Abstract:Objective To study the etiological characteristics,risk factors and prevention and control strategies of infections of multidrug-resistant organism(MDRO)after surgery for Stanford type A aortic dissection(TAAD).Methods A retrospective analysis was conducted on 292 patients with TAAD who underwent surgical treatment in First Affiliated Hospital of Chinese PLA Air Force Medical University from Jan.2022 to Dec.2024,and their postoperative infection status was statistically analyzed.Patients with postoperative MDRO infection were assigned to MDRO group,while patients without MDRO infection were randomly selected from the remaining patients at a ratio of 1:4 to form non-MDRO group.Clinical data were collected in 2 groups,and Logistic regression model was used to analyze the risk factors.The receiver operating characteristic(ROC)curve was plotted based on the probability values fitted by the regression equation.Results There were 18 cases of postoperative MDRO infection(6.16%),with 32 strains of MDRO pathogens,among which gram-negative bacteria were the main pathogens.A total of 72 patients were randomly selected into non-MDRO group at a ratio of 1:4.The results of multi-factor Logistic regression analysis showed that age,operation time,length of stay in ICU and indwelling time of central venous catheter were independent risk factors for postoperative MDRO infection in TAAD patients(P<0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of the combined prediction for postoperative MDRO infection was 0.968,with a 95%confidence interval(95%CI)of 0.925-1.000,a sensitivity of 0.944,and a specificity of 0.944.Conclusion The pathogens causing MDRO infection after TAAD surgery are mainly gram-negative bacteria.Age,operation time,length of stay in ICU and indwelling time of central venous catheter are independent risk factors for MDRO infection after TAAD surgery.Prevention and control measures should be implemented from three aspects:strengthening management,enhancing prevention and control measures,and rational use of antimicrobial agents,so as to reduce the risk of MDRO infection.

Abstract:Objective To investigate the effect of five-party linkage(hospital-community-partner-family-individual)three-dimensional control mode on disease management behaviors,self-efficacy and blood pressure(BP)control in patients with hypertension.Methods This study was a prospective randomized controlled study.The patients with essential hypertension(EH,n=168)were selected,and divided,using random digital table,into control group and intervention group(each n=84)in Department of Cardiovascular Medicine of Changsha Fourth Hospital from Jan.to Dec.2022.The control group was given routine treatment,and intervention group was additionally using the five-party linkage three-dimensional control mode.Disease management behaviors,self-efficacy,compliance behaviors,blood pressure variability(BPV)and BP control status were observed and compared in 2 groups after intervention for 3 ad 6 months.Results Before intervention,there were no statistically significant differences in disease management behaviors,scores of General Self-Efficacy Scale(GSES),BP,BP control rate,and BPV between 2 groups(P>0.05).At 3 and 6 months after intervention,the scores of disease management behaviors,GSES scores,and the rate of medication adherence in the intervention group were all higher than those in the control group(P<0.05).At 3 and 6 months after intervention,the systolic blood pressure(SBP),diastolic blood pressure(DBP),systolic blood pressure variability(SBPV)and diastolic blood pressure variability(DBPV)were all lower,while BP control rate was higher in intervention group than those in control group(P<0.05).At 6 months after intervention,the incidence of adverse events was lower in intervention group than that in control group(7.14%vs.25.00%,P<0.05).Conclusion Chronic hypertensive patients receiving the five-party linkage three-dimensional control model can develop healthy behaviors,enhance self-efficacy,improve treatment compliance and BP control rate,as well as reduce BPV and the incidence of adverse events.

Abstract:Objective To investigate the correlation among systemic immune inflammation index(SII);systemic inflammatory response indexes(SIRI)and severity of coronary artery lesions in patients with coronary atherosclerotic heart disease(CAHD)complicated by type 2 diabetes mellitus(T2DM).Methods A total of 1214 patients received coronary angiography(CAG)examination were selected from Department of Cardiovascular Medicine,Central Hospital of Baotou City from Mar.2023 to July 2024.The patients were divided into non-CAHD+non-T2DM group(n=371),T2DM+non-CAHD group(n=59),CAHD+non-T2DM group(n=441)and T2DM+CAHD group(n=343).The severity of coronary artery lesions was evaluated using Gensini score.The T2DM+CAHD group was divided into 3 subgroups based on the tertiles of the Gensini score:mild lesion subgroup(≤21 points),moderate lesion subgroup(22～43 points)and severe lesion subgroup(>43 points).Unordered multinomial Logistic regression analysis was used to identify the risk factors influencing T2DM,CAHD,and T2DM complicated by CAHD.Spearman correlation analysis was applied to evaluate the correlations among SII,SIRI and Gensini score.Results There were statistically significant differences in age,body mass index(BMI),glycated hemoglobin(HbA1c),SII and SIRI among 4 groups(P<0.05).The results of Logistic regression analysis showed that SII and SIRI were independent factors for CAHD and T2DM complicated by CAHD(P<0.05).In T2DM+CAHD group,SII and SIRI were significantly higher in severe lesion subgroup than those in mild lesion subgroup and moderate lesion subgroup(P<0.05).The results of Spearman analysis showed that SII,SIRI and Gensini score had significantly positive correlation in T2DM+CAHD group(r=0.560,r=0.508,P<0.001).The results of ROC curve analysis showed that AUC of combined index of SII and SIRI was the largest in predicting the severity of coronary artery stenosis in patients with T2DM complicated by CAHD,and the optimal cutoff value was 0.52,sensitivity was 59.8%and specificity was 82.8%.Conclusion Both SII and SIRI,and their combined index can serve as predictive indicators for the severity of coronary artery lesions in patients with T2DM complicated by.The elevated levels of these indices suggest severe coronary artery stenosis,which holds important clinical evaluation value.

