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.

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.

The dynamic characteristics of cardiorespiratory fitness during high-altitude acclimatization and deacclimatization are not well elucidated, and whether ubiquinol exerts beneficial effects on cardiorespiratory fitness remains debated. In this trial, 41 volunteers were randomized to receive oral ubiquinol or placebo administration, 14 days before departure to highlands. All individuals were carried to 3900 m by air and then returned to 300 m after 7 days. Cardiopulmonary exercise testing was performed at baseline, on the third day after arrival in the highlands, and on the seventh day after return. This trial revealed the dynamic characteristics of cardiorespiratory fitness during the entire high-altitude acclimatization and deacclimatization process. The short-term journey to the highlands did not significantly affect cardiorespiratory fitness or physical performance capacity after the return. Cardiovascular and respiratory recoveries were desynchronized after returning from the highlands. Ubiquinol supplementation maintained the physical performance capacity in the highlands and facilitated acclimatization to hypoxia. Trial registration: The Chinese Clinical Trial Registry, ChiCTR2200059900, http://www.chictr.org.cn/ChiCTR2200059900.

Background Imaging technique has emerged as an innovative tool for diagnosing and monitoring patients with pulmonary hypertension (PH). Current studies in radiomics primarily focus on hemodynamics and cardiac function, whereas the assessment of pulmonary vessels is often neglected. This study aims to investigate the diagnostic and prognostic value of computed tomography pulmonary vascular radiomics in PH. Methods This multicenter study enrolled 193 patients with PH and 193 controls (102 symptomatic non‐PH cases and 91 healthy volunteers) for diagnostic analysis, with external validation in 38 patients with PH and 38 controls. For prognostic analysis, 166 patients with PH were prospectively followed (median follow‐up: 16 months; 96 clinical deterioration events), with external validation in 32 patients with PH (median follow‐up: 7 months; 11 events). Pulmonary vascular radiomics features extracted from chest computed tomography were used to develop predictive models for PH diagnosis and prognosis. Results The diagnostic model integrating 7 radiomic and 3 clinical features achieved an area under the curve of 0.984 (95% CI, 0.959–0.995) in the derivation cohort and 0.980 (0.901–1.000) in external validation. For exploratory pulmonary arterial hypertension subtyping, the model incorporating 8 radiomic and 2 clinical features yielded an area under the curve of 0.898 (0.825–0.972) internally and 0.877 (0.352–1.000) externally. The prognostic radiomic‐clinical model outperformed the European Society of Cardiology 4‐strata risk assessment, with a 2‐year area under the curve of 0.866 (0.8–0.942) versus 0.709 (0.648–0.789). Conclusions The radiomics‐based models have strong diagnostic and prognostic capabilities for PH and can also successfully differentiate pulmonary arterial hypertension. This suggests the potential of radiomics to discern PH with different clinical risks, which may facilitate personalized drug therapy.

Despite the frequency of persistent new-onset conduction disturbances after transcatheter aortic valve replacement (TAVR), few preoperative methods of prediction exist. Patients who underwent TAVR in the Department of Cardiology of the Second Affiliated Hospital of the Army Medical University from December 2020 to September 2021 and postoperative aortic root modeling via the FEOPS finite element analysis were included in this single-center case–control study, divided into persistent conduction disturbances (PCD) and non-PCD groups according to their pre- and postoperative electrocardiograms in the first month. Risk factors affecting PCD were identified by comparing the baseline data of these two groups, including echocardiograms, computed tomography angiography of the aortic root, surgical decision-making, and FEOPS data. Independent risk factors were screened using logistic regression modeling, and the receiver operating characteristic (ROC) curve was used to test the predictive ability. A total of 56 patients were included in this study, 37 with bicuspid aortic valve (BAV) and 19 with trileaflet aortic valve (TAV), with 17 cases of PCD. The contact pressure index (CPI) of FEOPS, valve oversize ratio, differences between membranous interventricular septum length and implantation depth (ΔMSID) and valve implantation depth were statistically different (P < 0.05). CPI could be used as an independent risk factor for PCD (P < 0.05), and the ROC curve comparison showed that the CPI was more predictive (AUC = 0.806, 95

