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Objective: To investigate the triaging pathways of patients after coronary computed tomography angiography (CCTA)., Methods: The patients undergoing CCTA were enrolled consecutively during the period from March 3, 2008 to June 23, 2009. The rate of coronary angiography (CAG) examinations after CCTA was calculated. The rates of normal CAG, medication, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) were compared between CCTA and direct CAG cohorts., Results: A total of 8030 cases receiving CCTA and 3260 receiving direct CAG were included in the study. The CCTA patients had significantly fewer risk factors than those having direct CAG. Of the 8030 patients undergoing CCTA, 953 (12.03%) received further CAG and 6977 (87.97%) did not. Of the patients who received CAG after CCTA, 35 (3.7%) had normal CAG findings, 604 (63.4%) underwent PCI, 108 (11.3%) received conservative treatment with medications, and 206 (21.6%) underwent CABG. In the 3260 patients directly undergoing CAG, 706 (52.3%) underwent subsequent PCI, 142(4.4%) underwent CABG, 815(25.1%) received medications, and 579 (17.9%) had normal CAG findings. Comparison between the cases receiving direct CAG and CAG after CCTA showed that CCTA resulted in a significant increase in the revascularization rate (P<0.0001)., Conclusion: CCTA can help prevent unnecessary CAG and allows more accurate patient triage.

Objective: To investigate the effect of angiotensin II (ang II), aldosterone (ald) and their receptor antagonists losartan (los) and spironolactone (spi) on the proliferation and collagen production of cardiac fibroblasts (CFs) in rats., Methods: CFs were isolated from neonatal SD rats by collagenase II method and purified with differential attachment and detachment method. The 3 or 4 passages of the CFs were divided into the following groups: angiotensin II, angiotensin II+aldosterone, aldosterone, angiotensin II+losartan, and aldosterone+spironolactone. The cell viability of the CFs was assessed by Cell Counting Kit-8 (CCK-8) after the drug administration. The mRNA and protein expression levels of COL1A1, COL3A1, MMP1 and TIMP1 were detected by reverse transcription polymerase chain reaction (RT-PCR) and Western blot respectively., Results: Ang II and Ald facilitated the proliferation rate of the CFs independently compared with that in the control group (38.5% vs 28.5%; P<0.05), and the proliferation rate in the ang II+ald group was higher than that in the ang II group and ald group alone (54.4%, P<0.05). Los and spi inhibited the effect induced by ang II and ald respectively (P<0.05). Compared with the control group, ang II and ald significantly enhanced COL1A1, COL3A1 and MMP1 expression both at the mRNA and protein levels (P<0.05), but the TIMP1 expression was inhibited (P<0.05), which could be abolished by corresponding receptor antagonists los and spi (P<0.05)., Conclusion: Ang II and ald can promote the proliferation of CFs, and the COL1A1 and COL3A1 expression is enhanced both at mRNA and protein levels. Ang II and ald have synergistic effect when they are used together, while los and spi may restrain the effect. The mechanism is probably linked with the balance of MMPs/TIMPs.

Objective: To assess the feasibility and accuracy of CT coronary angiography (CTCA) combined with CT first-pass myocardial perfusion imaging (CT first-pass MPI) at rest for diagnosis of obstructive coronary artery disease (CAD)., Methods: Fifty-five patients, suspected or diagnosed as CAD, were performed with CTCA and CAG within 2 weeks. CT first-pass MPI detected myocardial ischemia through analyzing the raw date of CTCA., Results: Comparison with the results of CAG, the sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CT first-pass MPI at rest for detecting obstructive CAD were 84.6%, 68.8%, 86.8%, 64.7% and 80.0%, respectively; and 92.3%, 93.8%, 97.3%, 83.3%, 92.7% for CTCA combined with CT first-pass MPI, respectively., Conclusion: CTCA combined with CT first-pass MPI at rest could detect obstructive CAD feasible and accurately.

