Clinical significance of 201Tl reverse redistribution in patients with aorto-coronary bypass surgery

Detection of myocardial ischemia by the stress thallium scan has traditionally been performed using transient defect analysis on exercise, followed by redistribution studies. Worsening of the ²⁰¹Tl myocardial image from exercise to redistribution is referred to as reverse redistribution. In this study, we found reverse redistribution in 10 (21%) of 48 angina pectoris patients who had undergone aortocoronary bypass surgery. The clinical significance of this phenomenon in these patients was investigated in relation to angiographic and surgical findings. Reverse redistribution was found to occur in regions which were supplied by bypass grafts. These areas showed increased coronary blood flow and rapid thallium washout. Our results indicate that a perfusion defect in the bypass region of the redistribution image might be caused by relatively rapid washout in the bypass graft region compared to the adjacent normal myocardium. These results should be considered in the clinical interpretation of stress thallium scans.     

Postaggressionsstoffwechsel nach Herzinfarkt — dargestellt am Verhalten kurzlebiger Plasmaproteine

Zusammenfassung Die Kinetik kurzlebiger Plasmaproteine im Postaggressionssyndrom wurde vergleichend bei Patienten nach Herzinfarkt (HI) mit und ohne klinische Komplikationen und nach Angina Pectoris-Anfall (AP) am Beispiel der Akut-Phase-Proteine ₁-Antitrypsin, C-reaktives Protein, Fibrinogen und Haptoglobin sowie der Transportproteine Präalbumin und Transferrin nach der Methode der radialen Immundiffusion untersucht. Während AP keinen Einfluß auf die Proteinkinetik ausübt, zeigen sich nach HI ein kontinuierlicher Anstieg der Akut-Phase-Proteine und ein dazu parallel verlaufender Abfall der Transportproteine mit Maximal- bzw. Minimal-Konzentrationen zwischen dem 3. und 5. Tag nach dem Ereignis und anschließender Rückbildung zu den Ausgangswerten. Die Veränderungen, die in ähnlicher Weise auch nach chirurgischen Traumata beobachtet werden, sind abhängig vom Schweregrad der Erkrankung und entsprechend prognostisch verwertbar.Im Postaggressionssyndrom wird demnach das Verhalten der nahrungsabhängigen Proteine Präalbumin und Transferrin sowohl durch Art und Stärke des Streßeinflusses als auch durch den Ernährungszustand beeinflußt. Der Mechanismus dieser Veränderungen und die Konsequenzen für die Verwendung der Proteine als diagnostische Kenngrößen werden diskutiert.     

Syndrome X in women is associated with oestrogen deficiency

This study was undertaken to ascertain whether gynaecologicalhistory or a reduction in ovarian hormones are triggers of anginain menopausal women with a positive exercise test and normalcoronary arteries. The majority of patients with angina pectoris,a positive exercise test and normal coronary arteries are female,suggesting that the female gender may be important in the aetiology.We studied the gynaecological features of 107 women (age 53±9 years) with syndrome X, taken from a population of134 patients including 27 males. Cardiological investigationswere undertaken and detailed gynaecological history obtainedfrom all the female patients. Menopausal status was confirmedby plasma levels of oestradiol-17ß100 pmol. l^–1. In 95 of the 107 female patients, chest pain began either duringthe perimenopausal period (32) or after the menopause (63).Of the 63 menopausal patients, 43 had undergone hysterectomyat an average of 8 ± 6 years prior to the onset of chestpain. The incidence of hysterectomy in the study population(40%) was four times greater than that of an age-matched population.These findings confirm that the majority of patients with syndromeX are women in whom the chest pain began after the onset ofmenopause. Ovarian hormone deficiency may, therefore, play arole in the onset of syndrome X in female patients.     

长效钙离子拮抗剂在稳定型心绞痛中的应用

目的观察比较长效钙离子拮抗剂（CCB）在治疗稳定型心绞痛患者中的疗效。方法188例稳定型心绞痛患者进行随机双盲CCB和安慰剂对照研究,其中包括拜新同30 mg与安慰剂两种。结果两组采用不同药物治疗的患者1年内死亡数,校正χ^2=3.78,P〈0.05;两组治疗后患者的1年内致残性卒中数,χ^2=3.93,P〈0.05,两样本率间差异有统计学意义;两组治疗后患者的1年内心肌梗死发生数,χ^2=4.34,P〈0.05,两样本率间差异有统计学意义。结论早期联合应用CCB对稳定型心绞痛患者是有利的,可以有效解除冠状动脉痉挛,改善缺血区的供血供氧,缓解临床症状,防止进展为心肌梗死;有效降低致残性脑卒中的风险,提高患者的生存质量。     

心绞痛和脑梗死患者血浆TAT、D-D、ET水平变化及临床意义

目的探讨心绞痛和脑梗死患者血浆TAT、D-D、ET水平变化及临床意义。方法检测心绞痛和脑梗死组各50例及对照组40例血浆TAT、D-D、ET。结果心绞痛组和脑梗死组血浆TAT、D-D、ET水平均显著高于对照组（P〈0．01）;不稳定型心绞痛TAT、D-D、ET水平均显著高于稳定型心绞痛（P〈0．05）;急性期脑梗死TAT水平显著高于亚急性、慢性期（P〈0．01）;亚急性期D-D水平显著高于急性期和慢性期（P〈0．05）。结论血浆rrAT、D-D、ET水平反映了心绞痛和脑梗死患者凝血功能活跃、纤溶亢进、血管内皮损伤,有利于早期诊断和治疗。     

Blood Pressure Variations,Hemorheological Determinants,and Platelet Aggregation in Hypertensive Patients with Unstable Angina

Plasma viscosity, fibrinogen, haematocrit and ß-thromboglobulin were assessed on venous blood samples taken within 24 hours of admission from 20 consecutive male hypertensive patients with unstable angina and 20 male hypertensive patients with stable angina, matched for clinical variables.

