BACKGROUND:Hypertension (HTN) is a major risk factor for cardiovascular diseases, with chronic low-grade inflammation emerging as a critical contributor to its development and target organ damage. Emerging evidence implies gut microbiota in blood pressure regulation. However, the long-term impact of patient-derived gut dysbiosis on the chronic progression of HTN remains insufficiently characterized. This study aimed to determine how HTN-associated gut microbiota contributes to sustained blood pressure elevation and target organ damage during long-term colonization, and to elucidate underlying immune-metabolic mechanisms using multi-omics analyses. Fecal microbiota from hypertensive patients or normotensive controls were transplanted into germ-free mice, followed by continuous monitoring for 10 weeks to mimic the long-term adaptive remodeling of humanized microbiota within the host. Temporal dynamics of gut microbiota were assessed by 16S rRNA sequencing. Integrated metabolomic and transcriptomic analyses were performed on intestinal, cardiac, fecal, and serum samples. FMT from hypertensive patients induced sustained systolic blood pressure elevation and structural damage in target organs. HTN-FMT mice exhibited reduced microbial diversity and a dysbiotic signature characterized by enrichment of pro-inflammatory taxa and depletion of beneficial commensals. Metabolomic profiling revealed marked disturbances in polyunsaturated fatty acids metabolism. These metabolic alterations were accompanied by enhanced CD4⁺ T cell activation, elevated systemic inflammatory cytokines, and concordant enrichment of interleukin-17 signaling pathways in both intestinal and myocardial transcriptomes. These findings reveal interactions among gut dysbiosis, metabolic imbalance, and immune activation during long-term colonization with HTN-associated microbiota, underscoring the central role of the gut-immune axis in the chronic progression of hypertensive target organ injury.

BACKGROUND:The routine implementation of heart teams for patients with complex coronary artery disease (CAD) is challenging due to the insufficient multidisciplinary specialist resources for face-to-face discussion. A real-time heart team during the angiography, based on an online meeting, offers the potential to efficiently integrate resources. OBJECTIVES:In this study, we sought to evaluate the implementation value and safety of a "real-time heart team" decision making approach. METHODS:This noninferiority randomized controlled trial enrolled patients with de novo left main or 3-vessel CAD at 3 cardiac centers. Patients were randomly assigned to the conventional heart team group (discussed by a face-to-face meeting after the angiography) or the real-time heart team group (discussed by an online meeting during the angiography). Implementation value outcomes included care efficiency (waiting time for treatment, recatheterization, specialist workload, and economic outcomes) and process evaluation metrics (discussion adequacy, surgeon participation, and shared decision making). The safety outcomes were a composite of 1-year major adverse cardiovascular and cerebrovascular events (MACCE) (including all-cause mortality, myocardial infarction, stroke, unplanned revascularization, and readmission due to reangina) and revascularization decision making. RESULTS:Overall, 490 complex CAD patients were included, with 245 patients in each group. Waiting time for final therapy (median: 2 days [Q1-Q3: 0-7 days] vs 5 days [Q1-Q3: 2-10 days]; P < 0.001), recatheterization rate (12.5% vs 98.9%; P < 0.001), specialist high workload rate (5.3% vs 29.0%; P < 0.001), and percutaneous coronary intervention (PCI) hospitalization cost (percentage of decrease: 18.0%; P < 0.001) were significantly reduced in the real-time group. More discussion time spent (4.0 ± 1.8 min vs 3.4 ± 1.6 min), better specialist satisfaction (based on NASA Task Load Index scale), more chief surgeon participation (26.5% vs 18.8%), but less multidisciplinary synchronous shared decision making (2.0% vs 11.5%) were found in the real-time group. The real-time heart team group was noninferior to the conventional group in 1-year MACCE (8.2% vs 10.6%; risk difference: -2.45%; 95% CI: -7.61%-2.71%; P for noninferiority < 0.001). The proportions of PCI, coronary artery bypass grafting, and medical therapy were similar between the 2 groups (P = 0.892). CONCLUSIONS:Compared with the conventional heart team, the real-time heart team significantly improved care efficiency and process evaluation metrics, with similar clinical outcomes and decision making. However, insufficient shared decision making and intercenter generalizability should be optimized before widespread implementation of this approach. (Feasibility and Effectiveness of a Real-Time Heart Team Approach in Complex CAD [EHEART; NCT05514210]).

