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Quantitative and qualitative assessment of non-obstructive left main coronary artery plaques using 64.multislice computed tomography compared with intravascular ultrasound

第十三次全国心血管病学术会议

作者： ma jian-ying,qian ju-ying,SUN Ai-jun,ge jun-bo Department of Cardiology,zhongshan Hospital,fudan university,shanghai institute of cardiovascular Medicine, shanghai 20003.,china

Objective The purpose of this study was to investigate the role of serum cathepsin S,matrix metalloproteinase-2,matrix metalloproteinase-9 and high sensitive C-reactive protein at different plaque *** 84.patients were enrolled in our study,including 12 patients with acute myocardial infarction,29 patients with unstable angina,55 patients with stable angina *** ultrasound was performed before coronary *** were divided into three

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Chinese Medical Journal 2010年第7期123卷 827-833页

作者： SHEN Yi qian ju-ying WANG Ming-hui LIU Yuan LIU Xue-bo ge Lei ma jian-ying ge jun-bo Department of Internal Medicine Zhongshan Hospital Fudan University Shanghai Institute of Cardiovascular Diseases Shanghai 200032 China Department of Cardiology Zhongshan Hospital Fudan University Shanghai Institute of Cardiovascular Diseases Shanghai 200032 China Department of Cardiology Zhongshan Hospital Fudan University Shanghai Institute of Cardiovascular Diseases Shanghai 200032 China

Background There are few reports of quantitative and qualitative measuring of left main coronary artery （LMCA） plaques by multislice computed tomography coronary angiography （MSCTA）, especially when compared with intravascular ultrasound （IVUS） as reference standard. The aim of this study was to evaluate the use of 64.MSCTA in the diagnosis of LMCA disease, and the accuracy of MSCTA in the quantitative and qualitative assessment of the LMCA lesion as compared with *** A total of 91 patients （53 men, 38 women, mean age （64.78±9.19） years） were examined by 64.MSCTA and IVUS. Compared with the IVUS, the sensitivity, specificity, positive and negative predictive values （PPV and NPV） of the MSCTA on the diagnosis of LMCA diseases were calculated. Also, kappa index （K） for the agreement between MSCTA and IVUS was calculated. Minimal lumen area （MLA）, external elastic membrane cross-sectional area （EEM-CSA） and plaque burden were measured by two blinded and independent operators on MSCTA cross-sectional reconstruction and compared with the parameters measured from IVUS by manually tracing. The CT value of soft, fibrous and calcific plaques was measured using IVUS classification of the *** The sensitivity, specificity, PPV and NPV of MSCTA for detecting LMCA plaques were 93.1%, 84.2%, 95.7%, 76.2%, respectively. Kappa index （K=0.74., P〈0.001） indicated excellent agreement between MSCTA and IVUS. The Pearson index between MLA on IVUS and MLA on MSCTA was 0.815 （P 〈0.01）. The Pearson index of plaque burden and EEM-CSA between IVUS and MSCTA was 0.736 and 0.74. respectively （both P 〈0.01）. The CT value of soft plaque, fibrous plaque and calcific plaque compared with IVUS were （52.52±15.71） HU, （108.32±4..4.） HU and （604.16±377.67） HU （P〈0.001）. Receiver operating characteristic curve analysis of CT value of non-calcific plaques for predicting soft plaques showed the cutpoint was 54.35 HU, with a sensitivity of 83.3% and specificity of 94.4.. Conclusions Si

关键词： multislice computed tomography intravascular ultrasound left main coronary artery

Retrograde approach for the recanalization of coronary chronic total occlusion： collateral selection and collateral related complication

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Chinese Medical Journal 2013年第6期126卷 1086-1091页

作者： ma jian-ying qian ju-ying ge Lei FAN Bing WANG Qi-bing YAN Yan ZHANG Feng YAO Kang HUANG Dong ge {4.-bo Department of Cardiology Zhongshan Hospital Fudan University shanghai institute of cardiovascular diseases Shanghai 200032 China

