Clinical studies have extensively demonstrated that central aortic blood pressure (CABP) has greater clinical significance in comparison with peripheral blood pressure. Despite the existence of various techniques for noninvasively measuring CABP, the clinical applications of most techniques are hampered by the unsatisfactory accuracy or large variability in measurement errors. In this study, we proposed a new method for noninvasively estimating CABP with improved accuracy and reduced uncertain errors. The main idea was to optimize the estimation of the pulse wave transit time from the aorta to the occluded lumen of the brachial artery under a suprasystolic cuff by identifying and utilizing the characteristic information of the cuff oscillation wave, thereby improving the accuracy and stability of the CABP estimation algorithms under various physiological conditions. The method was firstly developed and verified based on large-scale virtual subject data ( n  = 800) generated by a computational model of the cardiovascular system coupled to a brachial cuff, and then validated with small-scale in vivo data ( n  = 34). The estimation errors for the aortic systolic pressure were −0.05 ± 0.63 mmHg in the test group of the virtual subjects and −1.09 ± 3.70 mmHg in the test group of the patients, both demonstrating a good performance. In particular, the estimation errors were found to be insensitive to variations in hemodynamic conditions and cardiovascular properties, manifesting the high robustness of the method. The method may have promising clinical applicability, although further validation studies with larger-scale clinical data remain necessary.

The coronary slow-flow phenomenon (CSFP) is a manifestation of coronary artery disease wherein coronary angiography reveals no apparent stenosis; however, there is a delay in blood flow perfusion. Given its increased occurrence in male patients, with the majority of subjects in previous studies being male, this study aimed to explore whether distinct risk factors are present in female patients with CSFP. This single-center retrospective study focused on female patients diagnosed with CSFP by using coronary angiography. Eligible patients meeting the predefined inclusion and exclusion criteria were divided into the study group (presenting with CSFP) and control group (displaying normal epicardial coronary arteries). Comparative analyses of clinical and diagnostic data were performed. Ninety-two patients with CSFP and an equal number of controls were enrolled in this study. Patients with CSFP exhibited a higher prevalence of smokers (P = .017) and a heightened incidence of diabetes mellitus (DM) (P = .007). Significantly elevated levels of total cholesterol (TC) (P = .034) and free fatty acids (FFA) (P = .016) were observed in the CSFP group compared to those in the control group. Additionally, patients with CSFP displayed lower levels of apolipoprotein E (ApoE) (P = .092), free thyroxine (FT4) (P = .001), and total thyroxine (TT4) (P = .025). Logistic regression analysis indicated that smoking (P = .019), FFA (P < .001), ApoE (P = .015), and FT4 (P < .001) were independent risk factors for CSFP, accounting for confounding factors. Additionally, the area under the ROC curve (AUC) of the combined effect of smoking, ApoE, FT4, and FFA on CSFP was 0.793 (95% CI: 0.729–0.857, P < .01). In addition to the established risk factors for smoking, diabetes, and hyperlipidemia, female patients with CSFP exhibited significant differences in apoE, FFA, FT4, and TT4 levels compared to the control group. Smoking, FFA, and FT4 levels emerged as independent risk factors for CSFP.

Central aortic pressures are better predictors of cardiovascular events than peripheral pressures. However, central aortic blood pressures cannot be measured noninvasively; for this reason, estimating aortic pressures from noninvasive measurements of peripheral pressures has been the subject of numerous studies. In the present study, a novel method was proposed to noninvasively estimate aortic pressures from the oscillometric wave of a suprasystolic brachial cuff. The errors of estimation were evaluated in relation to various cardiovascular properties using an integrated cardiovascular-cuff model. Obtained results demonstrated that the estimation errors are affected mainly by aortic stiffness. The estimation errors for aortic systolic pressure, diastolic pressure, pulse pressure and wave shape under the assumed cardiovascular conditions were 5.84 ± 1.58 mmHg, -0.28 ± 0.41 mmHg, 6.12 ± 1.42 mmHg and 1.72 ± 0.57 mmHg, respectively, all of which fell within the error ranges established by existing devices. Since the method is easy to be automated and bases the estimation fully on patient-specific information, its clinical application is promising, although further clinical studies are awaited to validate the method in vivo.

