摘要：The important work of Yu,et al.[1]who presented one of the first randomized controlled trials (RC-Ts) to directly compare robot-assisted and man-ual percutaneous coronary intervention (PCI),is comme-ndable;offering important insights into the feasibility and outcomes of this emerging technology. While the analysis is timely,several issues warrant further consideration.

摘要：BACKGROUND Coronary microembolization(CME)is the major leading cause of perioperative myocardial injury during coronary revascularization.Semaglutide exerts multiple protective biological activities,but its cardioprotective effects on CME remain unclear.Th-us,this experiment studied the impact of semaglutide on CME-induced myocardial injury. METHODS A rat CME model was generated by injecting microspheres into the left ventricle while clamping the ascending aorta.A H9c2 cardiomyocyte model was constructed by stimulation of lipopolysaccharide combined with hypoxia.Semaglutide or the high mob-ility group box 1(HMGB1)antagonist glycyrrhizin administrations were ahead of CME and cell modeling.Cardiac function,myocardi-al injury markers,cell viability and morphological alternations were detected.Apoptotic and inflammatory factors,cytosolic HMGB1 and its translocation,advanced glycosylation end-product specific receptor(RAGE),and nuclear factor kappa B p65(NF-κB p65)were eval-uated. RESULTS Semaglutide pretreatment ameliorated CME-induced cardiac systolic dysfunction and relieved the cardiac injury.Semaglu-tide attenuated myocardial apoptosis and inflammatory response following CME in vivo and in vitro.Moreover,semaglutide downregu-lated HMGB1 expression and suppressed its nuclear-cytoplasmic translocation.Both glycyrrhizin and semaglutide administration aff-ected the HMGB1/RAGE/NF-κB p65 pathway after CME. CONCLUSIONS Semaglutide pretreatment attenuates CME-induced myocardial injury by suppressing apoptosis and inflammati-on through the HMGB1/RAGE/NF-κB p65 pathway.

摘要：Scar-related ventricular tachycardia (VT) is a ma-lignant arrhythmia with high mortality rates in patients with cardiomyopathies such as ischemic and dilated cardiomyopathy.[1]While implantable cardio-verter defibrillators (ICD) effectively terminate VT episo-des and prevent sudden cardiac death,recurrent ICD dis-charges may precipitate electrical storms and severely im-pair quality of life.

摘要：BACKGROUND Solid fuel use for cooking and heating is a major environmental risk factor,yet its association with new-onset heart di-sease(HD)remains unclear.The aim of this study was to investigate the relationship between solid fuel exposure and new-onset HD in a la-rge cohort. METHODS Multivariable logistic regression models assessed associations between cooking/heating fuel types(coal,crop residue/wood,liquefied petroleum gas,natural gas,and others)and new-onset HD.Subgroup analyses explored effect modification by age,sex,edu-cation,smoking,alcohol use,and region. RESULTS A prospective cohort study included 5915 participants,with 781 participants(13.2%)developing new-onset HD.Coal use for cooking showed an initial association with new-onset HD risk(OR=1.41,95%CI:1.06-1.86,P=0.02),which attenuated after full adjus-tment(OR=1.28,95%CI:0.96-1.72,P=0.10).Coal use for heating demonstrated robust associations across all models(OR=1.86,95%CI:1.42-2.43,P<0.001).Crop residue/wood burning for heating was also significant(Model 2:OR=1.40,95%CI:1.06-1.86,P=0.02).Subgro-up analyses revealed stronger associations among females,non-smokers,non-drinkers,and less-educated participants.Geographic str-atification showed significant associations in southern but not northern regions. CONCLUSIONS Solid fuel use,particularly coal for heating,is associated with increased new-onset HD risk.Reducing solid fuel expos-ure is crucial for HD prevention in low-resource settings.

