Objective To investigate the changes and roles of myocardial adenosine triphosphate enzyme(ATPase) in the mechanism of cardiac dysfunction after blunt chest trauma（BCT）. Methods Thirtysix rabbits were divided into 6 groups with random number table, control group, 2 h group, 4 h group, 8 h group, 12 h group and 24 h group, 6 in each group. The models of BCT were established with BIMⅡ biological impact machine, catheterization technique was used through the right jugular artery into the left ventricle measure its pressure. The hemodynamics and the activities of ATPase in myocardial cell plasm, homogenate and mitochondria were measured at preinjury(control group), 2 h, 4 h, 8 h, 12 h and 24 h postinjury. Results Left ventricular endsystolic pressure(LVESP), the maximal ascending rate of left intraventricular pressure(+dp/dtmax), isovolemec pressure(IP) and the maximal physiological velocity(Vpm) decreased significantly at 2 h group after BCT(Plt;0.05）, and recovered to preinjury level in 4 h, 8 h and 12 h group during 4-12 h after BCT; isovolumic relaxation phase left ventricular pressure descending time constant (T). Left ventricular enddiastolic pressure(LVEDP) and the maximal descending rate of left intraventricular pressure(-dp/dtmax) were significantly higher （Plt;0.05, 0.01）. The activity of ATPase in homogenate, mitochondria and cell plasm decreased significantly at 2 h group and 4 h group after BCT（Plt;0.05, 001, respectively）, and 8 h group and 12 h group recovered after BCT. There was negative correlations between [CM(159mm]LVEDP and -dp/dtmax and the decrease of the activity of Na+-K+-ATPase in homogenate（r=-0.674, -0.691, Plt;0.05）, the Ca2+-ATPase in homogenate（r=-0.613,-0.642, Plt;0.05）, the Na+-K+-ATPase in mitochondria（r=-0.622,-0.616, Plt;0.05）,the Ca2+-ATPase in myocardial cell plasm（r=-0.672,-0.658, Plt;0.05）, the Na+-K+-ATPase in myocardial cell plasm（r=-0.627,-0.632,Plt;0.05）,and the Mg2+-ATPase in myocardial cell plasm（r=-0.677,-0.661, Plt;0.05）. Conclusion The left ventricular function is impaired obviously after BCT, especially in diastolic phase. The decrease of the activity of ATPase in myocardial cells may be one of the reasons of cardiac dysfunction after BCT.
Objective To investigate the changed rules of the cardiac functions in rabbits and to provide theoretical gists for clinical diagnosis and treatment after blunt chest trauma(BCT). Methods Using the models of moderate to severe BCT with BIM-Ⅱ Bio-impactor in 20 rabbits to examinate the cardiac functions with cardiac catheterization, the single photonemission computed tomography(SPECT) and the Doppler echocardiography at preinjury and 1h, 2h, 4h, 6h, 8h, 12h and 24h after BCT. Results Central venous pressure( CVP）, left ventricular enddiastolic pressure (LVEDP) and the decreasing time constant of left intraventricular pressure (T) at 24h after trauma were higher obviously than those before trauma (Plt;0.05,0.01). The -dp/dtmax at 24h after trauma was lower markedly than that before trauma (Plt;0.05 ). The ejection fraction(EF),1/3 EF, 1/3 ejection rate（1/3ER） and the ratio of 1/3 filling rate (1/3FR) to 1/3ER of the right ventricle at 24h after impacted were lower markedly than those before impacted (Plt;0.05). The peak filling rate, 1/3 filling fraction, 1/3 filling rate, the ratio of peak filling rate to peak ejection rate and the ratio of 1/3FR to 1/3ER of the left ventricular at 24h after impacted were lower obviously than those before impacted (Plt;0.05, 0.01). Conclusion The cardiac functions are changed significantly after BCT. The expressions of the right ventricular dysfunctions mainly are systolic dysfunction while the left ventricular dysfunctions are mainly diastolic dysfunction after BCT. All the cardiac catheterization, SPECT and the Doppler echocardiography are beneficial to the diagnosis of cardiac dysfunction after BCT. The SPECT is more exactitude and the Doppler echocardiography is more cheaper.
