1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mo...1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mortality. Clinical decision-making in modem medicine is increasingly dependent on cardiovascular imaging techniques. 2012 ACCF/AHA/ACP/AATS/ PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease has been issued by American Heart Association （AHA）. European Society of Cardiology （ESC） has issued 2013 ESC guidelines on the management of stable coronary artery disease.展开更多
The study was to investigate the role of pinhole single photon emission computed tomography (SPECT), the human pulmonary adenocarcinoma bone-seeking metastasis cell line SPC-A-1BM was used.These cells form typical ost...The study was to investigate the role of pinhole single photon emission computed tomography (SPECT), the human pulmonary adenocarcinoma bone-seeking metastasis cell line SPC-A-1BM was used.These cells form typical osteolytic bone metastases when inoculated into the arterial circulation of NIH-Beige-Nude-XD (BNX) mice via the left ventricle.In order to evaluate the irradiation impact of ^(99m)Tc-MDP versus X-ray on cells growth,we used six groups of SPC-A-1BM cells in our imaging scheme and irradiated by various doses of ^(99m)Tc-MDP (37,74,111, 370,740 MBq) and X-ray(40 kV,2 mA,6 s) respectively.The cell's number of each group was well recorded in different exposure time(4,8,12,24,48,72,96 hours).After that,SPC-A-1BM cells(1×106) were inoculated into the mice via left ventricle.We compared the results obtained with those different doses of ^(99m)Tc-MDP using pinhole SPECT and conventional X-ray skeletal surveys.The data show that the cell-survival number of 111 MBq group has insignificant difference with that of X-ray and the dose is adequate to have an ideal image.Besides,it is important that the chromosome of the cells in the group of 111 MBq showed no irradiation-related damages in our test.These results implied that ^(99m)Tc-MDP pinhole SPECT may provide another way other than conventional X-ray skeletal surveys in detecting bone metastasis of pulmonary adenocarcinoma in BNX mice.展开更多
Objective To investigate the safety and efficacy of a self-developed novel multi-electrode radiofrequency ablation catheter （Spark） for catheter-based renal denervation （RDN）. Methods A total of 14 experimental mi...Objective To investigate the safety and efficacy of a self-developed novel multi-electrode radiofrequency ablation catheter （Spark） for catheter-based renal denervation （RDN）. Methods A total of 14 experimental miniature pigs were randomly divided into four groups （55°＆ 5-watt, 55°＆ 8-watt, 65°＆ 5-watt, and 65° ＆ 8-watt groups）. Spark was used for left and right renal artery radiofrequency ablation. Blood samples collected from renal arteries and veins as well as renal arteriography were performed on all animals before, immediately after, and three months after procedure to evaluate the effects of Spark on the levels of plasma renin, aldosterone, angiotensin I, and angiotensin II as well as the pathological changes of renal arteries. Results One pig died of an anesthetic accident, 13 pigs successfully underwent the bilateral renal artery ablation. Compared with basic measurements, pigs in all the four groups had significantly decreased mean arterial pres- sure after procedure. Histopathological analysis showed that this procedure could result in intimal hyperplasia, significant peripheral sympa- thetic nerve damage in the renal arteries such as inflammatory cell infiltration and fibrosis in perineurium, uneven distribution of nerve fibers, tissue necrosis, severe vacuolization, fTagmented and unclear nucleoli myelin degeneration, sparse axons, and interruption of continuity. In addition, the renal artery radiofrequency ablation could significantly reduce the levels of plasma renin, aldosterone, angiotensin I, and angio- tensin II in pigs. Conclusions The results suggest that this type of multi-electrode catheter-based radiofrequency ablation could effectively remove peripheral renal sympathetic nerves and reduce the activity of systemic renin-angiotensin system in pigs, thus facilitating the control of systemic blood pressure in pigs.展开更多
