摘要：Background Non-invasive computed tomography angiography(CTA)-based fractional flow reserve(CT-FFR)could become a gatekeeper to invasive coronary angiography.Deep learning(DL)-based CT-FFR has shown promise when compared to invasive FFR.To evaluate the performance of a DL-based CT-FFR technique,DeepVessel FFR(DVFFR). Methods This retrospective study was designed for iScheMia Assessment based on a Retrospective,single-center Trial of CT-FFR(SMART).Patients suspected of stable coronary artery disease(CAD)and undergoing both CTA and invasive FFR examina-tions were consecutively selected from the Beijing Anzhen Hospital between January 1,2016 to December 30,2018.FFR obtained during invasive coronary angiography was used as the reference standard.DVFFR was calculated blindly using a DL-based CT-FFR approach that utilized the complete tree structure of the coronary arteries. Results Three hundred and thirty nine patients(60.5±10.0 years and 209 men)and 414 vessels with direct invasive FFR were included in the analysis.At per-vessel level,sensitivity,specificity,accuracy,positive predictive value(PPV)and negative pre-dictive value(NPV)of DVFFR were 94.7％,88.6％,90.8％,82.7％,and 96.7％,respectively.The area under the receiver operating characteristics curve(AUC)was 0.95 for DVFFR and 0.56 for CTA-based assessment with a significant difference(P＜0.0001).At patient level,sensitivity,specificity,accuracy,PPV and NPV of DVFFR were 93.8％,88.0％,90.3％,83.0％,and 95.8％,respectively.The computation for DVFFR was fast with the average time of 22.5±1.9 s. Conclusions The results demonstrate that DVFFR was able to evaluate lesion hemodynamic significance accurately and effect-ively with improved diagnostic performance over CTA alone.Coronary artery disease(CAD)is a critical disease in which coron-ary artery luminal narrowing may result in myocardial ischemia.Early and effective assessment of myocardial ischemia is essen-tial for optimal treatment planning so as to improve the quality of life and reduce medical costs.

摘要：Background Based on the China-VHD database,this study sought to develop and validate a Valvular Heart Disease-specific Age-adjusted Comorbidity Index(VHD-ACI)for predicting mortality risk in patients with VHD. Methods & Results The China-VHD study was a nationwide,multi-centre multi-centre cohort study enrolling 13,917 patients with moderate or severe VHD across 46 medical centres in China between April-June 2018.After excluding cases with missing key variables,11,459 patients were retained for final analysis.The primary endpoint was 2-year all-cause mortality,with 941 deaths(10.0％)observed during follow-up.The VHD-ACI was derived after identifying 13 independent mortality predictors:car-diomyopathy,myocardial infarction,chronic obstructive pulmonary disease,pulmonary artery hypertension,low body weight,anaemia,hypoalbuminaemia,renal insufficiency,moderate/severe hepatic dysfunction,heart failure,cancer,NYHA functional class and age.The index exhibited good discrimination(AUC,0.79)and calibration(Brier score,0.062)in the total cohort,outper-forming both EuroSCORE Ⅱ and ACCI(P＜0.001 for comparison).Internal validation through 100 bootstrap iterations yielded a C statistic of 0.694(95％CI:0.665-0.723)for 2-year mortality prediction.VHD-ACI scores,as a continuous variable(VHD-ACI score:adjusted HR(95％CI):1.263(1.245-1.282),P＜0.001)or categorized using thresholds determined by the Yoden index(VHD-ACI ≥ 9 vs.＜9,adjusted HR(95％CI):6.216(5.378-7.184),P＜0.001),were independently associated with mortality.The pro-gnostic performance remained consistent across all VHD subtypes(aortic stenosis,aortic regurgitation,mitral stenosis,mitral re-gurgitation,tricuspid valve disease,mixed aortic/mitral valve disease and multiple VHD),and clinical subgroups stratified by therapeutic strategy,LVEF status(preserved vs.reduced),disease severity and etiology. Conclusion The VHD-ACI is a simple 13-comorbidity algorithm for the prediction of mortality in VHD patients and providing a simple and rapid tool for risk stratification.

