Coronary artery anomalies: the left main coronary artery or left anterior descending coronary artery originating from the proximal of right coronary artery

Coronary artery anomalies （CAAs） are present at birth, but are usually asymptomatic and are found during coronary angiography or multi-slice computed tomography （MSCT） examinations. Their prevalence is less than 1.3% based published series.1＇2 The most common coronary anomaly is separate origin of the left anterior descending coronary artery （LAD） and left circumflex coronary artery （LCX） from the left sinus of the Valsalva. The second most common anomaly is the origin of the LCX artery from the right coronary artery （RCA） or right sinus of the Valsalva. We present two cases of coronary artery anomalies： one is the left main coronary artery （LMCA） arising from the proximal RCA, the other is the LAD originating from the proximal RCA.     

Soluble CD40 ligand is associated with angiographic severity of coronary artery disease in patients with acute coronary syndrome

Background Recently,studies have disclosed soluble CD40 ligand （sCD40L） during atherosclerosis development and plaque destabilization.The objective of the present study was to test the hypothesis that sCD40L levels are higher in acute coronary syndrome （ACS） patients with a greater extent of angiographic coronary involvement.Methods This cross-sectional study examined ACS patients who underwent coronary angiography by measuring their sCD40L levels.In order to estimate the serum levels of sCD40L,10 ml of peripheral venous blood was drawn within 24 hours of admission.sCD40L levels were measured using an enzyme-linked immunosorbent assay （ELISA,RapidBio,West Hills,CA,USA）.Demographic data,presence of concomitant diseases,ACS characteristics,and angiographic findings were evaluated.A review of medical records and patient interviews were conducted to assess coronary risk factors.And the severity of coronary artery disease was evaluated using the Gensini score index.Results Two hundred and eighty-nine patients were included in the study,of whom 186 were male,with an average age of 64.1±10.0 years.Median sCD40L levels were 1.7 ng/ml （0.3-7.3 ng/ml） and Gensini scores were 50 （0-228）.After adjusting for demographic variables and cardiovascular risk factors,the Gensini score was associated with the natural logarithm of the sCD40L level （Coefficient b=0.002,95％ CI 0.000-0.003,P=0.029）.Conclusion sCD40L levels were independently associated with angiographic severity of coronary artery disease in patients with ACS.     

Influence of preoperative coronary collateral circulation on in-hospital mortality in patients undergoing coronary artery bypass graft surgery with intra-aortic balloon pump support

Background Outcomes in patients requiring coronary artery bypass graft （CABG） surgery have been improved with devices such as the intra-aortic balloon pump （IABP）.Good coronary collateral circulation （CCC） has been shown to reduce mortality in patients with coronary artery disease （CAD）.We aimed to investigate whether poor preoperative CCC grade is a predictor of in-hospital mortality in CABG surgery requiring IABP support.Methods Fifty-five consecutive patients who were undergoing isolated first time on-pump CABG surgery with IABP support were enrolled into this study and CCC of those patients was evaluated.Results Twenty-seven patients had poor CCC and 28 patients had good CCC.In-hospital mortality rate in poor CCC group was significantly higher than good CCC group （14 （50％） vs.4 （13％）,P=0.013）.Preoperative hemoglobin level （OR：0.752; 95％ CI,0.571-0.991,P=0.043）,chronic obstructive pulmonary disease （OR：6.731; 95％ CI,1.159-39.085,P=0.034） and poor CCC grade （OR：5.750; 95％ CI,1.575-20.986,P=0.008） were associated with post-CABG in-hospital mortality.Poor CCC grade （OR：4.853; 95％ CI,1.124-20.952,P=0.034） and preoperative hemoglobin level （OR：0.624; 95％ CI,0.476-0.954,P=0.026） were independent predictors of in-hospital mortality after CABG.Conclusion Preoperative poor CCC and hemoglobin are predictors of in-hospital mortality after CABG with IABP support.     