摘要：BACKGROUND Many conditions may affect left ventricular(LV)phenotypes which have been classified according to LV mass and geometry.There is limited data on the prognostic value of LV phenotypes classified by cardiac magnetic resonance(CMR).This study ai-med to determine the prognostic value of LV phenotypes in elderly and non-elderly patients with known or suspected coronary artery disease. METHODS This is a retrospective cohort study among patients who underwent stress or viability CMR.LV phenotypes were classif-ied according to the LV mass index,the LV end-diastolic volume index and the LV mass/volume ratio,into normal,concentric remodel-ing,concentric hypertrophy,and eccentric hypertrophy.The primary outcome was a composite of death or heart failure. RESULTS A total of 3289 patients was studied.The average age was 68.0±12.7 years,52.2%of patients were women.Elderly were de-fined as age≥65 years accounting for 63.9%of the cohort.LV phenotypes were normal,concentric remodeling,concentric hypertrop-hy,and eccentric hypertrophy at 74.5%,5.8%,9.2%,and 10.5%,respectively.The median duration of follow-up was 41.4 months.The com-posite outcome of death or heart failure occurred in 7.3%of patients.The prognostic impact of LV phenotypes was more pronounced in the elderly,with eccentric hypertrophy showing the worst prognosis,followed by concentric hypertrophy and concentric remodeling wi-th the adjusted hazard ratio(95%CI)of 2.37(1.72-3.25),1.53(1.12-2.08),and 1.14(0.76-1.71),respectively,compared to normal phenoty-pe.Patients with eccentric hypertrophy also demonstrated abnormal global longitudinal LV strain,left atrial strain,and extracellular vo-lume fraction. CONCLUSIONS LV phenotypes by CMR independently predict adverse clinical outcomes in elderly patients with known or suspe-cted coronary artery disease.In non-elderly patients,the prognostic value of LV phenotypes was less evident.Assessment of LV phenoty-pes may be useful for risk stratification.

摘要：Heart failure(HF)is a complex clinical syndrome that promotes high morbidity and multi-systemic damage.Skeletal muscle can be directly affected by HF through a loss of physical capacity and various inflammatory,hormonal,and metabolic mechan-isms observed in this cardiac condition,which collectively contribute to a high prevalence of sarcopenia in HF patients.Therefore,the aim of this review was to compile the main recent clinical and epidemiological data on muscle health in HF patients.Nine studies we-re selected from systematic reviews and clinical trials,which demonstrated a high prevalence of sarcopenia in patients with HF,par-ticularly in males,hospitalized patients,the elderly,and those with HF with reduced ejection fraction.Oxidative stress markers and hig-her levels of natriuretic peptides were also observed in HF patients who exhibited damaged muscle parameters.Furthermore,the ove-rall deterioration of prognosis in HF was associated with criteria defining sarcopenia,such as low muscle strength and lean mass loss.Th-ese findings reinforce the importance of evaluating skeletal muscle in HF patients,which can provide improvements in morbidity and functionality.

摘要：The morbidity rate of primary cardiac tumors(PCTs) is only 0.0138％.[1]Calcified amorphous tumors (CATs) are a particularly rare entity with only a few cases reported in the literature,and account for only 2.47％ of PCTs.[2]CATs can occur at any age and have been identified at various intracardiac locations.

摘要：The post-hoc analysis of the PERSEO registry by Minardi,et al.[1]offers critical insights into anti-thrombotic management for elderly patients (≥ 80 years) on oral anticoagulation undergoing percutan-eous coronary intervention. While the authors effectively demonstrate the vulnerability of this population,charac-terized by substantial comorbidity burden and markedly elevated rates of mortality,ischemic events,and bleeding at one year compared with younger cohorts,their findin-gs raise important questions about contemporary practice patterns and their alignment with evidence-based guide-lines.

