Abstract Background Chronic total occlusion (CTO) is a challenging subset of coronary artery disease characterized by complete vessel obstruction and development of collateral circulation. In CTO patients, donor vessels supplying collateral flow may be at risk of functional ischemia. Functional assessment of these donor vessels can provide valuable insights into the ischemic status. Quantitative flow ratio (QFR) is an angiography-based method for the functional assessment of coronary arteries and Murray-law based QFR (µQFR) requires only a single coronary projection, enhancing its applicability. This study primarily aims to investigate the agreement between µQFR and 3D-QFR for functional assessment of donor vessels in CTO patients. Methods This single-center retrospective study enrolled patients with a single-vessel CTO lesion between January 2015 and June 2023. Both µQFR and 3D-QFR were used to assess the function of the predominant collateral donor artery following standard protocol. Results A total of 336 CTO patients were included. There was a good correlation between µQFR and 3D-QFR (r = 0.947, p < 0.001). The diagnostic accuracy was 96.1% (95% CI, 93.5%–97.9%). ROC curve analysis revealed an AUC of 0.984 (95% CI, 0.971–0.997) for µQFR in estimating 3D-QFR. Conclusions µQFR has good correlation and agreement with standard 3D-QFR for the functional assessment of donor vessels in CTO patients.

Objective:The aim of this study was to investigate the quantitative flow ratio (QFR) outcomes in the left circumflex artery (LCX) following the placement of a crossover stent from the left main coronary artery (LM) to the left anterior descending artery (LAD) in LM bifurcation lesions. In addition, we sought to assess the relationship between these QFR results and clinical prognoses. Background:The treatment approach for LM bifurcation lesions remains a topic of debate, with the LM-LAD single-stent technique being one possible option. QFR, a fractional flow reserve calculation method derived from angiography that does not require pressure guide wires, could serve as an alternative functional assessment of the LCX. This study aims to evaluate the clinical outcomes of postoperative LCX by utilizing QFR measurements, addressing a current gap in the relevant literature on this topic. Methods:This study was a retrospective, single-center analysis of patients with LM bifurcation lesions who underwent percutaneous coronary intervention (PCI) guided by intravascular ultrasound. QFR values were derived from angiographies. The primary endpoint was the 1-year rate of major adverse cardiac events, defined as a composite of cardiovascular death, target bifurcation-related myocardial infarction (MI), or target bifurcation revascularization. The secondary clinical endpoint was defined as the persistence or recurrence of angina pectoris after PCI. Results:We analyzed 91 patients from a total of 180 who were screened for LM bifurcation lesions. All patients completed the 1-year follow-up. The pre- and post-PCI QFR values were 0.89 ± 0.09 and 0.86 ± 0.11, respectively. Subgroup analysis showed that 74 patients were in the postoperative QFR ≥0.80 group, whereas 17 patients were in the QFR <0.80 group. In addition, 32 patients had a ΔQFR ≥0, and 58 patients had a ΔQFR <0. Nine patients (9.9%) achieved the primary endpoint, including one patient with non-ST elevation myocardial infarction who received revascularization in both the LM-LAD and LCX arteries. In addition, nine patients (9.9%) reported no substantial improvement in their chest pain symptoms. Post-LCX-QFR <0.8 was associated with a higher 1-year incidence of cardiovascular death or MI (P = 0.036). ΔQFR proved to be a robust predictor of the 1-year incidence of the primary endpoint, with an incidence of 15.3% in the ΔQFR ≥0 group compared to 0% in the ΔQFR <0 group (area under the curve: 0.822; 95% CI: 0.728-0.895, P < 0.001), especially when ΔQFR ≤-0.03. Conclusions:After the LM-LAD single-stent strategy for LM bifurcation lesions, a ΔQFR of LCX ≤-0.03 was associated with a higher risk of 1-year main adverse cardiac events, indicating the superior prognostic value of the post-PCI physiological assessment.

