Abstract:Coronary atherosclerotic heart disease(CHD)and diabetes mellitus(DM),as two major metabolic-related chronic diseases now,exhibit a synergistic rise in prevalence.Notably,their co-occurrence would form a vicious pathological cycle that leads to adverse clinical outcomes such as doubled cardiovascular event risks and exacerbated target organ damage,posing significant challenges in contemporary chronic disease management.This review comprehensively examines the epidemiological characteristics,pathogenic mechanisms,the impact of diabetes duration on CHD prognosis and therapeutic strategies regarding the CHD-DM comorbidity,aiming to provide a theoretical foundation for comprehensive clinical management.

Abstract:Objective To analyze the relationship between serum lipid carrier protein 2(LCN2),Kruppel like factor 15(KLF15)expression,cardiac function,and prognosis in patients with coronary heart disease(CHD).Method 200 CHD patients diagnosed at the First Hospital of Handan City from January 2022 to January 2024 were selected for the study(CHD group).According to cardiac function,they were divided into GradeⅠgroup(n=80),GradeⅡgroup(n=73),and GradeⅢgroup(n=47).Based on the prognosis 6 months after surgery,they were divided into poor group(n=50)and good group(n=150).Another 200 healthy individuals who underwent physical examinations during the same period were selected as the control group.Collect the basic information such as age,gender and past medical history of the subjects with CHD and the control group.The levels of serum LCN2 and KLF15 before the operation,one month after the operation and three months after the operation were detected by enzyme-linked immunosorbent assay kit.The correlation between LCN2,KLF15 and cardiac function was analyzed by Pearson method.Multivariable Logistic regression was performed to determine whether LCN2 and KLF15 are independent influencing factors after adjusting for potential confounders.Receiver operating characteristic(ROC)curve analysis was used to evaluate the prognostic predictive performance of LCN2 and KLF15.Bootstrap resampling was conducted to validate the stability and reproducibility of the ROC model.Decision curve analysis(DCA)was employed to assess the clinical utility and decision supporting value of the model in terms of net benefit.Results The preoperative KLF15 of patients in the CHD group was lower than that of the control group[(3.54±0.42)ng/ml vs.(7.21±1.24)ng/ml,P<0.05],and the preoperative LCN2 was higher than that of the control group[(5.17±1.21)ng/ml vs.(2.32±0.35)ng/ml,P<0.05].Left ventricular ejection fraction(LVEF)[(56.31±10.38)%vs.(47.29±6.89)%vs.(40.58±5.16)%,P<0.05]and preoperative KLF15[(4.86±0.67)ng/ml vs.(3.37±0.36)ng/ml vs.(1.56±0.16)ng/ml,P<0.05]gradually decreased in groups Ⅰ,Ⅱ,and Ⅲ,while left ventricular end-systolic dimension[(4.86±0.67)ng/ml vs.(3.37±0.36)ng/ml vs.(1.56±0.16)ng/ml,P<0.05],left ventricular end-diastolic dimension[(LVEDD)(48.29±3.74)mm vs.(51.28±5.02)mm vs.(56.54±6.31)mm,P<0.05],brain natriuretic peptide(BNP),and LCN2[(3.46±0.12)ng/ml vs.(5.39±0.46)ng/ml vs.(7.74±1.35)ng/ml,P<0.05)]gradually increased(P<0.05).LCN2 was negatively correlated with LVEF(r=-0.358,P<0.05)and positively correlated with LVESD,LVEDD,and BNP(r=0.296,0.337,0.415,P<0.05).Preoperative KLF15 was positively correlated with LVEF(r=0.406,P<0.05)and negatively correlated with LVESD,LVEDD,and BNP(r=-0.318,-0.354,-0.372,P<0.05).The poor group had lower LVEF[(39.97±5.56)%vs.(52.43±9.57)%,P<0.05]and preoperative KLF15[(1.67±0.45)ng/ml vs.(4.17±0.92)ng/ml,P<0.05],and higher LVESD[(41.24±4.89)mm vs.(28.34±3.61)mm,P<0.05]、LVEDD[(56.81±6.21)mm vs.(49.50±4.39)mm,P<0.05],BNP,and preoperative LCN2[(7.59±1.44)ng/ml vs.(4.36±1.02)ng/ml,P<0.05]than the good group(P<0.05).Multivariate Logistic results showed that after adjusting for LVEF,LVESD,LVEDD and BNP,preoperative LCN2(OR=1.982,95%CI 1.579-2.488,P<0.05)and preoperative KLF15(OR=0.742,95%CI 0.620-0.889,P<0.05)were prognostic factors.ROC curve showed that the area under the curve(AUC)of preoperative LCN2,preoperative KLF15,and their joint in predicting prognosis was 0.845,0.855,and 0.926,respectively,with the joint being higher than the use alone(Zjoint vs.preoperative LCN2=3.072,P=0.002;Zjoint vs.preoperative KLF15=2.193,P=0.028).Internal validation results showed that χ2=2.367 and P=0.821,indicating good model consistency.The DCA curve results show that when the high-risk threshold is 0.28 to 0.96,the net benefit rate of the combined prediction of prognosis by preoperative serum LCN2 and KLF15 is relatively high.Conclusion Preoperative LCN2 and KLF15 are associated with changes in cardiac function and prognosis in CHD patients.And the combination of preoperative LCN2 and KLF15 exhibits high predictive efficacy for the prognosis of CHD patients.

