BackgroundStent fracture (SF) is a rare but potentially serious complication after percutaneous coronary intervention, which may lead to in-stent restenosis or acute coronary syndrome.Case summaryA 70-year-old woman with a history of hypertension and diabetes mellitus presented with acute anterior wall myocardial infarction. She had previously undergone multiple stent implantations in the left anterior descending (LAD) artery. Coronary angiography and optical coherence tomography (OCT) demonstrated a complete stent fracture accompanied by neointimal hyperplasia in the mid-LAD segment. A new drug-eluting stent was subsequently implanted at the fracture site, and the patient had an uneventful recovery.DiscussionThis case highlights that long and overlapping stents may predispose to mechanical fatigue and subsequent fracture. Early detection using intravascular imaging modalities such as OCT is crucial for prompt management and the prevention of recurrent ischemic events.

The cardiac stem cells (CSCs) are essential in improving myocardial infarction (MI). Although miR-199a-5p and hypoxia-inducible factor-1 alpha (HIF-1α) were proven to participate in the process of heart repair, the related mechanisms are still unclear. This study aimed to explore the effects of miR-199a-5p and HIF-1α on c-kit+ cells and their regulatory mechanisms. After isolating, purifying, and identifying CSCs (c-kit+ cells) from mice, they were subjected to a hypoxia model. After the c-kit+ cells were transfected with corresponding transfectants, the CCK-8, EdU staining, and wound healing approaches were used to evaluate their cell viability, proliferation, and migration. The targeted relation between miR-199a-5p and HIF-1α was determined using a dual-luciferase reporter. Immunofluorescence staining, RT-qPCR, and Western blot approaches were employed to determine Nkx2.5, CD31, α-SMA, miR-199a-5p, and HIF-1α expression. Overexpressing miR-199a-5p and knocking down HIF-1α both inhibited the cell viability (p<0.01), reduced the proliferation (p<0.05), suppressed the migration (p<0.001), and down-regulated the Nkx2.5, CD31, and α-SMA expression of c-kit+ cells (p<0.05). Overexpressing HIF-1α effectively reversed the effects of overexpressing miR-199a-5p on c-kit+ cells (p<0.05). Taken together, miR-199a-5p negatively targeted HIF-1α to inhibit the proliferation, migration, and differentiation of c-kit+ cells.

Objective To explore the expression of junctophilin 2(JP2)and fibroblast growth factor 23(FGF23)in a rabbit model of atrial fibrillation mediated-cardiomyopathy(AMC). Methods Rabbit models of atrial fibrillation (AF) were developed through rapid atrial stimulation and then divided into three groups: control group (pacemakers implanted without pacing, n=6), AF group (pacing with ejection fraction decrease ＜10%,n=5), and AMC group (pacing with ejection fraction decrease ≥10%, n=6).Echocardiography was performed to detect left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD) and left ventricular ejection fraction(LVEF). JP2 and FGF23 were detected by ELISA method.Western blot and RT-qPCR were conducted to detect protein and mRNA expression of JP2 and FGF23. Results Left atrial diameter, right atrial diameter and right ventricular diameter increased and LVEF decreased in the AMC group as compared with the control group. AMC group had lower LVEF and larger aorta and right ventricle diameter. Compared with the control group, the expression of FGF23(P＜0.001)and JP2(P＜0.01)in left atrial cardiomyocytes was significantly increased in the AF group, while the expression of JP2 was decreased in the AMC group(P＜0.001).AMC group had lower expression of JP2 and FGF23 compared with AF group. Compared to the control group,plasma concentration of JP2 and FGF23 increased in the AF group and FGF23 plasma concentration increased in the AMC group. Plasma concentration of FGF23 and JP2 was lower in AMC group than that in AF group . Conclusions FGF23 expression increased and JP2 expression decreased as found in the rabbit AMC model.

