Objective This study aimed to analyze the relationship between cardiorespiratory fitness(CRF)and the increasing severity of coronary artery tortuosity(CAT)in patients with non-stenosed coronaries.Methods A total of 39...Objective This study aimed to analyze the relationship between cardiorespiratory fitness(CRF)and the increasing severity of coronary artery tortuosity(CAT)in patients with non-stenosed coronaries.Methods A total of 396 patients who underwent coronary angiography and cardiopulmonary exercise testing(CPET)between August 2020 and July 2021 were included in this single-center retrospective study after excluding patients with significant coronary artery disease(≥50%stenosis).Patients were divided into two groups:no or mild coronary artery tortuosity(N/M-CAT)and moderate to severe coronary artery tortuosity(M/S-CAT)and laboratory electrocardiographic,echocardiographic,and CPET parameters were compared between two groups.Results M/S-CAT was found in 46.9%of the study participants,with 66.7%being women.M/S-CAT was significantly associated with advanced age(P=0.014)and females(P=0.001).Diastolic dysfunction parameters,E velocity(P=0.011),and E/A ratio(P=0.004)also revealed significant differences between the M/S-CAT group and N/M-CAT group.VO2@peak(1.22±0.39 vs.1.07±0.39,P<0.01)and VO2@AT(0.77±0.22 vs.0.71±0.21,P=0.017)were significantly lower in the M/S-CAT group than in the N/M-CAT group.Multivariate logistic regression analysis identified females(OR=0.448;95%CI,0.296–0.676;P=0.000)and E/A ratio(OR=0.307;95%CI,0.139–0.680;P=0.004)to be independent risk factors of M/S-CAT and showed no association of CPET parameters to M/S-CAT.Conclusion The results indicate that increasing severity of CAT is strongly associated with female gender and E/A ratio and is not directly correlated with decreasing CRF.Further research with a larger patient population and a longer follow-up time is required to fully comprehend the impact of CAT on CRF.展开更多
BACKGROUND Patients with depression following coronary heart disease often exhibit insufficient psychological resilience and self-care abilities;therefore,emphasis must be placed on nursing interventions.AIM To analyz...BACKGROUND Patients with depression following coronary heart disease often exhibit insufficient psychological resilience and self-care abilities;therefore,emphasis must be placed on nursing interventions.AIM To analyze the application value of problem-oriented education combined with nursing interventions based on the Snyder hope theory model in depressed patients after percutaneous coronary intervention(PCI).METHODS This study included 150 patients diagnosed with PCI postoperative depression because of coronary heart disease between February 2022 and February 2024.Participants were divided into two groups:A control group(n=75)receiving problem-oriented education and an observation group(n=75)receiving combined nursing interventions based on the Snyder hope theory model.Depression status,psychological resilience,self-care ability,and quality of life were compared between the two groups.RESULTS Before nursing interventions,there were no significant differences between the two groups(P>0.05).After the interventions,depression scores decreased while psychological resilience,self-care ability,and quality of life scores increased significantly in the observation group compared to that in the control group,with statistically significant differences noted(P<0.05).This combined approach can enhance psychological resilience,improve self-care abilities,and elevate the overall quality of life,warranting further promotion in clinical practice.CONCLUSION Combination of problem-oriented education and nursing interventions based on the Snyder hope theory model effectively alleviates depression in patients following PCI for coronary heart disease.展开更多
Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods W...Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.展开更多
Objective To develop a non-invasive predictive model for coronary artery stenosis severity based on adaptive multi-modal integration of traditional Chinese and western medicine data.Methods Clinical indicators,echocar...Objective To develop a non-invasive predictive model for coronary artery stenosis severity based on adaptive multi-modal integration of traditional Chinese and western medicine data.Methods Clinical indicators,echocardiographic data,traditional Chinese medicine(TCM)tongue manifestations,and facial features were collected from patients who underwent coro-nary computed tomography angiography(CTA)in the Cardiac Care Unit(CCU)of Shanghai Tenth People's Hospital between May 1,2023 and May 1,2024.An adaptive weighted multi-modal data fusion(AWMDF)model based on deep learning was constructed to predict the severity of coronary artery stenosis.The model was evaluated using metrics including accura-cy,precision,recall,F1 score,and the area under the receiver operating characteristic(ROC)curve(AUC).Further performance assessment was conducted through comparisons with six ensemble machine learning methods,data ablation,model component ablation,and various decision-level fusion strategies.Results A total of 158 patients were included in the study.The AWMDF model achieved ex-cellent predictive performance(AUC=0.973,accuracy=0.937,precision=0.937,recall=0.929,and F1 score=0.933).Compared with model ablation,data ablation experiments,and various traditional machine learning models,the AWMDF model demonstrated superior per-formance.Moreover,the adaptive weighting strategy outperformed alternative approaches,including simple weighting,averaging,voting,and fixed-weight schemes.Conclusion The AWMDF model demonstrates potential clinical value in the non-invasive prediction of coronary artery disease and could serve as a tool for clinical decision support.展开更多
BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials e...BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials exist to determine the optimal therapeutic strategy for these patients.CASE SUMMARY We present the case of a 27-year-old Chinese man who simultaneously experie-nced acute concomitant cerebrocardiac infarction(CCI)and painless ST-elevation myocardial infarction.The patient was successfully treated with elective percu-taneous coronary intervention(PCI)after receiving urgent systemic thrombolysis at the standard dose for AIS.CONCLUSION Urgent thrombolysis followed by elective PCI was an appropriate strategy for the management of simultaneous CCI.展开更多
BACKGROUND Acute myocardial infarction(AMI)is rare among patients aged≤40 years but imposes significant morbidity,psychological distress,and economic burden.App-roximately 10%of AMI hospitalizations involve patients ...BACKGROUND Acute myocardial infarction(AMI)is rare among patients aged≤40 years but imposes significant morbidity,psychological distress,and economic burden.App-roximately 10%of AMI hospitalizations involve patients under 45 years,under-scoring the need to study this group.Compared to older patients,young AMI pa-tients exhibit fewer traditional risk factors(e.g.,hypertension,diabetes)but higher rates of smoking,obesity,and non-atherosclerotic causes like spontaneous coro-nary artery dissection or coronary spasm,often linked to substance use.Global trends show rising obesity and dyslipidemia in young populations,with smoking contributing to 62%–90%of AMI cases in this age group.Family history of coro-nary artery disease also elevates risk,particularly in acute coronary syndrome.Studies like Bhardwaj et al report that young AMI patients are predominantly male with single-vessel disease,unlike the multi-vessel disease typical in older cohorts.This study characterizes AMI in young adults(≤40 years)at a single center,focusing on presentation,risk factors,angiographic findings,and manage-ment to guide preventive strategies.AIM To describe the characteristics of AMI in young patients,including presentation,risk factors,coronary angiography(CAG)findings,and management strategies.METHODS This retrospective cross-sectional study analyzed 91 patients aged 20–40 years diagnosed with AMI at Mouwasat Hospital Dammam,from June 2020 to May 2023.Data on clinical presentation,cardiovascular risk factors,CAG findings,and treatments were collected from medical records.Descriptive statistics were used to summarize findings.RESULTS Of 91 patients(96.7%male,mean age 35.9 years±3.4 years),43.9%were obese(body mass index>30 kg/m^(2)).Hyperlipidemia was the most prevalent risk factor(69.2%),followed by smoking(49.5%),diabetes mellitus(33.0%),and hypertension(26.4%).ST-elevation myocardial infarction(STEMI)was the most common presentation(57.1%).The left anterior descending artery was frequently affected(78.0%),with single-vessel disease predominant(72.5%).Most patients underwent percutaneous coronary intervention(PCI)(74.7%),while 8.8%required surgery.CONCLUSION Young AMI patients are predominantly obese males with hyperlipidemia and smoking as key risk factors,pre-senting with STEMI and single-vessel disease amenable to PCI.展开更多
