BACKGROUND:The mechanisms underlying stroke recurrence after patent foramen ovale (PFO) closure for secondary prevention remain poorly understood. This study evaluated incomplete device apposition (IDA) using cardiac CT angiography (CTA) and investigated its association with stroke recurrence. METHODS:In this prospective cohort study conducted at four centres in China (2020-2026), 233 patients (mean age: 37.01±6.73 years; 48.9% male) without known vascular risk factors were included from 382 consecutive candidates who underwent transcatheter PFO closure with follow-up ≥6 months. Cardiac CTA at 6 months post closure assessed the presence, location and extent of IDA defined as a gap between the left disc and the interatrial septum. Recurrent stroke and new-onset symptoms (atrial tachyarrhythmia, migraine headache, chest pain/discomfort) were recorded and their associations with IDA were analysed. RESULTS:IDA was observed in 55.8% of patients predominantly at the anterior-inferior rim (93.4%). IDA was significantly associated with larger and longer PFOs, larger devices and greater in vivo device thickness (p < 0.001 for all). During a median follow-up of 20.00 (IQR 18.00-24.00) months, patients with IDA had a higher risk of recurrent stroke (log-rank p = 0.022) and new-onset symptoms (log-rank p < 0.001). In eight patients who underwent repeat CTA, device apposition remained stable after 6-month closure. Pathological validation was available in one patient with severe chest pain/discomfort and a well-apposed device had sufficient endothelialisation. CONCLUSION:IDA is common after PFO closure and is associated with increased risks of recurrent stroke and new-onset symptoms. Preventive strategies warrant further investigation. TRIAL REGISTRATION NUMBER:NCT04686253.

BACKGROUND:Understanding metabolic evolution of right ventricle (RV) of pulmonary arterial hypertension associated with atrial septal defect (PAH-ASD) helps elucidate the underlying pathobiology and reveal disease-specific biomarkers. However, the exact metabolic profile of RV of PAH-ASD is scarce. OBJECTIVES:This study aimed to unveil precisely the metabolic signatures of trans-RV of PAH-ASD through non-targeted metabolomics. METHODS:Participants with PAH-ASD were recruited and their blood samples were obtained from superior vena cava (SVC) and pulmonary artery (PA) through right cardiac catheterization. Non-targeted metabolomics analysis on the basis of UHPLC-MS/MS was utilized to generate the metabolomic signature of trans-RV by comparing the metabolites change from SVC to PA. RESULTS:1060 metabolites were detected from blood samples from 40 PAH-ASD participants. A total of 44 differential metabolites were identified based on screening criteria after flowing through the RH, including 10 metabolites with decreased levels and 34 metabolites with increased levels. Among them, phosphatidylcholines, sphingomyelins, AICARP, XMP, inosine 5'-Monophosphate, prostaglandin A1, oleoyl ethanolamide, tyramine, 2-phenylethylamine, 23-nordeoxycholic acid, LPI 20:4, and LPE 22:6 were discovered. Moreover, distinct metabolic perturbations, such as the change of sphingomyelins, inosine 5'-Monophosphate and LPE 22:6, was correlated with the significant clinical variables indicating RV dysfunction in clinical association analysis. CONCLUSION:Our study correctly defined metabolic signatures indicating towards a metabolic pathogenesis of trans-RV of PAH-ASD, emphasizing the importance of these metabolites in promoting of RV dysfunction and devising therapeutic strategies.

