Abstract:Objective To analyze the relationship of heart rate variability(HRV),brachial-ankle pulse wave velocity(baPWV)and inflammatory factors with blood pressure circadian rhythm in patients with essential hypertension.Methods A retrospective analysis was conducted on the clinical data of 118 patients with essential hypertension admitted to our hospital from January 2022 to January 2024.According to the nighttime blood pressure decline rate,43 patients with non-dipper hypertension were assigned to group A and 75 patients with dipper hypertension to group B.Blood pressure circadian rhythm,HRV parameters,baPWV,and inflammatory factor levels were compared between the two groups.The relationships between nighttime blood pressure decline rate and HRV parameters,baPWV,IL-6,and TNF-α levels were also analyzed.Results Compared with group B,group A had higher 24-hour mean systolic blood pressure(24h SBP),24-hour mean diastolic blood pressure(24h DBP),daytime mean systolic blood pressure(dSBP),daytime mean diastolic blood pressure(dDBP),nighttime mean systolic blood pressure(nSBP),nighttime mean diastolic blood pressure(nDBP)],baPWV,interleukin-6 and tumor necrosis factor(TNF)-α(P<0.05),while the standard deviation of normal RR intervals(SDNN),low frequency power(LF)and LF/HF were lower(P<0.05).There were no significant differences between the two groups in standard deviation of 5-minute mean RR intervals(SDANN),root mean square of difference(rMSSD),percentage of difference>50ms(PNN50)and high frequency power(HF)(P>0.05).Pearson correlation analysis showed that nighttime blood pressure decline rate was negatively correlated with baPWV,IL-6,and TNF-α(P<0.05),and positively correlated with SDNN,LF,and LF/HF(P<0.05).Conclusion The circadian rhythm of blood pressure in patients with essential hypertension is significantly correlated with HRV,baPWV,and inflammatory factors,which are associated with cardiovascular events.

Abstract:Objective To investigate the relationship between instantaneous wave-free ratio(iFR)and fractional flow reserve(FFR)in elderly patients with mild to moderate coronary artery stenosis and its prognostic significance.Methods From January 2020 to May 2022,293 elderly patients with stable coronary artery disease(CAD)who underwent coronary angiography were continuously enrolled in The First Affiliated Hospital of Xi'an Medical College.FFR and iFR were measured by quantitative coronary angiography and intracoronary pressure wire technique.The primary outcome was major adverse cardiovascular events(MACE),and the secondary outcome was defined as a composite of myocardial infarction(MI)and events requiring emergency revascularization.Results The area under ROC curve of iFR as a physiological significance index(FFR≤0.80)was 0.893(95%CI:0.860～0.926,P<0.001),and the corresponding cutoff value was 0.93(specificity 81.2%,sensitivity 81.7%).By Spearman analysis,iFR and FFR were positively correlated(P<0.001).However,a mismatch between iFR and FFR was observed in 18.44%of lesions.Multivariate Logistic regression analysis showed that after adjusting for FFR,estimated glomerular filtration rate,diabetes mellitus,aortic stenosis,high-sensitivity C-reactive protein,lesion location,minimum lumen diameter,and diffuse lesions were still independent influencing factors for iFR(P<0.05).The rates of MACE and MI/need for emergency revascularization in patients with inconsistent FFR and iFR were significantly higher than those in patients with consistent FFR and iFR(P<0.05).Kaplan-Meier analysis showed that compared with patients with iFR>0.93,patients with iFR≤0.93 had significantly worse prognosis in terms of MACE and MI/need for urgent revascularization(P<0.05).However,FFR was not significantly associated with MACE or MI/need for emergency revascularization prognosis(P>0.05).Conclusion iFR and FFR are positively correlated,but there is still a certain degree of inconsistency.In elderly patients with mild to moderate coronary artery stenosis,iFR may provide more information about coronary ischemia and prognosis than FFR,and it may be more useful to develop revascularization strategies and predict adverse events based on iFR than on FFR.

Abstract:Objective To evaluate the influence of left ventricular hypertrophy(LVH)on myocardial mechanics in elderly patients with hypertension by applying two-dimensional speckle tracking imaging(2D-STI).Methods The elderly patients with primary hypertension(n=144)were selected into hypertension group,and according to left ventricular mass index(LVMI),they were divided into LVH group and non-LVH group(NLVH group).The elderly people with no previous cardiovascular and cerebrovascular diseases matching in age and sex were selected into normal control group(NC group).The general clinical data,conventional echocardiographic parameters,left ventricular longitudinal strain(GLS),basal longitudinal strain(BLS),middle longitudinal strain(MLS),and apical longitudinal strain(ALS)were detected and compared in all groups.The factors impacting GLS were observed by using correlation analysis and multiple linear regression analysis.Results GLS decreased in turn from NC group,NLVH group to LVH group(P<0.05).Compared with NC group,BLS and MLS decreased(P<0.05),and ALS had no significant change(P>0.05)in NLVH group and LVH group.Compared with NLVH group,BLS decreased significantly(P<0.05),and MLS and ALS had no significant change(P>0.05)in LVH group.In hypertension group,GLS was negatively correlated to systolic blood pressure(SBP),diastolic blood pressure(DBP),left ventricular posterior wall thickness at end diastole(LVPWD),interventricular septal thickness(IVST),body mass index(BMI),relative wall thickness(RWT),LVMI and E/e'(r=-0.699,-0.220,-0.337,-0.340,-0.430,-0.293,-0.554,-0.408,all P<0.001),and GLS was independently correlated to SBP,BMI and LVMI(P<0.05).Conclusion Compared with NC group,GLS was impaired in varying degrees in NLVH group and LVH group,which is the most severe in LVH group.Compared with NC group,BLS and MLS were impaired in NLVH group and LVH group,and BLS is impaired more severely in LVH group compared with NLVH group.Myocardial hypertrophy has a negative impact on myocardial mechanics in patients with hypertension,and hypertension,obesity high LVMI level are important factors affecting GLS value.