BACKGROUND The atherogenic index of plasma(AIP)has been shown to be positively correlated with cardiovascular disease in previous studies.However,it is unclear whether elderly people with long-term high AIP levels are...BACKGROUND The atherogenic index of plasma(AIP)has been shown to be positively correlated with cardiovascular disease in previous studies.However,it is unclear whether elderly people with long-term high AIP levels are more likely to develop coronary heart disease(CHD).Therefore,the aim of this study was to investigate the relationship between AIP trajectory and CHD incidence in elderly people.METHODS 19,194 participants aged≥60 years who had three AIP measurements between 2018 and 2020 were included in this study.AIP was defined as log10(triglyceride/high-density lipoprotein cholesterol).The group-based trajectory model was used to identify different trajectory patterns of AIP from 2018 to 2020.Cox proportional hazards models were used to estimate the hazard ratio(HR)with 95%CI of CHD events between different trajectory groups from 2020 to 2023.RESULTS Three different trajectory patterns were identified through group-based trajectory model:the low-level group(n=7410,mean AIP:-0.25 to-0.17),the medium-level group(n=9981,mean AIP:0.02-0.08),and the high-level group(n=1803,mean AIP:0.38-0.42).During a mean follow-up of 2.65 years,a total of 1391 participants developed CHD.After adjusting for potential confounders,compared with the participants in the low-level group,the HR with 95%CI of the medium-level group and the high-level group were estimated to be 1.24(1.10-1.40)and 1.43(1.19-1.73),respectively.These findings remained consistent in subgroup analyses and sensitivity analyses.CONCLUSIONS There was a significant correlation between persistent high AIP level and increased CHD risk in the elderly.This suggests that monitoring the long-term changes in AIP is helpful to identify individuals at high CHD risk in elderly people.展开更多
The observation that physical activity(PA)reduces the risk of coronary heart disease dates back more than 70 years ago and it is now established that regular PA reduces all-cause mortality,in part,by reducing the risk...The observation that physical activity(PA)reduces the risk of coronary heart disease dates back more than 70 years ago and it is now established that regular PA reduces all-cause mortality,in part,by reducing the risk of numerous chronic diseases including coronary heart disease,stroke,cancer,type 2 diabetes,and Alzheimer's disease.During the past decade the increased use of activity tracking devices has significantly improved our understanding of the dose-response relationships between PA and all-cause mortality.Further,our appreciation of the impact that prolonged sitting has on all-cause mortality has increased.Moreover,new research provides key insight into the signaling mechanisms that connect PA to the reduced risk of disease in multiple organ systems.Therefore,given the recent advances in the study of PA and all-cause mortality,it is an appropriate time to review the latest evidence on this topic as well as the mechanisms responsible for the PA-induced protection against allcause mortality.Therefore,this review will summarize recent data on the dose-response association between PA on all-cause mortality and the negative impact that sedentary behavior has on all-cause mortality.Further,we also highlight potential mechanisms linking PA with the reduced risk of developing several chronic diseases.Finally,we conclude with a brief discussion of the emerging evidence that the health benefits associated with PA are derived,in part,from skeletal muscle-organ crosstalk involving muscle produced hormones(myokines)that exert their effects in either an autocrine,paracrine,or endocrine manner.展开更多
BACKGROUND Coronary heart disease(CHD)has shown a consistent upward trend in global incidence in recent years.Notably,older adults with CHD complicated by arrhy-thmia exhibit significantly higher susceptibility to psy...BACKGROUND Coronary heart disease(CHD)has shown a consistent upward trend in global incidence in recent years.Notably,older adults with CHD complicated by arrhy-thmia exhibit significantly higher susceptibility to psychological distress com-pared with the general CHD population.This increased vulnerability has garn-ered growing clinical and research interest in the potential therapeutic benefits of structured psychological interventions for alleviating comorbid depressive and anxiety symptoms in this high-risk demographic.AIM To evaluate the efficacy of psychological care in reducing anxiety and depressive symptoms among older adult patients with CHD and comorbid arrhythmia.METHODS This retrospective analysis included 100 patients with CHD and arrhythmia admitted to the First Affiliated Hospital of Jinzhou Medical University from June 2024 to December 2024.Of these,49 patients in the control group received routine care,whereas 51 patients in the observation group received psychological care in addition to routine care.Therapeutic outcomes were compared between the two groups.Psychological distress was assessed before and after providing nursing care.A treatment compliance scale developed by the hospital was used to assess adherence.Complication rates were also compared.Quality of life was evaluated using the Short Form-36 Health Survey after providing nursing care.Patient satisfaction with nursing care was assessed using a self-designed questionnaire.RESULTS The observation group demonstrated a higher overall treatment effectiveness compared with the control group(P<0.05).After nursing care,both groups showed reduced scores on the Self-Rating Anxiety Scale and Self-Rating Depression Scale compared with baseline(P<0.05),with significantly greater improvements in the observation group(P<0.05).Treatment compliance was higher and complication rates were lower in the observation group(P<0.05).Additionally,the observation group demonstrated better quality of life after 1 month of care and higher satisfaction with nursing services(P<0.05).CONCLUSION Psychological care for patients with CHD and comorbid arrhythmia effectively enhanced therapeutic outcomes,reduced anxiety and depression,improved treatment compliance and quality of life,and lowered the risk of complications.These findings support the broader implementation of psychological care for patients with CHD in clinical practice.展开更多
Interleukins(ILs),a subset of cytokines,play a critical role in the pathogenesis of coronary heart disease(CHD)by mediating inflammation.This review article summarizes the role of ILs such as IL-1,IL-2,IL-3,IL-4,IL-5,...Interleukins(ILs),a subset of cytokines,play a critical role in the pathogenesis of coronary heart disease(CHD)by mediating inflammation.This review article summarizes the role of ILs such as IL-1,IL-2,IL-3,IL-4,IL-5,IL-6,IL-7,IL-8,IL-9,and IL-10 in the pathogenesis of CHD.Individuals with mild coronary artery disease(CAD)and angina who have ischemic heart disease have higher serum concentrations of IL-1b.Larger studies are needed to verify the safety and assess the effectiveness of low-dose IL-2 as an anti-inflammatory treatment.IL-3 is found more often in patients receiving coronary angioplasty compared to patients with asymptomatic CAD or without CAD.Serum levels of IL-4 are reliable indicators of CAD.An independent correlation between IL-5 and the incidence of CAD was demonstrated.IL-6 helps serve as a reliable biomarker for the degree of CAD,as determined by the Gensini score,and is a key factor in the development of atherosclerosis.Also,variants of IL-7/7R have been linked to the Han Chinese population's genetic susceptibility to CHD.IL-8 plays a role in the progression of CAD occurrences.By interacting with conventional risk factors for CAD,IL-9 may contribute to the development of CAD and offer an innovative approach to its prevention and management.There was a 34%increased risk of a CHD incident for every standard deviation rise in baseline IL-10 levels.展开更多
