Abstract:Objective To explore the correlation between serum stromal interaction molecule 1(STIM1),spliced X-box binding protein(XBP1S),transcription factor 21(TCF21),and the risk of major adverse cardiovascular events(MACE)in elderly patients with hypertension and chronic heart failure(CHF).Methods A total of 208 elderly patients with hypertension and concomitant CHF admitted to the Department of Cardiology,Yuncheng Central Hospital in Shanxi Province from May 2021 to May 2024 were selected as the study group and classified by New York Heart Association(NYHA)class into Ⅰ～Ⅱ and Ⅲ～Ⅳ.Patients were divided into the MACE group and the non-MACE group based on whether MACE occurred after discharge.Another 208 healthy individuals who underwent physical examinations in our hospital during the same period were selected as the control group.The correlations between the levels of serum STIM1,XBP1S and TCF21 in the study group and the laboratory indicators were analyzed using Pearson correlation.Logistic regression was conducted to identify factors of MACE in elderly patients with hypertension and CHF.Results The levels of serum STIM1,XBP1S,TCF21,uric acid(UA),and N-terminal pro-brain natriuretic peptide(NT-proBNP)in the study group were higher than those in the control group(P<0.05).The levels of serum STIM1,XBP1S,TCF21,UA and NT-proBNP in patients with NYHA grades Ⅲ～Ⅳ were higher than those in patients with grades Ⅰ～Ⅱ(P<0.05).According to the Pearson correlation results,STIM1,XBP1S,and TCF21 were all related to UA and NT-proBNP(P<0.05).There were statistically significant differences in age and left ventricular ejection fraction(LVEF)between the non-MACE group and the MACE group(P<0.05).The levels of serum STIM1,XBP1S,TCF21,UA and NT-proBNP in the MACE group were higher than those in the non-MACE group(P<0.05).Logistic regression analysis showed that age,UA,NT-proBNP,STIM1,XBP1S,and TCF21 were all risk factors affecting the occurrence of MACE in elderly patients with hypertension and CHF(P<0.05).Conclusion Serum STIM1,XBP1S,and TCF21 are abnormally elevated in elderly patients with hypertension and CHF.All three are related to the occurrence of MACE in patients.

Abstract:Objective To investigate the safety and efficacy of anhydrous ethanol chemical ablation of the vein of Marshall(VOM)combined with radiofrequency catheter ablation(RFCA)of 2C3L[2C:bilateral circumferential pulmonary-vein ablation(CPVA);3L:left atrial roof line,mitral valve isthmus(MVI),tricuspid isthmus line]in patients with persistent atrial fibrillation(PeAF).Methods PeAF patients(n=22)were selected and divided into group A(with anhydrous ethanol ablation)and group B(without anhydrous ethanol ablation,n=11)in the Fourth Medical Center of Chinese PLA General Hospital from Nov.2021 to Aug.2023.Group A was treated with anhydrous ethanol ablation of VOM combined with 2C3L procedure,and group B was only treated with routine 2C3L procedure.After both groups were converted to sinus rhythm,the achievement of surgical endpoints was evaluated by verifying pulmonary vein isolation and whether each ablation line was blocked.The clinical success rate(defined as no AF recurrence within 1 y of follow-up after a single ablation)and surgical safety were discussed in patients who underwent anhydrous ethanol ablation of VOM combined with 2C3L procedure.Results Except for the CHA2DS2-VaSc-60 score,there were no statistically significant differences in other baseline data between the two groups of patients(P>0.05).In group A,the success rate of ethanol ablation of the Marshall vein during the operation was 100%,and the termination rate of atrial fibrillation ablation during the operation was 100%in both groups.The surgical success rate of no AF recurrence within 1 y after a single ablation in group A was higher than that in group B(81.82%vs.54.55%).None of the patients had complications such as esophageal-atrial fistula,cardiac tamponade,pulmonary vein stenosis,or vascular puncture-related complications during or after the procedure.Conclusion anhydrous ethanol ablation of VOM combined with 2C3L procedure is safety and feasible in PeAF treatment.

