Transcatheter aortic valve replacement (TAVR) is contraindicated for rheumatic aortic stenosis (RAS). Evidence on the efficacy and safety of TAVR is scarce despite several cases of RAS recorded in China. This study aimed to evaluate the efficacy of TAVR in patients with RAS. A total of 359 patients were enrolled and divided into the RAS ( n = 71) and non-RAS ( n = 288) groups according to the World Heart Federation guidelines for rheumatic heart disease combined with computed tomography imaging. Propensity score matching was performed to ensure comparability between groups. A self-expanding valve was used in all the patients. Primary endpoints included technical success, device success, and 1-year composite outcomes. Short-term complications and anatomical differences were analysed. Patients with RAS had higher N-terminal pro-B-type natriuretic peptide levels and Society of Thoracic Surgeons scores, higher atrial fibrillation rates, and worse cardiac metrics (enlargement, valve regurgitation, and lower estimated glomerular filtration rates). The patients in the RAS group had fewer bicuspid valves, less calcification, more elliptical annuli, and larger left ventricular outflow tract/annulus area ratios. The RAS group had a higher prosthesis positioning and oversizing rate. Technical success, device success, and early safety rates were similar between groups. However, the RAS group had a higher pacemaker implantation and transcatheter heart valve displacement (THVD) risk, yet demonstrated superior 1-year outcomes. TAVR may be safe and effective for the treatment of RAS. The anatomical characteristics of patients with RAS increased the risk of THVD and pacemaker implantation. A high-release strategy and appropriate oversizing could partially alleviate the risk of THVD. TAVR, transcatheter aortic valve replacement; RAS, rheumatic aortic valve stenosis.

Background It is currently unclear whether erythropoietin (EPO) has value in predicting the prognosis of acute aortic syndrome (AAS). Methods A real-world analysis was conducted on the relationship between EPO and AAS outcomes. The primary end points were all-cause mortality and aortic-related mortality. The major adverse cardiac and cerebral events included all-cause mortality, acute myocardial infarction, stroke, and secondary procedures. Serum EPO concentration was examined using the Quantikine Human EPO ELISA. Results A total of 254 AAS patients were recruited, of whom 73 died. The median time of follow-up was 18.1 months. In Cox regression analysis, log EPO (hazard ratio [HR]: 2.491, P < 0.001), Stanford type A (HR: 3.003, P < 0.001), and treatment with surgery/thoracic endovascular aortic repair (TEVAR; HR: 0.283, P < 0.001) were independent predictors of all-cause mortality. In Kaplan-Meier curves, patients with EPO ≤16 IU/mL had significantly higher survival and event-free rates. Nomograms indicated that log EPO had the greatest contribution to AAS prognosis. In subgroup analysis, log EPO was an important prognostic indicator for patients with type A AAS and those treated without surgery/TEVAR. In correlation analyses, EPO was positively correlated with C-reactive protein, interleukin (IL)-4, IL-6, and monocytes and negatively correlated with albumin. The maximum diameter of the ascending aorta was positively correlated with EPO in AAS and aortic dissection (AoD) patients. The false lumen diameter and false lumen area were positively correlated with EPO in AoD patients. Conclusion The serum EPO level is closely associated with the adverse outcomes of AAS and has good prognostic value.

Aims:Macrophages play a crucial role in coronary artery plaque development and can be quantified as circumferential arc features via optical coherence tomography (OCT). However, the prognostic implications of macrophage arc characteristics remain underexplored. Methods and results:In this multicentre, retrospective study, consecutive patients with coronary artery disease (CAD) undergoing OCT between January 2017 and April 2023 were enrolled. The macrophage arc was evaluated using maximum arc, mean arc, and mean arc score (MAS) in the target vessel. Among 1025 patients (1173 vessels), 61 (5.9%) experienced major adverse cardiovascular events (MACEs). Receiver operating characteristic analysis identified optimal predictive thresholds: maximum arc ≥ 157.5°, mean arc ≥ 97.88°, and MAS ≥ 2.27 (all P < 0.001). Elevated mean arc [hazard ratio (HR) = 7.628, P < 0.0001], maximum arc (HR = 6.902, P < 0.0001), and MAS (HR = 6.704, P < 0.0001) were independently associated with MACEs. When combined with thin-cap fibroatheroma (TCFA) status, these parameters demonstrated enhanced predictive power: mean arc ≥ 97.88° + TCFA (HR = 8.779, P < 0.0001), maximum arc ≥ 157.5° + TCFA (HR = 8.149, P < 0.0001), and MAS ≥ 2.27 + TCFA (HR = 7.509, P < 0.0001). Notably, among TCFA-negative patients, a mean arc ≥ 97.88° showed markedly improved predictive capacity for MACEs (HR = 6.685, P < 0.001), as did maximum arc ≥ 157.5° (HR = 4.490, P < 0.001) and MAS ≥ 2.27 (HR = 5.126, P < 0.001). Conclusion:Macrophage arc parameters are strongly associated with long-term cardiovascular risk, serving as novel OCT-derived biomarkers for patients with CAD.

