Background Cardiometabolic multimorbidity (CMM) is increasingly prevalent in ageing populations and confers substantial clinical and societal burdens. The C-reactive protein–triglyceride–glucose index (CTI) integrates inflammatory and metabolic information, but evidence linking long-term CTI patterns to incident CMM and the role of adiposity as a potential mediator remains limited. Methods We included 5,778 participants aged ≥ 45 years who were free of CMM at baseline. Exposures were baseline CTI in 2012, cumulative CTI(cuCTI) from 2012 to 2015, and CTI change-pattern (trajectory) groups derived from repeated measurements. Incident CMM was assessed in 2018. Multivariable logistic regression models were pooled across multiple imputations; restricted cubic splines examined dose–response. Prediction performance was evaluated using C-statistics (DeLong test), net reclassification improvement, and integrated discrimination improvement. Mediation by adiposity indices was assessed. Results Incident CMM occurred in 333 participants (5.8%). In fully adjusted models, higher baseline CTI and greater cumulative CTI exposure were independently associated with higher odds of incident CMM (baseline CTI per IQR: OR 1.545 (95% CI 1.344–1.776); cuCTI per IQR: OR 1.651 (95% CI 1.429–1.907), both P < 0.001). Change-pattern (trajectory) analyses further indicated substantially higher risk among participants with persistently elevated CTI compared with those with persistently low CTI (OR 3.078 (95% CI 2.169–4.369), P < 0.001). Adding baseline CTI, cuCTI, or change-pattern grouping improved discrimination beyond the basic model and improved reclassification. Adiposity indices partially mediated the CTI–CMM associations. Conclusions Higher cumulative CTI and persistently elevated CTI change patterns were associated with incident cardiometabolic multimorbidity and improved risk prediction, with partial mediation by adiposity.

Although sodium‒glucose cotransporter-2 (SGLT2) inhibitors have cardiorenal benefits, their efficacy in patients with type 2 diabetes mellitus (T2DM) and chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI) remains underexplored. To evaluate the cardiorenal protective effects of the SGLT2 inhibitor dapagliflozin in patients with T2DM and CCS receiving PCI. This was a cross-sectional analysis of 1,430 patients from a tertiary hospital database who underwent PCI (January 1, 2018, to March 31, 2022). Cardiac outcomes (PMI/4aMI) and renal outcomes (eGFR and CI-AKI). After 1:1 propensity score matching (PSM) (176 dapagliflozin vs. 176 control), the dapagliflozin group showed significantly lower PMI/4aMI rates pre-PSM (39.78

Background Allogeneic Blood transfusion is common in hip surgery but is associated with increased morbidity. Accurate prediction of transfusion risk is necessary for minimizing blood product waste and preoperative decision-making. The study aimed to develop machine learning models for predicting perioperative blood transfusion in hip surgery and identify significant risk factors. Methods Data of patients undergoing hip surgery between January 2013 and October 2021 in the Peking Union Medical College Hospital were collected to train and test predictive models. The primary outcome was perioperative red blood cell (RBC) transfusion within 72 h of surgery. Fourteen machine learning algorithms were established to predict blood transfusion risk incorporating patient demographic characteristics, preoperative laboratory tests, and surgical information. Discrimination, calibration, and decision curve analysis were used to evaluate machine learning models. SHapley Additive exPlanations (SHAP) was performed to interpret models. Results In this study, 2431 hip surgeries were included. The Ridge Classifier performed the best with an AUC = 0.85 (95% CI, 0.81 to 0.88) and a Brier score = 0.21. Patient-related risk factors included lower preoperative hemoglobin, American Society of Anesthesiologists (ASA) Physical Status > 2, anemia, lower preoperative fibrinogen, and lower preoperative albumin. Surgery-related risk factors included longer operation time, total hip arthroplasty, and autotransfusion. Conclusions The machine learning model developed in this study achieved high predictive performance using available variables for perioperative blood transfusion in hip surgery. The predictors identified could be helpful for risk stratification, preoperative optimization, and outcomes improvement.