Correlation between low tube voltage in dual source CT coronary artery imaging with image quality and radiation dose

The influence of low tube voltage in dual source CT（DSCT） coronary artery imaging on image quality and radiation dose and its application value in clinical practice were investigated. Totally, 300 cases of chest pain with low body mass index（BMI 〈18.5 kg/m2） subjected to DSCT coronary artery imaging were prospectively enrolled. The heart rate in all patients were greater than 65/min. The retrospective ECG gated scanning mode and simple random sampling method were used to assign the patients into groups A, B and C（n=100 each）. The patients in groups A, B and C experienced 120-, 100-, and 80-kV tube voltage imaging respectively, and the image quality was evaluated. The CT volume dose index（CTDIvol） and dose length product（DLP） were recorded, and the effective dose（ED） was calculated in each group. The image quality scores and radiation doses in groups were compared, and the influence of tube voltage on image quality and radiation dose was analyzed. The results showed that the excellent rate of image quality in groups A, B and C was 95.69%, 94.72% and 96.33% respectively with the difference being not statistically significant among the three groups（P〉0.05）. The CTDIvol values in groups A, B and C were 51.35±12.21, 21.28±7.13 and 6.34±3.34 mGy, respectively, with the difference being statistically significant（P〈0.05）. The ED values in groups A, B and C were 9.27±1.63, 4.56±2.29 and 2.29±1.69 mSv, respectively, with the difference being statistically significant（P〈0.05）. It was suggested that for the patients with low BMI, the application of DSCT coronary artery imaging with low tube voltage can obtain satisfactory image quality, and simultaneously, significantly reduce the radiation dose.     

Confluence at distal end of multiple coronary artery fistulae: two cases treated with interventional approach

Coronary artery fistula （CAF）, an uncommon congenital heart disease, often results in myocardial ischemia. In the last two decades, there are some reports about interventional treatment of CAF,4-6 but few on transcatheter treatment of multiple CAFs. With different interventional procedures, we treated successfully two cases of percutaneous closure of two multiple CAFs which were confluent at the distal ends.     

Coronary anomaly: the single coronary artery

Single coronary artery （SCA）, defined as an artery that arises from the arterial trunk and nourishes the entire myocardium, is rare. We report two cases of SCA, one is the fight coronary artery （RCA） originating from the middle of left descending artery （LAD）, and the other is the left main coronary artery （LMCA） arising from the proximal fight coronary artery.     

Retrieval of dislodged coronary stent from left renal artery by gooseneck snare

A rapamycin-eluting stent was dislodged during attempt of implantation at the proximal right coronary artery,which was found by fluoroscopy to have migrated into the anterior trunk of the left renal artery.We chose a 5 mm diameter Amplatz gooseneck snare and successfully retrieved the lost stent from the lodging vessel.     

Ten years patency of left internal mammary artery trunk dissection graft after coronary artery bypass procedure

The left internal mammary artery （LIMA） had become the conduit of choice for myocardial revascularization, since it has been rates of LIMA grafts are proved that 10 ears patency more than 90%. The arterial graft trunk dissection is a rare event, affecting the procedure effects and related to reoperation.3 According to Kim and coworker＇s study,4 the arterial graft trunk delayed dissection manifested by early post-operative angiography only occurred in 6 of 1111 of the off-pump coronary artery bypass grafts. So up to now, the consequence of dissections without severe hemodynamic abnormality is beyond our knowledge.     

Interventional therapy of coronary artery disease in China：retrospective and perspective

Coronary artery disease is the most common cardiovascular disease and constitutes the major cause of death in China. The interventional treatment of coronary artery disease has developed rapidly during the last decade, with the number of percutaneous coronary intervention （PCI） procedures being around 147 300 in the year of 2007. The number is expected to be elevated greatly in the coming years because of great improvement in national health care system and interventional expertise This article reviews the current status of coronary intervention in China.     