Background:Quantitative flow ratio (QFR) based lesion selection for percutaneous coronary intervention (PCI) treatment has shown clinical benefits in terms of reduced risk for myocardial infarction and repeat revascularization. Whether this benefit is consistent across different age groups still needs further investigation. Methods:In this prespecified subgroup study of FAVOR III China trial, we compared long-term clinical outcomes between QFR-guided and angiography-guided PCI among different age groups among 3825 enrolled subjects. The primary endpoint was major adverse cardiac events (MACEs), a composite of all-cause death, myocardial infarction, and ischemia-driven revascularization. Results:Of the 3825 patients, 1717 (44.9%) were aged ≥ 65 years. At baseline, patients ≥ 65 had higher rates of hypertension, hyperlipidaemia, stroke history (P < 0.0001), and peripheral vascular disease (P = 0.024) and had higher SYNTAX scores (P = 0.0095). Compared with standard angiography guidance, the QFR-guided strategy consistently reduced the 1-year (≥ 65 years, 6.04% vs. 9.19%, HR = 0.65, 95% CI: 0.46-0.92; < 65 years, 5.53% vs. 8.43%, HR = 0.65, 95% CI: 0.47-0.91) and 3-year MACE rates in both age groups (≥ 65 years, 11.8% vs. 15.2%, HR: 0.75, 95% CI: 0.58-0.98; < 65 years, 9.5% vs. 14.6%, HR = 0.63; 95% CI: 0.49-0.81), without a significant interaction (P interaction = 0.99). Within the QFR-guided group, the 3-year MACE rate in patients with deferred vessels was numerically greater in patients aged ≥ 65 years than in those aged < 65 years (8.3% vs. 3.0%, P = 0.10). Conclusions:Although with higher rate of comorbidities and more complex coronary anatomy, the long-term benefit of the QFR-guided PCI strategy remained consistent in patients ≥ 65 years, compared with those < 65 years.

OBJECTIVES:To analyze sex and age distribution of global disease burden of calcific aortic valve disease (CAVD) from 1990 to 2021. METHODS:CAVD data during 1990-2021 were obtained from the IHME website for Global Burden of Disease (GBD). The prevalence, mortality, years lived with disability (YLDs), and disability-adjusted life years (DALYs) were analyzed by gender and age groups. Joinpoint regression was used to calculate annual percentage change (APC) and average annual percentage change (AAPC). RESULTS:In 2021, there were 13.32 million CAVD patients and 142 000 deaths caused by CAVD globally. Age-standardized prevalence was higher in males (193.2/105) than that in females (128.9/105). Patients in 65-<85 age group accounted for 64.0% of total cases, while those ≥85 years old accounted for 16.1%. From 1990 to 2021, prevalence increased in both sexes with an AAPC of 0.72% for males and 0.57% for females, respectively. Prevalence grew fastest from 2000 to 2010, slowed thereafter, and declined from 2015 to 2021. In <65 years old, the mortality of males was 2.4 times higher than that of females, while in ≥85 years old, mortality of females (117.3/105) exceeded that of males (99.1/105). YLD rates increased with age, and were higher in males for all age groups. DALY rates decreased overall but increased in ≥85 years old, with a greater increase in females. CONCLUSIONS:There are significant gender and age disparities in global disease burden of CAVD, with the elderly, especially super-elderly females deserving particular attention. It is recommended to develop personalized intervention strategies for these populations.

