Background:Conventional nickel-titanium patent foramen ovale (PFO) occluders hinder transseptal puncture due to septal obstruction, limiting access for left-heart interventions. To address this, we developed a modified PFO occluder with a designated puncturable zone. Methods:An artificial PFO model was created in six pigs by puncturing and dilating the fossa ovalis. A novel PFO occluder preserving a central puncture area was implanted and validated intraoperatively via digital subtraction angiography (DSA) and transesophageal echocardiography (TEE). Transthoracic echocardiography and histology were performed 3 months post-implantation. Transseptal left atrial appendage closure (LAAC) was subsequently attempted through the occluder's puncturable zone. Results:All PFO closures were successful, with DSA/TEE confirming device stability. At 3 months, transseptal LAAC via the occluder's preserved area was achieved in all cases (6/6), validated by imaging. Histology revealed complete endothelialization of both occluders, intact nitinol framework, and precise puncture tracks within the designated zone without structural compromise. Conclusion:The novel PFO occluder with a dedicated puncture zone enables effective PFO closure while permitting safe transseptal access for subsequent left-heart interventions. This study demonstrates the occluder's feasibility, reliability, and clinical potential for aging populations requiring sequential cardiac procedures.

Currently, the influence of metabolic syndrome (Mets) on the plaque characteristics and prognosis of patients with acute coronary syndrome (ACS) is poorly understood. Thus, the study aimed to characterize the pancoronay plaques of ACS patients with Mets using optical coherence tomography (OCT) and to evaluate the cohort’s prognosis. Between February 2015 and September 2020, 745 ACS patients who underwent OCT imaging of the three coronary arteries were included, divided into Mets (n = 252) and non-Mets (n = 493) groups. The major adverse cardiovascular event (MACE) was a composite of cardiac death, non-fatal myocardial infarction (MI), and revascularization. Compared to the non-Mets group, the Mets group exhibited a higher proportion of females and cases of multivessel disease. In the Mets group, culprit lesions were found to have a greater degree of stenosis, thinner fibrous cap thickness and more thin-cap fibroatheroma (TCFA). Additionally, nonculprit lesions were more likely to exhibit plaque rupture, high-risk plaque characteristics, TCFA, macrophage infiltration, cholesterol crystals, and layered plaque. After a median follow-up of 2 years, 8.3

PurposeTo evaluate a noval bilateral asymmetric single-rivet occluder with reserved interatrial septal puncture area for treating patent foramen ovale (PFO).Materials and methodsThe study established a pig model of patent foramen ovale (PFO) by puncturing the oval fossa and then performing high-pressure balloon dilation. A specially designed bilateral asymmetric occluder for the reserved interatrial septal puncture area was then. used to close the PFO through catheter-based intervention. The pigs were kept for 3 months before undergoing a second catheter-based intervention, involving interatrial septal puncture using a newly developed occluder in the reserved interatrial septal puncture area. During 6 months, the experimental pigs underwent assessment using digital subtraction angiography (DSA), echocardiography, and histological evaluation.ResultsA patent foramen ovale (PFO) model was successfully established in 6 pigs using the puncture atrial septum high-pressure balloon dilation method. The diameter of the unclosed PFO was measured (3.56 ± 0.25 mm). Using the newly developed occluder device, all 6 pigs with unclosed PFO underwent successful catheter-based closure surgeries, with intraoperative and postoperative transesophageal echocardiography showing excellent device positioning and complete closure without residual shunting. After 3 months of implantation, the catheter-based interatrial septal puncture was performed through the reserved interatrial septal puncture area, and all procedures were successful. Immediately following euthanasia, a histological examination revealed intact and undamaged occluder devices with visible puncture holes in the reserved interatrial septal puncture area. No fracture of the nitinol wire was observed, and the surface of the occluder device showed coverage of endothelial and connective tissues. Utilizing a bilateral asymmetric single-rivet occluder device implanted through the reserved interatrial septal puncture area has proven effective in closing PFO. After implantation, the occluder device allows subsequent interatrial septal puncture procedures through the reserved area.ConclusionThe novel occluder device demonstrated excellent closure performance, biocompatibility, and puncturability in the experiment. This indicates the feasibility of conducting further catheter-based interventions on the interatrial septum.