BACKGROUND:The significance of evaluating myocardial viability in making decisions regarding coronary artery bypass grafting (CABG) for patients with ischemic left ventricular dysfunction (ILVD) remains controversial. This study aimed to examine the impact of integrated assessment of hibernating myocardium and scars on the survival benefit associated with CABG in patients with ILVD. METHODS:Consecutive patients with ILVD who underwent fluorine-18 fluorodeoxyglucose positron emission tomography and cardiac magnetic resonance imaging with late gadolinium enhancement viability testing from January 2015 and April 2018 were retrospectively enrolled. The primary end point was all-cause death. The secondary end point was a composite of cardiovascular death, cardiovascular hospitalization, heart transplantation, revascularization, insertion of an implantable cardioverter-defibrillator, or nonfatal stroke. Cox models calculated hazard ratios (HRs) and CIs for CABG vs medical therapy alone for subgroups with different levels of hibernation and scars. RESULTS:During a median follow-up of 71.5 months in 507 patients, 98 patients reached the primary end point and 194 reached the secondary end point. After adjustment, CABG was associated with lower risks of all-cause mortality (HR, 0.249; 95% CI, 0.154-0.428; P<.001) and lower incidences of secondary outcomes (HR, 0.457; 95% CI, 0.318-0.658; P<.001) compared with medical treatment alone in the population. Across all 4 subgroups classified by the optimal cutoff value (10% hibernation and 26% scar), CABG was associated with favorable outcomes regardless of the hibernation and scar level. CONCLUSIONS:The extent and severity of hibernating myocardium and scars appear not to influence the effects of CABG in patients with ILVD.

BACKGROUND:This study aimed to investigate the relationship between pressure overload-induced right ventricular (RV) fibrotic remodeling detected by 99mTc-fibroblast activation protein inhibitor (FAPI) single photon emission computed tomography/computed tomography (SPECT/CT) and echocardiographic biomechanical adaptation/maladaptation in chronic thromboembolic pulmonary hypertension (CTEPH). METHODS:Thirty-seven CTEPH patients scheduled for balloon pulmonary angiography (BPA) underwent baseline 99mTc-FAPI SPECT/CT, speckle-tracking echocardiography (measuring RV global strain [GS] and free-wall strain [FWS]), and right heart catheterization. Baseline RV FAPI uptake (peak myocardial-to-blood ratio, TBRpeak) was compared with RV strain and RV-pulmonary artery coupling parameters. Twenty patients received repeated BPA sessions, and a subgroup of 10 underwent repeat FAPI SPECT and strain analysis after a single BPA. RESULTS:Baseline global RV FAPI TBRpeak varied among CTEPH patients (mean ± SD: 2.92 ± 0.96; range: 1.44-4.76). Patients without RV uptake exhibited significantly higher strain values and preserved RV-pulmonary artery coupling compared to those with uptake. TBRpeak of free wall correlated positively with RVGS (r = 0.450, P = 0.005), RVGS/sPAP (global right ventricular longitudinal strain/systolic pulmonary artery pressure) (r = 0.370, P = 0.024), right ventricular free-wall longitudinal strain (RVFWS, r = 0.386, P = 0.018), and RVFWS/sPAP (r = 0.347, P = 0.035). Following a single BPA, RV FAPI uptake decreased in 6 of 10 patients and increased modestly in 4. Changes in FAPI uptake (global ΔTBRpeak) significantly correlated with ΔRVGS (r = 0.697, P = 0.025), ΔRVFWS (r = 0.710, P = 0.022), ΔRVGS/sPAP (r = 0.694, P = 0.026), ΔRVFWS/sPAP (r = 0.700, P = 0.024). CONCLUSION:In CTEPH, RV fibrotic remodeling quantified by FAPI SPECT/CT correlated with echocardiographic RV strain and ventricular-pulmonary artery coupling. Following BPA, changes in RV FAPI uptake appeared dynamic, with fluctuations potentially corresponding to alterations in both RV strain and ventricular-pulmonary coupling parameters.

