• Title/Summary/Keyword: Cardiac ischemia

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Osstem Cardiotec Centum Stent Versus Xience Alpine Stent for De Novo Coronary Artery Lesion: A Multicenter, Randomized, Parallel-Designed, Single Blind Test

  • Chang-Hwan Yoon;Jihong Jang;Seung Ho Hur;Jun-Hee Lee;Seung Hwan Han;Soon-Jun Hong;Kiyuk Chang;In-Ho Chae
    • Korean Circulation Journal
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    • v.52 no.5
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    • pp.354-364
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    • 2022
  • Background and objectives: To compare the safety and efficacy of a new everolimus-eluting stent with an abluminal-coated biodegradable polymer (Osstem Cardiotec Centum) with those of the Xience Alpine stent (Xience). Methods: This randomized, prospective, multicenter, parallel-designed, single-blind trial was conducted among patients with myocardial ischemia undergoing percutaneous coronary intervention (PCI) from 21st September 2018 until 3rd July 2020. The primary efficacy endpoint was in-segment late lumen loss (LLL) at 270 days after the procedure and the primary safety endpoints were major adverse cardiac events (MACE), composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: We enrolled 121 patients and analyzed 113 patients who finished 270 days of follow-up for the primary efficacy endpoint. The mean age of the participants was 66.8 years. As for the primary efficacy endpoint, LLL of the Osstem Cardiotec Centum group was 0.09±0.13 mm and that of the Xience group was 0.12±0.14 mm (upper limit of 1-sided 95% confidence interval, 0.02; p for non-inferiority, 0.0084). This result demonstrates the non-inferiority of the Osstem Cardiotec Centum. As for the primary safety endpoint, MACE occurred in one patient (1.59% of the Xience group). Meanwhile, no MACE occurred in the Osstem Cardiotec Centum group. Conclusions: The Osstem Cardiotec Centum is non-inferior to the Xience Alpine® stent and is confirmed to be safe. It could be safely and effectively applied to patients with coronary artery disease undergoing PCI.

Pre-and Post-ishemic Changes of the Constituent Enzymes in Isolated Rabbit's Myocardium (허혈전후 적출 가토 심근내의 구성 효소의 변화)

  • 천수봉;전도환;이재성;김송명
    • Journal of Chest Surgery
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    • v.33 no.2
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    • pp.117-124
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    • 2000
  • Background: Nucleoside transport inhibitor(NTI) Keeps AMP, ADP, ATP levels high in myocytes by inhibiting adenosine cataboilsm so that it may preserve the myocardial contractability during ischemia In this study we investigated the effects of cyclic AMP phosphodiesterase inhibor(C-AMP PDSI) and S-P-nitrobenzyl-6 -thioniosine(NBT; a sort of NIT) on myocadial preservation and changes of constituent enzyme. Material and method: Twenty-six isolated rabbit hearts were perfused with Krebs-Henseleit buffer solution for 20 minutes arrested for 20 minutes and ten reperfused for 30 minutes. The following four groups were prepared and hemodynamic changes coronary effluent lactate dehydrogenase (LDH) a-hydroxybutylic accid(a-HBD) levels and myocardial LDH creatine kinase-MB (CK-MB) adenosine deaminase(ADA) a-HBD levels and myocardial LDH creatine kinase-MB (CK-MB) adenosine deaminase(ADA) a-HBD levels were analysed before and after cardiac arest ; Group I(control) ; the heart was only perfused with K-H ; Group II ; the heart was perfused with K-H including C-AMP PDSI(Amrinone 25mg/L); Group III ; the heart was perfused with K-H including NBT(4.19mg/L) ; Group IV ; the heart was perfused with K-H including C-AMP PDSI + NBT. Result : Left venticular developed pressure(LVDP) at 10 minutes of the equilibrium was significantly higher in group III(72.1$\pm$5.3 mmHg p<0.01) and group III(72$\pm$5.6 mmHg P<0.025) as compared with group I (40.8$\pm$4.7mmHg) and LVDP at 20 minutes of the reperfusion was significantly higher in group II(74$\pm$5.3mmHg p<0.01) and group III(72$\pm$5.6mmHg p<0.025) as compared with group I (44.2$\pm$4.6mmHg). Percentage recovery of LVDP at the reperfusion was the highest in group II(123.3%) Percentage recovery of coronary flow at the equilibrium reperfusion were higher in group II(310%, 270%) group III(230%, 290%) group IV(310%, 280%) as compared with group I (100%) respectively. Myocadial LDH level was significant lower in group IV(33495$\pm$1802 IU/gm p<0.04) as compared with group I(48767$\pm$1421 IU/gm) Myocadial CK-MB level was significant higher in group II(74820$\pm$1421 IU/gm) compared with group I (45450$\pm$1737 IU/gm) Myocadial ADA level was significant higher group IV(1215$\pm$8 IU/gm p<0.05) compared with group I(125$\pm$15 IU/gm) but there was no significant difference between group I and group II ,III, IV in changes of coronary effluent LDH, a-HBD levels. Conclusion: C-AMP PDSI solely appears to have a better effect on myocardial preservation after ischemia than NBT but with no synergistic effect and it could keep CK-MB leve high in myocardial tissues.