摘要：Background Patients aged 85 years or older admitted for heart failure(HF)have increased enormously due to improved sur-vival in this disease.However,few studies assess the characteristics,treatments,and prognosis of very elderly patients admitted for acute HF. Methods This study is a retrospective analysis of the EPICTER registry,that included patients admitted for acute HF in 74 Spanish hospitals.For this analysis,a total of 1887 patients were included and divided into 2 groups:85 years or older(very eld-erly,680 patients)and those under 85 years. Results Compared to patients＜85 years,very elderly patients were more frequently women,had more hypertension and dis-ease cerebrovascular disease,and less presence of chronic obstructive pulmonary disease(COPD),diabetes,and acute myocardi-al infarction.There were no differences in symptoms,except for delirium,significantly more common in very elderly patients.Management of these patients was more conservative and died more than the younger ones(41％vs.25％,P＜0.001).The predict-or variables of mortality in very elderly patients were the presence of COPD and peripheral arterial disease,delirium,and estim-ated survival of less than 6 months assessed by the physician in charge of the patient care. Conclusion Very elderly patients admitted for HF differ from younger ones in comorbidities,management,and symptoms,and have higher mortality.The presence of delirium,peripheral arterial disease,and COPD worsen the prognosis in these pa-tients and can help to adapt the therapeutic effort and place emphasis on adequate symptom control.

摘要：Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health prob-lem.The aim of the study was to assess the incidence of delirium and determine the risk factors for delirium in patients ≥ 60 years of age hospitalized due to acute myocardial infarction(AMI). Methods The study included 405 consecutive patients(mean age:73.1±8.5,males:61％)hospitalized due to AMI divided and characterized according to the in-hospital delirium presence. Results Of 405 patients,57(14％,mean age:80.9±7.3,males:58％)experienced delirium.Patients with delirium were older(80.9±7.3 vs.71.82±8.1 years),all of them presented multimorbidity,they more frequently used polypharmacy(96.5 vs.30.2％)and their hospitalization was longer(8.0±1.4 vs.4.6±1.0 days)as compared to the patients without delirium.Patients with delirium more frequently experience periprocedural complications as well as the in-hospital reversible problems:fever(40.4 vs.0.9％),in-fections(78.9 vs.3.7％),pulmonary oedema(73.7 vs.0.6％),hypoxemia(91.1 vs.98.3％),urinary catheter(96.5 vs.17.2％),dehydra-tion(89.5 vs.6.6％),and insomnia(71.9 vs.0.3％)compared to patients without delirium(P＜0.001 for all).Valvular heart disease(OR=4.78;95％CI:1.10-2.70;P＜0.001,pulmonary oedema(OR=66.79;95％CI:12.04-370.34,P＜0.001),and dehydration(OR=37.26;95％CI:10.50-132.27,P＜0.001)were risk factors for delirium occurrence. Conclusions The in-hospital course of AMI is complicated by delirium occurrence in 14％of patients ≥ 60 years old.Recogniz-ing and modification of potential,reversible risk factors associated with AMI can reduce the risk of delirium.

摘要：Severe aortic stenosis has increased exponentially as a result of the aging of the population.Transcatheter aortic valve replace-ment(TAVR)procedures increase by 20％-30％per year in Spain.Referred patients are increasingly older,have comorbidities,and frailty.TAVR cardiac rehabilitation(CR)programs significantly improve both functional capacity and quality of life of pa-tients.However,there are no guidelines on how to carry out them and few elderly patients are referred to CR.Furthermore,mor-tality in women who undergo TAVR is higher than in men and even fewer are referred to CR programs.Multidisciplinary pa-tient care,including comorbidities and frailty,is essential.It is necessary to ensure exquisite continuity of care during TAVR,CR,and the rest of the patient's life.Telerehabilitation could be an option in some lower-risk patients to include more patients in CR programs after TAVR,given the high demand.This article reviews the evidence on why CR should be performed in post-TAVR patients and proposes a practical and novel approach to the care process and the recommended aspects and components of the CR program.

摘要：Aortic stenosis(AS)is the most common valv-ular heart disease,with a prevalence of over 4％among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with age,account-ing for 25％of patients aged 85 years and older in Europe and 12％of patients older than 80 years in Japan.

摘要：Caffeine is a widely consumed stimulant known for its cardiovascular and metabolic effects.However,its impact on cardiovascular risk,including arrhythmias,in older adults remains underexplored.Emerging evidence highlights sex-specific differences in caffeine metabolism,which may influence its role in cardiovascular health.This perspective examines the interaction between caffeine,hormonal changes,metabolic processes,and lifestyle factors,focusing on older women compared to men.Understanding these differenc-es is essential for tailoring dietary and clinical recommendations to mitigate cardiovascular risks and promote healthy aging.

摘要：Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessm-ent tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAVI).Their efforts underscore the growi-ng importance of frailty assessment in cardiovascular risk stratification.We would like to respectfully highlight se-veral areas that,if addressed in future studies(Figure 1),could further enhance the utility and inclusivity of these assessments.