Objective To explore the effectiveness of renal denervation (RDN) on blood pressure with the appropriate dosage of phenol/ethanol solution in spontaneously hypertensive rats (SHRs). Methods RDN was performed on the bi...Objective To explore the effectiveness of renal denervation (RDN) on blood pressure with the appropriate dosage of phenol/ethanol solution in spontaneously hypertensive rats (SHRs). Methods RDN was performed on the bilateral renal artery. Forty SHRs were divided into four groups according on the dosage of phenol (10% phenol in absolute ethanol): sham group, 0.5 mL phenol group, 1 mL phenol group and 1.5 mL phenol group (n = 10 in each group). Blood pressure was measured by tail-cuff plethysmography. Plasma creatinine was determined four weeks after the treatment. The kidneys and renal arteries were collected and processed for histological examination. Results A sustained decrease in systolic blood pressure (SBP) was only observed after the application of 1 mL phenol for four weeks, while SBP was lowered during the first week after RDN and increased in the following three weeks in the 0.5 mL and 1.5 mL phenol groups compared with the sham group. Renal norepinephrine (NE) was significantly decreased four weeks after RDN in the 1 mL and 1.5 mL phenol group compared with the sham group, but not in the 0.5 ml group. RDN with 1 mL phenol obviously reduced glomerular fibrosis. Histopathological analysis showed that tyrosine hydroxylase immunoreactivity was lower in the 1 mL and 1.5 mL phenol groups compared with the sham group. Moderate renal artery damage occurred in the 1.5 mL phenol group. Conclusion Chemical denervation with 1 ml phenol (10% phenol in absolute ethanol) effectively and safely damaged peripheral renal sympathetic nerves and contributed to the sustained reduction of blood pressure in SHRs.展开更多
Atrial fibrillation(AF)is the most preval-ent arrhythmia in the aging population,with people over 75 years accounting for 70%of the AF population.[1]Over the past twe-nty years,despite tremendous progress has been mad...Atrial fibrillation(AF)is the most preval-ent arrhythmia in the aging population,with people over 75 years accounting for 70%of the AF population.[1]Over the past twe-nty years,despite tremendous progress has been made in catheter ablation for rhythm control of AF,we still cannot establish a reliable ablative target for non-paroxysmal AF.Part of the reason is an incomplete understanding of the mechanism underlying the pro-gressive nature of AF.In the time chain of AF,AF bur-den increases,and the success rate of catheter abla-tion decreases as AF progresses from paroxysmal AF(PAF)to persistent AF(PerAF)and long-stand-ing persistent AF(LS-PerAF)form.Recently,with the advance in mapping technologies combined with biophysical insight,a new concept of AF mainten-ance has been introduced--the rotor(spiral waves).Meanwhile,the concept of complete electrical left atr-ial(LA)isolation has been introduced for AF with ext-ensive atrial fibrosis.These innovative ideas en-riched our armamentarium to combat different AF subtypes.This article proposes a rotor hypothesis to illustrate the mechanism underlying AF progress and discuss the application of new strategies in dif-ferent AF subtypes.展开更多
Background Evaluation of acute myocardial infarction after reperfusion by dual phase contrast-enhancement multislice computed tomography(MSCT)was implicated in porcine model.There have been few attempts to use this di...Background Evaluation of acute myocardial infarction after reperfusion by dual phase contrast-enhancement multislice computed tomography(MSCT)was implicated in porcine model.There have been few attempts to use this diagnostic modality for the early assessment of coronary reperfusion in patients with ST-elevation myocardial infarction(STEMI),especially after primary percutaneous coronary intervention(PCI).In elderly patients with STEMI,the safety issues remain unknown.Methods Dual phase contrast-enhancement MSCT examinations were performed in 11 elderly patients(≥60 years old)with STEMI within one week after primary PCI.The presence,location and enhancement pattern on MSCT were evaluated.MSCT findings were compared with the catheter angiographic results and area under the curve of creatine kinase(CK)release.Serum creatinine level was recorded before and after MSCT scan.Results MSCT scans were successfully performed in all the patients.Early myocardial perfusion defect(early defect,ED)was detected in all of the 11 patients(100%)in the early phase of the contrast bolus(subendocardial ED in 10 patients and transmural in 1 patient).Mean CT attenuation value of ED was significantly different from CT attenuation value of remote myocardium(46±17 HU vs 104±17 HU;P<0.01).Location of ED area correlated well with infarction related artery territory on catheter angiography in all of the 11 patients(100%).On delayed phase of MSCT scan,different enhancement patterns were observed:isolated subendocardial late enhancement(LE)in 6 patients,subendocardial residual perfusion defect(RD)and subepicardial LE in 1 patient,subendocardial RD in 4 patients.Infarct volume assessed by MSCT correlated well with area under the curve CK release(R=0.72,P<0.01).Serum creatinine level after MSCT scan showed no difference with that before MSCT scan.Conclusion Dual phase MSCT could be safely implicated in elderly patients with STEMI.Variable abnormal myocardial enhancement patterns were seen on dual phase MSCT in these patients with STEMI after primary PCI.Assessment of myocardial attenuation on MSCT gives additional information of the location and extent of infarction after reperfusion.展开更多
