Abstract:Objective To discuss the effect of personalized nursing under electrocardiographic(ECG)monitoring on patients with myocardial infarction(MI)complicated by arrhythmia.Methods This study was a prospective study.A total of 112 patients with MI complicated by arrhythmia were selected,who visited the 7th Medical Center of Chinese PLA General Hospital from May 2022 to May 2023.They were divided into observation group(n=56,treated with a personalized nursing plan under ECG monitoring)and control group(n=56,treated with a conventional nursing plan)according to the random number table method,and both groups received intervention for 48 h.The ECG parameters,occurrence of arrhythmia and changes of quality of life(QOL)were compared between 2 groups.Results After the intervention,the ECG parameters(QTc interval,QT interval,ST-segment depression amplitude,and T-wave duration)were lower in both groups than those before the intervention,and the parameters were lower in observation group than those in control group(P<0.05).After the intervention,the incidence of arrhythmia was lower in both groups during different time periods within 1～48 h after treatment start than that before the intervention,and the incidence was lower in observation group than that in control group(P<0.05).After the intervention,the scores of physical function,pain,vitality,and emotional health were higher than those before the intervention in both groups,and the scores were higher in observation group than those in control group(P<0.05).Conclusion The personalized nursing under ECG monitoring can significantly improve ECG parameters,reduce arrhythmia incidence and promote QOL in patients with MI complicated by arrhythmia.

Abstract:Objective To investigate the relationship between body mass index(BMI)and the risk of new-onset atrial fibrillation(NOAF)in patients with chronic heart failure(CHF).Methods This study was a retrospective cohort study.A total of 512 patients diagnosed with CHF were included at Zhangjiakou First Hospital between 2020 and 2023,and they were divided into 4 groups based on body mass index(BMI):underweight group(n=45),normal weight group(n=212),overweight group(n=203),and obese group(n=52).The primary outcome was NOAF.The follow-up duration was 3 y.Kaplan-Meier survival analysis,multivariate Cox regression analysis,restricted cubic spline(RCS)analysis,and subgroup analysis were used to evaluate the relationship between BMI and NOAF risk.Results Kaplan-Meier analysis showed that NOAF risk was significantly higher in underweight,overweight,and obese groups than that in normal weight group(Log-rank P=0.020).Multivariate Cox regression analysis indicated that compared with normal weight group,NOAF risk was significantly increased in overweight group(HR=1.56,95%CI:1.05～2.32,P=0.019)and obese group(HR=2.38,95%CI:1.38～4.10,P=0.002).RCS analysis revealed a U-shaped non-linear relationship between BMI and NOAF risk(non-linear P<0.001).Subgroup analysis found that the association between BMI and NOAF was stronger in females(P for interaction=0.046),and was only significant in subgroups with diastolic blood pressure(DBP)<90 mmHg(HR=1.19,95%CI:1.13～1.25,P<0.001)and B-type natriuretic peptide(BNP)≤300 pg/mL(HR=1.15,95%CI:1.08～1.22,P<0.001).Conclusion There is a U-shaped relationship between BMI and NOAF risk in CHF patients,and overweight and obese patients have a significantly increased risk.This association is more pronounced in female patients and those with lower DBP and BNP level.

Abstract:Objective To investigate the clinical efficacy of different doses of tolvaptan in elderly patients with chronic heart failure(CHF).Methods Elderly CHF patients(n=97)were selected from People's Hospital Affiliated to Shandong First Medical University from Jan.2020 to Jan 2023,and randomly divided into low-dose group(n=48)and high-dose group(n=49).The low-dose group was given therapy of basic cardiotonic-diuretic and tolvaptan(7.5 mg/d),and high-dose group was given therapy of basic cardiotonic-diuretic and tolvaptan(15 mg/d).The changes of heart function,daily urine volume,6-minute walk distance(6MWD),and blood electrolytes were compared between 2 groups before and after treatment.The differences in clinical efficacy and prognostic outcomes were compared between 2 groups.Results The comparison had no statistical significance in left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),left ventricular ejection fraction(LVEF),interventricular septum thickness of end-diastole(IVSTd),left ventricular posterior wall thickness(LVPWT)and ratio of early diastolic mitral valve flow velocity to late diastolic mitral valve flow velocity(E/A)between 2 groups before and after treatment(P>0.05).The measured values of LVEDd,LVESd,IVSTd and LVPWT decreased significantly(P<0.05),and LVEF and E/A increased significantly(P<0.05)in 2 groups after treatment.The comparison in urine volume had no statistical significance between 2 groups before treatment(P>0.05),and urine volume was significantly lower in low-dose group than that in high-dose group on the 3rd,5th,7th and 14th d after treatment(P<0.05).The comparison in 6MWD and N-terminal pro-brain natriuretic peptide(NT-proBNP)had no statistical significance between 2 groups before treatment(P>0.05),and 6MWD increased and NT-proBNP decreased in 2 groups after treatment(P<0.05).The comparison in blood sodium,blood potassium and blood chlorine had statistical significance between 2 groups before treatment(P>0.05),and blood sodium and blood potassium increased in 2 groups after treatment(P<0.05).The measured values of blood sodium and blood potassium were lower in low-dose group than those in high-dose group(P<0.05).The comparison in clinical efficacy had no statistical significance between 2 groups after treatment(P>0.05).The incidence of adverse reactions was lower in low-dose group than that in high-dose group(14.58%vs.32.65%,P<0.05).Conclusion Tolvaptan achieves good therapeutic effects in elderly CHF patients.When comparing 2 doses of 15 mg/day and 7.5 mg/day,the 7.5 mg/day dose helps reduce the incidence of adverse reactions while ensuring the therapeutic effect.