Background The assessment of coronary function and microcirculation in patients with ST-segment elevation myocardial infarction (STEMI) may be useful to guide long-term prognosis, but the research is limited. This study aimed to investigate the value of angio-based fraction flow reserve (AccuFFR) and an index of microcirculatory resistance (AccuIMR) after percutaneous coronary intervention (PCI) for evaluating the long-term prognosis of STEMI patients. Methods Data of patients with STEMI who underwent PCI at Peking University Third Hospital between January 2017 and March 2022 were retrospectively analyzed. AccuFFR and AccuIMR were analyzed immediately after primary PCI. According to AccuFFR and AccuIMR, patients were classified into four groups: normal coronary function, macrovascular disorder, microvascular disorder, and mixed disorder. Results A total of 1297 patients were enrolled. The median follow-up time was 35 (24, 58) months. The risks of major adverse cardiovascular events (MACE), all-cause death, cardiovascular death and readmission for heart failure in the mixed disorder group were significantly higher than those in the other three groups (all P < 0.001). Both AccuFFR (hazard ratio [HR]: 0.948 per 0.01 increase, 95%CI: 0.914-0.983, P=0.004) and AccuIMR (HR: 1.018, 95%CI: 1.009-1.027, P<0.001) were independent predictors of MACE. A nomogram model was established to predict MACE after PCI in patients with STEMI at 1, 3, and 5 years. The ROC curve, C-index, and calibration curve showed that the model had high discrimination. Conclusion Coronary function and microcirculation assessment immediately after primary PCI are important in evaluating the prognosis of patients with STEMI. (Trial registration: NCT06435728)

Currently, precise stent manipulation and placement in percutaneous coronary intervention remain compromised. Intravascular imaging techniques are often limited by either spatial resolution or depth of penetration. A hybrid intravascular ultrasound (IVUS)-optical coherence tomography (OCT) system would be a better choice for interventional cardiologists. To validate the image quality and safety of the novel IVUS-OCT system for guiding coronary intervention in Chinese patients, a total of 114 cases were included. The proportion of clear imaging length was 96.21% ± 10.16%. Device success rate was 99.1%, technical success rate was 98.2%, and excellent image rate was 96.5%. No catheter-related adverse events occurred, and the incidence of device defects was 0.9%. This study preliminarily verified the image quality and safety of the novel Hybrid IVUS and OCT imaging system. (The StUdy to Evaluate the Performance and safEty of the Novasight HybRid System Using Objective PeRformance Criteria [SUPERIOR]; NCT04617899).

Introduction: Revascularization of nonculprit arteries in patients with ST-Segment Elevation Myocardial Infarction (STEMI) is now recommended based on several trials. However, the optimal therapeutic strategy of nonculprit lesions remains unknown. Murray law-based Quantitative Flow Ratio (μQFR) is a novel, non-invasive, vasodilator‐free method for evaluating the functional severity of coronary artery stenosis, which has potential applications for nonculprit lesion assessment in STEMI patients. Material and methods: Patients with STEMI who received staged PCI before hospital discharge were enrolled retrospectively. μQFR analyses of nonculprit vessels were performed based on both acute and staged angiography. Results : Eighty-four patients with 110 nonculprit arteries were included. The mean acute μQFR was 0.76 ± 0.18, and the mean staged μQFR was 0.75 ± 0.19. The average period between acute and staged evaluation was 8 days. There was a good correlation (r = 0.719, P < 0.001) between acute μQFR and staged μQFR. The classification agreement was 89.09%. The area under the receiver operator characteristic (ROC) curve for detecting staged μQFR ≤ 0.80 was 0.931. Conclusions : It is feasible to calculate the μQFR during the acute phase of STEMI patients. Acute μQFR and staged μQFR have a good correlation and agreement. The μQFR could be a valuable method for assessing functional significance of nonculprit arteries in STEMI patients.