Sinus bradycardia is a common clinical problem with a population prevalence of approximately 4/1000.[1]Most patients are asymptomatic,but some patients experience symptoms such as fatigue,dizziness,exercise intoleranc...Sinus bradycardia is a common clinical problem with a population prevalence of approximately 4/1000.[1]Most patients are asymptomatic,but some patients experience symptoms such as fatigue,dizziness,exercise intolerance,syncope,or pre-syncope,worsening of angina symptoms,worsening of heart failure,or cognitive slowing.Although both European and American guidelines recommend cardiac pacing for patients with severe symptoms of sinus bradycardia,there are problems such as infection,electrode detachment,perforation,and pacemaker replacement.展开更多
Objective To evaluate the utility of multi-slice computed tomography (MSCT) in assessing acute non-reperfused myocardial infarct size. Methods Seven domestic pigs (mean weight 17.3 ± 1.9 kg) underwent ligation of...Objective To evaluate the utility of multi-slice computed tomography (MSCT) in assessing acute non-reperfused myocardial infarct size. Methods Seven domestic pigs (mean weight 17.3 ± 1.9 kg) underwent ligation of the distal left anterior descending artery to establish a model of acute myocardial infarction (MI). MSCT and triphenyltetrazolium chloride (TTC) staining were performed two hours later. The following data were acquired and analyzed:MI volume (%), CT values of the infarcted region, left ventricular cavity and normal cardiac tissue at various scanning time-points (1, 5, 10, 15, 20 min after contrast injection). Results Using MSCT, the overall MI volume showed a time-dependent decrease, with a reduction of 28.87%after 20 min. The greatest reduction occurred at the 5 min time-point. In TTC staining, MI volume was 9.87%± 2.44%. When MI size, as determined by MSCT, was compared with that by TTC staining in Bland-Altman plots, there was a better agreement at 5, 10, and 15 min time-points at 1 and 20 min. Conclusions The study indicates that double-phase scanning examination using MSCT is a useful tool to assess MI size, and the optimal late-phase scanning time-point set within 5-15 min of contrast injection.展开更多
文摘1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mortality. Clinical decision-making in modem medicine is increasingly dependent on cardiovascular imaging techniques. 2012 ACCF/AHA/ACP/AATS/ PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease has been issued by American Heart Association （AHA）. European Society of Cardiology （ESC） has issued 2013 ESC guidelines on the management of stable coronary artery disease.
基金Supported by the Key Project for Basicl Research in Shanghai Science and Technology Commission,China (Grant No.071409011)
文摘The study was to investigate the role of pinhole single photon emission computed tomography (SPECT), the human pulmonary adenocarcinoma bone-seeking metastasis cell line SPC-A-1BM was used.These cells form typical osteolytic bone metastases when inoculated into the arterial circulation of NIH-Beige-Nude-XD (BNX) mice via the left ventricle.In order to evaluate the irradiation impact of ^(99m)Tc-MDP versus X-ray on cells growth,we used six groups of SPC-A-1BM cells in our imaging scheme and irradiated by various doses of ^(99m)Tc-MDP (37,74,111, 370,740 MBq) and X-ray(40 kV,2 mA,6 s) respectively.The cell's number of each group was well recorded in different exposure time(4,8,12,24,48,72,96 hours).After that,SPC-A-1BM cells(1×106) were inoculated into the mice via left ventricle.We compared the results obtained with those different doses of ^(99m)Tc-MDP using pinhole SPECT and conventional X-ray skeletal surveys.The data show that the cell-survival number of 111 MBq group has insignificant difference with that of X-ray and the dose is adequate to have an ideal image.Besides,it is important that the chromosome of the cells in the group of 111 MBq showed no irradiation-related damages in our test.These results implied that ^(99m)Tc-MDP pinhole SPECT may provide another way other than conventional X-ray skeletal surveys in detecting bone metastasis of pulmonary adenocarcinoma in BNX mice.