Prevalence of depression in coronary heart disease in China: a systematic review and meta-analysis

Background Coronary heart diseases （CHD） have been identified as one of topmost diseases affecting the Chinese population.However,depression in CHD has not been reported and there are limited high quality empirical studies in China focused on the prevalence of the comorbidity.This study aimed to estimate the pooled prevalence of depression with CHD in China.Methods Systematic review and meta-analysis of published epidemiologic studies on the depression in CHD patients in China were conducted.The research findings dated before 30 September 2013 were obtained from Ovid Medline,EMBASE and two Chinese electronic publication libraries WANFANG and CNKI.We used ＂cardiovascular disease＂,＂depression＂ and ＂China＂ as the search themes in Ovid Medline and EMBASE and ＂cardiovascular disease＂ and ＂depression＂ in WANFANG and CNKI.Random-effects meta-analysis was used to estimate the prevalence of depression in CHD patients.Results Twenty-seven studies were included in the review.Twenty-three studies had 5 236 participants who were hospitalized and four studies had 1 353 participants from community.The overall prevalence of depression in CHD from hospital was 51% （95% CI：0.43,0.58; Ⅰ-squared=97%,P=-0.000）.The prevalence of depression in CHD from community ranged between 34.6% to 45.8%,and the severe depression was found ranging between 3.1% to 11.2%.Conclusions On comparing data with other countries,the prevalence of depression in CHD among admitted patients in China was found to be high.The physicians and healthcare providers should pay more attention to the ＂physical-mental＂ health of the CHD patients.     

Evaluation of triple anti-platelet therapy by modified throm- belastography in patients with acute coronary syndrome

Most cases of acute coronary syndrome （ACS） involve coronary atherosclerosis and plaque rupture, as well as subsequent thrombosis. The initial thrombotic events leading to red thrombus formation are platelet adherence and aggregation. Platelets play a very important role during the establishment and progression of a thrombosis in a coronary artery. Therefore, in recent years guidelines have been developed in an effort to strengthen antiplatelet therapy in ACS, but unfortunately the methods to evaluate platelet activity and the strength of platelet inhibition are lacking.     

Transcatheter coil embolization of multiple coronary artery-to- left ventricle fistulas: report of a rare case

Coronary artery fistula （CAF） is uncommon but remains the most frequent hemodynamically significant congenital coronary artery anomaly.The majority of fistula is single and drains into the right heart, only 3.5% into the left ventricle.^2 A large fistula requires closure to prevent complications such as myocardial ischemia resulting from coronary steal, congestive heart failure, endocarditis and potential aneurysmal dilatation and rupture.^3-5 Here we presented a rare case of CAF with multiple origins involving left anterior descending artery （LAD）, left circumflex branch （LCX） and right coronary artery （RCA）, and draining into the left ventricle, which was successfully closed by coil embolization.     

Detection of congenital uterine malformation by using transvaginal three-dimensional ultrasound

This study assessed the clinical application of transvaginal three-dimensional ultrasound （3D TVUS） in the diagnosis of congenital uterine malformation. A retrospective study was performed on 62 patients with congenital uterine malformation confirmed hysteroscopically and/or laparoscopically. The patients were subjected to transvaginal two-dimensional ultrasound （2D TVUS） and 3D TVUS. The accuracy rate was compared between the two methods. The accuracy rate of 3D TVUS was （98.38%, 61/62）, higher than that of 2D TVUS （80.65%, 50/62）. 3D TVUS coronal plane imaging could demon- strate the internal shape of the endometrial cavity and the external contour of the uterine fundus. It al- lowed accurate measurement on the coronary plane, and could three-dimensionally show the image of cervical tube, thereby providing information for the diagnosis of some complex uterine malformation. 3D TVUS imaging can obtain comprehensive information of the uterus malformation, and it is superior to 2D TVUS for the diagnosis of congenital uterine malformations, especially complex uterine anomaly.     

Spontaneous coronary dissection associated with myocardial bridge causing acute myocardial infarction

Spontaneous coronary artery dissection （SCAD） is a rare cause of myocardial ischemia, myocardial infarction and sudden-cardiac death.This disease mainly occurs in young women with oral contraceptive or during the peripartum period, without risk factors for coronary artery disease. Although SCAD results in a hemorrhagic separation of the intima and the media, and creates a false lumen, leading to distal myocardial ischemia, infarction and sudden death, the causes and the optimal management for this challenging condition are still controversial.     