Abstract Background: Previous studies reached inconsistent conclusions about the relationship between alcohol or cigarette consumption and coronary artery calcification (CAC). We aim to explore the association between drinking and smoking with CAC in men. Methods: Male patients who underwent coronary angiography (CAG) and intravascular ultrasound (IVUS) and diagnosed with coronary heart disease (CHD) were retrospectively included. Maximum angle of calcified plaque (Arc) and calcium length were measured by IVUS to evaluate CAC severity. Drinking and smoking details were collected. Drinking and smoking were stratified to 4 layers according to weekly alcohol intake(g) and total smoking(package*years), respectively. Uni- and multivariable analysis were performed to explore the association between drinking and smoking with severe coronary artery calcification (SCAC). Results: Totally, 359 men with CHD were included, of whom 151 were regular drinkers and 275 were smokers. Compared with non-drinkers, calcium length in light drinkers decreased (P<0.05), both Arc and calcium length in moderate and heavy drinkers increased (all P<0.05). Weekly alcohol intake was positively correlated with Arc and calcium length (r=0.490, P<0.001; r=0.381, P<0.001). A negative association was found between light drinking and SCAC (OR: 0.492, 95%CI: 0.177-1.372, P=0.175), while moderate (OR: 5.244, 95%CI: 2.245-12.252, P＜0.001) and heavy drinking (OR: 15.238, 95%CI: 5.695-40.767, P＜0.001) were positively associated with SCAC. No associations were found between smoking and SCAC (P>0.05). Conclusions: Light drinking showed a slight negative association with SCAC, whereas moderate and heavy drinking were positively associated with SCAC in Chinese men. No associations were found between smoking and SCAC.

目的:研究餐后血脂水平与冠状动脉粥样硬化(CAS)发生、发展的关系.方法:依据冠脉造影结果,我院704例患者被分为冠心病(CHD)组(448例)和非冠心病(NCHD)组(256例);依据是否行冠脉介入治疗,CHD组被分为介入亚组(323例)与非介入亚组(125例),比较各组空腹和餐后血脂:TG、TC、HDL-C、LDL-C及载脂蛋白(Apo)水平及其与CAS发生、发展的关系.结果:与NCHD组比较,空腹时,CHD组血清HDL-C、Apo A1水平、血清Apo A1/B水平比值均显著降低,血清TG水平显著升高(P均＜0.01);餐后,CHD组血清TG水平显著升高,血清TC、HDL-C、LDL-C、Apo A1水平、ApoA1/B水平比值均显著降低(P＜0.05或＜0.01).与非介入亚组比较,空腹时,介入亚组血清HDL-C、Apo A1水平、血清Apo E水平均显著降低(P＜0.05或＜0.01);餐后,介入亚组血清TC、HDL-C、Apo A1、Apo E水平均显著降低(P＜0.05或＜0.01).多因素Logistic回归分析显示,空腹TG、男性和糖尿病史是CAS的独立危险因素(OR=1.361～2.383,P均＜0.01),餐后Apo A1是CAS的独立保护因素(OR=0.371,P=0.024);餐后HDL-C与Apo E是CAS斑块发展的独立保护因素(OR=0.293、0.886,P=0.002、0.031),而糖尿病史是其独立危险因素(OR=1.785,P=0.020).结论:餐后血脂水平变化与CAS的发生发展密切联系,餐后HDL-C水平对CAS斑块发展具一定的预测价值.

