Ma Changsheng

Improved myocardial perfusion and cardiac function by controlled-release basic fibroblast growth factor using fibrin glue in a canine infarct model

Objective: Angiogenic therapy is emerging as a potential strategy for the treatment of ischemic heart disease but is limited by a relatively short half-life of growth factors. Fibrin glue (FG) provides a reservoir for controlled- release of growth factors. The aim of this study was to evaluate the effects of basic fibroblast growth factor (bFGF) incorporating FG on angiogenesis and cardiac performance in a canine infarct model. Methods: Acute myocardial infarction was induced by ligation of the left anterior descending coronary artery (LAD). Group I (n=6) underwent ligation of LAD alone. In Group II, transmural channels were created in the infarct area (n=6). In Group III, non-transmural channels were created to locate FG cylinders containing bFGF (n=6). Eight weeks after operation, myocardial perfusion was assessed by single photon emission computed tomography, cardiac function by echocardiography, and vascular development by immunohistochemical staining. Results: Total vascular density and the number of large vessels (internal diameter ≥50 μm) were dramatically higher in Group III than in Groups I and II at eight weeks. Only the controlled-release group exhibited an improvement in regional myocardial perfusion associated with lower defect score. Animals in Group III presented improved cardiac regional systolic and diastolic functions as well as global systolic function in comparison with the other two groups. Conclusions: Enhanced and sustained angiogenic response can be achieved by controlled-release bFGF incorporating FG within transmyocardial laser channels, thus enabling improvement in myocardial perfusion and cardiac function.

The effect of exogenous creatine phosphate on myocardial injury after percutaneous coronary intervention.

Objective: To evaluate the effect of exogenous creatine phosphate (CP) on myocardial injury after percutaneous coronary intervention (PCI). Method: Four hundred patients were divided to receive conventional therapy (control group) or 3-day intravenous infusion of CP after PCI (CP group). Levels of creatine kinase MB (CK-MB) and troponin I (TnI) were measured before and on postprocedural day 3. Results: Postprocedural CK-MB and TnI in the CP group were significantly increased compared to the control group. In the CP group, 8.0% and 5.0% of patients had an increase in CK-MB 1 to 3 times and >3 times, respectively, which were significantly lower than that of the control group (19.0% and 9.0%, respectively); 12.0% and 10.0% of patients had an increase in TnI 1 to 3 times and >3 times, respectively, which were significantly lower than that of the control group (21.0% and 18.0%, respectively). Conclusion: Exogenous CP was helpful to reduce myocardial injury after PCI.

UPDATED META-ANALYSIS OF PROSPECTIVE RANDOMIZED CONTROLLED TRIALS EVALUATING ADJUNCTIVE THROMBECTOMY IN PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ST-ELEVATION MYOCARDIAL INFARCTION

The clinical efficacy of thrombectomy in ST segment myocardial infarction (STEMI) remains controversial. The literature was searched by formal searches of electronic databases (MEDLINE, Pubmed). Trials that randomized STEMI patients to thrombectomy prior to primary percutaneous coronary

e0570 Can hatch score predict recurrence of atrial fibrillation after catheter ablation

Background HATCH score (1*hypertention+1*[age>75]+2*[stroke or transient ischaemic attack]+1*[chronic obstructive pulmonary disease]+2* [heart failure]) is an established predictor of progression from paroxysmal to persistent atrial fibrillation (AF). Whether atrial remodelling indexed by HATCH score could be a predictor of recurrence after catheter ablation of AF needs to be explored. Methods The data of 608 consecutive AF patients who underwent an index circumferential pulmonary veins ablation were retrospectively analysed. Of these patients, 313 (51.5%) patients had HATCH=0, 225 (37.0%) patients had HATCH=1, 70 (11.5%) patients had HATCH≥2. Results The patients with HATCH≥2 had significantly the largest left atrium size, the largest left ventricular end systolic diameter, and the lowest ejection fraction among the three HATCH categories. There were significant differences of the proportion of diabetes mellitus, statins medication, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers medications among the three HATCH categories. After a mean follow-up of 474±330 days, the recurrence rate were 36.4%, 38.7%, 34.3%, from HATCH=0 to HATCH≥2 categories (p=0.707). Univariate analysis revealed that nonparoxysmal AF, left atrium size, body mass index were predictors of AF recurrence. Multivariate analysis revealed that nonparoxysmal AF (HR=1.43, 95% CI 1.03 to 1.99, p =0.031) was the only independent predictor of AF recurrence. HATCH and left atrium size were not independent predictors of AF recurrence. Conclusion HATCH has no value in prediction of AF recurrence after catheter ablation.