ObjectiveTo investigate the effect of anterior chest wall depression on the cardiac function and the effectiveness of minimally invasive surgery for pectus excavatum by comparing cardiac function and morphology between pre- and post-operation. MethodsBetween August 2009 and December 2010, 102 adult patients with pectus excavatum were treated with minimally invasive surgery, including the primary operation in 95 cases and the reoperation in 7 cases. There were 84 males and 18 females, aged 18-57 years (mean, 23.4 years). The haller index (HI) was 4.59 ± 1.51. Of 102 patients, 59 were classified as pectus excavatum type I and 43 as type II; 42 had clinical symptoms and 19 had the physical sign of heart. The preoperative chest CT examination showed cardiac compression in all patients and heart displacement in 74 patients. The left ventricular ejection fraction (LVEF) was 68.9% ± 6.2%. ResultsThe procedure was successful in all patients, and no death or serious complication occurred. The patients were followed up 12-28 months (mean, 21 months). The clinical symptoms and cardiac physical sign of the patients disappeared after operation. HI was 2.70 ± 0.33 at 12 months after operation, showing significant difference when compared with preoperative HI (t=5.83, P=0.00). According to Nuss’s evaluation method, the results were excellent in 99 patients and good in 3 patients. CT examination showed complete relief of cardiac compression in 101 patients and mild cardiac compression in 1 patient; the heart position was normal at 12 months after operation. Electrocardiogram returned to normal in 4 patients having abnormal electrocardiogram. LVEF was 70.5% ± 4.8% after operation, showing no significant difference when compared with preoperative LVEF (t=1.08, P=0.30). ConclusionThe main effects of pectus excavatum in adults on heart are compression and displacement. Cardiac compression may be relieved efficiently and the patient’s clinical symptoms can be abated by minimally invasive surgery.
ObjectiveTo evaluate the mid-term recovery of cardiac function after heart valve replacement and concomitant bipolar radiofrequency ablation for atrial fibrillation (AF). Methods Clinical data of 191 patients with heart valve disease and AF in the same surgical team of Xinqiao Hospital from January 2011 Jan to December 2013 was retrospectively analyzed. Heart valve replacement was performed for a control group (n=93), which includes 31 males and 62 females with their age of 48.33±7.55 years and AF duration of 4.80±2.03 years. Valve replacement and concomitant bipolar radiofrequency ablation was performed for a synchronism ablation group (n=98), which includes 27 males and 71 females with their age of 46.95±7.70 years and AF duration of 5.06±2.26 years. The echocardiogram, electrocardiogram and complications at hospitalization, 6 months, 1 year and 2 year after operation were analyzed. ResultsNo in-hospital death occurred. There were statistical differences in aortic cross-clamp time, cardiopulmonary bypass time, tricuspid ring, ICU stay, total volume of postoperative drainage between the two groups. All the patients were followed up for 2 years. Two years postoperatively, in the synchronism ablation group, 85 patients (86.73%) were followed up, 1 patient with cerebral embolism, 2 patients with cerebral hemorrhage. In the control group, 85 patients (91.40%) were followed up, 4 patients with cerebral embolism, 2 patients with cerebral hemorrhage. There were no death, cardiac rupture, and permanent cardiac pacemaker implantation in the two groups during the follow-up. One year and 2 years postoperative fractional shortening of the synchronism ablation group was significantly higher than those of the control group (37.18%±5.35% vs. 34.72%±6.40%, P=0.007; 37.95%±7.99% vs. 35.18%±5.15%, P=0.008). One year and 2 years postoperative left ventricular ejection fraction of the synchronism ablation group was significantly higher than that of the control group (66.27%±6.99% vs. 63.33%±8.14%, P=0.012). The rate of self-feeling cardiac function improvement in 1 year and 2 years after surgery of the synchronism ablation group was significantly higher than that of the control group (85.39% vs. 72.94%, P=0.005; 84.71% vs. 68.24%, P=0.005). ConclusionCardiac function of the mid-term after the valve replacement and concomitant bipolar radiofrequency ablation for atrial fibrillation obviously improves.
