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 In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.T...Background In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.The study aim was to determine 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 undergoing PCI between January 1st,2017 and January 1st,2021.The primary endpoint was all-cause mortality at long-term followup.Results A total of 155,683 patients underwent PCI,of which 100,209(64.4%)acute coronary syndrome cases.Compared to patients 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 within 30 days following the index intervention(0.9%vs.0.7%;P=0.024),though they less often underwent revascularization at longterm 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 significant 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 morbidity and mortality.展开更多
BACKGROUND Coronary microembolization(CME)is the major leading cause of perioperative myocardial injury during coronary revascularization.Semaglutide exerts multiple protective biological activities,but its cardioprot...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.Thus,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 mobility group box 1(HMGB1)antagonist glycyrrhizin administrations were ahead of CME and cell modeling.Cardiac function,myocardial 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 evaluated.RESULTS Semaglutide pretreatment ameliorated CME-induced cardiac systolic dysfunction and relieved the cardiac injury.Semaglutide attenuated myocardial apoptosis and inflammatory response following CME in vivo and in vitro.Moreover,semaglutide downregulated HMGB1 expression and suppressed its nuclear-cytoplasmic translocation.Both glycyrrhizin and semaglutide administration affected the HMGB1/RAGE/NF-κB p65 pathway after CME.CONCLUSIONS Semaglutide pretreatment attenuates CME-induced myocardial injury by suppressing apoptosis and inflammation through the HMGB1/RAGE/NF-κB p65 pathway.展开更多
The post-hoc analysis of the PERSEO registry by Minardi,et al.[1]offers critical insights into antithrombotic management for elderly patients(≥80 years)on oral anticoagulation undergoing percutaneous coronary interve...The post-hoc analysis of the PERSEO registry by Minardi,et al.[1]offers critical insights into antithrombotic management for elderly patients(≥80 years)on oral anticoagulation undergoing percutaneous coronary intervention.While the authors effectively demonstrate the vulnerability of this population,characterized by substantial comorbidity burden and markedly elevated rates of mortality,ischemic events,and bleeding at one year compared with younger cohorts,their findings raise important questions about contemporary practice patterns and their alignment with evidence-based guidelines.展开更多
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 ...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 CTFFR 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–derived 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 predictors. 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 longterm outcomes. The combined model exhibits improved prediction abilities, which is beneficial for risk stratification.展开更多
The important work of Yu,et al.[1]who presented one of the first randomized controlled trials(RCTs)to directly compare robot-assisted and manual percutaneous coronary intervention(PCI),is commendable;offering importan...The important work of Yu,et al.[1]who presented one of the first randomized controlled trials(RCTs)to directly compare robot-assisted and manual percutaneous coronary intervention(PCI),is commendable;offering important insights into the feasibility and outcomes of this emerging technology.While the analysis is timely,several issues warrant further consideration.展开更多
Background:Drug-coated balloons(DCBs)are receiving increasing attention in interventional therapy for coronary artery disease.However,evidence regarding their application in acute myocardial infarction(AMI),particular...Background:Drug-coated balloons(DCBs)are receiving increasing attention in interventional therapy for coronary artery disease.However,evidence regarding their application in acute myocardial infarction(AMI),particularly in high-risk AMI patients,is limited,leading to significant clinical concerns.This study aims to compare the efficacy and safety of DCBs versus standard drug-eluting stents(DESs)in AMI patients and explore their efficacy differences in patients with ST-segment elevation myocardial infarction(STEMI),non-ST-segment elevation myocardial infarction(NSTEMI),and different risk stratifications.Methods:A single-center,retrospective cohort study was conducted,involving 86 patients who underwent percutaneous coronary intervention(PCI)for AMI between January 2023 and July 2025.Patients were divided into a DCB group(n=26)and a DES group(n=60)based on the treatment modality.According to the Killip