BACKGROUND AND AIMS:While surgical left atrial appendage occlusion (SLAAO) reduces stroke in atrial fibrillation (AF) patients, its efficacy in patients without pre-operative AF but with CHA₂DS₂-VASc ≥2 remains uncertain despite their high post-operative AF risk (15-54%). The aim of this study was to evaluate whether prophylactic SLAAO reduces post-operative thrombo-embolic events in valvular surgery patients. METHODS:The OPINION was a multicentre, open-label, randomized, superiority trial conducted at three cardiac surgery centres in China. Eligible non-AF patients with CHA₂DS₂-VASc ≥2 and an indication for valve repair or replacement due to mitral or aortic valve lesions were randomly assigned (1:1) to undergo SLAAO (intervention arm) or not undergo SLAAO (control arm) during surgery. The primary outcome was a composite of ischaemic stroke, transient ischaemic attack (TIA), or cardiovascular mortality assessed at 1 year. The primary analysis was done in the intention-to-treat population. RESULTS:Between April 2021 and June 2024, a total of 2157 patients were enrolled and randomized. After exclusion of 39 patients who withdrew informed consent, 2118 participants were included in the intention-to-treat population (1062 in the SLAAO group and 1056 in the control group). Baseline characteristics were well-balanced between the SLAAO group and control group (mean age 55.5 [11.4] vs 55.6 [11.5] years, P = .65; female 32.9% vs 32.3%, P = .78; CHA2DS2-VASc score 2.88 [0.98] vs 2.87 [0.96], P = .83; median EuroSCORE II 1.58% [1.42%] vs 1.56% [1.28%], P = .74). The 1-year primary endpoint occurred in 73 (6.9%) patients in the SLAAO group and in 87 (8.2%) patients in the control group (hazard ratio 0.83; 95% confidence interval 0.61-1.14; P = .25). CONCLUSIONS:For valvular surgery patients with CHA₂DS₂-VASc scores ≥2 but no pre-operative AF, routine prophylactic left atrial appendage closure did not significantly reduce the incidence of the primary composite endpoint (ischaemic stroke, TIA, and cardiovascular mortality) at 1-year follow-up. TRIAL REGISTRATION:ChiCTR.org registry ChiCTR2100042238.

Background: Gastrointestinal bleeding events represent a serious complication after coronary revascularization. In recent years, hybrid coronary revascularization (HCR) has gradually become one of the main surgical methods for multivessel coronary artery disease. This study aimed to identify risk factors for gastrointestinal bleeding following one-stop HCR. Method: This single-center retrospective study included 231 patients with coronary artery disease who underwent one-stop HCR between April 2018 and April 2023. Baseline conditions and perioperative parameters of patients were collected from electronic medical records; gastrointestinal bleeding events were documented, and retrospective statistical analyses were performed. Results: Among the 231 patients, 12 experienced gastrointestinal bleeding events, yielding an incidence rate of 5.2%; three patients died due to gastrointestinal bleeding, corresponding to a mortality rate of 25.0% among patients with bleeding events. Compared with patients without bleeding events, those with gastrointestinal bleeding had significantly higher rates of prior cerebrovascular disease (50.0% vs. 21.0%), preoperative creatinine (defined as the last serum creatinine measured within 24 h before surgery) (78.5 vs. 67.7 μmol/L), perioperative total blood transfusion volume during the period (600 vs. 0 mL), perioperative blood transfusion >5 units (33.3% vs. 8.7%), intraoperative bleeding volume (400 vs. 200 mL), total postoperative drainage volume (1453 vs. 1160 mL), mechanical ventilation time (18.0 vs. 16.0 h), and mortality (25.0% vs. 3.2%) (all p < 0.05). Single-factor and multi-factor regression analyses identified prior cerebrovascular disease (CVD) as an independent risk factor for gastrointestinal bleeding (odds ratio (OR) = 3.754, 95% confidence interval (CI) = 1.202–11.724; p = 0.023). Mortality was significantly higher in the gastrointestinal bleeding group than in the control group. Conclusion: Previous cerebrovascular disease is a risk factor for gastrointestinal bleeding after one-stop HCR. In such patients, antiplatelet strategies should be appropriately adjusted to prevent and reduce gastrointestinal bleeding. However, the number of events in our study was limited, and future studies should incorporate larger sample sizes to validate these findings.