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

BACKGROUND:High-altitude exposure changes the electrical conduction of the heart. However, reports on electrocardiogram (ECG) characteristics and potent prophylactic agents during high-altitude acclimatization and de-acclimatization are inadequate. This study aimed to investigate the effects of ubiquinol on electrophysiology after high-altitude hypoxia and reoxygenation. METHODS:The study was a prospective, randomized, double-blind, placebo-controlled trial. Forty-one participants were randomly divided into two groups receiving ubiquinol 200 mg daily or placebo orally 14 days before flying to high altitude (3900 m) until the end of the study. Cardiopulmonary exercise testing was performed at baseline (300 m), on the third day after reaching high altitude, and on the seventh day after returning to baseline. RESULTS:Acute high-altitude exposure prolonged resting ventricular repolarization, represented by increased corrected QT interval (455.9 ± 23.4 vs. 427.1 ± 19.1 ms, P < 0.001) and corrected Tpeak-Tend interval (155.5 ± 27.4 vs. 125.3 ± 21.1 ms, P < 0.001), which recovered after returning to low altitude. Ubiquinol supplementation shortened the hypoxia-induced extended Tpeak-Tend interval (-7.7 ms, [95% confidence interval (CI), -13.8 to -1.6], P = 0.014), Tpeak-Tend /QT interval (-0.014 [95% CI, -0.027 to -0.002], P = 0.028), and reserved maximal heart rate (11.9 bpm [95% CI, 3.2 to 20.6], P = 0.013) during exercise at high altitude. Furthermore, the decreased resting amplitude of the ST-segment in the V3 lead was correlated with decreased peak oxygen pulse (R = 0.713, P < 0.001) and maximum oxygen consumption (R = 0.595, P < 0.001). CONCLUSIONS:Our results illustrated the electrophysiology changes during high-altitude acclimatization and de-acclimatization. Similarly, ubiquinol supplementation shortened the prolonged Tpeak-Tend interval and reserved maximal heart rate during exercise at high altitude. REGISTRATION:URL: www.chictr.org.cn; Unique identifier: ChiCTR2200059900.

Post-myocardial infarction ventricular septal rupture (PIVSR) is one of the most severe types of mechanical complications after acute myocardial infarction (AMI) with high mortality and poor prognosis. The risk factors for short-term mortality of patients with PIVSR may be not widely recognized. We aimed to assess the prevalence and short-term mortality risk predictors of PIVSR. A total of 62 patients with a diagnosis of PIVSR were admitted to three top general public hospitals in Chongqing, China. Clinical characteristics and short-term outcomes of patients with PIVSR were compared. Predictors of PIVSR were assessed using logistic regression analysis. Mean age was 70.7 ± 10.7 years (38.7

BackgroundMany retrospective studies suggest that risk improvement may be a suitable efficacy surrogate endpoint for pulmonary arterial hypertension (PAH) medication trials. This prospective multicenter study assessed the efficacy of domestic ambrisentan in Chinese PAH patients and observed risk improvement and time to clinical improvement (TTCI) under ambrisentan treatment.MethodsEligible patients with PAH were enrolled for a 24-week treatment with ambrisentan. The primary efficacy endpoint was 6-min walk distance (Δ6MWD). The exploratory endpoints were risk improvement and TTCI, defined as the time from initiation of treatment to the first occurrence of risk improvement.ResultsA total of 83 subjects were enrolled. After ambrisentan treatment, Δ6MWD was significantly increased at week 12 (42.2 m, P < 0.0001) and week 24 (53.4 m, P < 0.0001). Within 24 weeks, risk improvement was observed in 53 (64.6%) subjects (P < 0.0001), which is higher than WHO-FC (30.5%) and TAPSE/PASP (32.9%). Kaplan–Meier analysis of TTCI showed a median improvement time of 131 days and a cumulative improvement rate of 75.1%. Also, TTCI is consistent across different baseline risk status populations (log-rank P = 0.51). The naive group had more risk improvement (P = 0.043) and shorter TTCI (log-rank P = 0.008) than the add-on group, while Δ6MWD did not show significant differences between the two groups.ConclusionsDomestic ambrisentan significantly improved the exercise capacity and risk status of Chinese PAH patients. TTCI has a relatively high positive event rate within 24-week treatment duration. Compared to Δ6MWD, TTCI is not affected by baseline risk status. Additionally, TTCI could identify better improvements in patients, which Δ6MWD does not detect. TTCI is an appropriate composite surrogate endpoint for PAH medication trials.Clinical Trial RegistrationNCT No. [ClinicalTrials.gov], identifier [NCT05437224].