classification of myocardial infarction at admission,patients were categorized into a low-risk group(Killip Class I,n=68)and a high-risk group(Killip Classes II-IV,n=18).The primary efficacy endpoint was targeting lesion restenosis as shown by coronary angiography follow-up(6-12 months).Safety endpoints included acute in-stent thrombosis during hospitalization(ARC criteria)and long-term coronary slow flow.A multivariate logistic regression model was used to evaluate the associations between intervention modality,risk stratification,infarction type,and endpoint events,and to test for interactions.Results:The DCB and DES groups were generally balanced in terms of baseline traditional risk factors.During hospitalization,three cases(5.0%)of acute in-stent thrombosis occurred in the DES group,all requiring urgent re-intervention,while no such events occurred in the DCB group(0%).Acute in-stent thrombosis formation was significantly associated with high-risk stratification(χ2 test,p=0.047).The overall restenosis rate was 22.1%(19/86).Multivariate analysis showed no statistically significant difference in restenosis risk between the intervention modalities(DCB vs.DES)(adjusted odds ratio[OR]=1.07,95%confidence interval[CI]0.27-4.21,p=0.920),and no statistical differences were found in subgroups based on risk stratification(p=0.382)or infarction type(p=0.484).There was a trend toward increased restenosis risk in high-risk patients(OR=12.34),but the difference was not statistically significant(95%CI 0.28-542.75,p=0.193).The incidence of long-term coronary slow flow was significantly higher in the DES group than in the DCB group(16.7%vs.3.8%,Fisher’s exact test,p=0.048),with a statistically significant difference.Conclusion:For AMI patients,DCBs demonstrate similar efficacy to DESs in preventing restenosis.However,DESs are associated with a higher risk of acute thrombosis during hospitalization,especially in high-risk patients,and a higher risk of long-term slow coronary flow.DCBs exhibit superior perioperative and long-term safety compared to DESs.Given the limited sample size,particularly the small number of high-risk patients and those treated with DCBs,the conclusions require validation through larger-scale prospective studies.展开更多
As one of the main chronic diseases in modern society,coronary heart disease,as a major disease that affects people’s lives and health,has the characteristics of hidden onset and sudden onset.Coronary heart disease h...As one of the main chronic diseases in modern society,coronary heart disease,as a major disease that affects people’s lives and health,has the characteristics of hidden onset and sudden onset.Coronary heart disease has relatively clear risk factors.Among them,blood lipid levels and blood sugar levels,as two main risk factors,play an important role in promoting the onset of coronary heart disease.The two complement each other in a vicious cycle,synergize and promote each other,promote the process of coronary atherosclerosis,thereby causing coronary heart disease.Multiple components in blood lipids and poor management of long-term blood sugar levels play a major role in specific clinical problems.This article reviews the different components of blood lipids and the effects of hyperglycemia on coronary heart disease,and initially expounds the mechanism by which blood lipids and blood sugar levels synergize each other to aggravate the risk of coronary heart disease,and combines them with relevant clinical issues,in order to help clinicians guide the prevention of coronary heart disease in terms of blood lipids and blood sugar levels.展开更多
Objective Patients with atherosclerotic cardiovascular disease(ASCVD)following percutaneous coronary intervention(PCI)are classified as very-high-risk individuals in cardiovascular disease(CVD)risk stratification.The ...Objective Patients with atherosclerotic cardiovascular disease(ASCVD)following percutaneous coronary intervention(PCI)are classified as very-high-risk individuals in cardiovascular disease(CVD)risk stratification.The distribution pattern of traditional Chinese medicine(TCM)syndromes in this patient population,as well as its association with blood lipid profiles and clinical prognosis,remains unclear.The present prospective cohort study aims to investigate these correlations,thereby providing insights to enrich the research fields.Methods We enrolled consecutive patients with ASCVD who underwent PCI at the Integrated Cardiology Unit of China-Japan Friendship Hospital between September 1,2020 and December 31,2022.Demographics and clinical characteristics,signs and symptoms defining each TCM syndrome,and fasting venous blood samples were collected at baseline and follow up or upon major adverse cardiovascular events(MACEs).We analyzed the correlation between TCM syndromes,blood lipid profiles,and MACEs,and developed a new joint prognostic model incorporating both TCM