摘要：BACKGROUND Antithrombotic strategies after percutaneous coronary interventions(PCI)in elderly patients on oral anticoag-ulant therapy(OAT)are debated due to the balance between ischemic and bleeding risks.Recent guidelines recommend early tran-sitioning from triple antithrombotic therapy to dual antithrombotic therapy,but there are limited data on elderly patients. METHODS We performed a post-hoc age-specific analysis of the PERSEO Registry population aimed to compare clinical featur-es,therapeutic strategies,and outcomes of individuals aged ≥ 80 years and＜80 years who were on OAT and underwent PCI with stent.The primary endpoint was net adverse clinical events at 1-year follow-up.Secondary endpoints included major adverse cardi-ac and cerebral events(MACCE),major bleeding[Bleeding Academic Research Consortium(BARC)type 3-5],and clinically relevant bleeding(BARC type 2-5). RESULTS Among the 1234 patients enrolled,31％of patients were aged ≥ 80 years(84±3 years,76％males).Compared to youn-ger patients,elderly patients had higher rates of comorbidities such as hypertension,anaemia or chronic kidney disease,and atrial fi-brillation was the leading indication for OAT.Elderly patients were more often discharged on dual antithrombotic therapy(23％)co-mpared to younger patients(13％)(P＜0.0001).They experienced higher net adverse clinical events(38％vs.21％,P＜0.001),MAC-CE(24％vs.12％,P＜0.001),as well as higher bleeding rates.Specifically,rates of major bleeding(9％vs.6％,P=0.026),and clinic-ally relevant bleeding(21％vs.12％,P＜0.001)were significantly higher in elderly patients. CONCLUSIONS Elderly patients on OAT undergoing PCI are a particular frail population with higher risk of MACCE and blee-ding compared to younger patients despite a less aggressive antithrombotic therapy.

摘要：Coronavirus disease 2019(COVID-19)has had a substantial global health impact,with over 765 million confirmed cases and nearly 7 million deaths.[1]In South Korea,stringent lockdown policy hea-vily restricted the daily activities for over two years,resul-ting in widespread public health issues.Approximately 46％of Koreans experienced a weight gain of more than 4.9 kg,contributing to stress-related eating disorders,obesity,and poor management of chronic conditions.[2]Elderly po-pulations,already vulnerable due to multi-morbidities,faced heightened risks of hypertension,diabetes mellitus,cerebrovascular diseases,chronic kidney failure,and deme-ntia.As South Korea now transitions into a super-aged so-ciety,understanding the effects of prolonged isolation on fr-ail elderly is critical.This study evaluates the body compo-sition and cardiovascular changes in individuals aged 65 years and older during the COVID-19 pandemic,emphasi-zing the need for precise quarantine guidelines and geriat-ric care.

摘要：Kounis syndrome(KS)is a rare but clinically sig-nificant condition characterized by the simul-taneous occurrence of acute coronary syndro-me(ACS)and allergic reactions,which can develop in pa-tients with either normal or diseased coronary arteries.[1,2]The condition is typically triggered by various allergens in-cluding medications(particularly contrast media),environ-mental factors,or food exposures,with symptom onset us-ually occurring within one hour of exposure.

摘要：BACKGROUND Physical inactivity is a significant yet underappreciated risk factor for cardiovascular disease(CVD),particularly among older adults.The aim of this study was to analyze the global burden of CVD attributable to physical inactivity in individuals ag-ed 70 years and older from 1990 to 2021 using the Global Burden of Disease data. METHODS We assessed trends in disability-adjusted life years(DALYs)and deaths,decomposed changes into population growth,ag-ing,and epidemiological factors,and examined health inequalities across sociodemographic index(SDI)regions. RESULTS From 1990 to 2021,a substantial rise in DALYs was observed,especially in low and middle SDI regions,with a 120.06％in-crease in the low SDI region,but a 23.10％decline in the high SDI region.Decomposition analysis identified population aging and gro-wth as primary drivers for the burden,contributing 66.39％and 83.56％to the increase in middle and low SDI regions,respectively.By con-trast,epidemiological improvements alleviated burden in the high SDI region(54.91％).Gender disparities persisted,with women exper-iencing a higher burden.Inequality analysis indicated a shift in CVD burden towards the low SDI region,with declining concentration indices for DALYs(—0.03 to-0.13)and deaths(-0.07 to—0.15).The Bayesian age-period-cohort projections suggest continued increas-es in DALYs and deaths through 2050,with women disproportionately affected. CONCLUSIONS These findings highlight the urgent need for targeted interventions promoting physical activity,improving healt-hcare access,and implementing region-specific prevention strategies.