ABSTRACTBackground and ObjectivesChest pain is a relatively long‐term symptom that commonly occurs in patients who have contracted COVID‐19. The reasons for these symptoms remain unclear, with coronary microvascular dysfunction (CMD) emerging as a potential factor. This study aimed to assess the presence of CMD in these patients by measuring the angio‐derived index of microcirculatory resistance (AMR).MethodsIn this cross‐sectional case–control study, patients who had chest pain and a history of COVID‐19 infection within the preceding 30 to 60 days were included. The control subjects were patients without COVID‐19. Demographic, clinical, and echocardiographic data were recorded. Angiographic images were collected for AMR analysis through an angioplus quantitative flow ratio measurement system. Propensity score matching (PSM) was performed to match the two groups. Multivariate logistic regression was used to examine the association between COVID‐19 incidence and the increase in AMR (AMR > 285 mmHg*s/m) after correction for other confounders.ResultsAfter PSM, there were 58 patients in each group (the mean age was 66.3 ± 9.04 years, and 55.2% were men). The average time between the onset of COVID‐19 infection and patient presentation at the hospital for coronary angiography was 41 ± 9.5 days. Moreover, there was no significant difference in the quantitative flow ratio between the two groups. Patients with COVID‐19 had a greater mean AMR (295 vs. 266, p = 0.002). Multivariate logistic regression analysis revealed that COVID‐19 (OR = 3.32, 95% CI = 1.50–7.60, p = 0.004) was significantly associated with an increase in AMR.ConclusionsLong‐term COVID‐19 patients who experience chest pain without evidence of myocardial ischemia exhibit an increase in AMR, and CMD may be one of the reasons for this increase. COVID‐19 is an independent risk factor for an increase in AMR.

Objective To analyze the influence factors of new-onset complete left bundle branch block（CLBBB） after transcatheter aortic valve replacement（TAVR） in patients with aortic stenosis（AS）, and to explore the impact of CLBBB on postoperative cardiac remodeling reversal. Methods Totally 55 patients with AS who underwent TAVR were enrolled. Among them, new-onset CLBBB after TAVR and lasted for at least 1 month was observed in 16 patients（CLBBB group）,while 31 patients did not develop new CLBBB after operation and 8 patients developed new CLBBB within 1 day after operation but CLBBB disappeared within 1 month were included in NO-CLBBB group. The hemoglobin（Hb）, N-terminal pro-brain natriuretic peptide（NT-proBNP）, creatinine（Cr）, creatine kinase-MB（CK-MB） and troponin（cTn） before and 1 day after TAVR were compared between groups. Echocardiographic parameters, as well as NYHA cardiac function classification before and 1 month after TAVR were also compared between groups. Results Serum cTn at 1 day after TAVR was significantly higher than that before in both groups（both P＜0.05）, and there was no significant difference between groups（both P＞0.05）. The interventricular septum thickness at end-diastole（IVSD）, aortic valve peak pressure gradient（PPG） and aortic valve mean pressure gradient（MPG） of CLBBB group were significantly higher than those of NO-CLBBB group before TAVR（all P＜0.05）. In NO-CLBBB group, 1 month after TAVR, the left ventricular mass（LVM）, IVSD, left ventricular posterior wall thickness at end-diastole（LVPWD）, pulmonary artery systolic pressure（PASP）, PPG and MPG decreased, while aortic valve orifice area（AVA） increased compared with those before operation（all P＜0.01）. In CLBBB group, IVSd, PPG and MPG decreased 1 month after TAVR, while AVA increased compared with those before operation（all P＜0.01）. There was no significant difference of the other indexes between and within groups（all P＞0.05）. Conclusion After TAVR for treating AS, PPG, MPG and IVSD were impact factors of new CLBBB. New-onset CLBBB affected postoperative cardiac remodeling reversal.

目的 以血流储备分数(FFR)为金标准,比较定量血流分数(QFR)与静息全周期比值(RFR)评估冠状动脉临界病变的准确性及临床应用价值.方法 回顾性纳入2020年9月至2022年1月,在北京大学第三医院因冠状动脉性心脏病行冠状动脉造影并同时接受FFR和RFR检测的142例患者142支血管病变,分析RFR、QFR与FFR的线性相关性和诊断一致率,并进行受试者工作特征(ROC)曲线分析.根据性别及靶血管进行亚组分析.结果 142例患者年龄66(58,71)岁,87例(61.3%)为男性,110支(77.5%)靶病变位于左前降支,RFR与FFR相关性r=0.814(95%CI 0.748～0.864,P＜0.0001)、QFR与FFR相关性r=0.617(95%CI 0.503～0.709,P＜0.0001),均存在显著线性相关关系.RFR对应FFR≤0.80的AUC 0.786(95%CI 0.715～0.857),而QFR对应FFR≤0.80的AUC 0.707(95%CI 0.633～0.782),两者之间的AUC差异无统计学意义(P=0.056).在不同性别及靶病变的亚组分析中,RFR和QFR的AUC差异均无统计学意义(均P＞0.05).结论 RFR、QFR与FFR有较高的一致性,二者与FFR诊断一致率较高,性别和靶病变对二者诊断准确性影响较小.

