女性缺血性心脏病的研究现状及展望

心血管系统疾病在女性中的发病率逐年升高,已成为女性死亡的最主要原因,却没有引起足够的重视,由于女性心血管病患者的临床症状及发病机理具有一定特异性,临床诊断与治疗过程往往被延误。因此更好的理解性别差异在诊断心血管疾病中的作用是改善女性冠心病患者预后的第一步。该文对女性心血管病的临床症状、发病机理、临床诊断等方面进行阐述。     

Toll-like receptor 7/8 agonist resiquimod induces late preconditioning in neonatal cardiac myocytes

Aim:

To investigate whether R-848 (resiquimod, toll-like receptor 7/8 agonist) can induce late preconditioning in neonatal cardiac myocytes.

Methods:

The protective effects of R-848 on neonatal myocytes against anoxia-reoxygenation-induced injury were tested, and intracellular reactive oxygen species (ROS) were determined. The protein synthesis inhibitor cyclohexamide (CH) and the ROS scavenger N-acetylcysteine (NAC) were used in this model to test if new protein synthesis and oxidative stress were necessary for their cardioprotective effects. The activation of nuclear factor kappa B (NFκB) and hypoxia inducible factor 1 (HIF1) was investigated by electrophoretic mobility shift assays (EMSA), and inducible nitric oxide synthase (iNOS) was assessed by immunoblotting. After iNOS was down-regulated by small interfering RNA (siRNA) transfection, the cardioprotective effect was reassessed.

Results:

ROS were triggered soon after R-848 (0.01–1.0 μg/L) administration, however, the cardioprotective effect of which was induced 24 h later. This protection was abolished by CH or NAC pretreatment. NFκB and HIF1 activation and iNOS up-regulation were involved in this protective mechanism. The cardioprotective effect was also attenuated after iNOS was knocked down.

Conclusion:

R-848 provided a cardioprotective effect through a late preconditioning mechanism via a ROS/NFκB-HIF1/iNOS-dependent pathway.     

CALCITONIN GENE-RELATED PEPTIDE MEDIATES THE CARDIOPROTECTIVE EFFECTS OF RUTAECARPINE AGAINST ISCHAEMIA–REPERFUSION INJURY IN SPONTANEOUSLY HYPERTENSIVE RATS

• 1 It has been shown that calcitonin gene‐related peptide (CGRP) plays an important role in mediating the cardioprotection exerted by rutaecarpine in normal animals. The aim of the present study was to determine whether rutaecarpine is able to decrease the susceptibility of hypertensive animals to ischaemia–reperfusion injury by stimulating CGRP release.
• 2 Spontaneously hypertensive rats (SHR) were pretreated with rutaecarpine (20 or 40 mg/kg per day, i.g.) for 18 days and then the heart and thoracic aorta were isolated for cardiac function and vascular relaxation analysis. Blood samples and coronary effluent were collected to measure CGRP levels and creatine kinase activity, respectively. The effect of 10 or 30 µmol/L rutaecarpine on CGRP release was also examined in isolated aortic rings set up in a homeothermal organ bath.
• 3 Rutaecarpine treatment resulted in a hypotensive effect in SHR concomitant with increases in plasma CGRP levels. In addition, rutaecarpine significantly stimulated the release of CGRP from aortic rings. Twenty minutes ischaemia and 30 min reperfusion resulted in a marked decrease in myocardial function and a significant increase in the release of creatine kinase in normal control (Wistar‐Kyoto) rats, an effect that was exacerbated in SHR. Similarly, the decreased vasodilator response to acetylcholine (3 ? 10^?9 to 10^?6 mol/L) in isolated aortic rings from Wistar‐Kyoto rats was also aggravated in SHR. Both cardiac function and vasodilator responses were significantly improved in SHR after pretreatment with rutaecarpine.
• 4 The results of the present study suggest that the increased cardiac susceptibility to ischaemia–reperfusion injury in SHR is related to decreased plasma CGRP levels and that antihypertensive therapy with rutaecarpine reverses cardiac susceptibility to reperfusion injury by stimulating CGRP release.

