Objective: To explore the association between metabolic dysfunction-associated fatty liver disease (MAFLD) and myocardial ischemia in non-obese patients with suspected coronary heart disease (CAD), and to analyze the differences in this association across subgroups stratified by body mass index (BMI) and coronary artery lesion severity. Methods: This retrospective study enrolled non-obese patients (18.5 kg/m²≤BMI<28.0 kg/m²) with suspected CAD who underwent stress/rest radionuclide myocardial perfusion imaging (MPI) at the Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University between January 1, 2022 and December 31, 2024. Patients were divided into myocardial ischemia group and non-ischemia group based on MPI findings. MAFLD diagnosis was determined based on hepatic steatosis detected by low-dose CT integrated with single-photon emission computed tomography/CT (SPECT/CT), combined with established diagnostic criteria (no excessive alcohol consumption plus presence of metabolic dysfunction). Univariate and multivariate logistic regression models were applied to analyze the correlation between MAFLD and myocardial ischemia. Stratified analyses were further performed according to BMI (normal weight: 18.5 kg/m²≤BMI<24.0 kg/m²; overweight: 24.0 kg/m²≤BMI<28.0 kg/m²) and coronary angiography results (obstructive or non-obstructive CAD) to assess the relationship between MAFLD and myocardial ischemia in each subgroup. Results: A total of 271 patients with suspected CAD were enrolled, aged (61.6±10.2) years, with 143 (52.8%) males. There were 135 patients in the myocardial ischemia group and 136 in the non-ischemia group. MAFLD was diagnosed in 88 patients (32.5%). The proportion of patients diagnosed with MAFLD was higher in the myocardial ischemia group than in the non-myocardial ischemia group (61 cases (45.2%) vs. 27 cases (19.9%), P<0.001). Multivariate logistic regression analysis showed that MAFLD was independently associated with myocardial ischemia (OR=3.43, 95%CI 1.85-6.28, P<0.001). Subgroup analysis revealed that MAFLD was associated with myocardial ischemia in both normal weight group (OR=7.62, 95%CI 2.48-23.44, P<0.001) and overweight group (OR=2.60, 95%CI 1.20-5.60, P=0.015), with a stronger association observed in normal-weight individuals. This association also existed in non-obstructive CAD group (OR=6.50, 95%CI 2.23-18.94, P<0.001) and obstructive CAD group (OR=3.05, 95%CI 1.37-6.80, P=0.006). Conclusion: MAFLD acts as an independent risk factor for myocardial ischemia in non-obese patients with suspected CAD, and this association persists across subgroups stratified by BMI (normal weight vs. overweight) and coronary lesion phenotype (obstructive vs. non-obstructive CAD).
Objective: To investigate the effect of Roux-en-Y gastric bypass (RYGB) on salt-sensitive hypertension and its underlying molecular mechanism. Methods: (1) Clinical study: A total of 57 patients who underwent RYGB at Daping Hospital, Army Medical University between December 2010 and May 2025 were enrolled. According to the diagnostic criteria for hypertension, the patients were divided into normotensive group and hypertensive group. Baseline and postoperative clinical data were collected. Daily sodium intake was calculated based on 24-hour urinary sodium excretion, and the correlation between preoperative sodium intake and the reduction of postoperative systolic blood pressure was analyzed. (2) Animal experiment: Forty-eight 6-week-old male Dahl salt-sensitive hypertensive rats were fed an 8% high-salt diet for 8 weeks to establish the salt-sensitive hypertension models. Thirty modeled rats were randomly divided into the RYGB group (n=15) and the sham operation group (n=15). The remaining 18 rats were randomly divided into control group (n=6), liraglutide group (n=6) and liraglutide+EX9-39 group (n=6), which were treated with normal saline, liraglutide (0.2 mg·kg-1·d-1), and