Background The retrograde approach through collaterals has been applied in the treatment of chronic total occlusion （CTO） lesions during percutaneous recanalization of coronary arteries. This study was to investigate the success rate of recanalization and collateral related complications in patients when using the retrograde approach. Methods Eighty-four cases subjected to retrograde approach identified from july 2005 to july 2012 were included in this study. Patient characteristics, procedural outcomes and in-hospital clinical events were evaluated. Results Mean age of the patient was （59.6＋11.2） years old and 91.7% were men. The target CTO lesions were distributed among the left anterior descending artery in 4. cases （53.5%）, left circumflex artery in one case （1.2%）, right coronary artery in 34.cases （4..5%）, and left {4.in in four cases （4.8%）. The overall success rate of recanalization was 79.8%. The septal collateral was three times more frequently used for retrograde access than the epicardial collateral, 68/84.（81%） vs. 16/84.（19%）. Successful wire passage through the collateral channel was achieved in 58 （72.6%） patients. The success rate of recanalization was 93.1% （54.58） in patients with and 50% （13/26） in patients without successful retrograde wire passage of the collateral channel （P 〈0.01）. Successful retrograde wire passage through the collaterals was achieved in 4. of 68 septal collaterals （72.1%） and in 9 of 16 epicardial collaterals （56.3%）（P=NS）. There was no significant difference between the septal collateral group and the epicardial group in the success rate of recanalization after retrograde wire crossing the collaterals （91.8% vs. 100%, P 〉0.05）. CART or reverse CART technique was used in 15 patients, and 14.patients （93.3%） were recanalized successfully. Collateral related perforation occurred in three （18.8%） cases with the epicardial collateral as the first choice （compared with the septal collateral group （0）, P 〈0.01 ）. There were 17 （2

关键词： chronic total occlusion retrograde collateral complication percutaneous coronary intervention

Prevalence and characteristics of myocardial bridging in coronary angiogram data from consecutive 5525 patients

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Chinese Medical Journal 2009年第6期122卷 632-635页

作者： qian ju-ying ZHANG Feng DONG Min ma jian-ying ge Lei LIU Xue-bo FAN Bing WANG Qi-bing CUI Shan-jing ge jun-bo Department of Cardiology Zhongshan Hospital Fudan University Shanghai Institute of Cardiovascular Diseases Shanghai 200032 China

Background Large discrepancy of the incidence of myocardial bridging （MB） has been reported either among the postmortem studies or among the studies with coronary angiogram. This study was to investigate the prevalence of MB in large number of coronary angiograms and the angiographic characteristics of MB.Methods A total of 5525 consecutive patients who underwent first diagnostic coronary angiography from January 2003 to march 2006 in zhongshan Hospital were enrolled in this study. MB was diagnosed when the angiographical ＂milking effect＂, defined as the systolic compression and complete or partly release of the compression in diastole, was seen in the epicardial coronary arteries. Angiography was routinely repeated after intracoronary injection of 200 pg nitroglycerin. The systolic compression and length of MB were compared before and after the administration of nitroglycerin and also before and after stent implantation in patients with significant stenosis in segment proximal to the MB.Results Among 5525 patients, MBs were found in a total of 888 patients angiographically with the prevalence of 16.1%. Atherosclerotic lesions were found more often in the segment proximal to the MB with 34./854.（4..3%） patients than in the segment distal to the MB with 4./854.（5.5%）（P 〈0.01）. The systolic compression （（4..3±13.7）% at baseline vs （54.2±14.0）% after nitroglycerine） and the average length （（20.9±7.5） mm at baseline vs （22.7±8.0） mm after nitroglycerine） of the MB segment were increased after intracoronary injection of nitroglycerin （both P 〈0.01）. Stent implantation was performed in 88 patients with significant stenosis in the segment proximal to the MB. The systolic compression and the length of the MB segment were increased after stenting compared with those before stenting （systolic compression, （4..4.14.6）% at baseline vs （57.3±12.3）% after stenting, and length of MB, （19.5±6.1） mm at baseline vs （21.8±6.3） mm after stenting, P 〈0.01）.Conclusions MB was a fr

关键词： myocardial bridging coronary angiography prevalence nitroglycerine stent

Exenatide Reduces Tumor Necrosis Factor-α-induced Apoptosis in Cardiomyocytes by Alleviating Mitochondrial Dysfunction

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Chinese Medical Journal 2015年第23期128卷 3211-3218页

作者： Yuan-Yuan Cao Zhang-Wei Chen Yan-Hua Gao Xing-Xu Wang jian-ying ma Shu-Fu Chang ju-ying qian jun-bo ge Department of Cardiology Shanghai Institute of Cardiovascular Diseases Zhongshan Hospital Fudan University Shanghai 200032 China

Background： Tumor necrosis factor-α （TNF-α） plays an important role in progressive contractile dysfunction in several cardiac diseases. The cytotoxic effects of TNF-α are suggested to be partly mediated by reactive oxygen species （ROS）- and mitochondria-dependent apoptosis. Glucagon-like peptide- 1 （GLP-1） or its analogue exhibits protective effects on the cardiovascular system. The objective of the study was to assess the effects ofexenatide, a GLP- 1 analogue, on oxidative stress, and apoptosis in TNF-α-treated cardiomyocytes in vitro. Methods： Isolated neonatal rat cardiomyocytes were divided into three groups： Control group, with cells cultured in nor{4.l conditions without intervention; TNF-α group, with cells incubated with TNF-α （4. ng/ml） for 6, 12, or 24.h without pretreatment with exenatide; and exenatide group, with cells pretreated with exenatide （100 nmol/L） 30 mins before TNF-α （4. ng/ml） stimulation. We evaluated apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling （TUNEL） assay and flow cytometry, measured ROS production and mitochondrial membrane potential （MMP） by specific the fluorescent probes, and assessed the levels of proteins by Western blotting for all the groups. Results： Exenatide pretreatment significantly reduced cardiomyocyte apoptosis as measured by flow cytometry and TUNEL assay at 12 h and 24.h. Also, exenatide inhibited excessive ROS production and {4.intained MMP. Furthermore, declined cytochrome-c release and cleaved caspase-3 expression and increased bcl-2 expression with concomitantly decreased Bax activation were observed in exenatide-pretreated cultures. Conclusion： These results suggested that exenatide exerts a protective effect on cardiomyocytes, preventing TNF-α-induced apoptosis; the anti-apoptotic effects {4.y be associated with protection ofmitochondrial function.