Abstract:Cardiovascular disease is the most common complication of type 2 diabetes.Risk factors such as hyperglycemia,dyslipidemia,hypertension and obesity associated with metabolic syndrome collectively promote the onset and progression of coronary atherosclerosis.The novel hypoglycemic agent glucagon-like peptide-1(GLP-1)receptor agonist not only lowers blood glucose and improves pancreatic function but also reduces body weight,lowers blood pressure,regulates lipids,suppresses inflammation and enhances vascular endothelial function.Consequently,it significantly reduces the risk of cardiovascular events in diabetic patients,with extensive evidence-based research confirming its cardiovascular protective effects.This article aims to review the mechanisms of the action and recent research advances of GLP-1 receptor agonist in cardiovascular protection,and explore their application prospects in the prevention and treatment of cardiovascular diseases.

Abstract:Objective To investigate the correlation between triglyceride glucose product(TyG)index,plasma arteriosclerosis index(AIP),systemic immune inflammation(SII)and chronic total occlusion of coronary artery disease(CTO).Methods A retrospective analysis was made in the patients who underwent coronary angiography(CAG)in the First Hospital of Handan City from November 2021 to December 2023 due to suspected coronary heart disease.According to CAG results,the patients who met the criteria were divided into CTO group(202 cases)and non-CTO group(340 cases).The blood samples including neutrophil count(NE),platelet count(Plt),fasting blood glucose(FBG),serum creatinine(Scr),Serum troponin I(cTnI),total cholesterol(CHOL),alanine aminotransferase(ALT),low density lipoprotein cholesterol(LDL-C)and other laboratory indicators were recorded,and TyG,AIP and SII index were calculated.Logistic regression analysis was used to analyze the risk factors to the CTO patients,ROC curve was drawn to analyze the predictive value of each index.Results TyG index,AIP index and SII index of the patients with CTO were significantly higher than that of non-CTO group[(9.05±0.68)vs.(8.53±0.40)、(0.61±0.10)vs.(0.51±0.08)、(2168.04±1417.72)vs.(987.47±770.79)],with significant differences.Binary Logistic regression analysis show that TyG,AIP and SII index were the risk factors of CTO(P<0.05).ROC curve analysis showed that the areas under the curve(AUC)of the TyG index,AIP,and SII index were 0.726(95%CI:0.679-0.773,P<0.001),0.787(95%CI:0.745-0.829,P<0.001),and 0.728(95%CI:0.679-0.776,P<0.001),respectively.Conclusion TyG,AIP and SII indices are closely correlated with CTO and can be used as simple laboratory indexes for diagnosis and prediction of CTO.

Abstract:Objective To explore the correlation between the systemic inflammatory response index(SIRI)and severe coronary artery calcification in patients with hypertension and its diagnostic value.Methods 580 patients with hypertension who were treated in Beijing Friendship Hospital from August 2015 to December 2023 were selected.The baseline clinical data and laboratory test results of the patients were collected.They were divided into the severe coronary artery calcification group(n=316)and non-severe coronary artery calcification group(n=264)based on whether severe coronary artery calcification(coronary artery calcium score>400)occurred.Three Logistic regression models were constructed by stepwise adjustment of confounding factors:Model 1(unadjusted),Model 2(adjusted for age and gender)and Model 3(further adjusted for other clinical covariates on the basis of Model 2).Logistic regression analysis was conducted by taking SIRI as a continuous variable and a categorical variable(divided into T1,T2 and T3 groups according to the SIRI tertiles)to explore the relationship between SIRI and severe coronary artery calcification.The potential nonlinear relationship was further explored through restricted cubic splines(RCS),and the performance indicators of SIRI in predicting severe coronary artery calcification were calculated.Results The baseline data showed that the SIRI level in the severe calcification group was significantly higher than that in the non-severe calcification group[0.74(0.50,1.12)vs.0.92(0.64,1.34),P<0.001].Logistic regression results indicated that in the three stepwise adjusted models,SIRI,whether as a continuous variable or a categorical variable,was the risk factor for severe coronary artery calcification(Model 1:OR=1.68,95%CI 1.27-2.23,P<0.001;Model 2:OR=1.66,95%CI 1.20-2.22,P<0.001;Model 3,OR=1.63,95%CI 1.20-2.22,P=0.002),and the risk of severe coronary artery calcification gradually increased with the increase of SIRI level.The risk of severe coronary artery calcification in the high SIRI value group(T3)was 2.34 times that in the low SIRI value group(T1).RCS analysis further confirmed that SIRI level was linearly and positively correlated with the risk of severe coronary artery calcification(nonlinear test P=0.172,total effect P=0.004).Taking the SIRI value when the odds ratio=1 as the cut-off value,the cut-off value of the three models was 0.821.When SIRI>0.821,the risk of severe coronary artery calcification increased with the increase of SIRI value.The predictive performance of this cut-off value was as follows:sensitivity 56.01%,specificity 57.20%,positive predictive value 61.03%,negative predictive value 52.07%,and Youden index 0.1321.Conclusion There is a positive linear relationship between the SIRI and severe coronary artery calcification in patients with hypertension,and it is a potential indicator for predicting severe calcification.