Background:Percutaneous coronary intervention (PCI) is one of the most important diagnostic and therapeutic techniques in cardiology. At present, the traditional prediction models for postoperative events after PCI are ineffective, but machine learning has great potential in identification and prediction of risk. Machine learning can reduce overfitting through regularization techniques, cross-validation and ensemble learning, making the model more accurate in predicting large amounts of complex unknown data. This study sought to identify the risk of hemorrhea and major adverse cardiovascular events (MACEs) in patients after PCI through machine learning. Methods:The entire study population consisted of 7,931 individual patients who underwent PCI at Jiangsu Provincial Hospital and The Affiliated Wuxi Second People's Hospital from January 2007 to January 2022. The risk of postoperative hemorrhea and MACE (including cardiac death and in-stent restenosis) was predicted by 53 clinical features after admission. The population was assigned to the training set and the validation set in a specific ratio by simple randomization. Different machine learning algorithms, including eXtreme Gradient Boosting (XGBoost), random forest (RF), and deep learning neural network (DNN), were trained to build prediction models. A 5-fold cross-validation was applied to correct errors. Several evaluation indexes, including the area under the receiver operating characteristic (ROC) curve (AUC), accuracy (Acc), sensitivity (Sens), specificity (Spec), and net reclassification improvement (NRI), were used to compare the predictive performance. To improve the interpretability of the model and identify risk factors individually, SHapley Additive exPlanation (SHAP) was introduced. Results:In this study, 306 patients (3.9%) experienced hemorrhea, 107 patients (1.3%) experienced cardiac death, and 218 patients (2.7%) developed in-stent restenosis. In the training set and validation set, except for previous PCI and statins, there were no significant differences. XGBoost was observed to be the best predictor of every event, namely hemorrhea [AUC: 0.921, 95% confidence interval (CI): 0.864-0.978, Acc: 0.845, Sens: 0.851, Spec: 0.837 and NRI: 0.140], cardiac death (AUC: 0.939, 95% CI: 0.903-0.975, Acc: 0.914, Sens: 0.950, Spec: 0.800 and NRI: 0.148), and in-stent restenosis (AUC: 0.915; 95% CI: 0.863-0.967, Acc: 0.834, Sens: 0.778, Spec: 0.902 and NRI: 0.077). SHAP showed that the number of stents had the greatest influence on hemorrhea, while age and drug-coated balloon were the main factors in cardiogenic death and stent restenosis (all P<0.05). Conclusions:The XGBoost model (machine learning) performed better than the traditional logistic regression model in identifying hemorrhea and MACE after PCI. Machine learning models can be used as a tool for risk prediction. The machine learning model described in this study can personalize the prediction of hemorrhea and MACE after PCI for specific patients, helping clinicians adjust intervenable features.

Background and Objective: In cardiovascular diseases (CVDs), acute myocardial infarction (AMI) is considered one of the leading causes of human death, and its diagnosis mainly relies on the detection of the cardiac biomarker troponin I. Traditional detection methods have certain limitations, which has prompted the development of methods with higher sensitivity and specificity. In recent years, biosensors, as an emerging technology, have been widely applied in the clinical medicine and biodetection fields. We retrieved and reviewed relevant articles published over the past 3 years and subsequently summarized the research progress of different types of biosensors in detecting cardiac troponin I and the challenges faced in achieving simple, specific, and portable point-of-care testing (POCT) technology for bedside rapid detection. The aim of this review is to serve as reference for the early diagnosis and treatment of CVDs. Methods: This study searched for relevant literature published from 2019 to 2022 in the PubMed database of the National Center for Biotechnology Information (NCBI). The keywords used were as follows: "cardiac troponin I", "biosensor", "point-of-care testing", "electrochemical detection", and "surface-enhanced Raman spectroscopy". Key Content and Findings: The review found that biosensor technology has high specificity and sensitivity in the detection of cardiac troponin I and is simpler and more convenient than is traditional laboratory testing. Its vigorous development can facilitate the diagnosis of AMI earlier and faster. Conclusions: This study reviewed the progress of cardiac troponin I detection based on biosensing strategies. We found that cardiac troponin I detection methods based on biosensing strategies have their own advantages and disadvantages in clinical applications, and their sensitivity has been constantly improved. In the future, the detection of cardiac troponin I using biosensing technology will be simpler, faster, more sensitive, and portable.