Abstract:Objective Cardiac allograft vasculopathy(CAV)following heart transplantation(HTx)is a major factor affecting patients'long-term prognosis.Invasive coronary angiography(CAG)is the gold standard for CAV monitoring,but it carries certain risks and may underestimate early-stage lesions.This study aimed to investigate the predictive value of coronary flow velocity reserve(CFVR)measured by echocardiography for the long-term prognosis in HTx patients.Methods This study is a single center retrospective study that included 90 patients who received HTx in the Seventh People's Hospital of Zhengzhou City from Jan.2020 to Apr.2024.CFVR,defined as the ratio of blood flow velocity under adenosine-induced hyperemia to that at rest,was evaluated by echocardiography to explore its association with the primary endpoint events,including all-cause mortality and major adverse cardiac events(MACE).Kaplan-Meier survival analysis and Cox proportional hazards model were applied for assessment.Results The percentage of CAV was 94.4%in low-CFVR group(CFVR<2),which was significantly higher than that in high-CFVR group(26.4%,χ2=29.7,P<0.001).CAV grading analysis showed that grade 3 CAV was predominant in low-CFVR group(44.4%),whereas grade 0 CAV was predominant in high-CFVR group(73.6%,χ2=31.8,P<0.001).The usage rate of aspirin was 72.2%in low-CFVR group,which was significantly higher than that in high-CFVR group(34.7%,χ2=8.7,P=0.003).The parameters of biventricular systolic function were significantly impaired in low-CFVR group.Diastolic function analysis showed that low-CFVR group exhibited a more pronounced restrictive filling pattern.The median MACE free survival rate was 23.5 months in low-CFVR group,which was significantly lower than that in high-CFVR group(46 months;HR=2.785,95%CI:1.322～5.867,P=0.007).The median survival rate was 30.5 months in low-CFVR group,which was significantly lower than that in high-CFVR group(49 months;HR=4.808,95%CI:2.112～10.98,P=0.0002).Conclusion CFVR is a predictive indicator for long-term prognosis in HTx patients,and its non-invasive nature supports its application as a routine CAV monitoring tool.

Abstract:Objective To investigate the relationship among endothelial cell specific molecule-1(ESM-1),hypoxia inducible factor-1α(HIF-1α)and coronary collateral circulation(CCC)formation in patients with unstable angina pectoris(UAP).Methods UAP patients(n=158)were selected into UAP group,patients with stable angina pectoris(SAP)were selected into SAP group(n=79)and patients with acute myocardial infarction(AMI)were selected into AMI group(n=79)in Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine from Jan.2022 to Sept.2024.The levels of ESM-1 and HIF-1α were detected and compared in 3 groups.According to CCC status in UAP patients,they were divided into poor CCC group(n=60)and good CCC group(n=98),and levels of ESM-1 and HIF-1α were compared between these 2 groups.The relationship among ESM-1,HIF-1α and poor CCC was analyzed.Results The levels of ESM-1 and HIF-1α were higher in AMI group and UAP group than those in SAP group,and were higher in AMI group than those in UAP group(P<0.05).The levels of ESM-1 and HIF-1α were higher in poor CCC group than those in good CCC group(P<0.05).The results of single-factor analysis showed that the proportion of complicated diabetes and smoking history were higher in poor CCC group than those in good CCC group(P<0.05).The results of multi-factor Logistic regression analysis showed that complicated diabetes,smoking history and higher levels of ESM-1 and HIF-1α were influence factors for poor CCC formation(P<0.05).Conclusion The levels of serum ESM-1 and HIF-1α are risk factors for poor CCC formation in UAP patients.

Abstract:Objective To investigate the value of three-dimensional speckle tracking echocardiography(3D-STE)to assessment of right ventricular myocardial fibrosis in patients with end-stage heart failure(HF)due to dilated cardiomyopathy(DCM).Methods The patients with end-stage HF due to DCM(n=122)were selected from Central Hospital of Yuncheng City affiliated to Shanxi Medical University from Jan.2019 to June 2024.According to cardiac magnetic resonance results,the patients were divided into fibrosis group(n=85)and non-fibrosis group(n=37).All patients were given right heart catheterization to detect systolic pulmonary arterial pressure(sPAP),diastolic pulmonary arterial pressure(dPAP),right atrial pressure,pulmonary artery wedge pressure(PAWP),transpulmonary pressure gradient and pulmonary vascular resistance(PVR),and 3D-STE examination to calculate right ventricular end-diastolic volume(RVEDV),right ventricular end-systolic volume(RVESV),right ventricular stroke volume(RVSV),right ventricular ejection fraction(RVEF)and three-dimensional right ventricular free wall longitudinal strain(3D-RVFWSL).The clinical value of 3D-STE parameters to myocardial fibrosis was assessed by using receiver operating characteristic(ROC)curve,and the influence factors for myocardial fibrosis were investigated by uing binary Logistic stepwise regression analysis in patients with end-stage HF due to DCM.Results RVEDV and RVESV were higher,and RVSV,RVEF and 3D-RVFWLS were lower in fibrosis group than those in non-fibrosis group(P<0.05).In assessment of myocardial fibrosis,AUC of RVEDV was 0.649(95%CI:0.604～0.694),AUC of RVESV was 0.736(95%CI:0.686～0.781),AUC of RVSV was 0.819(95%CI:0.774～0.869),AUC of RVEF was 0.853(95%CI:0.803～0.903),and AUC of 3D-RVFWLS was 0.934(95%CI:0.889-0.984).The number of patients with history of hypertension and diabetes were more in fibrosis group than that in non-fibrosis group(P<0.05).The results of multi-factor Logistic analysis showed that diabetes(OR=1.992,95%CI:1.119～3.544),RVEDV(OR=2.147,95%CI:1.305-3.532),RVESV(OR=2.442,95%CI:1.315～4.537),RVSV(OR=2.601,95%CI:1.240～5.457),RVEF(OR=2.838,95%CI:1.561-5.159)and 3D-RVFWLS(OR=3.089,95%CI:1.750～5.454)were influence factors for myocardial fibrosis in patients with end-stage HF due to DCM(P<0.05).Conclusion 3D-STE has clinical value and is an effective tool in assessment of myocardial fibrosis in patients with end-stage HF due to DCM.

