SCOR IN CORONARY AND VASCULAR DISEASES

这是一个多学科的建议，探讨基本的病理生理学 缺血和梗死心肌的生物化学和实施知识 这种疾病的病理生理学的程序，以：（1）确定那些在 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患者的管理。 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， 心肌及缺血、瘢痕心肌的舒张特性 将在动物模型中检查左心室功能的决定因素， 伙计 灯盏花素在缺血中的作用及其在抗心肌缺血药物作用机制中的作用 将探索心脏活性药物。 我们会尝试找出 有创和无创性心脏性猝死的预测因子， 探索与解剖冠状动脉病变相关的风险因素特征， 预后 我们将探索一种新的自动化的治疗潜力， 人体植入式除颤器：随机临床干预 试验将包括：（1）硝酸甘油加普萘洛尔在低风险患者中 急性梗死（与安慰剂相比）;（2）主动脉内球囊反搏， 硝酸甘油在急性梗死高危患者中的应用（与常规治疗相比）; (3)新的与传统的心肺复苏技术;（4）一个缓慢的 不稳定型心绞痛患者中的通道阻滞剂（与安慰剂相比）;（5）a 急性梗死幸存者中膜活性抗血栓剂与安慰剂的比较 被评估为随后猝死的高风险;（6）使用 减少冠状动脉搭桥手术并发症的围手术期药物。 核心支持实验室包括：病理学，核心脏病学， 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.