Abstract:Objective To clarify the abnormal expression of endothelin(EDN1)in adipose-derived stem cells(ADSCs)from obese patients through comparative analysis,and further explore its effects on vascular endothelial cell function and potential mechanism.Methods The fasting serum was collected from the obese patients who visited the Fifth Affiliated Hospital of Xinjiang Medical University from January 1,2023,to December 31,2023,and divided into the normal group(n=20)and the obese group(n=26).The levels of leptin,nitric oxide(NO)and endothelin-1(EDN1)in the serum were measured,alongside the blood pressure level taking in both the normal and obese groups.ADSCs were isolated and cultured in vitro,with purity identified by flow cytometry,differentiation ability verified by oil red O staining,and EDN1 protein expression detected by Western blot(WB).The human umbilical vein endothelial cells(HUVECs)were co-cultured with ADSCs;HUVEC proliferation was assessed using CCK-8;angiogenesis was evaluated via tube formation assay;and the expression levels of endothelial nitric oxide synthase(eNOS),EDN1,vascular endothelial growth factor A(VEGFA),serine/threonine protein kinase 1(AKT1)and phosphorylated AKT1(p-AKT1)were detected by WB.ADSCs were transfected with EDN1 knockdown/overexpression vectors and co-cultured with HUVECs after confirming transfection efficiency.CCK-8 and tube formation assays were used to test the cell proliferation and angiogenesis.RT-qPCR was used to measure the EDN1,VEGFA and AKT1 mRNA expression and WB was used to analyze the EDN1,VEGFA,AKT1/p-AKT1 and eNOS protein levels.Results Compared to the normal group,the obese group showed significantly higher blood pressure and serum levels of Leptin and EDN1(P<0.05),and significantly lower NO levels(P<0.05).ADSC analysis showed a significant upregulation of EDN1 protein in the obese group(P<0.05).Co-culture experiments indicated that,compared with the normal ADSCs group,both obese ADSCs and exogenous EDN1 overexpression significantly promoted HUVEC proliferation and angiogenesis,while inhibiting eNOS expression(P<0.05).EDN1 knockdown inhibited HUVEC proliferation and angiogenesis while promoting eNOS expression(P<0.05).EDN1 knockdown also inhibited the VEGFA/AKT1 pathway,reducing VEGFA mRNA and protein expression levels and significantly reducing the p-AKT1/AKT1 ratio(P<0.05);EDN1 overexpression produced the opposite effect(P<0.05).Conclusion The high expression of EDN1 in ADSCs from the obese patients activates the VEGFA/Akt1 pathway while inhibiting eNOS/NO activity,promoting endothelial cell proliferation and angiogenesis and contributing to the development of cardiovascular diseases.

Abstract:Objective To explore the clinical value of the serum C1q tumor necrosis related protein 9(CTRP9)and C-X-C motif chemokine ligand 8(CXCL8)in predicting recurrence of atrial fibrillation(AF)after radiofrequency ablation.Methods 158 AF patients who underwent radiofrequency ablation for the first time and were admitted to Huai'an Hospital Affiliated to Xuzhou Medical University from June 2021 to June 2024 were included as the study subjects.The patients were followed up and assigned into the recurrence group(41 cases)and the non recurrence group(117 cases).ELISA kits were used to detect the serum CTRP9 and CXCL8.Color Doppler ultrasound diagnostic equipment was used to examine the cardiac function indicators.The clinical data were collected.The ROC curve was used to explore the predictive value of the serum CTRP9 and CXCL8 for recurrence in the AF patients after radiofrequency ablation.Multivariate Logistic regression was used to explore the factors affecting recurrence in the AF patients after radiofrequency ablation.Results The levels of left atrial diameter(LAD)[(36.39±6.27)mm vs.(31.21±5.25)mm]and serum CXCL8[(2.79±0.46)ng/ml vs.(2.25±0.34)ng/ml]in the recurrence group were higher than those in the non-recurrence group,while the levels of left ventricular ejection fraction(LVEF)[(58.17±6.25)%vs.(64.19±7.23)%],left ventricle shortening fraction(LVFS)[(34.04±5.69)ml vs.(37.96±4.37)ml]and serum CTRP9[(238.95±35.32)ng/ml vs.(290.50±40.24)ng/ml]were lower(P<0.05).The levels of serum CTRP9 and CXCL8 in the AF patients were correlated with the levels of LAD,LVEF and LVFS(P<0.05).Elevated serum CXCL8 was the risk factor for recurrence in the AF patients after radiofrequency ablation,while elevated serum CTRP9 was the protective factor(P<0.05).The AUC values of serum CTRP9 and CXCL8 alone and their combination for predicting recurrence were 0.848,0.834 and 0.920,respectively.The combined prediction was better than the individual predictions(Z=2.809,3.003,P=0.005,0.003).Conclusion The patients with AF who experience recurrence after radiofrequency ablation have lower serum CTRP9 and higher CXCL8.Both serum CTRP9 and CXCL8 have certain predictive value for postoperative recurrence.

Abstract:Objective To investigate the impact of early initiation and intensive statin therapy on gut microbiota,complication risk and adverse events in patients with acute coronary syndrome(ACS).Methods A total of 216 ACS patients were enrolled at Wangjing Hospital,China Academy of Chinese Medical Sciences,from January 2020 to December 2024.According to whether they received intensified statin therapy within 24 hours after admission,patients were divided into two groups:the early initiation with intensive statin group(n=156)and the non-early initiation group(n=60).Among the early initiation group,patients were further categorized into the low-dose subgroup(n=84)and the high-dose subgroup(n=72)based on the intensity of statin therapy.The lipid profiles,vascular function,cardiac function,inflammatory markers and gut microbiota composition were compared among the groups.The incidences of the complications and adverse events were also analyzed.Results The adverse reactions increased significantly across the non-intensified,low-dose and high-dose groups,while the complication rates decreased in the same order[18(30.00%)vs.16(19.05%)vs.8(11.11%),P<0.05].The high-dose group also showed a marked reduction in major adverse cardiovascular events[25(41.67%)vs.25(29.76%)vs.10(13.89%),P<0.05].The baseline lipid profiles,vascular and cardiac function,inflammatory markers and the intestinal barrier parameters were comparable across the groups(P>0.05)before the treatment.After the treatment,all these improved significantly(P<0.05),with the greatest gains in the high-dose group,followed by the low-dose group,and minimal changes in the non-intensified group.The serum diamine oxidase(DAO)decreased significantly post-treatment only in the high-and low-dose groups(14.77±0.52)U/L vs.(10.32±1.74)U/L,(14.78±0.61)U/L vs.(11.88±1.56)U/L,all P<0.05).The gut microbiota analysis revealed reduced Enterobacteriaceae and Enterococcus and increased Bifidobacterium after the treatment(P<0.05),with the most pronounced shifts in the high-dose group(P<0.05).Early statin initiation was negatively correlated with the complications,and both were significantly associated with improvements in lipids,vascular and cardiac function,inflammation,intestinal barrier integrity and gut microbiota composition(P<0.05).Multivariate regression analysis identified early statin initiation and the post-treatment levels of total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),vascular endothelial growth factor(VEGF),left ventricular ejection fraction(LVEF),high-sensitivity C-reactive protein(hs-CRP),longitudinal measurements of Enterobacteriaceae,Enterococcus,Bifidobacterium,diamine oxidase(DAO)and D-lactate as the independent predictors of the complication occurrence(P<0.05).Conclusion Early initiation combined with intensive statin therapy can significantly reduce the incidence of the complications and major adverse cardiovascular events in ACS patients,while markedly improving the lipid profiles,vascular and cardiac function,inflammatory status,intestinal barrier function and gut microbiota composition.However,this approach is accompanied by a moderate increase in adverse events,suggesting that clinical decision-making should carefully balance the efficacy and safety,tailoring treatment strategies to individual patient characteristics.