INTRODUCTION:Right heart (RH), as a junction between the venous system and pulmonary circulation, gains great emphasis on exploring the relevant pathological mechanism of many cardiopulmonary diseases. Although these pathogensis researches centering on RH-related diseases advance, the physiological mechanism research of the RH is scarce. OBJECTIVES:This study aimed to accurately unravel the metabolic features of normal trans-RH through non-targeted metabolomics. METHODS:Patent foramen ovale (PFO) participants with normal function of RH were recruited and their blood samples from superior vena cava (SVC) and pulmonary artery (PA) were collected through right cardiac catheterization. Non-targeted metabolomics analysis based on UHPLC-MS/MS was utilized to generate the metabolic feature of trans-RH by comparing the metabolites change from SVC to PA, revealing its physiological gradient metabolic mechanism. RESULTS:1060 metabolites were tentatively identified in blood samples from 28 PFO participants. 51 differential metabolites were defined based on screening criteria after flowing through RH, including 39 down-regulated metabolites and 12 up-regulated metabolites. Among them, phosphatidylcholines, sphingomyelins, amino acids, triacylglycerol, neopterin, and tetradecanedioic acid were the most relevant. CONCLUSION:Our study provides a more profound and extensive understanding of the psychological metabolism of trans-RH, expanding the current knowledge of normal RH function and providing clues for the pathogenesis research of RH-related diseases.

In patients with valvular heart disease (VHD), fibroblast activation induced by pressure or volume overload can be identified by molecular imaging with fibroblast activation protein inhibitor (FAPI). The study sought to explore the potential of serial FAPI imaging for monitoring the reverse myocardial remodeling triggered by valve replacement. A cohort of 31 VHD patients scheduled for transcatheter or surgical valve replacement underwent 99mTc-FAPI SPECT/CT imaging and echocardiography. All patients repeated echocardiography and 22 of them completed repeat FAPI scans at 3-month follow-up. Cardiac FAPI uptake was quantified as maximum standardized uptake value (SUVmax), maximum of myocardial-to-blood ratio (TBRmax), and fibroblast activation volume (FAV). Myocardial remodeling patterns were evaluated through a comprehensive analysis of left ventricular geometric parameters derived from echocardiography. Myocardial FAPI uptake showed heterogeneous among VHD patients (range: SUVmax 0.67–8.33; TBRmax 1.13–7.50; FAV 0-597 mL). FAPI uptake significantly correlated with levels of circulating N-terminal prohormone of brain natriuretic peptide and left ventricle mass index before valve replacement. Following relief of overload, 22 patients who underwent repeat FAPI imaging demonstrated significant reductions in TBRmax (3.31 [1.73–4.87] vs. 2.43 [1.63–4.23], p = 0.029) and FAV (31.5 [0-227] vs. 12.0 [0-144] mL, p = 0.004). Follow-up echocardiography revealed that 9 out of 31 patients transitioned to normal geometry from concentric or eccentric hypertrophy, achieving complete reverse remodeling. Multivariable regression suggested baseline FAPI uptake intensity TBRmax significantly associated with complete reverse remodeling post-intervention after adjustment (OR: 0.288 [0.097–0.852], p = 0.024). 99mTc-FAPI SPECT/CT imaging is feasible to quantitatively track dynamics of fibroblast activation following valve replacement. Patients with lower preprocedural fibrotic activity identified by FAPI imaging may have greater potential for complete reverse remodeling.

BACKGROUND:In heart failure with preserved ejection fraction (HFpEF), elevated mean left atrial pressure (MLAP) is a recognised haemodynamic feature. This pilot study explored the use of a personalised approach-combined radiofrequency ablation and balloon dilation (CURB)-to establish interatrial communication in patients with elevated resting MLAP. METHODS:Between September 2020 and March 2023, a single-arm study was conducted at Fuwai Hospital (Beijing, China) in patients with HFpEF and resting MLAP ≥18 mm Hg. CURB was performed using graded balloon dilation to achieve an MLAP target of <15 mm Hg, followed by rim stabilisation with radiofrequency ablation. Clinical status, interatrial fenestration and haemodynamic parameters were assessed during follow-up. RESULTS:Thirty-two patients were included (mean age 68.4 years; 59% male). The procedural target was achieved in 31 patients (97%). Median MLAP changed from 19.0 mm Hg (IQR 18.0, 21.0) to 13.0 mm Hg (IQR 12.0, 13.3), and mean pulmonary arterial pressure from 26.9 mm Hg (SD 3.9) to 23.5 mm Hg (SD 3.7). Over a median follow-up of 15.5 months (IQR 11.0, 18.0), fenestrations remained patent. The intervention was associated with favourable change in New York Heart Association functional class (median change: -1 class), 6 min walk distance (+48.5 m) and quality of life scores (-21.7 points). Reassessment in a subset (n=8) beyond 1 year showed sustained MLAP levels. CONCLUSIONS:Among patients with HFpEF and elevated MLAP, the CURB technique was feasible and associated with mid-term changes in haemodynamics and functional measures. Further controlled studies are needed to assess long-term outcomes, safety and broader applicability. TRIAL REGISTRATION NUMBER:NCT04573166.

