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   Table of Contents - Current issue
October-December 2019
Volume 4 | Issue 4
Page Nos. 103-130

Online since Tuesday, December 31, 2019

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Levosimendan attenuates myocardial injury induced by coronary microembolization in swine by inhibiting myocardial inflammation and apoptosis p. 103
Han Chen, Jiang-You Wang
Aims: In addition to its cardiotonic effect, Levosimendan (Levo) has been thought to have multiple cardiovascular benefits, including anti-inflammatory and anti-apoptotic effects. The present study was undertaken to determine whether the Levo pretreatment could attenuate myocardial apoptosis and inflammation and improve cardiac function in a swine model of coronary microembolization (CME). Materials and Methods: A total of 15 swine were randomly and equally divided into a sham-operated (control) group, CME group, and CME plus Levo group. Swine CME was induced by intracoronary injection of inertia plastic microspheres (42 μm diameter) into the left anterior descending (LAD) coronary artery, with or without pretreatment of Levo. Echocardiological measurements, a pathological examination, Terminal-deoxynucleoitidyl Transferase-Mediated dUTP Nick End-Labeling (TUNEL) staining, H and E staining, and Western blotting were performed to assess the functional, morphological, and molecular effects in CME. Results: The expression levels of caspase-3 and tumor necrosis factor-α (TNF-α) were increased in cardiomyocytes following CME. Downregulation of caspase-3 and TNF-α with Levo pretreatment was associated with improved cardiac troponin I (cTnI) and high sensitivity C-reactive protein. In addition, through Pearson correlation analysis, the left ventricular ejection fraction was negatively correlated with caspase-3, TNF-α, and cTnI. Conclusion: This study demonstrated that Levo pretreatment could significantly inhibit CME-induced myocardial apoptosis and inflammation and improve cardiac function. The data generated from this study provide a rationale for the development of myocardial apoptosis and inflammation-based therapeutic strategies for CME-induced myocardial injury.
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Correlation between myocardial myosin-binding protein C, hypertension with left ventricular enlargement, and dilated cardiomyopathy p. 111
Ya-Li Sun, Muhammad Nabeel Dookhun, Xin-Zheng Lu
Background: Dilated cardiomyopathy (DCM) is a relatively common clinical cardiac condition, and its progression will eventually lead to heart failure. Cardiac myosin-binding protein C (cMyBP-c) plays a vital role in the diastolic and contractile function of the heart muscle. At present, most of the relevant researches are focused on the genetic level. Our study discusses the expression of cMyBP-C in patients with DCM and its potential clinical application. Methodology: One hundred and twenty-two subjects were selected from the First Affiliated Hospital of Nanjing Medical University from August 2016 to October 2017. They were divided into two groups according to the left ventricular end-diastolic dimension (LVDd) as measured by echocardiography: normal (n = 34) and left ventricular enlargement (LVE) groups (n = 88). The LVE group was further divided into two subgroups according to the etiology: DCM (n = 57), and LVE due to hypertension (LVEH, n = 31). The left ventricular ejection fraction (EF%) was also defined in each group. Enzyme-linked immunosorbent assay (ELISA) was used for the determination of cMyBP-C in the serum. Results: (1) Serum cMyBP-C concentration was higher in DCM than in LVEH and control groups (P < 0.05) and (2) the LVDd, EF%, creatinine (Cr), urea (Ur), and uric acid (UA) in the DCM group were significantly higher than those in the LVEH group (P < 0.05). Conclusion: The serum level of cMyBP-C is expected to become a new biomarker for the diagnosis of DCM. Cr, Ur, and UA may be factors contributing to the development of DCM.