BACKGROUND:Macrophages are key drivers of coronary artery plaque development and can be detected via optical coherence tomography as circumferential regions. However, the association between macrophage arc and plaque vulnerability remains unclear. OBJECTIVES:The objective of the study was to evaluate the correlation between macrophage arc and vulnerable plaques. METHODS:This multicenter, retrospective study enrolled consecutive patients with coronary artery disease who underwent optical coherence tomography (January 2017-April 2023). Macrophage arc was evaluated using maximum arc, mean arc, and mean arc score (MAS) in the target vessel. The mean arc and MAS were calculated as the total detectable macrophage arc or score of each frame, divided by imaged vessel segment length (mm). Furthermore, the association between macrophage arc, plaque vulnerability, and acute myocardial infarction (AMI) at admission was investigated. RESULTS:Overall, 1,129 patients (1,278 vessels; 1,525 vulnerable plaques) were enrolled. The macrophage arc was significantly increased in cases of plaque rupture (PR), thin-cap fibroatheroma (TCFA), and AMI cases (P < 0.0001). Both the mean arc and MAS were markedly higher in regions adjacent to PR or TCFA compared with the entire segment (P < 0.0001). Multivariate analyses demonstrated that maximum arc, mean arc, and MAS were correlated with PR, TCFA, and AMI. Receiver operating characteristic analysis identified optimal cutoff values-maximum arc ≥156.5°, mean arc ≥78.89°/mm, and MAS ≥2.34-each significantly associated with PR, TCFA, and AMI, respectively (all P < 0.001). CONCLUSIONS:Macrophage arcs are associated with plaque vulnerability and AMI. Further external validation and prospective studies are needed to confirm these observations.

AIMS:Previous analyses of the relationship between blood pressure (BP) and heart failure (HF) outcomes have primarily used baseline values rather than longitudinal measurements. We aimed to elucidate associations between longitudinal BP and clinical outcomes in patients with HF with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF). METHODS AND RESULTS:We conducted a comprehensive analysis of 28 406 patients from eight trials, evaluating time-dependent BP categorized by tertiles and per 10 mmHg increments in BP on outcomes. The primary endpoint was the time to the first occurrence of a composite endpoint comprising cardiovascular death or HF hospitalization. Multivariate Cox regression analysis revealed a J-shaped relationship between BP and the composite outcome in HFrEF. Specifically, compared with the middle-level systolic BP (SBP), low SBP was associated with a higher risk of the composite endpoint (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.60-1.82; p < 0.001) and high SBP showed a non-significant change in risk (HR 1.07, 95% CI 0.97-1.18; p = 0.187). Conversely, a U-shaped relationship was observed in HFmrEF and HFpEF. Low SBP was linked to a higher risk of the composite endpoint (HR 1.74, 95% CI 1.47-2.07; p < 0.001), and high SBP similarly increased the risk (HR 1.77, 95% CI 1.45-2.17; p < 0.001). CONCLUSIONS:The relationship between BP and HF outcomes is non-linear and closely tied to left ventricular ejection fraction. Low SBP consistently predicts a poor prognosis, whereas high SBP is associated with an increased risk in HFmrEF and HFpEF but not in HFrEF.