Abstract:The global prevalence of heart failure(HF),particularly heart failure with preserved ejection fraction(HFpEF),continues to rise.Obesity,as a major clinical phenotype,has become a key driver in the pathogenesis of HFpEF.The conventional HF therapies,mostly derived from studies in heart failure with reduced ejection fraction,have shown limited efficacy in obese HFpEF patients,highlighting the urgent clinical need for interventions targeting metabolic phenotypes.In recent years,glucagon-like peptide-1 receptor agonists(GLP-1 RAs)have emerged as a focal point in HFpEF research due to their combined benefits in weight reduction and cardiovascular protection.This review summarizes the mechanistic roles of GLP-1 RAs in obese HFpEF,including their multifaceted effects on weight loss,inflammation modulation,hemodynamic improvement and cardiorenal protection.It also highlights the key findings from pivotal clinical trials such as STEP-HFpEF and SUMMIT,and further explores their potential applications across different HF subtypes and personalized treatment strategies.GLP-1 RAs hold promise for redefining the therapeutic landscape of HFpEF and advancing metabolism-targeted therapies toward individualized and precision-based heart failure management.

Abstract:Heart failure is a complex clinical syndrome caused by various etiologies that lead to structural and/or functional abnormalities of the heart,resulting in impaired ventricular systolic and/or diastolic function.The endoplasmic reticulum,a critical organelle in eukaryotic cells responsible for protein folding,processing and transport,plays a vital role in maintaining cellular homeostasis.Endoplasmic reticulum autophagy(ERA),a selective form of autophagy,regulates endoplasmic reticulum membrane content by eliminating excess or dysfunctional endoplasmic reticulum structures and associated macromolecular complexes.ERA is widely involved in numerous physiological processes,including metabolic regulation,immune responses,inflammatory signaling and cell survival,and has emerged as a focal point in autophagy research.Simultaneously,ERA serves as a key endogenous mechanism in alleviating endoplasmic reticulum stress(ERS),and the two processes work synergistically to maintain endoplasmic reticulum homeostasis.Recent studies have revealed that both ERA and ERS exert protective effects on cardiomyocytes in heart failure but the excessive stress may exacerbate myocardial injury.Therefore,the interplay between ERA and ERS plays a crucial role in the pathogenesis of heart failure.This review first outlines the cell biological characteristics and core receptors of ERA,then summarizes its regulatory mechanisms in heart failure,aiming to provide a theoretical foundation for further mechanistic studies and potential therapeutic targets in heart failure.

Abstract:Objective In order to explore new therapeutic strategies for myocardial ischemic injury,this study was conducted to construct trehalose biomimetic nanovesicles(Tre NVs),observe their physicochemical properties,and explore their protective effects on hypoxic-induced myocardial cell injury in vitro.Methods A microfilter was used to continuously extrude the bone marrow mesenchymal stem cells to extract the nanovesicles(NVs).Trehalose(Tre)was actively loaded into NVs via sonication to generate Tre NVs.The particle size,zeta potential,morphology and cytotoxicity of Tre NVs were systematically characterized.The cardioprotective efficacy of Tre NVs under hypoxic stress was assessed by flow cytometry and fluorescent staining.Result Tre NVs were successfully prepared.Tre NVs exhibited a morphology similar to typical extracellular vesicles,forming tea tray shaped vesicles with a double-layer membrane structure.The particle size of Tre NVs was concentrated at(133.9±1.27)nm,and the potential was(-47.1±2.23)mV.The efficiency of Tre loaded on vesicles was determined to be(40.42±0.85)%by high performance liquid chromatography(HPLC)analysis.In addition,the CCK-8 experiment detected that the increase in Tre NVs concentration did not significantly affect the activity of co cultured cardiomyocytes,and the survival rate of cardiomyocytes remained at around 85%.Through laser confocal microscopy,it was observed that Tre NVs labeled with DiI red fluorescent dye could be taken up by H9C2 cells and dispersed around the nucleus of the myocardial cells.Under simulated myocardial ischemia conditions in vitro,the myocardial cells could still effectively uptake Tre NVs,and the apoptosis of the myocardial cells was significantly reduced by flow cytometry after treatment with Tre NVs.By using the DCFH-DA reactive oxygen species detection kit to detect ROS generation,it could be observed that after Tre NVs administration,the ROS generation levels in the hypoxia induced cardiomyocytes were significantly reduced.Tre NVs could significantly attenuate the high reactive oxygen species environment after myocardial ischemia injury and played a protective role on the hypoxic-induced myocardial cell injury models.Conclusion The biomimetic Tre NVs delivery platform efficiently encapsulates trehalose,markedly enhancing its bioavailability.Tre NVs ameliorate the oxidative microenvironment following myocardial ischemia and effectively protect cardiomyocytes from hypoxia-provoked injury.