syndromes and blood lipids using logistic regression.The analyses were based on detailed baseline and one-year follow-up data.Results A per-protocol analysis was performed on 586 patients with complete data ultimately.During the one-year follow-up,174 patients(29.69%)experienced a MACE.We performed statistical analyses on comorbidities,medication,and biochemical indicators across groups defined by TCM syndrome differentiation.When comparing different TCM syndromes,no significant differences were found in age,body mass index(BMI),history of revascularization,comorbidities,family history of CVD,smoking or drinking,or statin intensity(P>0.05).Patients with intertwined phlegm and blood stasis syndrome exhibited significantly higher levels of total cholesterol(TC,5.27±1.18 mmol/L,P<0.001),triglyceride(TG,1.96±1.33 mmol/L,P=0.008),low-density lipoprotein cholesterol(LDL-C,3.35±0.79 mmol/L,P<0.001),and high-density lipoprotein cholesterol(HDL-C,1.24±0.81 mmol/L,P<0.001)compared with those with other TCM syndromes combined.A multivariable logistic regression model was constructed to predict MACEs.The model included TCM syndrome type[with intertwined phlegm and blood stasis as a predictor,adjusted odds ratio(OR)=1.413,95%confidence interval(CI):0.517–3.864,P=0.501],age(adjusted OR=0.97,95%CI:0.955–1.001,P=0.057),male gender(adjusted OR=0.698,95%CI:0.416–1.170,P=0.173),TC(adjusted OR=1.004,95%CI:0.513–1.965,P=0.990),and LDL-C(adjusted OR=5.825,95%CI:2.214–15.326,P<0.001).This model demonstrated good discriminatory ability for MACEs in post-PCI ASCVD patients[the area under the receiver operating characteristic(ROC)curve(AUC)=0.865,95%CI:0.816–0.914].Conclusion The intertwined phlegm and blood stasis TCM syndrome is associated with a distinct atherogenic lipid profile characterized by elevated levels of TC and LDL-C.The prognostic model that incorporates this TCM syndrome type along with conventional lipid parameters(TC and LDL-C)shows good discriminatory ability for predicting MACEs in ASCVD patients after PCI,underscoring the potential clinical utility of integrating TCM syndrome differentiation into CVD risk assessment.展开更多
Objective:To establish a mouse model of homocysteine(Hcy)-induced coronary microvascular dysfunction(CMD),and to evaluate the therapeutic efficacy of Shexiang Tongxin dropping pill(STDP)and elucidate its underlying me...Objective:To establish a mouse model of homocysteine(Hcy)-induced coronary microvascular dysfunction(CMD),and to evaluate the therapeutic efficacy of Shexiang Tongxin dropping pill(STDP)and elucidate its underlying mechanisms.Methods:The chemical composition and quality of STDP were characterized using ultra-high performance liquid chromatography,and its absorbed components were identified using ultra-high performance liquid chromatography with quadrupole time-of-flight mass spectrometry.CMD was induced in C57BL/6J mice by feeding a 3%methionine diet for four weeks.STDP efficacy was evaluated using laser speckle perfusion imaging,tomato lectin staining,and quantification of plasma nitric oxide(NO),reactive oxygen species(ROS),and endothelial adhesion molecules(intercellular cell adhesion molecule-1[ICAM-1],vascular cell adhesion molecule-1[VCAM-1]).Network pharmacology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed to identify potential targets and regulatory pathways.An in vitro Hcy-induced endothelial injury model was used to validate the effects of STDP on cell viability,NO production,and activation of phosphatidylinositol 3-kinase/protein kinase B/endothelial nitric oxide synthase(PI3K/Akt/eNOS)pathway.Results:STDP was stable,with 180 constituents identified in the preparation and 30 absorbed components in plasma.STDP treatment restored perfusion,increased plasma NO,decreased ROS,and downregulated ICAM-1 and VCAM-1.Network analysis identified 152 putative targets,highlighting the PI3K/Akt pathway as the central,with PIK3CA,AKT1,and NOS3 as key nodes.In vitro,STDP enhanced cell viability,NO production,and PI3K/Akt/eNOS phosphorylation,these effects were abolished by pharmacological inhibition of PI3K and eNOS.Conclusion:A 3%methionine diet for four weeks effectively induces CMD in C57BL/6J mice.STDP,rich in bioactive components,alleviates Hcy-induced CMD by activating the PI3K/Akt/eNOS pathway,thereby improving endothelial function and microvascular perfusion.These findings support STDP as a promising therapeutic candidate for CMD management.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
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
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
Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to e...Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to experience myocar-dial ischemic symptoms post-procedure,largely due to coronary microvascular dysfunction(CMD).The pathophysiological mechanisms of CMD are complex and involve endothelial dysfunction,microvascular remodeling,reperfusion in-jury,and metabolic abnormalities.Moreover,components of metabolic syndrome,including obesity,hyperglycemia,hypertension,and dyslipidemia,exacerbate the occurrence and progression of CMD through multiple pathways.This review systematically summarizes the latest research advan-cements in CMD after PCI,including its pathogenesis,diagnostic techniques,management strategies,and future research directions.For diagnosis,invasive techniques such as coronary flow reserve and the index of microcirculatory resistance,as well as non-invasive imaging modalities(positron emission tomography and cardiac magnetic reso-nance),provide tools for early CMD detection.In terms of management,a multi-level intervention strategy is emphasized,incorporating lifestyle modifications(diet,exercise,and weight control),pharmacotherapy(vasodilators,hypoglycemic agents,statins,and metabolic modulators),traditional Chinese medicine,and specialized treatments(enhanced external counterpulsation,metabolic surgery,and lipoprotein apheresis).However,challenges remain in CMD treatment,including limitations in diagnostic tools and the lack of personalized treatment strategies.Future research should focus on the complex interactions between CMD and metabolic risks,aiming to optimize diagnostic and therapeutic strate-gies to improve the long-term prognosis of patients post-PCI.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 clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vesse...BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA Ⅲ trial were retrospectively measured for postPCI QFR.The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs,composite of target vessel-related cardiac death,target vessel-related myocardial infarction,and ischemia-driven target vessel revascularization).Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs,and all vessels were stratified by this optimal cutoff value.Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.RESULTS Among 428 CTO vessels treated with PCI,353 vessels (82.5%) were analyzable for post-PCI QFR.31 VOCEs (8.7%) occurred at 2 years.Mean value of post-PCI QFR was 0.92±0.13.Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91.The incidence of 2-year VOCEs in the vessel with post-PCI QFR<0.91 (n=91) was significantly higher compared with the vessels with post-PCI QFR≥0.91 (n=262)(22.0%vs.4.2%,HR=4.98,95%CI:2.32–10.70).CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO.Achieving functionally optimal PCI results (post-PCI QFR value≥0.91) tends to get better prognosis for patients with CTO lesions.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
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 In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.The study aim was to determine 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 undergoing PCI between January 1st,2017 and January 1st,2021.The primary endpoint was all-cause mortality at long-term followup.Results A total of 155,683 patients underwent PCI,of which 100,209(64.4%)acute coronary syndrome cases.Compared to patients 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 within 30 days following the index intervention(0.9%vs.0.7%;P=0.024),though they less often underwent revascularization at longterm 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 significant 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 morbidity and mortality.
文摘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.Thus,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 mobility group box 1(HMGB1)antagonist glycyrrhizin administrations were ahead of CME and cell modeling.Cardiac function,myocardial 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 evaluated.RESULTS Semaglutide pretreatment ameliorated CME-induced cardiac systolic dysfunction and relieved the cardiac injury.Semaglutide attenuated myocardial apoptosis and inflammatory response following CME in vivo and in vitro.Moreover,semaglutide downregulated HMGB1 expression and suppressed its nuclear-cytoplasmic translocation.Both glycyrrhizin and semaglutide administration affected the HMGB1/RAGE/NF-κB p65 pathway after CME.CONCLUSIONS Semaglutide pretreatment attenuates CME-induced myocardial injury by suppressing apoptosis and inflammation through the HMGB1/RAGE/NF-κB p65 pathway.
文摘The post-hoc analysis of the PERSEO registry by Minardi,et al.[1]offers critical insights into antithrombotic management for elderly patients(≥80 years)on oral anticoagulation undergoing percutaneous coronary intervention.While the authors effectively demonstrate the vulnerability of this population,characterized by substantial comorbidity burden and markedly elevated rates of mortality,ischemic events,and bleeding at one year compared with younger cohorts,their findings raise important questions about contemporary practice patterns and their alignment with evidence-based guidelines.