Objective: The objective was to evaluate the relationship between carotid stenting and off-pump coronary artery grafting (CAS-OPCABG) and OPCABG only in patients with asymptomatic severe carotid stenosis. Methods: This study retrospectively included 669 patients with asymptomatic severe carotid artery stenosis who underwent OPCABG at multiple centers. After propensity score matching for baseline characteristics, the study compared two groups of patients with clinical data, early and midterm death, stroke, and myocardial infarction (MI). Results: After matching, there was no significant difference between two groups at baseline. The rates of early stroke, midterm stroke, and intensive care unit (ICU) stay were significantly lower in the CAS OPCABG group, yet the use of the internal mammary artery (IMA) was comparatively lower. Kaplan-Meier analysis revealed that there was no significant difference in midterm mortality between two groups. In the bilateral asymptomatic carotid stenosis subgroup, the early stroke rate was significantly lower after CAS-OPCABG, but there was no significant difference in the unilateral carotid stenosis subgroup. Multivariate logistic regression analysis identified previous atrial fibrillation, previous stroke, aortic atherosclerosis, bilateral carotid stenosis and the use of an intra-aortic balloon pump (IABP) as significant risk factors for early postoperative stroke, CAS emerged as a protective factor. Use of IMA was found to be a protective factor against postoperative mortality. Conclusions: CAS-OPCABG is an efficacious and safe approach for the treatment of asymptomatic severe carotid artery stenosis, effectively decreasing the incidence of postoperative stroke.

BACKGROUND:In 2012, the randomised trial IABP SHOCK II demonstrated that IABP did not reduce 30-day mortality in patients with acute myocardial infarction complicating cardiogenic shock (CS). However, SCAI proposed a new standardised classification of cardiogenic shock in 2019. It is reasonably hypothesised that the use of IABP may have different benefits for patients in different stages of CS. METHODS:AMI patients ≥18 years who had received treatment of implantation of IABP during emergency setting in Beijing Chaoyang Hospital between December 2010 and July 2021 were enrolled in this study. CS stages were classified at admission for all eligible cases. During the same period, AMI patients without implantation of IABP were matched with each stage of CS above using propensity score matching (PSM). Data were as follows: Stage B (n = 302), Stage C (n = 290), Stage D (n = 68), and Stage E (n = 32). In-hospital mortality was compared between using and without using IABP at each stage. RESULTS:In stage C, the in-hospital mortality was significantly lower in the IABP group (31/145, 21.4%) than in the group without IABP (47/145, 32.4%) (OR 0.567, 95% CI, p = .034). In-hospital mortality had no significant difference between use and no-use of IABP in stage B (16.6% vs 14.6%, p = .634), stage D (47.1% vs 38.2%, p = .462), and in stage E (81.3%vs 68.8%, p = .414). CONCLUSIONS:For patients with acute myocardial infarction complicating cardiogenic shock, IABP has no effect on in-hospital mortality in SCAI stages B, D, and E. However, in SCAI stage C, IABP can reduce in-hospital mortality.

Little is known about how acute myocardial infarction (AMI) mortality has changed over the past two decades in young US adults. We aimed to evaluate the AMI mortality trend among young adults in the US from 1999 to 2020. Data were extracted from the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Young adults aged 15–44 years with AMI listed as a contributing or underlying cause of death were included. Joinpoint regression was used to estimate the annual percent changes (APCs) and average annual percentage changes (AAPCs) in AMI-related age-adjusted mortality rates (AAMRs). There were 81,272 AMI-related deaths among young adults. The overall AAMR shows a stable trend from 1999 to 2003 (APC 0.2%); a steeper decrease from 2003 to 2009 (APC -4.2%); a steady decrease from 2009 to 2018 (APC -1.8%); and a significant increase from 2018 to 2020 (APC 7.3%); with an AAPC of -1.3% per year (95% CI -2.0% to -0.5%). The AAMR significantly decreased among men (AAPC -1.5%; 95% CI -2.2% to -0.7%), women (AAPC -1.0%; 95% CI -2.4% to -0.4%), non-Hispanic White (AAPC -1.9%; 95% CI -2.6% to -1.1%), and non-Hispanic or African American (AAPC -1.2%; 95% CI -1.8% to -0.6%). Across all geographical regions, the AAMR declined, most significantly in large metropolitan areas (AAPC -1.8%; 95% CI -2.7% to -0.8%). In conclusion, AMI mortality rates among young adults mostly declined from 1999 to 2020, with significant demographic and geographic variation.