RISK FACTOR OF NON-VALVULA ATRIAL FIBRILLATION COMBINING WITH THROMBOSIS

Objectives It has been reported that brain natriuretic peptide (BNP) levels and C-reactive protein (CRP) levels are elevated in patients with atrial fibrillation (AF). The aim of this study is to investigate alteration of plasma BNP and CRP count in patients with non-valvula atrial fibrillation combining thrombus. In patients with non-valvula atrial fibrillation combining thrombus. Methods 154 patients with AF (with thrombus 46, non-thrombus 108) were detected the concentration of CRP, BNP in scatt turbidimetry and D-dimer in. immunoturbidmetry. They were examined transesophageal echocardiography (TEE) and echocardiography (LAd, FS, LVEF). Results In aspect of BNP, CRP, Lad and LVEF, the patients in thrombus are significant difference with patients in non-thrombus, respectively: BNP (1168.39±1013.89 pg/ml vs 347.75±429.24 pg/ml p<0.001) CRP (5.77±6.37 mg/l vs 1.73±2.39 mg/L P=0.003), LAd (59.86±10.70 mm vs 47.97±13.19 mm p<0.001), LVEF (58.75±8.28% vs 64.10±6.75% p<0.001). The results of Logistic regression analysis: BNP≥400 pg/ml (OR 3.260 95% CI 1.397 to 7.608 p=0.006), CRP≥1.3 mg/l (OR 2.615 95% CI 1.141 to 5.992 p=0.023) are independent risk factors of patients with non-valvula atrial fibrillation combining with thrombosis. Conclusions CRP and BNP are independent risk factors of patients with non-valvula atrial fibrillation combining with thrombosis.

Angiographic evaluation of a new technique for common femoral artery access: the inguinal ligament-guided

Objective Various techniques have been used to acquire common femoral artery (CFA) access which was proved to be safe with lower risk of complications in percutaneous catheterisation. In order to increase the success rate of CFA puncture, a relatively simple, safe and reliable technique was developed. Methods We introduced a new inguinal ligament-guided technique and inguinal division. Clinical data were collected on 822 unselected patients undergoing transfemoral percutaneous coronary catheterisation between 2004 and 2009. Inguinal ligament was utilised as a reference to conduct artery puncture site. After palpating anterior superior iliac spine and pubic symphysis with caution to locate the inguinal ligament, medius pinpointed the intersection of inguinal ligament and femoral artery. Thereafter, place forefinger beside the medius, perform artery puncture at the inferior margin of forefinger with 45° modified seldinger technique. By femoral angiogram, we utilised the femoral head as a landmark, of which the midpoint, inferior and superior margin were referred to borderlines, to divide the inguinal region into zone A, B1, B2 and C so as to identify the location of femoral artery cannulation. Femoral head (zone B) was defined as the optimal area of femoral artery puncture. Results Successful CFA cannulation occurred in 82.8% (681/822) of cases. Arterial puncture over the femoral head (zone B) occurred in 96.8% (796/822) of patients, 36.0% (296/822) for zone B1 and 60.8% (500/822) for zone B2, respectively. When femoral artery puncture located on zone B, B1, B2 and C, CFA cannulation occurred in 83.9% (668/796), 91.6% (271/296), 79.4% (397/500) and 40% (8/20), respectively. Conclusions Inguinal ligament is a reliable reference for guiding the puncture of CFA in transfemoral percutaneous catheterisation.

Safety evaluation of vascular closure devices in femoral artery access

Objective The aim of the study was to evaluate the in-hospital and long term safety performance of vascular closure devices (VCDs) in femoral artery access. Methods One thousand and seventy eight patients who undergoing transfemoral percutaneous cardiac catheterisations from June 2008 to October 2009 were enrolled. We compared the incidence of in-hospital vascular complications between manual compression group and VCDs group. Femoroiliac angiographic data were collected and analysed on 92 patients undergoing repeat catheterisation via ipsilateral femoral artery for which VCDs have been used for at least 3 month during index transfemoral catheterisation. The percent diameter stenosis (ΔDS%) was utilised to evaluate the long-term safety performance of vascular closure devices on femoral angiogram. Restenosis of femoral artery was defined as ΔDS% ≥50%. Results The overall in-hospital incidence of vascular complication was 0.74% (8/1078). Patients in VCDs group had relatively lower rate of in-hospital complications (p=0.039) compared with manual compression group. The median interval of femoral angiogram recheck was 232 days. Femoral restenosis at the site of vascular access occurred in 3.3% of 92 patients, but no one had complaints of limb ischemia. Conclusions VCDs demonstrated greater in-hospital and long-term safety performance compared with manual compression. Femoral restenosis at puncture site is very rare and usually asymptomatic.