摘要：Significant progress has been recently made in studying artemisinin and its derivatives for treating cardiovascu-lar diseases,making this area a prominent research focus.Artemisinin,discovered with great acclaim,was initially and widely adopted in antimalarial treatments.As scientific research steadily progressed,its latent potential role in the cardiovascular sys-tem gradually captured the attention of the global scientific community.Artemisinin and its derivatives can reportedly play a protective role in the cardiovascular system through various mechanisms,including anti-inflammatory,anti-angiogenic,antioxid-ant,and anti-fibrotic effects,as well as the regulation of blood lipids and blood pressure.In particular,they have shown prom-ising therapeutic effects in models of cardiovascular diseases such as atherosclerosis,myocardial ischaemia,and cardiac hyper-trophy.In addition,artemisinin and its derivatives can improve cardiovascular function and prevent cardiovascular injury by regulating signalling pathways closely related to cardiovascular disease,such as AMPK and NF-kB.Although numerous ex vivo and in vivo experiments have verified the potential role of artemisinin in treating cardiovascular diseases,systematic studies to comprehensively elucidate its specific mechanism of action remain scarce.Further exploration of the precise roles of artemisinin and its derivatives in cardiovascular disease therapy,along with their potential clinical applications,could offer valuable insights for future research and treatment strategies.

摘要：Background Recent studies have suggested a potential role of the oral microbiome in the development of cardiovascular dis-eases.This study aims to investigate the association between oral microbiota and cardiovascular disease risk,including atrial fib-rillation,myocardial infarction,chronic heart failure,and hypertension. Methods We analyzed GWAS data from East Asian populations'oral microbiome,involving 2,017 tongue and 1,915 saliva samples from 2,984 individuals with whole-genome sequencing.Additionally,we sourced cardiovascular disease GWAS data from NBDC,including atrial fibrillation(8,180 cases,28,621 controls),myocardial infarction(14,992 cases,146,214 controls),chronic heart failure(10,540 cases,168,186 controls),and systolic blood pressure(145,505 individuals). Results Several oral microbiota taxa were found to be significantly associated with cardiovascular disease outcomes.Specific microbiota,such as Centipeda,Corynebacterium,and Pseudomonas E,were negatively correlated with heart failure.In contrast,taxa like Neisseria D and Actinomyces were associated with an increased risk of atrial fibrillation and myocardial infarction.Ad-ditionally,certain oral microbiota showed correlations with changes in blood pressure,highlighting their potential role in hyper-tension. Conclusion Our findings suggest that the oral microbiota may influence the development and progression of cardiovascular diseases,providing new insights into the potential impact of oral health on cardiovascular risk.

摘要：Objective To determine whether frailty is a risk factor for hospitalization and mortality in older adults enrolled in the"Chronic Heart Failure Program"at a hospital in Lima,Peru,between 2018-2021. Methods This was an ambispective cohort study.A total of 85 older adults participating in the Chronic Heart Failure Program at Guillermo Almenara National Hospital were included.Each had an initial frailty assessment,forming two cohorts:frail and non-frail older adults.Medical records were reviewed,and patients were followed for one year to track events of interest(hospit-alization and mortality).Overall survival and risk factors for hospitalization and death were determined. Results During follow-up,15.3%of the older adults died,and frailty was identified in 58.8%of the patients.Overall survival us-ing the Kaplan-Meier method was 96.5%at 3 months after entering the Chronic Heart Failure Program;92.9%at 6 months;and 85.9%at one year.Multivariate analysis using Poisson regression found that frailty was not a risk factor for hospitalization(aRR=0.92;95%CI:0.42-2.03).Survival analysis using the Cox proportional hazards model showed that frailty was also not a risk factor for mortality after one year of follow-up(aHR=1.32;95%CI:0.27-6.53). Conclusions Our research does not confirm frailty as a risk factor for hospitalization or mortality in older adults enrolled in the"Chronic Heart Failure Program"after one year of follow-up.

摘要：When patients initially present with atrial fibrillation along with an enlarged heart and heart failure,followed by atrioven-tricular block,it's essential to consider genetic factors.[1]Genetic testing can offer crucial diagnostic evidence,aid-ing in prognosis assessment and the adoption of appro-priate treatment strategies.