Background:Atelectasis is a common complication after minimally invasive direct coronary artery bypass grafting (MIDCABG), which can lead to hypoxemia and even life-threatening conditions. This study aimed to compare the efficacy of prone vs. supine lung recruitment maneuvers in patients undergoing MIDCABG. Methods:This retrospective study included 170 patients who underwent MIDCABG and developed hypoxemia due to atelectasis during postoperative invasive mechanical ventilation in the cardiac surgical intensive care unit (CSICU). Patients were randomized into prone and supine groups. Clinical recovery indicators and physiological and laboratory parameters at different time points were compared between the two groups. Multiple linear regression was used to analyze the effect of different lung recruitment strategies on the improvement of the oxygenation index. Subgroup analyses were conducted to assess whether the effect of prone vs. supine lung recruitment on oxygenation improvement varied across different patient populations. Results:Prone-position lung recruitment significantly reduced hospital stay, extubation time, time to first ambulation, time to first flatus, duration of mechanical ventilation, and duration of non-invasive oxygen therapy. Lung recruitment strategies significantly improved oxygenation index, carbon dioxide elimination, heart rate control, and inflammatory markers, with the prone group showing superiority at multiple key time points. Multiple linear regression indicated that the prone lung recruitment strategy significantly enhanced the improvement of the oxygenation index, and this effect remained robust after adjusting for age, sex, BMI, and baseline comorbidities. Subgroup analyses revealed that the beneficial effect of prone lung recruitment was more pronounced in patients without diabetes and those with a history of PCI. Conclusion:Lung recruitment significantly improves oxygenation, carbon dioxide clearance, heart rate control, and inflammatory markers in MIDCABG patients with postoperative atelectasis, with the prone strategy being more effective than the supine. Multivariable and subgroup analyses confirmed the robustness of this effect, particularly in non-diabetic patients and those with a history of PCI.

To identify specific metabolites and metabolic pathways associated with coronary microvascular dysfunction (CMVD) and to evaluate the potential of differential metabolites from coronary and radial artery samples as diagnostic biomarkers, using coronary angiography-derived index of microcirculatory resistance (IMR) as the diagnostic reference. In this prospective study, 68 patients undergoing coronary angiography and IMR measurement were enrolled and divided into discovery (n = 40) and validation (n = 28) cohorts. Blood samples were collected from both coronary and radial arteries, and untargeted metabolomic analysis was performed using liquid chromatography-mass spectrometry. Ten differential metabolites were consistently identified in coronary artery samples across both cohorts; three metabolites (N-palmitoylglycine, L-gulose, and 3-hydroxybenzoic acid) were downregulated, and seven were upregulated in patients with abnormal IMR. Two metabolites (glycine and 2-hydroxyethanesulfonic acid) were consistently altered in radial artery samples. KEGG pathway enrichment analysis identified significant involvement in oxidative stress, amino acid biosynthesis, and fatty acid metabolism. Significant correlations were observed between specific metabolites and clinical parameters such as glycated hemoglobin levels, lipoprotein(a), body mass index, and inflammatory markers. Diagnostic models combining metabolites from both coronary and radial artery samples achieved an area under the ROC curve of 0.850 in the discovery cohort and 0.893 in the validation cohort. Metabolic alterations involving oxidative stress, inflammation, and energy metabolism are significantly associated with CMVD. Specific metabolites identified may serve as potential biomarkers for CMVD diagnosis. Combining metabolites from both coronary and radial artery samples enhances diagnostic accuracy, suggesting the feasibility of less invasive diagnostic approaches for CMVD.

OBJECTIVE:To assess the three year outcomes of the no-touch vein harvesting technique in coronary artery bypass grafting surgery compared with the conventional approach. DESIGN:Three year extended follow-up of the randomised PATENCY (graft patency between the no-touch vein harvesting technique and conventional approach in coronary artery bypass graft surgery) trial. SETTING:Seven cardiac surgery centres in China; enrolment between April 2017 and June 2019. PARTICIPANTS:2655 participants aged 18 and older undergoing isolated coronary artery bypass grafting surgery. INTERVENTIONS:Patients were randomly assigned 1:1 to the no-touch vein harvesting technique group or the conventional approach group during surgery and followed up. MAIN OUTCOME MEASURES:Vein graft occlusion (based on computed tomography angiography) at three years. RESULTS:Mean age of participants was 61 years (standard deviation ±8 years) and 22% were women. 99.4% (2621) attended the three year follow-up visit, while 86.5% (2281) received computed tomography angiography. At three years, the no-touch group showed a significantly lower vein graft occlusion rate (5.7% v 9.0%, P<0.001) than the conventional group (odds ratio 0.62, 95% confidence interval 0.48 to 0.80), with absolute risk difference of -3.2% (95% confidence interval -5.0% to -1.4%). The intention-to-treat analysis, including all 2655 randomised patients with multiple imputations for missing data, showed consistent findings, with occlusion rates of 6.1% in the no-touch group versus 9.3% in the conventional group (odds ratio 0.63, 95% confidence interval 0.51 to 0.81; absolute risk difference-3.1%, 95% confidence interval -4.9% to -1.4%; P<0.001). These results confirm the robustness of the no-touch technique in reducing vein graft occlusion. CONCLUSIONS:The no-touch technique consistently and robustly reduced the risk of vein graft occlusion and several cardiac events by one third to one half within three years after coronary artery bypass grafting surgery. TRIAL REGISTRATION:ClinicalTrials.gov NCT03126409.

