The exploration of coronary microcirculatory dysfunction in diabetes has accelerated in recent years.Cardiac function is compromised in diabetes.Diabetic patients manifest accelerated atherosclerosis in coronary arter...The exploration of coronary microcirculatory dysfunction in diabetes has accelerated in recent years.Cardiac function is compromised in diabetes.Diabetic patients manifest accelerated atherosclerosis in coronary arteries.These data are confirmed in diabetic animal mod-els,where lesions of small coronary arteries have been described.These concepts are epitomized in the classic microvascular complications of diabetes,i.e.blindness,kidney failure and distal dry gangrene.Most importantly,accumulating data indicate that insights gained from the link between inflammation and diabetes can yield predictive and prognostic information of considerable clinical utility.This review summarizes the evidence for the predisposing factors and the mechanisms involved in diabetes,and assesses the current state of knowledge regarding the triggers for inflammation in this disease.We evaluate the roles of hyperglycemia,oxidative stress,polyol pathway,protein kinase C,advanced glycation end products,insulin resistance,peroxisome proliferator-activated receptor-γ,inflammation,and diabetic cardiomyopathy as a "stem cell disease".Furthermore,we discuss the mechanisms responsible for impaired coronary arteriole function.Finally,we consider how new insights in diabetes may provide innovative therapeutic strategies.展开更多
Objective:To evaluate the immediate effect of Kuanxiong Aerosol(KXA)on perioperative coronary microcirculation in patients with unstable angina(UA)suffering from elective percutaneous coronary intervention(PCI).Method...Objective:To evaluate the immediate effect of Kuanxiong Aerosol(KXA)on perioperative coronary microcirculation in patients with unstable angina(UA)suffering from elective percutaneous coronary intervention(PCI).Methods:From February 2021 to July 2023,UA inpatients who underwent PCI alone in the left anterior descending(LAD)branch were included.Random numbers were generated to divide patients into the trial group and the control group at a ratio of 1:1.The index of coronary microcirculation resistance(IMR)was measured before PCI,and the trial group was given two sprays of KXA,while the control group was not given.IMR was measured again after PCI,cardiac troponin I(cTnI)and creatine kinase isoenzyme-MB(CK-MB)were detected before and 24 h after surgery,and major cardiovascular adverse events(MACEs)were recorded for 30 days.The data statistics and analysis personnel were blinded.Results:Totally 859 patients were screened,and 62 of them were involved into this study.Finally,1 patient in the trial group failed to complete the post-PCI IMR and was excluded,30 patients were included for data analysis,while 31 patients in the control group were enrolled in data analysis.There was no significant difference in baseline data(age,gender,risk factors,previous history,biochemical index,and drug therapy,etc.)between the two groups.In addition,differences in IMR,cTnI and CK-MB were not statistically significant between the two groups before surgery.After PCI,the IMR level of the trial group was significantly lower than that of the control group(19.56±14.37 vs.27.15±15.03,P=0.048).Besides,the incidence of perioperative myocardial injury(PMI)was lower in the trial group,but the difference was not statistically significant(6.67%vs.16.13%,P=0.425).No MACEs were reported in either group.Conclusions:KXA has the potential of improving coronary microvascular dysfunction.This study provides reference for the application of KXA in UA patients undergoing elective PCI.展开更多