The coronary sinus collects coronary blood flow back to the right atrium. Myocardial dysfunction might occur after the obstruction of coronary sinus, however, there is no relevant report. In this article, myocardial congestion secondary to iatrogenic obstruction of the coronary sinus was reported in a patient with coronary artery fistulae. Further research is required to investigate the mechanisms.

目的 探索飞秒激光在不同重复频率以及平均输出功率组合下体外切除猪心肌的效果.方法 调谐飞秒激光的重复频率与平均输出功率,形成20组不同参数组合,分别对新鲜离体猪心进行体外切除实验,并使用光学显微成像系统进行观察,测量切除区域面积、结痂区面积和热损伤区面积.比较不同参数组合下飞秒激光的切除效果并通过病理学检查进行验证.结果 20组飞秒激光切除心肌样本中,切除区域总面积为32 841.23(15 263.22,57 532.55)μm2(1 119.01～231 059.66 μm2),结痂区面积为 33 486.64(13 894.10,52 697.15)μm2(2 111.05～127 205.66 μm2),热损伤区面积为 447 444.31(354 901.10,734 165.18)μm2(59 596.94～2 211 946.79 μm2),切除区域深度 370.14(321.30,443.53)μm(248.40～545.90 μ.m).所有切除区域形态规则,边缘光整;激光烧灼处周围心肌细胞胞质嗜酸性增强、肌丝横纹消失,部分心肌细胞空泡变性.其中,功率1.8W结合重复频率600 kHz的参数组合造成的心肌切除区域与周围结痂区面积比值最大(2.25),其切除区域与周围热损伤区面积比值为0.14.结论 飞秒激光切除心肌区域形态规则,边缘光整.低功率与中等频率的参数组合造成的周围心肌热损伤最小.

Journal Article Long QT syndrome induced by cervical spondylosis Get access En Li, En Li Department of Cardiology, The Second Affiliated Hospital, Zhengzhou University, 2 Jingba Road, Zhengzhou 450014, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Chaowu Yan, Chaowu Yan Department of Structural Heart Disease, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, 167 Beilishi Road, Beijing 100000, China Corresponding authors. Tel: +86 18638686933, Email: yangxy1900@zzu.edu.cn (X.Y.); Email: chaowuyan@163.com (C.Y.) https://orcid.org/0000-0001-8864-5505 Search for other works by this author on: Oxford Academic PubMed Google Scholar Xiaoyu Yang Xiaoyu Yang Department of Cardiology, The Second Affiliated Hospital, Zhengzhou University, 2 Jingba Road, Zhengzhou 450014, ChinaBasic Medical Research and Experimental Center, School of Basic Medical Sciences, Zhengzhou University, 100 Science Avenue, Zhengzhou 450001, China Corresponding authors. Tel: +86 18638686933, Email: yangxy1900@zzu.edu.cn (X.Y.); Email: chaowuyan@163.com (C.Y.) https://orcid.org/0000-0001-8858-8619 Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal, ehad608, https://doi.org/10.1093/eurheartj/ehad608 Published: 22 September 2023

