SCOR IN CORONARY AND VASCULAR DISEASES

这是一项探索基础病理生理学的多学科建议。 和缺血和梗死心肌的生物化学，并实施知识 将这种疾病的病理生理学纳入计划，以：(1)在 严重缺血事件的风险和(2)检查改善 对表现为缺血性心脏病的患者的处理。对中国传统文化的研究 缺血心肌的代谢将利用核磁共振 识别能量状态的快速变化。形状变化的重要性， 心肌松弛特性与缺血和瘢痕心肌的关系 左心功能的决定因素将在动物模型和 天哪。前列腺素在脑缺血中的作用及其作用机制 将探索心脏活性药物。我们将尝试识别解剖结构 侵袭性和非侵袭性心脏性猝死的预测因素 探讨危险因素与解剖冠脉病变的关系 预后。我们将探索一种新的自动医疗设备的治疗潜力 人体植入式除颤器。随机临床干预 试验将包括：(1)硝酸甘油联合心得安用于低风险患者 急性脑梗塞(与安慰剂相比)；(2)主动脉内球囊反搏和 硝酸甘油在急性脑梗塞高危患者中的应用(与常规治疗相比) (3)新的心肺复苏技术与传统的心肺复苏技术；(4)缓慢的 通道阻滞剂(与安慰剂相比)治疗不稳定型心绞痛；(5)a 膜活性抗心律失常药与安慰剂在急性心肌梗死存活者中的比较 被评估为随后猝死的高风险和(6)使用 减少冠脉搭桥术并发症的围手术期用药。 核心支持实验室包括：病理学、核心脏病、 超声心动图和药理学。

This is a multidisciplinary proposal to explore the fundamental pathophysiology and biochemistry of ischemic and infarcted myocardium and to implement knowledge of the pathophysiology of this disease into programs to: (1) identify those at risk of serious ischemic events and (2) examine means for improving the management of those patient manifesting ischemic heart disease. Studies of the metabolism of ischemic myocardium will utilize nuclear magnetic resonance to identify rapid changes in energy state. The importance of shape changes, relaxation characteristics of myocardium and ischemic and scarred myocardium as determinants of left ventricular function will be examined in animal models and man. The role of prostaglandins in ischemia and in the mechanism of action of cardiac active drugs will be explored. We will attempt to identify the anatomic predictors of sudden cardiac death invasively and non-invasively as well as explore risk factor profile in relationship to anatomic coronary lesions and prognosis. We will explore the therapeutic potential of a new automatic implantable defibrillator device in man. Randomized clinical intervention trials will include: (1) nitroglycerin plus propranolol in low risk patients with acute infarction (vs. placebo); (2) intraaortic balloon pumping and nitroglycerin in high risk patients with acute infarction (vs. routine therapy); (3) new vs. conventional cardiopulmonary resuscitative techniques; (4) a slow channel blocker (vs. placebo) in patients with unstable angina pectoris; (5) a membrane active anti-arrhythmic agent vs. placebo in survivors of acute infarcts assessed to be at high risk of subsequent sudden death and (6) use of perioperative agents for decreasing complications of coronary bypass surgery. Core support laboratories include: Pathology, Nuclear Cardiology, Echocardiography and Pharmacology.