Background: Studies reporting the status of coronary microvascular function in the infarct-related artery (IRA) after primary percutaneous coronary intervention (PCI) remain limited. This study utilized the coronary angiography-derived index of microcirculatory resistance (caIMR) to assess coronary microvascular function in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI. Methods: We used the FlashAngio system to measure the caIMR after primary PCI in 157 patients with STEMI. The primary endpoint was the occurrence of a major adverse cardiovascular event (MACE), defined as a composite endpoint encompassing cardiac mortality, target vessel revascularization, and rehospitalization due to congestive heart failure (CHF), myocardial infarction (MI), or angina. Results: Approximately 30% of patients diagnosed with STEMI and who experienced successful primary PCI during the study period had a caIMR in the IRA of >40. The caIMR in the IRA was significantly higher than in the reference vessel (32.9 ± 15.8 vs. 27.4 ± 11.1, p < 0.001). The caIMR in the reference vessel of the caIMR >40 group was greater than in the caIMR ≤40 group (30.9 ± 11.3 vs. 25.9 ± 10.7, p = 0.009). Moreover, the caIMR >40 group had higher incidence rates of MACEs at 3 months (25.5% vs. 8.3%, p = 0.009) and 1 year (29.8% vs. 13.9%, p = 0.04), than in the caIMR ≤40 group, which were mainly driven by a higher rate of rehospitalization due to CHF, MI, or angina. A caIMR in the IRA of >40 was an independent predictor of a MACE at 3 months (hazard ratio (HR): 3.459, 95% confidence interval (CI): 1.363–8.779, p = 0.009) and 1 year (HR: 2.384, 95% CI: 1.100–5.166, p = 0.03) in patients with STEMI after primary PCI. Conclusions: Patients with STEMI after primary PCI often have coronary microvascular dysfunction, which is indicated by an increased caIMR in the IRA. An elevated caIMR of >40 in the IRA was associated with an increased risk of adverse outcomes in STEMI patients undergoing primary PCI.

Background: Frailty and clonal hematopoiesis of indeterminate potential (CHIP) have emerged as crucial predictors of adverse cardiovascular outcomes in older adults. However, their combined impact on major adverse cardiovascular events (MACE) in patients with severe atherosclerotic renal artery stenosis (ARAS) remains unclear. Methods: We conducted a prospective cohort study involving 175 patients aged 60 years and older with severe ARAS (luminal stenosis ≥ 70%) who underwent renal artery stenting at Beijing Hospital between January 2019 and December 2022. Frailty was assessed using the Fried phenotype, categorizing patients into robust, prefrail, and frail subgroups. CHIP status was determined through targeted gene sequencing of peripheral blood, stratifying patients into No CHIP (VAF < 2%), Small CHIP (VAF 2%-<10%), and Large CHIP (VAF ≥ 10%) subgroups. All patients were systematically followed up until June 30, 2024. The primary outcome was the incidence of MACE, which was a composite of renal function deterioration (RFD), initiation of renal replacement therapy, renal artery revascularization, nonfatal myocardial infarction, hospitalization for heart failure, nonfatal stroke, and cardiorenovascular death. We employed Cox proportional hazards models, Kaplan-Meier survival analysis, and heatmaps to explore the combined impact of frailty and CHIP on MACE risk. Results: The mean age of the patients was 68.3 years. Of the cohort, 64.6% had no CHIP, 26.8% had Small CHIP, and 8.6% had Large CHIP. Frail patients showed a higher prevalence of CHIP, particularly in the Small (34.7%) and Large (10.2%) CHIP categories. During a median follow-up of 32 months, 54 MACE occurred. Kaplan-Meier survival curve revealed that frailty was associated with a higher incidence of MACE (35.7% in frail vs. 29.5% in prefrail vs. 24.6% in robust, P = 0.045) and RFD (16.3% in frail vs. 11.5% in prefrail vs. 7.7% in robust, P = 0.034). Patients with Large CHIP experienced significantly higher rates of MACE (60.0% vs. 36.2% in Small CHIP vs. 24.8% in No CHIP, P = 0.004) and RFD (26.7% vs. 14.9% in prefrail vs. 8.0% in robust, P = 0.019). Findings for RFD appeared to be consistent with those for MACE. Frailty and CHIP status showed independent contribution to overall risk. The greatest spread for MACE and RFD risk was obtained in models that incorporated frail and Large CHIP. Conclusion: Frailty and CHIP, independently and jointly, contribute to a significantly higher risk of MACE and RFD in elderly patients with severe ARAS undergoing stenting. These findings highlight the necessity for integrated risk stratification and targeted management strategies in this high-risk population.