关键词： Cell Apoptosis: Glucagon-like Peptide-1 Mitochondrial Function Oxidative Stress Tumor Necrosis Factor-α

Safety and efficacy of cobalt chromium alloy based sirolimus-eluting stent with bioabsorbable polymer in porcine model

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Chinese Medical Journal 2012年第6期125卷 983-989页

作者： WU Yi-zhe SHEN Li WANG Qi-bing HU Xi XIE jian qian ju-ying ge jun-{4. Department of Cardiology Shanghai Institute of Cardiovascular Diseases Zhongshan Hospital Fudan University Shanghai 200032 China Shandong Huaan Biotechnology Co. Ltd. Laiwu Shandong 271113 China

Background First generation drug-eluting stents （DESs） were based on 316L stainless steel and coated with a permanent polymer. The vessel wall of these DESs was inflammatory and late in-stent thrombosis was reported. Hence, cobalt chromium based DES coated with a bioabsorbable polymer was an alternate choice. Methods Cobalt chromium based DES with bioabsorbable polymer （Simrex stent） as well as control stents （Polymer stent and EXCELTM stent） were implanted into porcine arteries. At a designated time, angiography, quantitative coronary angiography （QCA） analysis, histomorphometry, and electron-microscopical follow-up were performed. Results A total of 98 stents of all the three groups were harvested. At week 24. percent diameter stenosis （%DS）, late loss （LL）, and percent area stenosis （%AS） of Simrex was （12.9±0.4.%, （0.35±0.02） mm, and （24.5±4.2）%, respectively, without significant difference in comparison to commercialized EXCELTM stent. Slight inflammatory reaction was seen around the stent strut of Simrex, just as in the other two groups. Electron-microscopical follow-up suggested that it might take 4.12 weeks for Simrex to complete its re-endothelialization process. Conclusions Cobalt chromium based, bioabsorbable polymer coated sirolimus-eluting stent showed excellent biocompatibility. During 24.weeks observation in porcine model, it was proved that this novel DES system successfully inhibited neointima hyperplasia and decreased in-stent stenosis. It is feasible to launch a clinical evaluation to improve the current prognosis of DES implantation.

关键词： coronary artery disease drug-eluting stent bioabsorbable polymer cobalt chromium alloy in-stent restenosis

Establishment of a Novel Mouse Model of Coronary Microembolization

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Chinese Medical Journal 2016年第24期129卷 2951-2957页

作者： Yuan-Yuan Cao Zhang-Wei Chen jian-Guo Jia Ao Chen You Zhou Yong Ye Yan-Hua Gao Yan Xia Shu-Fu Chang jian-ying ma {4.-ying qian jun-bo ge Department of Cardiology The Second Xiangya Hospital Central South University Changsha Hunan 410011 China Department of Cardiology Shanghai Institute of Cardiovascular Diseases Zhongshan Hospital Fudan University Shanghai 200032 China

Background： Coronary microembolization （CME） has been frequently seen in acute coronary syndromes and percutaneous coronary intervention. Small animal models are required for further studies of CME related to severe prognosis. This study aimed to explore a new mouse model of CME. Methods： The mouse model of CME was established by injecting polystyrene microspheres into the left ventricular chamber during 15-s occlusion of the ascending aorta. Based on the average diameter and dosage used, 30 C57BL/6 male mice were randomly divided into five groups （n = 6 in each）： 9 μm/500,000, 9 μm/800,000, 17 μm/200,000, 17 μm/500,000, and sham groups. The postoperative survival and performance of the mice were recorded. The mice were sacrificed 3 or 10 days after the surgery. The heart tissues were harvested for hematoxylin and eosin staining and masson trichrome staining to compare the extent of inflammatory cellular infiltration and fibrin deposition among groups and for scanning transmission electron microscopic examinations to see the ultrastructural changes after CME. Results： Survival analysis demonstrated that the cumulative survival rate of the 17 μm/500,000 group was significantly lower than that of the sham group （0/6 vs. 6/6, P = 0.001）. The cumulative survival rate of the 17 μm/200,000 group was lower than those of the sham and 9 μm groups with no statistical difference （cumulative survival rate of the 17 μm/200,000, 9 μm/800,000, 9 μm/500,000, and sham groups was 4.6, 5/6, 6/6, and 6/6, respectively）. The pathological alterations were similar between the 9 μm/500,000 and 9 μm/800,000 groups. The extent of inflammatory cellular infiltration and fibrin deposition was more severe in the 17 μm/200,000 group than in the 9 μm/500,000 and 9 μm/800,000 groups 3 and 10 days after the surgery. Scanning transmission electron microscopic examinations revealed platelet aggregation and adhesion, microthrombi formation, and changes in cardiomyocytes. Conclusion： The injection of 50