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Isolation and culture of vascular wall-resident cd34+ stem/progenitor cells p. 116
Yan Wu, Ruo-Nan Zhang, Sen-Zhao, Jun-Ming Tang
Objective: The aim of this study is to observe the maintenance of stem cell properties of purified CD34-positive cells in vessel walls during in vitro expansion. Materials and Methods: Cells that migrated from the adventitial tissues of rat were collected and purified by microbead selection method to obtain CD34+ vascular wall-resident stem (VRS)/progenitor cell (PC). Those purified CD34+ VRS/PCs were evaluated by flow cytometry and immunofluorescent staining. The CD34+ VRS/PCs were continuously cultured until passage P3. Each passaged cell was evaluated by flow cytometry with anti-CD34. Results: After microbead selection, the CD34+ cells reached 88.07% ± 4.36% and these cells expressed neither endothelial (CD31) nor mature smooth muscle cell (smooth muscle-myosin heavy chain and SM22α) markers. Incubation of the purified CD34+ VRS/PCs at a density of 1.5 × 105 cells/100-mm dish, resulted in a gradual reduction of CD34-positive traits when passaged in vitro, starting at P1. Interestingly, the purified primary CD34+ VRS/PCs at a density of 1.0 × 104 cells per 100-mm dish show the traits of colony form growth, and P1 passaged cells were 79.2% ± 2.15% positive for CD34, then gradually lost the traits of CD34-positive cells when passaged in vitro. Conclusions: High purity CD34+ VRS/PCs can be obtained by magnetic bead screening. In vitro, low cell densities contribute to the maintenance of CD34+ VRS/PC traits.
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Efficacy of sodium nitroprusside combined with verapamil in the treatment of no-reflow during coronary interventional therapy p. 121
Chao Gao, Lei Wang, Linghua Li, Peijun Shao, Fengtian Li, Chao Kang, Jianjun Dai
Context: The possible pathophysiological mechanisms of no-reflow are ischemic injury, reperfusion injury, endothelial injury, distal thromboembolism, etc., Moreover, no-reflow can also remarkably increase the risks of acute myocardial infarction, heart failure, malignant arrhythmia, pericardial tamponade, and even death. Aims: The aim was to evaluate the efficacy of sodium nitroprusside combined with verapamil in the treatment of no-reflow. Settings and Design: From December 2016 to December 2017, 100 patients with no-reflow during coronary intervention in our hospital were selected and randomly divided into two groups: treatment group (50 cases) treated by sodium nitroprusside combined with verapamil and control group (50 cases) treated with sodium nitroprusside treatment alone. Subjects and Methods: The blood flow grading of the two groups according to a thrombolysis test in myocardial infarction (TIMI) was compared and analyzed, and the incidence of cardiovascular adverse events was compared in the 6-month period following the operation. Statistical Analysis Used: SPSS 17.0 (IBM, America) was employed in all calculations. Quantitative data were expressed as mean ± standard deviation, and intergroup comparison was calculated using a two-tailed t-test. Qualitative data were presented in percentages, and intergroup comparison was performed with Chi-square test.P < 0.05 was considered statistically significant. Results: The patients with TIMI Grade III blood flow in the treatment group were significantly more than those in the control group after medication, and the difference was statistically significant (P < 0.05). In the following 6-month period after the operation, the incidence of cardiovascular adverse events in the treatment group was 6.00% (3/50), which was lower than that in the control group 18.0% (9/50), with statistically significant difference (P < 0.05). Conclusions: Sodium nitroprusside combined with verapamil can significantly improve the no-reflow following coronary interventional therapy and reduce the incidence of adverse cardiovascular events.
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Surgical retrieval of a left atrial appendage closure device (Watchman TM) following embolization into the mitral valve p. 125
Kevin P Birmingham, Nader Moawad, Ricardo Boix Garibo, David Rose
Percutaneous placement of occluding devices in patients with atrial fibrillation (AF) is now a viable alternative to established treatment methods. A favorable advantage is its minimally invasive technique, although it equally poses a risk. Unstable fixation after deployment, while uncommon, can lead to a catastrophic outcome, including damage to intracardiac structures and embolization to the aorta, causing stroke and possibly death. This can quickly become a surgical emergency that requires urgent intervention in the form of open-heart surgery.
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Spontaneous coronary artery dissection: Two case reports and a brief review p. 128
Yun-Ping Song, Wen-Nan Liu, Yong-Le Li
Spontaneous coronary artery dissection (SCAD) is an unusual, special type of coronary heart disease characterized by various symptoms, such as chest pain, ST-elevation acute coronary syndrome (ACS), ventricular arrhythmia, and sudden cardiac death. Here, we report two different cases who presented with ACS and were found through coronary angiography (CAG) and intravascular ultrasound (IVUS) to have SCAD, but for whom follow-up CAG and IVUS 3 months later showed different outcomes.
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