Abstract:Objective To evaluate the predictive value of serum monocyte chemoattractant protein-1(MCP-1)and 3-nitrotyrosine(3-NT)concentrations for adverse cardiac events in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods A total of 106 patients with AMI admitted to the First Affiliated Hospital of Xi'an Jiaotong University from June 2022 to June 2024 were divided into an events group(n=47)and non-events group(n=59)according to the occurrence of adverse cardiac events.Serum MCP-1,3-NT,and cardiac function indices were compared between groups,and the correlations between these indices and adverse cardiac events were analyzed.Results Compared with the non-events group,MCP-1 and 3-NT levels were significantly higher in the events group(P<0.05).Left ventricular ejection fraction(LVEF)was significantly higher,while left ventricular end-diastolic diameter(LVEDD)and left ventricular end-diastolic area(LVEAD)were significantly higher than in the non-events group(P<0.05).Multivariable analysis showed that a history of heart failure,MCP-1,and 3-NT were independent factors associated with adverse cardiac events after PCI in AMI patients(P<0.05).The area under the receiver operating characteristic(ROC)curve for MCP-1 was 0.869(sensitivity 71.2%,specificity 53.8%),and for 3-NT was 0.786(sensitivity 93.7%,specificity 19.2%).Conclusion Serum MCP-1 and 3-NT levels are independent influencing factors associated with adverse cardiac events in patients with AMI after PCI,and show predictive utility for event occurrence.

Abstract:Objective To screen factors for carotid plaque formation based on regression model of least absolute shrinkage and selection operator(LASSO),and construct a prediction model based on these factors in patients with prehypertension(PHT).Methods PHT patients(n=752)were selected from Heze Municipal Hospital from June 2022 to May 2023.According to the formation of carotid plaques,patients were divided into a plaque group(n=295)and a plaque free group(n=457).The baseline data was compared between 2 groups.The factors that may affect the formation of carotid plaques in PHT patients were screened by using LASSO regression model and analyzed by using binary Logistic regression analysis.Based on the analysis results,a nomogram model was constructed and internally validated,and the model's predictive value to carotid plaque formation was analyzed by using ROC curve in PHT patients.Results Age,body mass index(BMI),triglycerides(TG),uric acid(UA)and percentage of staying up late were higher(P<0.05),and high-density lipoprotein cholesterol(HDL-C)was lower in plaque group than those in plaque free group.There were 6 potential relative factors screened by LASSO regression model,including age,BMI,staying up late,TG,HDL-C and UA.The results of Logistic regression analysis showed that age and BMI were independent risk factors(OR>1,P<0.05),and HDL-C was a protective factor(OR<1,P<0.05)for carotid plaque formation in PHT patients.The nomogram model was validated by using Bootstrap internal validation method.The concordance index value was 0.702.The ROC curve showed that AUC for predicting carotid plaque formation in PHT patients by the nomogram was 0.702(95%CI:0.665～0.739,P<0.001),with a specificity of 0.595,sensitivity of 0.719,and Youden index of 0.314,indicating certain predictive value.The results after plotting the decision curve showed that within the threshold ranges of 0.000～0.619 and 0.834～1.000,the net benefit rate of combining age,BMI and HDL-C to predict carotid plaque formation was superior to that of any single predictor alone in PHT patients.Conclusion Age,BMI and HDL-C are influence factors for carotid plaque formation in PHT patients.The nomogram model,constructed based on above influence factors,can effectively predict risk of carotid plaque formation in PHT patients.

Abstract:Objective To investigate the predictive effect of atrial fibrillation(AF)burden on all-cause death and major adverse cardiovascular events(MACE)in patients with new-onset atrial fibrillation(NOAF)after acute myocardial infarction(AMI).Methods The clinical data were analyzed in patients with NOAF after AMI(n=812)hospitalized in the Tenth People's Hospital of Shanghai City from Feb.2014 to Feb.2022,and the patients were divided into all-cause death group and MACE based on the occurrence of all-cause death and MACE.The independent risk factors were determined by using single-factor and multi-factor Logistic regression analyses,and predictive value of AF burden to prognosis was analyzed by using ROC curve in NOAF patients after AMI.Results Age and heart failure(HF)were risk factors for all-cause death,and age,AF burden and HF history were risk factors for MACE in NOAF patients after AMI.The results of ROC curve analysis showed that age had poor diagnostic efficacy for all-cause death with an AUC of 0.747,a sensitivity of 63.9%and a specificity of 73.6%,and AF burden had good diagnostic efficacy for MACE with an AUC of 0.887,a sensitivity of 68.2%,a specificity of 92.1%,a Youden's index of 0.603,and the optimal cutoff value of 15.32%in NOAF patients after AMI.Conclusion AF burden has a good diagnostic efficacy for MACE occurrence,and can be used as an indicator to predict MACE occurrence in NOAF patients AMI.