BACKGROUND Early control of low-density lipoprotein cholesterol(LDL-C)is crucial for reducing the progress of cardiovascular disease.However,its additional role to the risk of primary osteoporosis in men with coronary...BACKGROUND Early control of low-density lipoprotein cholesterol(LDL-C)is crucial for reducing the progress of cardiovascular disease.However,its additional role to the risk of primary osteoporosis in men with coronary heart disease was inconclusive.Our study aims to determine the association of LDL-C and its trajectories for osteoporosis risk in the middle-aged and aged men of China.METHODS The retrospective cohort study of 1546 men aged 69.74±11.30 years conducted in Beijing,China from 2015 to 2022.And the incidence of primary osteoporosis was annually recorded.LDL-C trajectories were further identified by latent class growth model using repeated measurements of LDL-C.The association of baseline LDL-C for osteoporosis was estimated using hazard ratio(HR)with 95%CI in Cox proportional hazard model,while mean level and trajectories of LDL-C for osteoporosis were evaluated using odds ratio(OR)with 95%CI in logistic regression model.RESULTS During the median 6.2-year follow-up period,70 men developed primary osteoporosis.The higher level of baseline LDLC(HR=1.539,95%CI:1.012–2.342)and mean LDL-C(OR=2.190,95%CI:1.443–3.324)were associated with higher risk of osteoporosis in men with coronary heart disease after adjusted for covariates.Compared with those in the LDL-C trajectory of low-stable decrease,participants with medium-fluctuant trajectory,whose longitudinal LDL-C started with a medium LDL-C level and appeared an increase and then decrease,were negatively associated with osteoporosis risk(OR=2.451,95%CI:1.152–5.216).And participants with initially high LDL-C level and then a rapid decrease demonstrated a tendency towards reduced risk(OR=0.718,95%CI:0.212–2.437).CONCLUSIONS Elevated LDL-C level and its long-term fluctuation may increase the risk of primary osteoporosis in men.Early controlling a stable level of LDL-C is also essential for bone health.展开更多
BACKGROUND The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant(LT).AIM To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.METHOD...BACKGROUND The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant(LT).AIM To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.METHODS This retrospective single-center cohort study included all adult patients undergoing elective evaluation for first cadaveric donor orthotopic LT for liver cirrhosis with or without hepatocellular carcinoma at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico in Rome,Italy.Cardiac contraindications for LT listing were defined after a center-specific cardiac workup,which included cardiac stress tests for most patients.The diagnostic accuracy of the CAR-OLT score was evaluated using the area under the receiver operating characteristic(AUROC)method.RESULTS A total of 342 LT candidates were evaluated between 2015 and 2019,with a moderate cardiovascular risk profile(37%diabetes,34%hypertension,22%obesity).Of these,80(23%)candidates underwent coronary angiography.Twenty-one(6%)candidates were given cardiac contraindications to LT listing,48%of which were due to coronary artery disease.The CAR-OLT score predicted cardiac contraindications to LT listing with an AUROC of 0.81.The optimal cut-off for sensitivity was a CAR-OLT score≤23,which showed a 99%negative predictive value for cardiac contraindications to LT listing.A total of 84(25%)LT candidates with a CAR-OLT score≤23 underwent 87 non-invasive cardiac tests and 13 coronary angiographies pre-listing,with estimated costs of approximately 48000€.The estimated savings per patient was€574.70 for the Italian National Health System.CONCLUSION A CAR-OLT score≤23 can identify LT candidates who can be safely listed without the need for cardiac stress tests,providing time and cost savings.These findings require external validation.展开更多
Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide ...Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide mononitrate sustained-release capsules(IMSRC)combined with conventional treatments,compared to isosorbide mononitrate tablets(IMT)combined with conventional treatments,for managing angina pectoris in patients with coronary heart diseases.A network meta-analysis(NMA)was conducted to assess the efficacy and safety of IMSRC and IMT.Relevant literature was sourced from databases,including PubMed,Embase,Cochrane Library,ScienceDirect,Web of Science,CNKI,Wanfang,and VIP,covering publications up to July 2023.The cost-effectiveness analysis(CEA)was performed from the perspective of China’s healthcare system,utilizing inputs derived from the NMA.The analysis included 15 studies.The NMA results revealed no significant difference in efficacy and safety between IMSRC plus conventional treatments and IMT plus conventional treatments.However,both combinations were more effective than conventional treatments without isosorbide mononitrate.No differences in safety were observed among the three groups.The surface under the cumulative ranking(SUCRA)of the NMA indicated that IMT had a slight edge over IMSRC in the total effective rate of angina pectoris,whereas IMSRC showed higher probabilities for markedly effective rate and ECG effective rate compared to IMT.The incidence of adverse events was ranked as IMT>conventional preparation>IMSRC.The CEA results highlighted that the incremental cost-effectiveness ratios(ICERs)for the markedly effective and total effective rates of angina pectoris were-133.41 and-260.20,respectively.The ICERs for ECG effective rates were-83.34 and-234.24,respectively.In conclusion,while IMSRC combined with conventional treatments and IMT combined with conventional treatments were similar in efficacy and safety,IMSRC proved to be more economical.展开更多
Pericoronary adipose tissue(PCAT)plays an important role in the pathogenesis and progression of cardiovascular diseases due to its bidirectional communication with the coronary artery wall.In recent years,PCAT paramet...Pericoronary adipose tissue(PCAT)plays an important role in the pathogenesis and progression of cardiovascular diseases due to its bidirectional communication with the coronary artery wall.In recent years,PCAT parameters measured using coronary computed tomography have emerged as potential noninvasive imaging biomarkers for quantifying coronary artery inflammation,with significant clinical value in the early detection,disease progression assessment,treatment efficacy evaluation,and prognosis prediction of cardiovascular diseases.Furthermore,new technologies such as PCAT radiomics analysis have broadened its potential applications in evaluating coronary plaque vulnerability,predicting cardiovascular events,and improving risk stratification.This review discusses recent advances in PCAT research,focusing on its role in coronary artery disease risk identification and inflammation monitoring,and aims to offer imaging-based insights to support its future clinical use in cardiovascular disease management.展开更多
BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA...BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA)as an independent predictor of the prognosis of patients admitted to the coronary care unit(CCU).AIM To use the RDW and albumin level to predict the prognosis of patients in the CCU.METHODS Data were obtained from the Medical Information Mart Intensive Care III database.The primary outcome was 365-day all-cause mortality,whereas the secondary outcomes were 30-and 90-day all-cause mortality,hospital length of stay(LOS),and CCU LOS.Cox proportional hazards regression model,propen-sity score matching,and receiver operating characteristic curve analyses were used.RESULTS The hazard ratio(95%confidence interval)of the upper tertile(RA>4.66)was 1.62(1.29 to 2.03)when compared with the reference(RA<3.84)in 365-day all-cause mortality.This trend persisted after adjusting for demographic and clinical variables in the propensity score-matching analysis.Similar trends were observed for the secondary outcomes of hospital and CCU LOS.Receiver operating characteristic curve analysis was performed by combining the RA and sequential organ failure assessment(SOFA)scores,and the C-statistic was higher than that of the SOFA scores(0.733 vs 0.702,P<0.001).CONCLUSION RA is an independent prognostic factor in patients admitted to the CCU.RA combined with the SOFA score can improve the predictive ability of the SOFA score.However,our results should be verified in future prospective studies.展开更多