liraglutide combined with EX9-39 (75 μg·kg-1·d-1), respectively. Rat blood pressure was measured via non-invasive tail-cuff method and invasive radiotelemetry method, and isolated vascular function was detected. HE, PAS and Masson staining were used to evaluate mesenteric vascular remodeling, glomerular matrix distribution and renal fibrosis degree, respectively. Enzyme-linked immunosorbent assay was adopted to detect serum levels of glucagon-like peptide-1 (GLP-1) and angiotensin Ⅱ (AngⅡ). Western blot was performed to determine the protein expression of tumor necrosis factor-α, interleukin-6, GLP-1 receptor (GLP-1R), angiotensin-converting enzyme (ACE) 1, ACE2, angiotensin Ⅱ type 1 receptor (AGTR1), phosphorylated Na⁺/H⁺ exchanger 3 (NHE3) and total NHE3 in renal cortex. (3) Cell experiments: Rat renal epithelial NRK-52E cells were used. Four experimental groups were set up: high-salt group (treated with 160 mmol/L NaCl for 24 h), high-salt+liraglutide group (100 nmol/L liraglutide), high-salt+liraglutide+EX9-39 group(100 nmol/L liraglutide+150 nmol/L EX9-39), and control group (equal volume of drug vehicle). Western blotting was performed to detect the expression of ACE1, AGTR1, phosphorylated NHE3 and total NHE3. Results: (1) Clinical study: The enrolled patients had an age of (43.91±10.19) years, including 33 males (58%). There were 24 patients in the normotensive group and 33 in the hypertensive group. Compared with the baseline levels, both systolic blood pressure ((133.26±16.48) mmHg vs. (118.23±15.40) mmHg, 1 mmHg=0.133 kPa) and diastolic blood pressure ((83.16±12.44) mmHg vs. (74.54±8.80) mmHg) were decreased after RYGB (both P<0.05). The median daily preoperative sodium intake of all participants was 10.45 (8.19, 15.58) g/d. A positive correlation was observed between preoperative sodium intake and the reduction in postoperative systolic blood pressure (R=0.326, P=0.013). (2) Animal experiment: At the 8th week after surgery, the tail-cuff systolic blood pressure ((125.33±12.16) mmHg vs. (182.00±11.61) mmHg), 24-hour mean systolic blood pressure ((125.81±12.89) mmHg vs. (182.11±10.21) mmHg) and 24-hour mean diastolic blood pressure ((97.36±6.59) mmHg vs. (144.85±16.58) mmHg) in the RYGB group were lower than those in the sham group (all P<0.05). Compared with the sham group, the RYGB group presented a lower ratio of vascular wall thickness to outer vessel diameter, higher vasodilation of mesenteric arteries, and less glomerular collagen deposition. Meanwhile, the levels of serum creatinine, blood urea nitrogen and urinary protein, as well as the expression of tumor necrosis factor-α and interleukin-6 in renal cortex were also lower in RYGB group than sham group (all P<0.05). In addition, compared with sham group, the serum GLP-1 level, renal cortical GLP-1 receptor expression and NHE3 phosphorylation level were higher in the RYGB group, while serum AngⅡ and the expression of ACE1 and AGTR1 in renal cortex were lower (all P<0.05). Drug intervention results showed that tail-cuff systolic blood pressure was lower in the liraglutide group than in the control group ((167.00±9.98) mmHg vs. (182.00±6.26) mmHg, P<0.05). No significant difference in tail-cuff systolic blood pressure was found between the liraglutide+EX9-39 group and the control group (P>0.05). (3) Cell experiments: High-salt treatment upregulated the expression of ACE1 and AGTR1 and inhibited NHE3 phosphorylation in NRK-52E cells. Liraglutide reversed the above abnormalities, whereas EX9-39 antagonized the regulatory effects of liraglutide. Statistically significant differences were observed in the expression levels of the above proteins among all groups (all P<0.05). Conclusion: RYGB can effectively ameliorate salt-sensitive hypertension. The underlying mechanism is associated with GLP-1-mediated inhibition of renin-angiotensin system activity and promotion of NHE3 phosphorylation.