Endothelial-to-mesenchymal transition (EndoMT), a widely recognized biological process leading to abnormal endothelial function, has been implicated in various cardiovascular pathologies. DEAD-box proteins represent the largest family of RNA helicases associated with multiple physiological and pathophysiological processes; however, their role in the homeostasis of endothelial cells (ECs) remains largely unexplored. Here, we show that the levels of DEAD-box protein 3 X-linked (DDX3X), a DEAD-box RNA helicase protein, were significantly increased during EC transition in vivo and in vitro. DDX3X overexpression promoted EndoMT as well as endothelial dysfunction and inflammation, whereas its downregulation effectively inhibited this transition in ECs. Mechanistically, elevated DDX3X resulted in downregulation of bone morphogenetic protein receptor type 2 (BMPR2), a protein that is pivotal for maintaining endothelial homeostasis and function. Furthermore, our co-immunoprecipitation assays demonstrated a molecular interplay between DDX3X and BMPR2. Importantly, DDX3X was shown to promote the lysosomal degradation of BMPR2, thereby interrupting its downstream signal transduction. These findings identify DDX3X as a novel regulator of EndoMT by modulating BMPR2 signaling.

Osteosarcoma is the most common primary malignant tumor of bone and occurs predominantly in children and adolescents during periods of accelerated skeletal growth. Within the tumor microenvironment (TME), vascular smooth muscle cells (VSMCs) may acquire osteogenic characteristics. Nuclear factor of activated T cells c1 (NFATc1) is central to skeletal biology, yet its behavior in VSMCs in osteosarcoma remains insufficiently defined. We profiled fresh osteosarcoma tissues by single-cell RNA sequencing on the 10x Genomics Chromium platform. Mechanical and enzymatic dissociation yielded single-cell suspensions; viable cells (> 85

Sodium–glucose cotransporter-2 inhibitors (SGLT2i) have been proven to prevent decline in kidney function and failure. Whether SGLT2i affect the risk of contrast-associated acute kidney injury (CA-AKI) remains uncertain. Use of SGLT2i was assessed in consecutive diabetics undergoing coronary angiography (CA) or percutaneous coronary intervention (PCI) from January 2020 to May 2023 at a tertiary hospital in Chongqing, China. Propensity-matched analysis was used to adjust for baseline variables. CA-AKI was defined by the Acute Kidney Injury Network (AKIN) as creatinine increase ≥ 0.3 mg/dl (26.4 μmol/l), or a percentage increase in the serum creatinine level of ≥ 50

Lipopolysaccharide (LPS) results in a lethal hypoglycemic response. However, the main molecular mechanism involved in LPS-induced glucose metabolism disorder is poorly understood. This study intends to investigate the signaling pathways involved in LPS-induced hypoglycemia and potential efficacy of extracellular signal-regulated kinase (ERK) inhibitor SCH772984. The effects of LPS and SCH772984 on gluconeogenesis, glucose absorption, and glycogenolysis were evaluated by pyruvate tolerance test, oral glucose tolerance test, and glucagon test, respectively. After a single intraperitoneal injection of 0.5 mg/kg LPS, the mice’s blood glucose levels and gluconeogenesis ability were significantly lower than that of control group. Besides, mRNA and protein expression of glucose-6-phosphatase (G6Pase) and phosphoenolpyruvate carboxykinase (PEPCK) decreased significantly after LPS treatment. LPS induced the phosphorylation of ERK1/2, MEK1/2 (mitogen-activated protein kinase), and Foxo1 while inhibited Foxo1 expression in the nucleus, indicating an important role of the MEK/ERK/Foxo1 signaling in the inhibition of gluconeogenesis by LPS. Furthermore, SCH772984 elevated blood glucose, increased the G6Pase and PEPCK expression, and inhibited pERK1/2 and pFoxo1 expression in LPS-induced mice. In summary, LPS inhibited gluconeogenesis and induced hypoglycemia through the MEK/ERK/Foxo1 signal pathway, and ERK inhibitor could effectively reverse decreased blood glucose in mice with LPS treatment. These findings provide a novel therapeutic target for LPS-induced hypoglycemia.

Aim: To identify the predictive role of triglyceride-glucose (TyG) index in pulmonary hypertension (PH) in coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI) treatment. Methods: Blood biomarkers have been measured at the cross-section of entrance. The baseline and followed-up echocardiography have been performed at both cross-sections. Results: The incidence of PH was 8.91%. The baseline myoglobin (MYO), was significantly higher among PH patients (p < 0.001). In the univariate regression, body mass index (BMI p = 0.020), left atria end-diastolic internal diameter (LAD, p = 0.083), creatinine (Cr, p = 0.005), triglyceride (TG, p < 0.001), high-density lipoprotein cholesterol (HDL-C, p = 0.056) and TyG index (p = 0.002) were potential predictors for PH. Finally, the adjusted COX regression indicated that BMI (p = 0.001), LAD (p = 0.030), Cr(p = 0.005) and TyG index (p = 0.002) were independent predictors of the onset of PH. Conclusion: Baseline TyG index, BMI, LAD, Cr level were independent predictors for PH in CAD patients after PCI treatment.