Abstract:Objective To explore the application value of deep learning algorithm(DLA)combined with low-kV and low-dose contrast agent scan(dual-low scan)in coronary CT angiography(CCTA)in overweight patients.Methods A total of 100 overweight patients[body mass index(BMI)≥26 kg/m2]with suspected or confirmed coronary artery disease were prospectively enrolled in Jiaozuo People's Hospital of Henan Province from July to Oct.2024.They were divided into control group(n=50,tube voltage:100 kVp,contrast agent dose:0.7 mL/kg)and experimental group(n=50,tube voltage:80 kVp,contrast agent dose:0.35 mL/kg)using random digital table method.Image reconstruction was performed with 50%adaptive statistical iterative reconstruction(50%ASIR-V)and deep learning image reconstruction-high(DLIR-H)algorithm for 2 groups,respectively,with all other parameters kept consistent.CT values and noise were measured at the proximal,middle and distal segments of the right coronary artery,left anterior descending artery and left circumflex artery,followed by the calculation of signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR).The subjective image quality was evaluated by 2 radiologists using the 5-point Likert scale in 2 groups.The data conforming to normal distribution were analyzed with independent-samples t-test,otherwise the Mann-Whitney U test was used.Kappa test was adopted for consistency analysis of subjective scores.Results There was no statistically significant difference in the baseline data between 2 groups.The mean effective radiation dose and contrast agent dose were 3.70±0.92 mSv and 28.86±4.09 mL,respectively,in experimental group,which were reduced by approximately 26.6%and 48.8%compared with those in control group(5.04±1.58 mSv and 56.41±7.63 mL,respectively;t=-5.157 and-22.517,respectively,P<0.001).However,the image noise of CCTA images was lower,while both SNR and CNR were higher in experimental group than those control group(P<0.05).The experimental group had significantly better subjective scores in noise level,vascular margin and overall image quality than control group(P<0.01),whereas there was no statistically significant difference in lumen contrast score between 2 groups(P=0.075).Conclusion For overweight patients,80kVp combined with DLA improves significantly CCTA image quality,and reduces radiation dose and contrast agent dose.

Abstract:Objective To discuss the association between estimated glucose clearance rate(eGCR)and cardiometabolic multimorbidity(CMM).Methods A total of 7181 participants aged 45 y and above from the China Health and Retirement Longitudinal Study(CHARLS)were included,who had complete data on eGCR at baseline and no CMM.The association between different control levels of eGCR and CMM incidence was analyzed by using Logistic regression analysis.The non-linear relationship between eGCR and CMM incidence was analyzed by using restricted cubic spline(RCS)analysis.Results There were totally 7181 participants included in this study,with a median age of 57 y,among whom 3982 were male and 3199 were female.During a 9-month follow-up,572 participants(7.97%)developed CMM,1614 participants(22.48%)developed heart disease,599 participants(8.34%)experienced stroke,and 1051 participants(14.64%)developed diabetes.The results of restricted cubic spline curve analysis showed a significant negative relationship between eGCR and CMM.The multivariable-adjusted model revealed that a lower eGCR level was significantly correlated to an increased risk of CMM.The results of subgroup analysis indicated that there was a stronger association between eGCR and CMM risk in the married subgroup(P=0.01).Conclusion Persistent low levels of eGCR can serve as one of the important predictors for CMM occurrence.This provides new insights for identifying cardiovascular disease risk factors beyond hyperglycemia in clinical practice,and also offers a scientific basis for eGCR application of in clinical practice.Clinically,monitoring the dynamic changes of eGCR can be used as one of the strategies for early identification of patients at high risk of CMM among middle-aged and elderly populations in China.

Abstract:Objective To evaluate the predictive value of contrast transcranial Doppler(cTCD),contrast trans-thoracic echocardiography(cTTE),and transesophageal echocardiography(TEE)for catheter passage during transcatheter patent foramen ovale(PFO)closure.Methods A retrospective analysis was conducted on 164 patients who successfully underwent transcatheter PFO closure at Fuwai Central China Cardiovascular Hospital between January 2023 and December 2023.All patients were preoperatively screened to exclude organic heart disease and sequentially underwent cTCD,cTTE,and TEE(when necessary)to confirm PFO.Based on intraoperative catheter passage,patients were divided into two groups:Direct passage group(n=109):Catheter successfully passed through the PFO and completed closure in one attempt.Indirect passage group(n=55):Required auxiliary maneuvers(46 cases using a straight-tip supporting catheter,9 cases using guidewire assistance)to complete closure.Preoperative examination results were compared between groups.Receiver operating characteristic(ROC)curves were plotted to analyze the clinical value of preoperative examinations in predicting catheter passage during PFO closure.Results The study included 164 patients[mean age:39.07±15.25 years;64 males(39.02%)].ROC curve analysis revealed significant differences in predictive efficacy among the three modalities:cTCD:AUC=0.685(95%CI:0.598～0.772);cTTE:AUC=0.617(95%CI:0.524～0.710);TEE:AUC=0.776(95%CI:0.696～0.857)(TEE was significantly superior to cTTE,P=0.012);Among combined approaches,TEE+cTCD showed the best predictive performance(AUC=0.775,95%CI:0.705～0.846).Conclusion For predicting catheter passage during PFO closure:cTCD+cTTE demonstrated lower sensitivity but higher specificity than individual cTCD,cTTE,or TEE assessments.TEE combined with either cTCD or cTTE achieved superior specificity.