AbstractObjectivesPatients undergoing a prior failed attempt of chronic total occlusion‐percutaneous coronary intervention (CTO‐PCI) represent a challenging subgroup across all patients undergoing CTO‐PCI. There are limited data on the effects of a prior failed attempt on the outcomes of subsequent CTO‐PCI. We aimed to compare the procedural results and 24‐month outcomes of prior‐failed‐attempt CTO‐PCI with those of initial‐attempt CTO‐PCI.MethodsPatients who underwent attempted CTO‐PCI between January 2017 and December 2019 were prospectively enrolled. We analyzed the procedural results and 24‐month major adverse cardiac events (MACE) between patients who underwent prior‐failed‐attempt and initial‐attempt CTO‐PCI. MACE was defined as a composite of cardiac death, target vessel‐related myocardial infarction, and ischemia‐driven target vessel revascularization (TVR) during follow‐up.ResultsIn total, 484 patients who underwent CTO‐PCI (prior‐failed‐attempt, n = 49; initial‐attempt, n = 435) were enrolled during the study period. After propensity score matching (1:3), 147 patients were included in the initial‐attempt group. The proportion of the Japanese‐CTO (J‐CTO) score ≥2 was higher in the patients who underwent prior failed attempt than in those who underwent initial attempt (77.5% vs. 38.8%, p < 0.001). The retrograde approach was more often adopted in the prior‐failed‐attempt group than in the initial‐attempt group (32.7% vs. 3.4%, [P< 0.001). Successful CTO revascularization rates were significantly lower in the prior‐failed attempt‐group than in the initial attempt group (53.1% vs. 83.3%, P < 0.001). The multivariate analysis revealed that J‐CTO score ≥2 [odds ratio (OR), 0.359; 95% confidence interval (CI), 0.159–0.812; P = 0.014], intravascular ultrasound procedure (OR, 4.640; 95% CI, 1.380–15.603; P = 0.013), and prior failed attempt (OR, 0.285; 95% CI, 0.125–0.648; P = 0.003) were the independent predictors for successful CTO revascularization. There were no significant differences in major procedural complications (2.0% vs. 0.7%, p = 0.438) and MACE rates (4.1% vs. 8.8%, p = 0.438) between the groups, mainly due to the TVR rate (4.1% vs. 8.2%, P = 0.522).ConclusionsCompared with initial‐attempt CTO‐PCI, prior‐failed‐attempt CTO‐PCI deserves more attention, since it is associated with a lower successful CTO revascularization rate. Prior failed attempt, J‐CTO score ≥2, and IVUS procedure are the determining factors for predicting successful CTO revascularization. There are no significantly different unfavorable outcomes between patients who undergo prior‐failed‐attempt and initial‐attempt CTO‐PCI.

目的 探讨aVR导联T波不同形态与心力衰竭的相关性.方法 随机选取新疆石河子市人民医院心血管内科 2019 年 1 月至 2020 年 12 月住院患者,经心脏超声Simpson's法测量心脏左心室射血分数(LVEF),LVEF％≤40％病例 101 例、40％＜LVEF％＜50％病例 106 例、LVEF％≥50％病例 101 例,并记录首次就诊时脑钠肽测量值;根据首次就诊aVR导联T波形态,分组为T波直立组、未明显偏移组及倒置组,比较研究T波形态、QTc时限与心力衰竭的相关性.结果 研究发现年龄增大并患房颤、高血压及冠心病者,心力衰竭患病率明显偏高.T波直立组中,LVEF%≥50％病例有 1 例(1.62％);T波未明显偏移组中,LVEF％≥50％病例有 53 例(40.46％);T波倒置组中,LVEF%≥50％病例有 16 例(13.92％),其组间两两比较,差异有统计学意义(P＜0.05);aVR导联T波的不同形态组间比较,T波直立组的左心房前后径大、左心室舒张末内径大、左心室舒张容积大、LVEF低、脑钠肽高、QTc时限长,差异有统计学意义(P＜0.05).LVEF降低或轻度降低的患者aVR导联QTc时限不论男性或女性人群,均与脑钠肽、右心室前后径、左心室舒张末内径、心室舒张容积成呈正相关(r为正值、P＜0.05),而与EF值呈负相关(r为负值、P＜0.05).结论 aVR导联T波直立、QTc时限延长,是无创早期可以初步判断心功能状态的映像参数.

Purpose:Coronary angiography-derived fractional flow reserve (caFFR) is a novel computational flow dynamics (CFD)-derived assessment of coronary vessel flow with good diagnostic performance. Herein, we performed a retrospective study to evaluate the reproducibility of caFFR findings between observers and investigate the diagnostic performance of caFFR for coronary stenosis defined as FFR ≤0.80, especially in the grey zone (0.75≤caFFR ≤0.80). Patients and Methods:A total of 150 patients (167 coronary vessels) underwent caFFR (with FlashAngio used for calculation of flow variables) and subsequent invasive fractional flow reserve (FFR) measurements. Outcomes, including reproducibility, were compared for vessels in and outside the grey zone. Results:The correlation of caFFR findings was good between the two laboratories (r = 0.723, p<0.001). The AUC of ROC were both high for caFFR-CoreLab1 and caFFR-CoreLab2 (0.975 and 0.883). The diagnostic accuracy, sensitivity, specificity, and negative and positive predictive values were not significantly different between the two laboratories (p>0.05). caFFR had a strong correlation with measures to FFR (r=0.911, p<0.001). There was no systematic difference between caFFR and FFR on Bland-Altman analysis in and outside the grey zone. There was no difference in diagnostic accuracy between the grey and non-grey zones in the prediction of FFR ≤0.80 (p=0.09). Conclusion:The inter-observer reproducibility for caFFR was high, and the diagnostic accuracy of caFFR was good compared to that of FFR.