Background Acute myocardial infarction(AMI),one of the most critical cardiovascular emergencies,carries a high mortality rate due to progressive cardiac dysfunction caused by myocardial ischemia.Percutaneous coronary ...Background Acute myocardial infarction(AMI),one of the most critical cardiovascular emergencies,carries a high mortality rate due to progressive cardiac dysfunction caused by myocardial ischemia.Percutaneous coronary intervention(PCI)is an effective treatment for AMI,rapidly restoring blood flow,reducing myocardial injury,and mitigating adverse remodeling.However,reperfusion injury and ventricular remodeling post-PCI may still lead to heart failure.Recent studies highlighted the cardioprotective effects of sodium-glucose cotransporter-2(SGLT-2)inhibitors,particularly dapagliflozin,which improves myocardial energetics,reduces inflammation,and attenuates adverse remodeling.However,high-quality evidence on its early application following primary PCI in AMI re-mains limited.In this study,we aimed to evaluated the clinical utility of dapagliflozin in AMI management.Meth-ods This study retrospectively analyzed the clinical data of 100 patients with AMI undergoing emergency PCI ad-mitted to our hospital between June 2022 and June 2024.They were randomly divided into observation group(n=50)and control group(n=50).The control group received standard post-PCI medication(antiplatelet and lipid-low-ering therapy),while the observation group received additional dapagliflozin.Cardiac function parameters,serolog-ical markers,and the incidence of major adverse cardiovascular events(MACE)were compared between the two groups.Results After 14 days of treatment,observation group exhibited significantly lower left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)(P<0.05)and higher left ventricu-lar ejection fraction(LVEF)(P<0.05)compared to control group.Additionally,the level of myocardial injury mark-ers[creatine kinase-MB(CK-MB),cardiac troponin I(cTnI),and brain natriuretic peptide(BNP)]were significant-ly lower in observation group(P<0.05).However,there was no significant difference in the incidence of MACE be-tween the two groups(P>0.05).Conclusions The combination of dapagliflozin with standard post-PCI therapy improves cardiac function and reduces the level of myocardial injury markers in AMI patients,though it does not significantly affect the short-term incidence of adverse cardiovascular events.展开更多
BACKGROUND Inadequately controlled hypertension often leads to an increased cardiovascular death rate in type 2 diabetes mellitus(T2DM).It remains unclear whether systolic blood pressure(SBP)status of hypertension is ...BACKGROUND Inadequately controlled hypertension often leads to an increased cardiovascular death rate in type 2 diabetes mellitus(T2DM).It remains unclear whether systolic blood pressure(SBP)status of hypertension is related to coronary inflammation and plaques in T2DM.AIM To evaluate whether SBP variability(SBPV)and levels of hypertension are related to coronary inflammation and plaques in T2DM patients using coronary computed tomography angiography(CCTA).METHODS This retrospective study involved 881 T2DM patients with CCTA images,including 668 hypertension and 213 normotension patients.Hypertension patients were subgroup based on SBP status:(1)SBPV:Low(<8.96 mmHg)and high(≥8.96 mmHg)groups;and(2)SBP levels:Controlled(<140 mmHg)and uncontrolled(≥140 mmHg)groups.Pericoronary adipose tissue(PCAT)attenuation,high-risk plaques(HRPs)and obstructive stenosis(OS)were evaluated by CCTA.Propensity score matching was utilized to compare these CCTA findings for these groups.The impact of SBPV and SBP levels of hypertension on these CCTA findings in T2DM patients were evaluated by multivariate logistic regression and multivariable linear regression.RESULTS PCAT attenuation of the left anterior descending artery(LAD),any low attenuation plaque(LAP),any spotty calcification(SC),any positive remodeling(PR),and OS had significant differences between the hypertension group and the normotension group,as well as between the high SBPV or uncontrolled SBP group and the low SBPV or controlled SBP group(all P<0.05).Hypertension was independently positively correlated with LADPCAT attenuation(β=1.815,P=0.010),LAP(OR=1.612,P=0.019),SC(OR=1.665,P=0.013),PR(OR=1.549,P=0.033),and OS(OR=1.928,P=0.036)in all T2DM patients.Additionally,high SBPV and uncontrolled SBP were independently positively correlated with LAD-PCAT attenuation(high SBPV:β=1.673,P=0.048;uncontrolled SBP:β=2.370,P=0.004)and PR(high SBPV:OR=1.903,P=0.048;uncontrolled SBP:OR=2.230,P=0.013)in T2DM patients with hypertension.CONCLUSION Inadequately controlled hypertension,including high SBPV and/or uncontrolled SBP levels,may be related to increased coronary artery inflammation,HRPs,and OS in T2DM,leading to increased cardiovascular risk.Achieving both low SBPV and controlled SBP levels simultaneously,especially in individuals with T2DM and hypertension,warrants clinical attention.展开更多
Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD pat...Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.展开更多
BACKGROUND 2D-echocardiography(2DE)has been the primary imaging modality in children with Kawasaki disease(KD)to assess coronary arteries.AIM To report the presence and implications of incidental congenital coronary a...BACKGROUND 2D-echocardiography(2DE)has been the primary imaging modality in children with Kawasaki disease(KD)to assess coronary arteries.AIM To report the presence and implications of incidental congenital coronary artery anomalies that had been misinterpreted as coronary artery abnormalities(CAAs)on 2DE.METHODS Records of children diagnosed with KD,who underwent computed tomography coronary angiography(CTCA)at our center between 2013-2023 were reviewed.We identified 3 children with congenital coronary artery anomalies in this cohort on CTCA.Findings of CTCA and 2DE were compared in these 3 children.RESULTS Of the 241 patients with KD who underwent CTCA,3(1.24%)had congenital coronary artery anomalies on CTCA detected incidentally.In all 3 patients,baseline 2DE had identified CAAs.CTCA was then performed for detailed evaluation as per our unit protocol.One(11-year-boy)amongst the 3 patients had complete KD,while the other two(3.3-year-boy;4-month-girl)had incomplete KD.CTCA revealed separate origins of left anterior descending artery and left circumflex from left sinus[misinterpreted as dilated left main coronary artery(LCA)on 2DE],single coronary artery(interpreted as dilated LCA on 2DE)and dilated right coronary artery on 2DE in case of anomalous origin of LCA from the main pulmonary artery.The latter one was subsequently operated upon.CONCLUSION CTCA is essential for detailed assessment of coronary arteries in children with KD especially in cases where there is suspicion of congenital coronary artery anomalies.Relying solely on 2DE may not be sufficient in such cases,and findings from CTCA can significantly impact therapeutic decision-making.展开更多
BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal ...BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes.We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes.AIM To determine association between cardiovascular abnormalities and clinical and laboratory parameters.To study the time-line for resolution of various abnormalities.METHODS In this prospective study done in a tertiary care hospital,270 were recruited from June 2020 to January 2022.Baseline demographic data and clinical presentation were recorded.Laboratory parameters and echocardiography were done at admission.Follow-up was done at 2 weeks,3 months,6 months and 1 year after diagnosis.Descriptive statistics were used for parametric and non-parametric data.Risk factors were identified by multivariate regression analysis.RESULTS The 211(78.2%)had cardiac involvement and 102 needed intensive care unit(ICU)admission.Cardiovascular abnormalities observed were shock 123(45.6%),coronary dilatation 28(10.4%),coronary aneurysm 77(28.5%),left ventricular(LV)dysfunction 78(29.3%),mitral regurgitation(MR)77(28.5%)and pericardial effusion 98(36.3%).Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7%and 0.9%respectively.Multivariate regression analysis revealed breathlessness[odds ratio(OR)=3.91,95%CI:1.25-12.21,P=0.019]and hi-flow nasal cannula(HFNC)support(OR=8.5,95%CI:1.06-68.38,P=0.044)as predictors of cardiovascular involvement.Higher mean age(OR=1.16,95%CI:1.02-1.32,P=0.026),breathlessness(OR=4.99,95%CI:2.05-12.20,P<0.001),gallop(OR=4.45,95%CI:0.41-2.52,P=0.016),MR(OR=3.61,95%CI:1.53-8.53,P=0.004)and invasive ventilation(OR=4.01,95%CI:1.28-12.58,P=0.017)were predictive of LV dysfunction.Altered sensorium(OR=4.96,95%CI:2.23-11.02,P<0.001),headache(OR=6.61,95%CI:1.46-29.92,P=0.014),HFNC(OR=7.03,95%CI:2.04-24.29,P=0.002),non-rebreathing mask usage(OR=21.13,95%CI:9.00-49.61,P<0.001)and invasive ventilation(OR=5.64,95%CI:1.42-22.45,P=0.014)were risk factors for shock.Anemia was a risk factor for coronary involvement(OR=3.09,95%CI:1.79-5.34,P<0.001).CONCLUSION Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management.Although shock resolved quickly,resolution of ventricular function and coronary abnormalities were slower,and hence warrants a structured long-term follow-up protocol.展开更多
基金supported by the Key Project of Health and Family Planning Commission of Hubei Province,China(No.WJ2017Z012).