文摘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 CTFFR 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–derived 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 predictors. 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 longterm outcomes. The combined model exhibits improved prediction abilities, which is beneficial for risk stratification.
文摘The important work of Yu,et al.[1]who presented one of the first randomized controlled trials(RCTs)to directly compare robot-assisted and manual percutaneous coronary intervention(PCI),is commendable;offering important insights into the feasibility and outcomes of this emerging technology.While the analysis is timely,several issues warrant further consideration.
基金Social Development Science and Technology Project of Dongguan Science and Technology Bureau(Project No.:20221800905302)。
文摘Background:Drug-coated balloons(DCBs)are receiving increasing attention in interventional therapy for coronary artery disease.However,evidence regarding their application in acute myocardial infarction(AMI),particularly in high-risk AMI patients,is limited,leading to significant clinical concerns.This study aims to compare the efficacy and safety of DCBs versus standard drug-eluting stents(DESs)in AMI patients and explore their efficacy differences in patients with ST-segment elevation myocardial infarction(STEMI),non-ST-segment elevation myocardial infarction(NSTEMI),and different risk stratifications.Methods:A single-center,retrospective cohort study was conducted,involving 86 patients who underwent percutaneous coronary intervention(PCI)for AMI between January 2023 and July 2025.Patients were divided into a DCB group(n=26)and a DES group(n=60)based on the treatment modality.According to the Killip classification of myocardial infarction at admission,patients were categorized into a low-risk group(Killip Class I,n=68)and a high-risk group(Killip Classes II-IV,n=18).The primary efficacy endpoint was targeting lesion restenosis as shown by coronary angiography follow-up(6-12 months).Safety endpoints included acute in-stent thrombosis during hospitalization(ARC criteria)and long-term coronary slow flow.A multivariate logistic regression model was used to evaluate the associations between intervention modality,risk stratification,infarction type,and endpoint events,and to test for interactions.Results:The DCB and DES groups were generally balanced in terms of baseline traditional risk factors.During hospitalization,three cases(5.0%)of acute in-stent thrombosis occurred in the DES group,all requiring urgent re-intervention,while no such events occurred in the DCB group(0%).Acute in-stent thrombosis formation was significantly associated with high-risk stratification(χ2 test,p=0.047).The overall restenosis rate was 22.1%(19/86).Multivariate analysis showed no statistically significant difference in restenosis risk between the intervention modalities(DCB vs.DES)(adjusted odds ratio[OR]=1.07,95%confidence interval[CI]0.27-4.21,p=0.920),and no statistical differences were found in subgroups based on risk stratification(p=0.382)or infarction type(p=0.484).There was a trend toward increased restenosis risk in high-risk patients(OR=12.34),but the difference was not statistically significant(95%CI 0.28-542.75,p=0.193).The incidence of long-term coronary slow flow was significantly higher in the DES group than in the DCB group(16.7%vs.3.8%,Fisher’s exact test,p=0.048),with a statistically significant difference.Conclusion:For AMI patients,DCBs demonstrate similar efficacy to DESs in preventing restenosis.However,DESs are associated with a higher risk of acute thrombosis during hospitalization,especially in high-risk patients,and a higher risk of long-term slow coronary flow.DCBs exhibit superior perioperative and long-term safety compared to DESs.Given the limited sample size,particularly the small number of high-risk patients and those treated with DCBs,the conclusions require validation through larger-scale prospective studies.
文摘As one of the main chronic diseases in modern society,coronary heart disease,as a major disease that affects people’s lives and health,has the characteristics of hidden onset and sudden onset.Coronary heart disease has relatively clear risk factors.Among them,blood lipid levels and blood sugar levels,as two main risk factors,play an important role in promoting the onset of coronary heart disease.The two complement each other in a vicious cycle,synergize and promote each other,promote the process of coronary atherosclerosis,thereby causing coronary heart disease.Multiple components in blood lipids and poor management of long-term blood sugar levels play a major role in specific clinical problems.This article reviews the different components of blood lipids and the effects of hyperglycemia on coronary heart disease,and initially expounds the mechanism by which blood lipids and blood sugar levels synergize each other to aggravate the risk of coronary heart disease,and combines them with relevant clinical issues,in order to help clinicians guide the prevention of coronary heart disease in terms of blood lipids and blood sugar levels.
