BACKGROUND Unfractionated heparin(UFH)is routinely used during coronary angiography,but the optimal dosing strategy for diagnostic coronary physiology procedures such as fractional flow reserve or microvascular assess...BACKGROUND Unfractionated heparin(UFH)is routinely used during coronary angiography,but the optimal dosing strategy for diagnostic coronary physiology procedures such as fractional flow reserve or microvascular assessment in stable patients remains unclear.While weight-based dosing is standard in percutaneous coronary intervention,a fixed-dose approach may simplify workflow.AIM To compare bleeding and thromboembolic outcomes between fixed-dose and weight-based UFH during diagnostic coronary physiology procedures without percutaneous coronary intervention.METHODS We conducted a retrospective single-center study of 128 patients undergoing fractional flow reserve or microvascular testing from January 2021 to February 2024.Patients received either fixed-dose(5000 IU)or weight-based(70-100 IU/kg)UFH.The primary outcome was a composite of thromboembolic complications:Radial artery occlusion,stroke,or periprocedural myocardial infarction.Secondary outcomes included bleeding(Bleeding Academic Research Consortium criteria),association with patient characteristics,access site,and length of stay.RESULTS Of 128 patients,78 received fixed-dose and 50 received weight-based UFH.No thromboembolic events occurred in either group.Bleeding(all Bleeding Academic Research Consortium 1-2)occurred in 15%overall,with no significant difference between groups(15%vs 12%,P=0.47).No significant association between bleeding and patient age,sex,weight,body mass index,access site,antiplatelet,or anticoagulant use.Median hospital stay was 1 day in both groups.CONCLUSION In this exploratory study,a fixed 5000 IU UFH regimen appeared to be a safe and practical alternative to weightbased dosing in diagnostic coronary physiology procedures.Larger prospective studies are warranted to confirm these findings.展开更多
Microvascular function and oxygen metabolism are central to tissue and organ health.However,label-free methods for imaging oxygen dynamics in three-dimensional(3D)microvascular networks at the level of single red bloo...Microvascular function and oxygen metabolism are central to tissue and organ health.However,label-free methods for imaging oxygen dynamics in three-dimensional(3D)microvascular networks at the level of single red blood cells(RBCs)—the fundamental units of oxygen transport in vivo—remain lacking.Here,we introduce super-resolution functional photoacoustic microscopy(SR-fPAM),which spatiotemporally tracks RBC movements under dualwavelength excitation.SR-fPAM reconstructs super-resolved 3D microvascular architecture comparable to two-photon microscopy while providing quantitative measurements of RBC flow and oxygenation.In live mice,SR-fPAM revealed redistribution of oxygen and hemodynamics across 3D microvascular networks following a single-vessel stroke.These findings establish SR-fPAM as an enabling tool that bridges a critical gap in oxygen-metabolism imaging and opens new avenues for studying microvascular health and disease with unprecedented functional insights.展开更多
Objective:To investigate the potential protective effect of Shexiang Tongxin dropping pills(STDP)on ischemia-reperfusion injury and its underlying mechanisms in improving endothelial cell function in coronary microvas...Objective:To investigate the potential protective effect of Shexiang Tongxin dropping pills(STDP)on ischemia-reperfusion injury and its underlying mechanisms in improving endothelial cell function in coronary microvascular disease(CMVD).Methods:A rat model of myocardial ischemia-reperfusion injury with CMVD was established using ligation and reperfusion of the left anterior descending artery.The effect of STDP(21.6 mg/kg)on cardiac function was evaluated using echocardiography,hematoxylin-eosin staining,and Evans blue staining.The effects of STDP on the microvascular endothelial barrier were assessed based on nitric oxide production,endothelial nitric oxide synthase expression,structural variety of tight junctions(TJs),and the expression of zonula occludens-1(ZO-1),claudin-5,occludin,and vascular endothelial(VE)-cadherin proteins.The mechanisms of STDP(50 and 100 ng/mL)were evaluated by examining the expression of sphingosine 1-phosphate receptor 2(S1PR2),Ras Homolog family member A(RhoA),and Rho-associated coiled-coil-containing protein kinase(ROCK)proteins and the distribution of ZO-1,VE-cadherin,and Factin proteins in an oxygen and glucose deprivationeoxygenation model.Results:The administration of STDP on CMVD rat model significantly improved cardiac and microvascular endothelial cell barrier functions(all P<.05).STDP enhanced the structural integrity of coronary microvascular positioning and distribution by clarifying and completing TJs and increasing the expression of ZO-1,occludin,claudin-5,and VE-cadherin in vivo(all P<.05).The S1PR2/RhoA/ROCK pathway was inhibited by STDP in vitro,leading to the regulation of endothelial cell TJs,adhesion junctions,and cytoskeletal morphology.Conclusion:STDP showed protective effects on cardiac impairment and microvascular endothelial barrier injury in CMVD model rats induced by myocardial ischemia-reperfusion injury through the modulation of the S1PR2/RhoA/ROCK pathway.展开更多