Background: The relationship between novel anthropometric indices, specifically a body shape index (ABSI) and body roundness index (BRI), with abdominal aortic calcification (AAC) or severe AAC (SAAC) is unclear. The aim of our study was therefore to investigate possible relationships between novel anthropometric indices and prevalence of AAC and SAAC. Methods: We obtained U.S. general population data from the National Health and Nutrition Examination Survey between 2013 and 2014. The study used restricted cubic spline (RCS) analysis, multivariable logistic regression modeling, subgroup analysis, and receiver operating characteristic (ROC) curve assessment. We investigated relationships between ABSI or BRI and AAC and SAAC risk. Associations between ABSI or BRI and the degree of AAC were also evaluated using a generalized additive model. Results: The study cohort was comprised of 1062 individuals. The RCS plots revealed a U-shaped curve associating ABSI with AAC risk. A similar trend emerged for SAAC, where the risk initially increased before subsequently decreasing with rising ABSI levels. Additionally, BRI exhibited a positive correlation with both AAC and SAAC risk. As ABSI and BRI values increased, the degree of AAC also increased. In ROC analysis, ABSI displayed a significantly larger area under the curve compared to BRI. Conclusions: ABSI is associated with AAC prevalence following a U-shaped curve. Additionally, BRI is positively correlated with AAC risk. ABSI demonstrates a superior discriminative ability for AAC compared to BRI. Therefore, maintaining an appropriate ABSI and BRI may reduce the prevalence of AAC.

急性冠状动脉综合征发病率高且预后较差,及时行经皮冠状动脉介入治疗开通罪犯血管是目前救治的关键.术中可发现许多患者合并有多支血管病变,且部分非罪犯病变会快速进展导致不良事件的发生.因此对非罪犯病变的评估和适当干预成为目前研究的热点.相较于传统的冠状动脉造影,冠状动脉功能学检查及影像学技术为进一步评估病变的血流储备能力、斑块特点及是否需要血运重建等方面提供了有力帮助.近年来临床研究发现,完全血运重建相较于仅处理罪犯血管可以改善患者的临床结局.本文对如何管理非罪犯病变进行综述.

心尖肥厚型心肌病(ApHCM)是肥厚型心肌病(HCM)的一种特殊亚型.超声心动图是诊断ApHCM的影像检查手段,操作简单,但有漏诊的可能;心脏磁共振视野大,能获得高质量的图像,对心肌纤维化敏感,但检测时间长、技术要求高,在一定程度上限制了其发展.该文介绍ApHCM影像学诊断的最新进展.

Objective:To explore the effect of self-made dynamic cardiovascular three-dimensional model combined with CBL (case-based learning) teaching method in the clerkship of valvular heart disease for medical students.Methods:Sixty five-year clinical medical undergraduates from Nanjing Medical University (Batch 2016) were randomly divided into experimental group and control group. The experimental group received dynamic cardiovascular 3D model combined with CBL teaching method, while the control group received traditional model combined with CBL teaching method. After the course, the teaching effect was evaluated by examination and questionnaire. SPSS 19.0 was used for independent sample t test and chi-square test. Results:Compared with the control group, the students in experimental group had higher scores of basic theoretical knowledge [(43.10±3.51) vs. (40.87±3.19)] and clinical thinking ability [(42.20±3.15) vs. (40.20±3.81)], with significant differences ( P<0.05). Furthermore, they showed higher evaluation and satisfaction to learning initiative and enthusiasm, mastery of theoretical knowledge, clinical thinking ability, classroom learning interest, classroom activity and clarity of knowledge teaching, with significant differences ( P<0.05). Conclusion:In the teaching of valvular heart disease clerkship, the application of self-made dynamic cardiovascular three-dimensional model combined with CBL teaching method, can cultivate students' clinical diagnostic thinking ability and improve teaching quality.