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Human Recombinant Apyrase Therapy Protects Against Myocardial Ischemia/Reperfusion Injury and Preserves Left Ventricular Systolic Function in Rats, as Evaluated by 7T Cardiovascular Magnetic Resonance Imaging

  • Ziqian Xu;Wei Chen;Ruzhi Zhang;Lei Wang;Ridong Chen;Jie Zheng;Fabao Gao
    • Korean Journal of Radiology
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    • v.21 no.6
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    • pp.647-659
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    • 2020
  • Objective: The occurrence of intramyocardial hemorrhage (IMH) and microvascular obstruction (MVO) in myocardial infarction (MI), known as severe ischemia/reperfusion injury (IRI), has been associated with adverse remodeling. APT102, a soluble human recombinant ecto-nucleoside triphosphate diphosphohydrolase-1, can hydrolyze extracellular nucleotides to attenuate their prothrombotic and proinflammatory effects. The purpose of this study was to temporally evaluate the therapeutic effect of APT102 on IRI in rats and to elucidate the evolution of IRI in the acute stage using cardiovascular magnetic resonance imaging (CMRI). Materials and Methods: Fifty-four rats with MI, induced by ligation of the origin of the left anterior descending coronary artery for 60 minutes, were randomly divided into the APT102 (n = 27) or control (n = 27) group. Intravenous infusion of APT102 (0.3 mg/kg) or placebo was administered 15 minutes before reperfusion, and then 24 hours, 48 hours, 72 hours, and on day 4 after reperfusion. CMRI was performed at 24 hours, 48 hours, 72 hours, and on day 5 post-reperfusion using a 7T system and the hearts were collected for histopathological examination. Cardiac function was quantified using cine imaging and IMH/edema using T2 mapping, and infarct/MVO using late gadolinium enhancement. Results: The extent of infarction (p < 0.001), edema (p < 0.001), IMH (p = 0.013), and MVO (p = 0.049) was less severe in the APT102 group than in the control group. IMH size at 48 hours was significantly greater than that at 24 hours, 72 hours, and 5 days after reperfusion (all p < 0.001). The left ventricular ejection fraction (LVEF) was significantly greater in the APT102 group than in the control group (p = 0.006). There was a negative correlation between LVEF and IMH (r = -0.294, p = 0.010) and a positive correlation between IMH and MVO (r = 0.392, p < 0.001). Conclusion: APT102 can significantly alleviate damage to the ischemic myocardium and microvasculature. IMH size peaked at 48 hours post reperfusion and IMH is a downstream consequence of MVO. IMH may be a potential therapeutic target to prevent adverse remodeling in MI.

Antithrombotic Therapy for Ischemic Stroke (허혈성 뇌졸중에서의 항혈전 치료)

  • Hah, Jung-Sang;Lee, Jun
    • Journal of Yeungnam Medical Science
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    • v.20 no.1
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    • pp.1-12
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    • 2003
  • Ischemic stroke is among the principal causes of death and disability in the elderly. Although control of blood pressure, decreased cigarette smoking, and modified dietary habits are among important reasons for stroke decline, the use of antithrombotic therapy, rigorously prescribed. Several antiplatelet agents are approved to reduce the risk of recurrent stroke. Aspirin is the best-studied and most widely used antiplatelet agent for stroke prevention; it provides approximately 15% to 25% relatively risk reduction for secondary prevention of stroke or the major vascular death. Combining 2 antiplatelet agents with different mechanism of action was demonstrated to provide a substantial increase in efficacy in several studies. Anticoagulation should be considered first with potential cardiac sources of embolism. Heparin reduces development of erythrocyte-fibrin thrombi that form in regions of vascular stasis especially within the heart, in severely stenosed arteries sometimes engrafted on white thrombi, in acute arterial occlusion. Heparin should not be indiscriminately given to all acute brain ischemia patients, but may contribute to treatment of large artery occlusion and severe stenosis, cardiogenic embolism with a high acute recurrence risk, and dural sinus and cerebral venous thromobosis.