Abstract:Objective To discuss the relationship between serum trimethylamine N-oxide(TMAO)and S100 calcium binding protein A4(S100A4)and in-stent restenosis after percutaneous coronary intervention(PCI)in patients with unstable angina(UA).Methods A total of 195 UA patients who visited Yantai Yeda Hospital from January 2022 to January 2024 were selected and included in the UA group;additionally,120 healthy volunteers of similar age who underwent physical examinations at the same hospital during the same period were selected and included in the healthy control group.The differences in serum TMAO and S100A4 levels between UA patients after 1 week of treatment and healthy control subjects at the time of their physical examination were measured using enzyme-linked immunosorbent assay(ELISA).Pearson correlation analysis was used to assess the correlation between TMAO and S100A4 levels in UA patients.All UA patients underwent a 1-year follow-up,and those experiencing physical discomfort underwent coronary angiography.Based on whether patients developed ISR,the UA group was divided into ISR and non-ISR groups.The clinical data as well as changes in TMAO and S100A4 levels between ISR and non-ISR groups were compared.Logistic regression analysis was used to identify risk factors for ISR in UA patients,and receiver operating characteristic(ROC)curve analysis was employed to evaluate the predictive efficacy of serum TMAO and S100A4 levels for ISR in UA patients.Results After one week of treatment,UA patients had higher levels of low-density lipoprotein cholesterol,serum TMAO,and S100A4 compared to healthy individuals,while their high-density lipoprotein cholesterol levels were lower than those of the healthy group(P<0.05).Serum TMAO levels in UA patients were positively correlated with S100A4 levels(r=0.560,P<0.001).Coronary angiography results indicated that in the UA group,43 patients developed ISR(ISR group),while 152 patients did not(non-ISR group).HDL cholesterol levels in ISR patients were lower than those in the non-ISR group,whereas stent length,LDL cholesterol,TMAO,and S100A4 levels were higher than those in the non-ISR group(P<0.05).High levels of serum TMAO,S100A4,and longer stent length are risk factors for ISR in UA patients(P<0.05).The area under the curve(AUC)values of serum TMAO,S100A4,and their joint in predicting ISR in UA patients were 0.801,0.781,and 0.879,respectively,the joint prediction performance of two indicators was better than that of a single indicator,and its prediction performance was high(ZTMAO-joint prediction=2.033,ZS100A4 joint prediction=2.560,P=0.042,P=0.010).Conclusion After PCI treatment,UA patients show increased serum TMAO and S100A4 levels.The elevation of these two indicators can lead to a higher risk of ISR in patients.Clinically,the probability of ISR in UA patients after PCI can be effectively assessed by changes in the levels of these two markers.

Abstract:Objective To explore the correlation among neutrophil gelatinase-associated lipocalin(NGAL),adiponectin(APN),soluble suppression of tumorigenicity 2(sST2),C-type natriuretic peptide(CNP)and left ventricular hypertrophy(LVH)in patients with essential hypertension(EH).Methods EH patients(n=102)admitted in the Nineth Hospital of Xi'an City from Jan.2022 to Oct.2024 were divided,according to left ventricular mass index(LVMI),into observation group[n=54,including EH patients complicated by LVH,LVMI≥95 g/m2(female),LVMI≥115 g/m2(male)],and control group[n=48,including EH patients without LVH,LVMI<95 g/m2(female),LVMI<115 g/m2(male)].The levels of serum NGAL,APN,sST2 and CNP,as well as heart function parameters[left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),heart rate(HR),diastolic blood pressure(DBP),systolic blood pressure(SBP)]were compared between 2 groups.The relationship among the levels of serum NGAL,APN,sST2 and CNP,LVMI and heart function was analyzed,and the value of aforementioned serological parameters was evaluated in predicting LVH in EH.Results The levels of serum NGAL,sST2 and CNP and LVMI were higher,and APN was lower in observation group than those in control group(P<0.05).LVEDD,LVESD,HR,SBP and DBP were higher,and LVEF was lower in observation group than those in control group(P<0.05).In EH patients complicated by LVH,APN was negatively correlated to LVMI(P<0.05),and serum NGAL,sST2 and CNP were negatively correlated to LVEF,and positively correlated to LVMI,LVEDD and LVESD(P<0.05).Serum NGAL has the highest efficacy in predicting LVH in EH.When Youden index reached its maximum,the corresponding cut-off value was 15.32 ng/mL,the area under the curve(AUC)was 0.826,sensitivity was 0.91,and specificity was 0.71.NGAL≥15.32 ng/mL,APN≤10.52 mg/L,sST2≥24.49 ng/L and CNP≥21.99 ng/L were risk factors for LVH occurrence in EH patients(P<0.05).Conclusion The levels of serum NGAL,sST2 and CNP are higher and APN level is lower,and are closely correlated to abnormal heart function,and can be used as indicators to predict LVH in EH patient complicated by LVH.

