The Evaluate Of Effect Of Tong Guan Capsule On Left Ventricular Remodeling After Acute Myocardial Infarction(AMI)

Objective:1. To evaluate the clinical treatment effect of Tong Guan capsule on left ventricular remodeling after Acute Myocardial Infarction.2. To evaluate the treatment effect of Tong Guan capsule on left ventricular remodeling of rats after Acute Myocardial Infarction.Methods:1. the clinical study79 cases diagnosed qi deficiency and blood stasis were randomly divided into 2 groups ,the test group(40 cases) and the control group(39 cases).There was no statistical difference between them .The control group was received appropriately conventional western medicine therapy such as plavix(75mg, po,qd),Aspirin (0.1, po, qd),captopril(12.5mg, po, bid),betaloc(12.5mg, po, qd),lipitor (10mg, po, qn) .Central venous catheter was indwelled preparing the temporary pacemakers or intra-aortic balloon pumping (IABP) if the proximal sector of right Coronary artery was blocked or cardiac hemodynamics was not stable. Plavix(300mg, po),Aspirin(100mg, po) were received 24 hours before surgery of percutaneous transluminal coronary angioplasty (PTCA), and after Surgery ,plavix(75mg, qd),Aspirin(100mg, qd)were took continuously 3 months.Tong Guan capsule(3# ,Tid)was received by the test group 3 months in foundation treatment. We observed the targets of ultrasonic cardiogram, such as LVESVI,LVEF,LVDd,LVSd,IVSd,LPWd,LWMI and the syndrome of qi deficiency and blood stasis on the first day,14th and 84th day after surgery.2. The animal study28 prague Dawley rats surviving AMI, which Was achieved by ligating coronary artery,were divided randomly into AMI control group(n=8),AMI Tong Guan capsule treatment group(n=7) and AMI captopril treatment group(n=7). Sham-operation group(n=6)was also established. The AMI Tong Guan capsule treatment group was received Tong Guan capsule(lg/lOOg) and the AMI captopril group was given captopril(0.5mg/100g).The groups else were given 0.9%NS(3ml).After 4 weeks treatment the following items were measured:①heart weight,left ventricle weight,heart weight index and left ventricle weight index②the ultrasonic cardiogram index: LVDD,LVDS,IVSD,PWD,LVEF,LVFS③angiotensinⅡ,blood plasma aldosterone.Results:1. The targets of ultrasonic cardiogramThe comparison between the control group and the treatment group: The first day after operation ,there was no statistical difference every index .On the 14th or 84th day, every one improved (P＜0.05). The control group contrasted oneself before and after treatment : On the 14th or 84th day, there was statistical difference and the index of LVEF improved remarkably(p＜0.01). The treatment group contrasted oneself before and after treatment: On the 14th or 84th day, therewas statistical difference((P＜0.05)) except the index of IVSD(on the 84th day), and the indexes of LVEF,EDVI,LVDD,LVDS(On the 14th day)improved remarkably(p＜0.01).2. Syndrome of qi deficiency and blood stasis.There was no statistical difference on the 1st day after operation between the control and test group (p＞0.05). On the 14th or 84th day, there was remarkable statistical difference (p＜0.01)between the two groups except the control group on the 84th day(P＞0.05). The control group contrasted oneself before and after treatment : on the 14th day, there was evidently statistical difference(P＜0.01)and on the 84th day there was no statistical difference(P＞0.05).There was remarkable statistical difference (P＜0.01) on the 14th or 84th day of the treatment.3. Heart weight,left ventricle weight,Heart weight index,left ventricle weight index(rats)Compared with the sham group, the four indexes of AMI model groups increased markedly(p＜0.01).The AMI Tong Guan capsule and captopril treatment group increased less than AMI contrasting group (P＜0.01). There was no statistical difference between Tong Guan treatment group and captopril treatment group (p＞0.05).4. Ultrasonic cardiogram of rats :LVDD,LVDS,IVSD,PWD,LVEF,LVFS.Compared with the sham group, about the index of LVDD,LVDS,IVSD,PWD, the model groups increased markedly(p＜0.01)but the items of LVEF,LVFS decreased (P＞0.01). The AMI Tong Guan capsule and captopril treatment group improved less than AMI contrasting group (P＜0.01). There was no remarkable statistical difference between Tong Guan treatment group and captopril treatment group (p＞0.05).2. angiotensinⅡ,blood plasma aldosteron (rats).Compared with the sham group, the two indexes of model groups decreased markedly(p＜0.01).The AMI Tong Guan capsule and captopril treatment group decreased much more than the AMI contrasting group(P＜0.01).There was also remarkable statistical difference(p＜0.01) between Tong Guan and captopril treatment groups about A-Ⅱexcept blood plasma aldosteron(p＞0.05).Conclusion:1. The capsule of Tong Guan can inhibit left ventricular remodeling and improve the syndrome of qi deficiency and blood stasis after coronary intervention in patients with Acute Myocardial Infarction(AMI).2. The capsule of Tong Guan can inhibit left ventricular remodeling of rats with Acute Myocardial Infarction and it seems independent with captopril.3. The mechanism of the capsule of Tong Guan inhibiting Acute Myocardial Infarction probably has relation with anticoagulation,anti--platelet and imroving microcirculation of cardiac muscle.