Abstract:Objective To discuss the relationship between triglyceride-glucose index(TyG)and carotid atherosclerotic plaque(CAP).Methods The cases with physical examinations(n=45 806)were selected from the First Affiliated Hospital of Xi'an Jiaotong University from Jan.2022 to Dec.2023.According to carotid artery ultrasound examination results,the patients were divided into CAP group(n=18 619)and non-CAP group(n=27 187).The general data and laboratory test results were collected in CAP group and non-CAP group.The correlation between TyG as a continuous variable and CAP was analyzed by using single-factor and multi-factor Logistic regression analyses.The adjusted models included sex,age,body mass index(BMI),waist circumference,blood lipids,blood pressure(BP),uric acid(UA),creatinine(Cr),estimated glomerular filtration rate(eGFR),and smoking rate.According to TyG quartiles,the cases were divided into Q1 group(TyG<7.247),Q2 group(7.247≤TyG≤7.663)、Q3 group(7.664≤TyG≤8.095)and Q4 group(TyG≥8.096).The incidence of CAP was compared among groups Q1～Q4.Results TyG was significantly higher in CAP group than that in non-CAP group(7.85±0.64 vs.7.61±0.65,P<0.001).Compared to non-CAP group,CAP group had higher proportions of males,as well as higher age,BMI,waist circumference,systolic blood pressure(SBP),diastolic blood pressure(DBP),UA,fasting blood glucose(FBG),total cholesterol(TC),low-density lipoprotein(LDL),triglycerides(TG),smoking rate and Cr levels,while eGFR and high-density lipoprotein cholesterol(HDL-C)levels were lower,with statistically significant differences(P<0.001).The results of Multi-factor linear regression analysis showed that TyG was correlated to CAP after adjusting for multiple confounding factors.For every 1-unit increase in TyG,there was a positive correlation with CAP incidence(unadjusted OR=1.775,95%CI:1.723～1.829;fully adjusted OR=1.063,95%CI:1.004～1.125).The results of grouping according to TyG quartiles showed that as TyG increased,CAP detection rate progressively rose,with detection rates of 26.35%,39.23%,46.92%,and 50.09%in groups Q1～Q4,respectively.Conclusion TyG is positively correlated to CAP,which is independent of traditional cardiovascular risk factors.

Abstract:Objective To investigate the potential causal relationship among 4 indicators of blood lipid[triglyceride(TG),total cholesterol(TC),high-density lipoprotein-cholesterol(HDL-C),low-density lipoprotein-cholesterol(LDL-C)]and hypertension by using two-sample Mendelian randomization(MS).Methods The instrumental variables[single nucleotide polymorphism(SNP)loci]that met research criteria were screened and extracted from summarized data of genome-wide association study(GWAS).The MR analysis was conducted by using method of inverse-variance weighted(IVW)with random effects,MR-Egger regression,weighted median method,etc.,to evaluate the causal relationship between blood lipid indicators and hypertension by using odds ratios(OR).The horizontal pleiotropy and heterogeneity of instrumental variables were evaluated by using MR-Egger regression,Cochran's Q test,and method of leave-one-out(LOO)simultaneously.Results The results of IVW analysis showed that TG(OR=1.023,95%CI:1.017～1.030,P<0.001)and TC(OR=1.008,95%CI:1.001～1.015,P<0.05)were risk factors for hypertension,HDL-C(OR=0.989,95%CI:0.983～0.995,P=0.001)was a protective factor for hypertension,and LDL-C(OR=1.000,95%CI:0.992～1.008,P=0.958)had no strong causal relationship with hypertension.There was no gene-level pleiotropy observed in MR-Egger intercept term and LOO analysis.Cochran's Q test indicated the presence of heterogeneity,and thus greater emphasis should be placed on IVW results.Conclusion MR analysis indicates suggests there is a causal relationship among TC,TG,HDL-C and hypertension.Controlling actively lipid indicators can reduce hypertension risk.