Objective: To investigate the effects of arginine vasopressin (AVP) and its receptor antagonist conivaptan (CON) on the proliferation of cardiac fibroblasts (CFs) and the production of collagen I and III., Methods: CFs were isolated by collagenase II method and purified with differential attachment and detachment methods. The cell viability of CFs after AVP and/or CON administration was assessed by cell counting kit-8 (CCK-8). The expressions of COL1A1 and COL3A1 mRNA were detected by RT-PCR, and the protein levels of (collagen type 1, alpha 1, COL1A1) and COL3A1 were assessed by Western blotting., Results: At 24 h after intervention, 10(-7); mol/L AVP promoted the proliferation of CFs in comparison with that in control group (P<0.01), and 10(-7); mol/L CON inhibited the effect significantly (P<0.01). At 12 h after intervention, 10(-7); mol/L AVP significantly enhanced the expressions of COL1A1 and COL3A1 at both mRNA and protein levels, and 10(-7); mol/L CON inhibited the effect again., Conclusion: AVP promoted the proliferation of CFs and enhanced the COL1A1 and COL3A1 expressions at both mRNA and protein levels, while CON could restrain the AVP effects partially.

Background: Unstable plaque is believed to be responsible for major adverse cardiac events (MACE)., Objective: To determine whether coronary computed tomography angiography (CCTA) could be used to predict future MACE., Methods: Patients undergoing CCTA between January 2008 and February 2010 were consecutively enrolled in the study. The hospital database was screened for patients who later developed acute ST segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) or cardiac death. Plaque scores were calculated and analyzed using one-way ANOVA to examine the relationship between plaque scores and MACE., Results: Of the 8557 patients who underwent CCTA, 1055 had hospital records available for follow-up. During follow-up, 25 patients experienced MACE including death (six patients), heart failure (two patients), STEMI (11 patients) and NSTEMI (six patients). The plaque scores were significantly increased in patients who later died, developed heart failure or experienced STEMI (P<0.05). Calcification, erosion and severe stenosis were responsible for the events (P<0.05). Mild and moderate lesions, positive remodelling, drug-eluting stent placement, occlusion and diffuse lesions were not predictive of MACE (P>0.05)., Conclusion: Severe calcification, erosion and severe stenosis predict death, heart failure and STEMI.

Background: Optical coherence tomography (OCT) is an imaging technology with high resolution which provides new opportunities for evaluating the vascular healing reaction after stent implantation. We used OCT to compare neointimal coverage and stent strut apposition with different types of drug-eluting stent (DES) at more than 12 months follow-up., Methods: Fifty five patients who accepted 72 DESs (19 sirolimus-eluting stents [SES, Cypher Select], 27 paclitaxel-eluting stents [PES, Taxus Liberte], 26 zotarolimus-eluting stents [ZES, Endeavor]) were enrolled in our study. OCT was performed at 12-18 months after stent implantation. The neointimal hyperplasia (NIH) thickness and stent strut apposition at 1-mm interval and the presence of thrombus in each stent were observed., Results: The average NIH thickness (0.1806 ± 0.1726 mm in SES vs. 0.2558 ± 0.2187 mm in PES vs. 0.2983 ± 0.2567 mm in ZES, p<0.001) and percentage of NIH area (17.21 ± 14.05% in SES vs. 23.09 ± 14.53% in PES vs. 28.73 ± 20.47% in ZES, p=0.002) were significantly greater in ZES than in other DESs. The prevalence of uncovered struts (8.96% in SES vs. 6.19% in PES vs. 2.98% in ZES, p<0.01) and malapposed struts (6.36% in SES vs. 2.32% in PES vs. 1.69% in ZES, p<0.01) was significantly lower in ZES than in other DESs. Thrombus was less frequently observed in ZES than in other DESs (SES 1.70% vs. PES 0.83% vs. ZES 0.17%, p<0.01)., Conclusions: Compared with SES and PES, ZES showed lower prevalence of uncovered struts and malapposed struts at more than 12 months follow-up., (Copyright © 2011. Published by Elsevier Ireland Ltd.)