BackgroundThe usefulness of lung ultrasound (LUS) in guiding heart failure (HF) treatment is still controversial.PurposeWe aimed to evaluate the usefulness of LUS-guided treatment vs. usual care in reducing the major adverse cardiac event (MACE) rate in patients with HF.Materials and methodsWe performed a systematic review and meta-analysis of randomized controlled trials (RCTs) identified through systematic searches of MEDLINE, EMBASE, the Cochrane Database, Google Scholar, and SinoMed. The primary outcome was MACEs (a composite of all-cause mortality, HF-related rehospitalization, and symptomatic HF). The required information size was calculated by trial sequential analysis (TSA).ResultsIn total, ten RCTs involving 1,203 patients were included. Overall, after a mean follow-up period of 4.7 months, LUS-guided treatment was associated with a significantly lower risk of MACEs than usual care [relative risk (RR), 0.59; 95% confidence interval (CI), 0.48–0.71]. Moreover, the rate of HF-related rehospitalization (RR, 0.63; 95% CI, 0.40–0.99) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration (standardized mean difference, –2.28; 95% CI, –4.34 to –0.22) were markedly lower in the LUS-guided treatment group. The meta-regression analysis showed a significant correlation between MACEs and the change in B-line count (p < 0.05). The subgroup analysis revealed that the risk of MACEs was markedly lower in patients aged up to 70 years (RR, 0.54; 95% CI, 0.44–0.67), with a lower rate of atrial fibrillation (< 27.2%) (RR, 0.53; 95% CI, 0.43–0.67), and with a lower NT-proBNP concentration (< 3,433 pg/ml) (RR, 0.51; 95% CI, 0.40–0.64). TSA indicated a lower risk of MACEs with LUS-guided treatment than with usual care among patients with HF (p < 0.05).ConclusionLung ultrasound seems to be a safe and effective method to guide HF treatment.Systematic review registration[https://inplasy.com/], identifier [INPLASY202220124].

目的:验证冠状动脉造影血流储备分数(caFFR)在灰区的诊断准确度及其测量可重复性.方法:回顾性纳入进行经导丝血流储备分数(FFR)测定的冠心病患者150例,按照FFR的不同,分为灰区(FFR 0.75～0.80)组(n=55)及非灰区(FFR<0.75或FFR>0.80)组(n=95).由2名操作者独立使用FlashAngio系统进行caFFR离线测定.利用Pearson相关系数分析FFR与caFFR的相关性,Bland-Altman图示法分析FFR与caFFR的一致性以及2名操作者间的测量变异度,利用准确度、灵敏度、特异度等评价caFFR的诊断价值.结果:回顾性测量的caFFR与导丝FFR相关性(r=0.870,P<0.001)及一致性良好(差值均值为0.00,95％一致限:-0.08～0.09).caFFR在灰区的诊断准确度稍有下降,但与非灰区相比差异无统计学意义(85.7％vs.93.7％,P=0.089).caFFR在不同操作者间的测量可重复性良好,平均差值为0.00(95％一致限:-0.12～0.13).结论:caFFR在灰区的诊断准确度及不同观察者间测量一致性较好.

Background: There are scarce published data reporting the effect of rotational atherectomy (RA) on coronary microcirculation function. Objectives: We aimed to evaluate coronary microcirculation function indicated by the coronary angiography-derived index of microvascular resistance (caIMR) in patients undergoing RA. Methods: RA procedures between January 2013 and December 2021 were retrospectively analyzed. We investigated coronary microcirculation function indicated by caIMR as well as peri-procedural adverse events among the study population. All caIMR measurements were performed using a FlashAngio system. The primary outcome was a composite of post-RA thrombolysis in myocardial infarction (TIMI) flow grade <3 in the target vessel, myocardial injury, procedure-related myocardial infarction, and cardiac death during hospitalization. Results: A total of 155 RA procedures were analyzed. The post-RA caIMRs were significantly higher than pre-RA caIMRs in the target vessels (16.0 ± 7.0 vs. 14.5 ± 7.5, p = 0.029). Patients with post-RA caIMR ≥25 accounted for nearly 12% of those with pre-RA caIMR <25. Patients with post-RA thrombolysis in myocardial infarction (TIMI) flow grade <3 had a significantly higher pre-RA caIMR (23.5 ± 10.2 vs. 13.7 ± 6.6, p = 0.005), and the proportion of patients with pre-RA caIMR ≥25 in the group with TIMI flow grade <3 was greater (61.5% vs. 38.5%, p < 0.001) than that in the group with TIMI flow grade of 3. Maximum RA time of each pass (odds ratio: 1.127, 95% confidence interval: 1.025–1.239, p = 0.014) and pre-RA caIMR ≥25 (odds ratio: 3.254, 95% confidence interval: 1.054–10.048, p = 0.040) were identified to be the independent predictors of the primary outcome for patients who underwent RA. Conclusions: There were significant changes in the coronary microcirculation function of the target vessels after receiving RA as indicated by increased post-RA caIMR compared to pre-RA caIMR. Patients with baseline coronary microcirculatory dysfunction were more likely to have post-RA TIMI flow grade <3, whereas those with pre-RA caIMR ≥25 experienced worse outcomes.