Abstract:Objective To investigate the correlation between expression levels of serum microRNA-499a-5p(miR-499a-5p)and Toll-like receptor 2(TLR2),and major adverse cardiovascular events(MACE)in patients with coronary heart disease(CHD).Methods A total of 130 CHD patients(CHD group)was selected who received treatment in the Department of Cardiovascular Medicine,Anqing Petrochemical Hospital of Nanjing Drum Tower Hospital Group from Aug.2021 to Aug.2022.According to MACE occurrence within 1 y after discharge,they were divided into non-MACE group and t MACE group.In addition,130 healthy people were selected who underwent physical examination in the same hospital during the same period as control group.The severity of coronary artery lesion was evaluated using the Gensini score in CHD patients.The expression levels of serum miR-499a-5p and TLR2 mRNA were detected by qRT-PCR method.The Spearman method was used to analyze the correlation between serum miR-499a-5p and TLR2 mRNA levels,as well as the correlations of each of the two with the Gensini score.Multivariate Logistic regression analysis was applied to identify the influencing factors for MACE in CHD patients.Results Compared with control group,the expression level of miR-499a-5p was significantly decreased in CHD group,while the level of TLR2 was significantly increased(P<0.05).There was a negative correlation between the serum expression levels of miR-499a-5p and TLR2 in CHD patients(r=0.742,P<0.05).The expression level of serum miR-499a-5p was negatively correlated to Gensini score(r=-0.695,P<0.05),and TLR2 was positively correlated to Gensini score(r=0.557,P<0.05)in CHD patients.Compared with non-MACE group,the expression levels of serum miR-499a-5p decreased significantly,and TLR2 expression leveland Gensini score increased significantly in MACE group(P<0.05).The high level of miR-499a-5p was a protective factor(P<0.05),and high levels of TLR2 and Gensini score were risk factors for MACE occurrence(P<0.05).Conclusion The increase of TLR2 and decrease of miR-499a-5p level are closely correlated to MACE occurrence in CHD patients.

Abstract:Objective To explore the relationship between the levels of circulating exosomal miR-32-5p and serine/threonine/tyrosine interacting protein(STYX)and the risk of developing early-onset coronary heart disease.Methods 50 patients with coronary atherosclerotic heart disease(coronary heart disease group)who visited the Department of Cardiovascular Medicine of Puyang People's Hospital Affiliated to Xinxiang Medical University from October 2023 to October 2024,and 50 patients with normal coronary angiography results during the same period(control group)were selected,and their ages met the requirements of male≤55 years old and female≤65 years old.The clinical data and blood specimens of the two groups of research subjects were collected.Real-time fluorescence quantitative analysis was employed to measure the relative expression levels of plasma miR-32-5p and STYX in both groups.The expression levels of miR-32-5p and STYX were analyzed by relative Cq method(ΔCq).A logistic regression model was employed to examine the factors influencing premature coronary heart disease.Receiver Operating Characteristic curve was used to evaluate the diagnostic value of miR-32-5p and STYX alone and in combination for early-onset coronary heart disease.To investigate the relationship between the expression levels of plasma exosomal miR-32-5p,STYX,and low-density lipoprotein cholesterol,Spearman correlation analysis was utilized.Results Univariate analysis showed a significant increase in plasma miR-32-5p levels in the early-onset coronary heart disease group compared to the control group,with the difference reaching statistical significance(P<0.05).Furthermore,STYX levels were considerably lower in the early-onset coronary heart disease group when compared to the control group.Further multivariate logistic regression analysis revealed that the risk of coronary heart disease escalated with elevated plasma miR-32-5p levels and decreased with higher STYX levels.Receiver Operating Characteristic curve results showed that the area under the diagnostic curve of plasma miR-32-5p expression level was 0.815(95%CI:0.729～0.902),and the area under the diagnostic curve ofplasma STYX expression level was 0.850(95%CI:0.729～0.902),and the area under the combined diagnosis curve was 0.904(95%CI:0.845～0.963).According to the maximum value of Jorden index,the best diagnostic threshold value was miR-32-5p≥0.775,STYX≤0.960,the sensitivity and specificity for miR-32-5p were 78%and 82%,while those for STYX were 88%and 78%.Spearman correlation analysis showed miR-32-5p was negatively correlated with STYX(r=-0.366,P<0.05),positively correlated with LDL-C(r=0.370,P<0.05),and STYX was negatively correlated with LDL-C(r=-0.425,P<0.05).Conclusions Elevated plasma miR-32-5p and reduced STYX are associated with an increased risk of early-onset CHD.Measurement of these biomarkers may aid the early diagnosis of coronary heart disease,and both show potential as novel diagnostic markers.