Abstract:Objective To investigate the effect of Evolocumab combined with felodipine in the treatment of angina pectoris in elderly patients with chronic coronary syndrome(CCS)and its influence on Fas protein(Fas/Apol),soluble Fas protein(sFas),and soluble Fas protein ligand(sFas L).Methods Two hundred elderly patients with CCS angina pectoris admitted to Zigong Third People's Hospital from October 2022 to March 2024 were selected.They were divided into the observation group(n=100)and the control group(n=100)according to random number table method by the principle of 1∶1 pairing.The control group was given felodipine,while the observation group was given Evolocumab on the basis of the control group.The angina pectoris symptoms curative effect,electrocardiogram curative effect,cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),left ventricular posterior wall thickness(LVPWd)],occurrence of angina,blood lipid metabolism-related indicators[triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),proprotein convertase subtilisin/kexin type 9(PCSK9),total cholesterol(TC)],coronary endothelial function(endothelin-1,nitric oxide),apoptosis-related factors[Fas/Apol,sFas,sFas L levels],related scale scores[Seattle Angina Questionnaire(SAQ)score,Global Registry of Acute Coronary Events(GRACE)score]and myocardial ischemia state were compared between the two groups.Medication compliance and adverse reactions were statistically compared between the two groups during the treatment period;the incidence of major adverse cardiovascular events(MACE)was compared after 12 months of follow-up.Results The curative effect of angina symptoms and electrocardiogram in the observation group were higher than those in the control group(97.00%vs.88.00%,97.00%vs.90.00%,P<0.05).After 12 weeks of the treatment,compared with the control group,LVEF was higher but LVESV,LVPWd,frequency and duration of angina pectoris were lower in the observation group(P<0.05).After 12 weeks of the treatment,the levels of TC,TG,LDL-C and PCSK9 in the observation group were lower than those in the control group(P<0.05).After 12 weeks of the treatment,compared with the control group,the observation group had lower endothelin-1 and higher nitric oxide(P<0.05).After 12 weeks of the treatment,the levels of Fas/Apol,sFas,and sFas L in the observation group were lower than those in the control group[(186.35±15.11)ng/L vs(24.63±18.59)ng/L,(2.56±0.62)ng/L vs.(3.48±0.76)ng/L,(0.11±0.02)ng/L vs.(0.16±0.03)ng/L(P<0.05)].After 12 weeks of the treatment,the SAQ score in the observation group was higher than that in the control group,while the GRACE score was lower than that in the control group(P<0.05).The number of 24 h myocardial ischemia episodes and the duration of ischemia in the observation group were lower than those in the control group(P<0.05).There was no significant difference in medication compliance and incidence of adverse reactions between the two groups during the treatment period(P>0.05).After 12 months of follow-up,5 cases in the observation group and 3 cases in the control group were lost to follow-up;and the total incidence of MACE in the observation group was lower than that in the control group[7.37%(7/95)vs.17.53%(17/97)(P<0.05)].Conclusion The combination of Evolocumab and felodipine for the treatment of angina pectoris in elderly patients with CCS is beneficial in improving clinical efficacy,cardiac function and coronary endothelial function,alleviating angina symptoms,ameliorating the curative effect and quality of life of patients,without obvious increase in adverse reactions.

Abstract:Objective To investigate the correlation between the serum levels of syndecan(SDC)4 and Kruppel-like factor 15(KLF15)and the severity of coronary artery stenosis and prognosis in coronary heart disease(CHD)patients.Methods From January 2022 to February 2024,161 CHD patients in Handan Central Hospital were considered as the observation subjects(CHD group).They were divided into the poor group(n=44)and the good group(n=117)based on their one-year prognosis.Another 118 patients with no abnormalities detected in the examination were considered the control group.ELISA method was applied to detect the serum SDC4 and KLF15.Pearson method was applied to explore the relationship between serum SDC4,KLF15 and Gensini score.Multivariate Logistic regression was applied to analyze the factors that affected the prognosis of the patients.ROC curves was used to evaluate the predictive value.Results The CHD group exhibited higher serum SDC4 levels[(6.96±1.02)pg/ml vs.(3.82±0.53)pg/ml]than the control group,whilst KLF15 levels[(29.46±4.20)pg/ml vs.(54.18±7.53)pg/ml]were lower than the control group(P<0.05).In the mild,moderate,and severe groups,the serum SDC4 levels[(5.09±0.76)pg/ml vs.(7.26±1.07)pg/ml vs.(8.41±1.22)pg/ml]and Gensini scores[(18.72±4.69)points vs.(52.18±12.24)points vs.(97.89±12.76)points]progressively increased,while KLF15 levels[(34.23±4.69)pg/ml vs.(28.87±4.26)pg/ml vs.(25.56±3.63)pg/ml]progressively decreased(P<0.05).The serum SDC4 was positively correlated with Gensini score,while the serum KLF15 was negatively correlated with SDC4 and Gensini score(P<0.05).Compared with the good group,the poor group had significantly higher serum SDC4 levels[(8.03±1.23)pg/ml vs.(6.57±0.94)pg/ml]and Gensini scores[(73.56±11.63)vs.(45.93±9.15)],along with significantly lower serum KLF15 levels[(25.34±3.61)pg/ml vs.(31.01±4.42)pg/ml]and a lower proportion of patients with TIMI grade≥2 in the infarct-related artery(P<0.05).Gensini score and SDC4 were the risk factors for poor prognosis in CHD patients,while TIMI grade≥2 and KLF15 were the protective factors(P<0.05).The combined predictive efficacy of serum SDC4 and KLF15 was superior to that of either marker alone(P<0.05).Conclusion Elevated serum SDC4 levels and reduced KLF15 levels in patients with CHD correlate with worsening coronary artery stenosis severity.Furthermore,the combined detect of the two markers demonstrates high predictive value for poor prognosis in CHD patients.