Besides, all patients underwent automated indirect blood pressure monitoring for 24 hours, starting just after hospitalization.

Despite similar average 24-hour, day-time and night-time systolic and diastolic blood pressure, hypertensive patients with unstable angina showed an increased variability of 24-hour (p<0,01) and day-time (p<0,05) systolic and diastolic blood pressure, together with higher values of all haemorhelogical parameters (plasma viscosity, fibrinogen and haematocrit) (p<0,01) and ß-thrombogobulin (p<0,05), when compared with hypertensive patients with stable angina. Moreover, significant correlations between plasma viscosity and 24-hour systolic (r=0,42, p<0,01) and diastolic (r=0,39, p<0,05) blood pressure variability were shown in hypertensive patients with unstable angina.

Besides, in the same patients, the haematocrit was positively correlated with 24-hour systolic blood pressure variability (r=0,37, p<0,05).

Our data further support the relevance of rheological determinants, platelet activation and haemodynamic factors in the genesis of the high risk condition of unstable angina.     

维奥欣在非ST段抬高性心肌梗死患者中的作用

目的探讨维奥欣在非ST段抬高性心肌梗死患者中的作用。方法44例非ST段抬高性心肌梗死患者随机分为2组后，分别在标准治疗的基础上加用维奥欣，观察患者心绞痛发作的改善情况以及3个月内死亡和1年内死亡率的情况。结果加用维奥欣的治疗组心肌梗死后并发症明显减少，症状缓解快，3个月内死亡和2年内死亡率例数少。讨论维奥欣可增加患者冠脉血流量，减少心肌耗氧量，还有调节脂质代谢、改善血液流变学、抗血小板的作用，故有缓解心绞痛、改善长期预后的作用。     

丹参田七粉辅助治疗冠心病心绞痛52例临床观察

目的:研究自制丹参田七粉辅助治疗冠心病心绞痛的临床效果。方法:将98例冠心病心绞痛患者随机分为两组,治疗组52例,对照组46例。对照组予常规西药抗心绞痛治疗,治疗组在常规抗心绞痛治疗基础上,加用丹参田七粉辅助治疗。治疗6个月后观察两组患者的心绞痛缓解、心电图心肌缺血、部分心功能指标改善情况,血脂、血液流变学各指标的变化。结果:治疗组心绞痛缓解总有效率(90.38%)明显高于对照组(68.18%)(P<0.05),心电图示心肌缺血及部分心功能指标改善情况、血脂、血液流变学各指标均明显好转,与治疗前比较有显著性差异(P<0.05),与对照组比较也有显著性差异(P<0.05)。结论:丹参田七粉辅助治疗老年冠心病心绞痛有明显的治疗效果。     

Search for Optimal Frequencies and Amplitudes of Therapeutic Electrical Carotid Sinus Nerve Stimulation by Application of the Evolution Strategy

In humans, electrical, bipolar, bilateral carotid sinus nerve stimulation (CSNS; impulse duration 0.35 ms) was applied, using frequencies between 10 and 110 Hz and voltages between individual thresholds and maximal amplitudes of stimulation. Ten anginal patients and two hypertensive patients were studied at an interval of up to 12 years after implantation of electrodes and a radiofrequency receiver for chronic therapeutic CSNS. In search of combinations of frequency and voltage of CSNS, eliciting largest ("optimal") depressor responses of blood pressure and heart rate in the individual patient, Rechenberg's evolution strategy was applied. This strategy simulates mutation and selection of biological evolution. In each patient and on each test stimulation, a value of quality was computed from actual heart rate and blood pressure values as a selection criterion for the strategy. Either responses to uninterrupted CSNS were investigated, while stimulation parameters were adjusted every 3 min, according to the strategy, or responses to 3 min of CSNS after a change in stimulation parameters were compared to intercalated 3-min control periods. In each patient, one or more combined settings of frequency and voltage elicited "optimal" responses. In principle, "optimal" CSNS frequencies ranged between 35 and 105 Hz with large interindividual differences. Due to chronic implantation of electrodes and technical features of radiofrequency transmitted stimulation energy, interindividually different voltages led to an optimal response to CSNS. Also according to the present results, the frequency of CSNS has to be determined individually. It is concluded that the evolution strategy was applied successfully, because voltage and frequency settings leading to "optimal" responses were found within 90-180 min, whereas intraindividual systematic investigations would not be feasible due to their necessarily very long duration. So far, only short-term responses have been evaluated. A broader use of the strategy in other applications is encouraged, as for example in pacemaker optimization and especially in functional electrostimulation.     

麝香保心丸通过改善血管内皮功能治疗冠状动脉微循环障碍的临床研究

目的 探讨麝香保心丸对冠状动脉微循环障碍(CMD)的疗效.方法 收集2018年5月—2020年12月于南京医科大学康达学院附属滨海县人民医院心血管内科确诊为冠脉微循环障碍的111例患者,随机分为对照组(标准治疗)和观察组(标准治疗加麝香保心丸),通过比较两组患者心绞痛症状评分、心电图变化以及硝酸甘油停减率评估患者临床症...