Background Scarce data exist regarding the occurrence of mitral valve interference after transcatheter aortic valve replacement (TAVR) with Venus-A valve implantation. Several case reports have noted that the anterior mitral leaflet (AML) is mechanically affected by the prosthesis frame, particularly when implanted in a low position. This study aimed to investigate the potential factors influencing the clinical outcomes of AML interference after Venus-A valve implantation.Methods We retrospectively included 20 severe aortic valve stenosis patients who had undergone TAVR and had been implanted with the Venus-A valve at our hospital between October 2020 and June 2021. Pre- and post-procedural CT scans were used for the FEops HEARTguide simulation. Anatomically influencing factors were measured using the 3mensio software and derived from the FEops HEARTguide. The prosthesis-AML interference (PAI) was defined when it met both of two criteria:1) significant interference and limited AML movement shown by transthoracic or transoesophageal echocardiography, and 2) more than half cell intersection between the simulated Venus-A valve and the reconstructed AML revealed by the FEops HEARTguide. Anatomical factors and clinical outcomes were compared between the PAI and non-PAI groups.Results Nine PAI patients and 11 non-PAI cases were identified. PAI was associated with shorter mitral-aortic annulus distance (2.7±1.7 mm vs 5.0±2.2 mm, P = 0.019), larger prosthesis valve size ( P = 0.013), deeper implantation (12.2±3.3 mm vs 6.2±2.9 mm at non-coronary cusp side, P < 0.001) and less calcification of non-coronary cusp (median calcification score, 52.2 mm3 vs 156.0 mm3, P = 0.046). Regarding the clinical impact, PAI was associated with a higher rate of moderate or severe perivalvular leakage before discharge than those associated with the absence of PAI, with no difference in haemodynamic parameters and incidence of adverse events at the 30-day and 12-month follow-ups between the groups.Conclusions Interference between the Venus-A prosthesis valve and AML after TAVR was associated with a shorter mitral-aortic annulus distance, larger prosthesis usage, greater implantation depth, and less calcification of the non-coronary cusp. However, further studies are required to explore its long-term clinical impact.### Competing Interest StatementNic Debusschere and Giorgia Rocatello are employees of Feops NV. Sihang Cheng is an employee of Venus Medtech. The other authors report no disclosures of competing interest.### Funding StatementThis work was funded by the Chongqing Talents Project (Jin Jun) and Young Doctor Incubation Program of Xinqiao Hospital (2022YQB094).### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This study was approved by the Research Ethics Committee of the Second Affiliated Hospital (Xinqiao Hospital) of the Army Military Medical University, and the requirement for informed consent was waived because of its retrospective design.I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesThe raw/processed data required to reproduce these findings cannot be shared at this time as the data also forms part of an ongoing study.

Aim To identify the predictive role of the TyG index for the onset of pulmonary hypertension in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI) treatment. Methods We performed this prospective cohort study among CAD patients who received PCI treatment in our center from July 2016 to October 2022. The baselines of echocardiography at both cross-sections and blood biomarkers. A coronary angiography operation was also performed. Within a median of 4.5 years of follow-up, the patients underwent echocardiography to measure their pulmonary hypertension (PH). Results Baseline BNP was statistically higher in the PH patients (p = 0.007). The baseline myoglobin (MYO), was significantly higher among PH patients (p < 0.001). Though the glucose level showed no difference between PH and non-PH groups, the HDL-C was in a lower level in the PH group (p = 0.033). However, TyG index showed no differences between PH and non-PH groups [6.95 (6.47-7.36) vs. 7.15 (6.49-7.96), p = 0.202]. In the univariate regression, cerebral infarction history, right atria end-diastolic internal diameter, MYO, triglyceride, HDL-C and TyG index (p < 0.05) were potential predictors for PH. Finally, the adjusted logistic regression indicated that cerebral infarction history (p = 0.39), MYO (p = 0.044) and TyG index (p = 0.048) were independent predictors of the onset of PH. Conclusion PH is prevalent in CAD patients after PCI treatment. The baseline TyG index, cerebral infarction history, and MYO level were independent predictors for PH in CAD patients after PCI treatment.