摘要：Renal cell carcinoma(RCC)is an aggressive tum-or known for its propensity to invade the infer-ior vena cava(IVC)into the heart.Cardiac meta-stasis of RCC without IVC involvement is rare.Even rarer is ventricular arrhythmia as the primary manifestation of cardiac metastasis of RCC with only two cases reported.[1,2]We add to the literature the third case,the diagnosis of wh-ich was only possible with cardiac magnetic resonance(CMR).

摘要：OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to tr-aditional manual percutaneous coronary intervention(M-PCI). METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were random-ly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical su-ccess was defined as visually estimated residual post-percutaneous coronary intervention stenosis＜30％with no 30-day major adve-rse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area pro-duct. RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6％).Both groups achieved 100％clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI gr-oup had a technical success rate of 100％.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator ra-diation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups. CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assist-ed system is safe and effective and does not result in conversion to M-PCI.

摘要：Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in pa-tients with atrial fibrillation(AF).However,outcomes among patients age＞75 years undergoing LAAO are lacking. Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data in-cluding clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite out-come was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days. Results Mean age was 75±8 years and 434(60％)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and medi-an HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age＞75 years in both unadjusted(17.1％vs.11.5％,P=0.03)and adjusted(Odds Ratio=1.59,95％CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3％vs.0,P=0.04)among patients age＞75 years.The secondary outcome of procedural success was also lower among patients age＞75 years(92.2％vs.96.2％,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age＞75 years and less than 75 years. Conclusion Patients age＞75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.

摘要：Background Medical informatics accumulated vast amounts of data for clinical diagnosis and treatment.However,limited ac-cess to follow-up data and the difficulty in integrating data across diverse platforms continue to pose significant barriers to clinic-al research progress.In response,our research team has embarked on the development of a specialized clinical research database for cardiology,thereby establishing a comprehensive digital platform that facilitates both clinical decision-making and research endeavors. Methods The database incorporated actual clinical data from patients who received treatment at the Cardiovascular Medicine Department of Chinese PLA General Hospital from 2012 to 2021.It included comprehensive data on patients' basic information,medical history,non-invasive imaging studies,laboratory test results,as well as peri-procedural information related to interven-tional surgeries,extracted from the Hospital Information System.Additionally,an innovative artificial intelligence(AI)-powered interactive follow-up system had been developed,ensuring that nearly all myocardial infarction patients received at least one post-discharge follow-up,thereby achieving comprehensive data management throughout the entire care continuum for high-risk patients. Results This database integrates extensive cross-sectional and longitudinal patient data,with a focus on higher-risk acute coron-ary syndrome patients.It achieves the integration of structured and unstructured clinical data,while innovatively incorporating AI and automatic speech recognition technologies to enhance data integration and workflow efficiency.It creates a comprehens-ive patient view,thereby improving diagnostic and follow-up quality,and provides high-quality data to support clinical research.Despite limitations in unstructured data standardization and biological sample integrity,the database's development is accom-panied by ongoing optimization efforts. Conclusion The cardiovascular specialty clinical database is a comprehensive digital archive integrating clinical treatment and research,which facilitates the digital and intelligent transformation of clinical diagnosis and treatment processes.It supports clin-ical decision-making and offers data support and potential research directions for the specialized management of cardiovascular diseases.

摘要：Recent clinical trials have demonstrated a protective effect in using traditional Chinese medicine Tongxinluo(TXL)capsule to treat atherosclerosis.However,clinical evidence of the effects of TXL treatment on coronary plaque vulnerabil-ity is unavailable.In response,we developed this study to investigate the hypothesis that on the basis of statin therapy,treatment with TXL capsule may stabilize coronary lesions in patients with acute coronary syndrome(ACS).The TXL-CAP study was an in-vestigator-initiated,randomized,double-blind clinical trial conducted across 18 medical centers in China.Patients with ACS aging from 18 to 80 years old who had a non-intervened coronary target lesion with a fibrous cap thickness(FCT)＜100 μm and lipid arc＞90° as defined by optical coherence tomography(OCT)were recruited.A total of 220 patients who met the selection criteria but did not meet the exclusion criteria will be finally recruited and randomized to receive treatment with TXL(n=110)or placebo(n=110)for a duration of 12 months.The primary endpoint was the difference in the minimum FCT of the coronary tar-get lesion between TXL and placebo groups at the end of the 12-month follow-up.Secondary endpoints included:(1)changes of the maximum lipid arc and length of the target plaque,and the percentage of lipid,fibrous,and calcified plaques at the end of the 12-month period;(2)the incidence of composite cardiovascular events and coronary revascularization within the 12 months;(3)changes in the grade and scores of the angina pectoris as assessed using the Canadian Cardiovascular Society(CCS)grading sys-tem and Seattle angina questionnaire(SAQ)score,respectively;and(4)changes in hs-CRP serum levels.The results of the TXL-CAP trial will provide additional clinical data for revealing whether TXL capsules stabilizes coronary vulnerable plaques in Chinese ACS patients.