Abstract:Objective To investigate the application effect of online+offline health education based on information-motivation-behavioral skills model(IMB)in fall prevention in elderly patients with heart failure(HF).Methods A total of 130 elderly HF patients were selected,who were treated in Department of Cardiology of Huai'an First Hospital Affiliated to Nanjing Medical University from Jan.2023 to Dec.2023,and they were divided into control group and experimental group(each n=65)by using random digital table method.The control group received conventional health education,while experimental group received online+offline combined health education based on IMB model.The cognition and skills of fall prevention,self-efficacy,fall alertness and patient satisfaction were compared between 2 groups before and after intervention.Results After intervention,the scores of cognitive and skills were significantly higher in experimental group than those in control group(P<0.001).The scores of Falls Efficacy Scale International(FES-I)were significantly lower in experimental group than those in control group,with a higher self-efficacy(P<0.001).The scores of all dimensions of fall alertness(safety and environmental alertness,physical function alertness,drug alertness,cognitive behavioral alertness)and satisfaction(education content,method,interactive experience,actual effect)were significantly higher in experimental group than those in control group(P<0.001).Conclusion The online+offline health education based on IMB can effectively improve the cognition and skills related to fall prevention,enhance self-efficacy and fall alertness in elderly HF patients with,and improve patient satisfaction.

Abstract:Objective To investigate the effects of acupoint-enhanced external counterpulsation(EECP)on exercise capacity and cardiovascular events in patients with chronic coronary syndrome(CCS)based on qi-blood theory.Methods The patients with CCS and qi-deficiency blood-stasis pattern(n=80)were selected into control group and acupoint group(each n=40)based on random digital table method in the First Affiliated Hospital of Henan University of Chinese Medicine from Sept.2023 to Sept.2024.The control group was treated with conventional Western medicine combined with EECP,while the acupoint group received conventional Western medicine plus acupoint-EECP.Both groups underwent treatment once daily,with each session lasting 35～50 minutes,for a total of 35 sessions.The changes of TCM syndrome scores,peak oxygen consumption(Peak VO2),anaerobic threshold oxygen consumption(VO2AT),metabolic equivalent(MET)and scores of Seattle Angina Questionnaire(SAQ),and occurrence of major adverse cardiovascular events(MACE)were compared between 2 groups.Results After 3 months of intervention,the TCM syndrome scores decreased in both groups(P<0.050),and the scores of acupoint group were lower than those in control group at all time points(P<0.050).The levels of Peak VO2,VO2AT and MET were higher in acupoint group than those in control group(P<0.050).The scores of all dimensions of SAQ were higher than those before treatment in both groups(P<0.050),and acupoint group showed significantly better performance than control group in terms of angina stability,angina attack frequency and treatment satisfaction scores(P<0.050).During the 6-month follow-up,the incidence of MACE(7.5%)was lower in the acupoint group than that in control group(17.5%,P<0.050).Conclusion The acupoint-EECP under guidance of qi-blood theory can effectively relieve clinical symptoms,improve exercise capacity and quality of life,reduce MACE risk,and it was worth clinical promoting.

