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Abstract:Coronary heart disease (CHD) in the elderly is featured with systemic atherosclerosis background, multiple cardiovascular risk factors, several chronic diseases and(or) multiple organ dysfunctions, atypical symptoms and diffuse and extensive lesions. Attention should be paid to the control of the relative risk factors and physical exercise and diet intervention. As for treatment of stable CHD, optical medical therapy(OMT) is strongly recommended according to COURAGE research, including anti-platelet therapy, lipid regulation, and anti-hypertensive and anti-anginal agents, not underestimating the effect of beta receptor blockers and resin angiotensin system inhibitors; and the therapeutic efficiency of percutaneous coronary intervention (PCI) is not inferior to that of coronary artery bypass grafting (CABG). For treatment of non-ST-segment elevation acute coronary syndromes (NSTE-ACS), anti-platelet and anti-thrombotic therapy is firstly recommended; drugs, including prasugrel, GP Ⅱb/Ⅲa receptor inhibitors, fondaparinux sodium, bivalirudin, and rivaroxaban, should be selected rationally, considering their different effects on reducing major adverse cardiac events (MACE) and hemorrhage risk; PCI at early stage exerts superior effect on high-risk patients. As for treatment of ST-segment elevation acute myocardial infarction (AMI), PCI is the first choice, except for the patients with definite contraindications; thrombolytic therapy is quite efficient for the patient without contraindication, but special caution should be paid for intracranial hemorrhage, a devastating complication. Currently, correlation of gene polymorphism with CHD in the elderly and new diagnosis and monitoring technology are now drawing attention.

Abstract:Objective To explore the clinical characteristics and coronary angiographic findings in elderly coronary heart disease (CHD) patients with type 2 diabetes mellitus (T2DM) Methods A total of 471 patients (age≥60 years) with angiographically diagnosed CHD were divided into 2 groups: 179 CHD patients with T2DM and 292 CHD patients without T2DM. The data of the clinical features and selective coronary angiographics were compared between the two groups. Results Multivariate unconditional logistic regression analysis showed that low density lipoprotein cholesterol (LDL-C), fasting blood glucose(FBG) and 2h post blood glucose (2hPBG) were independently correlated with CHD patients with T2DM (P≤0.001). Compared to CHD patients without T2DM, CHD patients with T2DM suffered much more from triple vessels lesions (P＜0.010), severe coronary artery stenosis, complete occlusions and diffuse lesions (all P＜0.01), and their Gensini scores were higher (P＝0.009). Conclusions The risk factors of LDL-C, FBG and 2hPBG are independently correlated with CHD patients with T2DM. Diffuse and severe lesions are more common in elderly CHD patients with T2DM.

Abstract:Objective To evaluate the efficiency of covered stent implantation on the elderly patients with coronary perforation occurred in percutaneous coronary intervention (PCI). Methods From June 2004 to June 2011, 8 cases having coronary perforation during PCI received covered stents implantation. They were followed up for 1 year for the occurrence of major adverse cardiac events (MACE). Results There were 4 males and 4 females with an age ranging from 65 to 76 years [mean (70.4±4.1) years]. Average diameter of implanted covered stents was (3.2±0.3)mm, and average length was (21.0±3.4)mm. In all patients, perforation was successfully closed, while no patient died in the procedure. One patient with acute anterior myocardial wall infarction died of multiple organ failure due to lung infection at day 19 after PCI. No patient had angina pectoris during 1 year follow-up. Both of mortality and MACE rate were 12.5% (1/8) in 1 year after PCI. Conclusion Treatment of covered stent in elderly patients with coronary perforation can achieve good efficacy.

Abstract:Objective To investigate the changes of multi-noninvasive indices, including endothelial function, arterial flexibility, carotid indima-media thickness (IMT), oxidative stress and inflammation in elderly patients with coronary artery disease. Methods Sixty-two male coronary artery disease patients (≥65 years old) with coronary artery stenosis ≥50% identified by coronary arteriography in our department from January 2008 to December 2011 were subjected in this study. They were divided into 2 groups according to the result of coronary angiography, that is, multiple vessel lesion group (n＝29) and single vessel lesion group (n＝33). Another 33 age-matched elderly male patients receiving coronary arteriography at the same period served as control. Before coronary arteriography, brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and carotid artery intima-media thickness (IMT) were measured, and serum level of nitric oxide (NO), endothelin-1 (ET-1), malondialdehyde (MDA) and high sensitive-C reactive protein (hs-CRP) were detected in all subjects. Results Significant differences were observed among the 3 groups in the levels of NO and ET-1, and baPWV, ABI and IMT (P＜0.05), but no difference was seen in the level of MDA and hs-CRP (P＞0.05). Moreover, carotid artery IMT became higher and higher with the increase of the number of diseased vessels. Logistic regression analysis showed that baPWV, smoking and diabetes mellitus were important factors for multiple vessel lesion in coronary artery disease (P＜0.05). Conclusion Among these multi-noninvasive indices, impaired endothelial dysfunction, the changes of the arterial flexibility as well as carotid artery IMT have close relation with the occurrence and development of coronary artery disease in elderly male patients. baPWV and carotid artery IMT may be predictors for the severity of coronary artery disease for the elderly.