Selective retrograde coronary venous perfusion with over-the-wire balloon: a new technique for cell transplantation

Objective Effective cell homing to ischemic myocardium remains a practical challenge. This study evaluated the efficiency of cell delivery via coronary venous system using over-the-wire balloon in a canine model of acute myocardial infarction. Methods Acute myocardial infarction was induced by ligation of the left anterior descending (LAD) coronary artery in eight dogs (22.1±1.9 kg). Mesenchymal stem cell (MSCs) from canine bone marrow were isolated and purified by density gradient centrifugation, cultured by adhering to culture-flask and labelled with enhanced green fluorescence protein (EGFP). One week after infarction, the coronary sinus was cannulated percutaneously and an over-the wire balloon catheter advanced to the proximal portion of anterior interventricular vein (AIV) in parallel to LAD. The balloon catheter was inflated temporarily to occlude the AIV, and 1×107 EGFP-labelled MSCs was injected into the AIV. Animals were sacrificed at days 14 (n=4), 28 (n=4), and the hearts were excised and examined. Results Complete AIV occlusion had no impact on LAD flow parameters. No death, cardiac tamponade, ventricular arrhythmia, or other procedural complications occurred. Immunofluorescence studies showed that EGFP-positive cells localised primarily in the infarct region but none in infarct marginal or normal regions both at 14 and 28 days. Conclusion Selective regional myocardial perfusion is feasible through coronary venous system with over-the-wire balloon, targeting selected ischemic myocardium. This novel technique has potential application for effective cell transplantation.

Angiographic evaluation of femoral bifurcation in Chinese population

Objective Common femoral artery (CFA) access has been proved to be safe with lower risk of complications in percutaneous catheterisation. The femoral head can be utilised as a reliable landmark to locate the level of femoral bifurcation and the common femoral artery. In the present study, we evaluated the site of femoral bifurcation in Chinese population on femoroiliac angiograms. Methods We enrolled 529 patients undergoing cardiac catheterisations via femoral artery from June 2008 to October 2009. Femoral angiograms were performed in all patients preparing to use vascular closure devices. Based on the femoral head and the midpoint of pubic symphysis as landmarks, the midpoint, inferior and superior margin of the femoral head were used as borderlines to divide the inguinal region into four zones (A, B1, B2 and C). Location of femoral bifurcation and CFA were evaluated on femoral angiogram. Results Femoral bifurcations located in the area of A, B1, B2 and C with 0.2% (1/529), 2.3% (12/529), 42.4% (223/529), 55.4% (293/529), respectively. When arterial puncture located on zone B, B1, B2 and C, CFA cannulation was obtained in 85.0% (436/513), 95.8% (160/167), 79.8% (276/346) and 38.5% (5/13), respectively. Conclusions We originally introduced a reliable method for inguinal vascular zone division. The majority of femoral bifurcations located below the midpoint of femoral head in Chinese population. It is an effective measure to puncture common femoral artery between the superior and inferior border of the femoral head, especially between the superior border and the midpoint of the femoral head.

e0470 Ultrasound guided thrombin injection for the treatment of iatrogenic postcatheterisation pseudoaneurysms in 76 cases

Ultrasound-Guided Thrombin Injection For The Treatment Of Iatrogenic Post-Catheterisation Pseudoaneurysms In 76 Cases Objective The purpose of this study was to evaluate the safety and efficacy of ultrasound-guided thrombin injection (UGTI) for the treatment of iatrogenic post-catheterisation pseudoaneurysms (PSAs). Methods A total of 76 patients (36 men, 40 women, 63.4±10.8 years) with iatrogenic PSAs were treated by UGTI. Results The mean diameter of the aneurysms was (3.01±1.27)×(1.65±0.67) cm, 93.4% (71/76) of the patients were under antiplatelet therapy with aspirin or clopidogrel or both, and additional low molecular weight heparin. The mean dose of bovine thrombin was 619±259 (150∼1400) u, single injection was primary successful in 69 patients, of which thrombus formation occurred in 1 patient in the superficial femoral artery after successful closure of the PSA, surgical embolectomy was performed. A second injection was required in 2 of the remaining 7 patients. 5 patients were treated by ultrasound-guided compression because of incomplete thrombosis after UGTI. 1 patient had acute allergy after 2 min of thrombin injection which was resolved by antiallergic therapy. The total success rate was 98.7%(75/76). reperfusion was detected in 4 patients within 72 h follow-up, recurrence rate of UGTI for PSAs was 5.3% (4/75), 3 patients were successfully managed by a second thrombin injection and another was treated with ultrasuound-guidance compression, there is no recurrence at 30days clinical follow up. ultrasound follow-up. At the 2 months were performed in 15 patients. The size of PSAs were significantly reduced from (2.90±1.17), (1.47±0.54) cm to (0.94±0.72)´(0.44±0.35) cm (p<0.001). Conclusion UGTI is a safe, rapid, well-tolerated and effective noninvasive method for the treatment of iatrogenic PSAs and should be considered as first-line therapy.