COPYRIGHT © 2023 Ye, Li, Xiao and Chang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Editorial: Complementary therapies for neurological disorders: from bench to clinical practices

In patients with symptomatic atrial fibrillation refractory to optimal medical therapy, atrioventricular node ablation followed by permanent pacemaker implantation is an effective treatment option. A 66-year-old woman with symptomatic persistent atrial fibrillation refractory to multiple ablation procedures was referred to our institution. After optimal drug therapy, the patient still had obvious symptoms. Sequential His-Purkinje conduction system pacing and atrioventricular node ablation were performed. Left bundle branch pacing was used as a backup pacing method if thresholds of His bundle pacing were too high or loss of His bundle capture occurred in the follow-up. At the 6-month follow-up, the European Heart Rhythm Association classification for AF was improved, the score of the Atrial Fibrillation Effect on Quality of Life was enhanced, and the 6-Minute Walk Test was ameliorated. The present case was subjected to His-Purkinje conduction system pacing in combination with atrioventricular node ablation as treatment for a symptomatic persistent atrial fibrillation refractory to multiple ablation procedures, and this procedure alleviated symptoms and improved the quality of life in a short-term follow-up.

心房颤动是临床常见的持续性心律失常类型，其与血栓栓塞并发症、心力衰竭和其他心血管事件发生 风险增加相关。因此，早期阻止心房颤动进展对改善患者预后具有重要意义。根据治疗目标，心房颤动的心律管理模 式可以分为“心率控制”和“节律控制”，其中节律控制指恢复并维持窦性心率，是改善心房颤动患者症状的主要治 疗措施之一，也是心房颤动治疗的一个重要目标。近年来随着循证证据的积累，临床更加重视通过节律控制（包括抗 心律失常药和/或消融技术）来减少心房颤动患者不良心血管结局。基于此，本文主要总结了支持心房颤动患者采取 早期节律控制的证据，并从药物治疗（Ⅰc类和Ⅲ类抗心律失常药）和非药物治疗（射频导管消融术、冷冻球囊消融 术、热球囊消融术及脉冲电场消融术等消融方法）角度分析了心房颤动的早期节律控制策略，以期为改善心房颤动患 者预后提供参考。

Atrial fibrillation mediated cardiomyopathy(AMC)refers to paroxysmal or persistent atrial fibrillation(AF)causing heart enlargement,resulting in impaired ventricular systolic and diastolic function,decreased left ventricular ejection fraction,and ultimately heart failure(HF).The symptoms of heart enlargement and HF can be completely or almost completely reversed after the patient returns to sinus rhythm or ventricular rate is strictly controlled.The clinical incidence of AMC is not low,and early diagnosis and intervention can significantly improve the prognosis of patients.However,at present,the diagnosis of AMC can only be made after excluding other causes,which lacks specific diagnostic indicators,and the pathological process of AMC is still unclear.This article starts with calcium homeostasis imbalance,introduces its role in AF and HF,and analyzes its relationship with AMC,in order to provide direction for the clinical diagnosis and treatment of AMC.

Objective: To explore the characteristics of plasma metabolites, feces gut microbiota and the crosstalk between gut microbiota and host metabolism in patients with acute ischemic stroke and phlegm-heat pattern（AIS-PHP）.Methods: The metabolic and microbiome profiles of 20 AIS-PHP patients and 20 healthy controls（HCs）were analyzed using liquid chromatography-tandem mass spectrometry（LC-MS/MS）-based metabolomics and 16s rDNA sequencing, respectively. The covariation between LC-MS/MS-based metabolite data and 16s rDNA sequence data was presented.Results: Distinct alterations in the plasma metabolic phenotype of AIS-PHP patients were found, in which 16 metabolites differed significantly between the AIS-PHP patients and the HCs. These metabolites represented 17 different metabolic pathways, including amino acid metabolism, lipid metabolism, and nucleotide metabolism. Additionally, significant alterations of gut microbiota composition and taxon were revealed at the phylum level between the AIS-PHP patients and the HCs. In AIS-PHP, Bacteroidetes,Firmicutes, and Proteobacteria dominated. Moreover, some microbes that differed between the 2 groups manifested a sole association with certain metabolites, such as the connection between Bacteroides and inosine and between Lachnospiraceae＿unclassified and hypoxanthine.Conclusion: The present study preliminarily investigated the metabolomic and gut microbiome characteristics of AIS-PHP patient indicators. The link between metabolic and microbial dysbiosis in AIS-PHP sheds new light on the function of gut microbiota and associated metabolomics in the pathogenesis of the disease.