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.

Background Cardiorespiratory fitness plays an important role in coping with hypoxic stress at high altitudes. However, the association of cardiorespiratory fitness with the development of acute mountain sickness (AMS) has not yet been evaluated. Wearable technology devices provide a feasible assessment of cardiorespiratory fitness, which is quantifiable as maximum oxygen consumption (VO2max) and may contribute to AMS prediction. Objective We aimed to determine the validity of VO2max estimated by the smartwatch test (SWT), which can be self-administered, in order to overcome the limitations of clinical VO2max measurements. We also aimed to evaluate the performance of a VO2max-SWT–based model in predicting susceptibility to AMS. Methods Both SWT and cardiopulmonary exercise test (CPET) were performed for VO2max measurements in 46 healthy participants at low altitude (300 m) and in 41 of them at high altitude (3900 m). The characteristics of the red blood cells and hemoglobin levels in all the participants were analyzed by routine blood examination before the exercise tests. The Bland-Altman method was used for bias and precision assessment. Multivariate logistic regression was performed to analyze the correlation between AMS and the candidate variables. A receiver operating characteristic curve was used to evaluate the efficacy of VO2max in predicting AMS. Results VO2max decreased after acute high altitude exposure, as measured by CPET (25.20 [SD 6.46] vs 30.17 [SD 5.01] at low altitude; P<.001) and SWT (26.17 [SD 6.71] vs 31.28 [SD 5.17] at low altitude; P<.001). Both at low and high altitudes, VO2max was slightly overestimated by SWT but had considerable accuracy as the mean absolute percentage error (<7%) and mean absolute error (<2 mL·kg–1·min–1), with a relatively small bias compared with VO2max-CPET. Twenty of the 46 participants developed AMS at 3900 m, and their VO2max was significantly lower than that of those without AMS (CPET: 27.80 [SD 4.55] vs 32.00 [SD 4.64], respectively; P=.004; SWT: 28.00 [IQR 25.25-32.00] vs 32.00 [IQR 30.00-37.00], respectively; P=.001). VO2max-CPET, VO2max-SWT, and red blood cell distribution width-coefficient of variation (RDW-CV) were found to be independent predictors of AMS. To increase the prediction accuracy, we used combination models. The combination of VO2max-SWT and RDW-CV showed the largest area under the curve for all parameters and models, which increased the area under the curve from 0.785 for VO2max-SWT alone to 0.839. Conclusions Our study demonstrates that the smartwatch device can be a feasible approach for estimating VO2max. In both low and high altitudes, VO2max-SWT showed a systematic bias toward a calibration point, slightly overestimating the proper VO2max when investigated in healthy participants. The SWT-based VO2max at low altitude is an effective indicator of AMS and helps to better identify susceptible individuals following acute high-altitude exposure, particularly by combining the RDW-CV at low altitude. Trial Registration Chinese Clinical Trial Registry ChiCTR2200059900; https://www.chictr.org.cn/showproj.html?proj=170253

目的 系统评价创伤后肺栓塞成年患者使用静脉血管滤器的有效性和安全性.方法 检索PuMed、Embase、the Cochrane Library、中国知网、中国生物医学文献数据库、维普数据库、万方数据库建库至2022年3月关于创伤后肺栓塞患者使用静脉血栓滤器的随机对照实验(randomized controlled trials,RCT),由2名研究者对文献质量进行严格评价,按照纳入排除标准独立对文献进行筛选提取,采用RevMan5.3软件对数据进行Meta分析.结果 纳入RCT 6篇,共810例患者,装有静脉血管滤器的创伤后肺栓塞患者为试验组,无静脉血管滤器的患者为对照组.Meta分析结果显示,两组深静脉血栓和肺栓塞(95％CI:0.29～0.77,P=0.003,MD=0.480)发生率比较差异有统计学意义,但病死率比较差异无统计学意义.通过安置静脉血管滤器,预防肺栓塞的发生率试验组优于对照组(95％CI:0.59～2.78,P=0.520,MD=1.290),深静脉血栓的发生率试验组高于对照组(95％CI:1.06～2.32,P=0.020,MD=1.570).结论 综合文献分析证实,预防性安置静脉血管滤器可以显著降低创伤患者肺栓塞的发生率,但同时预防性安置血管静脉滤器会导致深静脉血栓发生率显著升高.