摘要：Background In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical out-comes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.The study aim was to determ-ine clinical characteristics,risk of adverse cardiovascular events,and mortality in patients aged≥85 years compared to those aged<85 undergoing PCI. Methods In this retrospective study,data were obtained from the nationwide Netherlands Heart Registration on patients un-dergoing PCI between January 1st,2017 and January 1st,2021.The primary endpoint was all-cause mortality at long-term follow-up. Results A total of 155,683 patients underwent PCI,of which 100,209(64.4%)acute coronary syndrome cases.Compared to pa-tients aged<85 years,patients aged≥85 were more often female and showed a higher number of cardiovascular comorbidities,including impaired left ventricle ejection fraction and reduced kidney function.Mortality at short-term and long-term follow-up were significantly higher in those aged≥85(P<0.001).Patients aged≥85 were more likely to have a myocardial infarction with-in 30 days following the index intervention(0.9%vs.0.7%;P=0.024),though they less often underwent revascularization at long-term follow-up compared to patients aged<85(P<0.001). Conclusions The elderly(≥85 years)patient requiring PCI carries an extensive cardiovascular risk profile,translating in signi-ficant risk of recurrent cardiovascular events and increased mortality rate.Clinicians should carefully weigh perceived risks and potential benefits in the individual patient,considering the patients'age,cardiovascular risk profile,and associated risk of mor-bidity and mortality.

摘要：Background There is still limited data on predictive value of coronary computed tomography angiography(CCTA)-derived fractional flow reserve(CT-FFR)for long term outcomes.We examined the long-term prognostic value of CT-FFR combined with CCTA-defined atherosclerotic extent in diabetic patients with coronary artery disease(CAD). Methods A retrospective pooled analysis of individual patient data was performed.Deep-learning-based vessel-specific CT-FFR was calculated.All patients enrolled were followed-up for at least 5 years.Predictive abilities for major adverse cardiac events(MACE)were compared among three models(model 1,constructed using clinical variables;model 2,model 1+CCTA-de-rived atherosclerotic extent(Leiden risk score);and model 3,model 2+CT-FFR. Results A total of 480 diabetic patients[median age,61(55-66)years;52.9%men]were included.During a median follow-up time of 2197(2126-2355)days,55 patients(11.5%)experienced MACE.In multivariate-adjusted Cox models,Leiden risk score(HR:1.06;95%CI:1.01-1.11;P=0.013)and CT-FFR≤0.80(HR:6.54;95%CI:3.18-13.45;P<0.001)were the independent predict-ors.The discriminant ability was higher in model 2 than in model 1(C-index,0.75 vs.0.63;P<0.001)and was further promoted by adding CT-FFR to model 3(C-index,0.81 vs.0.75;P=0.002).Net reclassification improvement(NRI)was 0.19(P=0.009)for model 2 beyond model 1.Of note,adding CT-FFR to model 3 also exhibited significantly improved reclassification compared with model 2(NRI=0.14;P=0.011). Conclusion In diabetic patients with CAD,CT-FFR provides robust and incremental prognostic information for predicting long-term outcomes.The combined model exhibits improved prediction abilities,which is beneficial for risk stratification.

摘要：Background Frailty is common and significantly impacts prognosis in heart failure(HF).The Vulnerable Elders Survey-13(VES-13),widely used in oncogeriatrics and public health,remains unexplored as a frailty screening tool in HF outpatients.In this study,we prospectively evaluated VES-13 against a multimodal screening assessment in detecting frailty and predicting indi-vidual risk of adverse prognosis. Methods Frailty was assessed at the initial visit using both a multimodal approach,incorporating Barthel Index,Older Americ-an Resources and Services scale,Pfeiffer Test,abbreviated Geriatric Depression Scale,age>85 years,lacking support systems,and VES-13.Patients scoring≥3 on VES-13 or meeting at least one multimodal criterion were classified as frail.Endpoints in-cluded all-cause mortality,a composite of death or HF hospitalization,and recurrent HF hospitalizations. Results A total of 301 patients were evaluated.VES-13 identified 40.2%as frail and the multimodal assessment 33.2%.In Cox regression analyses,frailty identified by VES-13 showed greater prognostic significance than the multimodal assessment for all-cause mortality(HR=3.70[2.15-6.33],P<0.001 vs.2.40[1.46-4.0],P=0.001)and the composite endpoint(HR=3.13[2.02-4.84],P<0.001 vs.1.96[1.28-2.99],P=0.002).Recurrent HF hospitalizations were four times more frequent in VES-13 frail patients while two times in those identified as frail by the multimodal assessment.Additionally,stratifying patients by VES-13 tertiles provided robust risk differentiation. Conclusions VES-13,a simple frailty tool,outperformed a comprehensive multimodal assessment and could be easily integ-rated into routine HF care,highlighting its clinical utility in identifying patients at risk for poor outcomes.