文摘Objective This study aimed to analyze the relationship between cardiorespiratory fitness(CRF)and the increasing severity of coronary artery tortuosity(CAT)in patients with non-stenosed coronaries.Methods A total of 396 patients who underwent coronary angiography and cardiopulmonary exercise testing(CPET)between August 2020 and July 2021 were included in this single-center retrospective study after excluding patients with significant coronary artery disease(≥50%stenosis).Patients were divided into two groups:no or mild coronary artery tortuosity(N/M-CAT)and moderate to severe coronary artery tortuosity(M/S-CAT)and laboratory electrocardiographic,echocardiographic,and CPET parameters were compared between two groups.Results M/S-CAT was found in 46.9%of the study participants,with 66.7%being women.M/S-CAT was significantly associated with advanced age(P=0.014)and females(P=0.001).Diastolic dysfunction parameters,E velocity(P=0.011),and E/A ratio(P=0.004)also revealed significant differences between the M/S-CAT group and N/M-CAT group.VO2@peak(1.22±0.39 vs.1.07±0.39,P<0.01)and VO2@AT(0.77±0.22 vs.0.71±0.21,P=0.017)were significantly lower in the M/S-CAT group than in the N/M-CAT group.Multivariate logistic regression analysis identified females(OR=0.448;95%CI,0.296–0.676;P=0.000)and E/A ratio(OR=0.307;95%CI,0.139–0.680;P=0.004)to be independent risk factors of M/S-CAT and showed no association of CPET parameters to M/S-CAT.Conclusion The results indicate that increasing severity of CAT is strongly associated with female gender and E/A ratio and is not directly correlated with decreasing CRF.Further research with a larger patient population and a longer follow-up time is required to fully comprehend the impact of CAT on CRF.
文摘BACKGROUND Patients with depression following coronary heart disease often exhibit insufficient psychological resilience and self-care abilities;therefore,emphasis must be placed on nursing interventions.AIM To analyze the application value of problem-oriented education combined with nursing interventions based on the Snyder hope theory model in depressed patients after percutaneous coronary intervention(PCI).METHODS This study included 150 patients diagnosed with PCI postoperative depression because of coronary heart disease between February 2022 and February 2024.Participants were divided into two groups:A control group(n=75)receiving problem-oriented education and an observation group(n=75)receiving combined nursing interventions based on the Snyder hope theory model.Depression status,psychological resilience,self-care ability,and quality of life were compared between the two groups.RESULTS Before nursing interventions,there were no significant differences between the two groups(P>0.05).After the interventions,depression scores decreased while psychological resilience,self-care ability,and quality of life scores increased significantly in the observation group compared to that in the control group,with statistically significant differences noted(P<0.05).This combined approach can enhance psychological resilience,improve self-care abilities,and elevate the overall quality of life,warranting further promotion in clinical practice.CONCLUSION Combination of problem-oriented education and nursing interventions based on the Snyder hope theory model effectively alleviates depression in patients following PCI for coronary heart disease.
基金supported by the R&D project of Pazhou Lab(Huangpu)under Grant 2023K0610the National Natural Science Foundation of China(Grants 12126602)+4 种基金the National Natural Science Foundation of China(Grants 82030102)the Shenzhen Medical Research Fund(Grants C2302001)the Shenzhen Science and Technology Innovation Committee(No.ZDSYS20200810171403013)the Chinese Postdoctoral Science Foundation(No.2022M721463)the Ministry of Science and Technology of China(Grants 2022YFC3702703).
文摘Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.
基金Construction Program of the Key Discipline of State Administration of Traditional Chinese Medicine of China(ZYYZDXK-2023069)Research Project of Shanghai Municipal Health Commission (2024QN018)Shanghai University of Traditional Chinese Medicine Science and Technology Development Program (23KFL005)。
文摘Objective To develop a non-invasive predictive model for coronary artery stenosis severity based on adaptive multi-modal integration of traditional Chinese and western medicine data.Methods Clinical indicators,echocardiographic data,traditional Chinese medicine(TCM)tongue manifestations,and facial features were collected from patients who underwent coro-nary computed tomography angiography(CTA)in the Cardiac Care Unit(CCU)of Shanghai Tenth People's Hospital between May 1,2023 and May 1,2024.An adaptive weighted multi-modal data fusion(AWMDF)model based on deep learning was constructed to predict the severity of coronary artery stenosis.The model was evaluated using metrics including accura-cy,precision,recall,F1 score,and the area under the receiver operating characteristic(ROC)curve(AUC).Further performance assessment was conducted through comparisons with six ensemble machine learning methods,data ablation,model component ablation,and various decision-level fusion strategies.Results A total of 158 patients were included in the study.The AWMDF model achieved ex-cellent predictive performance(AUC=0.973,accuracy=0.937,precision=0.937,recall=0.929,and F1 score=0.933).Compared with model ablation,data ablation experiments,and various traditional machine learning models,the AWMDF model demonstrated superior per-formance.Moreover,the adaptive weighting strategy outperformed alternative approaches,including simple weighting,averaging,voting,and fixed-weight schemes.Conclusion The AWMDF model demonstrates potential clinical value in the non-invasive prediction of coronary artery disease and could serve as a tool for clinical decision support.
文摘BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials exist to determine the optimal therapeutic strategy for these patients.CASE SUMMARY We present the case of a 27-year-old Chinese man who simultaneously experie-nced acute concomitant cerebrocardiac infarction(CCI)and painless ST-elevation myocardial infarction.The patient was successfully treated with elective percu-taneous coronary intervention(PCI)after receiving urgent systemic thrombolysis at the standard dose for AIS.CONCLUSION Urgent thrombolysis followed by elective PCI was an appropriate strategy for the management of simultaneous CCI.
文摘BACKGROUND Acute myocardial infarction(AMI)is rare among patients aged≤40 years but imposes significant morbidity,psychological distress,and economic burden.App-roximately 10%of AMI hospitalizations involve patients under 45 years,under-scoring the need to study this group.Compared to older patients,young AMI pa-tients exhibit fewer traditional risk factors(e.g.,hypertension,diabetes)but higher rates of smoking,obesity,and non-atherosclerotic causes like spontaneous coro-nary artery dissection or coronary spasm,often linked to substance use.Global trends show rising obesity and dyslipidemia in young populations,with smoking contributing to 62%–90%of AMI cases in this age group.Family history of coro-nary artery disease also elevates risk,particularly in acute coronary syndrome.Studies like Bhardwaj et al report that young AMI patients are predominantly male with single-vessel disease,unlike the multi-vessel disease typical in older cohorts.This study characterizes AMI in young adults(≤40 years)at a single center,focusing on presentation,risk factors,angiographic findings,and manage-ment to guide preventive strategies.AIM To describe the characteristics of AMI in young patients,including presentation,risk factors,coronary angiography(CAG)findings,and management strategies.METHODS This retrospective cross-sectional study analyzed 91 patients aged 20–40 years diagnosed with AMI at Mouwasat Hospital Dammam,from June 2020 to May 2023.Data on clinical presentation,cardiovascular risk factors,CAG findings,and treatments were collected from medical records.Descriptive statistics were used to summarize findings.RESULTS Of 91 patients(96.7%male,mean age 35.9 years±3.4 years),43.9%were obese(body mass index>30 kg/m^(2)).Hyperlipidemia was the most prevalent risk factor(69.2%),followed by smoking(49.5%),diabetes mellitus(33.0%),and hypertension(26.4%).ST-elevation myocardial infarction(STEMI)was the most common presentation(57.1%).The left anterior descending artery was frequently affected(78.0%),with single-vessel disease predominant(72.5%).Most patients underwent percutaneous coronary intervention(PCI)(74.7%),while 8.8%required surgery.CONCLUSION Young AMI patients are predominantly obese males with hyperlipidemia and smoking as key risk factors,pre-senting with STEMI and single-vessel disease amenable to PCI.
