Abstract:Objective To investigate the association between the residual cholesterol inflammation index(RCII)and the risk of cardiovascular disease(CVD)in a Chinese population.Methods This cross-sectional study analyzed data from 10,815 participants aged≥45 years form the 2011 China Health and Retirement Longitudinal Study(CHARLS).The RCII was calculated as follows:RCII=RC×hs-CRP/10,where Residual Cholesterol(RC)=Total Cholesterol(TC)-(High-Density Lipoprotein Cholesterol(HDL-C)+Low-Density Lipoprotein Cholesterol(LDL-C)).Multivariable Logistic regression models were constructed to evaluate the associations of RC and RCII with CVD.The exposure-response relationships were characterized using restricted cubic splines(RCS)to test for non-linearity.Analyses were stratified by median high-sensitivity C-reactive protein(hs-CRP)levels(1.04 mg/L)to assess the modifying effect of inflammation.Subgroup analyses were also conducted.Additionally,receiver operating characteristic(ROC)curves were used to assess the discriminatory ability of RCII for CVD.Results The participants were categorized into RCII quartiles:Q1:0.011(0.006,0.015),Q2:0.034(0.027,0.042),Q3:0.081(0.065,0.105)and Q4:0.278(0.189,0.504).The prevalence of CVD increased progressively across these quartiles(11.2%,12.9%,15.8%and 18.0%).After adjusting for age,sex,urban/rural residence,smoking and alcohol consumption,and comorbidities(e.g.,hypertension and diabetes),multivariable Logistic regression revealed that higher RCII quartiles(Q3 and Q4)were independently associated with increased CVD risk(Q3:OR=1.185,95%CI 1.003-1.402;Q4:OR=1.24,95%CI 1.052-1.463).In contrast,RC quartiles did not show statistically significant association.RCS analysis indicated a linear relationship between RC and CVD(Pnonlinearity=0.981)and a significant non-linear relationship for RCII(Pnonlinearity<0.001).Stratified analysis revealed that RC was significantly associated with CVD only in the high-inflammation group(hs-CRP>1.04 mg/L;Poverall=0.006).ROC analysis demonstrated that RCII exhibited superior discriminatory ability for CVD compared to RC.Conclusions Elevated RCII levels are significantly associated with a higher risk of CVD in individuals aged 45 and older,suggesting that RCII may serve as a risk factor for CVD.Further research is needed to validate these findings.

Abstract:Objective To investigate the relationship between plasma lipoprotein(a)[Lp(a)]levels and the risk of acute myocardial infarction(AMI)in patients with severe renal disease[estimated glomerular filtration rate(eGFR)<30 ml·min-1·1.73m-2],as well as to evaluate the predictive value of plasma Lp(a)levels for AMI risk.Methods This study included 136 patients with coronary heart disease and severe renal disease who were admitted to the Cardiology Department of Peking University International Hospital between July 2018 and March 2023.Among these,43 patients were diagnosed with AMI and formed the study group(AMI group),while 93 patients without AMI constituted the control group(non-AMI group).High Lp(a)was defined as plasma Lp(a)>300 mg/L.Logistic regression analysis models and restricted cubic spline(RCS)model were used to assess the relationship between high Lp(a)(or quartiles of plasma Lp(a)levels)and AMI risk.Additionally,the receiver operating characteristic(ROC)curve analysis was performed to determine the predictive capability of plasma Lp(a)levels for AMI,calculating the area under the curve(AUC)and the associated 95%confidence interval(CI).The optimal cutoff point,sensitivity,and specificity of plasma Lp(a)for predicting AMI in patients with severe renal disease were derived based on the Youden index.Results In patients with severe renal disease,no significant difference in plasma Lp(a)levels was observed between patients with CKD 4 and CKD 5(P>0.05).However,the proportion of high Lp(a)was significantly higher in the AMI group than in the non-AMI group[275.0(132.0,778.0)mg/L vs.103.0(58.0,196.0)mg/L,P<0.05].Multivariable Logistic regression analysis and trend tests indicated that,after adjusting for confounders,high Lp(a)(OR=3.95,95%CI 1.59-9.83,P<0.01)was an independent predictor of AMI in patients with severe renal disease.Moreover,the risk of AMI in the highest quartile(Q4)of Lp(a)was 6.36 times that of the lowest quartile(Q1).RCS analysis demonstrated a linear dose-response relationship between Lp(a)and AMI risk(Pnonlinearity>0.05).ROC curve analysis revealed an AUC of plasma Lp(a)levels in predicting AMI was 0.713(95%CI 0.615-0.810,P<0.01),with an optimal cutoff value of 145 mg/L,the sensitivity of 0.744 and the specificity of 0.624.Conclusions Elevated plasma Lp(a)levels significantly increase the risk of AMI,with a linear dose-response relationship observed.Plasma Lp(a)levels can serve as a valuable predictor of AMI risk in this patient population.