目的 分析发生罪犯血管急性闭塞非ST段抬高型心肌梗死(NSTEMI)患者的临床特征和罪犯血管急性闭塞对院内结局影响.方法 回顾性入选2016年1月至2019年8月于河北省人民医院心内科诊断为NSTEMI的266例患者,将罪犯血管血流TIMI分级0～1级和无侧枝循环定义为急性闭塞.根据有无罪犯血管急性闭塞将患者分为两组,并比较两组临床基线特征、冠脉造影特征及院内事件发生率,通过Logistic回归分析急性闭塞对NSTEMI患者院内事件影响.结果 266例患者中32例(12.0％)发生罪犯血管急性闭塞,罪犯血管左回旋支更多(43.8％vs.25.6％,P<0.05),院内事件发生率较高(12.5％vs.3.4％,P<0.05),主要表现为发生恶性心律失常.经多因素Logistic回归分析,Killip分级(OR=3.531,95％CI:1.301～9.578,P<0.05)、罪犯血管急性闭塞(OR=4.401,95％CI:1.100～17.599,P<0.05)是NSTEMI患者院内事件的独立危险因素.结论 罪犯血管急性闭塞的NSTEMI患者罪犯血管为回旋支比例更高,院内事件和恶性心律失常发生率更高.罪犯血管急性闭塞、Killip分级是预测NSTEMI患者院内事件的独立危险因素.

Abstract Objective To explore the critical value of supra-normal ejection fraction after acute myocardial infarction primary PCI and possible mechanism. METHODS A total of 272 patients with acute ST-segment elevation myocardial infarction admitted to the Heart Center of Hebei General Hospital from November 2016 to June 2018 who underwent primary PCI and transthoracic echocardiographic measurement of left ventricular ejection fraction ≥ 50% were included. All transthoracic ultrasound data of the patients were collected. The correlation between LVEF and hospital outcomes (death, cardiogenic shock) was analyzed. The ROC curve was drawn and the area under the ROC curve was measured. The critical value of the correlation between LVEF and in-hospital death was obtained by drawing the ROC curve. Clinical indicators between the two groups[the supra-normal EF group(LVEF༞critical value) and the control group(LVEF < critical value)] were analyzed. RESULTS Logsitic univariate regression analysis (OR) between LVEF and in-hospital death was 1.350(95%CI 1.078–1.691, P = 0.009). The area under the ROC curve between LVEF and in-hospital death was 0.846(95%CI 0.628-1.000, P = 0.018); The maximum Youden index was 0.701, corresponding to the critical LVEF of 67.5%, and the sensitivity and specificity of predicting nosocomial death were 75% and 95.1%. The proportion of women in the abnormal ejection fraction group [7(43.80%) vs 42(16.40%), P = 0.015] and the application of IABP [2(12.50%) vs 2(0.80%), P = 0.018] were significantly higher than those in the control group. The pulse rate [65.00(14.75) vs 79.00(20.00), P = 0.004], postoperative blood flow grade 2–3 proportion [13(81.30%) vs 253(98.80%), P = 0.003], and left ventricular end-systolic diameter [28.00(4.25) vs 32.00(4.00), P < 0.001] were significantly lower than those in the control group. Other results were not statistically significant between the two groups. CONCLUSIONS There is a subgroup named supra-normal EF with a higher mortality in patients with ST-segment elevation myocardial infarction after primary PCI, with a cut-off value of 67.5%. Sex and coronary microcirculation disorder may be the promoting factors for occurrence and development of supra-normal ejection fraction.