Objective To explore the role of systolic and diastolic dysfunction in the prognosis of Chinese patients with coronary artery disease (CAD). Methods CAD patients who underwent coronary arteriography in the Department of Cardiology of West China Hospital between July 2008 and June 2012 were included in this study. All the patients underwent color Doppler echocardiographic examination. Based on patients’ systolic and diastolic cardiac function, left ventricular ejection fraction (LVEF) <55% was as the systolic dysfunction and the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/e’) >15 was as the diastolic dysfuntion. They were divided into normal cardiac function group (LVEF≥55%, E/e’ ratio≤15), systolic and diastolic dysfunction group (LVEF<55%, E/e’ ratio>15), diastolic dysfunction group (LVEF≥55%, E/e’ ratio>15) and systolic dysfunction group (LVEF<55%, E/e’ ratio≤15). The end points of follow-up were all-cause death and a major cardiovascular event (MACE). Results A total of 985 patients with complete echocardiographic report were included in this study. During the follow-up of (21.4±9.7) months, 46 patients (4.7%) died, and 52 (5.4%) had a MACE. Systolic dysfunction concomitant with diastolic dysfunction group and systolic dysfunction group patients had a higher risk of 36-month all-cause death (4.8%, 10.7%,P<0.001) and a higher risk of 41-month MACE (8.6%, 7.6%,P=0.028). Single factor analysis of all-cause death mortality showed that compared with the normal group, all-cause death mortality was the highest in systolic and diastolic dysfunction group (P<0.05), followed by diastolic dysfunction group (P<0.05) and systolic dysfunction group (P>0.05). Single factor analysis of MACE showed that compared with the normal group, MACE was still the highest in systolic and diastolic dysfunction group (P<0.05), followed by systolic dysfunction group (P<0.05) and diastolic dysfunction group (P>0.05). A multivariate Cox regression model analysis showed that compared with the normal group, the risk of all-cause death was the highest in the systolic and diastolic dysfunction group [hazard ratio (HR)=2.96, 95% confidence interval (CI) (1.34, 6.54),P=0.007], followed by the systolic dysfunction group [HR=1.91, 95%CI (0.67, 5.42),P=0.224] and the diastolic dysfunction group [HR=0.95, 95%CI (0.40, 2.23),P=0.905]. Conclusion Compared with normal patients, patients with either systolic or diastolic dysfunction have a poorer prognosis, and patients with systolic dysfunction concomitant with diastolic dysfunction have the poorest prognosis.
The study aimed to evaluate the therapeutic effect of nilotinib-loaded biocompatible gelatin methacryloyl (GelMA) microneedles patch on cardiac dysfunction after myocardial infarction(MI), and provide a new clinical perspective of myocardial fibrosis therapies. The GelMA microneedles patches were attached to the epicardial surface of the infarct and peri-infarct zone in order to deliver the anti-fibrosis drug nilotinib on the 10th day after MI, when the scar had matured. Cardiac function and left ventricular remodeling were assessed by such as echocardiography, BNP (brain natriuretic peptide) and the heart weight/body weight ratio (HW/BW). Myocardial hypertrophy and fibrosis were examined by WGA (wheat germ agglutinin) staining, HE (hematoxylin-eosin staining) staining and Sirius Red staining. The results showed that the nilotinib-loaded microneedles patch could effectively attenuate fibrosis expansion in the peri-infarct zone and myocardial hypertrophy, prevent adverse ventricular remodeling and finally improve cardiac function. This treatment strategy is a beneficial attempt to correct the cardiac dysfunction after myocardial infarction, which is expected to become a new strategy to correct the cardiac dysfunction after MI. This is of great clinical significance for improving the long-term prognosis of MI patients.