Abstract:Objective To investigate the secondary prevention and risk factor control in the patients with coronary artery diseases in order to analyze the differences between real world practice and evidence-based guidelines. Methods The patients with coronary angiography-diagnosed coronary heart disease hospitalized in our department during May 2010 to February 2011 were enrolled in this study. Their smoking condition, blood pressure, blood glucose, blood lipids and other risk factors during hospitalization and follow-up, and their medical treatment within 6 months after discharge were studied and analyzed. Results There were totally 128 patients being followed up. At discharge, the percentage of using aspirin, clopidogrel, beta blocker, ACEI/ARB and statins in their prescription was 91.41%, 97.66%, 67.19%, 65.63% and 97.66% respectively, and at the follow-up, the percentage changed to 87.50%, 83.59%, 57.03%, 57.81% and 85.16% respectively. The rate of smoking was decreased from 31.25% in hospitalization to 6.25% at follow-up, while the rate of normal blood pressure was increased from 54.69% in hospitalization to 75.78% at follow-up. The rate of the patients complicated with diabetes mellitus was 17.19% at discharge, and then increased to 27.27% at follow-up. During follow-up, there were 78.91%, 69.53% and 70.31% of the total patients who had normal levels of TC, TG and LDL-C. Conclusion Most patients comply to the medical treatment of secondary prevention during follow-up. And most risk factors are under well control. Prompt and effective measures should be taken to enhance medical education for secondary prevention to minimize the gap between clinical practice and evidence-based guidelines.

Abstract:Objective To compare the differences in clinical manifestation and treatment measures in very old patients and elderly patients with acute myocardial infarction (AMI). Methods Clinical data of 354 identified AMI patients who were admited in our hospital from June 2008 to June 2012 were subjected in this study. They were divided into 2 groups, that is, very old group [age ranging from 75 to 91years, mean (79.5±3.4)years, n＝46] and elderly group [age ranging from 36 to 74years, mean (61.8±8.4)years, n＝308]. Their clinical symptoms, risk factors and management strategies were retrospectively analyzed, and compared between the 2 groups. Results There were more patients having dyspnea, fatigue and other heart failure symptoms as the first symptoms at AMI onset in very old group than in elderly group (39.1% vs 16.6%，P＜0.01). More women (56.5% vs 29.2%, P＜0.05) and more non-ST-segment elevation myocardial infarction (45.7% vs 28.2%, P＜0.01) was found in very old group (P＜0.01). In very old group, there were more patients with hypertension (60.9% vs 47.1%, P＜0.05) and with diabetes mellitus (34.8% vs 15.6%, P＜0.05), but less patients with dyslipidemia (32.6% vs 52.3%, P＜0.05) and cigarette smoking (34.8% vs 63.6%, P＜0.05) when compared with those from elderly group. Time from symptom onset to hospital admission was significantly longer in very old group (P＜0.05). Both coronary angiography (78.2% vs 95.8%, P＜0.05) and reperfusion procedures (71.8% vs 94.8%, P＜0.05) were less applied to the very old patients (P＜0.05). Worsening renal function was more frequently in very old patients(6.5% vs 0.3%, P＜0.05). Conclusion There are more atypical clinical presentation and less reperfusion therapy in very old patients with acute myocardial infarction.