Abstract:Coronary heart disease(CHD)without standard modifiable risk factors represents a high-risk subgroup with poor prognosis that is often underestimated.Despite the absence of traditional risk factors,this population experiences higher short-term mortality and is often undertreated.The pathophysiology of CHD in these individuals transcends conventional frameworks and involves factors such as genetic predisposition,chronic inflammation,and environmental exposures,including elevated Lp(a)and hs-CRP.Clinical identification necessitates the integration of family history,Lp(a),hs-CRP,and coronary CT.Management emphasizes strict standard secondary prevention plus individualized targeted interventions for those with high inflammation or elevated Lp(a).Precision management of this subgroup is a key direction in cardiovascular precision medicine.

Abstract:Objective To explore the factors associated with arrhythmia in viral myocarditis,and to develop an individualized risk prediction model.Methods Medical records from 203 patients diagnosed with viral myocarditis at Dazhou Central Hospital between April 2018 and August 2024 were collected as the derivation cohort.Data from an additional 91 patients treated at the same hospital from September 2024 to November 2025 were collected as an external validation cohort.Based on the occurrence of arrhythmia,patients in the derivation cohort were divided into three groups:grade Ⅰ-Ⅱ arrhythmia,grade Ⅲ-Ⅳ arrhythmia,and no arrhythmia.The propensity score matching was performed among three subgroups,and the baseline characteristics after matching were compared.Multivariable Logistic regression analysis was used to identify factors associated with arrhythmia,which were then used to construct and externally validate a nomogram-based individualized risk prediction model.Results In the derivation cohort,significant differences were observed among the three groups in CRP,D-dimer,cTnI,CK-MB,QRS-T angle,and the proportion of patients with a QRS interval>120 ms(all P<0.05).Logistic regression analysis identified elevated levels of CRP,high D-dimer,high cTnI,high CK-MB,a larger QRS-T angle and QRS interval>120 ms as significant risk factors for arrhythmia(all P<0.05).A nomogram for predicting arrhythmia risk was constructed.Calibration curves showed good agreement between predicted and observed probabilities in both the derivation and validation cohorts,and the Hosmer-Lemeshow test indicated a good model fit(all P>0.05).The AUCs for predicting gradeⅠ-ⅡandⅢ-Ⅳarrhythmia were 0.817(95%CI 0.696-0.905)and 0.821(95%CI 0.700-0.908)in the derivation cohort,and 0.804(95%CI 0.697-0.886)and 0.812(95%CI 0.705-0.893)in the validation cohort,respectively.Decision curve analysis(DCA)demonstrated that the model provided a positive net benefit for predicting both gradeⅠ-ⅡandⅢ-Ⅳarrhythmia across a wide range of threshold probabilities in both cohorts(derivation cohort:0.05-0.97;validation cohort:0.05-0.95).Conclusion CRP,D-dimer,cTnI,CK-MB,QRS-T angle and QRS interval are significant predictors of arrhythmias in viral myocarditis.The individualized risk prediction model developed based on these factors demonstrates good predictive value and clinical applicability.

Abstract:Objective To investigate the association between high-density lipoprotein-related inflammatory indices(HDL-related inflammatory indices)and the formation of coronary collateral circulation(CCC)in patients with chronic total occlusion(CTO).Methods We consecutively enrolled 845 CTO patients admitted to the Heart Center of the First Hospital of Lanzhou University between January 2024 and June 2025.Based on the Rentrop classification,patients were divided into the good CCC group(n=509)and the poor CCC group(n=336).We compared baseline clinical characteristics between the two groups and calculated HDL-related inflammatory indices,including the neutrophil-to-HDL ratio(NHR),monocyte-to-HDL ratio(MHR),lymphocyte-to-HDL ratio(LHR),leukocyte-to-HDL ratio(WHR),and platelet-to-HDL ratio(PHR).Logistic regression models were used to assess the association between NHR and poor CCC formation,and multiple adjusted models were constructed to test the robustness of the findings.Receiver operating characteristic(ROC)curve and restricted cubic spline(RCS)analyses were performed to evaluate the predictive value and dose-response relationship,respectively.Subgroup analyses were also conducted.Results Compared to the good CCC group,patients in the poor CCC group had higher levels of body mass index,C-reactive protein(CRP),fasting glucose and triglycerides,while HDL levels were lower[0.950(0.840,1.110)mmol/L vs.1.000(0.840,1.180)mmol/L](all P<0.05).Among HDL-related inflammatory indices,NHR[4.500(3.350,6.023)vs.3.939(2.892,5.341)],WHR[6.741(5.330,8.348)vs.6.259(4.879,8.363)],and MHR[0.395(0.302,0.531)vs.0.372(0.274,0.500)]were significantly higher in the poor CCC group(all P<0.05),while LHR and PHR showed no significant differences.Univariate analysis indicated that BMI,CRP,serum creatinine,fasting glucose,and NHR were significantly associated with poor CCC.Multivariate analysis identified BMI,CRP,fasting glucose,and NHR as independent risk factors.Across all adjusted models,NHR consistently remained an independent predictor of poor CCC(Model 3:OR=1.094,95%CI 1.027-1.166,P<0.001).When stratified by tertiles,the high NHR group demonstrated a markedly increased risk of poor CCC.ROC analysis revealed a limited predictive ability of NHR alone(AUC=0.588),which improved to 0.711 after incorporating NHR into the baseline model(P<0.05).RCS analysis demonstrated a nonlinear positive association between NHR and poor CCC formation,revealing a threshold effect indicating that when NHR<2.92,the risk of poor CCC increased significantly with rising NHR levels(OR=2.26,95%CI 1.37-3.72,P<0.001).Subgroup analysis showed that the association between NHR and poor CCC formation was consistent across most subgroups,except for a significant interaction in patients with hypertension.Conclusions Elevated NHR is closely associated with impaired CCC formation in patients with CTO.NHR may serve as a simple and practical inflammatory biomarker for evaluating CCC development,providing valuable insights for risk stratification and clinical management of CTO patients.