Abstract:Objective To discuss the relationship between cardiometabolic index(CMI)and myocardial infarction(MI)in elderly population.Methods The data were derived from the database of the National Health and Nutrition Examination Survey(NHANES,2011～2018).A cross-sectional study was conducted involving 5132 patients aged 45 years and above.Clinical data such as demographic variables,socioeconomic status,health behaviors,and health status were collected.Patients were divided into non-MI group and MI group based on whether they had experienced MI.The baseline data were compared between 2 groups,and correlation between CMI and MI was assessed by using weighted Logistic regression model with CMI as a continuous variable based on quartiles.Subgroup analysis and mediation analysis were performed on potential covariates to further explore the modifying effect and indirect effect of covariates on the relationship between CMI and MI.Missing data were handled by using multiple imputation.Results Of the 5132 patients,335 had MI,with an incidence rate of 6.53%.The CMI value in MI group was significantly higher than that in non-MI group(0.61 vs.0.52,P<0.001).The results of Logistic regression analysis showed that for each unit increase in CMI,MI risk increased by 16.00%(OR=1.16,95%CI:1.03～1.32,P=0.015).CMI was analyzed by quartiles,and the results showed that patients in the third and fourth quartiles had a significantly increased MI risk compared with those in the lowest quartile.Subgroup analysis revealed a significant correlation between CMI and MI in males,non-Hispanic whites,those who were married or living with a partner,those with an educational level above high school,those with a poverty income ratio≥3.50,former smokers,former drinkers,diabetic patients,those without hypertension,patients with hypercholesterolemia,those with a body mass index(BMI)≥30 kg/m2,those with central obesity,those with a sleep duration<6 hours,and those without physical activity.The results of mediation analysis indicated that smoking,sleep duration,poverty-income ratio,hypertension,hypercholesterolemia,gender,race,diabetes,central obesity,BMI,and age had significant indirect effects on the relationship between CMI and MI,while smoking,poverty-income ratio,hypertension,gender,and age had direct effects on this relationship.Conclusion Elevated CMI is positively correlated to MI risk in middle-aged and older adults,and CMI is valuable for predicting MI occurrence in this population.

Abstract:Objective To investigate the relationship between serum-derived exosomal hsa-let-7b-5p and the degree of coronary atherosclerosis in patients with diabetes mellitus(DM)and coronary heart disease(CHD).Methods A total of 316 patients with clinically confirmed CHD and a control group of 59 patients with normal coronary angiography in the Department of Cardiology,the 960th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army were included.CHD patients were divided into DM+CHD group(163 cases)and CHD group(153 cases)based on blood glucose levels.DM+CHD patients were divided into mild stenosis group(SYNTAX score<22,86 cases)and moderate to severe stenosis group(SYNTAX score≥22,77 cases)based on SYNTAX score.All research subjects'clinical data were collected,and the levels of serum-derived exosomal hsa-let-7b-5p were measured.The correlation between serum-derived exosomal hsa-let-7b-5p and the degree of coronary atherosclerosis was analyzed.Logistic regression was used to analyze the influencing factors of coronary atherosclerosis in DM+CHD patients,and receiver operating characteristic(ROC)was used to analyze the predictive value of serum-derived exosomal hsa-let-7b-5p fot the severity of coronary atherosclerosis in DM+CHD patients.Results Hypertension,glycosylated hemoglobin(HbA1c),and triglyceride(TG)levels in the DM+CHD group were significantly higher than those in the CHD group and control group,and high density lipoprotein cholesterol(HDL-C)leveles was significantly lower than those in CHD group and control group,with statistically significant differences(P<0.05).The serum-derived exosomal hsa-let-7b-5p levels in the DM+CHD group and CHD group were higher than those in the control group,and the level of serum-derived exosomal hsa-let-7b-5p in the DM+CHD group was higher than that in the CHD group,with statistical significance(P<0.05).The levels of serum-derived exosomal hsa-let-7b-5p in the moderate to severe stenosis group were higher than those in the mild stenosis group,with statistically significant differences(P<0.05).Spearman correlation analysis found that the expression levels of serum-derived exosomal hsa-let-7b-5p of DM+CHD patients were positively correlated with SYNTAX scores(r=0.158).Logistic regression analysis showed that hypertension(OR=8.684),HbAlc(OR=1.698),TG levels(OR=1.715),HDL-C(OR=0.050),level of serum-dirived exosomal hsa-let-7b-5p(OR=2.925)were risk factors for moderate to severe coronary artery stenosis(SYNTAX score≥22),(P<0.05).The level of serum-derived exosomal hsa-let-7b-5p combined with traditional factors prediction model was superior to traditional factors in predicting severity of coronary Atherosclerosis in DM+CHD patients,and the difference was statistically significant(P=0.049).Conclusion The level of serum-dirived exosomal hsa-let-7b-5p in DM patients with CHD are higher,which is related to severity of coronary atherosclerosis.Combined with traditional risk factor assessment,serum-derived exosomal hsa-let-7b-5p have better predictive value for the severity of coronary artery disease.