基金supported by the National Key Research and Development Program of China(2017YFC1307705).
文摘BACKGROUND The atherogenic index of plasma(AIP)has been shown to be positively correlated with cardiovascular disease in previous studies.However,it is unclear whether elderly people with long-term high AIP levels are more likely to develop coronary heart disease(CHD).Therefore,the aim of this study was to investigate the relationship between AIP trajectory and CHD incidence in elderly people.METHODS 19,194 participants aged≥60 years who had three AIP measurements between 2018 and 2020 were included in this study.AIP was defined as log10(triglyceride/high-density lipoprotein cholesterol).The group-based trajectory model was used to identify different trajectory patterns of AIP from 2018 to 2020.Cox proportional hazards models were used to estimate the hazard ratio(HR)with 95%CI of CHD events between different trajectory groups from 2020 to 2023.RESULTS Three different trajectory patterns were identified through group-based trajectory model:the low-level group(n=7410,mean AIP:-0.25 to-0.17),the medium-level group(n=9981,mean AIP:0.02-0.08),and the high-level group(n=1803,mean AIP:0.38-0.42).During a mean follow-up of 2.65 years,a total of 1391 participants developed CHD.After adjusting for potential confounders,compared with the participants in the low-level group,the HR with 95%CI of the medium-level group and the high-level group were estimated to be 1.24(1.10-1.40)and 1.43(1.19-1.73),respectively.These findings remained consistent in subgroup analyses and sensitivity analyses.CONCLUSIONS There was a significant correlation between persistent high AIP level and increased CHD risk in the elderly.This suggests that monitoring the long-term changes in AIP is helpful to identify individuals at high CHD risk in elderly people.
文摘The observation that physical activity(PA)reduces the risk of coronary heart disease dates back more than 70 years ago and it is now established that regular PA reduces all-cause mortality,in part,by reducing the risk of numerous chronic diseases including coronary heart disease,stroke,cancer,type 2 diabetes,and Alzheimer's disease.During the past decade the increased use of activity tracking devices has significantly improved our understanding of the dose-response relationships between PA and all-cause mortality.Further,our appreciation of the impact that prolonged sitting has on all-cause mortality has increased.Moreover,new research provides key insight into the signaling mechanisms that connect PA to the reduced risk of disease in multiple organ systems.Therefore,given the recent advances in the study of PA and all-cause mortality,it is an appropriate time to review the latest evidence on this topic as well as the mechanisms responsible for the PA-induced protection against allcause mortality.Therefore,this review will summarize recent data on the dose-response association between PA on all-cause mortality and the negative impact that sedentary behavior has on all-cause mortality.Further,we also highlight potential mechanisms linking PA with the reduced risk of developing several chronic diseases.Finally,we conclude with a brief discussion of the emerging evidence that the health benefits associated with PA are derived,in part,from skeletal muscle-organ crosstalk involving muscle produced hormones(myokines)that exert their effects in either an autocrine,paracrine,or endocrine manner.
文摘BACKGROUND Coronary heart disease(CHD)has shown a consistent upward trend in global incidence in recent years.Notably,older adults with CHD complicated by arrhy-thmia exhibit significantly higher susceptibility to psychological distress com-pared with the general CHD population.This increased vulnerability has garn-ered growing clinical and research interest in the potential therapeutic benefits of structured psychological interventions for alleviating comorbid depressive and anxiety symptoms in this high-risk demographic.AIM To evaluate the efficacy of psychological care in reducing anxiety and depressive symptoms among older adult patients with CHD and comorbid arrhythmia.METHODS This retrospective analysis included 100 patients with CHD and arrhythmia admitted to the First Affiliated Hospital of Jinzhou Medical University from June 2024 to December 2024.Of these,49 patients in the control group received routine care,whereas 51 patients in the observation group received psychological care in addition to routine care.Therapeutic outcomes were compared between the two groups.Psychological distress was assessed before and after providing nursing care.A treatment compliance scale developed by the hospital was used to assess adherence.Complication rates were also compared.Quality of life was evaluated using the Short Form-36 Health Survey after providing nursing care.Patient satisfaction with nursing care was assessed using a self-designed questionnaire.RESULTS The observation group demonstrated a higher overall treatment effectiveness compared with the control group(P<0.05).After nursing care,both groups showed reduced scores on the Self-Rating Anxiety Scale and Self-Rating Depression Scale compared with baseline(P<0.05),with significantly greater improvements in the observation group(P<0.05).Treatment compliance was higher and complication rates were lower in the observation group(P<0.05).Additionally,the observation group demonstrated better quality of life after 1 month of care and higher satisfaction with nursing services(P<0.05).CONCLUSION Psychological care for patients with CHD and comorbid arrhythmia effectively enhanced therapeutic outcomes,reduced anxiety and depression,improved treatment compliance and quality of life,and lowered the risk of complications.These findings support the broader implementation of psychological care for patients with CHD in clinical practice.
文摘Interleukins(ILs),a subset of cytokines,play a critical role in the pathogenesis of coronary heart disease(CHD)by mediating inflammation.This review article summarizes the role of ILs such as IL-1,IL-2,IL-3,IL-4,IL-5,IL-6,IL-7,IL-8,IL-9,and IL-10 in the pathogenesis of CHD.Individuals with mild coronary artery disease(CAD)and angina who have ischemic heart disease have higher serum concentrations of IL-1b.Larger studies are needed to verify the safety and assess the effectiveness of low-dose IL-2 as an anti-inflammatory treatment.IL-3 is found more often in patients receiving coronary angioplasty compared to patients with asymptomatic CAD or without CAD.Serum levels of IL-4 are reliable indicators of CAD.An independent correlation between IL-5 and the incidence of CAD was demonstrated.IL-6 helps serve as a reliable biomarker for the degree of CAD,as determined by the Gensini score,and is a key factor in the development of atherosclerosis.Also,variants of IL-7/7R have been linked to the Han Chinese population's genetic susceptibility to CHD.IL-8 plays a role in the progression of CAD occurrences.By interacting with conventional risk factors for CAD,IL-9 may contribute to the development of CAD and offer an innovative approach to its prevention and management.There was a 34%increased risk of a CHD incident for every standard deviation rise in baseline IL-10 levels.
基金supported by the Multi-center RCT Clinical Project of the National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital(NCRCGPLAGH-2023001)the Beijing Nova Program(No.20220484020)+1 种基金the Beijing Natural Science Foundation(No.7252181)the Capital’s Funds for Health Improvement and Research(No.2024-2G-5033).
