (CMR) in an old aged male patient with acute myeloid leukemia (AML) French‐American‐British (FAB)‐class M5. Unfortunately, shortly after a prompt start of AML palliative chemotherapy protocols, the patient died due to massive intracranial hemorrhage (ICH).     

Mobile cardiac catheterization: Comparison with outpatient and inpatient catheterization at tertiary facilities

The study group included 1,553 consecutive patients from areas serviced by our mobile catheterization laboratories: 719 procedures were performed in the mobile unit at their local hospitals, 277 were performed at a tertiary hospital with less than a 24 hr hospital stay, and 557 were performed at a tertiary hospital as inpatients. The indications for mobile catheterization were predominantly atypical chest pain, angina pectoris, or positive treadmill stress test, whereas patients with less than 24 hr hospitalization at the tertiary center had their catheterization performed for additional reasons. The majority of the inpatient indications were for recent myocardial infarction or unstable angina. Using the American College of Cardiology/American Heart Association (ACC/AHA) criteria for outpatient catheterization, the mobile catheterizations were performed safely with a complication rate of only 0.7% compared to a complication rate of 3.1% for inpatients demonstrating that a low risk group of patients can be prospectively identified and catheterized safely in the mobile setting. An extremely high risk group of patients with ongoing unstable angina and recent myocardial infarction was also identified which should undergo catheterization only at a tertiary center.