Abstract:Objective To compare the efficacy and safety of rotational atherectomy(RA)and intravascular lithotripsy(IVL)in patients with severe coronary artery calcification(CAC).Methods This retrospective cohort study enrolled 155 patients with severe CAC undergoing percutaneous coronary intervention(PCI)with either RA(n=90)or IVL(n=65).Data on baseline characteristics,procedural features,major adverse cardiovascular events(MACE)at 30 days and 6 months and microcirculatory function were collected.Results There was no significant difference between the two groups in surgical success rate(87.8%vs.92.3%,P=0.360).However,the RA group had a higher incidence of periprocedural myocardial injury(28.9%vs.18.5%),although this difference did not reach statistical significance(P=0.056).Higher post-PCI QFRi(QFR of the stent plus 5 mm proximally and distally(in-segment),AMR and the incidence of postoperative microcirculation dysfunction in the RA group was significantly higher in the IVL group[(0.960±0.017)vs.(0.937±0.022),(237.620±35.272)mmHg·s/m vs.(225.510±35.124)mmHg·s/m,40.0%vs.24.6%,all P<0.05].The incidence of MACE at 30 days and 6 months did not differ significantly between the group(3.3%vs.3.1%;5.6%vs.4.6%,all P=1.000).Conclusion RA provides higher post-PCI QFRi,the rate of microvascular dysfunction is lower in IVL group,the safety is similar.

Abstract:Objective To investigate the predictive value of the red blood cell distribution width-to-albumin ratio(RAR)for long-term prognosis in patients with ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PCI).Methods We consecutively enrolled 1124 STEMI patients who underwent primary PCI at Nanjing First Hospital between July 2011 and April 2019.Baseline data were collected,including demographic characteristics,laboratory parameters,coronary angiography findings,and secondary preventive medications.The primary endpoint was all-cause mortality,while secondary endpoints included cardiac death,recurrent myocardial infarction,stent thrombosis,ischemic stroke,and target vessel revascularization.The safety endpoint was BARC type 3 or 5 major bleeding.Results During a median follow-up of 75±32 months,all-cause mortality occurred in 124 patients(11.0%).ROC curve analysis demonstrated that RAR predicted all-cause mortality with an area under the curve(AUC)of 0.701.At a cutoff value of 3.58,the sensitivity and specificity were 62.9%and 72.0%,respectively.The high-RAR group(RAR≥3.58)had significantly higher rates of all-cause mortality(HR=3.859,P<0.001),cardiac death,BARC type 3 or 5 major bleeding,and stent thrombosis rates than the low-RAR group.No sig-nificant differences were observed in recurrent myocardial infarction,target vessel revascularization,or ischemic stroke between groups.Multivariable Cox analysis identified age,Killip class Ⅲ-Ⅳ,hyperlipidemia,creatinine,uric acid,high RAR,left ventricular ejection fraction,single-vessel disease,intra-aortic balloon pump implantation,and ti-cagrelor use as independent predictors of all-cause mortality in STEMI patients.Conclusion RAR is a novel and readily available biomarker that effectively predicts all-cause mortality in STEMI patients,offering significant potential for risk stratification in clinical practice.

Abstract:Objective To investigate the agreement between TransDeepLab model and manual measurements for detecting lipid plaques in optical coherence tomography(OCT)images.Methods We prospectively enrolled 143 patients with coronary heart disease who underwent elective percutaneous coronary intervention(PCI)and OCT examination at the Sixth Medical Center of Chinese PLA General Hospital from January to December 2024,forming the training set.An additional 67 patients(70 lesions)constituted the test set,while 27 patients(30 lesions)from the First Medical Center of Chinese PLA General Hospital during the same period were included as the external validation set.Two physicians conducted manual analysis using OCT offline image analysis software to measure the maximum lipid arc,mean lipid arc,lipid length,and minimum fibrous cap thickness,with final adjudication performed by a senior physician.The artificial intelligence(AI)model was developed based on the TransDeepLab architecture,which integrates DeepLab and the Swin Transformer framework.Results Based on OCT-derived lipid plaque data from 237 patients across two centers of Chinese PLA General Hospital,using manual analyses by senior physicians as the reference standard,this study systematically evaluated the agreement between the TransDeepLab model and manual interpretation.In the internal validation,the AI model and manual analysis showed good agreement in maximum lipid arc(r=0.842,ICC=0.811),mean lipid arc(r=0.721,ICC=0.715),and lipid length(r=0.913,ICC=0.874),and moderate agreement in fibrous cap thickness(r=0.652,ICC=0.650).T he Bland-Altman plot indicated that the differences for most parameters fell within the acceptable limits.In the external validation,the agreement for all four-measurement metrics declined.Nevertheless,this AI model demonstrated good agreement with manual analysis in the quantification of OCT-derived lipid plaque length and lipid arc,whereas agreement for fibrous cap thickness was suboptimal.Conclusion The TransDeepLab model showed good and reproducible measurement agreement in the quantification of OCT-derived lipid plaques.Its assessments of lipid arc and length were in close concordance with the manual reference standard,while agreement for fibrous cap thickness was moderate yet statistically significant.This model holds promise for clinical application in the assessment of lipid plaques.