Abstract:Objective To discuss the influence of gender difference on short-term prognosis in patients with diabetes complicated by heart failure(HF).Methods By retrieving public data databases for secondary analysis,the clinical data was analyzed in HF patients(n=1525)hospitalized in the Fourth People's Hospital of Zigong City of Sichuan Province from Dec.2016 to June 2019,and they were divided into diabetes group(n=357)and non-diabetes group(n=1168).The differences in baseline characteristics were compared between 2 groups,and a propensity score matching was conducted according to baseline data in 2 groups.The correlation between all-cause death and rehospitalization composite endpoint events was assessed in patients with diabetes and AF by using multi-factor Logistic regression model within 6 months,and a subgroup analysis was conducted according to difference in gender and relative medical history.Results After adjusting for creatinine clearance rate(CCr),uric acid(UA),red blood cell count(RBC),hemoglobin(Hb),high-sensitivity cardiac troponin I(hs-cTnI),brain natriuretic peptide(BNP),total cholesterol(TC),low-density lipoprotein-cholesterol(LDL-C),and the presence of chronic renal failure,diabetes was independently correlated to adverse cardiovascular events within 6 months in hospitalized HF patients(OR=1.46,95%CI:1.14～1.87,P=0.003).The subgroup analysis suggested that there was no statistically significant difference(P>0.01)in the impact of diabetes on short-term prognosis 6 months after HF,regardless of a history of myocardial infarction,chronic obstructive pulmonary disease,or moderate-to-severe chronic kidney disease.Diabetes was significantly associated with the 6-month prognosis of hospitalized HF in males(OR=1.96,95%CI:1.32-2.91,P<0.001)but only marginally associated in females(OR=1.35,95%CI:0.98-1.85,P=0.063).The result of interaction analysis showed that there may be gender difference in the influence degree of diabetes on HF prognosis(P=0.074).Conclusion The risks of short-term death and/or rehospitalization are higher in patients with HF and diabetes than that in HF patients without diabetes.The influence of diabetes on HF prognosis may have gender difference,and male patients with diabetes have poorer prognosis than female ones within 6 months after discharged.

Abstract:Objective To investigate the relationship between level of mean arterial pressure(MAP)on admission and in-hospital mortality in patients with acute myocardial infarction(AMI).Methods AMI patients(n=869)were selected from Characteristic Medical Center of Chinese PLA Rocket Force from Mar.2015 to Jan.2020.The relationship between MAP admission and in-hospital mortality was statistically analyzed by using Logistic regression model,and HR and 95%CI were calculated.The relationship between MAP admission and in-hospital mortality was discussed by using restricted cubic spline(RCS)plots and inflection analysis.Results A total of 869 patients with AMI were included in this study.After adjusting for clinical features related to in-hospital all-cause mortality,MAP was an independent predictor of mortality in AMI patients.Compared with those with MAP<87.6 mmHg(1 mmHg=0.133 kPa),the patients with MAP≥98.2 mmHg had a significantly lower risk of in-hospital death,(HR=0.18,P<0.05).The results of RCS plots and inflection analyses showed an L-shaped curve of in-hospital all-cause mortality between MAP and AMI(P<0.05).In the inflection point analysis,patients with MAP<91 mmHg had a decreased risk of in-hospital mortality with increasing MAP(P<0.05).When MAP≥91 mmHg,there was no significant correlation between MAP and in-hospital mortality(P>0.05).Conclusion MAP may be an independent risk factor for in-hospital all-cause mortality,and an L-shaped relationship was found between MAP and in-hospital all-cause mortality in AMI patients.

Abstract:Objective Based on the China Health and Retirement Longitudinal Study(CHARLS)database,this study aimed to analyze and discuss the prevalence trend and risk factors of CKM syndrome among middle-aged and elderly populations in China.Methods A total of 3,584 respondents aged≥45 y were enrolled from CHARLS database in 2011 and 2015.An age-stratified model was established to explore the age-specific risk evolution pattern,and multivariate Logistic regression analysis was performed to identify the independent predictors for the progression of CKM syndrome to stage 4.Results From 2011 to 2015,the prevalence rate of stage 4 CKM syndrome increased significantly from 3.2%to 7.6%(P<0.001).Age-stratified analysis indicated that the prevalence of stage 4 CKM syndrome increased with age in both 2011(χ2=16.85,P=0.010)and 2015(χ2=16.05,P=0.010).Multivariate Logistic regression analysis revealed that increasing age(2011:OR=1.04,P<0.001;2015:OR=1.02,P=0.002),elevated platelet count(2011:OR=1.00,P=0.007;2015:OR=1.00,P=0.015),as well as comorbidities including dyslipidemia(2011:OR=2.51,P=0.001;2015:OR=2.48,P<0.001),chronic lung disease(2011:OR=1.89,P=0.015;2015:OR=2.02,P<0.001)and kidney disease(2011:OR=2.23,P=0.006;2015:OR=2.04,P=0.001)were significantly associated with an increased risk of stage 4 CKM syndrome.In addition,comorbid rheumatic disease in 2011(OR=1.74,P=0.006),female sex(OR=1.52,P=0.002)and elevated hemoglobin level(OR=1.10,P=0.001)in 2015 were also identified as independent risk factors for stage 4 CKM syndrome.Conclusion This study established the first longitudinal epidemiological database of CKM syndrome in the Chinese population,revealing the age-specific risk evolution pattern.It identified clusters of key modifiable risk factors,thereby providing a scientific basis for formulating hierarchical prevention and control strategies.

