This study aimed to compare the inter-arm blood pressure difference (IAD) based on the first reading versus the average of the second and the third readings using computer-programmed blood pressure measurement (CCBPM) in 3067 rural community residents. The detection rate of abnormal systolic IAD (sIAD) was 9.1% based on the first reading, compared to 5.6% based on the average reading—a difference of approximately 40%. These findings suggest that CCBPM should be used with the average of the second and the third readings for sIAD evaluation.

With the rising prevalence of cardiometabolic multimorbidity (CMM), it has become a significant public health issue affecting the health of middle-aged and elderly populations. The C-reactive protein-triglyceride-glucose index (CTI), as a composite biomarker integrating inflammatory and metabolic information, currently exhibits unclear associations with CMM risk. This study aimed to examine the association of cumulative exposure and longitudinal changes of the CTI with the risk of CMM in middle-aged and older Chinese adults. This longitudinal study used data from the China Health and Retirement Longitudinal Study (CHARLS). Cox regression and restricted cubic spline (RCS) models were employed to assess the association between cumulative CTI (cuCTI) and CMM risk. The area under the ROC curve (AUC) was computed to evaluate the predictive performance of different indicators. Participants were classified into three groups based on CTI changes using K-means clustering. Subgroup and sensitivity analyses were conducted to test the robustness of the results. The study included 4,461 participants, among whom 514 (11.5

This study compared the accuracy and agreement of an automated Korotkoff device (Hanvon FF690) and an oscillometric device (Omron HBP-1320T3) in two parts. In the first part, 60 patients undergoing coronary angiography were enrolled. Two non-invasive devices were applied in a randomized alternating order, with invasive aortic blood pressure (BP) serving as reference. In the second part, 134 outpatients were enrolled; two oscillometric BP monitors were first used to simultaneously measure and quantify the baseline inter-arm difference (IAD) for each patient. Subsequently, the two study devices were randomly assigned to two groups for simultaneous measurement, and the data were corrected using the baseline IAD. Paired tests and Bland–Altman analysis were used to assess accuracy and agreement, and linear regression was used to evaluate correlation. In the accuracy assessment, both non-invasive devices significantly overestimated invasive aortic systolic blood pressure (SBP). The oscillometric device overestimated SBP by a larger margin than the automated Korotkoff device (mean overestimation 14.8 ± 20.6 mmHg vs. 9.9 ± 18.6 mmHg, P < 0.001). For diastolic blood pressure (DBP), both methods showed no systematic bias against the invasive reference standard. In the clinical agreement assessment, the oscillometric device gave significantly higher SBP and DBP readings than the Korotkoff device (mean differences: SBP 3.34 ± 8.81 mmHg, DBP 2.87 ± 6.34 mmHg, both P < 0.001). Stratified analysis showed that the between-device difference for SBP remained stable across BP levels, whereas the DBP measurement difference tended to narrow at higher baseline pressures. Both the oscillometric and Korotkoff sound methods overestimated SBP by approximately 10–15 mmHg. Comparatively, the oscillometric SBP measurements remained 3–5 mmHg higher than those obtained via the Korotkoff sound method, with both approaches demonstrating substantial individual variability.

Hypertension plays a critical role in the development of vascular remodeling and atherosclerosis. STIM/Orai1 proteins mediate store-operated Ca2+ entry (SOCE), which is one of the cellular Ca2+ signaling machinery involved in the pathological process of cardiovascular remodeling. However, the role and mechanism of Orai1/Orai1 mediated SOCE in coronary artery dysfunction caused by hypertension remain incompletely elucidated. The present study aimed to investigate the role of the Orai1/NFAT/calcineurin signaling pathway in hypertension-induced coronary vasoconstriction impairment utilizing spontaneous hypertension rats (SHRs) and coronary arterial smooth muscle cells (CASMCs) exposed to high hydrostatic pressure (180 mmHg). Here, we found that agonists (5-HT, U46619, and ET-1) induced coronary artery constriction that was significantly reduced in SHRs compared with Wistar rats. The SOCE inhibitors SKF96365 and 2-APB also significantly inhibited coronary artery constriction in both SHRs and Wistar rats; only the inhibitory effect of low concentrations (50 μM) of 2-APB on SHRs was weaker than that of Wistar rats. Hypertension/high hydrostatic pressure (180 mmHg) induced phenotypic transformation of CASMCs, with an increase in the expression of STIM1/Orai1, Calcineurin-NFAT2, and the synthetic phenotypic marker protein OPN, and a decrease in the contractile phenotypic marker protein SMMHC. The intervention of Orai1/Orai1 mediated SOCE (overexpression with ad-Orai1, inhibition of SOCE channel with BTP2 or downregulation with Orai1 siRNA) regulated STIM1, Calcineurin-NFAT2 expression, and contraction/synthesis phenotypic markers. Together, these findings suggest that hypertension leads to coronary vascular dysfunction via the upregulation of Orai1, which is required for the phenotypic transformation of VSMCs by activating the Calcineurin-NFAT signaling pathway.