基金Capital Health Development Scientific Research Project(2020-2-4064)National Key Research and Development Program of China(2018YFC2002502).
文摘Objective Patients with atherosclerotic cardiovascular disease(ASCVD)following percutaneous coronary intervention(PCI)are classified as very-high-risk individuals in cardiovascular disease(CVD)risk stratification.The distribution pattern of traditional Chinese medicine(TCM)syndromes in this patient population,as well as its association with blood lipid profiles and clinical prognosis,remains unclear.The present prospective cohort study aims to investigate these correlations,thereby providing insights to enrich the research fields.Methods We enrolled consecutive patients with ASCVD who underwent PCI at the Integrated Cardiology Unit of China-Japan Friendship Hospital between September 1,2020 and December 31,2022.Demographics and clinical characteristics,signs and symptoms defining each TCM syndrome,and fasting venous blood samples were collected at baseline and follow up or upon major adverse cardiovascular events(MACEs).We analyzed the correlation between TCM syndromes,blood lipid profiles,and MACEs,and developed a new joint prognostic model incorporating both TCM syndromes and blood lipids using logistic regression.The analyses were based on detailed baseline and one-year follow-up data.Results A per-protocol analysis was performed on 586 patients with complete data ultimately.During the one-year follow-up,174 patients(29.69%)experienced a MACE.We performed statistical analyses on comorbidities,medication,and biochemical indicators across groups defined by TCM syndrome differentiation.When comparing different TCM syndromes,no significant differences were found in age,body mass index(BMI),history of revascularization,comorbidities,family history of CVD,smoking or drinking,or statin intensity(P>0.05).Patients with intertwined phlegm and blood stasis syndrome exhibited significantly higher levels of total cholesterol(TC,5.27±1.18 mmol/L,P<0.001),triglyceride(TG,1.96±1.33 mmol/L,P=0.008),low-density lipoprotein cholesterol(LDL-C,3.35±0.79 mmol/L,P<0.001),and high-density lipoprotein cholesterol(HDL-C,1.24±0.81 mmol/L,P<0.001)compared with those with other TCM syndromes combined.A multivariable logistic regression model was constructed to predict MACEs.The model included TCM syndrome type[with intertwined phlegm and blood stasis as a predictor,adjusted odds ratio(OR)=1.413,95%confidence interval(CI):0.517–3.864,P=0.501],age(adjusted OR=0.97,95%CI:0.955–1.001,P=0.057),male gender(adjusted OR=0.698,95%CI:0.416–1.170,P=0.173),TC(adjusted OR=1.004,95%CI:0.513–1.965,P=0.990),and LDL-C(adjusted OR=5.825,95%CI:2.214–15.326,P<0.001).This model demonstrated good discriminatory ability for MACEs in post-PCI ASCVD patients[the area under the receiver operating characteristic(ROC)curve(AUC)=0.865,95%CI:0.816–0.914].Conclusion The intertwined phlegm and blood stasis TCM syndrome is associated with a distinct atherogenic lipid profile characterized by elevated levels of TC and LDL-C.The prognostic model that incorporates this TCM syndrome type along with conventional lipid parameters(TC and LDL-C)shows good discriminatory ability for predicting MACEs in ASCVD patients after PCI,underscoring the potential clinical utility of integrating TCM syndrome differentiation into CVD risk assessment.
基金supported by the National Key Research and Development Program of China(2022YFC3500100)the National Natural Science Foundation of China(82230126 and U24A20800)+2 种基金the National Science and Technology Major Project of the Ministry of Science and Technology of China(2023ZD0502600)National Science Fund for Excellent Young Scholars(82222075)the Incubation Program for the Science and Technology Development of Chinese Medicine Guangdong Laboratory(Project HQL2024PZ045 and HQCML).