目的:探讨出院前培训结合出院后居家发音功能训练对喉癌患者术后喉功能重建的影响。方法:选取2016年10月至2019年9月在无锡市第二人民医院进行喉癌术后喉功能重建患者80例，依照入院时间将患者分为研究组和对照组各40例。研究组患者采用出院前培训结合出院后居家发音功能训练，对照组患者采用常规喉癌术后喉功能重建护理。比较两组患者的临床效果。结果:研究组术后并发症发生率为5.00%，显著低于对照组的25.00%，差异有统计学意义( P<0.05)；两组患者干预前基频(Fo)，基频微扰(Jitter)、振幅微扰(Shimmer)比较差异均无统计学意义(均 P>0.05)；干预后1个月、3个月研究组患者Fo、Jitter、Shimmer指标显著低于对照组，差异均有统计学意义(均 P<0.05)；研究组患者在干预后改良华盛顿大学生活质量量表(UWQOL)各项评分显著高于对照组，差异均有统计学意义(均 P<0.05)。 结论:出院前培训结合出院后居家发音功能训练对喉癌患者术后喉功能重建具有良好的应用价值，可显著降低患者的并发症发生率，提升患者喉部发音功能，显著提高患者的生活质量。

Background and Objective:With the wide application of electronic medical record systems in hospitals, massive medical data are available. This type of medical data has the characteristics of heterogeneity and multi-dimensionality. Traditional statistical methods cannot fully extract and use such data, but with their non-linear and cross-learning modes, machine-learning (ML) algorithms based on artificial intelligence can address these shortcomings. To explore the application of ML algorithms in the cardiovascular field, we retrieved and reviewed relevant articles published in the last 6 years and found that ML is practical and accurate in the auxiliary diagnosis of cardiovascular diseases. Thus, this article reviewed the research progress of ML in cardiovascular disease.Methods:This study searched relevant literature published in National Center for Biotechnology Information (NCBI) PubMed from 2016 to 2022. The relevant literature was extracted from NCBI PubMed with the following keywords and their combinations: "machine learning", "artificial intelligence", "cardiology", "cardiovascular disease", "echocardiography", "electrocardiogram" and "prediction model". All articles included in the review are English.Key Content and Findings:The review found that ML is practical and accurate in the diagnosis of cardiovascular diseases. Besides, ML can build clinical risk prediction models and help doctors evaluate the prognosis of patients.Conclusions:The study summarized the progress of ML in cardiovascular diseases and confirmed its advantages in clinical application. In the future, models and software based on ML will be common auxiliary tools in clinical practice.

Background:Clopidogrel is a traditional P2Y12 receptor inhibitor that is widely used in clinical practice, but there are significant individual differences in its therapeutic effect. Carriers of the CYP2C19 deletion allele have a higher risk of adverse cardiovascular events than non-carriers.Methods:In this study, 170 patients diagnosed with coronary heart disease (CHD) and on regular oral clopidogrel or ticagrelor antiplatelet therapy in the Department of Cardiology of Wuxi Second People's Hospital from August to December 2019 were screened. Baseline patient data were collected, percutaneous coronary angiography (CAG) or coronary computed tomography angiography (CTA) results were recorded, CYP2C19 gene type was detected, and prognosis/outcome was assessed by telephone/outpatient/inpatient follow-up for 12 months.Results:(I) Of the 170 patients, 0.66% were the fast metabolic type, 41.45% were the normal metabolic type, 42.76% were the intermediate metabolic type, and 15.13% were the poor metabolic type. CYP2C19*2 mutation accounted for 89.29% of all mutations, CYP2C19*3 mutation accounted for 9.82%, and CYP2C19*17 mutation accounted for only 0.89%. (II) Among the patients with CHD who regularly took clopidogrel, the risk in the intermediate metabolic group was 5.208-fold higher than that of normal metabolic group, and that of the poor metabolic group was 3.75-fold higher than that of normal metabolic group; there was no significant difference between the intermediate and poor metabolic groups. (III) Prognosis was significantly associated with regular use of ticagrelor or clopidogrel by patients in the intermediate metabolic group. There was no significant correlation between poor metabolism (PM) and normal metabolism (NM). Prognosis was significantly associated with regular use of ticagrelor or clopidogrel in patients undergoing percutaneous coronary intervention (PCI), but not in patients who did not undergo PCI.Conclusions:CYP2C19 polymorphism was associated with the prognosis of patients with CHD administered antiplatelet therapy with oral clopidogrel. The incidence of poor prognosis was significantly increased with CYP2C19*2 and/or CYP2C19*3 mutations, and patients undergoing PCI or carrying a single CYP2C19 deletion allele had a better prognosis with ticagrelor as replacement therapy.