Abstract:Objective To analyze the expressions of calcitonin gene-related peptide(CGRP),Caspase-1,interleukin-1β(IL-1β)in coronary atherosclerotic plaques and their relationship with major adverse cardiovascular events(MACE).Methods A total of 120 patients with coronary heart disease(CHD)were enrolled as the research subjects and assigned to CHD group,who received treatment in Xuzhou Mining Group General Hospital/the Second Affiliated Hospital of Xuzhou Medical University from Sept.2022 to Sept.2024.In addition,50 healthy subjects were selected as control group,who underwent physical examination during the same period.The patients with CHD were further divided into 2 subgroups according to their Gensini scores:mild stenosis subgroup(n=65)and moderate-to-severe stenosis subgroup(n=55).They were also categorized into MACE subgroup(n=88)and non-MACE subgroup(n=32)based on MACE occurrence.The differences in the levels of CGRP,Caspase-1 and IL-1β in peripheral blood among the groups were explored.Spearman's rank correlation analysis was adopted to analyze the correlations between each indicator and MACE.Receiver operating characteristic(ROC)curves were plotted to evaluate the value of each indicator in predicting MACE occurrence.Results The level of CGRP was lower,and levels of Caspase-1 and IL-1β were significantly higher in CHD group than those in control group(P<0.050).The level of CGRP was lower,and levels of Caspase-1 and IL-1β were significantly higher in moderate-to-severe stenosis subgroup than those in mild stenosis subgroup(P<0.050).The level of CGRP was lower,and levels of Caspase-1 and IL-1β were higher in MACE subgroup than those in non-MACE subgroup(P<0.050).The levels of Caspase-1 and IL-1β were risk factors,and CGRP was a protective factor for MACE occurrence(P<0.050).In predicting MACE occurrence with combined detection of CGRP,Caspase-1 and IL-1β,AUC was 0.903,which was higher than that of alone CGRP(0.798),alone Caspase-1(0.840)or alone IL-1β(0.764).Conclusion The expression levels of CGRP,Caspase-1 and IL-1β in peripheral blood have a correlation with status of coronary atherosclerotic plaques,and their combination can be taken as a auxiliary predictive indicator for MACE occurrence with a higher predictive efficacy.

Abstract:Objective To investigate the prognostic factors in patients with essential hypertension(EH)complicated by heart failure with reduced ejection fraction(HFrEF)in vulnerable phase.Methods General and prognostic data were collected from 263 patients with EH complicated by HFrEF who received outpatient or inpatient treatment at the First Affiliated Hospital of Anhui Medical University from Dec.2022 to Oct.2024.All patients were followed up via telephone at 3 months after discharge.The follow-up endpoints were defined as disease progression within 3 months,including readmission due to heart failure(HF)and cardiac death.Enrolled patients were divided into 3 groups(poor prognosis group,moderate prognosis group,and favorable prognosis group)based on the occurrence of endpoint events and the follow-up left ventricular ejection fraction(LVEF)values.The influencing factors of prognosis were analyzed by using Logistic regression analysis in this population during vulnerable phase.A value of P<0.050 was considered statistically significant.Results(1)A total of 68 patients were classified into poor prognosis group,including 5 cases of cardiac death and 63 cases readmitted due to HF;174 patients were assigned to moderate prognosis group;and 21 patients were categorized into favorable prognosis group.(2)Compared with favorable prognosis group,moderate prognosis group had a higher proportion of patients with atrial fibrillation(AF)and diabetes history,along with abnormally elevated levels of C-reactive protein(CRP)and admission B-type natriuretic peptide(BNP),as well as a significantly decreased estimated glomerular filtration rate(eGFR,P<0.050).Compared with favorable prognosis group,poor prognosis group presented with a higher proportion of male patients,smokers,and those with AF history,diabetes history and chronic kidney disease(CKD)history,accompanied by significantly reduced levels of serum albumin(ALB),left ventricular ejection fraction(LVEF)and eGFR,as well as abnormally increased CRP and admission BNP levels(P<0.050).When compared with moderate prognosis group,poor prognosis group had a higher proportion of male patients,smokers and those with CKD history,along with a significantly decreased eGFR and abnormally elevated admission BNP levels(P<0.050).(3)Results of ordinal multivariate Logistic regression analysis showed that male sex(OR=1.322,95%CI:1.035～1.689),ALB<35 g/L(OR=1.340,95%CI:1.031～1.744),eGFR<60 mL/(min·1.73 m2,OR=1.644,95%CI:1.173～2.303),admission BNP level>1500 pg/mL(OR=1.765,95%CI:1.190～2.617)and baseline LVEF(OR=0.868,95%CI:0.778～0.969)were independent influencing factors for the prognosis in patients with hypertension complicated by HFrEF during vulnerable phase.Conclusion Patients with EH complicated by HFrEF are at a high risk of HF readmission and cardiovascular death during vulnerable phase,while some patients still achieve favorable prognosis.Among these factors,male sex,ALB level,eGFR value,admission BNP level and baseline LVEF are independent influencing factors for the prognosis in such patients during vulnerable phase.

Abstract:Objective To explore the predictive value of combined detection of red blood cell distribution width to albumin ratio(RDW/ALB)and neutrophil to lymphocyte ratio(NLR)to in-hospital mortality risk in patients with acute myocardial infarction(AMI)complicated by cardiogenic shock(CS).Methods The patients with AMI complicated by CS were selected in Department of Cardiology of Chengdu Third People's Hospital(n=116)from June 2021 to June 2024,and divided into mortality group(n=24)and survival group(n=92)according whether or not in-hospital mortality occurred.The blood test indicators,including RDW,ALB and NLR,were collected,and RDW/ALB was calculated.The independent risk factors for in-hospital mortality was analyzed by using multivariate Logistic regression analysis.Results The levels of RDW/ALB,NLR,white blood cell count(WBC),C-reactive protein(CRP),D-dimer(D-D),blood lactate(Lac)and serum creatinine(Scr)were higher(P<0.05),while levels of albumin(ALB)and platelet count(PLT,P<0.050)were lower in mortality group than those in survival group.The results of multivariate Logistic regression analysis showed that elevated RDW/ALB(OR=1.012,95%CI:0.945-1.186),NLR(OR=1.018,95%CI:0.915～1.262),WBC(OR=1.068,95%CI:1.019～1.120)and CRP(OR=1.079,95%CI:1.027～1.133)were independent risk factors for in-hospital mortality in patients with AMI complicated by CS(P<0.050).The results of ROC curve analysis showed that the areas under the curve(AUC)of RDW/ALB)ratio and NLR for predicting in-hospital mortality were 0.806 and 0.784 in patients with AMI complicated by CS,with sensitivities of 0.792 and 0.708,and specificities of 0.761 and 0.869,respectively.The combined use of the two indicators yielded an AUC of 0.896,a sensitivity of 0.750,and a specificity of 0.935 for predicting in-hospital mortality in the patients(P<0.050).Conclusion RDW/ALB and NLR on admission can serve as independent predictors of in-hospital mortality risk in patients with AMI complicated by CS,and combined detection of the two indicators can improve the predictive value.