Objective:To study the effect of Shexiang Tongxin Dropping Pill(STDP)on angiogenesis in diabetic cardiomyopathy mice with coronary microcirculation dysfunction(CMD).Methods:According to a random number table,6 of 36 S...Objective:To study the effect of Shexiang Tongxin Dropping Pill(STDP)on angiogenesis in diabetic cardiomyopathy mice with coronary microcirculation dysfunction(CMD).Methods:According to a random number table,6 of 36 SPF male C57BL/6 mice were randomly selected as the control group,and the remaining 30 mice were injected with streptozotocin intraperitoneally to replicate the type 1 diabetes model.Mice successfully copied the diabetes model were randomly divided into the model group,STDP low-dose group[15 mg/(kg·d)],medium-dose group[30 mg/(kg·d)],high-dose group[60 mg/(kg·d)],and nicorandil group[15 mg/(kg·d)],6 in each group.The drug was given by continuous gavage for 12 weeks.The cardiac function of mice in each group was detected at the end of the experiment,and coronary flow reserve(CFR)was detected by chest Doppler technique.Pathological changes of myocardium were observed by hematoxylin-eosin staining,collagen fiber deposition was detected by masson staining,the number of myocardial capillaries was detected by platelet endothelial cell adhesion molecule-1 staining,and the degree of myocardial hypertrophy was detected by wheat germ agglutinin staining.The expression of the vascular endothlial growth factor(VEGF)/endothelial nitric oxide synthase(eNOS)signaling pathway-related proteins in myocardial tissue was detected by Western blot.Results:Compared with the model group,medium-and high-dose STDP significantly increased the left ventricular ejection fraction and left ventricular fraction shortening(P<0.01),obviously repaired the disordered cardiac muscle structure,reduced myocardial fibrosis,reduced myocardial cell area,increased capillary density,and increased CFR level(all P<0.01).Western blot showed that high-dose STDP could significantly increase the expression of VEGF and promote the phosphorylation of vascular endothelial growth factor receptor 2,phosphoinositide 3-kinase,protein kinase B,and eNOS(P<0.05 or P<0.01).Conclusion:STDP has a definite therapeutic effect on diabetic CMD,and its mechanism may be related to promoting angiogenesis through the VEGF/eNOS signaling pathway.展开更多
To the Editor:More than half of the patients undergoing invasive coronary angiography for angina or signs of myocardial ischemia present with non-obstructive coronary arteries(NOCA,<50%diameter reduction or fractio...To the Editor:More than half of the patients undergoing invasive coronary angiography for angina or signs of myocardial ischemia present with non-obstructive coronary arteries(NOCA,<50%diameter reduction or fractional flow reserve>0.80).[1]Coronary microvascular dysfunction(CMD)is a significant pathophysiological factor in these patients and is linked to adverse outcomes.[2]Although coronary reactivity testing(CRT)remains the gold standard for diagnosing CMD,it is both invasive and costly.Stress cardiac magnetic resonance(CMR)is a non-invasive and promising alternative,providing essential perfusion parameters such as myocardial perfusion reserve index(MPRI)and myocardial perfusion reserve(MPR)to diagnose CMD.Thus,based on current literature,there is robust evidence supporting the effectiveness of stress CMR in diagnosing CMD in patients with NOCA,as defined by CRT.展开更多
基金Supported by Grants from Pfizer Atorvastatin Research Award,No. 2004-37American Heart Association SDG,No. 110350047ANIH Grants,No. RO1 HL077566 and RO1 HL085119 to Zhang C
文摘The exploration of coronary microcirculatory dysfunction in diabetes has accelerated in recent years.Cardiac function is compromised in diabetes.Diabetic patients manifest accelerated atherosclerosis in coronary arteries.These data are confirmed in diabetic animal mod-els,where lesions of small coronary arteries have been described.These concepts are epitomized in the classic microvascular complications of diabetes,i.e.blindness,kidney failure and distal dry gangrene.Most importantly,accumulating data indicate that insights gained from the link between inflammation and diabetes can yield predictive and prognostic information of considerable clinical utility.This review summarizes the evidence for the predisposing factors and the mechanisms involved in diabetes,and assesses the current state of knowledge regarding the triggers for inflammation in this disease.We evaluate the roles of hyperglycemia,oxidative stress,polyol pathway,protein kinase C,advanced glycation end products,insulin resistance,peroxisome proliferator-activated receptor-γ,inflammation,and diabetic cardiomyopathy as a "stem cell disease".Furthermore,we discuss the mechanisms responsible for impaired coronary arteriole function.Finally,we consider how new insights in diabetes may provide innovative therapeutic strategies.