PURPOSE:After patent foramen ovale interventional closure, puncture of the interatrial septum through the occluder is difficult but sometimes needed for further interventional treatment. This paper presents findings from an in vivo experimental study of a reserved atrial septal puncture area patent foramen ovale occluder.MATERIALS AND METHODS:A patent foramen ovale model was established in canines using trans-septal puncture of the fossa ovale and high-pressure balloon dilation. Then, patent foramen ovale closure was performed with a reserved atrial septal puncture area and all canines were raised for 3 months. Then, the occluder was crossed and left atrial angiography was performed on the septal area with the occluder. Finally, DSA angiography, echocardiography, and histology were used to evaluate the performance and feasibility of the reserved atrial septal puncture area.RESULTS:A patent foramen ovale model was successfully established in 10 canines using the atrial septal puncture method. The average diameter of the patent foramen ovale was 3.77 ±0.19 mm, and the patent foramen ovale was successfully closed in all canines using a reserved atrial septal puncture area. As assessed using transoesophageal echocardiography, the new occluder exhibited an ideal position and was occluded entirely without a residual shunt intraoperatively and postoperatively. A 100% success rate of atrial septum puncture was achieved across the new occluder. The occluders were completely endothelialised 3 months post-implantation.CONCLUSIONS:The reserved atrial septal puncture area was effective in patent foramen ovale closure and exhibited positive sealing performance and biological compatibility. Trans-septal puncture was feasible and effective after reserved atrial septal puncture area patent foramen ovale closure.

Background: Previous studies have found that patients with calcified nodules (CN) experienced more major adverse cardiac events (MACE). This study aimed to investigate the predictors of adverse prognosis in acute coronary syndrome (ACS) patients with CN after stenting by using optical coherence tomography (OCT).Methods: A total of 93 ACS patients with CN culprit plaques who underwent OCT-guided drug eluting stent (DES) implantation were enrolled. Patients were divided into two groups according to the occurrence of MACE, which was defined as the composite of cardiac death, recurrent myocardial infarction, ischemia-driven target lesion revascularization, rehospitalization due to unstable or progressive angina.Results: Among 93 ACS patients, 22 patients (23.7%) developed MACE at a median follow-up of 2 years. Compared with patients without MACE, patients with MACE presented more frequently with chronic kidney disease (CKD, 22.7% vs. 5.6%, p=0.032) and dyslipidemia (77.3% vs. 40.8%, p=0.003), including higher level of triglyceride (219.8±150.9 mg/dl vs. 142.3±86.4 mg/dl, p=0.004), total cholesterol (192.9±50.5mg/dl vs. 156.2±32.8 mg/dl, p=0.001) and low-density lipoprotein cholesterol (LDL-C, 115.1±50.0 mg/dl vs. 92.9±27.8 mg/dl, p=0.010). OCT findings showed patients with MACE had smaller minimal stent diameter (2.1±0.4 mm vs. 2.3±0.4 mm, p=0.040) and a higher prevalence of stent under-expansion (90.9% vs. 64.8%, p=0.029). Multivariate analysis confirmed CKD, higher LDL-C, and stent under-expansion were independent predictors of MACE.Conclusions: 23.7% of ACS patients with CN developed MACE at about 2 years follow up after DES implanted, and CKD, higher LDL-C, and stent under-expansion were independent predictors of MACE.

[目的]分析新型冠状病毒肺炎(COVID-19)不同时期防控措施对非ST段抬高型心肌梗死(NSTEMI)住院患者并发肺部感染的诊断和预后影响.[方法]回顾性分析苏州大学附属第三医院在COVID-19不同防控措施下收治的126例NSTEMI患者,分为非新冠疫情流行组(2019年1月25日至2019年2月25日,非流行组,n=47),新冠疫情一级响应组(2020年1月25日至2020年2月25日,一级响应组,n=42)和新冠疫情常态化防控组(2021年1月25日至2021年2月25日,常态防控组,n=37).比较三组研究对象的临床特征、肺部感染以及院内病死率,分析疫情防控措施下NSTEMI住院患者并发肺部感染的影响因素.[结果]三组患者就诊时间、卧床时间、心率和心力衰竭比较,差异有统计学意义(P<0.05).非流行组、一级响应组和常态防控组肺部感染发生率比较差异有统计学意义(P<0.01).多因素二元Logistic回归分析显示,就诊时间、心力衰竭和卧床时间是NSTEMI患者发生肺部感染的影响因素(均P<0.05).[结论]COVID-19防控一级响应期间的救治措施提高了NSTEMI患者中肺部感染的诊断率,但未增加NSTEMI并发肺部感染患者院内不良预后.