Abstract:Objective To develop and validate a nomogram for predicting early arrhythmia risk after transcatheter closure of ventricular septal defect(VSD)in children.Methods The clinical data(modeling set)of 150 children with transthoracic VSD occlusion admitted to Anhui Children's Hospital and Children's Hospital of Fudan University from September 2021 to August 2024 were retrospectively selected.According to whether arrhythmia occurred within 3 months after operation,they were divided into occurrence group and non-occurrence group,an early warning model was established.In addition,64 children who underwent transthoracic VSD closure in our hospital from September 2024 to August 2025 were selected as the validation set to verify the established model.The clinical data of the occurrence group and the non-occurrence group were collected,Univariate and multivariate Lasso-Logistic regression were used to screen the influencing factors of early postoperative arrhythmia.The early warning model was constructed and presented in the form of visual nomogram,and the predictive performance of the model was evaluated and verified.Results The age[(2.86±0.95)years vs.(3.99±1.10)years]in the occurrence group was lower than that in the non-occurrence group,and the operation time[(123.48±19.51)min vs.(96.78±20.33)min]was longer than that in the non-occurrence group,the proportion of 9 F sheath size(5.00%vs.0.00%),asymmetric occluder(62.50%vs.38.18%),the size of the occluder[(8.05±1.00)mm vs.(6.79±1.13)mm],the inner diameter of the pulmonary artery[(23.49±3.61)mm vs.(20.17±4.80)mm],the blood flow velocity of the pulmonary valve[(151.83±9.78)cm/s vs.(144.25±10.67)cm/s]were higher than those in the non-occurrence group(all P<0.05).Age(OR=0.513,95%CI 0.343-0.769),operation time(OR=1.206,95%CI 1.061-1.369),asymmetry of occluder(OR=3.586,95%CI 1.911-6.727)and size of occluder(OR=1.424,95%CI 1.142-1.778)were independent influencing factors of early arrhythmia after transthoracic VSD occlusion(all P<0.05).The consistency index of the prediction model nomogram based on the above factors was 0.939.In the modeling set and validation set:the calibration curve analysis showed that the predicted results of the nomogram were consistent with the actual result curve(the intercept of the calibration curve was 0,and the slope was 1);the receiver operating characteristic curve showed that the area under the curve of the prediction model(nomogram)was 0.960(95%CI 0.902-0.985)and 0.939(95%CI 0.899-0.978),respectively.The sensitivity was 89.21%and 80.00%,respectively,and the specificity was 86.78%and 94.55%,respectively.The clinical decision curve analysis showed that at the threshold probability of 0.05-95%and 0.06-75%,the clinical net benefit could be obtained by using the nomogram to predict early postoperative arrhythmia.The clinical net benefit of the modeling set was up to 27%(threshold probability 0.05),and the clinical benefit of the validation set was up to 30%(threshold probability 0.06).Conclusions Age,operation time,occluder asymmetry and occluder size are independent influencing factors of early arrhythmia after transthoracic VSD closure.The accuracy,predictive performance and predictive value of the risk early warning model are high,which can provide an effective predictive tool for clinical practice.