动脉导管未闭(patent ductus arteriosus,PDA)是常见的先天性心脏病.细小PDA通常情况下不产生血流动力学影响,对于是否需要手术治疗目前尚有争议,但在某些特殊情况下,可能导致严重后果.本研究报道1例暴发性心肌炎合并细小PDA患者,经过紧急PDA介入封堵后获得成功救治.

Cardiorespiratory function influences exercise capacity and is an important determinant of high-altitude adaptation. Some studies have investigated the characteristics of changes in cardiorespiratory fitness during high-altitude acclimatization. However, studies on changes in cardiorespiratory fitness during high-altitude de-acclimatization are still lacking and have not yet been elucidated. Furthermore, few drugs have been studied to improve cardiorespiratory function during both processes. The Shigatse CARdiorespiratory Fitness (SCARF) study is a single-center, randomized, double-blind, placebo-control clinical trial to explore the effects of ubiquinol on cardiorespiratory fitness during high-altitude acclimatization and de-acclimatization in healthy adults. Participants will be randomly assigned 1:1 to ubiquinol 200 mg daily or a placebo for 14 days before departure until the end of data collection after return in 7 days. Cardiorespiratory fitness is the primary outcome, while acute mountain sickness and high-altitude de-acclimatization symptoms are secondary endpoints. In addition, laboratory measurements, including routine blood tests and serological measurements, will be performed. To the best of our knowledge, the SCARF study will be the first to reveal the changes in the cardiorespiratory fitness characteristics during high-altitude acclimatization and de-acclimatization. Furthermore, the results of this study will contribute to exploring whether ubiquinol supplementation could be beneficial for endurance exercise capacity at different altitudes and help improve adaptation to acute hypoxia and de-acclimatization. Clinical Trial Registration: This study has been registered in the Chinese Clinical Trial Register (www.chictr.org.cn) as ChiCTR2200059900 and ChiCTR2200066328.

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.

Insufficient cardiorespiratory compensation is closely associated with acute hypoxic symptoms and high-altitude (HA) cardiovascular events. To avoid such adverse events, predicting HA cardiorespiratory fitness impairment (HA-CRFi) is clinically important. However, to date, there is insufficient information regarding the prediction of HA-CRFi. In this study, we aimed to formulate a protocol to predict individuals at risk of HA-CRFi. We recruited 246 volunteers who were transported to Lhasa (HA, 3,700 m) from Chengdu (the sea level [SL], <500 m) through an airplane. Physiological parameters at rest and during post-submaximal exercise, as well as cardiorespiratory fitness at HA and SL, were measured. Logistic regression and receiver operating characteristic (ROC) curve analyses were employed to predict HA-CRFi. We analyzed 66 pulmonary vascular function and hypoxia-inducible factor- (HIF-) related polymorphisms associated with HA-CRFi. To increase the prediction accuracy, we used a combination model including physiological parameters and genetic information to predict HA-CRFi. The oxygen saturation (SpO2) of post-submaximal exercise at SL and EPAS1 rs13419896-A and EGLN1 rs508618-G variants were associated with HA-CRFi (SpO2, area under the curve (AUC) = 0.736, cutoff = 95.5%, p < 0.001; EPAS1 A and EGLN1 G, odds ratio [OR] = 12.02, 95% CI = 4.84–29.85, p < 0.001). A combination model including the two risk factors—post-submaximal exercise SpO2 at SL of <95.5% and the presence of EPAS1 rs13419896-A and EGLN1 rs508618-G variants—was significantly more effective and accurate in predicting HA-CRFi (OR = 19.62, 95% CI = 6.42–59.94, p < 0.001). Our study employed a combination of genetic information and the physiological parameters of post-submaximal exercise at SL to predict HA-CRFi. Based on the optimized prediction model, our findings could identify individuals at a high risk of HA-CRFi in an early stage and reduce cardiovascular events.