BACKGROUND:Coronary microvascular disease (CMVD), marked by dysfunction of the small coronary vessels, poses significant diagnostic challenges due to the complexity and high cost of current procedures like the index of microcirculatory resistance (IMR). This study aimed to identify metabolomic biomarkers from coronary artery samples to facilitate CMVD diagnosis using advanced bioinformatics techniques-specifically, random forest algorithms and generalized linear models (GLMs)-to develop more cost-effective blood-based diagnostics. METHODS:In this prospective study, 68 patients scheduled for coronary angiography and IMR assessment were enrolled. Plasma samples obtained from their coronary arteries were analyzed using untargeted metabolomics with liquid chromatography-mass spectrometry. Advanced bioinformatics methods were applied: random forest algorithms were utilized for feature selection to identify significant metabolites, and GLMs were constructed for predictive modeling. The diagnostic performance of the models was evaluated through receiver operating characteristic (ROC) curve analysis. RESULTS:The random forest analysis identified the top 10 metabolites that significantly contributed to the classification of CMVD. The GLM built using these metabolites demonstrated excellent diagnostic accuracy, achieving area under the ROC curve (AUC) values of 0.984 in the initial (discovery) cohort and 0.938 in the subsequent (validation) cohort. The use of mathematical modeling enhanced the robustness and interpretability of the biomarker selection process. CONCLUSIONS:Advanced bioinformatics techniques, including random forest algorithms and GLMs, effectively identified key metabolites associated with CMVD. While the collection of coronary artery blood samples is invasive due to the necessity of coronary angiography, this method offers a more practical and cost-effective alternative to IMR measurement, potentially improving the diagnostic approach for CMVD.

Background: Coronary artery bypass grafting (CABG) is one of the main treatments for coronary heart disease (CHD). Gut microbiota, including bacteria, fungi, archaea, and virus, has been reported to be associated with CHD. However, the changes in the multi-kingdom gut microbiota after CABG are not yet clear. This study aimed to explore the changes in multi-kingdom gut microbiota during the early postoperative period of CABG. Methods: We collected fecal samples from 40 patients before and 1 week after CABG surgery. Metagenomic sequencing was used to detect the microbial spectrum and gene functions in the patients’ fecal samples. Results: Post-CABG patients exhibited significant changes in the composition of multi-kingdom gut microbiota and gene functions. Among bacteria, beneficial species such as Bifidobacterium, Bacteroides, and Blautia were significantly reduced after CABG, while the harmful species Enterococcus was significantly increased. In fungi, Schizosaccharomyces pombe was significantly decreased in the postoperative group, while Saccharomyces cerevisiae and Aspergillus chevalieri were significantly increased postoperatively. Spearman correlation analysis indicated that Schizosaccharomyces pombe had positive interactions with beneficial bacteria such as Lachnospiraceae, Ruminococcus, and Blautia. Among archaea, the preoperatively enriched Methanomethylovorans-SGB40959 was significantly reduced postoperatively, and Spearman correlation analysis showed a significant positive interaction with probiotics Ruminococcus and Dorea. In viruses, the phage Enterococcus virus EFP01, which infects Enterococcus, was significantly increased postoperatively and showed a significant positive interaction with Enterococcus. Additionally, postoperative dysregulation of gene functions such as the Phosphoenolpyruvate-dependent Sugar Phosphotransferase System (PTS), Transposition, DNA-mediated, and Transposase Activity was observed, and Spearman correlation analysis indicated significant correlations between the dysregulated gene functions and the microbial communities. Conclusions: This study comprehensively revealed the changes in multi-kingdom species post-CABG. The reduction of beneficial microorganisms and the increase of harmful microorganisms after surgery are of significant clinical importance for understanding the overall health status of post-CABG patients and for optimizing postoperative treatment plans. Future research needs to further explore how to improve the prognosis of post-CABG patients by modulating the gut microbiota.