摘要：Chronic long-segment iliac artery occlusion represents a relatively rare and particularly severe form of iliac artery disease,often asso-ciated with complex anatomical challenges.When symptomatic,these patients are typically candidates for surgical revascularization.[1]However,this subset of pa-tients is frequently elderly and affected by advanced sys-temic atherosclerosis,multiple comorbidities,and espe-cially severe coronary artery disease,[2]all of which signi-ficantly increase operative risk and associated mortality.

摘要：Background The association of systemic inflammatory response index(SIRI)with prognosis of coronary artery disease(CAD)patients has never been investigated in a large sample with long-term follow-up.This study aimed to explore the association of SIRI with all-cause and cause-specific mortality in a nationally representative sample of CAD patients from United States. Methods A total of 3386 participants with CAD from the National Health and Nutrition Examination Survey(NHANES)1999-2018 were included in this study.Cox proportional hazards model,restricted cubic spline(RCS),and receiver operating characteristic curve(ROC)were performed to investigate the association of SIRI with all-cause and cause-specific mortality.Piece-wise linear regression and sensitivity analyses were also performed. Results During a median follow-up of 7.7 years,1454 all-cause mortality occurred.After adjusting for confounding factors,higher lnSIRI was significantly associated with higher risk of all-cause(HR=1.16,95％CI:1.09-1.23)and CVD mortality(HR=1.17,95％CI:1.05-1.30)but not cancer mortality(HR=1.17,95％CI:0.99-1.38).The associations of SIRI with all-cause and CVD mortality were detected as J-shaped with threshold values of 1.05935 and 1.122946 for SIRI,respectively.ROC curves showed that lnSIRI had robust predictive effect both in short and long terms. Conclusions SIRI was independently associated with all-cause and CVD mortality,and the dose-response relationship was J-shaped.SIRI might serve as a valid predictor for all-cause and CVD mortality both in the short and long terms.

摘要：Background Transcatheter Aortic Valve Implantation(TAVI)has changed the treatment paradigm of the aortic stenosis(AS).It has become the treatment of choice in patients with symptomatic AS and surgical high risk,and a valid alternative to surgical aortic valve replacement in patients with low and medium surgical risk.Despite numerous evidence on clinical results,indica-tions and benefits,only a few studies analyse it from patient's perspective and the impact of TAVI on them.The objective of this study is to evaluate the experience of patients undergoing TAVI. Methods Cross-sectional,descriptive observational study in two Spanish hospitals,with a establish Nurse TAVI program,with 100 patients undergoing TAVI.A specific questionnaire was designed(VALVEX questionnaire)and a pilot study was conducted by a multidisciplinary team of doctors,nurses and patients.The questionnaire was given to patients at 30 days after TAVI proced-ure during the follow up at the TAVI nurse clinic. Results The study demonstrated a mean satisfaction of 9 for the TAVI program,with 96％of patients that would recommend TAVI to other patients.Patients scored a high satisfaction on the information received prior to the procedure.During the proced-ure and admission,the satisfaction was high in relation to the care received.During the follow up,satisfaction was high in rela-tion to the role of the TAVI nurse,for the information and continuation of care during the procedure,in reducing anxiety,organ-ising their admission and understanding the process.However,questions with less scores were related to hospital catering,delay between diagnosed and treatment,and patient decision-making process. Conclusion The evaluation of patient experience allows us to improve the information given to the patient during their TAVI process and it can also allow patients to be more relax,aware and prepared for the procedure.Continuous follow up enables monitoring of patient recovery and helps to discuss any doubts improving patient's satisfaction.The use of PREMs and PROMs associated to TAVI pathway combined with an active participation of the patient on the design of the questionnaire is essential for keeping the patient in the centre of the TAVI pathway.