Abstract:Objective To discuss Professor Sun Tianfu's medication law and effective mechanism of in treating coronary heart disease-angina pectoris(CHD-AP)bases on data mining and network pharmacology.Methods Professor Sun Tianfu's effective medical records were collected to establish a medical record database from Jan.2021 to Oct.2023.The data of formulas in medical records were given frequency,association rule and cluster analyses by using Ancient and Modern Medical Record Cloud Platform(V2.3.7),Excel and SPSS software for digging common medicinal pairs and medicinal combinations and obtaining a core compound formula.The chemical composition and action targets were screened from the core compound formula by using Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP).The disease targets related to CHD-AP were screened from databases of DrugBank,GeneCards,TTD and OMIM.The medicinal-disease intersection targets were introduced into STRING platform to establish a protein target interaction network diagram(PPI),and the intersection targets were introduced into Metascape database for GO and KEGG analyses.Results There were 214 formulas screened out for treating CHD-AP involved 175 Chinese medicinals,mainly tonifying,tranquilizing and qi-regulating medicinals.he components of the core compound formula included Taizishen(Radix Pseudostellariae),Suanzaoren(Semen Ziziphi Spinosae),Maidong(Radix Ophiopogonis),Guizhi(Ramulus Cinnamomi),Wuweizi(Fructus Schisandrae),Xianhecao(Herba Agrimoniae)and Tanxiang(Lignum Santali).A total of 45 active components,443 gene targets,1486 disease targets and 178 medicinal-disease intersection targets were screened out.A total of 2200 biological processes,113 cellular components,196 molecular functions and 212 biological pathways were obtained by GO and KEGG enrichment analysis.Conclusion Professor Sun Tianfu's therapy for CHD-AP is mainly based on tonifying and heart-nourishing,as well as protecting spleen-lung qi and eliminating the pathogen.The core Chinese medicinals play a role in treating CHD-AP possibly through anti-inflammatory,anti-oxidative stress,inhibiting platelet aggregation and regulating lipid metabolism.

Abstract:Objective To investigate the correlation between levels of serum protease-activated receptor-2(PAR-2)and secreted frizzled-related protein-5(SFRP-5)and postoperative in-stent restenosis(ISR)in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods CHD patients(n=200)underwent PCI were selected in Anyang People's Hospital from July 2022 to Aug.2024.According to results of coronary angiography(CAG)after PCI for 6 month,the patients were divided into ISR group(n=50)and non-ISR group(n=150).The levels of serum PAR-2 and SFRP-5 were compared between 2 groups,and were compared among CHD patients with different degrees of coronary artery stenosis.The correlation among PAR-2,SFRP-5 and coronary artery stenosis after PCI was analysis using Pearson analysis.Results The level of PAR-2 was higher,and level of SFRP-5 was lower in ISR group than that in non-ISR group(P<0.050).The level of PAR-2 was higher,and level of SFRP-5 was lower in severe CHD group than that in mild CHD group(P<0.050).The results of Pearson analysis showed that PAR-2 was positively correlated to coronary artery stenosis,and SFRP-5 was negatively correlated to coronary artery stenosis after PCI(P<0.050).Conclusion The elevation of postoperative ISR is closely correlated to increased PAR-2 level and decreased SFRP-5 level in CHD patients after PCI,and dynamic monitoring of which is helpful to prevent the occurrence of ISR.

Abstract:Objective To compare the predictive value of triglyceride-glucose index(TyG index)and atherogenic index of plasma(AIP)for in-hospital major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI)undergoing emergency percutaneous coronary intervention(PCI).Methods This was a multicenter retrospective study.A total of 603 AMI patients who underwent emergency PCI were enrolled.According to the occurrence of in-hospital MACE,the patients were divided into MACE group(n=524)and non-MACE group(n=79).Baseline data,laboratory indicators and clinical outcomes were collected from all patients.The association between TyG index/AIP and in-hospital MACE was evaluated by using multivariate Logistic regression analysis,and the predictive efficacy of the two indices was compared by using receiver operating characteristic(ROC)curves.Results Both TyG index and AIP were significantly higher in MACE group than those in non-MACE group(P<0.05).the results of multivariate analysis showed that TyG index(OR=2.655,95%CI:1.578～4.467)and AIP(OR=7.809,95%CI:2.562～23.803)were independent predictors of in-hospital MACE.The results of ROC curve analysis indicated that the area under the curve(AUC)of TyG index was 0.638,which was superior to that of AIP(0.581,P=0.031).Conclusion Both TyG index and AIP can serve as independent predictors for in-hospital MACE in AMI patients after emergency PCI.Among them,TyG index has slightly better predictive efficacy than AIP and thus holds greater potential for clinical application.