Abstract:Objective To investigate the clinical value of systemic inflammatory response index(SIRI)as a predictive marker for premature coronary artery disease.Methods This study included 2,387 patients who underwent coronary computed tomography angiography examination at The First Hospital of Zhangjiakou City from 2013 to 2018.Patients were divided into four groups according to SIRI quartiles:Group 1 was the low SIRI group(SIRI≤0.76,n=597),Group 2 was the medium-low SIRI group(0.76<SIRI≤1.03,n=597),Group 3 was the medium-high SIRI group(1.03<SIRI≤1.42,n=596),and Group 4 was the high SIRI group(SIRI>1.42,n=597).Multivariate logistic regression analysis was used to evaluate the association between SIRI and premature coronary artery disease,followed by stratified subgroup analyses.Restricted cubic spline(RCS)curves were employed to explore the non-linear relationship between the two variables,and receiver operating characteristic(ROC)curves were used to assess the predictive value of SIRI.Results The incidence of premature coronary artery disease increased with higher SIRI levels.After multivariate adjustment,logistic regression analysis showed that compared with Group 1(SIRI≤0.76),the risk of premature coronary artery disease increased progressively in the other three groups(OR=1.72,2.53,and 5.74,respectively,all P<0.050).Stratified analyses revealed no significant interaction in the association between SIRI and premature coronary artery disease across different subgroups of gender,body mass index,hypertension,diabetes,and hyperlipidemia.RCS analysis confirmed a significant non-linear relationship between SIRI and premature coronary artery disease(P<0.050).ROC curve analysis demonstrated that SIRI had predictive value for premature coronary artery disease(AUC=0.659,95%CI:0.629～0.689,P<0.001).Conclusion Elevated SIRI levels are independently associated with increased risk of premature coronary artery disease.

Abstract:Objective To determine the efficacy and safety of proprotein convertase subtilisin/kexin type 9 inhibitors(PCSK9i)in treatment of coronary atherosclerotic plaques by applying a systematical evaluation method.Methods The databases of PubMed,Web of Science,Cochrane Library,EmBase,CNKI,WanFang Data,VIP and CBM were retrieved with computer from the inception of the databases until Mar.2023.All literature were screened according to inclusion and exclusion criteria,data was extracted and quality of included studies was reviewed by 2 independent evaluators.A Meta-analysis was conducted by using RevMan 5.4 software and Stata 16.0 software.Results There were totally 6 RCT included involved 2003 patients with coronary heart disease(CHD).The percent atheroma volume(PAV),(MD=-1.02,95%CI:-1.34～-0.69,P<0.001)and maximum lipid arc(MD=-11.25,95%CI:-22.39～-0.11,P=0.050)decreased,and the minimum fiber cap thickness(FCTmin),(MD=20.33 mm3,95%CI:10.73～29.93,P<0.001)and mean FCT(FCTmean),(MD=27.74,95%CI:4.56～50.91,P<0.050)increased in statin+PCSK9i therapy group compared with statin therapy group.The differences in neurocognitive impairment,new-onset diabetes and myalgia had no statistical significance between statin+PCSK9i therapy group and statin therapy group(P>0.050).The results of subgroup analysis showed that different treatment time,PCSK9i types and CHD subtypes had no significant impact on PAV results(P>0.050).The results of sensitivity analysis showed no any studies influencing PAV results(P>0.050).The results of funnel plot and Egger's test indicated no obvious publication bias.Conclusion PCSK9i combined with statins can significantly reverse plaque progression and increase plaque stability in CHD patients.It is expected that future studies will further determine whether the effect of PCSK9i on plaques can improve patient prognosis.

Abstract:Objective To conduct a systematic review and Meta-analysis of randomized controlled trials(RCTs)evaluating the efficacy and safety of traditional Chinese medicine(TCM)in treating coronary borderline lesions and to assess the evidence quality of existing studies.Methods Electronic searches were performed in PubMed,Embase,The Cochrane Library,Web of Science,CNKI,CBM,VIP,and Wanfang databases for RCTs on TCM interventions for coronary borderline lesions.Methodological quality was assessed using the Cochrane Risk of Bias Tool 5.1.0.Meta-analysis was conducted using RevMan 5.3 software,and the GRADE system was applied to evaluate the evidence quality of statistically significant outcomes.Results Eighteen studies involving 1,799 patients were included.Compared with conventional Western medicine alone,integrated TCM and Western therapy significantly improved the effective rates of TCM syndromes,angina relief,and electrocardiogram normalization,enhanced Seattle Angina Questionnaire scores(including physical activity limitations),reduced inflammatory markers(hs-CRP,IL-6),improved lipid profiles(lowered TC,TG,LDL-C;elevated HDL-C),decreased average coronary stenosis diameter,reduced positive treadmill exercise test results,increased left ventricular ejection fraction(LVEF),and lowered the incidence of major adverse cardiac events(MACE).GRADE evaluation indicated high-quality evidence for TCM in improving angina symptom efficacy,TCM syndrome efficacy,MACE reduction,LDL-C reduction,Seattle Angina Questionnaire-physical activity scores,and LVEF enhancement.Other outcomes were rated as very low-,low-,or moderate-quality evidence.Conclusions TCM demonstrates potential advantages in managing coronary borderline lesions.However,limitations in current evidence necessitate the establishment of a core outcome set tailored to TCM clinical trials and the implementation of large-scale RCTs to generate higher-quality evidence for this field.