BACKGROUND:Gut microbiota dysbiosis has been implicated in pulmonary arterial hypertension (PAH). However, the exact roles and underlying mechanisms of multi-kingdom gut microbiota, including bacteria, archaea, and fungi, in PAH remain largely unclear. METHODS:The shotgun metagenomics was used to analyse multi-kingdom gut microbial communities in patients with idiopathic PAH (IPAH) and healthy controls. Furthermore, fecal microbiota transplantation (FMT) was performed to transfer gut microbiota from IPAH patients or monocrotaline (MCT)-PAH rats to normal rats and from normal rats to MCT-PAH rats. FINDINGS:Gut microbiota analysis revealed substantial alterations in the bacterial, archaeal, and fungal communities in patients with IPAH compared with healthy controls. Notably, FMT from IPAH patients or MCT-PAH rats induced PAH phenotypes in recipient rats. More intriguingly, FMT from normal rats to MCT-PAH rats significantly ameliorated PAH symptoms; restored gut bacteria, archaea, and fungi composition; and shifted the plasma metabolite profiles of MCT-PAH rats toward those of normal rats. In parallel, RNA-sequencing analysis demonstrated the expression of genes involved in key signalling pathways related to PAH. A panel of multi-kingdom markers exhibited superior diagnostic accuracy compared with single-kingdom panels for IPAH. INTERPRETATION:Our findings established an association between multi-kingdom gut microbiota dysbiosis and PAH, thereby indicating the therapeutic potential of FMT in PAH. More importantly, apart from gut bacteria, gut archaea and fungi were also significantly associated with PAH pathogenesis, highlighting their indispensable role in PAH. FUNDING:This work was supported by Noncommunicable Chronic Diseases-National Science and Technology Major Projects No. 2024ZD0531200, No. 2024ZD0531201 (Research on Prevention and Treatment of Cancer, Cardiovascular and Cerebrovascular Diseases, Respiratory Diseases, and Metabolic Diseases), the National Natural Science Foundation of China of China (No. 82170302, 82370432), Financial Budgeting Project of Beijing Institute of Respiratory Medicine (Ysbz2025004, Ysbz2025007), National clinical key speciality construction project Cardiovascular Surgery, Reform and Development Program of Beijing Institute of Respiratory Medicine (Ggyfz202417, Ggyfz202501), Clinical Research Incubation Program of Beijing Chaoyang Hospital Affiliated to Capital Medical University (CYFH202209).

BACKGROUND:Despite improved treatments for acute myocardial infarction (AMI), myocardial fibrosis remains a key driver of adverse left ventricular (LV) remodeling and increased mortality. Fibroblast activation and proliferation significantly contribute to this process by enhancing cardiac fibrosis, which can lead to detrimental changes in LV structure. This study evaluates the effectiveness of 99mTc-labeled fibroblast activation protein inhibitor (99mTc-HFAPi) SPECT imaging in predicting LV remodeling over 12 months in post-AMI patients. METHODS:A cohort of 58 AMI patients (46 males, median age 61 [53, 67] years) underwent baseline 99mTc-HFAPi imaging (5 ± 2 days post-MI), perfusion imaging (6 ± 2 days post-MI), and echocardiography (2 ± 2 days post-MI). Additionally, 15 patients had follow-up 99mTc-HFAPi and perfusion imaging, while 30 patients had follow-up echocardiography. Myocardial 99mTc-HFAPi activity was assessed at the patient level. LV remodeling was defined as a ≥10% increase in LV end-diastolic diameter (LVEDD) or LV end-systolic diameter (LVESD) from baseline to follow-up echocardiography. RESULTS:AMI patients displayed localized but non-uniform 99mTc-HFAPi uptake, exceeding perfusion defects. Baseline 99mTc-HFAPi activity exhibited significant correlations with BNPmax, LDHmax, cTNImax, and WBCmax, inversely correlating with LVEF. After 12 months, 11 patients (36.66%) experienced LV remodeling. Univariate regression analysis demonstrated an association between baseline 99mTc-HFAPi uptake extent and LV remodeling (OR = 2.14, 95%CI, 1.04, 4.39, P = 0.038). CONCLUSIONS:99mTc-HFAPi SPECT imaging holds promise in predicting LV remodeling post-MI, providing valuable insights for patient management and prognosis.