文摘BACKGROUND Early control of low-density lipoprotein cholesterol(LDL-C)is crucial for reducing the progress of cardiovascular disease.However,its additional role to the risk of primary osteoporosis in men with coronary heart disease was inconclusive.Our study aims to determine the association of LDL-C and its trajectories for osteoporosis risk in the middle-aged and aged men of China.METHODS The retrospective cohort study of 1546 men aged 69.74±11.30 years conducted in Beijing,China from 2015 to 2022.And the incidence of primary osteoporosis was annually recorded.LDL-C trajectories were further identified by latent class growth model using repeated measurements of LDL-C.The association of baseline LDL-C for osteoporosis was estimated using hazard ratio(HR)with 95%CI in Cox proportional hazard model,while mean level and trajectories of LDL-C for osteoporosis were evaluated using odds ratio(OR)with 95%CI in logistic regression model.RESULTS During the median 6.2-year follow-up period,70 men developed primary osteoporosis.The higher level of baseline LDLC(HR=1.539,95%CI:1.012–2.342)and mean LDL-C(OR=2.190,95%CI:1.443–3.324)were associated with higher risk of osteoporosis in men with coronary heart disease after adjusted for covariates.Compared with those in the LDL-C trajectory of low-stable decrease,participants with medium-fluctuant trajectory,whose longitudinal LDL-C started with a medium LDL-C level and appeared an increase and then decrease,were negatively associated with osteoporosis risk(OR=2.451,95%CI:1.152–5.216).And participants with initially high LDL-C level and then a rapid decrease demonstrated a tendency towards reduced risk(OR=0.718,95%CI:0.212–2.437).CONCLUSIONS Elevated LDL-C level and its long-term fluctuation may increase the risk of primary osteoporosis in men.Early controlling a stable level of LDL-C is also essential for bone health.
文摘BACKGROUND The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant(LT).AIM To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.METHODS This retrospective single-center cohort study included all adult patients undergoing elective evaluation for first cadaveric donor orthotopic LT for liver cirrhosis with or without hepatocellular carcinoma at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico in Rome,Italy.Cardiac contraindications for LT listing were defined after a center-specific cardiac workup,which included cardiac stress tests for most patients.The diagnostic accuracy of the CAR-OLT score was evaluated using the area under the receiver operating characteristic(AUROC)method.RESULTS A total of 342 LT candidates were evaluated between 2015 and 2019,with a moderate cardiovascular risk profile(37%diabetes,34%hypertension,22%obesity).Of these,80(23%)candidates underwent coronary angiography.Twenty-one(6%)candidates were given cardiac contraindications to LT listing,48%of which were due to coronary artery disease.The CAR-OLT score predicted cardiac contraindications to LT listing with an AUROC of 0.81.The optimal cut-off for sensitivity was a CAR-OLT score≤23,which showed a 99%negative predictive value for cardiac contraindications to LT listing.A total of 84(25%)LT candidates with a CAR-OLT score≤23 underwent 87 non-invasive cardiac tests and 13 coronary angiographies pre-listing,with estimated costs of approximately 48000€.The estimated savings per patient was€574.70 for the Italian National Health System.CONCLUSION A CAR-OLT score≤23 can identify LT candidates who can be safely listed without the need for cardiac stress tests,providing time and cost savings.These findings require external validation.
基金The 2022 Ministry of Education General Project for Humanities and Social Sciences Research(Grant No.22YJAZH147)the General Subject of Guangzhou Philosophy and Social Science Development“14th Five-Year Plan”in 2023(Grant No.2023GZYB68)+2 种基金China University Industry-Academia-Research Innovation Fund-Huatong Guokang Medical Research Special Project(Grant No.2023HT017)2024 Guangdong Province General Project for the Planning of Philosophy and Social Sciences(Grant No.GD24CGL29)the Innovation Team Project of Colleges and Universities in Guangdong Province(Grant No.2022WCXTD011).
文摘Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide mononitrate sustained-release capsules(IMSRC)combined with conventional treatments,compared to isosorbide mononitrate tablets(IMT)combined with conventional treatments,for managing angina pectoris in patients with coronary heart diseases.A network meta-analysis(NMA)was conducted to assess the efficacy and safety of IMSRC and IMT.Relevant literature was sourced from databases,including PubMed,Embase,Cochrane Library,ScienceDirect,Web of Science,CNKI,Wanfang,and VIP,covering publications up to July 2023.The cost-effectiveness analysis(CEA)was performed from the perspective of China’s healthcare system,utilizing inputs derived from the NMA.The analysis included 15 studies.The NMA results revealed no significant difference in efficacy and safety between IMSRC plus conventional treatments and IMT plus conventional treatments.However,both combinations were more effective than conventional treatments without isosorbide mononitrate.No differences in safety were observed among the three groups.The surface under the cumulative ranking(SUCRA)of the NMA indicated that IMT had a slight edge over IMSRC in the total effective rate of angina pectoris,whereas IMSRC showed higher probabilities for markedly effective rate and ECG effective rate compared to IMT.The incidence of adverse events was ranked as IMT>conventional preparation>IMSRC.The CEA results highlighted that the incremental cost-effectiveness ratios(ICERs)for the markedly effective and total effective rates of angina pectoris were-133.41 and-260.20,respectively.The ICERs for ECG effective rates were-83.34 and-234.24,respectively.In conclusion,while IMSRC combined with conventional treatments and IMT combined with conventional treatments were similar in efficacy and safety,IMSRC proved to be more economical.
基金Supported by the Health Commission of the Sichuan Province Medical Science and Technology Program,China,No.24WXXT10the Sichuan Province Science and Technology Support Program,China,No.2021YJ0242the 23rd Batch of Student Scientific Research Project Approval of Jiangsu University,China,No.Y23A164.
文摘Pericoronary adipose tissue(PCAT)plays an important role in the pathogenesis and progression of cardiovascular diseases due to its bidirectional communication with the coronary artery wall.In recent years,PCAT parameters measured using coronary computed tomography have emerged as potential noninvasive imaging biomarkers for quantifying coronary artery inflammation,with significant clinical value in the early detection,disease progression assessment,treatment efficacy evaluation,and prognosis prediction of cardiovascular diseases.Furthermore,new technologies such as PCAT radiomics analysis have broadened its potential applications in evaluating coronary plaque vulnerability,predicting cardiovascular events,and improving risk stratification.This review discusses recent advances in PCAT research,focusing on its role in coronary artery disease risk identification and inflammation monitoring,and aims to offer imaging-based insights to support its future clinical use in cardiovascular disease management.
文摘BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA)as an independent predictor of the prognosis of patients admitted to the coronary care unit(CCU).AIM To use the RDW and albumin level to predict the prognosis of patients in the CCU.METHODS Data were obtained from the Medical Information Mart Intensive Care III database.The primary outcome was 365-day all-cause mortality,whereas the secondary outcomes were 30-and 90-day all-cause mortality,hospital length of stay(LOS),and CCU LOS.Cox proportional hazards regression model,propen-sity score matching,and receiver operating characteristic curve analyses were used.RESULTS The hazard ratio(95%confidence interval)of the upper tertile(RA>4.66)was 1.62(1.29 to 2.03)when compared with the reference(RA<3.84)in 365-day all-cause mortality.This trend persisted after adjusting for demographic and clinical variables in the propensity score-matching analysis.Similar trends were observed for the secondary outcomes of hospital and CCU LOS.Receiver operating characteristic curve analysis was performed by combining the RA and sequential organ failure assessment(SOFA)scores,and the C-statistic was higher than that of the SOFA scores(0.733 vs 0.702,P<0.001).CONCLUSION RA is an independent prognostic factor in patients admitted to the CCU.RA combined with the SOFA score can improve the predictive ability of the SOFA score.However,our results should be verified in future prospective studies.