Abstract:Objective To evaluate the intervention effect of group heart rate variability(HRV)biofeedback therapy on patients with early cardiovascular diseases complicated with high stress.Methods A total of 104 outpatients with early cardiovascular disease complicated with psychological stress were enrolled in this study who attended the Seventh Medical Center of Chinese PLA General Hospital from Apr.2023 to July 2023.They were divided into experimental group(n=52)and control group(n=52)using a random number table method.The control group received conventional treatment,while the experimental group was administered combined therapy,namely 8-week group heart rate variability biofeedback therapy(HRV-BFT)on the basis of conventional treatment.Indicators including stress level,HRV and blood pressure(BP)were evaluated in both groups before intervention,immediately after intervention,and 4 weeks after the end of intervention.Results No statistically significant differences were observed in stress level,systolic blood pressure(SBP)and diastolic blood pressure(DBP)between 2 groups in terms of intergroup effect and interaction effect(P>0.050),whereas significant differences were noted in terms of time effect(P<0.050).Pairwise comparisons showed that after treatment,the stress level,SBP and DBP of both groups were improved compared with those before treatment,but there was no statistically significant difference between 2groups(P>0.050).However,at 4 weeks of follow-up,the stress level,SBP and DBP were superior in experimental group to those in control group(P<0.050).Regarding SDNN,RMSSD,LF/HF ratio and heart rate,statistically significant differences were found between 2 groups in terms of time effect,intergroup effect and interaction effect(P<0.050).Pairwise comparisons indicated that after treatment,except for RMSSD,the SDNN,LF/HF ratio and heart rate of both groups were improved compared with those before treatment,but no statistically significant intergroup difference was observed(P>0.050).At 4 weeks of follow-up,all the above indicators were better in experimental group than those in control group(P<0.050).Conclusion After intervention,the therapeutic effect of combined therapy was comparable to that of conventional treatment in patients with early cardiovascular disease complicated with high stress.However,combined therapy exhibited distinct advantages in the maintenance phase.

Abstract:Objective To systematically evaluate the effectiveness and safety of the novel non-steroidal mineralocorticoid receptor antagonist finerenone in cardiovascular diseases.Methods Randomized controlled studies comparing finerenone with the control group were retrieved using database search tools,and then a meta-analysis was conducted for comprehensive assessment.Results A total of 8 articles were included,involving 21,328 patients.Compared with the control group,the all-cause mortality rate was lower in the finerenone group(OR=0.9,95%CI:0.83～0.99;heterogeneity:P=0.550,I2=0%);the risk of major adverse cardiovascular events(MACE)was significantly reduced in the finerenone group(OR=0.86,95%CI:0.78～0.94;heterogeneity:P=0.990,I2=0%);the risk of heart failure occurrence and rehospitalization due to heart failure was significantly reduced in the finerenone group(OR=0.79,95%CI:0.72～0.88;heterogeneity:P=0.750,I2=0%);the incidence of hyperkalemia was increased in the finerenone group(OR=2.17,95%CI:1.93～2.44;heterogeneity:P=0.180,I2=36%);the incidence of atrial flutter and atrial fibrillation in the finerenone group(4.24%)was lower than that in the control group(5.39%),mainly due to the reduction in the incidence of atrial fibrillation(3.67%vs.4.82%).There were no statistically significant differences in the risk of cardiovascular death(OR=0.89,95%CI:0.79～1.00;heterogeneity P=0.87,I2=0%),the risk of myocardial infarction(OR=0.91,95%CI:0.74～1.12;heterogeneity P=0.510,I2=0%),the risk of adverse effects(OR=0.97,95%CI:0.88～1.06;heterogeneity P=0.910,I2=0%),and the risk of drug discontinuation due to adverse effects(OR=1.15,95%CI:1.00～1.32;heterogeneity P=0.610,I2=0%).Conclusion Compared with the control group,finerenone reduces the risk of all-cause mortality,reduces the occurrence of MACE events,lowers the risk of heart failure and rehospitalization due to heart failure,and reduces the risk of atrial fibrillation,but increases the risk of hyperkalemia;there are no significant differences between the two groups in terms of cardiovascular death,myocardial infarction,adverse effects,and drug discontinuation due to adverse effects.

Abstract:Objective To observe and analyze the current status and risk factors of unplanned readmission from perspective of outpatient follow-up in patients with heart failure with reduced ejection fraction(HFrEF)during vulnerable phase.Methods A total of 162 patients in HFrEF vulnerable phase were enrolled in the study,who were admitted to Zhongnan Hospital of Wuhan University from Sept.2023 to June 2024,and their clinical data,laboratory indicators and imaging parameters were collected.The outpatient follow-up was carried out for 3 months,and then current status and risk factors of unplanned readmission were statistically analyzed in all patients.Results During the follow-up period,31 out of 162 patients in HFrEF vulnerable phase experienced unplanned readmission,with an incidence rate of 19.14%.Significant differences were observed between readmission group and non-readmission group in terms of the proportions of smoking,alcohol consumption,New York Heart Association(NYHA)classification,platelet count(PLT)<125×109/L,N-terminal pro-brain natriuretic peptide(NT-proBNP)>400 ng/L,left ventricular ejection fraction(LVEF)<40%,and malnutrition(P<0.050).The results of Logistic regression analysis showed that smoking,alcohol consumption,NT-proBNP>400 ng/L,LVEF<40%,and malnutrition were independent risk factors for unplanned readmission in HFrEF patients in vulnerable phase(P<0.050).The regression equation was:Logit(P)=5.014+1.362×(smoking)+1.228×(alcohol consumption)+1.936×(NT-proBNP>400 ng/L)+1.696×(LVEF<40%)+1.184×(m alnutrition).On this basis,the predictive value of the model was evaluated by plotting the receiver operating characteristic(ROC)curve.The results showed that when the optimal cut-off value was greater than 12.42,the area under the curve(AUC)was 0.867(95%CI:0.836～0.890),indicating that the model had a good predictive value for the occurrence of events.Conclusion Smoking,alcohol consumption,NT-proBNP>400 ng/L,LVEF<40% and malnutrition are risk factors for HFrEF patients in vulnerable phase.The regression equation and ROC curve established and plotted based on these risk factors can predict the risk of unplanned readmission with some clinical value.