Abstract:Objective To discuss the correlation between visceral adiposity index(VAI)and coronary atherosclerotic heart disease(CHD)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 3000 patients with T2DM were enrolled in this study in the Affiliated Hospital of Southwest Medical University from Jan.2019 to Dec.2022.Patients lost to follow-up,non-respondents and those who withdrew midway were excluded,with 2575 cases finally included.Through multivariate regression analysis,the potential associations between obesity-related indicators-especially Chinese visceral adiposity index(CVAI),visceral adiposity index(VAI),waist-to-hip ratio(WHR),body mass index(BMI),subcutaneous fat area(SFA),and visceral fat area(VFA)-and the incidence of coronary atherosclerosis were explored.In addition,to comprehensively clarify the relationships among the above indicators,Spearman correlation analysis was performed to evaluate their associations with CHD occurrence in T2DM patients.Results In a cross-sectional study involving 135 patients with CHD,the prevalence of CHD was significantly correlated with CVAI,T1:2.68%,T2:5.94%,T3:7.11%,P<0.001)and waist-to-height ratio(WtHR,T1:4.20%,T2:5.16%,T3:6.74%,P<0.050).The higher the CVAI,the higher the odds ratio(OR)for CHD(T1:reference;T2:OR=2.418,95%CI:1.266～4.620;T3:OR=3.951,95%CI:1.737-8.987).The sensitivity of CVAI for predicting CHD was 68.1%,the specificity was 52.7%,with a 95%CI of 0.572～0.662.Conclusion Among patients with T2DM,abdominal obesity indicators are significantly correlated with CHD risk,among which CVAI exhibits the optimal predictive efficacy.The higher the CVAI,the greater the CHD risk.Moreover,its diagnostic value outperforms that of other indicators,indicating that CVAI can serve as an important basis.

Abstract:Objective To evaluate the predictive value of contrast transcranial Doppler(cTCD),contrast trans-thoracic echocardiography(cTTE),and transesophageal echocardiography(TEE)for catheter passage during transcatheter patent foramen ovale(PFO)closure.Methods A retrospective analysis was conducted on 164 patients who successfully underwent transcatheter PFO closure at Fuwai Central China Cardiovascular Hospital between January 2023 and December 2023.All patients were preoperatively screened to exclude organic heart disease and sequentially underwent cTCD,cTTE,and TEE(when necessary)to confirm PFO.Based on intraoperative catheter passage,patients were divided into two groups:Direct passage group(n=109):Catheter successfully passed through the PFO and completed closure in one attempt.Indirect passage group(n=55):Required auxiliary maneuvers(46 cases using a straight-tip supporting catheter,9 cases using guidewire assistance)to complete closure.Preoperative examination results were compared between groups.Receiver operating characteristic(ROC)curves were plotted to analyze the clinical value of preoperative examinations in predicting catheter passage during PFO closure.Results The study included 164 patients[mean age:39.07±15.25 years;64 males(39.02%)].ROC curve analysis revealed significant differences in predictive efficacy among the three modalities:cTCD:AUC=0.685(95%CI:0.598～0.772);cTTE:AUC=0.617(95%CI:0.524～0.710);TEE:AUC=0.776(95%CI:0.696～0.857)(TEE was significantly superior to cTTE,P=0.012);Among combined approaches,TEE+cTCD showed the best predictive performance(AUC=0.775,95%CI:0.705～0.846).Conclusion For predicting catheter passage during PFO closure:cTCD+cTTE demonstrated lower sensitivity but higher specificity than individual cTCD,cTTE,or TEE assessments.TEE combined with either cTCD or cTTE achieved superior specificity.

Abstract:Objective To discuss the relationship between serum trimethylamine N-oxide(TMAO)and S100 calcium binding protein A4(S100A4)and in-stent restenosis after percutaneous coronary intervention(PCI)in patients with unstable angina(UA).Methods A total of 195 UA patients who visited Yantai Yeda Hospital from January 2022 to January 2024 were selected and included in the UA group;additionally,120 healthy volunteers of similar age who underwent physical examinations at the same hospital during the same period were selected and included in the healthy control group.The differences in serum TMAO and S100A4 levels between UA patients after 1 week of treatment and healthy control subjects at the time of their physical examination were measured using enzyme-linked immunosorbent assay(ELISA).Pearson correlation analysis was used to assess the correlation between TMAO and S100A4 levels in UA patients.All UA patients underwent a 1-year follow-up,and those experiencing physical discomfort underwent coronary angiography.Based on whether patients developed ISR,the UA group was divided into ISR and non-ISR groups.The clinical data as well as changes in TMAO and S100A4 levels between ISR and non-ISR groups were compared.Logistic regression analysis was used to identify risk factors for ISR in UA patients,and receiver operating characteristic(ROC)curve analysis was employed to evaluate the predictive efficacy of serum TMAO and S100A4 levels for ISR in UA patients.Results After one week of treatment,UA patients had higher levels of low-density lipoprotein cholesterol,serum TMAO,and S100A4 compared to healthy individuals,while their high-density lipoprotein cholesterol levels were lower than those of the healthy group(P<0.05).Serum TMAO levels in UA patients were positively correlated with S100A4 levels(r=0.560,P<0.001).Coronary angiography results indicated that in the UA group,43 patients developed ISR(ISR group),while 152 patients did not(non-ISR group).HDL cholesterol levels in ISR patients were lower than those in the non-ISR group,whereas stent length,LDL cholesterol,TMAO,and S100A4 levels were higher than those in the non-ISR group(P<0.05).High levels of serum TMAO,S100A4,and longer stent length are risk factors for ISR in UA patients(P<0.05).The area under the curve(AUC)values of serum TMAO,S100A4,and their joint in predicting ISR in UA patients were 0.801,0.781,and 0.879,respectively,the joint prediction performance of two indicators was better than that of a single indicator,and its prediction performance was high(ZTMAO-joint prediction=2.033,ZS100A4 joint prediction=2.560,P=0.042,P=0.010).Conclusion After PCI treatment,UA patients show increased serum TMAO and S100A4 levels.The elevation of these two indicators can lead to a higher risk of ISR in patients.Clinically,the probability of ISR in UA patients after PCI can be effectively assessed by changes in the levels of these two markers.