为什么发烧期间血压会比平时低? 感染新冠以后,部分患者因为高烧,特别是使用退烧药以后出现大汗淋漓可能造成失水,有的患者还有消化道症状:食量明显下降,甚至呕吐腹泻,都有可能出现血容量不足,从而导致血压下降. 这些情况下需要适量补充水分,并注意监测血压变化情况.

北京大学第三医院作为全国唯一一家能够同时覆盖北京、延庆、张家口三大赛区的冬奥会定点医疗保障机构,在医院本部启用冬奥专用诊区,实施闭环管理.为最大限度地减少人力资源浪费,保证冬奥专用诊区的护理质量,我院加大了护理管理力度,对专用诊区内的工作流程进行及时的调整梳理,对工作细节做了精确的把控.文章从诊区设置及设施配置、工作流程制定和完善、护理人力和质量管理以及院内感染防控等方面介绍了冬奥专用诊区的护理管理实践.

"急性心肌梗死的发病年龄上至八九十岁,下至20岁.近年来,35岁以下的患者发病率增长了59％.有研究表明,70％-80％的心梗患者其实都有心梗信号,但是只有大概25％的年轻患者会提供给医生,而75％的年轻患者都不会注意到这样的心梗信号.所以,如果能够认识到心梗信号,对于患者早期就诊非常重要.

目的:本研究拟对标准化病人(SP)参与病例为基础的情景式教学(CBL)是否有助于提高医学生医患沟通能力进行探讨.方法:将临床医学八年制生产实习阶段医学生分为对照组、学生角色扮演CBL组、SP参与CBL组3组.研究终点为临床沟通技巧考试成绩及实习前后考试成绩的差值.结果:参加研究的医学生共68人,其中对照组23人,学生角色扮演CBL组22人,SP参与CBL组23人.3组学生的实习前临床沟通技巧考试成绩分别为 8.00(6.25,9.00)分、8.00(6.50,9.00)分和 8.25(6.50,9.00)分(P=0.790).3 组学生实习后临床沟通技巧考试成绩均较实习前的摸底考试成绩均有所提高,SP参与CBL组的分数较对照组提高得更加显著(P=0.047),与学生角色扮演CBL组相比提高的幅度也很明显(P=0.016),而学生角色扮演CBL组与对照组相比,成绩的变化并无差异(P=0.532).结论:SP参与的情景式教学可以明显提高临床沟通技巧的成绩.

Acute obstruction of the right coronary artery（RCA） can lead to right ventricular myocardial infarction（MI）, which rarely lead to cardiogenic shock（CS）. Hemodynamic stability could be restored through fluid resuscitation and vasoactive drugs in most circumstances. Here,we present a highly representative case of refractory CS caused by massive right ventricular MI with apical aneurysm formation, who was successfully treated with extracorporeal membrane oxygenation（ECMO）post severe complication of acute right coronal dissection.