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Protective Effects of Ginkgolide B on Reperfusion of the Isolated Perfused Guinea Pig Heart (Ginkgolide B의 Guinea Pig 적출 심장에 대한 허혈 유발후 Reperfusion시의 보호 작용에 관한 연구)

  • Kwon, Kwang-il;Lee, Young-sin;Lee, Jae-heung
    • Korean Journal of Clinical Pharmacy
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    • v.3 no.2
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    • pp.147-155
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    • 1993
  • The cardiac effects of PAF antagonist Ginkgolide B(BN 52051) have been investigated on the isolated perfused guinea pig hearts maintained at the constant hydrostatic perfusion pressure of 80 cm water. PDE(Phosphodiesterase) inhibitor KR-30289 was used as a positive control to see the positive inotropic effects on the perfused hearts. In this expriments, Ginkgolide $B(10^{-5}-SM)$ showed negative inotropic effects by decreasing of LVP, LVDP, LV dp/dt, HR and RPP(Rate Pressure Product). Ginkgolide B also decreased the number of extrasystole by $51.9\%(from\;23.75\pm9.22/min\;to\;11.43\pm435/min)$ induced by global ischemia and reperfusion. The rate, [-dp/dt]/[+dp/dt] increased in preischemia but decreased in postischemia. 1n the separated study the injection of 1ml of Ginkgolide B$(10^{-4M})$ on the isolated heart, increased coronary flow(CF) by $11.8\%(from\;7.5\pm7.65ml/min\;to\;8.5\pm0.29ml/min)$ and decreased the number of extrasystole by $47.6\%(from\;21\pm5.92/min\;to\;11\pm5.27/min)$. In conclusion, Ginkgolide B showed antiarrhythmic and protective effects by decreasing the number of extrasystole and by increasing the coronary flow, respectively.

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Bryonia alba and Its Biochemical, Pharmacological Actions and Toxicity

  • Lee, Dong Wook;Aprikian, G.V.;Sohn, Hyung-Ok
    • Journal of the Korean Society of Tobacco Science
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    • v.35 no.1
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    • pp.56-61
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    • 2013
  • Bryonia alba L. belongs to the Cucurbitaceae family and grows in Europe, Asia, America, Africa, Russia, Ukraina and Armenia. The root of Bryonia alba has been used for neuropsychical diseases, psychosis, hysteria, paralysis, epilepsy, vertigo, headache, migrain, melancholia, forgetfulness, sadness, absent mindedness, delirium, cardiovascular disease, ischemia, gastrointestinal diseases, gastric ulcer and respiratory diseases. The root of Bryonia alba contains an oxidized tetra cyclic triterpens, cucurbitaceous, polyunsaturated hydrocarbons, phospholipids, phosphatidylcholines, ethereal oils, fatty acids, a great amount of amino acids, alcohol soluble enzymes, sugar, carotene, vitamin C and E. Bryonia alba increases coronary blood-flow and the amplitude of cardiac contractions. Bryonia alba has an antistressor action and increases the working capacity. Bryonia alba activates connective tissue cells. Bryonia alba markedly increases the oxygen consumption by young and senescent rat brain, liver as well as heart mitochondrial fraction as Korean Ginseng. Bryonia alba decreases lipid peroxidation after immobilization stress. In conclusion, Bryonia alba like Ginseng used in traditional medicine came from ancient time has a good perspective administration as prophylactic and medical remedy, as remedy of lot of diseases in modern medicine.

Canonical Transient Receptor Potential Channels and Their Link with Cardio/Cerebro-Vascular Diseases

  • Xiao, Xiong;Liu, Hui-Xia;Shen, Kuo;Cao, Wei;Li, Xiao-Qiang
    • Biomolecules & Therapeutics
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    • v.25 no.5
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    • pp.471-481
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    • 2017
  • The canonical transient receptor potential channels (TRPCs) constitute a series of nonselective cation channels with variable degrees of $Ca^{2+}$ selectivity. TRPCs consist of seven mammalian members, TRPC1, TRPC2, TRPC3, TRPC4, TRPC5, TRPC6, and TRPC7, which are further divided into four subtypes, TRPC1, TRPC2, TRPC4/5, and TRPC3/6/7. These channels take charge of various essential cell functions such as contraction, relaxation, proliferation, and dysfunction. This review, organized into seven main sections, will provide an overview of current knowledge about the underlying pathogenesis of TRPCs in cardio/cerebro-vascular diseases, including hypertension, pulmonary arterial hypertension, cardiac hypertrophy, atherosclerosis, arrhythmia, and cerebrovascular ischemia reperfusion injury. Collectively, TRPCs could become a group of drug targets with important physiological functions for the therapy of human cardio/cerebro-vascular diseases.