Objective Single-pill amlodipine besylate (AML) plus losartan (LOS) has been used to treat inadequately controlled hypertension after antihypertensive monotherapy; however, relevant data in China are limited. This study aimed to compare the efficacy and safety of single-pill AML/LOS and LOS alone in Chinese patients with inadequately controlled hypertension after LOS treatment. Methods In this multicenter, double-blind, randomized, controlled phase III clinical trial, patients with inadequately controlled hypertension after 4 weeks of LOS treatment were randomized to receive daily single-pill AML/LOS (5/100 mg, AML/LOS group, N = 154) or LOS (100 mg, LOS group, N = 153) tablets for 8 weeks. At weeks 4 and 8 of treatment, sitting diastolic and systolic blood pressure (sitDBP and sitSBP, respectively) and the BP target achievement rate were assessed. Results At week 8, the sitDBP change from baseline was greater in the AML/LOS group than in the LOS group (−8.84 ± 6.86 vs. −2.65 ± 7.62 mmHg, P < 0.001). In addition, the AML/LOS group also showed greater sitDBP change from baseline to week 4 (−8.77 ± 6.60 vs. −2.99 ± 7.05 mmHg) and sitSBP change from baseline to week 4 (−12.54 ± 11.65 vs. −2.36 ± 10.33 mmHg) and 8 (−13.93 ± 10.90 vs. −2.38 ± 12.71 mmHg) (all P < 0.001). Moreover, the BP target achievement rates at weeks 4 (57.1% vs. 25.3%, P < 0.001) and 8 (58.4% vs. 28.1%, P < 0.001) were higher in the AML/LOS group than those in the LOS group. Both treatments were safe and tolerable. Conclusion Single-pill AML/LOS is superior to LOS monotherapy for controlling BP and is safe and well tolerated in Chinese patients with inadequately controlled hypertension after LOS treatment.

BACKGROUND Recurrence of atrial fibrillation（AF） is common in patients with persistent AF even after multiple ablation procedures. His-Purkinje conduction system pacing（HPCSP） combined with atrioventricular node ablation（AVNA） is effective in managing patients with AF and heart failure. This study aimed to determine whether HPCSP combined with AVNA can improve quality of life and alleviate symptoms in older patients with symptomatic persistent AF refractory to multiple ablation procedures, as well as evaluate the feasibility and safety of this therapy.METHODS Older patients（≥ 65 years） with symptomatic persistent AF refractory to at least two ablation procedures were treated with combined HPCSP and AVNA. The success rates and complications were recorded. Pacing parameters, European Heart Rhythm Association（EHRA） scores, and Atrial Fibrillation Effect on Quality-of-Life（AFEQT） scores obtained perioperatively were compared with those recorded at the 6-month follow-up examination.RESULTS Thirty-one patients were enrolled; of those, only thirty patients were eventually treated with AVNA because one patient developed a complete atrioventricular block following the withdrawal of the His bundle pacing lead. The success rates were100% for HPCSP（22 cases with His bundle pacing, and 9 cases with left bundle branch pacing） and 93.3%（28/30） for AVNA, respectively. By the 6-month follow-up examination, EHRA scores improved significantly（3.00 ± 0.73 vs. 2.44 ± 0.63, P = 0.014） and AFEQT scores increased markedly（49.6 ± 20.6 vs. 70.9 ± 14.0, P = 0.001）. No severe complications developed.CONCLUSIONS When used in older patients with symptomatic persistent AF refractory to multiple ablation procedures, HPCSP combined with AVNA significantly alleviated symptoms and improved quality of life during short-term follow-up. This therapy was proved to be safe and effective in this patient population.