冠状动脉扩张是一类以冠状动脉管径异常扩张为特征的罕见病，其病因多样，发病机制尚未完全阐明，治疗手段有限，且预后不良。近年来国内外对该疾病的机制研究多聚焦于免疫炎症和细胞外基质降解两方面，但对不同病因所致冠状动脉扩张的发病机制的异同仍不清楚。为了加强对该疾病的认知、更好地指导临床诊疗，该文基于冠状动脉扩张的病因，对其发病机制予以总结和探讨。
Objective: To investigate the safety and efficacy of the Laager left atrial appendage occlusion system in stroke prevention in patients with atrial fibrillation. Methods: This was a prospective, multicenter, non-randomized, single-arm cohort study with prespecified performance goal. Patients with nonvalvular atrial fibrillation were enrolled at 12 centers nationwide from November 2017 to April 2019. All enrolled patients had CHA2DS2-VASc scores of ≥2 for males and ≥3 for females, and were not suitable for long-term warfarin anticoagulation therapy. All patients underwent left atrial appendage occlusion with the Laager occlusion system and were followed up. The primary efficacy endpoint was the rate of successful left atrial appendage occlusion, defined as a residual shunt ≤3 mm on transesophageal echocardiography at 12 months postoperatively. The primary safety endpoint was the incidence of ischemic stroke. Results: A total of 212 patients with nonvalvular atrial fibrillation were enrolled, with an age of (65.9±8.5) years, including 86 females (40.6%). Immediate procedural success was achieved in 210 patients (99.1%), and residual shunt >3 mm was observed in 2 patients post-procedure. At 12 months postoperatively, 187 patients completed transesophageal echocardiography (including 2 patients with residual shunt >3 mm post-procedure), and the success rate of left atrial appendage occlusion was 96.8% (181/187). The incidence of ischemic stroke was 0.5% (1/212). Conclusion: The Laager left atrial appendage occlusion system demonstrates favorable safety and efficacy for stroke prevention in patients with nonvalvular atrial fibrillation.
Objective: To investigate the prognostic value of single-photon emission computed tomography (SPECT) myocardial perfusion imaging parameters in patients with ischemic heart disease of different sexes. Methods: This retrospective cohort study consecutively enrolled patients diagnosed with ischemic heart disease who underwent rest gated SPECT myocardial perfusion imaging at the First Hospital of Shanxi Medical University between 2016 and 2021. Patients were followed up and categorized into good and poor prognosis groups within each sex based on the occurrence of major adverse cardiovascular events. Propensity score matching was used to balance clinical covariates between prognostic groups within each sex, and differences in SPECT myocardial perfusion imaging parameters were compared between groups. Multivariate Cox regression analysis was performed to identify prognostic factors for patients of different sexes. Results: A total of 1 475 patients completed follow-up (follow-up time: 3.05 (1.71,4.97) years), with an age of (60.5±12.7) years, including 1 058 males (71.7%). After propensity score matching, 866 males (433 in the good prognosis group and 433 in the poor prognosis group) and 302 females (151 in the good prognosis group and 151 in the poor prognosis group) were included. No statistically significant differences were observed in baseline clinical characteristics between prognostic groups within each sex (all P>0.05). Among male patients, the poor prognosis group exhibited higher total perfusion deficit, lower eccentricity index, left ventricular ejection fraction, and peak filling rate compared to the good prognosis group. Among female patients, the poor prognosis group demonstrated a lower peak filling rate than the good prognosis group (all P<0.05). Multivariate Cox regression analysis revealed that increased total perfusion deficit (HR=1.01, 95%CI: 1.00-1.02) and decreased eccentricity index (HR=0.14, 95%CI: 0.02-0.93) were independent risk factors in male patients, whereas decreased peak filling rate (HR=0.67, 95%CI: 0.50-0.91) was an independent risk factor in female patients (all P<0.05). Conclusions: Sex-specific differences exist in the prognostic value of SPECT myocardial perfusion imaging parameters for ischemic heart disease. Increased total perfusion deficit and decreased eccentricity index are independent risk factors in male patients, while decreased peak filling rate is an independent risk factor in female patients.