Abstract:Objective To advance the reform of medical insurance payment for TCM(Traditional Chinese Medicine)dominant diseases,it is necessary to develop evidence-based research on medical insurance payment for TCM dominant diseases based on evidence-based medicine.Methods Computer-based retrieval was conducted to collect information on dominant diseases published on the official websites of the National Health Commission of the People's Republic of China(hereafter referred to as NHCC),the National Administration of Traditional Chinese Medicine(NATCM),as well as the health commissions,medical insurance administrations and TCM administrations of various provinces and municipalities.The CNKI database was searched to identify whether there were corresponding primary studies,secondary studies,guidelines,expert consensuses and clinical pathways for TCM dominant diseases released by various provinces and municipalities.Lumbar disc herniation,the disease with the highest repetition rate among dominant diseases,was selected as an example to evaluate the quality of evidence-based evidence for this disease.Results A total of 127 TCM dominant diseases were identified after removing duplicate diseases from 37 cities across 17 provinces.Among these,3 diseases(2.4％)had no relevant primary studies,and 24 diseases(18.9％)had no relevant secondary studies.There were 63 diseases(49.6％)with available TCM guidelines or consensuses,and 81 diseases(63.8％)with TCM clinical pathways.For lumbar disc herniation,A Measurement Tool to Assess Systematic Reviews 2(AMSTAR-2)evaluation results of its secondary literature all showed moderate to low credibility,with no high-level credibility.Specifically,25％of the literature had low credibility,and 75％had moderate credibility.The guidelines and consensuses were evaluated using the Appraisal of Guidelines for Research&Evaluation Ⅱ(AGREE Ⅱ),among which one guideline achieved the highest quality.When matching the PICO(Population,Intervention,Comparison,Outcome)framework,conclusions of secondary studies on lumbar disc herniation,and guidelines/consensuses(as evidence-based evidence)with corresponding clinical pathways,only acupuncture was supported by the most sufficient secondary study evidence.Conclusion At present,TCM dominant diseases included in medical insurance payment have accumulated a certain foundation of evidence-based medicine research.However,on the whole,this foundation remains weak,which is reflected in the generally low quality of existing evidence.The quantity and level of evidence from evidence-based medicine research are not sufficient to fully support the inclusion of TCM dominant diseases in medical insurance payment and meet the demand for providing comprehensive information for medical insurance payment evidence.To carry out the reform of medical insurance payment based on TCM dominant diseases,it is necessary to conduct extensive and in-depth evidence-based medicine research on links such as the establishment of TCM dominant diseases,clinical pathways,efficacy evaluation standards,and the reform direction of the medical insurance payment system,and establish a working system for acquiring medical insurance payment evidence of TCM dominant diseases based on evidence-based medicine research.

Abstract:Objective To discuss the application value of heart rehabilitation training combined with atorvastatin to coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods CHD patients(n=286)were selected from Beijing Chaoyang Hospital Affiliated to Capital Medical University from Mar.2022 to Feb.2023,all of whom underwent PCI.According to random digital table,they were divided into control group(n=143)and observation group(n=143).The control group was treated with aspirin and clopidogrel after surgery,while the observation group was additionally treated with heart rehabilitation training combined with atorvastatin,with continuous medication for 3 months.The myocardial blood perfusion,coagulation function,exercise capacity,heart function and microcirculation function were compared between 2 groups before treatment and 3 months after treatment.The incidence of major adverse cardiovascular events(MACE)was compared between 2 groups during the 12-month follow-up.Results After treatment,the platelet aggregation rate,fibrinogen,prothrombin time,and corrected coronary flow frame count in observation group were lower than those in control group;the thrombolysis in myocardial infarction(TIMI)flow grade 3,myocardial tissue perfusion grade 3,and coronary blood flow velocity were higher than those in control group(P<0.05).After treatment,both groups showed increased exercise tolerance,prolonged 6-minute walk test(6MWT)distance,and decreased Borg Rating of Perceived Exertion(BRPE)score,with more significant changes in observation group(P<0.05).After treatment,the left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)decreased,and left ventricular ejection fraction(LVEF)increased in both groups,and the changes were more obvious in observation group(P<0.05).Compared with control group,observation group had a lower circulatory resistance index,a higher coronary flow reserve index,and a lower incidence of MACE after treatment(P<0.05).Conclusion The heart rehabilitation training combined with atorvastatin can improve exercise capacity,microcirculation and prognosis in CHD patients after PCI.