摘要BACKGROUND Unfractionated heparin(UFH)is routinely used during coronary angiography,but the optimal dosing strategy for diagnostic coronary physiology procedures such as fractional flow reserve or microvascular assessment in stable patients remains unclear.While weight-based dosing is standard in percutaneous coronary intervention,a fixed-dose approach may simplify workflow.AIM To compare bleeding and thromboembolic outcomes between fixed-dose and weight-based UFH during diagnostic coronary physiology procedures without percutaneous coronary intervention.METHODS We conducted a retrospective single-center study of 128 patients undergoing fractional flow reserve or microvascular testing from January 2021 to February 2024.Patients received either fixed-dose(5000 IU)or weight-based(70-100 IU/kg)UFH.The primary outcome was a composite of thromboembolic complications:Radial artery occlusion,stroke,or periprocedural myocardial infarction.Secondary outcomes included bleeding(Bleeding Academic Research Consortium criteria),association with patient characteristics,access site,and length of stay.RESULTS Of 128 patients,78 received fixed-dose and 50 received weight-based UFH.No thromboembolic events occurred in either group.Bleeding(all Bleeding Academic Research Consortium 1-2)occurred in 15%overall,with no significant difference between groups(15%vs 12%,P=0.47).No significant association between bleeding and patient age,sex,weight,body mass index,access site,antiplatelet,or anticoagulant use.Median hospital stay was 1 day in both groups.CONCLUSION In this exploratory study,a fixed 5000 IU UFH regimen appeared to be a safe and practical alternative to weightbased dosing in diagnostic coronary physiology procedures.Larger prospective studies are warranted to confirm these findings.
基金supported in part by the National Institutes of Health(NS099261,NS120481,NS125677,and AG079503 to S.H.,P41GM135018 to H.F.Z.and C.S.)the National Science Foundation(202988 to S.H.)+2 种基金the Chan Zuckerberg Initiative Frontiers of Imaging Award(2020-226174 to S.H.)Washington University’s Imaging Sciences Pathway Fellowship(to Z.W.and J.H.)supported by the U.S.DOE,Office of Basic Energy Sciences,under Contract No.DE-AC02-06CH11357.
摘要Microvascular function and oxygen metabolism are central to tissue and organ health.However,label-free methods for imaging oxygen dynamics in three-dimensional(3D)microvascular networks at the level of single red blood cells(RBCs)—the fundamental units of oxygen transport in vivo—remain lacking.Here,we introduce super-resolution functional photoacoustic microscopy(SR-fPAM),which spatiotemporally tracks RBC movements under dualwavelength excitation.SR-fPAM reconstructs super-resolved 3D microvascular architecture comparable to two-photon microscopy while providing quantitative measurements of RBC flow and oxygenation.In live mice,SR-fPAM revealed redistribution of oxygen and hemodynamics across 3D microvascular networks following a single-vessel stroke.These findings establish SR-fPAM as an enabling tool that bridges a critical gap in oxygen-metabolism imaging and opens new avenues for studying microvascular health and disease with unprecedented functional insights.
基金supported the National Natural Science Foundation of China(81930113).
摘要Objective:To investigate the potential protective effect of Shexiang Tongxin dropping pills(STDP)on ischemia-reperfusion injury and its underlying mechanisms in improving endothelial cell function in coronary microvascular disease(CMVD).Methods:A rat model of myocardial ischemia-reperfusion injury with CMVD was established using ligation and reperfusion of the left anterior descending artery.The effect of STDP(21.6 mg/kg)on cardiac function was evaluated using echocardiography,hematoxylin-eosin staining,and Evans blue staining.The effects of STDP on the microvascular endothelial barrier were assessed based on nitric oxide production,endothelial nitric oxide synthase expression,structural variety of tight junctions(TJs),and the expression of zonula occludens-1(ZO-1),claudin-5,occludin,and vascular endothelial(VE)-cadherin proteins.The mechanisms of STDP(50 and 100 ng/mL)were evaluated by examining the expression of sphingosine 1-phosphate receptor 2(S1PR2),Ras Homolog family member A(RhoA),and Rho-associated coiled-coil-containing protein kinase(ROCK)proteins and the distribution of ZO-1,VE-cadherin,and Factin proteins in an oxygen and glucose deprivationeoxygenation model.Results:The administration of STDP on CMVD rat model significantly improved cardiac and microvascular endothelial cell barrier functions(all P<.05).STDP enhanced the structural integrity of coronary microvascular positioning and distribution by clarifying and completing TJs and increasing the expression of ZO-1,occludin,claudin-5,and VE-cadherin in vivo(all P<.05).The S1PR2/RhoA/ROCK pathway was inhibited by STDP in vitro,leading to the regulation of endothelial cell TJs,adhesion junctions,and cytoskeletal morphology.Conclusion:STDP showed protective effects on cardiac impairment and microvascular endothelial barrier injury in CMVD model rats induced by myocardial ischemia-reperfusion injury through the modulation of the S1PR2/RhoA/ROCK pathway.