Background Postoperative atrial fibrillation (POAF) constitutes a significant complication following coronary artery bypass graft surgery (CABG), potentially linked to epicardial adipose tissue (EAT). This investigation seeks to elucidate the association between POAF and EAT at the genetic level. Methods EAT and clinical data from patients undergoing CABG were systematically acquired, adhering to established inclusion and exclusion criteria. Patients were categorized into POAF and Non-POAF groups based on the presence or absence of POAF. High-throughput sequencing data of EAT were subjected to differential expression analysis and gene function assessment. A random selection of long noncoding RNAs (lncRNAs) underwent quantitative real-time polymerase chain reaction (qRT-PCR) for validation of the high-throughput sequencing findings. Coexpression analysis was employed to elucidate the interactions between lncRNAs and messenger RNAs (mRNAs). Results RNA sequencing yielded a total of 69,685 transcripts (37,740 coding and 31,945 noncoding sequences), representing 16,920 genes. Within this dataset, 38 mRNAs and 12 lncRNAs exhibited differential expression between the POAF and Non-POAF groups ( P < 0.05, fold change > 1.5). The qRT-PCR results for lncRNAs corroborated the sequencing findings ( P < 0.01). Functional enrichment analysis of genes and the coexpression network indicated that these differentially expressed RNAs were primarily implicated in processes such as cell growth, differentiation, signal transduction, as well as influencing tissue fibrosis and ion transmembrane transport. Conclusions This study unveils a potential association between myocardial fibrosis and ion channels co-regulated by mRNAs and lncRNAs, closely linked to the emergence of new-onset POAF, after accounting for clinical risk factors. This discovery holds promise for further advances in clinical and fundamental research.

BackgroundCoronary artery disease (CAD) is a prevalent cardiovascular condition, and numerous studies have linked gut bacterial imbalance to CAD. However, the relationship of gut fungi, another essential component of the intestinal microbiota, with CAD remains poorly understood.MethodsIn this cross-sectional study, we analyzed fecal samples from 132 participants, split into 31 healthy controls and 101 CAD patients, further categorized into stable CAD (38), unstable angina (41), and acute myocardial infarction (22) groups. We conducted internal transcribed spacer 1 (ITS1) and 16S sequencing to examine gut fungal and bacterial communities.FindingsBased on ITS1 analyses, Ascomycota and Basidiomycota were the dominant fungal phyla in all the groups. The α diversity of gut mycobiome remained unaltered among the control group and CAD subgroups; however, the structure and composition of the mycobiota differed significantly with the progression of CAD. The abundances of 15 taxa gradually changed with the occurrence and progression of the disease and were significantly correlated with major CAD risk factor indicators. The mycobiome changes were closely linked to gut microbiome dysbiosis in patients with CAD. Furthermore, disease classifiers based on gut fungi effectively identified subgroups with different degrees of CAD. Finally, the FUNGuild analysis further categorized these fungi into distinct ecological guilds.InterpretationIn conclusion, the structure and composition of the gut fungal community differed from healthy controls to various subtypes of CAD, revealing key fungi taxa alterations linked to the onset and progression of CAD. Our study highlights the potential role of gut fungi in CAD and may facilitate the development of novel biomarkers and therapeutic targets for CAD.FundingThis work was supported by the grants from the National Natural Science Foundation of China (No. 82170302, 92168117, 82370432), National clinical key specialty construction project- Cardiovascular Surgery, the Reform and Development Program of Beijing Institute of Respiratory Medicine (No. Ggyfz202417, Ggyfz202308), the Beijing Natural Science Foundation (No. 7222068); and the Clinical Research Incubation Program of Beijing Chaoyang Hospital Affiliated to Capital Medical University (No. CYFH202209).

Background:Myocardial fibrosis is a key pathological factor for the occurrence of ventricular arrhythmias in hypertrophic obstructive cardiomyopathy (HOCM).Case summary:This case series reports on two patients diagnosed with HOCM who underwent 18F-fibroblast activation protein inhibitor (FAPI) positron-emission tomography/computed tomography imaging and Morrow myotomy procedure. The collected myocardial tissue was examined histopathologically. Both patients exhibited intense and heterogeneous 18F-FAPI uptake in the septum, with significant number of activated fibroblasts.Discussion:Enhanced 18F-FAPI uptake was observed before irreversible fibrosis, and the degree of 18F-FAPI uptake was higher in tissue with greater fibrosis. 18F-FAPI imaging may provide a promising tool for guiding surgical strategy in HOCM, and further research is needed to fully explore its potential in clinical practice.