Abstract:Objective To investigate the clinical value of echocardiography combined with serum nicotinamide adenine dinucleotide phosphate oxidase(NOX2)and secretory frizzled-related protein 5(SFRP5)in diagnosing and prognosing myocardial injury in sepsis.Methods A total of 400 patients diagnosed with sepsis and admitted to Baotou Central Hospital between February 2020 and May 2023 were selected for this study.Patients were categorized into an injury group(n=173)and a non-injury group(n=227)based on the presence or absence of concomitant myocardial injury.Additionally,they were divided into a mortality group(n=65)and a survival group(n=108)based on their prognosis after 28 days of treatment.Serum NOX2 and SFRP5 expression levels were measured using ELISA.Pearson's correlation analysis was performed to assess the relationship between serum NOX2 and SFRP5 levels and echocardiographic parameters.ROC curve analysis was conducted to assess the diagnostic and prognostic value of echocardiographic parameters alongside serum NOX2 and SFRP5,both individually and in combination,for assessing myocardial injury in septic patients.Lasso-Cox regression analysis was used to identify factors associated with mortality in patients with septic myocardial injury.Results Compared to the non-injury group,the injury group had a larger LAD and LVEDD,along with elevated levels of serum NOX2[(145.39±22.85)pg/ml vs.(118.27±21.46)pg/ml],C-reactive protein,procalcitonin,cardiac troponin I,and creatine kinase-MB.LVEF and serum SFRP5[(37.08±6.65)ng/ml vs.(45.15±7.93)ng/ml]levels were significantly reduced(P<0.05).Serum NOX2 levels showed a negative correlation with LVEF and a positive correlation with LVEDD and LAD.Serum SFRP5 levels exhibited a positive correlation with LVEF and a negative correlation with LVEDD and LAD(P<0.001).The area under the curve(AUC)values for LVEF,LVEDD,and LAD in diagnosing myocardial injury in septic patients were 0.894,0.908,and 0.752 respectively,while those for serum NOX2 and SFRP5 were 0.862 and 0.874 respectively.The combined diagnostic AUC was 0.987,indicating superior diagnostic value(P<0.001).Compared with the survival group,the mortality group had a larger LAD,LVEDD,higher APACHE scores,and elevated levels of serum NOX2[(166.51±25.82)pg/ml vs.(132.68±21.06)pg/ml],procalcitonin,cardiac troponin I,and creatine kinase-MB.LVEF and decreased serum SFRP5 levels[(30.67±5.32)ng/ml vs.(40.93±7.45)ng/ml]were significantly lower(P<0.05).The results of the Lasso-Cox regression analysis identified CK-MB,LVEDD,LAD,and NOX2 as all risk factors for mortality in patients with septic myocardial injury,while LVEF and SFRP5 were found to be protective factors(P<0.05).The AUCs for LVEF,LVEDD,LAD,NOX2,and SFRP5 in predicting mortality were 0.917,0.890,0.859,0.845,and 0.857 respectively.The combined predictive AUC was 0.984,indicating superior predictive value for the combined assessment(P<0.001).Conclusions Patients with sepsis complicated by myocardial injury exhibit elevated serum NOX2 levels and reduced SFRP5 levels.The combination of echocardiographic parameters with serum NOX2 and SFRP5 demonstrates significant clinical value in diagnosing sepsis-associated myocardial injury and assessing its prognosis.

Abstract:Objective To investigate the association between plasma Copine3(CPNE3)levels and the formation of coronary collateral circulation(CCC)in patients with chronic total occlusion(CTO),as well as to evaluate its predictive value for major adverse cardiovascular events(MACE).Methods We conducted a retrospective cohort study involving 122 CTO patients diagnosed via coronary angiography at the People's Hospital of Xinjiang Uygur Autonomous Region from January to August 2024.Patients were categorized into two groups based on Rentrop classification:a poor CCC group(Rentrop grade 0～1,n=59)and a good CCC group(Rentrop grade 2～3,n=63).Plasma CPNE3 concentration was measured using enzyme-linked immunosorbent assay.Logistic regression analysis was performed to identify factors influencing CCC formation,while the predictive efficacy of CPNE3 was assessed using receiver operating characteristic(ROC)curve analysis.Additionally,Cox regression analysis was employed to identify risk factors for MACE.Results Plasma CPNE3 levels were significantly higher in the good CCC group compared to the poor CCC group[(2739.19±962.522)pg/ml vs.(2157.75±707.842)pg/ml,P<0.001].Multivariate analysis identified CPNE3 as an independent predictor of CCC formation(adjusted OR=2.604,95%CI 1.441-4.706,P=0.002).A negative correlation was observed between CPNE3 and coronary lesion severity(Gensini score r=-0.216,P=0.017).ROC curve analysis indicated that the optimal CPNE3 cut-off value for predicting good CCC was 1975.3 pg/ml(AUC=0.689).The incidence of MACE was significantly lower in the high CPNE3 expression group(≥1975.3 pg/ml)compared to the low expression group(14.3%vs.30.5%,P=0.031).Multivariate Cox regression revealed that CPNE3 acts as an independent protective factor against MACE(adjusted HR=0.215,95%CI 0.091-0.510,P=0.034).Conclusion Plasma CPNE3 levels are closely associated with CCC formation and clinical prognosis in CTO patients.CPNE3 may serve as a potential biomarker for evaluating collateral compensatory capacity and predicting MACE risk,providing a novel basis for risk stratification in this patient population.