BACKGROUND Intermediate coronary lesions (40-70% stenosis) present a higher risk for future cardiovascular events for instability of plaques. Shortened telomere is an indicator of cellular senescence, which is associated with age-related diseases. However, the relationship between telomere length and severity of intermediate coronary lesions remains largely unknown. METHODS A total of 121 lesions of 121 patients with intermediate coronary disease that underwent intravascular optical coherence tomography were enrolled. These patients were retrospectively divided into two groups according to whether accept percutaneous coronary intervention (PCI) treatment: non-PCI group and PCI group. RESULTS Leukocyte telomere length (LTL) in patients of PCI group were significantly shorter (12.54±2.70 vs. 15.32±3.72 kb, P<0.001) than non-PCI group. The PCI group had longer lipid length (17.17±9.94 vs. 12.21±10.15 mm, P=0.01) and greater lipid index (4,286.82±3,012.54 vs. 2,444.87±2,677.59 °*mm, P<0.001). There was a significant difference in the prevalence of thin-cap fibroatheroma (36.6% vs. 16.0%, P=0.013), macrophages (56.3% vs. 38.0%, P=0.047), plaque rupture (23.9% vs. 6.0%, P=0.009), cholesterol crystal (49.3% vs. 30.0%, P=0.034), dissection (23.9% vs. 4.0%, P=0.003) between PCI and non-PCI group. Logistic regression revealed that LTL was independently associated with PCI after adjusting for confounding factors (OR 0.952, CI: 0.930-0.974, per 1unit increase, P<0.001). Receiver operating characteristic (ROC) analysis revealed a LTL area under the ROC curve (AUC) of 0.714 (95% CI: 0.619-0.808, P<0.001) in the study population. Furthermore, LTL was inversely correlated with lipid length (r =-0.190, P=0.037), lipid arc (r =-0.301, P=0.001), lipid index (r =-0.182, P=0.046), and positive correlation with FCT (r =0.213, P=0.034). CONCLUSIONS LTL was independently associated with possibility of receiving PCI in intermediate coronary lesion patients and LTL is also significantly related to plaque instability features that evaluated by optical coherence tomography. LTL may be as an indicator to assess the necessity of PCI in intermediate coronary lesion patients.

目的:探索冠状动脉(冠脉)原位病变预处理成功的光学相干断层成像技术(OCT)标准及OCT在冠脉原位病变精准介入中的临床价值.方法:选取2020年9月-2021年7月上海交通大学医学院附属第九人民医院冠脉造影(CAG)后需要血运重建,适合行经皮冠脉介入且倾向非植入,并同意行OCT检查的冠心病患者,共30例(31处病变).在应用控制性球囊成形术作为预处理手段前后,及行药物涂层球囊或药物洗脱支架植入后分别行OCT检查,将OCT与CAG的检查数据及指导的治疗决策进行对比,观察术中预处理成功率及OCT指导的治疗决策转变.结果:按照CAG标准,有28处(90.3％)病变预处理成功;3处(9.7％)病变预处理失败,其中1处病变出现弹性回缩,2处病变出现C型夹层.按照OCT标准,有15处(48.4％)病变预处理成功;16处(52.6％)病变因出现预处理后发生的夹层预处理失败.两种预处理成功标准的治疗策略有统计学差异(P＜0.001).OCT指导的残余狭窄最小管腔参考直径比CAG指导的残余狭窄最小管腔参考直径更大,且有统计学差异[(2.93±0.07) mm∶(2.77±0.26) mm,P＜0.001].结论:OCT在指导冠脉原位病变介入治疗时更加精准明确客观,具有较高的临床应用价值.