Objective:We aimed to explore the molecular mechanism of berberine in the treatment of calcified aortic valve disease through the network pharmacology-molecular docking method.Methods:The targets of berberine and calcified aortic valve disease were retrieved, the interactions between the targets were analyzed, Cytoscape software was used to build a "target-path" network, R language was used to conduct enrichment analysis of GO and KEGG pathways, and AutoDock Vina was used to verify the binding force of the target protein and small molecules.Results:96 targets for berberine and 4293 disease targets were screened through multiple databases, and 56 targets were identified through veen analysis. The enrichment of PPI, GO, and KEGG pathways suggests that berberine may act on PIK3CD, PIK3CB, PIK3R1, MAPK14, MAPK10, and other targets, and regulate the role of calcified aortic valve disease through AGE-RAGE signaling pathway, Chemokine signaling pathway, Lipid and atherosclerosis, and other pathways. The docking results showed that berberine has good binding activity with the target on the key pathway AGE-RAGE signaling pathway.Conclusion:The network pharmacology preliminarily revealed the mechanism of berberine in the treatment of calcified aortic valve disease by regulating vascular calcification, inflammatory reaction, oxidative stress, and other effects, providing the basis for follow-up experimental research, and also providing the basis for clinical medication.

目的 探讨早发冠心病(PCHD)的危险因素,分析Nomogram预测模型对PCHD的预测价值.方法 回顾性分析自2020年5月至2021年8月陆军军医大学第二附属医院收治的620例疑诊为冠心病患者的临床资料.根据冠状动脉造影结果,将冠心病患者纳入PCHD组(n=502),未达冠心病诊断标准的患者纳入非冠心病(NCHD)组(n=118).比较两组临床指标.采用Logistic回归分析探讨PCHD的独立危险因素.构建Nomogram预测模型,绘制受试者工作特征(ROC)曲线和校正曲线,评估该预测模型的预测效能.结果 PCHD组男性比例、吸烟比例、糖尿病比例、高血压比例、体质量指数、超声颈动脉中膜厚度、白细胞计数、中性粒细胞计数、淋巴细胞计数、单核细胞计数、甘油三酯和纤维蛋白原均高于NCHD组,高密度脂蛋白胆固醇低于NCHD组,两组比较,差异均有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,吸烟、超声颈动脉中膜厚度、单核细胞计数、高密度脂蛋白胆固醇和纤维蛋白原是PCHD的独立危险因素(比值比分别为1.637、43.966、10.809、0.277、1.657,P＜0.05).预测 PCHD 的 Nomogram 模型总分为 34～146 分,对应 PCHD 的概率为 30％～99％.Nomo-gram 模型预测PCHD的ROC曲线下面积为0.750(95％可信区间0.701～0.799).结论 吸烟、超声颈动脉中膜厚度、单核细胞计数、高密度脂蛋白胆固醇和纤维蛋白原是PCHD的独立危险因素,整合这些指标构建的Nomogram模型对PCHD的预测效能较好.

急诊经皮冠状动脉内介入术(percutaneous coro-nary intervention,PCI)是治疗急性冠脉综合征的有效手段之一,其目的是尽快可靠地开通靶犯罪血管,重新建立有效的心肌灌注,从而挽救患者生命,改善其远期预后[1-2].

BackgroundTranscatheter aortic valve replacement (TAVR) in the treatment of patients with pure native aortic valve regurgitation (NAVR) has been based on the “off-label” indications, while the absence of aortic valve calcification and difficulty in anchoring was found to significantly increase the risk of prosthesis malposition. The aim of this study was to explore the anatomical predictors of severe prosthesis malposition following TAVR with the self-expandable Venus-A Valve among patients with NAVR.MethodsA total of 62 patients with NAVR who underwent TAVR with Venus-A Valve at four Chinese clinical centers were retrospectively observed. The clinical features, aortic multidetector computed tomography (MDCT) data, and clinical outcomes were compared between non-/mild malposition and severe malposition groups. Univariate logistic regression analysis was used to identify the risk factors of severe prosthesis malposition, and the receiver operating characteristic (ROC) curve was used to explore the predictive value of the risk factors.ResultsValve migration to ascending aortic direction occurred in 1 patient, and the remaining 61 patients (including 19 severe malposition cases and 42 non-/mild malposition cases) were included in the analysis. The diameter and height of the sinotubular junction (STJ) and STJ cover index (STJCI, calculated as 100%*STJ diameter/nominal prosthesis crown diameter) were all greater in the severe malposition group (all p < 0.05). Logistic regression showed that STJ diameter (OR = 1.23, 95% CI 1.04–1.47, p = 0.017), STJ height (OR = 1.24, 95% CI 1.04–1.47, p = 0.017), and STJCI (OR = 1.08, 95% CI 1.01–1.16, p = 0.032) were potential predictors for severe prosthesis malposition. The area under the ROC curve was 0.72 (95% CI 0.58–0.85, p = 0.008) for STJ diameter, 0.70 (95% CI 0.55–0.86, p = 0.012) for STJ height, and 0.69 (95% CI 0.55–0.83, p = 0.017) for STJCI, respectively. The cutoff value was 33.2 mm for STJ diameter (sensitivity was 84.2% and specificity was 65.8%), 24.1 mm for STJ height (sensitivity was 57.9% and specificity was 87.8%), and 81.0% for STJCI (sensitivity was 68.4% and specificity was 68.3%), respectively.ConclusionLarger and higher STJ, as well as greater STJ to valve crown diameter ratio, may help identify patients at high risk for severe prosthesis malposition among patients with NAVR undergoing TAVR with Venus-A prosthesis valve.