Abstract:Objective To analyze the influencing factors of frailty syndrome in elderly patients with heart failure with preserved ejection fraction(HFpEF).Methods The study period was from January 2024 to April 2025.A total of 200 patients with HFpEF admitted to our hospital during this period were selected for the study.According to whether the patients had frailty syndrome at the time of visit,they were divided into a frailty group(n=94)and the non-frailty group(n=106).The general data and clinical information of all patients were collected,and the influencing factors of frailty syndrome in elderly patients with HFpEF were analyzed.Results Among the 200 patients in this study,96 patients developed frailty syndrome,with an incidence rate of 48.00%.Univariate analysis showed significant differences between the two groups in New York Heart Association(NYHA)classification,stroke,history of falls,number of hospitalizations,left atrial diameter(LAD),albumin(ALB),and 25(OH)D3(P<0.05).Multivariable logistic regression analysis showed that NYHA classification,stroke,history of falls,number of hospitalizations,and LAD were risk factors for frailty syndrome in elderly patients with HFpEF,while ALB and 25(OH)D3 were protective factors(P<0.05).Conclusion The influencing factors for frailty syndrome in elderly patients with HFpEF include NYHA classification,stroke,history of falls,number of hospitalations,LAD,ALB,and 25(OH)D3.Early targeted intervention can be carried out clinically.

Abstract:Objective To study the effect of individualized rehabilitation intervention during the transition period on the physical function and readmission rate of elderly patients with acute decompensated heart failure(ADHF).Methods A total of 110 elderly patients with ADHF treated in our hospital from July 2024 to December 2024 were randomly divided into a control group(n=54,conventional intervention)and a study group(n=56,transitional individualized rehabilitation intervention)using a block randomization method.The psychological status,physical function,quality of life,and readmission rate of the two groups were compared.Results After 3 months of intervention,the scores of Hamilton Depression Rating Scale(HAMD)and Hamilton Anxiety Rating Scale(HAMA)decreased in both groups(tstudy group=17.740,tstudy group=23.014,tcontrol group=8.893,tcontrol group=15.730,P<0.05).The scores and total scores of each dimension in the two groups of Simple Physical Activity Test(SPPB)increased(tstudy group=4.636,tstudy group=4.334,tstudy group=5.371,tstudy group=7.398,tcontrol group=2.082,tcontrol group=2.522,tcontrol group=4.591,tcontrol group=5.537,P<0.05),The scores of each dimension of the Minnesota Heart Failure Quality of Life Questionnaire(MLHFQ)decreased in both groups(tstudy group=34.240,tstudy group=15.854,tstudy group=33.478,tcontrol group=35.139,tcontrol group=11.320,tcontrol group=29.559,P<0.05),And compared with the control group,the HAMD and HAMA scores of the study group were lower(t=6.076,8.053,P<0.05),the SPPB scores and total scores were higher(t=2.323,2.218,2.223,2.929,P<0.05),and the MLHFQ scores were lower(t=2.560,4.187,2.915,P<0.05).Compared with the control group(25.93%),the readmission rate of the study group(10.71%)was lower(P<0.05).Conclusion Individualized rehabilitation intervention during the transition period can be applied to patients with ADHF,which can reduce negative emotions,improve physical function and quality of life,and reduce readmission rates.

Abstract:Objective Defining the clinical risk factors before and after transcatheter closure of atrial septal defect(ASD)is helpful for formulating appropriate treatment strategies,and exploring the effectiveness of radiofrequency ablation before transcatheter closure of ASD.Methods A single-center retrospective study was conducted in ASD patients(n=405)from Jan.2015 to June 2023.All patients received ASD closure treatment.The incidence of AF and risk factors for AF before/after closure were analyzed in adult ASD patients.The patients were divided into ASD with AF group(ASD+AF group,n=27)and ASD with sinus rhythm group(ASD+SR group,n=378)based on preoperative AF status.After ASD closure,the patients were divided into new-onset AF group(n=23)and post-closure SR group(n=329)based on new-onset AF status.AF risk factors were analyzed by using single-factor and multi-factor Logistic regression analysis.The patients complicated by AF before the closure were further divided into RFA+closure group(n=8)and drug+closure group(n=19),and AF reoccurrence was compared between these 2 groups.Results The results of multi-factor Logistic regression analysis before the closure showed that left atrial diameter(LAD,OR=1.24)was an independent risk factors for ASD complicated by AF.The results of multi-factor Logistic regression analysis after the closure showed that age(OR=1.038),LAD(OR=1.086)and total bilirubin(TBIL,OR=1.054)were risk factors for post-closure new-onset AF(P<0.05).AF reoccurrence rate was significantly lower in RFA+closure group than that in drug+closure group(log-rank P<0.05).Conclusion LAD is a risk factor for ASD complicated by AF,and age,TBIL and LAD are risk factor for new-onset AF.The ratio of sustained sinus rhythm is higher in patients with ASD complicated AF after RFA treatment.