文摘Objective To investigate the safety and efficacy of a self-developed novel multi-electrode radiofrequency ablation catheter （Spark） for catheter-based renal denervation （RDN）. Methods A total of 14 experimental miniature pigs were randomly divided into four groups （55°＆ 5-watt, 55°＆ 8-watt, 65°＆ 5-watt, and 65° ＆ 8-watt groups）. Spark was used for left and right renal artery radiofrequency ablation. Blood samples collected from renal arteries and veins as well as renal arteriography were performed on all animals before, immediately after, and three months after procedure to evaluate the effects of Spark on the levels of plasma renin, aldosterone, angiotensin I, and angiotensin II as well as the pathological changes of renal arteries. Results One pig died of an anesthetic accident, 13 pigs successfully underwent the bilateral renal artery ablation. Compared with basic measurements, pigs in all the four groups had significantly decreased mean arterial pres- sure after procedure. Histopathological analysis showed that this procedure could result in intimal hyperplasia, significant peripheral sympa- thetic nerve damage in the renal arteries such as inflammatory cell infiltration and fibrosis in perineurium, uneven distribution of nerve fibers, tissue necrosis, severe vacuolization, fTagmented and unclear nucleoli myelin degeneration, sparse axons, and interruption of continuity. In addition, the renal artery radiofrequency ablation could significantly reduce the levels of plasma renin, aldosterone, angiotensin I, and angio- tensin II in pigs. Conclusions The results suggest that this type of multi-electrode catheter-based radiofrequency ablation could effectively remove peripheral renal sympathetic nerves and reduce the activity of systemic renin-angiotensin system in pigs, thus facilitating the control of systemic blood pressure in pigs.
基金the National Natural Science Foundation of China (81370361)Science and Technology Commission of Shanghai Municipality (12140902800)Scientific and Technical Project of Shanghai Chest Hospital (2014YZDH20300).
文摘Objective To explore the effectiveness of renal denervation (RDN) on blood pressure with the appropriate dosage of phenol/ethanol solution in spontaneously hypertensive rats (SHRs). Methods RDN was performed on the bilateral renal artery. Forty SHRs were divided into four groups according on the dosage of phenol (10% phenol in absolute ethanol): sham group, 0.5 mL phenol group, 1 mL phenol group and 1.5 mL phenol group (n = 10 in each group). Blood pressure was measured by tail-cuff plethysmography. Plasma creatinine was determined four weeks after the treatment. The kidneys and renal arteries were collected and processed for histological examination. Results A sustained decrease in systolic blood pressure (SBP) was only observed after the application of 1 mL phenol for four weeks, while SBP was lowered during the first week after RDN and increased in the following three weeks in the 0.5 mL and 1.5 mL phenol groups compared with the sham group. Renal norepinephrine (NE) was significantly decreased four weeks after RDN in the 1 mL and 1.5 mL phenol group compared with the sham group, but not in the 0.5 ml group. RDN with 1 mL phenol obviously reduced glomerular fibrosis. Histopathological analysis showed that tyrosine hydroxylase immunoreactivity was lower in the 1 mL and 1.5 mL phenol groups compared with the sham group. Moderate renal artery damage occurred in the 1.5 mL phenol group. Conclusion Chemical denervation with 1 ml phenol (10% phenol in absolute ethanol) effectively and safely damaged peripheral renal sympathetic nerves and contributed to the sustained reduction of blood pressure in SHRs.