摘要：BACKGROUND Acute myocardial infarction(AMI)is a major cause of mortality worldwide.The stress hyperglycemia ratio(SHR),which integrates glucose and glycated hemoglobin A1c levels,better reflects acute metabolic stress.This study assessed the SHR and long-term prognosis of patients with AMI. METHODS This study was a post-hoc analysis based on the prospective,multicenter OPTIMAL registry( number:NCT03084991).A total of 3384 consecutive patients who underwent percutaneous coronary intervention(PCI)at Departme-nt of Cardiology,The 2nd Affiliated Hospital of Harbin Medical University,Harbin,China were included in the present analysis after exclu-sions.Patients were stratified into quartiles according to the SHR.The primary endpoint was cardiovascular death,with all-cause death and major adverse cardiovascular events as secondary endpoints.The median follow-up duration was 24.1 months,with a completion rate of 99.5%. RESULTS Kaplan-Meier survival curves showed progressively worse survival across SHR quartiles(log-rank P<0.001),with patients in Q4(SHR≥1.34)experiencing the highest risk.Multivariate Cox regression analysis confirmed that the SHR was an independent predic-tor of cardiovascular death[hazard ratio(HR)=1.56],all-cause death(HR=1.48),and major adverse cardiovascular events(HR=1.34)for Q4(SHR≥1.34)versus Q2(SHR:0.93-1.11).Restricted cubic spline analysis revealed a J-shaped association between SHR and outcomes,with the lowest risk observed at an SHR of approximately 1.0. CONCLUSIONS The SHR is an independent predictor of long-term adverse outcomes in patients with AMI undergoing PCI,suppor-ting its use for early risk stratification and glycemic management.

摘要：A 64-year-old woman who presented with pro-gressive exertional dyspnea (NYHA class IIb)over the previous month,unresponsive to ad-justments in diuretic therapy. She denied chest pain or palpitations. On physical examination,bilateral lower ex-tremity edema and a right parasternal systolic murmur we-re noted. Electrocardiography showed sinus rhythm with first-degree atrioventricular block and complete right bu-ndle branch block.

摘要：Background Percutaneous coronary intervention(PCI)is a widely utilized revascularization technique for coronary artery dis-ease(CAD).While clinical and biomarker-based prognostic tools are standard for predicting outcomes,there is growing interest in sarcopenia as a marker of frailty and its potential role in long-term prognosis.The prognostic value of the psoas muscle index(PMI),a sarcopenia metric,remains underexplored in PCI populations regarding long term survival. Methods This single-center retrospective cohort study evaluated 177 patients undergoing PCI from 2015 to 2019.PMI was cal-culated from computed tomography(CT)imaging at the L3 vertebral level using the formula:(left psoas area+right psoas area)/height2 and expressed in cm2/m2.Sarcopenia was defined as the lowest sex-specific PMI quartile.Primary outcomes in-cluded 5-year all-cause mortality and 3-point major adverse cardiovascular events(MACE:non-fatal myocardial infarction,ischemic stroke,and cardiac death).Binary linear regression and Cox proportional hazards models were utilized to determine as-sociations between PMI and outcomes Results Sarcopenic patients exhibited significantly higher 5-year all-cause mortality compared to non-sarcopenic counterparts(64.4%vs.35.6%,P<0.001),while no significant difference was observed in 3-point MACE incidence(55.6%vs.51.4%,P=0.520).Sarcopenia was independently associated with all-cause mortality on binary logistic regression(OR = 3.49;95%CI:1.69-7.19;P = 0.0007),but not MACE(OR = 1.00;95%CI:0.50-1.98;P = 0.99).In a multivariable Cox regression model,sarcopenia was asso-ciated with increased hazard of mortality(HR = 1.60;95%CI:0.96-2.66;P = 0.071),though this did not reach statistical signific-ance.Kaplan-Meier analysis demonstrated significantly reduced survival among sarcopenic patients(χ2=6.13,P=0.0133). Conclusions PMI is a significant independent predictor of 5-year all-cause mortality in PCI patients,underscoring the pro-gnostic importance of assessing skeletal muscle mass in this population.