Abstract:Objective To investigate the causal relationship between Obstructive sleep apnea syndrome(OSAS)and hypoxia(represented by Sulfhydryl oxidase)and coronary heart disease(CHD)by means of bidirectional Mendelian randomization(MR)analysis.Methods Relevant genetic data were obtained from FinnGen and the European Institute for Bioinformatics genome databases in Genome Wide Association Study(GWAS).Suitable single nucleotide polymorphisms(SNPs)were screened as instrumental variables.Inverse-variance weighted(IVW)and several other MR approaches were employed.Sensitivity analysis,including the leave-one-out method and Cochran's Q test,were conducted to assess the robustness of the results.Results No significant association was found between OSAS and CHD;P values of all five methods were>0.05(IVW:OR=1.051,95%CI:0.974～1.128).However,hypoxia(sulfhydryl oxidase)was significantly associated with an increased risk of CHD(MR-Egger:OR=1.059,95%CI:1.015～1.103,P=0.015;weighted median:OR=1.044,95%CI:1.013～1.075,P=0.006;IVW:OR=1.036,95%CI:1.004～1.068,P=0.031;weighted model:OR=1.048,95%CI:1.020～1.077,P=0.003).The reverse analysis did not reveal significant associations.Sensitivity analyses suggested that the findings were robust.Conclusion Genetically predicted OSAS was not correlated with CHD,but hypoxia caused by OSAS may play an important role in the development of CHD.

Abstract:Objective Study the correlation between pathological characteristics and clinical indicators of coronary artery thrombosis in acute ST segment elevation myocardial infarction at different time periods,and explore the relationship between thrombus contents and peripheral blood cells at different stages.Methods A total of 32 patients with STEMI admitted to our hospital from January 2022 to January 2023 were divided into two groups based on the onset time:≤11 hours(Group A.twenty-six cases)and≥12 hours(Group B.six cases).The serum levels of various factors in the two groups were statistically analyzed,and the RBC and fibrin in the coronary artery were analyzed.Results The levels of CK-MB,TNT,and Gensini score in Group B were significantly higher than those in Group A(P<0.05).The total cholesterol and platelet levels in Group B with a longer onset time were significantly higher than those in Group A with a shorter onset time(P<0.05).Coronary thrombus composition:the FIB concentration in Group A was higher than that in Group B,and the RBC concentration in Group A was higher than that in Group B(P<0.0001).The proportions of fibrin(FIB)and red blood cells(RBC)in coronary artery thrombus components showed no statistically significant difference,r=-0.9698(P<0.0001).Conclusion In patients with acute ST-segment elevation myocardial infarction,the concentration of red blood cells in coronary thrombus is higher than that of fibrin in the early stage of onset,while the concentration of fibrin is higher than that of red blood cells in the late stage of onset.The earlier the patient visits the hospital,the lower the concentration of platelets and cholesterol.Therefore,the diagnosis and treatment plans for STEMI patients at different time periods are slightly different.

Abstract:Objective To analyze adverse drug events(ADE)of inclisiran using the FDA Adverse Event Reporting System(FAERS)to provide references for its clinical use.Methods ADE reports for inclisiran and other lipid-lowering drugs were retrieved from FAERS database from 2021 to 2023.The reporting odds ratio(ROR)was used for adverse event signal detection.Inclisiran was compared with conventional lipid-lowering drugs in the same therapeutic field(statins,ezetimibe,alirocumab and evolocumab).Results Inclisiran showed significant signals in musculoskeletal and connective tissue disorders(A:2030,ROR:2.64).The most frequent adverse event with a significant signal was"injection site pain"(A:677,ROR:14.49).For liver injury,significant signals were observed for"liver disease"(A:32,ROR:3.70)and"liver pain"(A:9,ROR:9.58).In glucose metabolism,significant signals were detected for"diabetes"(A:36,ROR:2.73)and"poor diabetic control"(A:8,ROR:3.62).The most frequent musculoskeletal adverse event with a significant signal was"arthralgia"(A:432,ROR:3.83).Conclusion Inclisiran generally demonstrates a favorable safety profile,with the most common adverse events being injection site reactions.However,there are potential risks related to liver injury,glucose metabolism and musculoskeletal systems,warranting further long-term and large-scale clinical observational studies.