Objective This study aimed to observe the clinical imaging features of patients with severe atherosclerotic renal artery stenosis (ARAS) receiving stent implantation, and to evaluate the associations between baseline clinical and imaging factors and renal-function deterioration at a 1-year follow-up. Methods This study was a single-center retrospective cohort study. A total of 159 patients with unilateral severe ARAS who underwent stent implantation at Beijing Hospital between July 2017 and December 2020 were consecutively enrolled. According to the renal glomerular filtration rate (GFR), detected by radionuclide renal imaging at 1-year follow-up, all patients were divided into a poor-prognosis group (with a ≥30% decrease in renal GFR; n=32 cases) and a control group (127 cases). Clinical imaging data, including the renal cortical blood perfusion pre- and post-sent implantation, were analyzed. Univariate and multivariate logistic regression analysis was used to evaluate the associations between clinical and imaging factors and renal-function deterioration. Results Of the 159 patients enrolled, 83 (52.2%) were men, with an average age of (57.2±14.7) years. The patient age, rate of diabetes, and systolic blood and diastolic blood pressure in the poor-prognosis group were significantly higher than those in the control group (all P<0.05). Before stent treatment, patients in the poor-prognosis group, compared with the control group, had a significantly smaller area under the ascending curve (AUC1), area under the descending curve (AUC2), and peak intensity (PI), and a longer time to peak intensity (TTP) and mean transit time (MTT) (all P<0.05). After stent treatment, patients in the poor-prognosis group, compared with the control group, showed significantly smaller AUC1, AUC2, and PI, and longer MTT (all P<0.05). Multivariate logistic regression analysis indicated that age (OR=1.251, 95%CI: 1.113–1.406, P=0.0002), diabetes (OR=1.472, 95%CI: 1.110–1.952, P=0.007), systolic blood pressure (OR=1.339, 95%CI: 1.082–1.657, P=0.007), renal GFR (OR=2.025, 95%CI: 1.217–3.369, P=0.006), and AUC1 post-stent (OR=2.173, 95%CI: 1.148–4.113, P=0.017) were the factors associated with renal deterioration at the 1-year follow-up. Conclusions Patients with severe RAS with renal-function deterioration after stent implantation were older, and often had diabetes, hypertension, and impaired renal cortical perfusion. Age, diabetes, systolic blood pressure, renal GFR, and AUC1 after stent implantation were independent factors associated with short-term renal deterioration.

目的 分析经皮冠状动脉介入(PCI)开通慢性完全闭塞(CTO)病变对左室心肌灌注和收缩同步性的影响.方法 登记2017年1月至2019年12月在北京医院对CTO病变行PCI治疗的312例患者,其中36例于CTO病变开通前及开通12个月后均进行了门控心肌灌注显像(G-MPI)检查纳入本研究.采用配对或独立样本t检验及Wilcoxon秩和检验的方法比较PCI开通CTO病变前后负荷总积分(SSS)、静息总积分(SRS)、差值总积分(SDS)、灌注可逆性节段数(RS)、灌注不可逆节段数(NRS)、心肌总灌注缺损范围(TPD)、左心室射血分数(LVEF)以及静息和负荷的相位直方图带宽(PBW)和相位标准差(PSD)等指标,用Pearson线性相关分析LVEF与PBW和PSD的关系.结果 36例患者CTO病变开通后,SSS(7.2±7.9比10.8±6.9,t=3.612,P=0.001)、SRS(4.4±6.3比5.9±5.9,t=2.721,P=0.010)和SDS(2.8±3.1比4.7±4.0,t=2.727,P=0.010)均较开通前显著降低,RS(1.9±1.9比3.5±2.1,t=3.843,P=0.001)和负荷TPD(10.0％±11.1％比14.7％±10.0％,t=3.838,P=0.001)也较开通前明显减少.在心肌收缩同步性参数中,负荷PBW[(66.7±26.8)°比(83.1±33.0)°,t=3.365,P=0.002]和PSD[(18.3±6.9)°比(22.8±9.7)°,t=2.972,P=0.005]较开通前显著降低.无论是CTO病变开通前还是开通后,LVEF与静息或负荷状态下的PBW和PSD均呈显著负相关,并且LVEF≥50％患者的静息PBW、PSD和负荷PBW、PSD均显著低于LVEF<50％者(均为P<0.05).结论 CTO病变经PCI开通后心肌可逆性缺血和负荷状态下的心肌收缩同步性可得到改善,LVEF与心肌收缩同步性指标呈负相关,高LVEF的CTO患者的心肌收缩同步性更好.