文摘Background Acute myocardial infarction(AMI),one of the most critical cardiovascular emergencies,carries a high mortality rate due to progressive cardiac dysfunction caused by myocardial ischemia.Percutaneous coronary intervention(PCI)is an effective treatment for AMI,rapidly restoring blood flow,reducing myocardial injury,and mitigating adverse remodeling.However,reperfusion injury and ventricular remodeling post-PCI may still lead to heart failure.Recent studies highlighted the cardioprotective effects of sodium-glucose cotransporter-2(SGLT-2)inhibitors,particularly dapagliflozin,which improves myocardial energetics,reduces inflammation,and attenuates adverse remodeling.However,high-quality evidence on its early application following primary PCI in AMI re-mains limited.In this study,we aimed to evaluated the clinical utility of dapagliflozin in AMI management.Meth-ods This study retrospectively analyzed the clinical data of 100 patients with AMI undergoing emergency PCI ad-mitted to our hospital between June 2022 and June 2024.They were randomly divided into observation group(n=50)and control group(n=50).The control group received standard post-PCI medication(antiplatelet and lipid-low-ering therapy),while the observation group received additional dapagliflozin.Cardiac function parameters,serolog-ical markers,and the incidence of major adverse cardiovascular events(MACE)were compared between the two groups.Results After 14 days of treatment,observation group exhibited significantly lower left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)(P<0.05)and higher left ventricu-lar ejection fraction(LVEF)(P<0.05)compared to control group.Additionally,the level of myocardial injury mark-ers[creatine kinase-MB(CK-MB),cardiac troponin I(cTnI),and brain natriuretic peptide(BNP)]were significant-ly lower in observation group(P<0.05).However,there was no significant difference in the incidence of MACE be-tween the two groups(P>0.05).Conclusions The combination of dapagliflozin with standard post-PCI therapy improves cardiac function and reduces the level of myocardial injury markers in AMI patients,though it does not significantly affect the short-term incidence of adverse cardiovascular events.
基金Supported by Natural Science Foundation of Hubei Province,No.2023AFB848.
文摘BACKGROUND Inadequately controlled hypertension often leads to an increased cardiovascular death rate in type 2 diabetes mellitus(T2DM).It remains unclear whether systolic blood pressure(SBP)status of hypertension is related to coronary inflammation and plaques in T2DM.AIM To evaluate whether SBP variability(SBPV)and levels of hypertension are related to coronary inflammation and plaques in T2DM patients using coronary computed tomography angiography(CCTA).METHODS This retrospective study involved 881 T2DM patients with CCTA images,including 668 hypertension and 213 normotension patients.Hypertension patients were subgroup based on SBP status:(1)SBPV:Low(<8.96 mmHg)and high(≥8.96 mmHg)groups;and(2)SBP levels:Controlled(<140 mmHg)and uncontrolled(≥140 mmHg)groups.Pericoronary adipose tissue(PCAT)attenuation,high-risk plaques(HRPs)and obstructive stenosis(OS)were evaluated by CCTA.Propensity score matching was utilized to compare these CCTA findings for these groups.The impact of SBPV and SBP levels of hypertension on these CCTA findings in T2DM patients were evaluated by multivariate logistic regression and multivariable linear regression.RESULTS PCAT attenuation of the left anterior descending artery(LAD),any low attenuation plaque(LAP),any spotty calcification(SC),any positive remodeling(PR),and OS had significant differences between the hypertension group and the normotension group,as well as between the high SBPV or uncontrolled SBP group and the low SBPV or controlled SBP group(all P<0.05).Hypertension was independently positively correlated with LADPCAT attenuation(β=1.815,P=0.010),LAP(OR=1.612,P=0.019),SC(OR=1.665,P=0.013),PR(OR=1.549,P=0.033),and OS(OR=1.928,P=0.036)in all T2DM patients.Additionally,high SBPV and uncontrolled SBP were independently positively correlated with LAD-PCAT attenuation(high SBPV:β=1.673,P=0.048;uncontrolled SBP:β=2.370,P=0.004)and PR(high SBPV:OR=1.903,P=0.048;uncontrolled SBP:OR=2.230,P=0.013)in T2DM patients with hypertension.CONCLUSION Inadequately controlled hypertension,including high SBPV and/or uncontrolled SBP levels,may be related to increased coronary artery inflammation,HRPs,and OS in T2DM,leading to increased cardiovascular risk.Achieving both low SBPV and controlled SBP levels simultaneously,especially in individuals with T2DM and hypertension,warrants clinical attention.
文摘Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.
文摘BACKGROUND 2D-echocardiography(2DE)has been the primary imaging modality in children with Kawasaki disease(KD)to assess coronary arteries.AIM To report the presence and implications of incidental congenital coronary artery anomalies that had been misinterpreted as coronary artery abnormalities(CAAs)on 2DE.METHODS Records of children diagnosed with KD,who underwent computed tomography coronary angiography(CTCA)at our center between 2013-2023 were reviewed.We identified 3 children with congenital coronary artery anomalies in this cohort on CTCA.Findings of CTCA and 2DE were compared in these 3 children.RESULTS Of the 241 patients with KD who underwent CTCA,3(1.24%)had congenital coronary artery anomalies on CTCA detected incidentally.In all 3 patients,baseline 2DE had identified CAAs.CTCA was then performed for detailed evaluation as per our unit protocol.One(11-year-boy)amongst the 3 patients had complete KD,while the other two(3.3-year-boy;4-month-girl)had incomplete KD.CTCA revealed separate origins of left anterior descending artery and left circumflex from left sinus[misinterpreted as dilated left main coronary artery(LCA)on 2DE],single coronary artery(interpreted as dilated LCA on 2DE)and dilated right coronary artery on 2DE in case of anomalous origin of LCA from the main pulmonary artery.The latter one was subsequently operated upon.CONCLUSION CTCA is essential for detailed assessment of coronary arteries in children with KD especially in cases where there is suspicion of congenital coronary artery anomalies.Relying solely on 2DE may not be sufficient in such cases,and findings from CTCA can significantly impact therapeutic decision-making.
文摘BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes.We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes.AIM To determine association between cardiovascular abnormalities and clinical and laboratory parameters.To study the time-line for resolution of various abnormalities.METHODS In this prospective study done in a tertiary care hospital,270 were recruited from June 2020 to January 2022.Baseline demographic data and clinical presentation were recorded.Laboratory parameters and echocardiography were done at admission.Follow-up was done at 2 weeks,3 months,6 months and 1 year after diagnosis.Descriptive statistics were used for parametric and non-parametric data.Risk factors were identified by multivariate regression analysis.RESULTS The 211(78.2%)had cardiac involvement and 102 needed intensive care unit(ICU)admission.Cardiovascular abnormalities observed were shock 123(45.6%),coronary dilatation 28(10.4%),coronary aneurysm 77(28.5%),left ventricular(LV)dysfunction 78(29.3%),mitral regurgitation(MR)77(28.5%)and pericardial effusion 98(36.3%).Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7%and 0.9%respectively.Multivariate regression analysis revealed breathlessness[odds ratio(OR)=3.91,95%CI:1.25-12.21,P=0.019]and hi-flow nasal cannula(HFNC)support(OR=8.5,95%CI:1.06-68.38,P=0.044)as predictors of cardiovascular involvement.Higher mean age(OR=1.16,95%CI:1.02-1.32,P=0.026),breathlessness(OR=4.99,95%CI:2.05-12.20,P<0.001),gallop(OR=4.45,95%CI:0.41-2.52,P=0.016),MR(OR=3.61,95%CI:1.53-8.53,P=0.004)and invasive ventilation(OR=4.01,95%CI:1.28-12.58,P=0.017)were predictive of LV dysfunction.Altered sensorium(OR=4.96,95%CI:2.23-11.02,P<0.001),headache(OR=6.61,95%CI:1.46-29.92,P=0.014),HFNC(OR=7.03,95%CI:2.04-24.29,P=0.002),non-rebreathing mask usage(OR=21.13,95%CI:9.00-49.61,P<0.001)and invasive ventilation(OR=5.64,95%CI:1.42-22.45,P=0.014)were risk factors for shock.Anemia was a risk factor for coronary involvement(OR=3.09,95%CI:1.79-5.34,P<0.001).CONCLUSION Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management.Although shock resolved quickly,resolution of ventricular function and coronary abnormalities were slower,and hence warrants a structured long-term follow-up protocol.