Abstract:Objective To observe the changes of serum cardiac troponin I(cTnI),N-terminal pro-B-type natriuretic peptide(NT-proBNP),creatine kinase isoenzyme(CK-MB),D-dimer(D-D)in patients with heart failure and analyze their association with frailty.Method This retrospective study included 156 patients with heart failure treated at Xingtai Central Hospital from March 2022 to March 2024,divided into a frailty group and a non frailty group based on whether the patients were frailty.Patients were divided into a frailty group(n=62)and a non-frailty group(n=94).General clinical data and serum levels of cTnI,NT-proBNP,CK-MB,and D-D were compared between groups.Spearman correlation analysis was performed to assess the relationship between frailty scores and biomarker levels,and multivariable logistic regression was used to identify independent factors associated with frailty.Result There were no significant differences between groups in sex,age,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),or primary diseases(P>0.05),whereas Killip functional class differed significantly(P<0.05).Serum cTnI,NT-proBNP,CK-MB,and D-D levels were higher in the frailty group than in the non-frailty group(P<0.05).Spearman correlation showed positive correlations between frailty scores and cTnI,NT-proBNP,CK-MB,and D-D levels(P<0.05).Multivariable logistic regression indicated that Killip class and levels of cTnI,NT-proBNP,CK-MB,and D-D were independent factors associated with frailty(P<0.05).Conclusion Killip class and serum cTnI,NT-proBNP,CK-MB,and D-D levels are closely related to the occurrence and severity of frailty in patients with heart failure.Patients with frailty exhibit higher biomarker levels and higher Killip class.Timely frailty assessment and appropriate interventions are warranted in clinical practice.

Abstract:Objective The purpose of this study was to use CiteSpace software to visually analyze the research status,hotspots,and trends of the research fields related to coronary heart disease and hemorrhage over the past 20 years.Methods The Web of Science Core Collection was selected as the data source,and CiteSpace 6.5.2 was used to conduct a visual analysis of research on coronary heart disease and hemorrhage over the past 20 years,examining research trends,authors,country/region and institution distributions,journal distributions,and keywords.Results A total of 926 articles were included in this study,involving 569 authors from 76 countries,292 institutions,274 co-cited journals and 267 keywords were identified.The author with the highest number of publications and the highest co-citation was Hiroyasu Iso;the top five countries in the research field were China,the United States,Japan,Germany and the United Kingdom;Harvard University ranks first in publication frequency;and CIRCULATION was the most frequently co-cited journal.Fifteen high-frequency keywords(frequency≥50)were identified,forming nine clusters of research significance.According to keyword clustering and burst keywords,research hotspots include coronary heart disease,high-density lipoprotein cholesterol,atrial fibrillation,arterial disease,bleeding,aspirin,clopidogrel,prevention of complications,atherosclerosis,and meta-analysis.Conclusion This study obtained the research hotspots and trends and provides a reference for subsequent studies on the association between coronary heart disease and bleeding.We speculate that the optimization of antiplatelet therapy strategies and the development of novel antiplatelet drugs and antithrombotic strategies are frontier hotspots.

Abstract:Objective To observe the influence of initiating liraglutide therapy in department of cardiology on indexes of blood sugar and blood fat in patients with coronary heart disease(CHD)complicated by diabetes,and review its clinical safety.Methods The patients with CHD complicated by diabetes(n=130)were retrospectively analyzed in Department of Cardiology of Beijing Anzhen Hospital from Sept.2022 to June 2023.The patients were divided into observation group(firstly prescribed liraglutide by cardiologist)and control group(treated with routine therapy,each n=65).The changes of body mass index(BMI),blood sugar and blood fat,and occurrence of adverse events were compared between 2 groups.Results The levels of glycated hemoglobin(HbAlc)and BMI were higher in observation group than those in control group before treatment[(8.22±1.23)%vs.(7.62±1.06)%,(28.63±2.69)kg/m2 vs.(26.09±2.86)kg/m2,P<0.01].After 6-month follow-up,HbAlc level was lower than that before treatment[(7.07±0.92)%vs.(8.22±1.23)%,P<0.001],the levels of low density lipoprotein cholesterol and triglyceride[(1.90±0.55)mmol/L,(1.59±0.72)mmol/L]were lower than those before treatment[(2.39±0.84)mmol/L,(2.04±1.04)mmol/L,P<0.001],and body weight was lower than that before treatment[(80.18±12.06)kg vs.(82.97±13.40)kg,(P<0.001)in observation group.After the follow-up,the difference in HbAlc had no statistical significance between observation group and control group(P>0.05).The level of triglyceride was significantly lower in observation group than that in control group[(1.59±0.72)mmol/L vs.(1.96±0.97)mmol/L,P<0.05].The descend range of body weight was higher in observation group than that in control group[(2.79±2.66)kg vs.(0.25±1.01)kg,P<0.001].There was no severe hypoglycemia in 2 groups during follow-up period.Conclusion The initiation of liraglutide therapy can effectively control blood sugar level,improve blood fat metabolism,reduce body weight,and cannot increase the risk of hypoglycemic event.