Background This study aimed to observe the correlation between renal cortical blood perfusion (CBP) parameters and BP response in patients with severe renal artery stenosis (RAS) who underwent stenting. Methods This was a single-center retrospective cohort study. A total of 164 patients with unilateral severe RAS after successful percutaneous transluminal renal artery stenting in Beijing Hospital from October 2017 to December 2020 were included. According to the results of BP evaluated at 12 months, all patients were divided into the BP response group (n = 98) and BP nonresponse group (n = 66). The baseline clinical and imaging characteristics and follow-up data about 24 h ABPM and CBP were recorded and analyzed. Pearson correlation analysis was used to evaluate the relationship between CBP parameters and 24 h average SBP. Univariate and multivariate logistic regression analysis was used to evaluate the risk factors for BP response. Results Among 164 patients with severe RAS, there were 100 males (61.0%), aged 37–75 years, with an average of 56.8 ± 18.4 years, and average artery stenosis of 84.0 ± 12.5%. The BP nonresponse patients had a longer duration of hypertension, more current smoking subjects and diabetic patients, lower eGFR, increased number of hypertensive agents, and rate of insulin compared with the BP response group (P < 0.05). After PTRAS, patients in the BP response group were associated with significantly lower BP and improved CPB, characterized by increased levels of maximum intensity (IMAX), area under ascending curve (AUC1), area under the descending curve (AUC2), shortened rising time (RT), mean transit time (mTT), and prolonged time to peak intensity (TTP; P < 0.05). However, the BP nonresponse group was only associated with significantly reduced RT (P < 0.05) compared with baseline data. During an average follow-up of 11.5 ± 1.7 months, the BP response group was associated with significantly lower levels of SBP, DBP, 24 h average SBP, and 24 h average DBP compared with the nonresponse group (P < 0.05). Pearson correlation analysis showed that the the pre-operative CBP parameters, including IMAX (r = 0.317), RT (r = 0.249), AUC1 (r = 0.614), AUC2 (r = 0.558), and postoperative CBP parameters, including RT (r = 0.283), AUC1 (r = 0.659), and AUC2 (r = 0.674) were significantly positively correlated with the 24 h average SBP, while the postoperative TTP (r = −0.413) and mTT (r = −0.472) were negatively correlated with 24 h average SBP (P < 0.05). Multivariate Logistic regression analysis found that diabetes (OR = 1.294), NT-proBNP (OR = 1.395), number of antihypertensive agents (OR = 2.135), pre-operation IMAX (OR = 1.534), post-operation AUC2 (OR = 2.417), and baseline dDBP (OR = 2.038) were related factors for BP response (all P < 0.05). Conclusion Patients in the BP nonresponse group often have diabetes, a longer duration of hypertension, significantly reduced glomerular filtration rate, and heavier renal artery stenosis. CBP parameters are closely related to 24 h average SBP, and pre-operation IMAX and post-operation AUC2 are markers for a positive BP response.