OBJECTIVE:To evaluate the correlation between the TIMI frame count, IMR, and CFR in coronary microvascular disease (slow flow phenomenon).METHODS:TFC and IMR were recorded in the nitroglycerin and ATP administration states, and the relationship between TFC, IMR, and CFR in specific states was analyzed.RESULTS:A total of 41 patients with baseline TFC >25 frames on coronary angiography were enrolled, and nitroglycerin reduced TFC by 50% from baseline in 24 (58.54%) patients; 16 of the remaining 17 patients were able to achieve a 50% reduction in TFC by further intracoronary ATP injection. 10 patients were further tested for IMR, and the results showed significant correlations between baseline TFC and IMR (r = 0.775, P=0.008), TFC and IMR after nitroglycerin (r = 0.875, P=0.001), and the minimal TFC and IMR that could be obtained with nitroglycerin or ATP administration (r = 0.890, P=0.001). There was also a significant correlation between the proportional improvement in TFC and CFR before and after nitroglycerin injection (r = 0.685, P=0.029). In addition, we observed a lower IMR measured after nitroglycerin than after ATP in three patients, suggesting that CMD may be dominated by NO-sensitive vascular such as prearterioles and that an extensive analysis of the target site of CMD may be achieved by stepwise drug administration.CONCLUSION:Induction of TFC in different states by a stepwise drug approach may serve as a potential primary screening method for coronary microcirculatory dysfunction, thereby reducing the need for further IMR or CFR testing.

急性ST段抬高型心肌梗死患者中约有50％合并多支血管病变.既往多项研究证实,对于非梗死相关血管(non-IRA),无论在冠状动脉造影(CAG)或冠状动脉血流储备分数(FFR)指导下进行血运重建均可降低主要不良心血管事件发生率.但近期有研究发现,应用FFR指导的non-IRA血运重建相较于CAG未能带来更多获益.本文拟对相关研究进展进行综述.

"支架之后是否可以运动?"这是临床工作中出现频次非常高的一个问题.很多患者被这个问题困扰,不仅没有按照医嘱进行心脏康复训练,甚至产生焦虑、抑郁等情绪,出现失眠、疲劳及躯体化症状,严重影响正常的生活. 有一位患者让我印象非常深刻.这名患者是一位中年人,因为大面积心肌梗死,来到医院后直接进行了紧急的心脏支架手术.因为他的病情非常重,在心脏监护室观察半个多月后才转到普通病房.比较幸运的是,他的心脏功能逐渐恢复,也顺利出院了.出院的时候,医生和护士反复告诉他日常生活中有哪些要注意的要点,尤其是每天要有一定量的活动.但是,这名患者出院后一直担心支架会脱落、血管会再次堵塞等问题,变得非常谨小慎微,平时出门都是让保姆用轮椅推着他.

目的 以血流储备分数(FFR)为标准,比较定量血流分数(QFR)和瞬时无波形比值(iFR)评估冠状动脉临界病变的准确性,并分析QFR与iFR的相关性及诊断一致率.方法 回顾性纳入北京大学第三医院2015年5月至2020年6月因冠心病进行冠状动脉造影(CAG)并接受FFR和iFR检测的62例患者,收集患者的临床和CAG病变解剖学资料、靶血管iFR和FFR值,并测量同一靶血管的QFR值.以FFR≤0.80为判断心肌缺血的临界值,比较QFR和iFR与FFR评估冠状动脉临界病变的准确性,并分析QFR与iFR的相关性及诊断一致率.结果 62例患者中,有53例(85.5％)靶血管为左前降支,基线直径狭窄率为48.0％(41.1％,55.7％).iFR、QFR与FFR均具有较好的相关性[r=0.773(95％CI 0.649～0.857)、r=0.626(95％CI 0.445～0.757),均P<0.001].QFR、iFR预测FFR≤0.80的受试者工作特征曲线下面积(AUC)比较,差异无统计学意义[0.859(95％CI 0.748～0.935)比0.875(95％CI 0.766～0.945),P=0.801];二者与FFR诊断一致率的差异无统计学意义(74.2％比79.0％,P=0.615).QFR与iFR的相关性较弱(r=0.396,95％CI 0.162～0.587,P=0.0015).QFR对应iFR≤0.89的AUC为0.663(95％CI 0.524～0.801,P=0.028).QFR、iFR联合诊断策略可以与FFR达到88.7％的诊断一致率,同时减少58.1％的压力导丝使用.结论 iFR与QFR评估冠状动脉临界病变具有相似的诊断准确率,但二者相关性较弱.二者联合诊断策略可进一步提高诊断准确率.