Abstract:Objective To establish and internally validate a prediction and risk stratification model for readmission in patients with coronary heart disease(CHD)complicated by heart failure(HF).Methods A total of 212 patients with CHD complicated by HF admitted to Puyang Oilfield General Hospital were retrospectively enrolled from June 2022 to Oct.2024.They were divided into readmission group(n=65)and control group(n=147)according to whether unplanned readmission occurred within 6 months after treatment.Baseline demographic data,medical history,disease-related data,laboratory test results and other clinical information of the patients were collected.After univariate analysis,variables were screened using the least absolute shrinkage and selection operator(LASSO)regression model.The screened indicators were then incorporated into a multivariate Logistic regression model to identify independent factors associated with readmission in CHD patients complicated by HF.Rsoftware was applied to construct a Nomogram warning model for predicting patient readmission.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive efficacy of the model,and Bootstrap method was used for internal validation.Calibration curves and decision curve analysis(DCA)were performed to assess the calibration degree and clinical benefit of the model.Furthermore,the SHapley Additive exPlanations(SHAP)model was used to explore the contribution of each independent influencing factor to the warning model.A risk stratification system was established based on the risk scores derived from Nomogram warning model.Results The unplanned readmission rate was 30.66%(65/212)among 212 CHD patients complicated by HF within 6 months after treatment.Compared with control group,the readmission group had significantly higher proportions of diabetes mellitus and chronic kidney disease,higher Charlson comorbidity index(CCI)scores,more advanced New York Heart Association(NYHA)functional classes,longer length of hospital stay,higher levels of triglyceride-glucose index(TyG),N-terminal pro-B-type natriuretic peptide(NT-proBNP),serum creatinine(Cr)and uric acid(UA),whereas levels of medication adherence and hemoglobin(Hb)were notably lower(all P<0.05).The LASSO regression model identified 7 predictive variables,namely CCI score,NYHA functional class,TyG index,NT-proBNP,serum Cr,UA,and medication adherence.The results of multivariate Logistic regression analysis revealed that CCI score,NYHA functional class,TyG index,NT-proBNP,serum Cr and UA were risk factors for unplanned readmission within 6 months in CHD patients complicated by HF,while medication adherence served as a protective factor(all P<0.05).The results of receiver operating characteristic(ROC)curve analysis demonstrated that the Nomogram warning model had an area under the curve(AUC)of 0.967(95%CI:0.947～0.988)for predicting 6-month readmission.The results of calibration curves and DCA analyses indicated that the model had good calibration and clinical utility,with excellent consistency confirmed by internal validation.The results of SHAP model analysis showed that the ranking of the importance of independent factors influencing the Nomogram warning model for readmission in CHD patients complicated by HF was as follows(in descending order):NT-proBNP>TyG index>UA>serum Cr>medication adherence>NYHA functional class>CCI score.A comprehensive risk score was calculated using the Nomogram warning model,and patients were stratified into three risk levels(high,moderate and low risk).The unplanned readmission rate increased significantly with the elevation of risk stratification in CHD patients complicated by HF within 6 months(P<0.050).Conclusion The Nomogram prediction model constructed based on NT-proBNP,TyG index,UA,serum Cr,medication adherence,NYHA functional class and CCI score has good predictive performance for readmission risk in CHD patients complicated by HF.

Abstract:Objective To investigate the characteristics of coronary total occlusion(CTO)and their predictive value to major adverse cardiovascular events(MACE)in patients with non-ST-segment elevation myocardial infarction(NSTEMI).Methods NSTEMI patients(n=197)were retrospectively analyzed in Department of Cardiology of Shanxi Bethune Hospital from Nov.2017 to Nov.2022.All patients were divided,according to whether or not acute thrombotic occlusion occurrence,into occlusion group and non-occlusion group.The clinical characteristics,laboratory indicators and prognosis were compared between 2 groups.The independent risk factors of CTO and MACE were analyzed and screened by applied Logistic regression analysis.Results A total 197 NSTEMI patients included,male accounted for 79.2%,and average age was(59.32±12.96).The incidence of acute thrombotic occlusion was 14.72%.The results of multivariate analysis showed that smoking history(OR=5.893,95%CI:1.715～20.246,P=0.005),and increased low-density lipoprotein-cholesterol(LDL-C,OR=1.693,95%CI:1.120～2.561,P=0.013),high sensitivity cardiac troponin T(hs-cTnT,OR=1.003,95%CI:1.001-1.005,P=0.002),brain natriuretic peptide(BNP,OR=1.002,95%CI:1.000～1.003,P=0.035)and soluble growth stimulation expressed gene 2(sST2,OR=1.024,95%CI:1.007～1.043,P=0.007)were independent risk factors for acute thrombotic occlusion.The incidence of MACE was 21.83%,and its independent risk factors were drinking history(OR=3.516,95%CI:1.118～11.057,P=0.031),and increased LDL-C(OR=1.881,95%CI:1.201～2.946,P=0.006),hs-cTnI(OR=1.007,95%CI:1.004～1.010,P<0.001),BNP(OR=1.004,95%CI:1.002-1.006,P<0.001)and sST2(OR=1.025,95%CI:1.002～1.048,P=0.034).In addition,age(OR=1.081,95%CI:1.031-1.134,P=0.001),smoking history(OR=2.321,95%CI:1.176-4.580,P=0.015)and hypertension history(OR=2.045,95%CI:1.163-3.598,P=0.013)were independent risk factors for number of lesion coronary vessels.Conclusion Smoking,dyslipidemia and elevated myocardial injury biomarkers(hs-cTnI,BNP,ST2)are closely related to acute thrombotic occlusion and MACE in NSTEMI patients.Elderly patients with hypertension are more prone to developing multi-vessel coronary artery disease,and it is necessary to strengthen early identification and intervention measures to improve prognosis.