Abstract. Background:. This study aims to observe the dynamic changes of renal artery (RA) disease and cortical blood perfusion (CBP) evaluated by contrast-enhanced ultrasound (CEUS) after percutaneous transluminal renal artery stenting (PTRAS) in patients with severe atherosclerotic renal artery stenosis (ARAS) and to analyze the relationship between CBP and prognosis. Methods:. This was a single-center retrospective cohort study. A total of 98 patients with unilateral severe ARAS after successful PTRAS in Beijing Hospital from September 2017 to September 2020 were included. According to renal glomerular filtration rate (GFR) detected by radionuclide imaging at 12 months after PTRAS, all patients were divided into the poor prognosis group (n = 21, GFR decreased by ≥20% compared with baseline) and the control group (n = 77, GFR decreased by < 20% or improved compared with baseline). Renal artery stenosis was diagnosed by digital subtraction angiography, and renal CBP was evaluated by CEUS using TomTec Imaging Systems (Germany) before PTRAS, at 6 months and 12 months after discharge. The receiver operating characteristic (ROC) curve with area under the curve (AUC) was used to analyze the predictive value of CBP parameters, including area under ascending curve (AUC1), area under the descending curve (AUC2), rising time (RT), time to peak intensity (TTP), maximum intensity (IMAX), and mean transit time (MTT) for poor prognosis. Results:. Among the 98 patients, there were 52 males (53.1%), aged 55–74 years old, with an average age of 62.1 ± 8.7 years, and an average artery stenosis of 82.3 ± 12.9%. The poor prognosis group was associated with significantly increased incidence of diabetes (76.2% vs. 41.6%), and lower levels of GFR of the stenotic kidney (21.8 mL/min vs. 25.0 mL/min) and total GFR (57.6 mL/min vs. 63.7 mL/min) (all P < 0.05), compared with the control group (P < 0.05). In addition, the rate of RA restenosis was significantly higher in the poor prognosis group than in the control group (9.5% vs. 0, χ2 = 9.462, P = 0.002). Compared with the control group, the poor prognosis group was associated with significantly decreased baseline AUC1 and AUC2, and extended duration of TTP and MTT (P < 0.05). At 6 months and 12 months of follow-up, patients in the control group were associated with markedly increased AUC1, AUC2, and IMAX, and shorter duration of RT and MTT (P < 0.05). The ROC curve showed that the predictive values of AUC1, AUC2, RT, TTP, IMAX, and MTT for poor prognosis were 0.812 (95% CI: 0.698–0.945), 0.752 (95% CI: 0.591–0.957), 0.724 (95% CI: 0.569–0.961), 0.720 (95% CI: 0.522–0.993), 0.693 (95% CI: 0.507–0.947), and 0.786 (95% CI: 0.631–0.979), respectively. Conclusions:. Preoperative renal CBP in severe ARAS patients with poor prognosis is significantly reduced, and does not show significant improvement after stent treatment over the first year of follow-up. The parameter AUC1 may be a good predictor for renal dysfunction after PTRAS in severe ARAS patients. Trial Registration:. ChiCTR.org.cn, ChiCTR1800016252.

目的 分析超声多普勒血流速度诊断支架植入术治疗重度粥样硬化性肾动脉狭窄(ARAS)术后支架内再狭窄的价值.方法 回顾性分析85例(94条肾动脉)肾动脉支架植入术后重度ARAS患者,根据术后12个月超声造影(CEUS)所示支架内径狭窄比判定狭窄程度,以<30％为无再狭窄,30％～50％为轻度再狭窄,51％～70％为中度再狭窄,>70％为重度再狭窄;对比其支架内收缩期峰值血流速度(PSV)及肾动脉PSV与腹主动脉PSV比值(RAR).采用受试者工作特征(ROC)曲线分析PSV、RAR对支架内再狭窄的诊断价值.结果 94条植入支架后肾动脉中,术后12个月2条支架闭塞.92条未闭塞动脉中,58条无再狭窄,15条轻度再狭窄,11条中度再狭窄,8条重度再狭窄.不同程度再狭窄肾动脉支架内PSV及RAR差异均有统计学意义(P均<0.01),且PSV、RAR随狭窄程度增高而逐渐加大(P均<0.05).以PSV>162.50 cm/s作为判断支架内径狭窄比>30％的阈值,其敏感度、特异度均为100％;以RAR>2.28作为阈值,敏感度为100％,特异度为96.60％.对于支架内径狭窄比>50％,以PSV>219.55 cm/s作为诊断阈值,其敏感度为100％,特异度为98.60％;以RAR>3.17作为阈值,敏感度为100％,特异度为94.50％.以PSV>310.53 cm/s作为支架内径狭窄比>70％的诊断阈值,敏感度为100％,特异度为100％;以RAR>4.33作为阈值,敏感度为100％,特异度为100％.结论 超声多普勒血流速度对于诊断肾动脉支架植入术治疗重度ARAS术后支架内再狭窄的效能较高.

Background Previous studies have revealed ethnic disparities in the prevalence of metabolic syndrome (MetS); however, the literature regarding aging-related patterns of disparities in MetS and its components remains limited. Methods This cross-sectional study recruited 28,049 subjects, consisting of one Chinese race and three American races, 18–85 years of age, from the National Health and Nutrition Examination Survey (NHANES, 1999–2018) of the United States, and the Guangdong Gut Microbiome Project (GGMP, 2018) of China. MetS was defined in accordance with the National Cholesterol Education Program Adult Treatment Panel III. A modified sliding-window-based algorithm was used to depict the trajectories of the prevalence of MetS with increased age. Logistic regression analysis was performed to investigate associations between MetS and its components. Results The prevalence of MetS increased non-linearly with age, with growth speed reaching its maximum at approximately 40–50 years. Chinese subjects exhibited a lower prevalence of MetS than non-Hispanic whites, non-Hispanic blacks, and Mexican Americans in all age groups. The two most prevalent components in Chinese subjects were reduced high-density lipoprotein cholesterol levels (42.0%) and elevated blood pressure (49.5%), and elevated triglyceride levels (36.3–49.5%) and abdominal obesity (55.8–55.9%) in Americans. Before 40 years of age, the top two MetS-associated components were abdominal obesity and elevated triglyceride levels in all races, while after 40 years, the prominent associations between MetS and its components varied among the different races and age groups. Conclusions Although racial disparities in the epidemic of MetS varied with increased age, abdominal obesity and elevated triglyceride levels were the top two MetS-associated components in all younger adults of different races.