PURPOSE:The systemic immune-inflammation index (SII) is a useful predictor in cardiovascular diseases. The purpose of this study was to investigate the association of SII with in-hospital mortality in patients with cardiogenic shock (CS) supported with extracorporeal membrane oxygenation (ECMO). PATIENTS AND METHODS:A total of 126 CS patients received ECMO implantation between January 2020 and December 2023. SII was calculated as follows: SII ​= ​neutrophil count × platelet count / lymphocyte count at admission. Participants were divided into high or low SII group based on the cut-off value of SII. In-hospital mortality was compared between the groups. RESULTS:The optimal SII cut-off value for predicting in-hospital mortality in CS patients supported with ECMO was 1735.9 (AUC 0.68, p ​= ​0.001). In-hospital mortality was significantly higher in the high SII group compared to the low SII group (59.09 % vs. 21.67 %, p <0.001). The univariate and multivariate logistic regression analyses had shown that SII and left ventricular ejection fraction (LVEF) were identified as independent predictors of in-hospital mortality in CS patients supported with ECMO (OR: 1.001, 95 % CI: 1.000-1.002, p ​= ​0.007 and OR: 0.881, 95 % CI: 0.803-0.966, p ​= ​0.007, respectively). SII combined with LVEF offered a superior prognostic capability compared to SII alone (AUC 0.707, v. s. AUC 0.68). CONCLUSION:We demonstrated that elevated admission SII was independently associated with in-hospital mortality in CS patients supported with ECMO. These findings highlight the potential role of SII as an indicator of mortality risk in this population.

ObjectiveThere is little evidence of the influence of living alone on hypertension risk among men 80 years or older. Additionally, the influence of living alone duration on hypertension risk lacks thorough investigation. Hence, this cohort study examines living alone and its duration’s link to hypertension risk in this specific group.MethodsWe included 2009 older men aged ≥80 years without hypertension from the Chinese Longitudinal Healthy Longevity Survey in the 2008 wave. Follow-up was conducted in the 2011 wave. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) to assess hypertension risk related to living alone and living alone time.ResultsWe included 2,009 older men, with a mean age of 90.7 years (standard deviation: 6.8). Over a median follow-up of 2.9 (1.3–3.0) years, 573 participants (28.5%) developed hypertension. Living alone was significantly associated with a higher hypertension risk than living with family (HR: 1.42; 95% CI 1.11–1.80). When compared to living with family, the hypertension risk was increased in the first quartile of living alone time (0–6.1 years) (HR: 1.76; 95% CI 1.16–2.66), the second quartile (6.1–10.6 years) (HR: 1.56; 95% CI 1.07–2.29), and the third quartile (10.6–19.3 years) (HR: 1.66; 95% CI 1.08–2.55). Surprisingly, no significant association was found in the fourth quartile (≥19.3 years) with hypertension risk. Stratified and Interaction analyses indicated no significant interaction effects between subgroups. Sensitivity analyses yielded consistent results.ConclusionLiving alone was independently associated with an increased risk of hypertension in older men. The highest risk was found in those with the least time alone. These findings imply that social isolation and lack of companionship could be pivotal in hypertension development. Furthermore, the study highlights the need to consider living alone duration when assessing its impact on health outcomes.

ObjectiveLeukocyte parameters are associated with cardiovascular diseases. The aim of the present study was to investigate the role of leukocyte parameters in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) with high thrombus burden (HTB).MethodsA total of 102 consecutive STEMI patients with HTB who underwent PPCI within 12 h from the onset of symptoms between June 2020 and September 2021 were enrolled in this study. In addition, 101 age- and sex-matched STEMI patients with low thrombus burden (LTB) who underwent PPCI within 12 h from the onset of symptoms were enrolled as controls. Leukocyte parameters, such as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR), were calculated at the time of admission.ResultsThe value of NLR and MLR were significantly higher in the HTB group than in the LTB group (6.24 ± 4.87 vs. 4.65 ± 3.47, p = 0.008; 0.40 ± 0.27 vs. 0.33 ± 0.20, p = 0.038). A cutoff value of >5.38 for NLR had a sensitivity and specificity of 53.9% and 74.3%, respectively, and MLR >0.29 had a sensitivity and specificity of 60.8% and 55.4%, respectively, for determining the STEMI patients with HTB [area under the receiver operating characteristic curve (AUC): 0.603, 95% confidence interval (CI): 0.524–0.681, p = 0.012; AUC: 0.578, 95% CI: 0.499–0.656, p = 0.046]. There was no significant difference of all-cause mortality rate and major adverse cardiac events (MACEs) between the STEMI patients with HTB or with LTB (3.92% in HTB group vs. 2.97% in LTB group, p = 0.712; 10.78% in HTB group vs. 8.91% in LTB group, p = 0.215). Compared with the HTB patients in the low NLR group, C-reactive protein, baseline troponin I, baseline brain natriuretic peptide, and leukocyte parameters, such as white blood cell, neutrophil, lymphocyte, NLR, PLR, and MLR, were also significantly higher in the high NLR group in STEMI patients who underwent PPCI with HTB (18.94 ± 19.06 vs. 35.23 ± 52.83, p = 0.037; 10.99 ± 18.07 vs. 21.37 ± 19.64, p = 0.007; 199.39 ± 323.67 vs. 430.72 ± 683.59, p = 0.028; 11.55 ± 3.56 vs. 9.31 ± 2.54, p = 0.001; 9.77 ± 3.17 vs. 5.79 ± 1.97, p = 0.000; 1.16 ± 0.44 vs. 2.69 ± 1.23, p = 0.000; 9.37 ± 4.60 vs 1.31 ± 2.58, p = 0.000; 200.88 ± 89.90 vs. 97.47 ± 50.99, p = 0.000; 0.52 ± 0.29 vs. 0.26 ± 0.14, p = 0.000, respectively). MACEs and heart failure in the high NLR group were significantly higher than that in the low NLR group of STEMI patients who underwent PPCI with HTB (20.45% vs. 4.25%, p = 0.041; 10.91% vs. 2.13%, p = 0.038).ConclusionThe value of NLR and MLR were higher in STEMI patients who underwent PPCI with HTB. In STEMI patients who underwent PPCI with HTB, a raised NLR could effectively predict the occurrence of MACEs and heart failure.