Abstract:Objective This study analyzes the clinical characteristics of multisystem inflammatory syndrome in children(MIS-C)and Kawasaki disease shock syndrome(KDSS),summarizes and identifies their main features,providing a basis for timely and accurate diagnosis and treatment.Methods Clinical data were retrospectively collected from 12 children diagnosed with multisystem inflammatory syndrome in children(MIS-C)at Capital Center for Children's Health,Capital Medical University from January to February 2023,and 38 children diagnosed with Kawasaki disease shock syndrome(KDSS)from January 2018 to December 2023.Demographic characteristics,clinical manifestations,complications,laboratory parameters(including white blood cell count,neutrophil count,platelet count,high-sensitivity cardiac troponin T,tumor necrosis factor-α,and interleukin-8)and treatment strategies were compared between the two groups.Binary logistic regression analysis was conducted to identify key diagnostic indicators useful for differentiating MIS-C from KDSS,and receiver operating characteristic(ROC)curves were used to evaluate their diagnostic performance.Results Among the 12 children with MIS-C,5 were male and 7 were female;among the 38 children with KDSS,18 were male and 20 were female.There were no statistically significant differences between the two groups regarding sex and age(P>0.05).The incidence rates of polymorphic rash(50.00%vs.84.21%),lymphadenopathy(75.00%vs.100.00%),non-purulent conjunctivitis(66.67%vs.94.74%),and erythema or induration of the extremities(33.33%vs.81.58%)were significantly lower in the MIS-C group compared with the KDSS group(P<0.05).Shock occurred significantly earlier in the MIS-C group than in the KDSS group[(5.58 ± 1.38)days vs.(6.47 ± 1.18)days,P=0.033].The incidence rates of myocardial injury(83.33%vs.34.21%,P=0.006),decreased left ventricular ejection fraction(50.00%vs.5.26%,P=0.001),and high-grade atrioventricular block(25.00%vs.2.63%,P=0.038)were significantly higher in the MIS-C group compared with the KDSS group.Although the incidence of coronary artery dilatation was lower in the MIS-C group(25.00%vs.44.74%),the difference was not statistically significant(P>0.05).Laboratory findings showed that levels of high-sensitivity cardiac troponin T,tumor necrosis factor-α,and interleukin-8 were significantly higher in the MIS-C group than in the KDSS group(P<0.05),whereas white blood cell count,platelet count,absolute CD3+T cell count,absolute CD16+CD56+natural killer cell count,and absolute lymphocyte count were significantly lower in the MIS-C group(P<0.05).Neutrophil and alanine aminotransferase levels were significantly higher in the KDSS group compared with the MIS-C group(P<0.05).The rates of methylprednisolone pulse therapy and the use of vasoactive agents were significantly higher in the MIS-C group compared with the KDSS group(P<0.05).Binary logistic regression analysis indicated that interleukin-8(OR=1.03,95%CI:1.004～1.055,P<0.05)and high-sensitivity cardiac troponin T(OR=1.15,95%CI:1.030～1.281,P<0.05)were useful diagnostic predictors for differentiating MIS-C from KDSS.Conclusion Compared with the KDSS group,shock occurred significantly earlier in the MIS-C group.Cardiovascular complications in MIS-C were characterized predominantly by myocardial injury,reduced left ventricular ejection fraction,and high-grade atrioventricular block rather than coronary artery lesions.Treatment of MIS-C more frequently required pulse-dose corticosteroids and vasoactive agents.Patients with interleukin-8 levels>72.1 pg/mL and high-sensitivity cardiac troponin T levels>14.5 ng/L were more likely to be diagnosed with MIS-C.

Abstract:Objective Clinical observation on the therapeutic effect of pacemaker implantation on patients of different age groups.Methods 108 elderly patients who underwent pacemaker implantation treatment at the 82nd Group Army Hospital of the Chinese People's Liberation Army from October 2019 to June 2023 were selected as the research subjects.They were divided into the elderly group(60-80 years old)and the elderly group(over 80 years old)based on age as the critical value.Both groups of patients met the indications for pacemaker implantation and underwent standardized permanent pacemaker implantation treatment by the same team of surgeons.Compare the cardiac function indicators,pacing parameters,pocket and lead conditions of two groups of patients 6 months after surgery,and evaluate the impact of age on pacemaker implantation patients.Results There was no statistically significant difference in cardiac function indicators between the two groups of patients before treatment(P>0.05);After treatment,the left ventricular ejection fraction(LVEF)of the two groups was higher than before treatment,and the left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),and P-wave dispersion(Pd)were lower than before treatment.In addition,the LVEF of the elderly group was higher than that of the elderly group,and LVEDD,LVESD,and Pd were lower than those of the elderly group,with statistical differences(P<0.05).Compared with the elderly group,the elderly group showed a statistically significant decrease in the healing time of the cyst,the time for hematoma regression,and the thresholds of the atrium and ventricle(P<0.05).Compared with the elderly group,the atrial pacing threshold and ventricular pacing threshold of the elderly group were both increased,with statistical differences(P<0.05).There was no statistically significant difference in activity tolerance between the two groups of patients before treatment(P>0.05);After treatment,the 6-minute walking distance of the two groups was higher than before treatment,and the MLHFQ score was lower than before treatment.In addition,the elderly group had a higher 6-minute walking distance and lower MLHFQ score than the elderly group,with statistical differences(P<0.05).Conclusion The implantation of pacemakers is safe and effective for both elderly and elderly patients,but the elderly group has a higher incidence of delayed bag healing,increased threshold parameters,and atrial arrhythmias after surgery.

