Abstract:Objective To investigate the influence of silent information regulator 6(SIRT6)on cardiomyocyte senescence induced by D-galactose(D-gal)through regulating forkhead box M1(FOXM1)/Wnt/β-catenin signaling pathway.Methods H9c2 cardiomyocytes were divided into Control group,D-gal group,D-gal+pcDNA3.1-NC group,D-gal+pcDNA3.1-SIRT6 group,D-gal+shRNA NT group and D-gal+SIRT6 shRNA group.The cell viability was detected by cell counting kit-8(CCK-8).The cell senescence was detected by β-galactosidase(SA-β-Gal)staining.The content of reactive oxygen species(ROS)was detected by DCFH-DA fluorescence probe assay.The changes of mitochondrial membrane potential(MMP)were detected by JC-1 staining.The mRNA expressions of SIRT6,p16 and p21 were detected by qRT-PCR.The protein expressions of SIRT6 protein and FOXM1/Wnt/β-catenin signaling pathway were detected by Western blotting assay.Results Compared with the D-gal group,the cell viability increased significantly in pcDNA3.1-SIRT6 group[(73.2±1.8)%vs.(88.7±1.1)%,P<0.05],and decreased significantly in D-gal+SIRT6 shRNA group[(73.2±1.8)%vs.(55.6±0.9)%,P<0.05].Compared with D-gal group,the intracellular MMP increased significantly[(96.2±3.8)%vs.(145.6±4.3)%,P<0.05],cardiomyocyte senescence rate decreased significantly[(57.4±1.1)%vs.(28.3±0.7)%,P<0.05],relative expressions of p16 mRNA[(1.83±0.14)vs.(1.34±0.09)]and p21 mRNA[(2.26±0.18)vs.(1.62±0.13)]decreased significantly(P<0.05),and ROS level[(786.5±4.4)vs.(422.8±3.6),P<0.050]decreased significantly in D-gal+pcDNA3.1-SIRT6 group.Compared with D-gal group,the relative expressions of FOXM1 protein[(0.44±0.03)vs.(0.72±0.06)]and Wnt3α protein[(0.51±0.04)vs.(0.76±0.05)]and ratio of p-β-catenin/β-catenin[(0.21±0.02)vs.(0.52±0.05)]significantly increased in pcDNA3.1-SIRT6 group(P<0.05).Conclusion SIRT6 may alleviate oxidative stress,mitochondrial damage and cellular senescence in cardiomyocytes by upregulating FOXM1/Wnt3α/β-catenin signaling pathway.

Abstract:Objective To investigate the role and mechanism of nucleobindin 1(NUCB1)in inflammatory response in rats after myocardial infarction(MI).Methods The blood samples were collected from 20 patients underwent coronary angiography(CAG)from Renmin Hospital of Wuhan University from Nov.2020 to July 2021.According to CAG results,the patients were divided into control group(n=10)and group of chronic total occlusion(CTO)of coronary artery(CTO group,n=10).The difference in NUCB1 level was analyzed by using proteomics,and correlation between NUCB1 and inflammatory pathway proteins was analyzed through protein-protein interaction(PPI).A MI model was established by using ligation of left anterior descending(LAD)in SD rats,and the rats were randomly divided into sham-operation group(Sham group,n=8)and MI group(MI group,n=8).After 28 d,the samples were stained with HE staining and Masson staining for reviewing morphopathology and pathological changes of MI tissue.The subcellular localization and expression of NUCB1 were observed by using immunofluorescence staining.Immunofluorescence PCR(qPCR)and Western blotting assay were used to determine the expression levels of inflammatory factors such as NUCB1,NOD-like receptor protein 3(NLRP3)and inducible cyclooxygenase(COX2)in myocardial tissue of border zone of infarction(BIZ).In addition,a hypoxia model of H9c2 cardiomyocytes was established to investigate the expression patterns of NUCB1 and inflammatory factors in the hypoxic model of cardiomyocytes.Results The serum level of NUCB1 was significantly elevated in CTO group.PPI analysis revealed that NUCB1 was correlated with inflammatory pathway proteins,including transforming growth factor-beta-induced protein(TGFBI),cathepsin B(CTSB),and complement C4A(C4A).HE staining and Masson staining showed that there was obvious inflammatory cell infiltration in the heart,loose arrangement of cardiomyocytes,and a significant increase in the area of myocardial fibrosis in MI group.The results of qPCR,immunofluorescence staining,and Western blotting assay showed that the expression level of NUCB1 was significantly increased in the myocardial tissue of BIZ,and the expression of corresponding proinflammatory proteins was also increased in MI group compared with control group(P<0.05).In the hypoxia model of H9c2 cardiomyocytes,qPCR and Western blotting assay showed that expression levels of NUCB1 and proinflammatory proteins were also increased(P<0.05).Conclusion The expression level of NUCB1 is increased in rat model of MI and hypoxic cardiomyocytes,and it may be involved in the occurrence and development of MI through inflammatory responses mediated by NLRP3 and COX2.

Abstract:Objective To discuss the curative effect and safety of drug-coated balloon(DCB)on unstable angina pectoris(UAP)based on optical coherence tomography(OCT).Methods UAP patients(n=50)diagnosed by coronary angiography(CAG)were selected from Hospital of Chinese PLA the 81st Group Army from July 2022 to Dec.2022.All patients were treated with percutaneous coronary intervention(PCI)under OCT guiding.The results of CAG,OCT and DCB expansion,and post-operative adverse reactions were observed in all patients.Results The time of DCB expansion continued for 60 s to 90 s(75±6 s).The degree of target vessel stenosis was significantly lower after DCB treatment compared with that before treatment(P<0.01).The minimum diameter of target vessel was(0.92±0.06)mm before the operation and(2.88±0.05)mm after the operation(P<0.01).All patients well recovered and discharged without relapsed angina pectoris and complications after PCI.Conclusion It is effective and safe for treating UAP with PCI by applying DCB based on OCT.

Abstract:I n recent years,with the continuous generation of genome sequencing data from a large number of molecular biology laboratories,researchers have been able to interpret the emergence and development of diseases from a molecular perspective,and explore the expression levels of single genes or genomes in diseases.However,the sequence characteristics,expression rules,correlations between genes,and interactions between metabolites contained in genes are very complex,which often makes researchers helpless when they try to the key role of genes in diseases,The emergence of the GEPIA(Gene Expression Proficiency Interactive Analysis)database has effectively solved this problem.The database mainly analyzes TCGA and GTEx data,explores analyzes the expression levels of genes in tumor samples,analyzes the role of genes in tumor production and development,evaluates the co expression levels of genes,and calculates their relationship with tumor prognosis.Through this database,researchers can analyze target genes in a one-stop manner,provide data support for disease treatment targets,achieve accurate disease prognosis classification and diagnosis,fill the gap in the comprehensive information platform of tumor genomics and treatment targets,and promote the application of bioinformatics data in a wide range of research fields.This provides a new perspective for the clinical treatment and diagnosis of diseases.

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

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

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

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

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

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

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

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

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

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

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

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

Abstract:Objective 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.