Background:Cholesterol crystals (CCs) in lesions are the hallmark of advanced atherosclerotic plaque. Previous studies have demonstrated that CCs could activate NLRP3 inflammasome, which played an important role in atherosclerotic lesion progression. However, the relationship between CCs, NLRP3 inflammasome pathway, and plaque vulnerability in patients with ACS is still not elucidated.Methods:Two hundred sixty-nine consecutive acute coronary syndrome (ACS) patients with 269 culprit lesions were included in this study. CCs and other plaque characteristics within the culprit lesion segment were evaluated by optical coherence tomography (OCT) before percutaneous coronary intervention (PCI). The NLRP3 mRNA expression in peripheral blood mononuclear cells (PBMCs) and the serum levels of interleukin (IL)-1β, IL-18, and other biological indices were measured.Results:Cholesterol crystals were observed in 105 (39%) patients with 105 culprit lesions. There were no significant differences in baseline clinical characteristics between the patients with CCs (CCs group, n = 105) and the patients without CCs (non-CCs group, n = 164) within the culprit lesion segment except for lipoprotein(a) [Lp(a)]. The CCs group had a higher level of NLRP3 mRNA expression in PBMCs and higher levels of serum cytokine IL-1β and IL-18. OCT showed that the CCs group had longer lesion length, more severe diameter stenosis, and less minimum luminal area (MLA) than the non-CCs group (all p < 0.05). The frequency of thin-cap fibroatheroma (TCFA), thrombus, accumulation of macrophages, plaque rupture, micro-channel, calcification, spotty calcification, and layered plaque was higher in the CCs group than in the non-CCs groups (all p < 0.05). Multivariate logistic analysis revealed that the level of NLRP3 expression (OR = 10.204), IL-1β levels (OR = 3.523), IL-18 levels (OR = 1.006), TCFA (OR = 3.593), layered plaque (OR = 5.287), MLA (OR = 1.475), macrophage accumulation (OR = 2.881), and micro-channel (OR = 3.185) were independently associated with CCs.Conclusion:Acute coronary syndrome patients with CCs in culprit lesions had a higher expression of NLRP3, IL-1β, and IL-18, and had more vulnerable plaque characteristics than patients without CCs. CCs might have interacted with NLRP3 inflammasome activation in patients with ACS, which could contribute to plaque vulnerability in culprit lesions.

Background Telomere shortening, an indicator of aging, is associated with age-related diseases. This study aims to investigate the association between leukocyte telomere length (LTL) and thin-capped fibroatheromata (TCFA) and the impact of using LTL cutoff to determine the incidence of major adverse cardiovascular events (MACEs) in patients with angiographically intermediate coronary lesions. Methods This was a signal-center retrospective study focusing on patients who underwent coronary angiography and optical coherence tomography (OCT). The degree of coronary stenosis was assessed by angiography. The presence of TCFA was determined by OCT imaging. A total of 156 patients with angiographically intermediate coronary lesions were enrolled. Results Leukocyte telomere lengths were significantly shorter in the TCFA group compared with non-TCFA group [11.95 (10.56, 15.21) kb vs. 13.81 (12.06, 16.11) kb, p = 0.003]. The short-LTL group and long-LTL group were divided according to the optimal cut-off value which was determined by the receiver operating characteristic (ROC) curve analysis. Logistic regression model revealed that short-LTL was independently associated with TCFA incidence (odds ratio [OR] 4.387, 95% CI: 1.902–10.120, p = 0.001) after adjusting for confounding factors. Over a 24-months follow-up, the MACE incidence among patients with short-LTL was significantly higher than those in the long-LTL group (12.5 vs. 2.0%, p = 0.006 by log-rank test). Multivariable cox regression analysis indicated that short-LTL (hazard ratio [HR] 9.716, 95% CI: 1.995–47.319, p = 0.005) was an independent prognostic factor of MACE incidence in angiographically intermediate coronary lesions patients. Conclusions Short-LTL was independently associated with the incidence of TCFA and may serve as a prognostic factor for MACE risk on top of conventional risk factors.