Sodium-glucose-cotransporter-2 inhibitors were originally developed as hypoglycemic agents. It lowers blood glucose by reducing glucose reabsorption in the proximal renal tubules. Chronic cardiac insufficiency can be improved by reducing cardiac load, improving cardiac energy metabolism, improving cardiac remodeling, and other mechanisms. With or without T2DM, SGLT2 inhibitors can prevent HF deterioration in HFrHF patients due to their excellent cardiovascular protection and benefits for the patients. However, there are few studies on the efficacy, safety, and appropriate timing of SGLT2 inhibitors in patients with acute heart failure, and further exploration is needed. This paper reviews the application of SGLT2 inhibitors in the treatment of AHF patients to provide theoretical guidance for further study of AHF patients.

Introduction: Majority of patients with acute coronary syndrome can be quickly identified by electrocardiogram, but there are still 30% of patients with acute coronary artery lesions that cannot be recognized by electrocardiogram in time, resulting in delayed treatment.Patient concerns: Due to its special manifestations, de Winter syndrome is easily ignored by clinicians.Diagnosis: In this article we report a case of de Winter syndrome with poor thrombolytic effect to explore the optimal emergency management strategy for this patient.Interventions: The patient underwent remedial percutaneous coronary intervention (PCI) immediately after diagnosis.Outcomes: Patients recover well after PCI.Conclusion: de Winter syndrome is a strong indication of severe coronary artery disease, requiring rapid identification and opening of coronary vessels to restore blood flow. For patients admitted to hospitals with PCI capacity or transferred primary PCI <2 hours, primary PCI should be performed as soon as possible. Thrombolysis can still be considered for patients first diagnosed in non-PCI institutions with transport time >2 hours, but its efficacy remains to be discussed and further verified.

BackgroundLeft ventricular ejection fraction (LVEF) is often used as an assessment indicator for left ventricular systolic function. As adverse events occur in some patients with preserved LVEF, other phenotypes based on LVEF may exist in the population with LVEF ≥50%, affecting the prognosis.ObjectiveTo explore the critical LVEF and possible pathogenesis in acute ST-elevation myocardial infarction (STEMI) patients with supra-normal ejection fraction after primary PCI.MethodsA total of 272 STEMI patients with initial LVEF ≥50% by transthoracic echocardiographic measurement after being treated with primary PCI were selected from Heart Center, Hebei General Hospital from November 2016 to June 2018. All patients were admitted to the cardiovascular care unit following primary PCI. Data were collected, including baseline characteristics (gender, smoking history, drinking history, family history of cardiovascular disease, angina in the past one month, diabetes history, hypertension history, stroke history, old myocardial infarction, age, body mass index, pulse rate, and mean arterial pressure) , time of onset of chest pain〔including time from symptom onset to first medical contact, time from symptom onset to first antiplatelet therapy, time from symptom onset to first anticoagulation, symptom onset to balloon time (SBT) , door-to-balloon (D-to-B) time〕, periprocedural data 〔pre-procedural TIMI flow grade, collateral circulation, treatment of non-infarct related artery (NIRA) , thrombus aspiration, IABP application, anticoagulant medication, pre-procedural use of β-blockers, renin-angiotensin-aldosterone system inhibitors (RAASi) , or statins, intra-procedural application of tirofiban and prourokinase, post-procedure TIMI flow grade〕, laboratory test results (leukocyte count, Neutrophil count, lymphocyte count, hemoglobin, hematocrit, platelet count, potassium ion, urea nitrogen, creatinine, random blood glucose, eGFR, total cholesterol, triacylglycerol, high-density lipoprotein, low-density lipoprotein, very low-density lipoprotein, non-high density lipoprotein, creatine kinase, creatine kinase isozyme) and transthoracic echocardiographic data. The correlation between LVEF and in-hospital death was analyzed. By ROC analysis, the optimal threshold of LVEF predicting in-hospital death was obtained, and patients with LVEF greater and less than the optimal threshold were compared in terms of clinical indictors.ResultsThe area under the ROC curve of LVEF predicting in-hospital death was 0.846〔95%CI (0.628, 1.000) , P=0.018〕, and the optimal threshold was 67.5% with a sensitivity of 75.0% and a specificity of 95.1%. Compared with those with LVEF <67.5%, patients with LVEF > 67.5% had higher in-hospital mortality〔18.8% (3/16) vs 0.4% (1/256) 〕, with a statistical difference (P<0.05) . Moreover, they also showed a statistical difference in Kaplan-Meier survival curve (χ2=36.526, P<0.001) . Furthermore, patients with LVEF > 67.5% showed higher female ratio and rate of IABP application, lower mean pulse rate as well as lower rate of post-procedure TIMI grade 2-3 flow (P<0.05) . They also demonstrated lower mean left ventricular end-systolic diameter (P<0.001) .ConclusionThere may be a subgroup in STEMI patients with preserved ejection fraction after primary PCI, who presented higher LVEF (supra-normal LVEF) and higher in-hospital mortality than those with normal LVEF. The optimal threshold of LVEF for predicting in-hospital death in these STEMI patients was 67.5%. Being female and coronary microcirculation disorder may contribute to the development of supra-normal ejection fraction.