Background: As an important place of material exchange, the homeostasis of the pulmonary circulation environment and function lays an essential foundation for the normal execution of various physiological functions of the body. Small metabolic molecules in the circulation can reflect the corresponding state of the pulmonary circulation. Methods: We enrolled patients with Patent Foramen Ovale and obtained blood from the pulmonary arteries and veins through heart catheterization. UPLC-MS based untargeted metabolomics was used to compare the changes and metabolic differences of plasma between pulmonary vein and pulmonary artery. Results: The plasma metabolomics revealed that pulmonary artery had a different metabolomic profile compared to venous. 1060 metabolites were identified, and 61 metabolites were differential metabolites. Purine, Amino acids, Nicotinamide, Tetradecanedioic acid and Bile acid were the most markedly. Conclusion: The differential metabolites are mostly related to immune inflammation and damage repaired. It is suggested that the pulmonary circulation is always in a steady state of injury and repair while pathological changes may be triggered when the homeostasis is broken. These changes play an important role in revealing the development process and etiology of lung homeostasis and related diseases. Relevant metabolites can be used as potential targets for further study of pulmonary circulation homeostasis.

(1) Background: the indications for transcatheter closure of large patent ductus arteriosus (PDA) with severe pulmonary hypertension (PH) are still unclear, and scholars have not fully elucidated the factors that affect PH prognosis. (2) Methods: we retrospectively enrolled 134 consecutive patients with a PDA diameter ≥10 mm or a ratio of PDA and aortic >0.5. We collected clinical data to explore the factors affecting follow-up PH. (3) Results: 134 patients (mean age 35.04 ± 10.23 years; 98 women) successfully underwent a transcatheter closure, and all patients had a mean pulmonary artery pressure (mPAP) >50 mmHg. Five procedures were deemed to have failed because their mPAP did not decrease, and the patients experienced uncomfortable symptoms after the trial occlusion. The average occluder (pulmonary end) size was almost twice the PDA diameter (22.33 ± 4.81 mm vs. 11.69 ± 2.18 mm). Left ventricular end-diastolic dimension (LVEDD), mPAP, and left ventricular ejection fraction (LVEF) significantly reduced after the occlusion, and LVEF recovered during the follow-up period. In total, 42 of the 78 patients with total pulmonary resistance >4 Wood Units experienced clinical outcomes, and all of them had PH in the follow-up, while 10 of them had heart failure, and 4 were hospitalized again because of PH. The results of a logistic regression analysis revealed that the postoperative mPAP had an independent risk factor (odds ratio = 1.069, 95% confidence interval: 1.003 to 1.140, p = 0.040) with a receiver operating characteristic curve cut-off value of 35.5 mmHg (p < 0.001). (4) Conclusions: performing a transcatheter closure of large patent ductus arteriosus is feasible, and postoperative mPAP was a risk factor that affected the follow-up PH. Patients with a postoperative mPAP >35.5 mmHg should be considered for targeted medical therapy or should undergo right heart catheterization again after the occlusion.

目的:初步探讨68Ga标记成纤维细胞激活蛋白抑制剂(68Ga-FAPI)PET/CT在肥厚型心肌病患者的图像特点及临床应用价值.方法:前瞻性纳入5例肥厚型心肌病患者,其中男性3例,平均年龄(61±6)岁.均进行68Ga-FAPIPET/CT显像,分别计算左心室心肌和血池(左心房)的最大标准化摄取值(SUVmax),并采用t检验进行比较.心脏磁共振成像(cMRI)用于测定心肌室壁厚度,并同时进行延迟增强(LGE)成像.采用x2检验分析各心肌节段68Ga-FAPI摄取的SUVmax与LGE的关系.结果:5例患者均有显著高于血池的心肌68Ga-FAPI摄取[SUVmax分别为(8.83±2.72)和(1.11±0.12),P=0.003],心肌摄取68Ga-FAPI 的范围明显大于LGE区域(P＜0.001),仅有68Ga-FAPI摄取的区域常位于LGE边缘.透壁LGE区的68Ga-FAPI摄取强度低于非透壁LGE区.结论:肥厚型心肌病患者左心室心肌有显著的68Ga-FAPI高摄取,且摄取范围明显超过cMRI-LGE区域,初步提示68Ga-FAPI PET/CT对早期鉴别纤维重构可能具有临床应用潜力.