关键词： Animal Model Embolization Mice Microspheres

Impact of pathogen burden on in-stent restenosis in patients after coronary stent implantation

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Chinese Medical Journal 2005年第21期118卷 1786-1790页

作者： NIU Yu-hong ge jun-bo XU Cong-feng SHI jian-hui JIN Xue-{4.an qian ju-ying ZOU Yun-zeng shanghai institute of cardiovascular diseases Zhongshan HospitalFudan University Shanghai 200032 China

Background Although some certain infectious pathogens could be detected in the patients with coronary artery disease, the roles of these infectious factors in the development of coronary artery diseases remain largely unknown. Since the number of infectious pathogens has been argued to be relative to the coronary artery diseases, we therefore examined whether there is a link between the number of infections and the incidence of in- stent restenosis after stent implantation. Methods One hundred and eighty-one patients were enrolled in this study. Infectious pathogens including serum anti-Chlymydia p neumoniae, cytomegalovirus, Helico pylori, human herpes simplex virus-1, human herpes simplex virus-2 antibodies and hepatitis B virus antigen were measured in all patients before coronary stent implantation. Coronary angiography was performed before, immediately after and 6 months after stent implantation. Results Restenosis rate 6 months post stent implantation was similar in patients with low pathogen burden （〈3 pathagens, 33.3% ） to those with high pathogen burden （ ≥3 pathogens, 29. 1% ）. Conclusions Previous infections with Chlymydia pneumoniae, cytomegalovirus, Helico pylori, human herpes simplex virus-l, human herpes simplex virus-2 and hepatitis B virus do not contribute to the incidence of restenosis after stent implantation.

关键词： restenosis infection burden stent implantation

Retrograde approach for the recanalization of coronary chronic total occlusion： preliminary experience of a single center

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Chinese Medical Journal 2010年第7期123卷 857-863页

作者： ge Lei qian ju-ying LIU Xue-bo QIN Qing CUI Shan-jing YAO Kang SHEN Li ma jian-ying HUANG Dong XU Shi-kun ZHANG Feng WANG Xiang-fei WANG Qi-bing FAN Bing YAN Yan FENG Qi WANG Hao SHEN An ZHU Ming-hui ge jun-bo Department of Cardiology Zhongshan Hospital Fudan UniversityShanghai Institute of Cardiovascular Diseases Shanghai 200032China

Background The success rate of antegrade approach for chronic total occlusions （CTO） recanalization has not dramatically increased, especially in complex CTO subset. The retrograde technique may hold great promise. This report aimed to describe our experience of retrograde recanalization for CTO, focusing on its safety and feasibility. Methods We identified 4. patients who underwent revascularization in CTO with retrograde approach from july 2005 to November 2009 in our *** Three kinds of strategy were applied： retrograde as primary strategy （50.0%）, retrograde immediately after antegrade failure （26.2%） and repeat procedure after previous antegrade failure （23.8%）. Septal collaterals were more frequently used as the retrograde access route （92.9%）. Overall success rate was 88.1%. In patients with successful retrograde wire crossing collateral channel to the distal cap of CTO, the success rate of recanalization was 94.1%. In patient with failure to cross the collaterals, the success rate was 62.5%. Eight different kinds of retrograde techniques were used： kissing wire technique （35.3%）, wire trapped and reverse wire trapped technique （17.6%）, back-end balloon and microcatherer reversal technique （14.7%）, controlled antegrade and retrograde subintimal tracking （CART） technique （8.8%）, reverse CART and modified reverse CART technique （8.8%）, retrograde wire crossing technique （2.9%）. There were 4.complications occurred without in-hospital major adverse cardiac events （maCE）. In-hospital maCE was 7.7%. All of them were non-Q wave myocardial infarction. There were no cases of death or target vessel revascularization, either surgery or *** The retrograde approach can be an effective tool for increasing the success rate of recanalization in the very complex CTO. To ensure the success and safety of the approach, careful case selection and device handling by experienced operators is essential.

关键词： chronic total occlusions retrograde collaterals percutaneous coronary intervention