目的 评价切割球囊联合药物涂层球囊在冠脉原发病变中的应用效果.方法 选择2017年8月11日～2020年6月11日行冠脉造影并拟行单纯药物涂层球囊治疗的冠脉原发病变患者,共91例.根据预处理方式的不同,将使用非顺应性或半顺应性球囊预处理的作为对照组(n=54),使用切割球囊预处理的作为观察组(n =37),比较两组在术中的预处理成功率.经过术后6个月的随访,比较两组患者的靶病变再狭窄、主要不良心血管事件发生率.结果 对照组的54例患者术中40例预处理成功,观察组37例患者术中36例预处理成功,两组差异具有统计学意义(P＜0.05).与对照组相比,观察组靶血管前降支和其他分支比例较高,回旋支、右冠比例较低,差异具有统计学意义(P＜0.05).对照组的54例患者中38例接受单纯药物涂层球囊治疗.观察组的37例患者中32例接受单纯药物涂层球囊治疗.与对照组比较,观察组预处理成功率较高,差异具有统计学意义(P＜0.05).预处理方式不同对预处理效果的影响具有统计学差异.非(不使用)切割球囊是预处理失败的独立危险因素.经过术后6个月随访,观察组中原靶病变再狭窄0例,非原靶病变血运重建1例.对照组中原靶病变再狭窄3例,非原靶病变血运重建2例,两组对比差异无统计学意义.结论 切割球囊完成冠脉原发病变预处理是一种非常良好的的病变准备手段,联合单纯药物涂层球囊后,获得了极低的靶血管失败率和良好的随访效果.

Background: The contemporary incidence of heart failure (HF) in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains unclear. This prospective cohort study was designed to study the incidence and predictors of new-onset HF in CAD patients after PCI (ChiCTR1900023033). Methods: From January 2014 to December 2018, 3,910 CAD patients without HF history undergoing PCI were prospectively enrolled. Demographics, medical history, cardiovascular risk factors, cardiac parameters, and medication data were collected at baseline. Multivariable adjusted competing-risk regression analysis was performed to examine the predictors of incident HF. Results: After a median follow-up of 63 months, 497 patients (12.7%) reached the primary endpoint of new-onset HF, of which 179, 110, and 208 patients (36.0, 22.1, and 41.9%) were diagnosed as having HF with reduced ejection fraction (EF) (HFrEF), HF with mid-range EF (HFmrEF), and HF with preserved EF (HFpEF), respectively. Higher B-type natriuretic peptide (BNP) or E/e′ level, lower estimated glomerular filtration rate (eGFR) level, and atrial fibrillation were the independent risk factors of new-onset HF. Gender (male) and angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) prescription were the negative predictors of new-onset HF. Moreover, it was indicated that long-term ACEI/ARB therapy, instead of beta-blocker use, was linked to lower risks of development of all three HF subtypes (HFrEF, HFmrEF and HFpEF). Conclusions: This prospective longitudinal cohort study shows that the predominant subtype of HF after PCI is HFpEF and ACEI/ARB therapy is accompanied with reduced risks of incident HF across three subtypes.

目的 在冠心病患者中应用光学相干断层成像(OCT)评估分层斑块并探讨其与冠状动脉易损性的关系.方法 入选2017年6月至2020年12月于上海交通大学医学院附属第九人民医院心内科住院,临床诊断为冠心病的患者222例.入院后行冠状动脉造影,并对靶血管行OCT检查.记录患者的一般资料、既往病史、心血管用药史、临床生化指标以及OCT数据.结果 共入选222例冠心病患者,OCT提示109例(49.1％)靶血管见分层斑块,其中左前降支61例(56.0％)、左回旋支20例(18.3％)、右冠状动脉28例(25.7％).心肌梗死患者中分层斑块占比65.0％(39/60),不稳定型心绞痛患者中分层斑块占比44.6％(25/56),稳定型心绞痛患者中分层斑块占比42.5％(45/106).两组患者生化指标比较,分层斑块组小而密低密度脂蛋白胆固醇[(1.16±0.38)mmol/L比(0.99±0.45)mmol/L]、肌钙蛋白[(2.69±11.57)ng/ml比(1.18±9.06)ng/ml]均高于非分层斑块组,差异均有统计学意义(均P<0.05).靶血管OCT特征方面,与非分层斑块组比较,分层斑块组最小管腔面积更小[(2.37±1.31)mm2比(3.35±2.23)mm2]、面积狭窄率更大[(69.11±12.26)％比(59.41±17.12)％]、病变长度更长[(20.05±8.94)mm比(17.03±7.75)mm]、脂质斑块弧度更大[(250.33±88.02)°比(181.55±115.71)°]、脂质斑块更长[(17.13±8.78)mm比(11.28±8.52)mm]、纤维帽更薄[(49.04±19.32)μm比(61.21±9.12)μm],差异均有统计学意义(均P<0.05).分层斑块组血栓形成、斑块破裂、巨噬细胞、微血管化、胆固醇结晶、内膜溃疡、内膜夹层、钙化斑块、薄纤维帽脂质斑块例数均较非分层斑块组更多,差异均有统计学意义(均P<0.05).受试者工作特征曲线显示,脂质斑块弧度预测分层斑块的曲线下面积(AUC)为0.683,敏感度为87.2％,特异度为43.4％,诊断临界值为167°(P<0.001);脂质斑块长度预测分层斑块的AUC为0.688,敏感度为77.1％,特异度为54.0％,诊断临界值为11.8 mm(P<0.001).非分层斑块组和分层斑块组9个月累计主要不良心血管事件发生率比较,差异有统计学意义(P=0.038),分层斑块组累计发生的MACE较多.结论 分层斑块不仅反映既往有斑块破裂或血栓形成的愈合史,还反映脂质斑块易损性,可能有预测未来冠状动脉事件潜在风险的价值.