Abstract:Objective To discuss the correlation between dispersion of ventricular repolarization(DVR)and 90-d prognosis in patients with advanced heart failure.Methods The patients were selected from the Department of Cardiovascular Medicine in Huangshan Shoukang Hospital from Jan.2023 to Feb.2024.All patients were divided,according to 90 d prognosis,into survival group and death group.The indicators were compared between 2 groups,including gender,age,underlying diseases,medication taken,left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NT-proBNP)and T-wave peak-to-end interval(Tpe).The indicators with differences in comparison between 2 groups were analyzed by using multi-factor Logistic regression analysis.Results A total of 134 patients was included in the study,among whom 81 were males(60.45%)and 53 were females(39.55%).Their ages ranged from 33 to 93 y,and the length of hospital stay was 4 to 32 d,with a median of 8.50(6.75,12.00)d.The 90-d prognosis showed that 112 patients(83.58%)survived in survival group and 22 patients(16.42%)died in death group.There were no significant differences in gender,underlying diseases,liver and kidney functions,electrolytes,C-reactive protein(CRP),and medications taken between 2 groups(P>0.05).LVEF was significantly lower(P=0.011),and NT-proBNP and age were higher(P=0.014,P=0.027)in death group than those in survival group.QT interval and Tpe(459.36±94.07 ms,108.18±28.52 ms)were higher in death group than those in survival group 425.04±66.35 ms,98.84±16.31 ms,P<0.05).The comparison in QT wave peak interval had no statistical significance between 2 groups(326.20±55.03 ms vs.351.18±66.47 ms,P=0.062).The results of multi-factor Logistic regression analysis showed that LVEF(OR=1.784,95%CI:1.002-3.177,P=0.049),NT-proBNP(OR=1.830,95%CI:1.202～2.785,P=0.005)and Tpe(OR=1.968,95%CI:1.139～3.398,P=0.015)were independent risk factors for death in patients with advanced heart failure.Conclusion Tpe is closely related to 90-d prognosis,and is an independent risk factor for predicting 90-d death risk in patients with advanced heart failure.

Abstract:Objective This study aimed to explore the research status and development trends of cardiac rehabilitation for coronary heart disease(CHD)at home and abroad,so as to provide references for promoting the development of this field in China.Methods Based on bibliometric methods,this study used CiteSpace 6.3.R1 software,with CNKI,WanFang Database,and Web of Science Core Collection as the literature retrieval sources.The retrieval time frame was set from Jan.1,2015,to Dec.31,2024.A bibliometric analysis was conducted on the number of publications,core authors,research institutions,keywords and other indicators in the field of CHD cardiac rehabilitation over the past decade,and corresponding visual maps were generated.Results A total of 2,521 Chinese literatures and 1,117 English literatures were included in this study.The results showed that the number of international publications remained relatively stable,while the number of domestic publications increased significantly before 2021;in the past three years,both domestic and international publications have shown a downward trend.Compared with foreign countries,domestic high-yield authors and research institutions exhibited high dispersion with low inter-institutional collaboration.The global research hotspots included quality of life and secondary prevention.Baduanjin and negative emotions were the focus of cutting-edge domestic research,while anxiety has emerged as a research hotspot in the international field of CHD cardiac rehabilitation in recent years.Conclusion Research on CHD cardiac rehabilitation in China started late but has developed rapidly.In recent years,relevant research at home and abroad has entered a steady stage of disciplinary development.Compared with the international community,China has not yet formed core research institutions in this field,and there is still room for improvement in research quality.It is suggested that cross-regional collaborative research should be actively promoted and funding investment should be increased in the future,so as to further advance the research progress and development of CHD cardiac rehabilitation.

Abstract:Objective To compare the effectiveness and safety of pulsed field ablation(PFA)and cryoballoon ablation(CBA)in treatment of atrial fibrillation(AF).Methods Electronic databases such as China National Knowledge Infrastructure(CNKI),Wanfang Database,PubMed,Cochrane Library and EMbase were retrieved to include eligible clinical studies.RevMan 5.4 software was used for statistical analysis of the data.Results Fifteen studies were included,involving a total of 4743 patients[1876 cases in PFA group and 2867 cases in CBA group].The results of Meta-analysis showed that,compared with CBA,PFA could increase the success rate of acute pulmonary vein isolation(OR=4.72,95%CI:2.36～9.45,P<0.001),reduce the recurrence rate of atrial arrhythmia(OR=0.82,95%CI:0.69～0.98,P=0.03)and the total incidence of complications(OR=0.46,95%CI:0.32～0.67,P<0.001),and shorten the operation time(OR=-12.77,95%CI:-15.25～-10.29,P<0.001).There was no statistically significant difference in fluoroscopy time between 2 groups(OR=1.44,95%CI:-1.01～3.89,P=0.25).Conclusion Compared with CBA,PFA can elevate the success rate of acute pulmonary vein isolation,reduce the recurrence rate of atrial arrhythmia and total incidence of complications,and shorten the operation time,and the conclusion needs more studies with large sample and high quality to verification.