文摘Atrial fibrillation(AF)is the most preval-ent arrhythmia in the aging population,with people over 75 years accounting for 70%of the AF population.[1]Over the past twe-nty years,despite tremendous progress has been made in catheter ablation for rhythm control of AF,we still cannot establish a reliable ablative target for non-paroxysmal AF.Part of the reason is an incomplete understanding of the mechanism underlying the pro-gressive nature of AF.In the time chain of AF,AF bur-den increases,and the success rate of catheter abla-tion decreases as AF progresses from paroxysmal AF(PAF)to persistent AF(PerAF)and long-stand-ing persistent AF(LS-PerAF)form.Recently,with the advance in mapping technologies combined with biophysical insight,a new concept of AF mainten-ance has been introduced--the rotor(spiral waves).Meanwhile,the concept of complete electrical left atr-ial(LA)isolation has been introduced for AF with ext-ensive atrial fibrosis.These innovative ideas en-riched our armamentarium to combat different AF subtypes.This article proposes a rotor hypothesis to illustrate the mechanism underlying AF progress and discuss the application of new strategies in dif-ferent AF subtypes.
文摘Background Evaluation of acute myocardial infarction after reperfusion by dual phase contrast-enhancement multislice computed tomography(MSCT)was implicated in porcine model.There have been few attempts to use this diagnostic modality for the early assessment of coronary reperfusion in patients with ST-elevation myocardial infarction(STEMI),especially after primary percutaneous coronary intervention(PCI).In elderly patients with STEMI,the safety issues remain unknown.Methods Dual phase contrast-enhancement MSCT examinations were performed in 11 elderly patients(≥60 years old)with STEMI within one week after primary PCI.The presence,location and enhancement pattern on MSCT were evaluated.MSCT findings were compared with the catheter angiographic results and area under the curve of creatine kinase(CK)release.Serum creatinine level was recorded before and after MSCT scan.Results MSCT scans were successfully performed in all the patients.Early myocardial perfusion defect(early defect,ED)was detected in all of the 11 patients(100%)in the early phase of the contrast bolus(subendocardial ED in 10 patients and transmural in 1 patient).Mean CT attenuation value of ED was significantly different from CT attenuation value of remote myocardium(46±17 HU vs 104±17 HU;P<0.01).Location of ED area correlated well with infarction related artery territory on catheter angiography in all of the 11 patients(100%).On delayed phase of MSCT scan,different enhancement patterns were observed:isolated subendocardial late enhancement(LE)in 6 patients,subendocardial residual perfusion defect(RD)and subepicardial LE in 1 patient,subendocardial RD in 4 patients.Infarct volume assessed by MSCT correlated well with area under the curve CK release(R=0.72,P<0.01).Serum creatinine level after MSCT scan showed no difference with that before MSCT scan.Conclusion Dual phase MSCT could be safely implicated in elderly patients with STEMI.Variable abnormal myocardial enhancement patterns were seen on dual phase MSCT in these patients with STEMI after primary PCI.Assessment of myocardial attenuation on MSCT gives additional information of the location and extent of infarction after reperfusion.
文摘Sinus bradycardia is a common clinical problem with a population prevalence of approximately 4/1000.[1]Most patients are asymptomatic,but some patients experience symptoms such as fatigue,dizziness,exercise intolerance,syncope,or pre-syncope,worsening of angina symptoms,worsening of heart failure,or cognitive slowing.Although both European and American guidelines recommend cardiac pacing for patients with severe symptoms of sinus bradycardia,there are problems such as infection,electrode detachment,perforation,and pacemaker replacement.
文摘Objective To evaluate the utility of multi-slice computed tomography (MSCT) in assessing acute non-reperfused myocardial infarct size. Methods Seven domestic pigs (mean weight 17.3 ± 1.9 kg) underwent ligation of the distal left anterior descending artery to establish a model of acute myocardial infarction (MI). MSCT and triphenyltetrazolium chloride (TTC) staining were performed two hours later. The following data were acquired and analyzed:MI volume (%), CT values of the infarcted region, left ventricular cavity and normal cardiac tissue at various scanning time-points (1, 5, 10, 15, 20 min after contrast injection). Results Using MSCT, the overall MI volume showed a time-dependent decrease, with a reduction of 28.87%after 20 min. The greatest reduction occurred at the 5 min time-point. In TTC staining, MI volume was 9.87%± 2.44%. When MI size, as determined by MSCT, was compared with that by TTC staining in Bland-Altman plots, there was a better agreement at 5, 10, and 15 min time-points at 1 and 20 min. Conclusions The study indicates that double-phase scanning examination using MSCT is a useful tool to assess MI size, and the optimal late-phase scanning time-point set within 5-15 min of contrast injection.