目的 探讨不同血栓负荷的ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉治疗(PCI)中血栓抽吸的效果.方法 回顾性研究.纳入接受直接经皮冠状动脉介入治疗(PPCI)的血栓负荷为4级(116例)或5级(261例)的377例STEMI患者,并根据PPCI术前是否行血栓抽吸分为抽吸组(209例)和对照组(168例).对照组行单纯PCI治疗,抽吸组行血栓抽吸联合PCI治疗.比较两组患者主要不良心脏事件(MACE)(包括全因死亡、心血管死亡、复发性心肌梗死、心力衰竭再住院治疗、再次血运重建)的发生情况,主要安全性终点是出院后卒中发生情况.结果 在4级或5级血栓负荷的患者中,抽吸组与对照组患者的一般资料比较均无统计学差异(均为P>0.05).院内随访结果显示,5级血栓负荷的患者中,抽吸组患者的院内死亡率、心力衰竭患病率显著低于对照组(均为P<0.05).中位随访(30.0±10.3)个月后,5级血栓负荷患者中抽吸组与对照组的卒中发生率相似,差异无统计意义(P>0.05).多因素Cox回归分析显示,血栓抽吸(HR=0.436)是5级血栓负荷患者PPCI术后发生MACE的保护因素,男性(HR=3.389)、吸烟史(HR=3.917)、高血压史(HR=1.835)是术后发生MACE的危险因素.结论 对于5级血栓负荷患者的STEMI患者,术中行血栓抽吸可能会改善患者的预后,且不增加卒中发生风险.

目的:分析血浆心房利钠肽原中间片段(MR-proANP)在心力衰竭(HF)合并心房颤动(AF)患者中的诊断价值.方法:选取河北省人民医院心血管内科住院的慢性HF患者207例,并纳入无HF及AF诊断但患有冠心病、糖尿病等57例为对照组.按照院前有无AF将HF分为窦性心律HF(HF-SR)组和HF合并AF(HF-AF)组,比较这3组患者基本资料差异.ROC曲线评价MR-proANP对HF-AF的诊断价值.结果:①MR-proANP在3组患者中的差异有统计学意义(P＜0.05).②左房内径(LAD)、MR-proANP在HF-AF组与HF-SR组中的差异有统计学意义(P＜0.017).③ROC分析显示,在HF-AF患者中,以对照组作为对照,MR-proANP 诊断 HF-AF 的曲线下面积(AUC)为 0.946(95％CI:0.913～0.979,P＜0.001),诊断 HF-AF 的灵敏度为 86.8％,特异度为 96.5％;以 HF-SR 组作为对照,MR-proANP 诊断 HF-AF 的 AUC 为 0.662(95％CI:0.588～0.736,P＜0.001),灵敏度为68.9％,特异度为60.4％.结论:HF-AF患者组中LAD增大,MR-proANP浓度明显升高.MR-proANP对HF-AF患者具有诊断价值.