     

Role of endothelium in ischaemia‐induced myocardial dysfunction of isolated working hearts: cardioprotection by activation of adenosine A2A receptors

1 This study aimed to determine the role of the vascular endothelium on recovery of contractile function following global low‐flow ischaemia of guinea‐pig isolated working hearts and the effects of adenosine analogues on this recovery. 2 Guinea‐pig isolated spontaneously beating or paced working hearts were set up and coronary flow (CF), aortic output (AO) (as an index of cardiac function), heart rate (HR), left ventricular pressure (LVP) and dP/dt max recorded. The endothelium was either intact or removed by a blast of oxygen. 3 In spontaneously beating hearts, low‐flow ischaemia for 30 min reduced CF and cardiac contractility (LVP, dP/dt max) but not AO. On reperfusion, CF, LVP and dP/dt max recovered, while AO fell precipitously followed by a gradual recovery, indicative of myocardial stunning. The effects of ischaemia did not differ between endothelium‐intact and ‐denuded hearts, indicating no role of the endothelium in the changes observed. 4 The adenosine analogues, N⁶‐cyclopentyladenosine (CPA, A₁ selective), 5'‐N‐ethylcarboxamidoadenosine (NECA, two‐fold A₂ selective over A₁) and 2‐p‐((carboxyethyl)‐phenethylamino)‐5'carboxamidoadenosine (CGS21680, A_2A selective) were infused (3 × 10^?7 M ) from 10 min into the 30‐min low‐flow ischaemia of denuded hearts and during reperfusion. 5 CGS21680 increased CF and improved the postischaemic functional recovery, as measured by the AO. NECA and CPA were not cardioprotective. The A_2A selective antagonist, ZM241385, attenuated the coronary vasodilatation by CGS21680 and abolished the improved recovery of AO on reperfusion. 6 Reperfusion of paced working hearts caused a dramatic fall in AO which failed to recover. Infusion of CGS21680 from 15 min into the ischaemic period produced vasodilatation but failed to restore AO, presumably because the ischaemic damage was irreversible. 7 Thus, the endothelium plays no role in myocardial dysfunction following low‐flow global ischaemia and reperfusion of guinea‐pig working hearts. The A_2A adenosine receptor‐selective agonist but not the non‐selective A₂ receptor agonist, NECA, attenuated ischaemia‐ and reperfusion‐induced stunning. This was attributed to increased CF and was independent of the endothelium.     

新型NO供体SP/W-5186在兔心肌缺血/再灌注损伤中的作用和机制

目的：研究一种结构中含有半胱氨酸的新型一氧化氮供体ＳＰ／Ｗ＝－５１８６,在新西兰兔缺血／再灌注心肌损伤中的作用和机制。方法：兔缺血４５ｍｉｎ继之再灌注１８０ｍｉｎ。再灌注前５ｍｉｎ,通过静脉单剂量给予低剂量（０．３μｍｏｌ／ｋｇ）或高剂量（１μｍｏｌ／ｋｇ）的ＳＰ／Ｗ０５１８６。结果：给予０．３μｊｏｌ／ｋｇＷＰ／Ｗ０－５１８６对平均动脉压、心率等心功能指标没有影响,可显著地降低血小板聚集,减少白     

The role of nicorandil in the treatment of myocardial ischaemia

Nicorandil is an anti-anginal agent that has been used in the United Kingdom for over 6 years and is becoming increasingly popular. It induces coronary and peripheral vasodilatation via a dualistic mode of action, mediated by the opening of potassium-ATP channels (K_ATP) and its nitrate effect by stimulation of adenyl cyclase, with an increase in cGMP levels. Comparison to nitrates and other anti-anginal agents have shown it to be of equal efficacy in relieving ischaemic symptoms. Recent evidence suggests a role for nicorandil as a myocardial preconditioning agent but this may be limited by systemic vasodilatation. There is ongoing research into its role in improving the long-term outcome of patients with ischaemic heart disease (IHD). It has been shown to be of proven efficacy in the treatment of IHD and further research will clarify other uses of this agent.     

Quantity and Quality Relationships in Cardiovascular Medicine

Hospital volume and often also operator volume have documented impacts on the quality of care for aortic and aortocoronary bypass surgery, for percutaneous angioplasty and for radiofrequency ablation for arrhythmias, whereas data are less consistent for treatment of acute myocardial infarction. A review of this research is given. In the Nordic countries hospitals are small, and often the plateau of the learning curve cannot be reached. To discourage low-volume centers from embarking upon too complicated interventional or surgical procedures, the author suggests that a minimal number should be set for certain major procedures, both for hospitals and for physicians.     

葡萄多酚对心肌保护作用研究进展

心血管疾病是目前威胁人类健康的世界头号杀手。近年来,葡萄中多酚类物质在心肌保护作用的研究取得了重要进展。就葡萄中的主要多酚类成分白藜芦醇、花青素、原花青素在心肌保护方面的研究进展进行综述,并讨论这些研究成果在临床上的潜在应用以及仍需进行的动物实验研究。