Background: Reperfusion injury often persists even with successful primary percutaneous catheterization intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI). Therefore, we developed volume-controlled reperfusion (VCR), a method combined with accurate gentle reperfusion for active protection against unstable plaque formation. This study aimed to investigate the feasibility, safety, and efficacy of VCR as an adjunct for PPCI in patients with STEMI.Methods: The STEMI VCR trial (http://www.chictr.org.cn; Unique identifier: ChiCTR2100052856) was a single-center prospective, interventional, randomized controlled trial. Sixty patients were randomized to the VCR (n = 30, VCR + routine PCI) or control (n = 30, routine PCI only) groups. In-hospital late gadolinium enhancement-cardiac magnetic resonance imaging (LGE-cMRI) was subsequently performed, with follow-up patient evaluation after 12 months.Results: No differences were observed in the occurrence of major adverse cardiac events (MACE) between the two groups. Similarly, there was no procedure failure in the VCR group. In-hospital echocardiographic left ventricular ejection fraction (LVEF) revealed significant differences between the VCR and control groups, with similar results observed in the anterior subgroups. However, LGE-cMRI and CMR-LVEF revealed no significant differences in infarct size, microvascular obstruction (MVO) mass, or MVO mass/infarct mass ratio in the anterior subgroup. Follow-up echocardiographic LVEF revealed significant differences between the two groups and the anterior subgroups.Conclusions: VCR was feasible and clinically safe in patients with STEMI undergoing PPCI, indicating that this adjunctive therapy might attenuate reperfusion injury.Trial Registration: ChiCTR2100052856.Funding: The trial was sponsored by the Clinical Research Incubation Fund (CYFH202204), Beijing Chao-Yang Hospital, Capital Medical University.Declaration of Interest: None.Ethical Approval: The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Beijing Chao-Yang Hospital, Capital Medical University (CYFH202204).

Alterations in the gut microbiota have been linked to hypertension, with the role of archaea, despite being stable constituents, remaining largely unexplored. Shotgun metagenomic analyses of fecal samples were performed on 341 participants from 3 cohorts: discovery cohort (88 individuals), validation cohort 1 (175 individuals), and validation cohort 2 (78 individuals). Principal Coordinates Analysis (PCoA) based on Bray-Curtis distances revealed significant alterations in the composition of enteric archaea between control individuals and hypertensive patients (P < 0.05). Hypertensive groups showed reduced abundances of halophilic archaea (Halorhabdus, Halovivax, and Halorubrum\_lipolyticum) and methanogenic archaea (Methanomassiliicoccus and Candidatus\_Methanomassiliicoccus_intestinalis). Eleven archaea species, depleted in fecal samples from hypertensive patients, distinguished them from control individuals, with areas under the receiver operating characteristic curve of 0.85, 0.79, and 0.91 in the discovery, validation cohort 1, and validation cohort 2, respectively. Significant correlations were observed between these archaea and clinical data across cohorts. Additionally, a significant positive correlation in richness between gut bacteria and archaea suggests a close cross-kingdom synergy within the microbiome. This study highlights significant shifts in the archaeal populations of hypertensive patients, underscoring the potential of archaeal biomarkers in hypertension diagnosis and suggesting avenues for future therapeutic research. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement the National Natural Science Foundation of China (No. 82170302, 92168117, 82370432), National clinical key specialty construction project- Cardiovascular Surgery, Reform and Development Program of Beijing Institute of Respiratory Medicine (Ggyfz202417), the Beijing Natural Science Foundation (No. 7222068). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval for the study was granted by the Ethics Committees of the Beijing Chao-Yang Hospital of Capital Medical University (approval No. 2024-ke-726) and Fuwai Hospital (approval No. 2020-1334), ensuring adherence to ethical guidelines. 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. Yes I 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). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Metagenomic sequences for the discovery cohort and validation cohort 1 are accessible through the European Nucleotide Archive (ENA) under the identifiers PRJEB21612 and PRJEB13870, respectively. Metagenomic sequences for validation cohort 2 can be obtained from the Sequence Read Archive (SRA) database under the identifier PRJNA1096143.