基金Supported by Capital's Funds for Health Improvement and Research(No.2022-1-2231)Beijing Science and Technology Program(No.Z221100007422127)Beijing Municipal Hospital Administration Green Seedling Talent Project(No.QML20231003)。
文摘Objective:To evaluate the immediate effect of Kuanxiong Aerosol(KXA)on perioperative coronary microcirculation in patients with unstable angina(UA)suffering from elective percutaneous coronary intervention(PCI).Methods:From February 2021 to July 2023,UA inpatients who underwent PCI alone in the left anterior descending(LAD)branch were included.Random numbers were generated to divide patients into the trial group and the control group at a ratio of 1:1.The index of coronary microcirculation resistance(IMR)was measured before PCI,and the trial group was given two sprays of KXA,while the control group was not given.IMR was measured again after PCI,cardiac troponin I(cTnI)and creatine kinase isoenzyme-MB(CK-MB)were detected before and 24 h after surgery,and major cardiovascular adverse events(MACEs)were recorded for 30 days.The data statistics and analysis personnel were blinded.Results:Totally 859 patients were screened,and 62 of them were involved into this study.Finally,1 patient in the trial group failed to complete the post-PCI IMR and was excluded,30 patients were included for data analysis,while 31 patients in the control group were enrolled in data analysis.There was no significant difference in baseline data(age,gender,risk factors,previous history,biochemical index,and drug therapy,etc.)between the two groups.In addition,differences in IMR,cTnI and CK-MB were not statistically significant between the two groups before surgery.After PCI,the IMR level of the trial group was significantly lower than that of the control group(19.56±14.37 vs.27.15±15.03,P=0.048).Besides,the incidence of perioperative myocardial injury(PMI)was lower in the trial group,but the difference was not statistically significant(6.67%vs.16.13%,P=0.425).No MACEs were reported in either group.Conclusions:KXA has the potential of improving coronary microvascular dysfunction.This study provides reference for the application of KXA in UA patients undergoing elective PCI.
基金Supported by the National Natural Science Foundation of China(No.81930113)。
文摘Objective:To study the effect of Shexiang Tongxin Dropping Pill(STDP)on angiogenesis in diabetic cardiomyopathy mice with coronary microcirculation dysfunction(CMD).Methods:According to a random number table,6 of 36 SPF male C57BL/6 mice were randomly selected as the control group,and the remaining 30 mice were injected with streptozotocin intraperitoneally to replicate the type 1 diabetes model.Mice successfully copied the diabetes model were randomly divided into the model group,STDP low-dose group[15 mg/(kg·d)],medium-dose group[30 mg/(kg·d)],high-dose group[60 mg/(kg·d)],and nicorandil group[15 mg/(kg·d)],6 in each group.The drug was given by continuous gavage for 12 weeks.The cardiac function of mice in each group was detected at the end of the experiment,and coronary flow reserve(CFR)was detected by chest Doppler technique.Pathological changes of myocardium were observed by hematoxylin-eosin staining,collagen fiber deposition was detected by masson staining,the number of myocardial capillaries was detected by platelet endothelial cell adhesion molecule-1 staining,and the degree of myocardial hypertrophy was detected by wheat germ agglutinin staining.The expression of the vascular endothlial growth factor(VEGF)/endothelial nitric oxide synthase(eNOS)signaling pathway-related proteins in myocardial tissue was detected by Western blot.Results:Compared with the model group,medium-and high-dose STDP significantly increased the left ventricular ejection fraction and left ventricular fraction shortening(P<0.01),obviously repaired the disordered cardiac muscle structure,reduced myocardial fibrosis,reduced myocardial cell area,increased capillary density,and increased CFR level(all P<0.01).Western blot showed that high-dose STDP could significantly increase the expression of VEGF and promote the phosphorylation of vascular endothelial growth factor receptor 2,phosphoinositide 3-kinase,protein kinase B,and eNOS(P<0.05 or P<0.01).Conclusion:STDP has a definite therapeutic effect on diabetic CMD,and its mechanism may be related to promoting angiogenesis through the VEGF/eNOS signaling pathway.
基金supported by the National Key R&D Program of China(Nos.2021YFF0501400 and 2021YFF0501404)the Key Project of National Natural Science Foundation of China(No.81930044).
文摘To the Editor:More than half of the patients undergoing invasive coronary angiography for angina or signs of myocardial ischemia present with non-obstructive coronary arteries(NOCA,<50%diameter reduction or fractional flow reserve>0.80).[1]Coronary microvascular dysfunction(CMD)is a significant pathophysiological factor in these patients and is linked to adverse outcomes.[2]Although coronary reactivity testing(CRT)remains the gold standard for diagnosing CMD,it is both invasive and costly.Stress cardiac magnetic resonance(CMR)is a non-invasive and promising alternative,providing essential perfusion parameters such as myocardial perfusion reserve index(MPRI)and myocardial perfusion reserve(MPR)to diagnose CMD.Thus,based on current literature,there is robust evidence supporting the effectiveness of stress CMR in diagnosing CMD in patients with NOCA,as defined by CRT.