High altitude (HA) exposure has been considered as a cardiac stress and might impair ventricular diastolic function. Atrial contraction is involved in ventricular passive filling, however the atrial performance to HA exposure is poorly understood. This study aimed to evaluate the effect of short-term HA exposure on bi-atrial function. Physiological and 2D-echocardiographic data were collected in 82 healthy men at sea level (SL, 400 m) and 4100 m after an ascent within 7 days. Atrial function was measured using volumetric and speckle-tracking analyses during reservoir, conduit and contractile phases of cardiac cycle. Following HA exposure, significant decreases of reservoir and conduit function indexes were observed in bi-atria, whereas decreases of contractile function indexes were observed in right atrium (RA), estimated via RA active emptying fraction (SL 41.7 ± 13.9% vs. HA 35.4 ± 12.2%, p = 0.001), strain during the contractile phase [SL 13.5 (11.4, 17.8) % vs. HA 12.3 (9.3, 15.9) %, p = 0.003], and peak strain rate during the contractile phase [SL − 1.76 (− 2.24, − 1.48) s−1 vs. HA − 1.57 (− 2.01, − 1.23) s−1, p = 0.002], but not in left atrium (LA). In conclusion, short-term HA exposure of healthy individuals impairs bi-atrial performance, mostly observed in RA. Especially, atrial contractile function decreases in RA rather than LA, which seems not to compensate for decreased ventricular filling after HA exposure. Our findings may provide a novel evidence for right-sided heart dysfunction to HA exposure.

Background Ascending to high altitude (HA) contribute to the development of acute mountain sickness (AMS). The prevalence, clinical features and relative risks for AMS may dynamically evolve but has not been described. Methods A total of 1,629 healthy men aged from 16 to 45 years were enrolled. A fast ascent cohort (n=1283) ascended to 3700 m by airplane and further ascended to 4400 m by bus; a slow ascent cohort (n=346) ascended to 3450 m by bus and further ascended to 4100 m by bus. AMS was diagnosed by the Lake Louise Scoring (LLS) system. Results As diagnosed by the old LLS and new LLS, the prevalence of AMS was 68.4% and 56.1% at 3700 m, respectively, which decreased to 21.4% and 14.3% after further ascending to 4400 m in the fast ascent cohort; the prevalence of AMS was 30.3% and 25.7% at 3450 m, which increased to 36.6% and 32.2% after further ascending to 4100 m in the slow ascent cohort. Moreover, AMS-related symptoms, such as headache, dizziness and fatigue, were the leading symptoms except at 4400 m in the fast ascent cohort. Fast ascent protocol was a risk factor during the initial ascent but became a protective factor after a further ascent to a higher altitude. Conclusions Ascent protocol was the primary factor that affected the incidence of AMS and related symptoms. These findings imply a novel strategy for high altitude travels or work with a plan to ascend to a higher altitude.

BACKGROUNDHigh altitude exposure induces overload of right-sided heart and may further predispose to supraventricular arrhythmia. It has been reported that atrial mechanical dyssynchrony is associated with atrial arrhythmia. Whether high altitude exposure causes higher right atrial (RA) dyssynchrony is still unknown. The aim of study was to investigate the effect of high altitude exposure on right atrial mechanical synchrony.METHODSIn this study, 98 healthy young men underwent clinical examination and echocardiography at sea level (400 m) and high altitude (4100 m) after an ascent within 7 days. RA dyssynchrony was defined as inhomogeneous timing to peak strain and strain rate using 2D speckle-tracking echocardiography.RESULTSFollowing high altitude exposure, standard deviation of the time to peak strain (SD-TPS) [36.2 (24.5, 48.6) ms vs. 21.7 (12.9, 32.1) ms, p<0.001] and SD-TPS as percentage of R-R' interval (4.6 ± 2.1% vs. 2.5 ± 1.8%, p<0.001) significantly increased. Additionally, subjects with higher SD-TPS (%) at high altitude presented decreased right ventricular global longitudinal strain and RA active emptying fraction, but increased RA minimal volume index, which were not observed in lower group. Multivariable analysis showed that mean pulmonary arterial pressure and tricuspid E/A were independently associated with SD-TPS (%) at high altitude.CONCLUSIONOur data for the first time demonstrated that high altitude exposure causes RA dyssynchrony in healthy young men, which may be secondary to increased pulmonary arterial pressure. In addition, subjects with higher RA dyssynchrony presented worse RA contractile function and right ventricular performance.