Abstract:Objective To evaluate the predictive value of two novel obesity indices,the lipid accumulation product(LAP)and relative fat mass(RFM)index,for coronary heart disease(CHD)in a middle-aged and elderly population.Methods A multicenter cross-sectional study was conducted on 3,000 adults aged≥45 years in Urumqi.LAP and RFM were calculated based on anthropometric and laboratory measurements.The associations of these factors with CHD were examined using multivariable Logistic regression and restricted cubic spline(RCS)analysis,while predictive performance was assessed using receiver operating characteristic(ROC)curves.Results The prevalence of CHD in the study population was 18.3%.Univariate analysis revealed that LAP and RFM levels in the CHD group were significantly higher than those in the non-CHD group[61.91(38.42,101.97)vs.20.81(11.63,35.14),40.48(30.14,43.71)vs.31.04(23.82,38.99),P<0.001].In multivariable Logistic regression,each unit increase in LAP was associated with a 2.0%increase in CHD risk in the unadjusted model(OR=1.020,95%CI:1.016-1.025).After adjusting for age,hypertension,diabetes,body mass index(BMI),triglycerides(TG),and high-density lipoprotein cholesterol(HDL-C),each unit increase in LAP and RFM was associated with a 4.1%(OR=1.041,95%CI 1.037-1.044)and an 8.6%(OR=1.086,95%CI 1.073-1.100)increase in CHD risk,respectively.Among the indices examined[LAP,RFM,BMI,and waist circumference(WC)],LAP demonstrated the highest predictive performance with an area under the curve(AUC)of 0.856.DeLong's test indicated that the AUC of LAP was significantly greater than that of BMI(0.803,P<0.05),WC(0.844,P<0.05),and RFM(0.713,P<0.05).Conclusion LAP and RFM are significantly associated with CHD risk in middle-aged and elderly adults and serve as effective predictive indicators.Notably,LAP exhibited the highest predictive value and showed promise as an early screening tool for CHD.

Abstract:Objective To investigate the effects of different exercise intensities on lipid profiles in patients after percutaneous coronary intervention(PCI).Methods A total of 93 patients who underwent PCI at Xiong'an Xuanwu Hospital between November 2024 and August 2025 were enrolled.They were randomly assigned to either a random number table to a moderate-intensity continuous training(MICT)group(n=43)or a high-intensity interval training(HIIT)group(n=50)using a random number talbe method.Low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)were designated as primary outcomes;total cholesterol(TC),triglycerides(TG),apolipoprotein A1(ApoA1),and apolipoprotein B(ApoB)served as secondary outcomes.Both groups completed exercise-based rehabilitation programs,and lipid indices were compared before and after the intervention both within each group and between groups.Results No significant differences were observed between groups at baseline in sex,age,body mass index(BMI),comorbidities,or baseline biochemical indices(all P>0.05).Within-group analyses revealed that in the MICT group,post-intervention levels of TC[3.55(3.13,4.01)mmol/L vs.4.16(3.60,4.83)mmol/L,P<0.001],LDL-C[1.77(1.56,2.10)mmol/L vs.2.61(2.14,3.40)mmol/L,P<0.001],ApoB[0.63(0.56,0.71)g/L vs.0.75(0.61,0.84)g/L,P=0.005],and HDL-C[(1.08±0.24)mmol/L vs.(1.22±0.26)mmol/L,P<0.001]decreased significantly,whereas TG and ApoA1 showed no significant changes(all P>0.05).In the HIIT group,TC[3.50(3.07,3.79)mmol/L vs.4.62(4.02,5.16)mmol/L,P<0.001],LDL-C[1.67(1.21,1.95)mmol/L vs.2.75(2.29,3.49)mmol/L,P<0.001],and ApoB[0.61(0.54,0.71)g/L vs.0.80(0.67,0.95)g/L,P<0.001]decreased significantly after the intervention,whileHDL-C,TG,and ApoA1 did not show significant changes(P>0.05).Between-group comparisons after the intervention indicated that LDL-C was significantly higher in the MICT group than in the HIIT group[1.77(1.56,2.10)mmol/L vs.1.67(1.21,1.95)mmol/L,P=0.033],while HDL-C was significantly lower in the MICT group than in the HIIT group[1.10(0.92,1.21)mmol/L vs.1.17(1.00,1.31)mmol/L,P=0.045)].Conclusions In PCI-treated patients with LVEF≥40%during the rehabilitation phase,both HIIT and MICT are feasible exercise-based rehabilitation modalities.However,considering the overall change in lipid profiles,HIIT appears to have an advantage in maintaining HDL-C stability and may be the preferred for patients with appropriate risk assessment and monitoring.The long-term benefits and generalizability to broader populations warrant further validation.Further validation is needed to explore the long-term benefits and generalizability of these findings to broader populations.

Abstract:Magnesium is an essential divalent cation that plays a critical role in numerous physiological processes,including energy metabolism,neuromuscular transmission,and the regulation of cardiac rhythm and vascular tone.Hypomagnesemia is a common yet frequently overlooked electrolyte disturbance,often observed in individuals with chronic diseases,critical illnesses,or those undergoing treatment with medications such as diuretics and proton pump inhibitors.Substantial evidence links hypomagnesemia to serious clinical sequelae,including arrhythmias,heart failure,exacerbated infections,acute kidney injury,and increased mortality.Despite its clinical significance,standardized screening,diagnosis,and treatment protocols for hypomagnesemia are currently lacking in China,resulting in suboptimal recognition and management in clinical practice.This consensus was developed by a multidisciplinary expert panel.Based on a systematic review of evidence-based medicine and incorporating real-world clinical experience in China,it provides targeted recommendations on the etiology,classification,diagnosis,treatment,and management of hypomagnesemia.The primary aims of this consensus are to standardize clinical practice,enhance the ability of healthcare professionals to identify and manage hypomagnesemia,and ultimately improve patient outcomes.