目的 探讨切割球囊在药物涂层球囊治疗冠脉原位病变时的临床价值.方法 选择2017年8月11日-2020年6月11日上海交通大学医学院附属第九人民医院心内科所有冠脉造影后需要血运重建,适合行冠脉介入治疗(PCI),并且同意行单纯药物涂层球囊的冠心病患者(1月内的急性ST段抬高型心肌梗死除外),共37例,平均年龄(67.2±10.2)岁.在单纯应用药物涂层球囊前,将切割球囊作为预处理策略,观察术中预处理成功率及6个月后的冠脉造影随访结果.结果 本组37例患者中,除1例无法到达靶病变外,其他36例(97.3％)均预处理成功.在实现了球囊直径大小和充盈压力管理策略的情况下,经过6个月的冠脉造影随访,单纯接受药物涂层球囊的32例患者,有1例再次血运重建(MACE),但非原靶病变.结论 通过切割球囊完成冠脉原位病变预处理的控制性球囊成形术,是一种良好的病变准备手段.

目的 分析传统术式和在左乳内动脉(left internal mammary artery,LIMA)上以Y型桥方式行冠状动脉旁路移植术(coronary artery bypass grafting,CABG)的术中桥血管流量情况.方法 选择2019年2月至2020年3月25例行上述两种方式之一搭桥的患者,根据非LIMA移植血管近端吻合口位置,分为传统术式组(桥血管近端吻合于主动脉,n=18)和LIMA Y-graft组(桥血管近端吻合于LIMA,n=7),使用MEDISTIM VeriQ血流仪于术中行桥血管流量实时测定,比较平均血流量(mean graft flow,MGF)和搏动指数(pulsatility index,PI).结果 传统术式组和Y-graft组患者LIMA-LAD桥MGF分别为26(17) ml/min和24(31) ml/min,平均PI分别为2.02±0.90和3.68±2.19,差异均无统计学意义(P＞0.05);传统术式组和Y-graft组患者非LIMA桥MGF分别为32(21.25)ml/min和27(26)ml/min,PI分别为2.57±1.17和2.89±1.70,差异也无统计学意义(P＞0.05).结论 传统术式与LIMA Y-graft吻合的桥血管的血流动力学效果一致,术者可结合临床选择合适手术方案.