Background and Objective Renal artery stenosis (RAS) is associated with an increased risk of renal function deterioration (RFD). Our previous study showed that renal cortical blood perfusion assessed by contrast-enhanced ultrasound (CEUS) was an important related factor for RFD in RAS patients. Based on several conventional related factors confirmed by previous studies, we aimed to establish and verify a CEUS+ scoring system to evaluate the risk of RFD at 1 year of follow-up in RAS patients. Methods This study was a single-center retrospective study. A total of 497 elderly RAS patients (247 in the training group and 250 in the verification group) admitted to the Beijing Hospital from January 2016 to December 2019 were included. The baseline characteristics of the patients on admission (including general conditions, previous medical history, blood pressure, blood creatinine, RAS, and cortical blood perfusion in the affected kidney) and renal function [glomerular filtration rate (GFR)] at 1-year of follow-up were collected. We used the univariate and multivariate logistic regressions to establish a CEUS+ scoring system model, the receiver operating characteristic (ROC) curve and area under the curve (AUC) to evaluate prediction accuracy, and the decision curve analysis and nomogram to evaluate the clinical application value of CEUS+ scoring system model. Results Among the 497 patients enrolled, 266 (53.5%) were men, with an average age of (51.7 ± 19.3) years. The baseline clinical-radiomic data of the training group and the verification group were similar (all p > 0.05). Multivariate logistic regression analysis results showed that age [Odds ratio (OR) = 1.937, 95% confidence interval (CI): 1.104–3.397), diabetes (OR = 1.402, 95% CI: 1.015–1.938), blood pressure (OR = 1.575, 95% CI: 1.138–2.182), RAS (OR = 1.771, 95% CI: 1.114–2.816), and area under ascending curve (AUCi) (OR = 2.131, 95% CI: 1.263–3.596) were related factors for the renal function deterioration after 1 year of follow-up (all p < 0.05). The AUC of the ROC curve of the CEUS+ scoring system model of the training group was 0.801, and the Youden index was 0.725 (specificity 0.768, sensitivity 0.813); the AUC of the ROC curve of the validation group was 0.853, Youden index was 0.718 (specificity 0.693, sensitivity 0.835). There was no significant difference in ROC curves between the two groups (D = 1.338, p = 0.325). In addition, the calibration charts of the training and verification groups showed that the calibration curve of the CEUS+ scoring system was close to the standard curve (p = 0.701, p = 0.823, both p > 0.10). Conclusion The CEUS+ scoring system model is helpful in predicting the risk of worsening renal function in elderly RAS patients.

Objective:To evaluate the diagnostic value of coronary angiography-based fractional flow reserve(caFFR)versus a wire-based fractional flow reserve(FFR)in elderly patients with stable ischemic heart disease.Methods:A total of 168 patients(186 vessels)who underwent a pressure wire(PW)-based FFR measurement from Jan.2015 to Dec.2019 in Beijing hospital were enrolled and analyzed retrospectively.Coronary angiography images and matched steady-state aortic pressure of patients were sent to the core laboratory for caFFR measurement under the blind method.All patients were divided into the non-elderly group(<65 years, n=93)and the elderly group(≥65 years, n=75). The diagnostic value of caFFR was evaluated by using the wire-based FFR cut-off value of ≤0.80 as the reference standard.The correlation and consistency of caFFR and wire-based FFR were analyzed, and compared between the non-elderly and elderly groups.Results:The caFFR had a good correlation and consistency with wire-based FFR in the elderly group( r=0.796, P<0.01). In non-aged versus elderly groups, diagnostic accuracy of caFFR was 91.9% versus 93.1%, diagnostic sensitivity of caFFR was 91.8% vs.93.2%, diagnostic specificity of caFFR was 92.3% vs.93.0%, all P>0.05.The area under the receiver-operating characteristic curve of caFFR had no significant difference between the non-elderly and elderly patients(0.964 vs.0.972, Z=0.00823, 95% CI: -0.037-0.052, P>0.05). Conclusions:The caFFR has a good diagnostic correlation and consistency with wire-based FFR in the elderly group, and caFFR's diagnostic performance in the elderly is similar to that in the non-elderly patients.