Objective： Angiogenic therapy is emerging as a potential strategy for the treatment of ischemic heart disease but is limited by a relatively short half-life of growth factors. Fibrin glue （FG） provides a reservoir for controlledrelease of growth factors. The aim of this study was to evaluate the effects of basic flbroblast growth factor （bFGF） incorporating FG on angiogenesis and cardiac performance in a canine infarct model. Methods： Acute myocardial infarction was induced by ligation of the left anterior descending coronary artery （LAD）. Group Ⅰ （n=6） underwent ligation of LAD alone. In Group Ⅱ, transmural channels were created in the infarct area （n=6）. In Group Ⅲ, nontransmural channels were created to locate FG cylinders containing bFGF （n=6）. Eight weeks after operation, myocardial perfusion was assessed by single photon emission computed tomography, cardiac function by echocardi- ography, and vascular development by immunohistochemical staining. Results： Total vascular density and the number of large vessels （internal diameter ≥50 pro） were dramatically higher in Group Ⅲ than in Groups Ⅰ and Ⅱ at eight weeks. Only the controlled-release group exhibited an improvement in regional myocardial perfusion associated with lower defect score. Animals in Group Ⅲ presented improved cardiac regional systolic and diastolic functions as well as global systolic function in comparison with the other two groups. Conclusions： Enhanced and sustained angiogenic response can be achieved by controlled-release bFGF incorporating FG within transmyocardial laser channels, thus enabling improvement in myocardial perfusion and cardiac function.
Shao-ping NIEXiao WANGShi-bin QIAOQiu-tang ZENGJu-quan JIANGXiao-qing LIUXiang-ming ZHUGuo-xiang CAOChang-sheng MA
Background Coronary slow flow phenomenon （CSFP） is an important, angiographic clinical entity but is lacking non-invasive detecting techniques. This study aimed to elucidate the value of transthoracic Doppler echocardiography （TTDE） in the diagnosis and monitoring of coronary slow flow in left anterior descending （LAD） coronary artery.Methods We consecutively enrolled 27 patients with CSFP in LAD detected by coronary arteriography from August 2009 to April 2010. Thirty-eight patients with angiographically normal coronary flow served as control. Corrected thrombolysis in myocardial infarction （TIMI） frame count （CTFC） was used to document coronary flow velocities. All subjects underwent TTDE within 24 hours after coronary angiography. LAD flow was detected and the coronary diastolic peak velocities （DPV） and diastolic mean velocities （DMV） were calculated.Results Sixty of 65 （92.3%） subjects successfully underwent TTDE. Baseline clinical characteristics were similar between the two groups. Coronary DPV and DMV of LAD were significantly lower in the CSFP group than in the control group （（0.228±0.029） m/s vs. （0.302±0.065） m/s, P=0.000; （0.176±0.028） m/s vs. （0.226±0.052） m/s, P=0.000,respectively）. There was a high inverse correlation between CTFC and coronary DPV and DMV （r=-0.727, P=0.000;r=-0.671, P=0.000, respectively）. Receiver operating characteristic （ROC） curve showed that the area under the curve （AUC） was less than one half for coronary DPV （AUC=0.104） and DMV （AUC=0.204）, respectively.Conclusions In patients with CSFP, there is a high inverse correlation between CTFC and coronary diastolic flow velocities in the LAD coronary artery, as measured by TTDE. The value of TTDE in the monitoring and evaluation of coronary flow in patients with CSFP deserves further investigation.