摘要：Background Cardiovascular disease(CVD)and frailty are interrelated conditions prevalent in aging populations,yet their dy-namic temporal relationship remains underexplored.This study investigates longitudinal changes in frailty trajectories before and after incident CVD across diverse cohorts. Methods Utilizing data from four longitudinal,multinational cohorts(ELSA,HRS,CHARLS,SHARE;n=66,537),we construc-ted the frailty index(FI)based on age-related health deficits,using 40,40,42,and 44 items from ELSA,HRS,CHARLS and SHARE,respectively.Linear mixed models assessed FI changes pre-and post-CVD,adjusting for demographics,lifestyle,and baseline FI.Sensitivity analyses excluded hypertension,diabetes,and arthritis to mitigate confounding. Results Frailty increased steadily before CVD onset(pre-CVD slope:ELSA β=0.005,HRS β=0.005,CHARLS β=0.012,SHARE β=0.007;all P<0.001),with an acute FI spike at diagnosis(post-CVD acute change:ELSA β=0.024,HRS β=0.031,CHARLS β=0.046,SHARE β=0.038;all P<0.001).Post-CVD,frailty progression further accelerated(ELSA β=0.008,HRS β=0.005,CHARLS β=0.017,SHARE β=0.010;all P<0.001).Sensitivity analyses confirmed robustness across age strata and FI definitions. Conclusions This first multinational study demonstrates bidirectional acceleration of frailty around CVD onset,highlighting their close temporal interplay.These findings suggest that incorporating frailty assessment into CVD management may help identify high-risk individuals and support timely,multidimensional care in aging populations.

摘要：Background Frailty is a major determinant of outcomes in patients with coronary artery disease(CAD)undergoing lower limb amputation.This study evaluates the impact of frailty on in-hospital outcomes in these patients. Methods We performed a retrospective analysis of the National Inpatient Sample(2016-2021)to identify adult patients with CAD who underwent lower limb amputation.Frailty was defined using the Johns Hopkins Adjusted Clinical Groups(ACG)frailty indicator.Multivariable logistic regression was used to assess the independent association of frailty with in-hospital out-comes,and propensity score matching(PSM)was performed to further account for confounding factors. Results After PSM,9,990 patients were included in each cohort.Frail patients experienced higher rates of in-hospital mortality(3.9%vs.1.5%,P<0.001),acute limb ischemia(3.8%vs.3.1%,P=0.015),fasciotomy(2.1%vs.1.4%,P<0.001),stump infection(7.9%vs.6.6%,P<0.001),cardiogenic shock(0.9%vs.0.7%,P=0.032),sudden cardiac arrest(2.7%vs.2.1%,P=0.004),mechanical circulatory support(0.3%vs.0.2%,P=0.028),major adverse cardiac and cerebrovascular events(7.7%vs.5.4%,P<0.001),and sepsis(18.3%vs.13.8%,P<0.001).In multivariable logistic regression analysis,frailty remained an independent predictor of in-hospital mortality and major complications. Conclusion Frailty is independently associated with increased in-hospital mortality and adverse events among CAD patients undergoing lower limb amputation.Incorporating frailty assessment into preoperative evaluation may improve risk stratification and guide clinical decision-making in this high-risk population.