文摘Objective:To establish a mouse model of homocysteine(Hcy)-induced coronary microvascular dysfunction(CMD),and to evaluate the therapeutic efficacy of Shexiang Tongxin dropping pill(STDP)and elucidate its underlying mechanisms.Methods:The chemical composition and quality of STDP were characterized using ultra-high performance liquid chromatography,and its absorbed components were identified using ultra-high performance liquid chromatography with quadrupole time-of-flight mass spectrometry.CMD was induced in C57BL/6J mice by feeding a 3%methionine diet for four weeks.STDP efficacy was evaluated using laser speckle perfusion imaging,tomato lectin staining,and quantification of plasma nitric oxide(NO),reactive oxygen species(ROS),and endothelial adhesion molecules(intercellular cell adhesion molecule-1[ICAM-1],vascular cell adhesion molecule-1[VCAM-1]).Network pharmacology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed to identify potential targets and regulatory pathways.An in vitro Hcy-induced endothelial injury model was used to validate the effects of STDP on cell viability,NO production,and activation of phosphatidylinositol 3-kinase/protein kinase B/endothelial nitric oxide synthase(PI3K/Akt/eNOS)pathway.Results:STDP was stable,with 180 constituents identified in the preparation and 30 absorbed components in plasma.STDP treatment restored perfusion,increased plasma NO,decreased ROS,and downregulated ICAM-1 and VCAM-1.Network analysis identified 152 putative targets,highlighting the PI3K/Akt pathway as the central,with PIK3CA,AKT1,and NOS3 as key nodes.In vitro,STDP enhanced cell viability,NO production,and PI3K/Akt/eNOS phosphorylation,these effects were abolished by pharmacological inhibition of PI3K and eNOS.Conclusion:A 3%methionine diet for four weeks effectively induces CMD in C57BL/6J mice.STDP,rich in bioactive components,alleviates Hcy-induced CMD by activating the PI3K/Akt/eNOS pathway,thereby improving endothelial function and microvascular perfusion.These findings support STDP as a promising therapeutic candidate for CMD management.
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.
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Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to experience myocar-dial ischemic symptoms post-procedure,largely due to coronary microvascular dysfunction(CMD).The pathophysiological mechanisms of CMD are complex and involve endothelial dysfunction,microvascular remodeling,reperfusion in-jury,and metabolic abnormalities.Moreover,components of metabolic syndrome,including obesity,hyperglycemia,hypertension,and dyslipidemia,exacerbate the occurrence and progression of CMD through multiple pathways.This review systematically summarizes the latest research advan-cements in CMD after PCI,including its pathogenesis,diagnostic techniques,management strategies,and future research directions.For diagnosis,invasive techniques such as coronary flow reserve and the index of microcirculatory resistance,as well as non-invasive imaging modalities(positron emission tomography and cardiac magnetic reso-nance),provide tools for early CMD detection.In terms of management,a multi-level intervention strategy is emphasized,incorporating lifestyle modifications(diet,exercise,and weight control),pharmacotherapy(vasodilators,hypoglycemic agents,statins,and metabolic modulators),traditional Chinese medicine,and specialized treatments(enhanced external counterpulsation,metabolic surgery,and lipoprotein apheresis).However,challenges remain in CMD treatment,including limitations in diagnostic tools and the lack of personalized treatment strategies.Future research should focus on the complex interactions between CMD and metabolic risks,aiming to optimize diagnostic and therapeutic strate-gies to improve the long-term prognosis of patients post-PCI.
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 CAMS Innovation Fund for Medical Sciences(No.2021-I2M-1-008)the National High Level Hospital Clinical Research Funding(No.2023-GSP-GG-2&No.2023-GSP-QN-34&No.2023-GSPRC-05).
文摘BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA Ⅲ trial were retrospectively measured for postPCI QFR.The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs,composite of target vessel-related cardiac death,target vessel-related myocardial infarction,and ischemia-driven target vessel revascularization).Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs,and all vessels were stratified by this optimal cutoff value.Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.RESULTS Among 428 CTO vessels treated with PCI,353 vessels (82.5%) were analyzable for post-PCI QFR.31 VOCEs (8.7%) occurred at 2 years.Mean value of post-PCI QFR was 0.92±0.13.Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91.The incidence of 2-year VOCEs in the vessel with post-PCI QFR<0.91 (n=91) was significantly higher compared with the vessels with post-PCI QFR≥0.91 (n=262)(22.0%vs.4.2%,HR=4.98,95%CI:2.32–10.70).CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO.Achieving functionally optimal PCI results (post-PCI QFR value≥0.91) tends to get better prognosis for patients with CTO lesions.
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.