Abstract:Objective To explore the effects of left bundle branch pacing(LBBaP)and right ventricular septal pacing(RVSP)on cardiac structure,function and quality of life in elderly patients with high proportion of ventricular pacing.Methods A total of 70 patients over 65 years old with grade Ⅱ type Ⅱ,high,third degree atrioventricular block requiring permanent pacing treatment from June 2020 to June 2023 in department of cardiology of 416 Hospital of the Nuclear Industry were randomly divided into LBBaP group(n=35)and RVSP group(n=35)with Random Number Table,and then operate LBBaP and RVSP respectively.QRS wave width,pacing parameters,cardiac structure parameters,cardiac function indicators and comprehensive geriatric assessment scales data of all patients were collected.Results ①There were no statistically significant differences in the ventricular electrode parameters(perception,impedance,threshold,ventricular pacing ratio)between the two groups of patients during and 6 months after surgery(P>0.05).②Compared to the RVSP group,the LBBaP group had a significantly lower plasma BNP value(P<0.05)and a significantly higher 6MWT value(P<0.05)at 6 months after surgery.③Compared to the RVSP group,the QRS wave width in the LBBaP group was significantly narrower immediately after surgery(P<0.01).④There were no significant differences in cardiac ultrasound indicators(LAD,LVEDD,RAD,RVEDD,LVEF,etc)between the two groups before and 6 months after surgery.However,there were statistically significant differences in the indicators of ΔEF and E/A values>1 between the two groups(P<0.01,P<0.05).⑤The Barthel scores and MNA scores of the LBBaP group were significantly higher than those of the RVSP group at 6 months after surgery(P<0.05,P<0.05).The GDS scores of the LBBaP group were lower than those of the RVSP group at 1 month and at 6 months after surgery(P<0.01,P<0.05).There were no statistically significant differences in MMSE scores between the two groups at each stage before and after surgery.Conclusion LBBaP has stable pacing parameters and can maintain good electro-mechanical synchronization,which is superior to RVSP in improving cardiac function and quality of life in elderly patients with high proportion of ventricular pacing.LBBaP is an ideal pacing method for elderly patients with atrioventricular block.

Abstract:Objective To analyze the changes in serum brain natriuretic peptide(BNP),fasting blood glucose(FBG),and apolipoprotein A2(ApoA2)in patients with acute ST-segment elevation myocardial infarction(STEMI),and their relationship with major adverse cardiovascular events(MACE)within one year after percutaneous coronary intervention(PCI).Methods A total of 100 STEMI patients at Xingtai Central Hospital between January 2022 and December 2023 were recruited and assigned into MACE group(n=31)and non MACE group(n=69)based on whether MACE occurred within one year after PCI.A fully automated biochemical analyzer was used to detect serum BNP,FBG,and ApoA2.Logistic regression was used to analyze the influencing factors of MACE in STEMI patients after PCI.The predictive value of serum BNP,FBG,and ApoA2 for MACE in STEMI patients one year after PCI was analyzed using ROC curve analysis.Results The MACE group had significantly higher serum BNP and FBG,and significantly lower ApoA2 than the non MACE group(P<0.05).Logistic analysis revealed BNP(OR=1.763,95%CI=1.196-2.599),FBG(OR=2.419,95%CI=1.274-4.592),and ApoA2(OR=0.725,95%CI=0.569-0.924)were influencing factors for MACE in STEMI patients after PCI(P<0.05).ROC analysis showed that the AUC of serum BNP,FBG,and ApoA2 in predicting MACE in STEMI patients one year after PCI was 0.792,0.816,and 0.799,with specificity of 73.90%,78.30%,and 71.00%,respectively.The AUC predicted by the combination of the three was 0.918,which was significantly higher than that predicted by BNP(Z=2.056,P=0.040),FBG(Z=2.009,P=0.045),and ApoA2(Z=2.268,P=0.023)separately.Conclusion Within one year after PCI,serum BNP and FBG in STEMI patients with MACE are significantly increased,while ApoA2 is significantly decreased.These three factors are correlated with MACE after PCI,and their combination has a certain predictive power for the occurrence of MACE in STEMI after PCI.