Abstract:Objective To elucidate the molecular mechanism of neural epithelial transforming factor-1(NET-1)improving apoptosis in myocardial ischemia-reperfusion injury(MIRI)through regulating nuclear factor-κB(NF-κB)/β-catenin signaling pathway.Methods An in vitro model of ischemia-reperfusion(I/R)injury in H9C2 cells was established via hypoxia/reoxygenation(H/R)treatment.The experimental design consisted of two parts:(1)A hypoxia time-gradient experiment(0,2,4,6,8,12 h)combined with gene overexpression/knockdown techniques to investigate the correlation between cell apoptosis and NET-1 expression.(2)Mechanistic studies:Co-immunoprecipitation(Co-IP)was performed to verify the protein-protein interactions between NET-1 and NF-κB,as well as between NF-κB and β-catenin.Furthermore,Western blot and RT-qPCR assays were employed to analyze the expression of downstream target genes,in conjunction with gene overexpression/knockdown techniques.Results(1)Cardiomyocyte apoptosis was positively correlated with hypoxia duration and NET-1 expression,with the peak observed at 6 h of hypoxia exposure.NET-1 overexpression significantly exacerbated cell apoptosis,whereas NET-1 knockdown markedly suppressed apoptosis.With the extension of hypoxia duration,the protein and mRNA expressions of NET-1,Caspase-3 and Bax were significantly upregulated,peaking at 6 h.Moreover,the protein and mRNA expressions of Caspase-3 and Bax were significantly increased in NET-1 overexpression group,but prominently decreased in NET-1 knockdown group.(2)NF-κB exerted a pro-apoptotic effect in hypoxia/reoxygenation-induced cardiomyocyte apoptosis,and it could interact with and be regulated by NET-1.The expression level of NF-κB was positively correlated with the protein and mRNA expressions of Caspase-3 and Bax.The expression of NF-κB was significantly increased in NET-1 overexpression group,but markedly decreased in NET-1 knockdown group.Co-IP assays demonstrated that NET-1 could be co-precipitated with NF-κB.(3)β-catenin exerted a pro-apoptotic effect in hypoxia/reoxygenation-induced cardiomyocyte apoptosis,and it could interact with and be regulated by NF-κB.The expression level of β-catenin was positively correlated with the protein and mRNA expressions of Caspase-3 and Bax.The expression of β-catenin was significantly increased in NF-κB overexpression group,but markedly decreased in NF-κB knockdown group.Co-IP assays demonstrated that NF-κB could be co-precipitated with β-catenin.Conclusion NET-1 positively regulates NF-κB and activates β-catenin,thereby synergistically promoting cardiomyocyte apoptosis associated with MIRI.Targeted inhibition of NET-1 can significantly alleviate cardiomyocyte apoptosis,suggesting its potential value as a novel therapeutic target.

Abstract:Objective To analyze the correlation among bolus tracking threshold trigger time,CT value and contrast medium extravasation in coronary CT angiography(CCTA),and to provide a scientific reference for the clinical rapid identification and management of contrast medium extravasation.Methods A retrospective study was conducted on 1124 outpatients who underwent CCTA at Peking University People's Hospital from Jan.2022 to Dec.2023,with their general demographic data collected.The patients were divided into an extravasation group and a non-extravasation group according to the occurrence of contrast medium extravasation,and further divided into 4 subgroups based on body mass index(BMI),contrast medium injection dose and injection rate(subgroup 1:underweight by BMI,injection dose 48 mL,injection rate 4 mL/s;subgroup 2:normal weight by BMI,injection dose 54 mL,injection rate 4.5 mL/s;subgroup 3:overweight by BMI,injection dose 60 mL,injection rate 5 mL/s;subgroup 4:obese by BMI,injection dose 66 mL,injection rate 5.5 mL/s).The bolus tracking threshold trigger time and CT value were counted in all patients.The changes of gender,age,educational level,BMI and CT value were compared between extravasation group and non-extravasation group,and the contrast medium extravasation status was compared among 4 subgroups.The risk factors for contrast medium extravasation were identified by using multivariate Logistic regression analysis,and influencing factors of CT value and trigger time were analyzed by using multiple linear regression analysis.Results Among the 1124 patients,25 cases(2.22%)had venous extravasation of contrast medium.There were no statistically significant differences in gender,age,educational level and BMI between the extravasation group and the non-extravasation group(P>0.050),while the difference in CT value between the two groups was statistically significant(P<0.050).The comparison in contrast medium extravasation status had no statistically significant difference among 4 subgroups(P>0.050).The results of multivariate regression analysis showed that gender,age,BMI,educational level and subgroup were not risk factors for contrast medium extravasation(P>0.050).The results of multiple linear regression analysis for trigger time and CT value indicated that gender,educational level and BMI were not their influencing factors(P>0.050),while age and subgroup were the influencing factors(P<0.050).Conclusion The prediction of contrast medium extravasation in CCTA based on the bolus tracking threshold trigger time and CT value is highly scientific,which can provide a reliable reference for clinical assessment of the risk of contrast medium extravasation.