Background Social app-assisted education and support may facilitate diabetes self-management. We aim to evaluate the effect of WeChat, a popular social app, on glycemic control in patients with coronary heart disease (CHD) and diabetes mellitus (DM). Methods We conducted a parallel-group, open-label, randomized clinical trial that included 160 patients with both CHD and diabetes mellitus from a tertiary hospital in China. The intervention group (n = 80) received educational materials (information on glucose monitoring, drug usage, medication, and lifestyle) and reminders in response to individual blood glucose values via WeChat. The control group (n = 80) received usual care. The primary outcome was a change in glycated hemoglobin (HbA1C) levels over 3 months. Secondary outcomes included fasting blood glucose (FBG), systolic blood pressure, and low-density lipoprotein (LDL) cholesterol from baseline to 3 months. Analysis was conducted using a linear mixed model. Results The intervention group had a greater reduction in HbA1C (−0.85 vs. 0.15%, between-group difference: −1.00%; 95% CI −1.31 to −0.69%; p < 0.001) compared with the control group. Change in fasting blood glucose was larger in the intervention group (−1.53 mmol/L; 95% CI −1.90 to −1.17; p < 0.001) and systolic blood pressure (−9.06 mmHg; 95% CI −12.38 to −5.73; p < 0.001), but not LDL (between-group difference, −0.08 mmol/L; 95% CI −0.22 to 0.05; p = 0.227). Conclusion The combination of social app with education and support resulted in better glycemic control in patients with CHD and DM. These results suggest that education and support interaction via social app may benefit self-management in CHD and DM.

There is scant information about the incidence, risk factors, and outcomes of coronary obstruction (CO) following valve-in-valve transcatheter aortic valve replacement (VIV-TAVR). A meta-analysis of the published studies from January 2000 to April 2020 was conducted, and the endpoint was CO. A total of 2858 patients were enrolled in this study. The mean age was 77.7 ± 9.8, and 39.9% of them were female. The Society of Thoracic Surgeons (STS) score, European System for Cardiac Operative Risk Evaluation (EuroSCORE), and Logistic EuroSCORE were 8.9 ± 7.8, 16.0 ± 10.9, and 26.3 ± 16.3, respectively. The overall incidence of CO was 2.58%. CO incidence between patients with prior stented and stentless valves were significantly different (1.67% versus 7.17%), with an odds ratio (OR) of 0.25 and a 95% confidence interval (CI) of 0.14-0.44 (P < 0.00001). The first-generation valves were significantly associated with higher CO incidence compared with the second-generation valves (7.09% versus 2.03%; OR, 2.44; 95%CI, 1.06-5.62; P = 0.04), while no statistical difference was found between self-expandable valves and balloon-expandable valves (2.45% versus 2.60%; OR, 0.99; 95%CI, 0.55-1.79; P = 0.98). Virtual transcatheter to coronary ostia (VTC) distance (3.3 ± 2.1 mm, n = 29 versus 5.8 ± 2.4 mm, n = 169; mean difference, -2.70; 95%CI, -3.46 to -1.95; P < 0.00001) and the sinus of Valsalva (SOV) diameter (27.5 ± 3.8 mm, n = 23 versus 32.3 ± 4.0 mm, n = 101; mean difference, -3.80; 95%CI, -6.55 to -1.05; P = 0.007) were enormously shorter in patients with CO. The 24-hour, in-hospital, and 30-day mortality of patients with CO were 10.5%, 30.8%, and 37.1%, respectively. In conclusion, device selections, VTC distances, and SOV diameters may be important factors in assessing the CO risk in VIV-TAVR.