Abstract:Objective To investigate the risk factors associated with atrial fibrillation(AF)in the young patients to establish a corresponding nomogram model and evaluate its validity.Methods The data of 959 consecutive patients aged≤35 years who were hospitalized in Fuwai Central China Cardiovascular Hospital for diagnosis and treatment from January to June 2023 were retrospectively analyzed,including 85(8.9%)with AF(the AF group)and 874(91.1%)without AF(the non-AF group).Univariate and multivariate Logistic regression analyses were used to identify the risk factors for AF and established a nomogram model.The discriminative ability and calibration of the model were assessed using the receiver operating characteristic(ROC)curve and calibration curve,respectively.The decision curve analysis was employed to evaluate the net benefit of the model.Results Univariate Logistic regression analyses showed that the age,male,history of smoking,history of alcohol consumption,valvular heart disease,dilated cardiomyopathy,heart failure,renal insufficiency,obstructive sleep apnea(OSA),family history of AF,non-alcoholic fatty liver disease(NAFLD),left atrial diameter(LAD),left ventricular ejection fraction,left ventricular end-systolic diameter,left ventricular end-diastolic diameter,right atrium medial-lateral dimension,right atrial superior-inferior dimension,serum albumin,uric acid,serum creatinine and glomerular filtration rate were associated with AF in the young patients.Multivariate Logistic regression analysis revealed that the history of alcohol consumption,dilated cardiomyopathy,OSA,family history of AF,NAFLD,LAD and serum albumin were the independent risk factors for AF in these patients(P<0.05).A nomogram model incorporating these factors was developed to predict the occurrence of AF in the young patients.The area under the ROC curve(AUC)was 0.830(95%CI 0.779-0.882).The Hosmer-Lemeshow test showed χ2=11.201,P=0.191(P>0.05).Internal validation using Bootstrap method with 1,000 resamples demonstrated high quality of the calibration curve.Decision curve analysis indicated a satisfactory net benefit range.Conclusion The history of alcohol consumption,dilated cardiomyopathy,OSA,family history of AF,NAFLD,LAD and serum albumin were the independent risk factors for AF in the young patients.The nomogram model established in this study has good predictive efficacy and discriminative ability.

Abstract:Objective To explore the relationship between the electrocardiogram heart rate variability(HRV)and myocardial fibrosis in patients with acute myocardial infarction(AMI)and its value in predicting the occurrence of malignant arrhythmias.Method A total of 180 patients with AMI admitted to Guanghan City People's Hospita from October 2023 to September 2024 were selected and underwent 24-hour dynamic electrocardiogram examination and their HRV parameters were recorded.They were followed up for 30 days and divided into the myocardial fibrosis group(n=38)and non myocardial fibrosis group(n=142)according to whether myocardial fibrosis occurring.The HRV parameters of the two groups were compared.At the same time,they were divided into the malignant arrhythmia group(n=57)and non malignant arrhythmia group(n=123)according to whether malignant arrhythmia occurring.The general information and HRV parameters of the two groups were compared.Multiple factor Logistic regression model was used to analyze the risk factors for malignant arrhythmia in AMI patients,and ROC curves were established to analyze the predictive value of each risk factor for malignant arrhythmia in AMI patients.Result The standard deviation of mean normalized NN interval(SDANN),standard deviation of all sinus rhythm NN intervals(SDNN)and the root mean square of continuous differences(RMSSD)in the malignant arrhythmia group were lower than those in the non malignant arrhythmia group.The SDANN,SDNN and RMSSD in the myocardial fibrosis group were lower than those in the non myocardial fibrosis group,and the differences were statistically significant(P<0.05).The levels of cardiac troponin I(cTnI)and creatine kinase MB(CK-MB)in the malignant arrhythmia group were higher than those in the non malignant arrhythmia group,and the differences were statistically significant(P<0.05).The lower SDANN、SDNN、RMSSD and the higher cTnI and CK-MB levels were the independent risk factor for the occurrence of malignant arrhythmia(P<0.05).The AUC values for the joint prediction of the SDANN,SDNN,RMSSD,cTnI and CK-MB were 0.865,0.812,0.738,0.834,0.799 and 0.965 respectively,with the sensitivities of 0.821,0.772,0.520,0.667,0.737 and 0.895 respectively,and the specificities of 0.807,0.719,0.895,0.878,0.756 and 0.919 respectively.These indicated that the joint multi-index prediction had the best performance,with good sensitivity and specificity.Conclusion The HRV parameters of AMI patients are closely related to the occurrence of myocardial fibrosis and malignant arrhythmia.The reduction of HRV parameters such as the SDANN,SDNN and RMSSD are the important biomarkers for predicting malignant arrhythmias.The elevations of cardiac injury markers such as the cTnI and CK-MB also increase the risk of malignant arrhythmia.The combining HRV parameters with myocardial injury markers can improve the predictive efficiency of malignant arrhythmia occurrence,providing a basis for clinical risk assessment and treatment decision-making.