Abstract:Objective To explore the relationship of the ratio of contrast medium volume to estimated glomerular filtration rate (eGFR) in percutaneous coronary intervention (PCI) and/or coronary angiography (CAG) with the incidence of contrast-induced nephropathy (CIN), so as to elucidate the predictive value of the ratio for CIN. Methods A total of 202 consecutive consenting patients with coronary heart disease who were given PCI and/or CAG for twice in an interval of (457.31±246.96) d in our department during July 2008 to June 2011 were enrolled. Their medical history, color Doppler echocardiogram, renal function and blood routine examination results at the first and second time of PCI and/or CAG were collected. The ratio of contrast medium volume to eGFR (V/eGFR) at the two performance was calculated, and its correlation with CIN was analyzed. Receiver operating characteristic (ROC) curve was plotted to determine the predictive value of the ratio. Results The CIN incidence of the cohort during the first time receiving PCI and/or CAG was 9.9% (20/202), while that during the second time was 17.33% (35/202), with significant difference between the two performance (P＜0.05). Multiple linear regression analysis showed that V/eGFR was the most significant predictive factor of CIN. For the patients who receiving PCI and/or CAG for the first time, the ratio of V/eGFR≥2.895 (OR＝1.986, 95% CI＝1.466–2.691, P＜0.001) was the independent predictor of CIN. In the second time, the ratio ≥2.230 (OR＝4.685, 95% CI＝2.783–7.885, P＜0.001) was the independent predictor. Conclusion For the patients having CIN in the first time receiving PCI and/or CAG, they are prone to CIN in the second time, suggesting that the ratio of V/eGFR might be a good predictive index of CIN.

Abstract:Objective To observe the effectiveness and safety of low-molecular-weight heparin in treatment of elderly patients with acute coronary syndrome (ACS) at high altitude. Methods Ninety elderly patients with ACS who were hospitalized in our department from April 2008 to October 2012 were randomly divided into conventional therapy group (n＝42) and delayed therapy group (n＝48). Patients in conventional group received subcutaneous injection of low-molecular-weight heparin for 5 to 7d, while those in delayed group received same treatment but with duration lasting for 10 to 14d. The basic therapy was similar between the two groups. The incidence of cardiovascular events, hemorrhage and platelet reduction within 30d were recorded. Results The incidence of cardiovascular events within 30d was significantly higher in conventional group than in delayed group (19.0% vs 4.2%, P＜0.05). The incidence of hemorrhage was similar between the two groups (4.8% vs 6.3%, P＞0.05). No reduction in platelet count was observed. Conclusion The strategy of delayed therapy with low-molecular-weight heparin in elderly patients at high altitude with ACS significantly decreases the incidence of cardiovascular events within 30d, but has no effect on hemorrhage risk.

Abstract:Objective To investigate the impact of right ventricular septal (RVS) active fixation lead on cardiac functions in elderly patients implanted with permanent pacemakers. Methods A total of 78 patients at an average age of 71.9±6.7 implanted with permanent pacemakers in our hospital during June 2008 to May 2011 were enrolled into this study. They were divided into 2 groups according to their own will of which type of pacemaker, that is, RVS pacing group (experiment group, implanted with active fixation lead, n＝42) and right ventricular apical (RVA) pacing group (control group, implanted with passive fixation lead, n＝36). Their fractional shortening (FS), stroke volume (SV), cardiac outcome (CO), left ventricular ejection fraction (LVEF) and E/A ratio (early to late atrial ventricular filling velocity) were evaluated by echocardiography before and 6 months after implantation. Results No significant difference in cardiac functions was found between the 2 groups before implantation (P＞0.05). A trend of decrease was found in FS, SV, CO, LVEF, and E/A ratio in RVS pacing group in 6 months after implantation though without significant difference (P＞0.05). Despite that RVA pacing group had no difference in FS compared with RVS pacing group in 6 months after implantation, it had significantly higher SV, CO, LVEF, and E/A ratio (P＜0.05). There was no difference in pacing threshold, perception, impedance pacing rate, and mean heart rate between the 2 groups (P＞0.05). Conclusion RVS pacemaker implantation is superior to RVA pacemaker implantation in cardiac functions for senile patients.