Abstract:Objective To explores the dynamic change law of myocardial mitophagy at different time points during pressure-overload-induced myocardial hypertrophy through establishing a pressure-overload-induced myocardial hypertrophy model.Methods SPF grade male SD rats were randomly divided into 5 groups,namely the 0-week(0W)group and the pressure-overload-induced myocardial hypertrophy groups at different time points(2-week[2W],4-week[4W],6-week[6W],and 8-week[8W]groups).A pressure-overload-induced myocardial hypertrophy model was established via abdominal aortic constriction surgery.The left ventricular structure was evaluated by directly measuring the left ventricular wall thickness,interventricular septum thickness and cardiac mass index,while Masson staining was performed to observe the degree of myocardial fibrosis.Western blotting assay was used to detect the expression of mitophagy-related proteins(LC3A/B,P62),myocardial hypertrophy-related proteins(BNP,β-MHC),apoptosis-related proteins(Bax,Bcl-2,Caspase-3,cleaved-Caspase-3,PDCD4),and mitochondrial oxidative stress-related protein SOD2 in myocardial tissue.The change patterns of these proteins were observed in each group at different time points.Results Compared with the 0W group,the 2W,4W,6W,and 8W groups showed significantly increased degrees of myocardial hypertrophy and fibrosis,elevated levels of cardiomyocyte apoptosis and mitochondrial oxidative stress,and a marked reduction in mitophagy.Under sustained pressure overload:The levels of myocardial apoptosis and mitochondrial oxidative stress exhibited a decreasing trend from 2W group to 6W group,followed by a significant increase in 8W group.In contrast,the level of mitophagy showed an increasing trend from 2W group to 6W group,and then a significant decrease at 8W group.Furthermore,the change in myocardial mitophagy was negatively correlated to the changes in myocardial apoptosis levels and mitochondrial oxidative stress levels.Conclusion Under sustained pressure overload,the myocardium exhibits significant hypertrophy,a continuous increase in the degree of fibrosis,a decrease in mitophagy levels,and a marked elevation(with fluctuating changes)in mitochondrial oxidative stress and myocardial apoptosis levels.These findings suggest that regulating mitophagy is a potential intervention target for improving myocardial hypertrophy,myocardial fibrosis,myocardial apoptosis and mitochondrial damage under long-term pressure overload.

Abstract:Objective To observe the changes of electrocardiogram(ECG)-related parameters and their association with ventricular arrhythmia(VA)and heart function in patients with chronic heart failure(CHF).Methods A total of 108 CHF patients admitted to Zigong First People's Hospital were enrolled from May 2020 to May 2024.The patients were divided into a VA group and a non-VA group based on the presence or absence of VA.By analyzing the changes in ECG-related parameters of CHF patients,the relationship among these parameters,risk of VA occurrence and heart function was discussed.Results There were significant differences in drinking history,heart failure classification,QTc interval,TP-Tec interval,and Tp-Te/QT ratio between VA group and non-VA group among(P<0.05).Logistic regression analysis showed that:model 1:QTc interval(OR=3.122,95%CI:1.439～6.773,P<0.05),TP-Tec interval(OR=5.881,95%CI:2.449～14.124,P<0.05),and Tp-Te/QT ratio(OR=4.161,95%CI:1.847～9.376,P<0.05)were all independent predictors of VA occurrence in CHF patients,model 2:heart failure with mid-range ejection fraction(HFmrEF,OR=5.747,95%CI:1.849～17.863,P<0.05),heart failure with reduced ejection fraction(HFrEF,OR=6.845,95%CI:1.817～25.791,P<0.05),and drinking history(OR=3.775,95%CI:1.112-12.807,P<0.05)were independent risk factors for VA occurrence in CHF patients,and model 3:QTc interval combined with drinking history(OR=1.002,95%CI:1.000～1.005,P<0.05)and TP-Tec interval combined with drinking history(OR=1.011,95%CI:1.001～1.021,P<0.05)revealed an interaction effect in VA occurrence among CHF patients.The results of ROC curve analysis demonstrated that AUC of QTc interval,TP-Tec interval,and Tp-Te/QT ratio for predicting VA in CHF patients were 0.774(95%CI:0.686～0.862,P<0.05),0.813(95%CI:0.730～0.897,P<0.05),and 0.803(95%CI:0.721～0.885,P<0.05),respectively.The results of Pearson correlation analysis indicated that QTc interval,TP-Tec interval,and Tp-Te/QT ratio were negatively correlated with left ventricular ejection fraction(LVEF)in CHF patients(r=-0.272,r=-0.262,r=-0.302,all P<0.05).There were significant differences in QTc interval,TP-Tec interval,and Tp-Te/QT ratio among 3 subgroups stratified by heart failure type(P<0.05),specifically,these indices were significantly higher in patients with HFmrEF and HFrEF than in those with heart failure with preserved ejection fraction(HFpEF,P<0.05).The results of linear regression analysis showed that Tp-Te/QT ratio was an independent risk factor for LVEF decline in CHF patients(t=-2.179,P<0.05).Conclusion The abnormal changes of QTc,TP-Tec and Tp-Te/QT are closely correlated to VA occurrence in CHF patients,which has some value to risk assessment.