Abstract:Objective To compare the long-term outcomes of patients undergoing percutaneous coronary rotational atherectomy who achieved complete versus incomplete revascularization.Methods Patients who underwent percutaneous coronary rotational atherectomy at Nanjing Drum Tower Hospital from November 2011 to December 2018 were included.Complete revascularization was defined as successful revascularization of all coronary artery segments with a reference diameter≥2.25 mm and diameter stenosis≥70%.Cox proportional hazards models were used to evaluate the risk factors for long-term major adverse cardiovascular events(MACE)and all-cause mortality.Results A total of 209 patients were included,with 118 in the complete revascularization group and 91 in the incomplete revascularization group.The median follow-up time was 82 months.The incidence of MACE in the complete revascularization group was lower than that in the incomplete revascularization group(17.8%vs.40.7%,P<0.001).There was no significant difference in the long-term all-cause mortality between the two groups(30.5%vs.42.9%,P=0.065).The independent influencing factors for the long-term MACE risk were complete revascularization(HR=0.45,95%CI 0.26-0.79,P=0.006),baseline Syntax score(HR=1.03,95%CI 1.00-1.05,P=0.036),and diabetes(HR=1.89,95%CI 1.11-3.23,P=0.019).The independent influencing factors for the long-term all-cause mortality risk were renal insufficiency(HR=3.01,95%CI 1.61-5.64,P=0.001),age(HR=1.05,95%CI 1.02-1.08,P=0.003)and rotational atherectomy of the left anterior descending artery(HR=0.54,95%CI 0.30-0.96,P=0.036).Conclusion For patients with severe coronary artery calcification undergoing rotational atherectomy,complete revascularization is associated with a reduced risk of long-term MACE.

Abstract:Objective To investigate the predictive value of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio(NHHR)for coronary heart disease(CHD)and its clinical phenotypes—chronic coronary syndrome(CCS)and acute coronary syndrome(ACS),as well as its association with the severity of coronary artery lesions.Methods A total of 803 patients who underwent coronary angiography(CAG)for chest pain or tightness at the Department of Cardiology,Hefei Second People's Hospital,from January 2020 to December 2024 were retrospectively enrolled.The patients were divided into the CHD group(n=639)and the control group(n=164)based on CAG results.The CHD group was further categorized into the CCS subgroup(n=275)and the ACS subgroup(n=364).The NHHR was calculated and stratified into tertiles(Q1,Q2 and Q3 groups).The subsequent analyses were conducted to probe into the association between NHHR and CHD and its different clinical phenotypes,evaluate the diagnostic performance of NHHR and traditional lipid parameters,and explore the correlation between NHHR and the Gensini score.Finally,stratified analysis was performed to test the robustness of the observed associations.Results The CHD group had significantly higher NHHR levels compared to the control group(P<0.05).Both the prevalence of CHD and Gensini scores increased progressively with rising NHHR tertiles(all P<0.05).After the multivariate adjustment,NHHR remained the independent risk factor for CHD,with a 3.89-fold higher risk in the Q3 group compared to Q1(OR=3.89,95%CI 2.21-6.85).RCS analysis indicated a linear dose-response relationship between NHHR and CHD risk(P-overall<0.01).Notably,the association strength of NHHR with ACS(OR=4.84)was higher than that with CCS(OR=3.62)after adjustment.ROC analysis showed that NHHR had an AUC of 0.720 for CHD diagnosis,which was significantly higher than non-HDL-C(AUC=0.600)and HDL-C(AUC=0.620),and demonstrated the highest diagnostic performance for ACS(AUC=0.758).Spearman correlation demonstrated a significant positive correlation between NHHR and Gensini score in both overall coronary artery disease and its subgroups(all P<0.01).Except for a significant interaction in the hypertension subgroup(P<0.05),the association between NHHR and CHD remained consistent across the other stratified analyses.Conclusion NHHR is the independent risk factor for CHD and its clinical phenotypes,closely associated with the severity of coronary artery lesions.It exhibits superior diagnostic performance to traditional lipid parameters,particularly in differentiating ACS,suggesting its clinical value in risk stratification and diagnosis.

Abstract:Objective To explore the causal relationship between the genetically predicted intake of fresh fruits and dried fruits and coronary heart disease using two-sample Mendelian randomization(MR).Methods Based on the genome-wide association study(GWAS)data from a European population,the single nucleotide polymorphisms(SNPs)associated with fresh fruit intake(n=433186)and dried fruit intake(n=409125)were selected as instrumental variables.The outcome data were from Finngen R12 database in Finland,including atherosclerosis(n=482913),coronary heart disease(n=500348)and myocardial infarction(n=447837).By setting a genome-wide significance threshold(P<5×10-8)and performing linkage disequilibrium(LD)exclusion(r2<0.001,distance>10000 kb),the independence and efficacy of IV were ensured.The main analysis method is inverse variance weighted(IVW),supplemented by sensitivity tests such as MR Egger regression,weighted median and weighted mode.In addition,Cochran Q test,MR Egger intercept test and MR-PRESSO analysis were conducted to evaluate the heterogeneity and horizontal pleiotropy.Results In the analysis of the fresh fruit intake,it was found that the fresh fruit intake was significantly negatively correlated with coronary heart disease(OR=0.63,95％CI 0.45-0.88,P=0.007)and myocardial infarction(OR=0.61,95％CI 0.40-0.91,P=0.01).Although there was a protective trend in atherosclerosis,the fresh fruit intake was not significant(OR=0.76,P=0.31).The dry fruit intake and the three outcomes all showed robust protective effects:atherosclerosis(OR=0.45,P=1.81e-05),coronary heart disease(OR=0.69,P=0.001),myocardial infarction(OR=0.57,P=0.0001).The results of multiple MR methods were consistent,and no significant level of pleiotropy or heterogeneity bias was found.The residual analysis further validated the robustness of the results.Conclusions This study reveals the potential protective effect of fresh fruit and dried fruit intake on atherosclerosis,coronary heart disease and myocardial infarction from the perspective of causal inference through large sample genetic data for the first time,and strengthens the application value of healthy diet model in the field of public health.