Abstract:目的 研究冠心病患者血糖、单核细胞趋化蛋白-1（MCP-1）、活化T细胞趋化因子（RANTES）的变化，探讨其在冠心病发病中的作用。方法 纳入冠心病患者300例，分为急性冠脉综合征（ACS）组（n＝180）以及稳定型心绞痛（SAP）组（n＝120），另纳入正常受试者60例为对照组。全部行冠状动脉造影（CAG）检查，冠状动脉病变严重程度采用Genisin评分评估，酶联免疫法测定RANTES、MCP-1浓度，冠心病组除确诊糖尿病患者，行简易葡萄糖耐量试验（OGTT），分析血糖与RANTES、MCP-1和冠状动脉病变的相关性。结果 （1）冠心病患者中糖代谢异常者70.7%，糖尿病组的 RANTES、MCP-1浓度显著高于糖调节受损及正常血糖组（组间比较均为P＜0.05）。（2）RANTES、MCP-1与血糖的相关性分析表明RANTE、MCP-1与血糖呈显著正相关。（3）ACS组的RANTES、MCP-1浓度显著高于SAP组及正常对照组（组间比较均为P＜0.05）。（4）多元逐步回归分析表明冠状动脉狭窄程度与RANTES、MCP-1、血糖、低密度脂蛋白胆固醇呈正相关，与高密度脂蛋白胆固醇呈负相关。结论 糖调节异常与RANTES、MCP-1呈正相关，共同参与冠心病的发生发展。

Abstract:Objective To evaluate the correlation between serum level of uric acid and severity of coronary lesions in elderly patients with coronary heart disease. Methods A cohort of 289 elderly patients with age over 70 years suffering from angiographically identified coronary artery disease (diameter stenosis ≥50% of lumen narrowing) admitted to our department from January 2011 to August 2012 were enrolled in this study. The severity of coronary artery disease was assessed by Gensini score. Preoperative serum uric acid level was measured with an automatic biochemical analyzer. The correlation of serum uric acid level with the extent and severity of coronary stenosis was analyzed. Results There was no significant difference in serum level of uric acid among the single-, double- and multiple-vessel lesion groups [(0.358±0.102) vs (0.379±0.112) vs (0.366±0.112), P＞0.05]. No significant difference was seen in serum level of uric acid among the senile with different severity of coronary artery stenosis [(0.360±0.100) vs (0.375±0.119) vs (0.369±0.100) vs (0.370±0.123), P＞0.05]. There was no significant difference in the severity of coronary artery stenosis (Gensini score) between normal uric acid group and hyperuricemia group [(37.138±24.934) vs (41.887±35.294), P＞0.05]. For male and female patients, there was still no significant difference in serum uric acid levels among the single-, double- and multiple-vessel lesion groups. The patients with different Gensini scores had no significant difference in serum uric acid level. Conclusion No adequate evidence shows that serum uric acid level can be used as a risk factor or predictor for the severity of coronary lesions among elderly patients with coronary heart disease.

Abstract:Objective To investigate the clinical features and related risk factors of coronary tortuosity in elderly patients. Methods A total of 304 elderly patients, with age over 60 years, including 157 males and 147 females, who underwent coronary angiography in our department during January to June 2010 were enrolled in this study. Coronary angiography and clinical data of all patients were retrospectively reviewed to analyze risk factors and correlation of blood pressure and severity of coronary tortuosity. Results Positive rate of coronary tortuosity was 55.3%(168/304) in the cohort of elderly patients, but the incidence for women was 60.12% (101/168). Moderate tortuosity was most common in the left circumflex coronary artery (33.9%). Those with triple-vessel lesions had highest score in tortuosity severity. Gender and blood pressure were the risk factors of coronary tortuosity for the elderly patients. A significant positive correlation was found between blood pressure and coronary tortuosity severity. Conclusion Elderly patients have a high incidence of coronary tortuosity, which have an intimate correlation with gender and blood pressure. The higher the blood pressure is, the more severe the coronary tortuosity.

Abstract:Objective To evaluate the role of regulatable expression of AT2R gene in vivo on the expression of matrix metalloproteinase 2 (MMP-2) in the neointima after vascular injury in rats by deoxycycline (Dox)-on mesenchymal stem cells (MSCs) transplantation. Methods　 Two successive rounds of transfection of cultured MSCs were performed with conventional molecular biological methods. MSCs with low background expression and high Dox-induced expression of AT2R gene were deemed double-stable MSCs. Rat models of balloon-induced carotid injury were established. Double-stable MSCs were then transplanted into the site of carotid injury, and Dox was injected via vena caudalis into rats. Pathological study was carried out at 14d and 28d after cell transplantation. AT2R gene expression in the neointima and its effect on the mRNA and protein expression of MMP-2 were analyzed by immunohistochemistry, immunoblotting and RT-PCR. Results Double stable MSCs line with low background expression and high Dox induced expression of AT2R gene was established successfully. Significant AT2R expression was observed after 48h of induction and further increased after 72h and remained stable over 8 weeks. Immunohistochemistry, immunoblotting and RT-PCR indicated that AT2R expression in the neointima was significantly upregulated in Dox group than in control group, MSC group and MSC transfection group (P＜0.01), but the expression of MMP-2 was significantly decreased in Dox group than in other groups (P＜0.01). Conclusion 　AT2R expression at the site of carotid injury after transfection of our double-stable MSCs were well controlled by Dox. After Dox induces the high expression of AT2R, the expression of MMP-2 in neointima is decreased, which may be one of the mechanisms of regulating AT2R expression in injured vessels to prevent vascular restenosis.