Background: High-resolution optical coherence tomography can detect in situ thrombi within patent foramen ovale (PFO), which can become a dangerous embolic source. This study aimed to investigate the frequency and size of in situ thrombus within PFO using optical coherence tomography. Methods: The cross-sectional study was conducted at Fuwai Hospital (Beijing, China) between 2020 and 2021. From 528 consecutive patients with PFO, 117 (age, 34.33 [SD, 11.30] years) without known vascular risk factors were included; according to PFO-related symptoms, they were divided into the stroke (n=43, including 5 patients with transient ischemic attack), migraine (n=49) and asymptomatic (n=25) groups. Optical coherence tomography was used to evaluate in situ thrombi and abnormal endocardium within PFO. Univariable analysis and a logistic model were used to evaluate the association between stroke and in situ thrombus; age, sex, body mass index, and antithrombotic therapy were included as covariates. Results: Antithrombotic therapy was used more frequently in the stroke group than in the migraine group (76.7% versus 12.2%; P<0.001). In situ PFO thrombi were detected in 36 (83.7%), 28 (57.1%), and 0 (0.0%) patients from the stroke, migraine, and asymptomatic groups, respectively (P<0.001). Between the stroke and migraine groups, there was no significant difference in the median (interquartile range) thrombus number per patient (7 [3–12] versus 2 [0–10]; P=0.199), maximum thrombus diameter (0.35 [0.20–0.46] versus 0.21 [0–0.68] mm; P=0.597), or total thrombus volume (0.02 [0.01–0.05] versus 0.01 [0–0.05] mm3; P=0.386). Additionally, in situ thrombus was significantly associated with stroke risk (odds ratio, 4.59 [95% CI, 1.26–16.69]). Abnormal endocardium within PFO occurred in patients with in situ thrombi (71.9%) but not in those without. During optical coherence tomography examination, migraine occurred in 2 patients with in situ thrombi. Conclusions: The frequency of in situ thrombus was extremely high in stroke and migraine groups, while none of the asymptomatic individuals presented with an in situ thrombus. In situ thrombus formation may play a role in patients with PFO-associated stroke or migraines and have therapeutic implications. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04686253.

Background:Transcatheter closure of inferior sinus venosus defect (ISVD) is still contraindication. To explore whether transcatheter closure with patent ductus arteriosus (PDA) occluders is possible for ISVD.Methods:From June 2014 to March 2021, 12 patients were recruited diagnosed as <25 mm ISVD. The three-dimensional printing (3DP) heart model was produced based on multi-slice computed tomography (MSCT) scans. Preoperative closure simulation was planned on the personalized 3D model for each patient. Follow-up including electrocardiography (ECG), transthoracic echocardiography (TTE), and X-ray was traced.Results:3DP models of 12 patients were successfully printed. Twelve patients had been diagnosed with <25 mm ISVD and 4 of them had another secundum atrial septal defect (ASD). All patients were produced interventional therapy successfully. PDA occluder was implanted to closed ISVD, and ASD was closed using ASD occluder simultaneously. The average diameter of ISVD measured by TTE was (12.67±3.80), and the average diameter of sagittal axes and longitudinal axes measured by the 3D-printed model was (17.08±3.20) and (18.42±4.62) mm, respectively. The average size of PDA (diameter of pulmonary artery side) was (28.17±3.35) mm. Compared with the preoperative, the X-ray cardiothoracic ratio (0.51±0.04 vs. 0.47±0.06, P=0.007) and the right ventricle anterior-posterior diameter (31.17±5.65 vs. 24.58±3.75 mm, P<0.001) of postoperative was significantly decreased. During the average (47.75±27.52) months follow-up, it has achieved satisfying results, and there were no severe adverse events such as device transposition, death, and pericardial tamponade occurred.Conclusions:Assisting by 3D heart model, transcatheter closure of ISVD with PDA occluder had an excellent outcome. This method provides a new considerable treatment strategy for ISVD.