Background Primary percutaneous coronary intervention (PCI) is the best available reperfusion strategy in patients with acute ST-segment elevation myocardial infarction (STEMI). However, PCI is associated with a serious problem known as no-reflow phenomenon, resulting in poor clinical and functional outcomes. This study aimed to compare the influences of different balloon deflation velocity on coronary flow and cardiovascular events during primary PCI in STEM as well as transient hemodynamic changes in in vitro experiments. Method and Results. 211 STEMI patients were randomly assigned to either a rapid or a slow balloon deflation group during stent deployment. The primary end point was coronary flow at the end of PCI procedure, and secondary end points included myocardial infarct size. Transient hemodynamic changes were evaluated through an in vitro experimental apparatus and a computer model. In clinical practice, the level of corrected TIMI frame count (cTFC) in slow balloon deflation after primary PCI was significantly lower than that of rapid balloon deflation, which was associated with smaller infarct size. Numerical simulations revealed that the rapid deflation led to a sharp acceleration of flow in the balloon-vessel gap and a concomitant abnormal rise in wall shear stress (WSS). Conclusion This randomized study demonstrated that the slow balloon deflation during stent implantation improved coronary flow and reduced infarct size in reperfused STEMI. The change of flow in the balloon-vessel gap and WSS resulted from different balloon deflation velocity might be partly accounted for this results.

AIMS:Patients with heart failure (HF) are typically designated as having reduced, mid-range, or preserved ejection fraction (EF) (HFrEF, HFmrEF, or HFpEF, respectively) because of the importance of left ventricular EF (LVEF) on therapeutic decisions and prognosis. However, such designations are not necessarily static, as there are many transitions among the three HF phenotypes during follow-up. This prospective longitudinal cohort study sought to examine the HF transitions over time and their clinical characteristics, prognosis, and response to medical therapy.METHODS AND RESULTS:We identified 1920 patients from a prospective cohort with a primary diagnosis of HF between 1 January 2007 and 31 December 2012. The enrolled HF patients were re-classified into three groups on the basis of baseline and 1 year follow-up echocardiography: HF with improved EF (HFiEF), HF with deteriorated EF (HFdEF), and HF with unchanged EF (HFuEF). The primary outcome was 5 year all-cause mortality. According to 1 year follow-up echocardiography, 490 (25.5%) were diagnosed as HFiEF, 179 (9.3%) as HFdEF, and 1251 (65.2%) as HFuEF. Ischaemic heart disease was an independent predictor of HFdEF, and beta-blocker prescription was an independent predictor of HFiEF. During the 5 year follow-up, patients with HFdEF had higher mortality, whereas patients with HFiEF had lower mortality. After adjustment, HFiEF, compared with HFuEF, was associated with a 62.1% decreased risk for mortality. Finally, the use of beta-blockers was associated with improved prognosis of patients with HFiEF and HFuEF.CONCLUSIONS:In this cohort of patients with HF, LVEF is a dynamic factor related to coexisting conditions and drug therapy. HFiEF and HFdEF are distinct HF phenotypes with different clinical outcomes than other phenotypes.

目的:探讨脉压(PP)、脉压指数(PPI)与冠脉钙化严重程度的关系.方法:回顾性分析我院心内科冠心病患者255例的临床资料,根据冠脉有无钙化及钙化病变的最大弧度分为无钙化组(63例),轻度钙化组(127例),重度钙化组(65例),比较3组之间的外周动脉血压、PP、PPI水平.钙化患者再按PP水平分为低PP组(42例),中PP组(109例),高PP组(41例),比较各组间血压及钙化情况.分析影响冠脉重度钙化的因素.结果:1、与无钙化组和轻度钙化组相比,重度钙化组收缩压[(136.2±13.7)mmHg、(136.2±14.1))mmHg比(144.6±14.2)mm-Hg]、PP[(54.1±11.0)mmHg、(56.8±11.2)mmHg,比(69.9±13.8)mmHg],PPI[(0.40±0.06)、(0.42±0.06)比(0.48±0.07)]均显著升高,舒张压[(82.1±10.7)mmHg、(79.3±9.2)mmHg比(74.7±11.0)mmHg]显著下降,P均<0.01;2、与低、中PP组比较,高PP组血管钙化长度[(7.35±6.14)mm、(8.99±7.58)mm比(14.37±8.87)mm],最大钙化角(103.48±58.03)°、(139.78±105.56)°比(245.83±105.12)°],病变长度[(16.34±6.90)mm、(17.61±7.78)mm比(21.34±10.78)mm]均显著增加,P<0.05或<0.01;3、二元Logistic回归分析显示,PP和年龄为冠脉重度钙化的独立危险因素(OR=1.084、1.052,P=0.001、0.029).结论:PP可能在冠脉钙化的发生发展中发挥作用,并能够预测冠脉重度钙化.