Abstract:Objective To determine the expression and significance of phosphatase and tensin homologue deleted on chromosome 10 (PTEN) in the marginal area of myocardial infarction, and the effect of peroxisome proliferator-activated receptor gamma agonist (PPAR-γ), rosiglitazone, on the expression in acute myocardial infarction (MI) rabbit model after the direct current (DC) electric fields (EFs) stimulation. Methods Fifty rabbits were randomly divided into sham-operation group (SH group, n＝5), MI group (n＝15), DCEFs treatment group (EFs group, n＝15), and DCEFs+rosiglitazone treatment group (R-EFs group, rosiglitazone 4 mg/kg·d, i.g.). After the corresponding model was established by occluding left anterior descending branch in the later 3 groups, DCEFs stimulation (4.0V/cm, 30min/d) was given to the later 2 groups for 1, 2 and 4 weeks respectively (n＝5 for each time point). The expression of PTEN in the ischemia myocardium was detected by Western blotting. Meanwhile, the ratio of left or right ventricular weight/body mass (LVW/BS or RVW/BS) and the hemodynamic indexes were measured. Results There was some expression of PTEN in cardiac tissue of SH group and MI group. The expression of PTEN in EFs group was higher than in MI group(P＜0.01), and the expression in R-EFs group was higher than EFs group(P＜0.05). In the meantime, compared to MI group, left ventricular function was improved in EFs group and R-EFs group. Conclusion PPARγ promotes the expression of PTEN and thus further improves the left ventricular systolic function.

Abstract:Objective To investigate the effect of interferon-α (IFN-α) on the migration of human brain vascular adventitial fibroblasts (VAFs). Methods VAFs were cultured in presence or absence of 2000 kU/L IFN-α for 24h. VAFs migration was investigated by cell scratch assay and counted by Transwell chamber test. The mRNA and protein expression of intreferon-inducible protein 16 were detected by semiquantitative RT-PCR and Western blotting. Results IFN-α treatment resulted in a reduce in cell migration and enhanced expression of intreferon-inducible protein 16 at mRNA and protein levels in VAFs. Conclusion IFN-α may inhibit the migration capacity of VAFs via up-regulating the expression of intreferon-inducible protein 16.

Abstract:Objective To investigate the effect of the activation of nuclear factor-erythroid 2-related factor 2 (Nrf2) on the injury of rat vascular smooth muscle cells (VSMCs) induced by oxidative stress. Methods Rat aortic VSMCs were cultured and divided into control group, oxidative damage group, Nrf2 activation group and Nrf2 siRNA-expressing lentiviral vector (Nrf2 siRNA) group. Protein level of Nrf2 was determined by Western blotting. Cell viability was measured by MTT assay, and cell apoptosis was determined by Hoechst 33342 and Annexin V/FITC. Results VSMCs were transiently transfected with Nrf2 siRNA. Nrf2 siRNA significantly inhibited the expression of Nrf2 at protein level compared to the control(P＜0.05). Compared to oxidative damage group, cell viability was significantly increased (P＜0.05) and cell apoptosis was decreased in Nrf2 activation group(P＜0.05). However, compared to oxidative damage group, cell viability was significantly decreased (P＜0.05) and cell apoptosis was increased in Nrf2 siRNA group(P＜0.05). Conclusion Nrf2 activation can reduce oxidative stress-induced damage inVSMCs.

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Abstract:Coronary artery dissection results from a tear in the inner layer of the artery, the tunica intima. This allows blood to penetrate and then to form an intramural hematoma in the central layer, the tunica media, and a restriction in the size of lumen. If the diagnosis and treatment is not prompt, the coronary artery may develop a tear, causing blood to flow between the 2 layers which forces them apart. And then the dissection may result in rupture of coronary artery, which in turn causes myocardial infarction, cardiogenic shock, and even sudden death. In this paper, we reviewed the genesis, imaging diagnosis and treatment strategies of this disorder.