Abstract:Objective To investigate the association of the layered plaque using optical coherence tomography(OCT)with major adverse cardiac events(MACE)in patients with acute coronary syndrome(ACS).Methods A total of 222 patients with acute coronary syndrome(ACS),who were consecutively enrolled from January 2018 to January 2023 at the Cardiac Center of the First Affiliated Hospital of Xinjiang Medical University and underwent both coronary angiography(CAG)and optical coherence tomography(OCT)examinations,were included in this study.Among them,5 patients were lost to follow-up,and 217 patients completed a 24-month follow-up.The occurrence of endpoint events was evaluated through telephone interviews or outpatient visits.Based on OCT imaging characteristics,patients were firstly classified into two groups:the layered plaque group(n=108)and non-layered plaque group(n=109).Then,the baseline characteristics,biochemical profiles and OCT plaque features were compared between the 2 groups.Finally,Kaplan-Meier survival curves were plotted and compared using the Log-rank test.The independent predictive value of layered plaques for MACE was assessed using a Cox proportional hazards regression model after adjusting for confounding factors.Results The serum uric acid level was significantly higher but the serum albumin level was significantly lower in the layered plaque group than in the non-layered plaque group(P<0.05).Regarding OCT characteristics,the layered plaque group had a significantly thinner fibrous cap[75.0(40.0,180.0)μm vs.120.0(60.0,200.0)μm,P<0.05],a higher lipid index[1735.0(762.5,2906.2)vs.1272.0(852.0,1758.0),P<0.05],a longer lesion length[(12.6±5.4)mm vs.(10.2±4.2)mm,P<0.05],and a smaller minimum lumen area[(1.9±0.6)mm²vs.(2.1±0.6)mm²,P<0.05].The detection rates of macrophage infiltration,cholesterol crystals,thrombus and calcified nodules were all significantly higher in the layered plaque group(P<0.05).The median follow-up duration was 21.5 months for the 217 patients.After adjustment for variables including body mass index(BMI),low-density lipoprotein,creatinine,number of diseased vessels and minimum lumen area,multivariable Cox regression analysis demonstrated that layered plaque was an independent risk factor for MACE in ACS patients(HR=2.26,95%CI 1.163-4.398,P=0.016).Conclusion The layered plaque is an independent predictor of adverse outcomes in ACS patients,serving as a novel imaging biomarker for clinical risk stratification.

Abstract:Objective To explore the diagnostic value of serum interleukin-6(IL-6)and monocyte count/high-density lipoprotein cholesterol ratio(MHR)in elderly patients with type 2 diabetes complicated with heart failure with preserved ejection fraction(HFpEF).Methods From August 2023 to August 2024,145 elderly patients with type 2 diabetes admitted to Cangzhou Hospital of Integrated Traditional and Western Medicine were included as the diabetes group,145 elderly patients with type 2 diabetes combined with HFpEF were selected as the diabetes combined with HFpEF group,and in the meantime,145 healthy people who were examined in our hospital were selected as the control group.According to the heart function classification of New York Heart Association(NYHA),the diabetes combined with HFpEF group was assigned into 49 cases of NYHAⅡ,57 cases of NYHAⅢ and 39 cases of NYHAⅣ.All the subjects underwent cardiac ultrasound and the left ventricular ejection fraction(LVEF),left atrial diameter(LAD)and left ventricular diameter(LVD)were recorded.Enzyme linked immunosorbent assay was applied to detect the serum IL-6,brain natriuretic peptide(BNP)and cardiac troponin I(cTnI)level.Absolute number of the monocytes and high-density lipoprotein cholesterol were measured and the MHR was calculated.Spearman correlation was used to analyze the correlation between the serum IL-6,MHR levels and heart function grading in the diabetes combined with HFpEF group.Logistic regression was used to analyze the influencing factors of HFpEF in elderly patients with type 2 diabetes.The diagnostic efficacy of serum IL-6 and MHR in elderly type 2 diabetes patients with HFpEF was analyzed by receiver operating characteristic(ROC)curve.Results The levels of serum IL-6[(30.65±8.69)ng/L vs.(76.32±20.42)ng/L vs.(108.75±27.39)ng/L]and MHR[(0.32±0.09)%,(0.75±0.19)%,(0.97±0.24)%]in control group,diabetes group and diabetes combined with HFpEF group increased in turn(all P<0.05).The serum levels of IL-6[(91.92±20.35)ng/L vs.(108.83±23.51)ng/L vs.(129.76±26.32)ng/L]and MHR[(0.75±0.18)%vs.(0.98±0.24)%vs.(1.24±0.31)%]in NYHA grade Ⅱ,grade Ⅲ and grade Ⅳ diabetes combined with HFpEF patients increased in turn(all P<0.05).Serum IL-6 and MHR levels were positively correlated with heart function grading in diabetes combined with HFpEF group(rs=0.629,0.546,P<0.05).There were differences in coronary heart disease history,heart rate,absolute number of monocytes,fasting blood glucose(FPG),total cholesterol(TC),glycosylated hemoglobin(HbA1c),serum BNP,cTnI,LAD and LVD between the control group,diabetes group and diabetes combined with HFpEF group(P<0.05).Logistic regression analysis showed that the history of coronary heart disease,heart rate,absolute number of monocytes,FPG,TC,HbA1c,serun BNP,IL-6 and MHR levels were the risk factors for HFpEF in elderly patients with type 2 diabetes(P<0.05).ROC curve showed that the area under the curve(AUC)of serum IL-6,MHR and their combined diagnosis for elderly type 2 diabetes with HFpEF was 0.821,0.833 and 0.921,respectively;the AUC of the combination of the two in the diagnosis was higher than that of IL-6 and MHR alone(P<0.05).Conclusion The serum levels of IL-6 and MHR in elderly type 2 diabetes patients with HFpEF are elevated,and the combination of the two was more effective in diagnosing elderly type 2 diabetes patients with HFpEF.