Abstract:Objective To compare the efficacy and safety of the Liwen procedure in treating obstructive hypertrophic cardiomyopathy(OHCM)across different age groups,with a specific focus on its safety and effectiveness in elderly patients.Methods This study employed a retrospective cohort analysis involving 108 patients with OHCM who underwent Liwen surgery at Wuhan Asia Heart Hospital from December 2019 to April 2024.Patients were stratified into two groups:those age<70 years(n=88)and those age≥70 years(n=20).Propensity score matching(PSM)was used to control for baseline confounding factors.Short-term efficacy and perioperative safety were compared between the two groups.Results Within-group comparisons demonstrated that the Liwen procedure was significantly effective in both age groups.The resting left ventricular outflow tract gradient(LVOTG)decreased significantly after the procedure(age<70 group:from 78.50 mmHg to 12.00 mmHg;age≥70 group:from 82.00 mmHg to 25.00 mmHg;P<0.05).Interventricular septal thickness(IVST)also decreased significantly[age<70 group:from(2.30±0.48)cm to(1.71±0.26)cm,P<0.001;age≥70 group:from(2.30±0.48)cm to(1.72±0.44)cm,P<0.001].Between-group comparisons after PSM indicated no significant differences in preoperative resting LVOTG or IVST 82.00(75.00,100.00)mmHg vs.78.50(64.50,116.00)mmHg,(2.30±0.48)cm vs.(2.30±0.48)cm,P>0.05].Postoperative resting LVOTG and IVST were also comparable between the two groups[25.00(12.00,49.50)mmHg vs.12.00(8.00,37.75)mmHg,IVST:(1.72±0.44)cm vs.(1.71±0.26)cm,P>0.05].There were no significant differences in ICU length of stay or complication rates,indicating favorable safety profiles across age groups.Conclusion The Liwen procedure significantly improves left ventricular outflow tract obstruction and reduces IVST in OHCM patients,Moreover,it demonstrates reliable safety in patients across different age groups.

Abstract:Coronary heart disease(CHD)in young adults,the occurrence of CHD in individuals aged 45 years or younger,represents a distinct subtype of the condition and has exhibited an increasing incidence in recent years.Current evidence indicates that insulin resistance serves as a key pathophysiological mechanism driving both the onset and progression of CHD within this demographic.In this context,the triglyceride-glucose index has emerged as a novel marker of insulin resistance,demonstrating significant research potential and clinical relevance.This review aims to explore the association between the triglyceride-glucose index and CHD in young adults,elucidate the underlying mechanisms,and discuss related intervention strategies,with the goal of providing new insights for the early identification and management of this condition.

Abstract:Ischemic heart disease(IHD)encompasses a range of heart conditions resulting from insufficient blood supply to the heart muscle via the coronary arteries,leading to myocardial ischemia,hypoxia,or necrosis.It is one of the leading causes of death globally.Recent large-scale cardiovascular studies have confirmed that sodium-glucose cotransporter 2 inhibitors(SGLT-2i)not only effectively lower blood glucose levels in patients with type 2 diabetes but also significantly reduce the risk of cardiovascular adverse events.This paper systematically reviews pertinent basic research and clinical trial literature to analyze the multiple mechanisms of SGLT-2i in IHD and some of its clinical efficacy,including reducing the progression of atherosclerosis,microvascular dysfunction,and myocardial damage associated with IHD.The review aims to provide deeper insights into the clinical application of SGLT-2i in managing IHD.

Abstract:Objective To evaluate the predictive value of uncoupling protein 2(UCP2),creatine kinase-MB(CK-MB),cardiac troponin T(cTnT),and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels for myocardial ischemia-reperfusion injury(MIRI)following cardiopulmonary bypass(CPB)surgery.Methods The study included 300 patients who underwent CPB surgery between January 2022 and December 2024 in Baoding First Central Hospital Cardiovascular Surgery,venous blood samples were collected at 1 h,6 h,12 h,24 h,and 48 h after surgery to measure UCP2,cTnI,CK-MB,and NT-proBNP.According to the occurrence of MIRI within 72 h post-operation(based on the Fourth Universal Definition of Myocardial Infarction),patients were divided into the MIRI group(n=120)and the non-MIRI group(n=180).Clinical outcomes included 30-day major adverse cardiovascular and cerebrovascular events(MACCE)and 90-day left ventricular ejection fraction(LVEF).The predictive efficacy of each indicator was assessed using multivariate Logistic regression analysis and receiver operating characteristic(ROC)curve analysis.Results Levels of UCP2,CK-MB,cTnT,and NT-proBNP were significantly higher in the MIRI group than in the non-MIRI group,with UCP2 showing the earliest change(P<0.05),Starting from 1 hour after surgery,UCP2 in the MIRI group was significantly higher than that in the non MIRI group[(16.1±2.6)ng/ml vs.(12.3±2.3)ng/ml,P<0.05]and persisted until 48 hours[(30.1±2.8)ng/ml vs.(8.8±2.4)ng/ml];CTnT,CK-MB,and NT proBNP showed significant differences after 6 hours.UCP2 had the highest odds ratio(OR=3.390)and demonstrated superior sensitivity(0.970)and specificity(0.953)in predicting MIRI.Follow-up results at 1 month and 3 months postoperatively showed that,patients in the MIRI group had significantly lower LVEF[(52.3±4.5)%vs.(58.2±3.8)%、(53.1±4.2)%vs.(59.0±3.5)%]and 6-minute walk test distances[(355.4±50.1)m vs.(426.8±60.7)m、(380.4±55.1)m vs.(450.7±65.4)m]compared to the non-MIRI group.Conclusion UCP2 is an independent,early,and potent predictor of MIRI following CPB surgery,demonstrating superior sensitivity and specificity compared with conventional biomarkers.It can be utilized for peri-operative risk stratification and to inform antioxidant and mitochondrial protective therapies.