Abstract:Objective To explore the influence of left bundle branch area pacing(LBBAP)on cardiac chamber and cardiac function in patients undergoing cardiac pacemaker implantation.Methods The data of patients underwent cardiac pacemaker implantation was retrospectively analyzed in Chengdu Third People's Hospital from Jan.2022 to June 2024.According to the different implantation sites of cardiac pacing electrodes,the patients were divided into right ventricular apical pacing(RVAP)group(underwent traditional RVAP)and LBBAP group(underwent LBBAP).Propensity score matching was adopted(with a caliper value of 0.01 and a matching ratio of 1:1),and 83 cases were enrolled in each group.The changes in pacing parameters(sensing,impedance,threshold)immediately after surgery,at 7 d,6 months,and 1 y postoperatively,as well as the changes in ventricular atrioventricular synchrony indicators[the ratio of left ventricular filling time to cardiac cycle(LVFT/RR),electrocardiogram QRS complex duration]immediately after surgery,at 1 month,6 months,and 1 y postoperatively were compared between 2 groups.The changes in ECG parameters[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left atrial diameter(LAD)]and cardiac function classification were compared between 2 groups before surgery and 6 months and 1 y after surgery,and the incidence of complications was statistically analyzed in both groups.Results There were no statistically significant differences in pacing sensing between groups,at different time points,and at interaction level(P>0.05).For pacing threshold and impedance,no statistically significant differences were observed at the interaction and inter-group levels(P>0.05),while the differences at the time level were statistically significant(P<0.050).There were statistically significant differences in LVFT/RR and QRS complex duration between groups,at different time points,and at interaction level(P<0.050).LVFT/RR,QRS complex duration and Ts-LV-RV were lower in LBBAP group than those in RVAP group at 1 month,6 months and 1 y after surgery(P<0.050).There were statistically significant differences in Ts-LV-RV between groups and at different time points(P<0.050).At 1 y after surgery,LVEDD was lower than that immediately after surgery(P<0.050).At 6 months and 1 y after surgery,NYHA classification was superior to that before surgery(P<0.050),and was superior in LBBAP group to that in RVAP group(P<0.050).There were no incision bleeding,pocket hematoma,infection,electrode displacement,or death occurred in either group after surgery.Conclusion The application of LBBAP can effectively improve the mechanical synchronicity,and then enhance heart function in patients with cardiac pacemaker implantation.

Abstract:Objective To investigate the influence of evolocumab on coronary artery restenosis 1 y after PCI and major adverse cardiovascular and cerebrovascular events(MACCE)3 y after PCI in patients with non-ST-segment elevation acute coronary syndromes(NSTE-ACS).Methods NSTE-ACS patients(n=240)were randomly divided into control group and evolocumab group(each n=120).The control group was given normal medication,and evolocumab group was additionally given evolocumab treatment.After medication for 1 y,indicators including total cholesterol(TC),triglycerides(TG),high-density lipoprotein-cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),high sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6),and incidence of coronary artery restenosis were observed in 2 groups.A 3-y follow-up was conducted to compare and analyze the primary endpoints(all-cause mortality,cardiac mortality,myocardial infarction),the composite secondary endpoint of MACCE(cardiac mortality,myocardial infarction,ischemia-driven revascularization,in-stent thrombosis,stroke),as well as the incidence rates of angina pectoris,rehospitalization and major bleeding.Results At 1-y follow-up visit,the levels of indicators including TC,TG,LDL-C,hs-CRP,TNF-α and IL-6,as well as the incidence of restenosis(2.50%vs.8.33%)in evolocumab group were significantly lower than those in control group(P<0.05).During 3-year follow-up,the rates of primary endpoint events(cardiac death,myocardial infarction),secondary endpoints(total MACCE,cardiac death,myocardial infarction,in-stent thrombosis,stroke),angina pectoris recurrence and re-revascularization in evolocumab group were significantly lower than those in control group(P<0.05).Conclusion Evolocumab can effectively reduce blood fat,inhibits inflammation,reduce restenosis 1 y after PCI and MACCE incidence 3 y after PCI in NSTE-ACS patients.