Association of N-terminal pro-brain natriuretic peptide with the severity of coronary artery disease in patients with normal left ventricular ejection fraction

Backround N-terminal pro-brain natriuretic peptide （NT-proBNP） is a reliable predictor in acute coronary artery disease （CAD）. Little is known about patients with stable CAD, especially Chinese patients with CAD. The aim of the present study was to investigate the association of NT-proBNP levels with the severity of CAD in patients with normal left ventricular ejection fraction. Methods A total of 658 consecutive patients were divided into two groups based on angiograms： CAD group （n=484） and angiographic normal control group （n=174）. The severity of CAD was evaluated by modified Gensini score, and its relationship with NT-proBNP was analyzed. Results The prevalence of risk factors such as age, male gender, diabetes mellitus （DM）, dyslipidemia, smoking, and family history of CAD in the CAD group were higher than that in the control group. In multivariate regression model analysis, age, gender, and DM were determinants of the presence of CAD. NT-pro BNP was found to be an independent predictor for CAD （OR：1.66 （95% CI： 1.06-2.61）, P 〈0.05）. In a receiver operating characteristic （ROC）curve analysis, an NT-proBNP value of 641.15 pmol/L was identified as a cut-off value in the diagnosis or exclusion of CAD （area under curve （AUC）=0.56, 95% CI： 0.51-0.61）. Furthermore, NT-proBNP was positively correlated with Gensini score （r=0.14, P 〈0.001） in patients with CAD. Conclusion NT-proBNP was an independent predictor for Chinese patients with CAD, suggesting that the NT-proBNP level might be associated with the presence and the severity of CAD.     

冠心病中医诊疗思考

冠心病是一个危害人类健康的主要的、非传感性疾病。根据WHO的统计,冠心病是世界上最常见的死亡原因,被称为“第一杀手”,2004年全世界死于新老心血管病为1530万人,占总死亡人数的1／4,其中冠心病死亡占1,2以上。目前研究表明：本病最常在男性40～60岁之间表现症状,女性发病多在绝经期前后。其发病男性多于女性。WHO的MONICA47个协作中心35-46岁年龄组急性冠心病事件标准化发病率的资料显示,我国男性发病率仅高于日本,居第46位;女性发病率仅高于日本和西班牙,居第45位。本文就冠心病近年研究的主要进展及中医对策的思考作一概述。     

Sequential saphenous vein grafting combined with selective arterialization of middle cardiac vein during off-pump coronary artery bypass surgery

Currently coronary artery bypass grafting （CABG） is the most commonly used procedure for revascularization of coronary heart disease. However it may not be suitable for the patients with diffuse coronary artery diseases. Under this circumstance, retrograde perfusion via cardiac venous system, namely retrograde coronary venous bypass graft （CVBG）,     

Platelet-Leukocyte Interaction and Thrombosis

Cerebrocardiac thrombotic disease such as acute myocardial infarction and acute ischemic stroke cause significant morbidity and mortality. Present therapies for these diseases besides anttcoagulation and fibrinolysis mainly aim toward limiting platelet adhesion and aggregation processes. However, their incomplete effectiveness suggests that other mechanisms may be important. Although the underlying cellular and molecular mechanisms of pathogenesis are complex, an early event in vessel injury is the adhesion of platelets and leukocytes to the damaged arterial wall. Recent studies havedemonstrated that the patients with acute coronary syndrome and ischemic stroke have not only increased interaction between platelets（ homotypic aggregates） but also increased interaction between platelets and leukocytes（heterotypic aggregates） detectable in circulating blood, and that the heterotypic aggregation contribute significantly to these disease progression.     

ONTARGET系列研究带来对阻断RAS治疗策略的进一步思考

1同一个研究，不同的解释 继HOPE研究之后，2008年3月发表的ONTARGET研究（Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial）再次证明了血管紧张素转换酶抑制剂（angiotensin converting enzyme inhibitors，ACEI）雷米普利是抗动脉粥样硬化的标准对照药。进一步丰富了ACEI的临床试验证据。     

Inflammatory response, drug-eluting stent and restenosis

Cardiovascular diseases are the major cause of mortality in the Western world and it is expected that this will rem-ain so during the foreseeable future. 1 Among them, coronary artery disease （CAD） is the most important underlying cause of death due to cardiovascular disease.^2 Current treatment of pattents with CAD includes mainly risk factor management, drug therapy and revascularization techniques.