Abstract:Objective This study aimed to investigate the risk factors associated with prolonged mechanical ventilation(PMV)duration following simple tricuspid valve surgery.The findings are intended to optimize surgical timing,enhance perioperative success rates,and improve patient prognosis.Methods A total of 158 patients who underwent simple tricuspid valvuloplasty or replacement surgery at department of cardiovascular surgery,General Hospital of Northen Theater Command,from January 2006 to October 2023 were included.Patients were divided into two groups:those requiring PMV(n=54)and those not requiring PMV(n=104),based on whether the duration of postoperative mechanical ventilation exceeded 24 hours.Results Among the 158 patients,109 underwent tricuspid valve replacement while 49 underwent tricuspid valvuloplasty,with no significant differences observed between the two groups.Univariate analysis indicated no significant statistical differences regarding secondary surgery rate,extracorporeal circulation time,liver function,brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),atrial diameter,right ventricular diameter,inferior vena cava diameter,and inspiratory rate(all P>0.05).However,patients in the PMV group were significantly older than those in the non-PMV group[(51.93±15.09)years vs.(59.78±10.25)years,P=0.027)and there was a higher proportion of females in PMV group compared to males(P=0.024).The incidence of preoperative atrial fibrillation in PMV group was significantly greater in PMV group(41%vs.34%,P=0.048),as was the prevalence of preoperative abnormal renal function was significantly higher than that in non-PMV group(P=0.001).Additionally,the preoperative right ventricular area change rate(RVFAC)was significantly lower in the PMV group compared to the non-PMV group[(36.43±4.23)%vs.(31.49±3.68)%,P=0.046],and the preoperative systolic displacement of the tricuspid annulus(TAPSE)was also significantly reduced in the non-PMV group[(15.14±4.89)mm vs.(9.53±6.36)mm,P=0.025].Furthermore,the preoperative peak systolic velocities at the lateral wall of the tricuspid annulus and the ventricular septum(TDIIVSs'and TDITVs')were significantly lower than in the non-PMV group[(8.46±2.64)cm/s vs.(6.63±1.85)cm/s,(12.44±4.53)cm/s vs.(9.13±3.36)cm/s,P=0.004 and 0.003].Multivariate analysis identified elevated preoperative creatinine levels and TDITVs'as significant risk factors for prolonged postoperative mechanical ventilation duration.With TDITVs'demonstrating notable predictive value for PMV after tricuspid valve surgery(AUC=0.80).Specifically,TDITVs≤11.65 cm/s were associated with an increased risk of postoperative PMV.Conclusion Reduced right ventricular systolic function is identified as a risk factor for prolonged mechanical ventilation in patients undergoing surgery for tricuspid regurgitation.Long-term follow-up of TDITVs can aid in determining the optimal timing for surgical intervention in these patients.

Abstract:Aortic diseases encompass a group of high-risk cardiovascular conditions that may compromise systemic circulation.Their initiation and progression are determined not only by focal anatomic abnormalities but also by global imbalance in the structure and function of the aortic wall.As the vascular conduit subject to the highest levels of pulsatile pressure and shear stress within the cardiovascular system,the aorta consists of multiple tissue constituents organized into the intima,media,and adventitia,and it exhibits marked proximodistal heterogeneity in embryological origin and biomechanical properties.The 2023 European Association for Cardio Thoracic Surgery/The Society of Thoracic Surgeon(EACTS/STS)guideline first introduced the concept of the"aortic organ",underscoring that the aorta functions not merely as a passive blood conduit but as a multifunctional organ a multifunctional organ capable of mechanical buffering,precise regulation,signal secretion,and serving as an immunometabolic interface.Investigating the aorta as an organ represents not only a theoretical advancement but also one with substantial implications for clinical practice,research frameworks,and patient management.We further propose the concepts of Aortic Medicine and Aortology,aiming to reshape current diagnostic and therapeutic models from an organ-based perspective.This review summarizes the heterogeneity and core functions of the aortic organ,discusses its clinical implications along with the associated paradigm shift in research,and highlights future directions for precision stratification and individualized interventions driven by high-quality clinical evidence,multi-omics/single-cell spatial atlases,and the integration of biomechanics with artificial intelligence.The ultimate goal is to inform mechanistic studies and develop organ-oriented management strategies for aortic diseases.