Abstract:Objective To explore the correlation among neutrophil gelatinase-associated lipocalin(NGAL),adiponectin(APN),soluble suppression of tumorigenicity 2(sST2),C-type natriuretic peptide(CNP)and left ventricular hypertrophy(LVH)in patients with essential hypertension(EH).Methods EH patients(n=102)admitted in the Nineth Hospital of Xi'an City from Jan.2022 to Oct.2024 were divided,according to left ventricular mass index(LVMI),into observation group[n=54,including EH patients complicated by LVH,LVMI≥95 g/m2(female),LVMI≥115 g/m2(male)],and control group[n=48,including EH patients without LVH,LVMI<95 g/m2(female),LVMI<115 g/m2(male)].The levels of serum NGAL,APN,sST2 and CNP,as well as heart function parameters[left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),heart rate(HR),diastolic blood pressure(DBP),systolic blood pressure(SBP)]were compared between 2 groups.The relationship among the levels of serum NGAL,APN,sST2 and CNP,LVMI and heart function was analyzed,and the value of aforementioned serological parameters was evaluated in predicting LVH in EH.Results The levels of serum NGAL,sST2 and CNP and LVMI were higher,and APN was lower in observation group than those in control group(P<0.05).LVEDD,LVESD,HR,SBP and DBP were higher,and LVEF was lower in observation group than those in control group(P<0.05).In EH patients complicated by LVH,APN was negatively correlated to LVMI(P<0.05),and serum NGAL,sST2 and CNP were negatively correlated to LVEF,and positively correlated to LVMI,LVEDD and LVESD(P<0.05).Serum NGAL has the highest efficacy in predicting LVH in EH.When Youden index reached its maximum,the corresponding cut-off value was 15.32 ng/mL,the area under the curve(AUC)was 0.826,sensitivity was 0.91,and specificity was 0.71.NGAL≥15.32 ng/mL,APN≤10.52 mg/L,sST2≥24.49 ng/L and CNP≥21.99 ng/L were risk factors for LVH occurrence in EH patients(P<0.05).Conclusion The levels of serum NGAL,sST2 and CNP are higher and APN level is lower,and are closely correlated to abnormal heart function,and can be used as indicators to predict LVH in EH patient complicated by LVH.

Abstract:Objective To investigate the correlation between expression levels of serum microRNA-499a-5p(miR-499a-5p)and Toll-like receptor 2(TLR2),and major adverse cardiovascular events(MACE)in patients with coronary heart disease(CHD).Methods A total of 130 CHD patients(CHD group)was selected who received treatment in the Department of Cardiovascular Medicine,Anqing Petrochemical Hospital of Nanjing Drum Tower Hospital Group from Aug.2021 to Aug.2022.According to MACE occurrence within 1 y after discharge,they were divided into non-MACE group and t MACE group.In addition,130 healthy people were selected who underwent physical examination in the same hospital during the same period as control group.The severity of coronary artery lesion was evaluated using the Gensini score in CHD patients.The expression levels of serum miR-499a-5p and TLR2 mRNA were detected by qRT-PCR method.The Spearman method was used to analyze the correlation between serum miR-499a-5p and TLR2 mRNA levels,as well as the correlations of each of the two with the Gensini score.Multivariate Logistic regression analysis was applied to identify the influencing factors for MACE in CHD patients.Results Compared with control group,the expression level of miR-499a-5p was significantly decreased in CHD group,while the level of TLR2 was significantly increased(P<0.05).There was a negative correlation between the serum expression levels of miR-499a-5p and TLR2 in CHD patients(r=0.742,P<0.05).The expression level of serum miR-499a-5p was negatively correlated to Gensini score(r=-0.695,P<0.05),and TLR2 was positively correlated to Gensini score(r=0.557,P<0.05)in CHD patients.Compared with non-MACE group,the expression levels of serum miR-499a-5p decreased significantly,and TLR2 expression leveland Gensini score increased significantly in MACE group(P<0.05).The high level of miR-499a-5p was a protective factor(P<0.05),and high levels of TLR2 and Gensini score were risk factors for MACE occurrence(P<0.05).Conclusion The increase of TLR2 and decrease of miR-499a-5p level are closely correlated to MACE occurrence in CHD patients.