Objective: To investigate the correlation between the findings by coronary computed tomography angiography (CCTA) and the risk factors for major adverse cardiac events (MACE)., Methods: This cohort study involved 706 out-patients who received examination with CCTA between June, 2008 and April, 2011. The severity of coronary artery disease (CAD) was graded to normal, mild, moderate, severe, and revascularization. Pearson correlation analysis and ANOVA were used to evaluate the relationship between the risk factors for CAD and coronary plaques identified by CCTA, and the predictive accuracy was determined by the receiver-operating characteristic (ROC) curve., Results: Of the 706 patients, 58.63% were found to have abnormal CCTA findings. A older age, hypertension, hyperlipidemia, diabetes mellitus, cerebral infarction, CAD, and myocardial infarction were associated with an significantly increased incidence of coronary plaques (P<0.01). The Framingham score, LDL, HCY, IMT, HDL and TC were also significantly correlated with the severity of the coronary plaques (P<0.05). The ROC curves showed that Framingham risk score (0.845), Cr (0.766), HCY (0.697), IMT (0.693) and HDL (0.316) had greater predictive value for the occurrence of coronary plaques (P<0.001)., Conclusion: The Framingham risk score, Cr, HCY, IMT and HDL are validated by CCTA as the major coronary risk factors and can be used for screening of CAD.

Objective: To investigate whether direct administration of adenoviral vectors (Ad) containing the complementary deoxyribonucleic acid (cDNA) of vascular endothelial growth factor 165 (Ad-VEGF165) induces porcine coronary collateral vessel formation, improves regional myocardial perfusion and function and is safe., Methods: Three weeks after miniature swine underwent left thoracotomy and placement of an Ameroid constrictor on the left circumflex coronary artery (LCX), Ad-VEGF165 (n = 6) or the control, Ad expressing beta-galactosidase cDNA (Ad-Gal, n = 6), was directly administered into the ischemic myocardium in the circumflex distribution. All animals were sacrificed 4 wk after the second surgery. Myocardial perfusion and function were assessed by electrocardiogram-gated single photon emission computed tomography (GSPECT) imaging. Ex vivo coronary angiography was performed to examine collateral vessels. Toxicity was assessed by blood analyses on the day just before (day 0) and on day 1, 3, 7, 28 after vector delivery and by vascular, myocardial and liver histology after sacrifice., Results: GSPECT imaging 4 wk after administration of Ad-VEGF165 demonstrated significant reduction in ischemic area (P < 0.01) and rest ischemic severity (P < 0.01) and significant improvement in the left ventricular ejection fraction (P < 0.01) and regional wall motion (P < 0.05) compared with that of Ad-Gal and before administration of Ad-VEGF165. Collateral vessel development assessed by coronary angiography was significantly greater in the Ad-VEGF165 group than in the Ad-Gal group (P < 0.05). General safety parameters, including routine blood parameters, liver and kidney function and cardiac specific parameters demonstrated no difference between Ad-VEGF165 and Ad-Gal animals except for the red blood cell count on day 28 (P < 0.05) and blood urea nitrogen on day 7 (P < 0.05). Only transient elevations in creatine phosphokinase (P < 0.05) and aspartate transaminase (P < 0.05) on day 1 were revealed compared with that before vector administration in both groups. Histologically, no atherosclerotic lesion in the circumflex and no inflammation in liver were revealed and only a small myocardial necrosis was observed in one Ad-VEGF165 animal (area < or = 20%) and one Ad-Gal animal (area < 10%)., Conclusions: Ad-VEGF165 can induce coronary collateral vessel formation, improve regional myocardial perfusion and function and is safe by means of direct injection, which suggesting that this strategy may be useful in treating human ischemic heart disease.