Background: Type 2 diabetes mellitus (T2DM) and hypertension are independently related to increasing risk of subsequent incident heart failure with preserved ejection fraction (HFpEF). This study was designed to evaluate the influences of long-term metformin prescription in these patients. Methods: Using a propensity score matching of 1:2 ratio, this retrospective claims database study compared metformin prescription (n = 130) and non-metformin therapy (n = 260) in patients with T2DMand hypertension and without clinical signs or symptoms of heart failure. Results: With a follow-up of 6 years, the new-onset symptomatic HFpEF occurred in 6 of 130 patients in metformin group and 31 of 260 patients in non-metformin group (P = .020). Metformin also generated more prominent improvement in left ventricular (LV) diastolic function and hypertrophy. And Cox proportional hazards regression model revealed that metformin prescription (HR 0.351, 95% CI: 0.145-0.846, P = .020) was associated with a reduced risk of new onset of symptomatic HFpEF. Conclusions: Long-term metformin exposure was associated with protective effects in terms of the incidence of new-onset symptomatic HFpEF, LV diastolic dysfunction and hypertrophy in patients with T2DM and hypertension, which might be beneficial for the delay of HFpEF progression. (c) 2019 Published by Elsevier B.V.

While coronary revascularization strategies guided by instantaneous wave-free ratio (iFR) are, in general, noninferior to those guided by fractional flow reserve (FFR) with respect to the rate of major adverse cardiac events at one-year follow-up in patients with stable angina or an acute coronary syndrome, the overall accuracy of diagnosis with iFR in large patient cohorts is about 80% compared with the diagnosis with FFR. So far, it remains incompletely understood what factors contribute to the discordant diagnosis between iFR and FFR. In this study, a computational method was used to systemically investigate the respective effects of various cardiovascular factors on FFR and iFR. The results showed that deterioration in aortic valve disease (e.g., regurgitation or stenosis) led to a marked decrease in iFR and a mild increase in FFR given fixed severity of coronary artery stenosis and that increasing coronary microvascular resistance caused a considerable increase in both iFR and FFR, but the degree of increase in iFR was lower than that in FFR. These findings suggest that there is a high probability of discordant diagnosis between iFR and FFR in patients with severe aortic valve disease or coronary microcirculation dysfunction.

患者,男,34岁,因"阵发性胸闷气急1 个月"于2015 年2月26日入院.患者1个月余前感冒后出现胸闷气急,活动后加重,休息后缓解,伴双下肢浮肿. 患者既往有高血压病史;否认其他慢性疾病及家族史. 入院时气稍促,伴有双下肢轻度浮肿,余体格检查无明显异常. 血常规提示白细胞、C反应蛋白明显升高;血肌酐偏高,肌钙蛋白 I 22. 33 ng/ml,脑钠肽( BNP) 2384 pg/ml. 心电图示:窦性心动过速,Ⅱ、Ⅲ、aVF、V5、V6 导联T波倒置. 心脏彩色超声示左室射血分数(LVEF)34. 1％,全心增大,左室收缩舒张功能明显减退. 给予抗感染、利尿减轻心脏负荷、抗血小板聚集、扩张冠状动脉、调脂稳斑、控制心室率、降压、改善心肌重构、营养心肌等治疗. 于3月3日行冠状动脉造影检查:右冠状动脉无明显狭窄,左主干正常,前降支近段30％狭窄,回旋支粗大,近段管壁不规则,TIMI血流3级.经治疗患者病情好转,出院诊断:扩张型心肌病,心功能不全,心功能Ⅱ级,原发性高血压3级. 出院后给予血管紧张素转换酶抑制剂、β受体阻滞剂、利尿剂及曲美他嗪治疗. 患者出院后长期服用上述抗心力衰竭药物,并随访复查心脏彩色超声,提示左室射血分数逐渐提高、心功能改善,平素一般活动不受限.