The Effects of Intracellular Monocarboxylates on the ATP-sensitive Potassium Channels in Rabbit Ventricular Myocytes

  • Kim, Na-Ri;Han, Jin;Kim, Eui-Yong;Ho, Won-Kyung;Earm, Yung E.
    • The Korean Journal of Physiology and Pharmacology
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    • v.2 no.5
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    • pp.581-589
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    • 1998
  • A regulating mechanism of the ATP-sensitive potassium channels $(K_{ATP}\;channels)$ is yet to fully explained. This study was carried out to investigate the effects of intracellular application of monocarboxylates (acetate, formate, lactate, and pyruvate) on $K_{ATP}$ channels in isolated rabbit ventricular myocytes. Single channel currents of $K_{ATP}$ channels were recorded using the excised inside-out or permeabilized attached (open-cell) patch-clamp technique at room temperature. Intracellular application of acetate, formate and pyruvate led to an inhibition of channel activity, whereas intracellular application of lactate increased channel activity. These effects were reversible upon washout. Analysis of single channel kinetics showed that monocarboxylates did not affect open-time constant and close-time constant. These results suggest that monocarboxylates participate in modulating $K_{ATP}$ channels activity in cardiac cells and that modulation of $K_{ATP}$ channels activity may resolve the discrepancy between the low $K_i$ in excised membrane patches and high levels of intracellular ATP concentration during myocardial ischemia or hypoxia.

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Successful Damage Control Resuscitation with Resuscitative Endovascular Balloon Occlusion of the Aorta in a Pediatric Patient

  • Heo, Yoonjung;Chang, Sung Wook;Kim, Dong Hun
    • Journal of Trauma and Injury
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    • v.33 no.3
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    • pp.170-174
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    • 2020
  • Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered an emerging adjunct therapy for profound hemorrhagic shock, as it can maintain temporary stability until definitive repair of the injury. However, there is limited information about the use of this procedure in children. Herein, we report a case of REBOA in a pediatric patient with blunt trauma, wherein the preoperative deployment of REBOA played a pivotal role in damage control resuscitation. A 7-year-old male patient experienced cardiac arrest after a motor vehicle accident. After 30 minutes of cardiopulmonary resuscitation, spontaneous circulation was achieved. The patient was diagnosed with massive hemoperitoneum. REBOA was then performed under ongoing resuscitative measures. An intra-aortic balloon catheter was deployed above the supraceliac aorta, which helped achieved permissive hypotension while the patient was undergoing surgery. After successful bleeding control with small bowel resection for mesenteric avulsion, thorough radiologic evaluations revealed hypoxic brain injury. The patient died from deterioration of disseminated intravascular coagulation. Although the patient did not survive, a postoperative computed tomography scan revealed neither remaining intraperitoneal injury nor peripheral ischemia correlated with the insertion of a 7-Fr sheath. Hence, REBOA can be a successful bridge therapy, and this result may facilitate the further usage of REBOA to save pediatric patients with non-compressible torso hemorrhage.

Legal Analysis and Development of managerial guideline to nursing activities related to observation (간호사의 경과관찰업무에 대한 판례분석 및 관리지침 개발)

  • Kim, In-Sook;Kim, Ki-Kyoung;Kim, Dae-Ran
    • Journal of Korean Academy of Nursing Administration
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    • v.8 no.2
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    • pp.273-281
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    • 2002
  • Purpose. The study was done to develop nursing guidelines to prevent nursing negligence in the clinical setting that would lead to malpractice. Method. A comprehensive review of the literature and focus groups interviews were used to search for malpractice cases related to "observation", one of the most basic nursing activities. The cases were analyzed with respect to nursing practice and a legal expert was consulted on the content. Results. 4 malpractice cases related to observation negligence were selected for this study; 1) a case of failing to observe dyspnea after a thyroidectomy, 2) a case of failing to observe a depressed patient for suicide attempts, 3) a case of failing to observe a VP shunt obstruction, 4) a case of failing to observe a cardiac ischemia after a bronchoscopy. 11 guidelines were developed for clinical nurses and 13 guidelines for nursing managers. Conclusion. These guidelines are useful in preventing malpractice due to nursing negligence. Therefore nurses need to apply them to their practices and continue to make an effort to develop guidelines for other malpractice situations.

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