Abstract:Objective To analyze the action mechanism of extracellular vesicles(EVs)derived from intestinal flora regulating atrial structural remodeling in rats with atrial fibrillation.Methods A total of 48 rats were randomly divided into control group,model group,EVs group and probiotic group(Bifidobacterium lactis triple-activated bacterial tablets),12 rats in each group.Except for control group,tail vein injection of adrenocortical hormone(Ach)-CaCl2 mixed solution was performed in the other groups to replicate atrial fibrillation models.The pathological changes of myocardial tissues were observed by HE staining and Masson staining.The cardiac function indexes,collagenⅠ(COL-Ⅰ)and collagenⅠ(COL-Ⅰ)in myocardial tissues,tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,IL-6,activities of superoxide dismutase(SOD)and glutathione peroxidase(GSH-px),and malondialdehyde(MDA)were compared,and Western blot was used to detect the changes of BCL-2 related X protein(Bax)/B lymphoma-2 gene(Bcl-2),NOD-like receptor thermal protein domain associated protein 3(NLRP3),cysteine protease-1(Caspase-1),and gasdermin D(GSDMD)in rat cardiomyocytes in each group.Results There were statistically significant differences in LVEF,LVFS,LVEDD,LVESD,collagen area percentage,COL-I positive expression rate,COL-Ⅲ positive expression rate,TNF-α,IL-1β,IL-6,SOD,GSH-Px,MDA,Bax/Bcl-2,NLRP3,Caspase-1,GSDMD protein levels among the control group,model group,experimental group and probiotic group(F=76.234,66.584,77.864,63.472,83.124,77.894,80.443,116.102,107.896,96.482,82.035,75.258,79.453,62.488,55.324,49.154,50.643,P<0.05).Compared with the control group,the LVEF and LVFS levels in the model group were decreased,and the LVEDD and LVESD levels were increased(t=15.666,14.242,16.872,13.015,P<0.05).Compared with the model group,the levels of LVEF and LVFS in the experimental group were increased,and the levels of LVEDD and LVESD were decreased(t=7.631,7.633,9.995,6.585,P<0.05).There was no significant difference in LVEF,LVFS,LVEDD and LVESD levels between the experimental group and the probiotic group(t=0.480,P=0.636;t=0.385,P=0.704;t=1.791,P=0.087;t=1.376,P=0.183).The HE staining results showed that the myocardial cells of rats in the control group were complete and evenly distributed,with no obvious abnormalities;the myocardial cells of rats in the model group were hypertrophy and irregularly arranged,myocardial fibers were broken,and a large number of inflammatory cells were infiltrated;the myocardial cells in the experimental group and the probiotic group were significantly alleviated.The collagen area percentage of myocardial tissue in the model group was higher than that in the control group(t=26.212,P<0.05),and the collagen area percentage of the experimental group was lower than that in the model group(t=20.509,P<0.05).There was no statistical difference in the percentage of collagen area in myocardial tissue between the experimental group and the probiotic group(t=0.794,P=0.436).The positive expression rates of COL-Ⅰ and COL-Ⅰ in the model group were higher than those in the cotrol group(t=21.882,20.899,P<0.05),and the positive expression rates of COL-Ⅰ and COL-Ⅰ in the experimental group were lower than those in the model group(t=17.139,16.370,P<0.05).There was no significant difference between the positive expression rates of COL-Ⅰ and COL-Ⅰ between the experimental group and the model group(t=0.471,P=0.642;t=0.335,P=0.741).The levels of TNF-α,IL-1β,and IL-6 in the model group were higher than those in the control group(t=24.363,28.145,21.733,P<0.05),and the levels of TNF-α,IL-1β,and IL-6 in the experimental group were lower than those in the model group(t=7.582,17.976,17.374,P<0.05).There was no significant difference in the levels of TNF-α,IL-1β,and IL-6 between the experimental group and the probiotic group(t=0.056,P=0.956;t=0.361,P=0.721;t=0.317,P=0.754).The SOD and GSH-Px levels in the model group were lower than those in the control group,and the MDA levels were higher than those in the control group(t=12.561,12.425,9.267,P<0.05).The levels of SOD and GSH-Px in the experimental group were higher than those in the model group,and the levels of MDA were lower than those in the model group(t=5.533,7.696,5.509,P<0.05).There was no significant difference in the levels of SOD,GSH-Px and MDA between the experimental group and the probiotic group(t=0.261,P=0.797;t=0.906,P=0.375;t=1.138,P=0.268).The protein levels of Bax/Bcl-2,NLRP3,Caspase-1 and GSDMD in the model group were higher than those in the control group(t=7.926,21.309,22.562,24.100,P<0.05),and the protein levels of Bax/Bcl-2,NLRP3,Caspase-1 and GSDMD in the experimental group were lower than those in the model group(t=6.010,17.488,19.620,18.641,P<0.05).There was no significant difference in the protein levels of Bax/Bcl-2,NLRP3,Caspase-1,and GSDMD between the experimental group and the probiotic group(t=0.653,P=0.520;t=1.623,P=0.119;t=1.386,P=0.180;t=1.386,P=0.180).Conclusion Intestinal flora EVs can effectively improve pathological injury of myocardial tissues and myocardial function,inhibit myocardial fibrosis and oxidative stress response,reduce inflammatory response and attenuate myocardial pyroptosis in rats with atrial fibrillation.The mechanism may be related to the regulation of NLRP3/Caspase-1/GSDMD signaling pathways.