Objective To investigate the anatomic factors influencing the implantation depth (ID) of self-expandable valve during transcatheter aortic valve replacement (TAVR) surgery, and to analyze the impact of ID on the short-term clinical prognosis. Methods Clinical data of 54 patients with severe aortic stenosis who underwent TAVR in our hospital from October 2017 to May 2020 were collected and retrospectively analyzed. The anatomic diameter of aortic root and its ratio to the implanted valve size was measured and calculated, and the depth of the valve implanted was also measured. The patients were assigned into either over-implanted group (>14.8 mm, the highest quartile of ID) or well-implanted group (≤14.8 mm) based on the ID of their valve. The differentiation of anatomical structures was compared between the 2 groups. Additionally, the impacts of ID on the clinical outcomes such as hemodynamics and conduction block were analyzed. Results There were 21 cases of bicuspid aortic valve (BAV) and 33 cases of tricuspid aortic valve (TAV), and the ID of valve was 0~21 mm, with a median of 11.6 mm. Among the BAV patients, the average diameter of sinotubular junction (STJ) was significantly larger in the over-implanted group than the well-implanted group (36.06±2.29 vs 29.69±2.55 mm, P=0.001). As for the TAV patients, the over-implanted group had a higher proportion of large prosthesis implantation (100.0% vs 26.9%, P=0.025), and a smaller ratio of the length of the left ventricular output tract to the bottom diameter of the valve (0.99±0.03 vs 1.12±0.15, P=0.021) when compared with the well-implanted group. Postoperative mortality was comparable between the 2 groups (4.88% vs 15.38%, P=0.242). However, the incidence of being converted to open surgery was higher in the over-implanted group than the other group (15.4% vs 0%, P=0.055). In 1 week after TAVR, there were no statistical differences in the mean aortic valve gradient, maximum velocity, permanent pacemaker implantation rate, moderate or severe paravalvular leakage, or new-onset left bundle branch block (LBBB) between the 2 groups (P>0.05), whereas the incidence of new-onset LBBB (50.0% vs 13.3%, P=0.044) and paravalvular leakage (33.3% vs 0%, P=0.009) were higher in the over-implanted group on the 30th day. The early safety was inferior in the over-implanted group (69.2% vs 95.1%, P=0.025). Conclusion The anatomical structure of the aortic root and its ratio to the size of the implanted valve have a certain effect on the implantation depth of self-expandable prosthesis. The BAVs patients with greater STJ as well as those TAVs patients treated with larger size valve may be both correlated with increased risks of deep implantation. Over implantation of the valve may increase the risk of new-onset LBBB and moderate or severe paravalvular leakage in 1 month after operation, and thus compromise the early safety.

BACKGROUND: The aim of this study is to explore the role of atorvastatin in rescuing pulmonary artery hypertension (PAH) by inhibiting the AKT/ERK-dependent PDGF-BB/HIF-1α axis.METHODS: PAH model in rats was established by MCT induction, followed by Atorvastatin intervention. Pulmonary hemodynamic measurement and pulmonary morphological evaluation in rats were conducted. Human pulmonary artery smooth muscle cells (hPASMCs) were subjected to hypoxic exposure or PDGF-BB treatment, followed by atorvastatin induction. Relative levels of HIF-1α, p-ERK and p-Akt were detected. Viability and apoptosis were respectively determined by cell counting kit-8 (CCK-8) assay and flow cytometry.RESULTS: Atorvastatin protected PAH-induced increases in RVSP and Fulton's index in rats. Meanwhile, it inhibited vascular remodeling following PAH by downregulating HIF-1α and PDGF-BB. Hypoxia or PDGF-BB treatment in hPASMCs resulted in upregulation of p-ERK and p-Akt, and viability increase, which were partially abolished by Atorvastatin intervention. In addition, atorvastatin triggered apoptosis in hypoxia or PDGF-BB-induced hPASMCs.CONCLUSIONS: Atorvastatin inhibits the activation of HIF-1α and proliferative ability, and triggers apoptosis in hPASMCs exposed to hypoxia or PDGF-BB treatment through inactivating the AKT/ERK pathway.