目的:分析探讨光学相干断层成像技术(OCT)对急性心肌梗死(AMI)易损斑块的识别及应用价值.方法:选择某医院收治的AMI患者60例为研究对象,分别于经皮冠状动脉介入治疗(PCI)前、PCI后及PCI术后3个月、6个月、12个月进行OCT检查.分析OCT对易损斑块的识别情况、冠脉血栓类型及罪犯病变的判定情况,评估PCI术后即刻效果和远期效果.结果:该组60例AMI患者,检出易损斑块52例(86.7％),其中,薄纤维帽28例(46.7％),大而软的脂质坏死核心10例(16.7％),破裂区巨噬细胞浸润6例(10.0％),病变处斑块严重钙化或钙化结节向腔内突出4例(6.7％),斑块表面发生侵蚀并出现血小板堆积2例(3.3％);红色血栓42例(70.0％),白色血栓12例(20.0％),混合血栓6例(10.0％);()CT检查发现斑块破裂48例(80.0％),斑块侵蚀8例(13.3％),斑块钙化结节4例(6.7％).该组有6例(10.0％)PCI术后即刻支架膨胀不良,4例(6.7％)支架贴壁不良,出现组织脱垂、支架边缘夹层、支架内即刻血栓各1例(1.7％);术后随访12个月55例中,发生支架内再狭窄6例(10.9％),支架内血栓形成4例(7.3％).结论:OCT检查有助于早期识别AMI患者易损斑块,判断血栓类型及罪犯病变性质,同时有助于评估PCI术后的即刻效果和远期随访.

目的:探讨使用计量型饮水机联合个体化限水治疗方案在心衰患者中的应用效果。方法:将120例心衰患者随机分为实验组与对照组，各60例。实验组使用计量型饮水机联合个体化限水治疗方案进行饮水管理；对照组使用常规限水治疗护理方案。观察两组患者限水治疗合格率、舒适度口渴评分、入院前后B型脑利钠肽前体(NT-proBNP)指标情况等。结果:两组患者规范饮水合格率实验组明显高于对照组，差异有统计学意义( P<0.05)。实验组口渴感评分低于对照组，差异有统计学意义( P<0.05)。两组B型脑利钠肽前体干预前后差异均有统计学意义( P<0.05)。 结论:应用计量型饮水机联合个体化限水治疗方案，效果满意，值得推广应用。

目的 研究分析新型冠状病毒肺炎(COVID-19)不同时期防控措施对急性ST段抬高型心肌梗死(STEMI)住院患者的救治和院内病死率影响.方法 回顾性分析苏州大学附属第三医院心内科2019年1月25日至2019年2月25日(COVID-19非流行期间组)、2020年1月25日至2020年2月25日(COVID-19一级响应组)、2021年1月25日至2021年2月25日(COVID-19常态化防控组)三个时期的STEMI住院患者,比较分析不同疫情防控措施下研究对象的就诊时间、治疗策略、首次医疗接触时间(FMC)、球囊扩张时间(D-to-B)以及院内全因病死率等指标.结果 共纳入107例STEMI患者,其中非流行期间组37例,一级响应组28例,常态化防控组42例;三组急诊溶栓和FMC以及D-to-B时间差异有统计学意义(P＜0.05);COVID-19一级响应组的FMC时间[14.0(7.0,21.3) min]显著长于非流行期间组[8.0(5.0,10.0) min]和常态化防控组[5.0(4.0,6.5) min](P＜0.05),D-to-B时间较非流行期间组显著延长[87.5(68.8,116.3)h vs 67.5(55.0,91.3)h,P＜0.05];一级响应组院内病死率显著高于常态化防控组(28.6％ vs 4.8％,P＜0.05);一级响应组非PCI患者病死率高于PCI患者(17.4％ vs 80.0％,P＜0.05).结论 COVID-19一级响应期间STEMI患者急诊再灌注的救治时间延长,在遵循COVID-19防控原则基础上,通过优化STEMI的救治流程可以降低院内全因死亡率.