Although balloon pulmonary angioplasty (BPA) has emerged as an alternative treatment option for chronic thromboembolic pulmonary hypertension (CTEPH), it is followed in some patients by residual PH. We studied the efficacy of BPA on pulmonary blood flow and the predictive value of ventilation/perfusion (V/Q) scanning. We retrospectively reviewed the clinical database, which included patients diagnosed with CTEPH who had received BPA. All patients undergone V/Q scanning to quantify the extent of pulmonary perfusion abnormality before and after BPA. Pulmonary hemodynamics were assessed by right heart catheterization, and cardiac function and exercise capacity were evaluated at baseline and post-BPA. A total of 120 CTEPH patients were included for analysis. BPA significantly alleviated mean pulmonary arterial pressure (mPAP: 48.0 ± 12.9 mmHg vs 34.7 ± 10.3 mmHg, P < 0.001) and pulmonary vascular resistance (PVR: 8.8 ± 4.1 Wood units vs 5.2 ± 3.0 Wood units, P < 0.001), and improved cardiac function (N-terminal pro B-type natriuretic peptide: 1628.7 ± 2887.2 pg/mL vs 400.4 ± 669.3 pg/mL, P < 0.001) and exercise capacity (6-minute walking distance: 386 ± 122 m vs 461 ± 86 m, P < 0.001). The extent of pulmonary perfusion abnormality represented by the percentage of perfusion defects (PPDs%) was improved after BPA (50.1 ± 13.6 vs 35.6 ± 14.2, P < 0.001), with the right and inferior lung lobes benefitting the most. PPDs% < 35.5 at baseline and greater restoration of PPDs% after BPA (∆PPDs% > 20.6) were associated with a better response to BPA (PPDs% < 35.5: odds ratio [OR] 10.857, 95% confidence interval [95%CI] 1.393–84.635, P = 0.023; ∆PPDs% > 20.6: OR 1.035, 95% CI 1.002–1.068, P = 0.036). BPA significantly restored pulmonary blood flow, predominantly in the right and inferior lobes. V/Q scanning has the potential to predict the therapeutic response to BPA for CTEPH.

Objective:To explore the feasibility of three-dimensional CT axial sequence assisted volumetric measurement (CTAS) in evaluating atrial septal defect (ASD).Methods:The patients with single secundum ASD who successfully underwent interventional therapy in Fuwai Hospital from January 2016 to December 2019 were retrospectively collected. The patients underwent coronary CT angiography (CTA) before and on the second day after closures, and DSA examinations during operation. A total of 52 cases met the inclusion conditions, among them, there were 37 patients with large defects which had deficient inferior rims ≤3 mm, and 15 patients with severe pulmonary arterial hypertension that occluded with fenestrated ASD occluder. The CT data of patients before and after operation were reconstructed by CTAS. Then the anatomical structure of ASD before the operation was evaluated, including the long diameter and short diameter of ASD, and the CT three-dimensional volume diameter of ASD was calculated by using the equivalent circle conversion formula of ellipse. The waist diameter of occluder and rims of the ASD were measured after occlusion on postoperative CT three-dimensional volume reconstruction images. Meanwhile, the deployed occluder waist dimension was measured in DSA examination during the operation by simulating the balloon measurement of ASD. Lastly, paired t-test and consistency analysis were carried out among the values of parameters. Results:Before operation, the equivalent circle diameter of ASD was (32.3±5.4) mm measured by CTAS. After ASD occlusion, the size of the waist dimension measured by DSA and CTAS were (32.5±4.9) mm and (32.6±4.9) mm. There were no significant differences between them ( P>0.05). There were also no significant differences for each rims of the ASD pre and post operation on CTAS except for the inferior rims and the total length of atrial septum in superior-inferior direction ( P>0.05). Conclusion:As an alternative to balloon sizing, CTAS can be used as a reference standard to conduct ASD interventional treatment.