Abstract:Objective To investigate the relationship between carotid intima-media thickness,serum angiotensin(Ang Ⅱ),myocardial injury markers and cardiac function indexes in elderly patients with hypertension and myocardial infarction.Methods A total of 223 elderly patients with essential hypertension and MI admitted to the Department of Cardiovascular Diseases,Fangshan Hospital,Beijing University of Chinese Medicine from October 2020 to October 2022 were selected and divided into a control group based on carotid artery intima-media thickness(IMT)results(IMT<1.0 mm,n=57),thickening group(1.0 mm≤IMT<1.2 mm,n=78)and plaque group(1.2≤IMT<1.4 mm,n=88).The serum AngⅡ levels,myocardial damage(troponin cTnI and creatine kinase isoenzyme CKMB)and cardiac function indicators(left ventricular end-diastolic diameter LVEDD and left ventricular ejection fraction LVEF)were compared in each group.Correlation analysis was performed on the above indicators.The relationship between IMT and single-factor and multi-factor logistic regression analysis was used to explore the independent influencing factors of IMT thickening.Results Serum AngⅡ[(77.49±18.02)vs.(58.01±11.87)vs.(41.02±10.01),F=116.499]in different carotid intimedia thickness groups,P<0.001),creatine kinase isoenzyme(CK-MB)[(122.87±25.19)vs.(58.19±14.99)vs.(21.09±5.66),F=576.234,P<0.001]and troponin I(cTnI)[(2.51±0.51)vs.(1.03±0.30)vs.(0.45±0.11),F=616.396,P<0.001]were statistically significant.The serum levels of AngⅡ,CK-MB and cTnI in the plaque group were significantly higher than those in the thickening group and the control group,and the serum levels of AngⅡ,CK-MB and cTnI in the thickening group were significantly higher than those in the control group.Serum levels of AngⅡ,CK-MB and cTnI in the thickening group were significantly higher than those in the control group.Patients with different carotid intimedia thickness,Left ventricular end-diastolic diameter(LVEDD)was[(55.23±3.06)vs.(49.01±3.27)vs.(41.33±3.22),F=332.819,P<0.001]and left ventricular ejection fraction(LVEF)[(36.39±3.77)vs.(52.21±3.05)vs.(65.23±3.01),F=562.061,P<0.001]were statistically significant.LVEDD in the plaque group was significantly higher than in the thickening and control groups.LVEF in the plaque group was significantly lower than that in the intima and control groups,and LVEDD in the thickening group was significantly higher than that in the control group.LVEF in the thickening group was significantly lower than in the control group.IMT was positively correlated with serum AngⅡ,CK-MB,cTnI and LVEDD(r=0.718,r=0.767,r=0.900,r=0.836,P<0.001),and negatively correlated with LVEF(r=-0.936,P<0.001).Logistic regression analysis showed that serum AngⅡ(OR=2.020,95％CI:1.081～3.774),CK-MB(OR=1.649,95％CI:1.040～2.613),cTnI(OR=1.839,95％CI:1.039～3.252),LVEDD(OR=1.738,95％CI:1.008～2.998)and LVEF(OR=0.582,95％CI:0.342～0.990)was a risk factor for carotid intima-media thickening in elderly hypertension with myocardial infarction(P<0.05).The prediction equation is logit(P)=-1.114+0.703XAngⅡ+0.502XCK-MB+0.609XcTnI+0.553XLVEDD-0.541XLVEF.Conclusion In elderly patients with hypertension complicated with myocardial infarction,the thickening degree of carotid intermedia is positively correlated with serum AngⅡ,CKMB,cTnI and LVEDD.

Abstract:Objective To explore the influence of evolocumab on lipid metabolism and major adverse cardiovascular events(MACE)in patients with acute coronary syndrome(ACS)underwent percutaneous coronary intervention(PCI).Methods A total of 105 ACS patients were selected from the Third People's Hospital of Chengdu City from Jan.2022 to Jan.2024.All patients were received PCI followed by routine treatment,and they were divided into routine group(without evolocumab treatment,n=52)and evolocumab group(with evolocumab treatment,n=53).The level of blood fat,vascular endothelial function,level of inflammatory factors,incidence of MACE and adverse reactions were compared between 2 groups.Results Compared with before treatment,after 2 months of treatment,the levels of total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),vascular endothelial growth factor(VEGF),endothelin-1(ET-1),interleukin-6(IL-6),and high-sensitivity C-reactive protein(hs-CRP)decreased in both groups;furthermore,these levels were lower in evolocumab group than those in routine group(P<0.05).The levels of high-density lipoprotein cholesterol(HDL-C),nitric oxide(NO),and interleukin-10(IL-10)increased,and the levels were higher in evolocumab group than those in routine treatment(P<0.05).During the treatment period,there was no statistically significant difference in adverse reactions between 2 groups(P>0.05).At the 6-month follow-up,MACE incidence was significantly lower in evolocumab group than that in routine group(P<0.05).Conclusion Administration of evolocumab to ACS patients after PCI can effectively regulate lipid metabolism,improve vascular endothelial function,alleviate inflammatory responses,and prevent the MACE occurrence,with high safety.

Abstract:Objective To discuss the correlation among left atrial volume(LAV),systolic pulmonary arterial pressure(sPAP)and atrial fibrillation(AF)after aortic valve replacement(AVR).Methods The patients underwent aortic valve replacement(n=144)were selected from the First Affiliated Hospital of Chinese PLA Air Force Medical University from May 2021 to July 2023.All patients were divided,according to AF occurrence after the operation,into AF group(n=57)and non-AF group(n=87).Clinical data and indicators of preoperative cardiac ultrasound and laboratory were recorded in 2 groups.The risk factors related to AF occurrence after aortic valve replacement were analyzed by using Logistic regression model.The predictive value of predictors for AF occurrence after aortic valve replacement was assessed by using ROC curve.Results The results of univariate analysis showed that age,tumor necrosis factor-α(TNF-α),left ventricular ejection fraction(LVEF),LAV,left atrial end-diastolic inner diameter(LAEDd),and sPAP were associated with AF occurrence in patients after AVR(P<0.05).The results of multivariate analysis showed that age(OR=1.230,P=0.001),LAV(OR=1.049,P=0.014),and sPAP(OR=0.121,P=0.000)were independent risk factors for postoperative AF occurrence in patients.The results of ROC curve analysis showed that age,LAV,sPAP,and the combined prediction of these three factors were all statistically significant for predicting AF occurrence(P=0.000,P=0.003,P=0.000,P=0.000).The results of Pearson analysis showed that age(r=0.338,P=0.000),LAV(r=0.261,P=0.002)and sPAP(r=0.427,P=0.000)had significant positive correlation with postoperative AF occurrence.Conclusion Age,LAV and sPAP are independent risk factors for postoperative AF occurrence,and they have some diagnostic value to predict AF occurrence and combined prediction of these three factors has a higher predictive value.