Background Positron emission tomography (PET) imaging with radiolabeled fibroblasts activation protein inhibitor (FAPI) provides the opportunity to directly visualize fibrosis. This study aimed to investigate the feasibility of 68 Ga-FAPI PET imaging in assessing right ventricular (RV) fibrotic remodeling and the relationship between FAPI uptake with parameters of pulmonary hemodynamics and cardiac function in pulmonary arterial hypertension (PAH) patients. Methods In this pilot study, sixteen PAH patients were enrolled to participate in cardiac 68 Ga-FAPI PET/CT imaging. All patients underwent right heart catheterization and echocardiography for assessment of pulmonary hemodynamics and cardiac function within seven days. Cardiac FAPI uptake was visually assessed and quantified as maximum standardized uptake value (SUVmax). Results Twelve PAH patients exhibited FAPI uptake in RV free wall and insertion point. The overall activity of FAPI accumulated in the RV free wall (SUVmax: 2.5 ± 1.8, P < 0.001) and insertion point (SUVmax:2.5 ± 1.7, P < 0.001) was significantly upregulated compared to left ventricle (SUVmax:1.5 ± 0.5). Patients with tricuspid annular plane systolic excursion (TAPSE) < 17 mm presented significantly higher uptake than those with TAPSE ≥ 17 mm in both RV free wall (SUVmax: 3.4 ± 1.9 vs 1.7 ± 1.1, P = 0.010) and insertion point (SUVmax: 3.4 ± 1.9 vs 1.6 ± 0.7, P = 0.028), indicating RV uptake of FAPI was associated with RV dysfunction. There was significant positive correlation between cardiac FAPI uptake and total pulmonary resistance and the level of N-terminal pro b-type natriuretic peptide. Conclusions 68 Ga-FAPI PET/CT imaging is feasible to directly visualize fibrotic remodeling of RV in patients with PAH.

Objective Preclinical research suggests that the combined use of radiofrequency ablation and balloon dilation (CURB) could create stable interatrial communications without device implantation. This study examined the first in-human use of CURB for modified atrial septostomy in patients with severe pulmonary arterial hypertension (PAH). Methods Between July 2018 and October 2021, CURB was performed in 19 patients with severe PAH (age: 31.5±9.1 years; mean pulmonary artery pressure: 73 mm Hg (IQR: 66–92); pulmonary vascular resistance: 18.7 Wood units (IQR: 17.8–23.3)). Under guidance of intracardiac echocardiography and three-dimensional location system, (1) fossae ovalis was reconstructed and ablated point-by-point with radiofrequency; (2) then graded balloon dilation was performed after transseptal puncture and the optimal size was determined according to the level of arterial oxygen saturation (SatO 2 ); (3) radiofrequency ablation was repeated around the rims of the created fenestration. The interatrial fenestrations were followed-up serially. Results After CURB, the immediate fenestration size was 4.4 mm (IQR: 4.1–5.1) with intracardiac echocardiography, systolic aortic pressure increased by 10.2±6.9 mm Hg, cardiac index increased by 0.7±0.3 L/min/m 2 and room-air resting SatO2 decreased by 6.2±1.9% (p<0.001). One patient experienced increased pericardiac effusion postoperatively; the others had no complications. On follow-up (median: 15.5 months), all interatrial communications were patent with stable size (intraclass correlation coefficient=0.96, 95%CI:0.89 to 0.99). The WHO functional class increased by 1 (IQR: 1–2) (p<0.001) with improvement of exercise capacity (+159.5 m, P<0.001). Conclusion The interatrial communications created with CURB in patients with severe PAH were stable and the mid-term outcomes were satisfactory. Trial registration number NCT03554330 .