The contractile function of vascular smooth muscle cells (VSMCs) typically undergoes significant changes with advancing age, leading to severe vascular aging-related diseases. The precise role and mechanism of stromal interaction molecule-1 (STIM1) in age-mediated Ca2+ signaling and vasocontraction remain unclear. The connection between STIM1 and age-related vascular dysfunction was investigated using a multi-myograph system, immunohistochemical analysis, protein blotting, and SA-β-gal staining. Results showed that vasoconstrictor responses in the thoracic aorta, intrarenal artery, and coronary artery decreased with age. STIM1 knockdown in the intrarenal and coronary arteries reduced vascular tone in young mice, while no change was observed in the thoracic aorta. A significant reduction in vascular tone occurred in the STIM1 knockout group with nifedipine. In the thoracic aorta, vasoconstriction significantly decreased with age following the use of nifedipine and thapsigargin and almost disappeared after STIM1 knockdown. The proportion of senescent VSMCs increased significantly in aged mice and further increased in sm-STIM1 KO aged mice. Moreover, the expression of senescence markers p21, p16, and IL-6 significantly increased with age, with p21 expression further increased in the STIM1 knockdown aged group, but not p16 or IL-6. These findings indicate that different arteries exhibit distinct organ-specific features and that STIM1 downregulation may contribute to age-related vasoconstrictive dysfunction through activation of the p21 pathway.

Oxidative Balance Scores (OBS) is composite measures that assess the balance between pro-oxidant and antioxidant factors in an individual’s diet and lifestyle. Evidence on OBS and cardiovascular disease (CVD) in diabetic patients is scarce. This study investigates the potential association between OBS and CVD-prevalence and all-cause and CVD-related mortality in adult diabetic patients. Participants were selected from the National Health and Nutrition Examination Survey (NHANES) 2007–2018. OBS-related data collection was initiated by linking the National Death Index to determine mortality due to all-cause and cardiovascular disease until December 31, 2019. Weighted logistic regression analyses explored the relationship between OBS and CVD. In addition, multivariable Cox proportional risk regression models and Kaplan–Meier curves were used to determine the correlation between OBS and mortality, with time to event as the time variable, as well as to estimate hazard ratios (HR) and 95

We aimed to explore whether the cuff/arm (C/A) circumference ratio within the suggested range (> 80%) affects the accuracy of mercury cuff blood pressure (BP) measurement (cuff BP) using intrabrachial BP (IABP) as a reference.A total of 253 patients aged 62.42 ± 9.70 years were included. After coronary angiography, the catheter in the right arm was gradually withdrawn toward the cubital fossa, and the IABP was continuously recorded. The cuff BP of the right arm was measured based on the artery blood flow using a special method similar to the traditional mercury method. The cuff was replaced using another C/A ratio after one minute, and the test was performed again. We used three different cuffs for each participant to meet the C/A ratios of 80%-84%, 85%-89%, and 90%-100%. We calculated the percentage deviation degree (DD) between the cuff BP and IABP values: DD = difference/IABP × 100%. The agreement between the values was evaluated using the Bland-Altman method.The IABP values were 138.52 ± 16.89/79.67 ± 9.81 mmHg. The DD of the systolic BP (SBP), with a ratio of 80%-84% (3.06%), was the smallest. The DD of the diastolic BP (DBP) was lowest at a ratio of 85%-89% (2.47%). Men and women had the lowest DD of the SBP at a C/A ratio of 80%-84% and the lowest DD of the DBP at a C/A ratio of 85%-89%. Regardless of whether the participants had coronary heart disease, the DD of the SBP at a C/A ratio of 80%-84% was the lowest, and the DD of the DBP at a C/A ratio of 85%-89% was the lowest.Even in the suggested range of > 80%, when the C/A ratio was 80%-84%, the difference in the SBP between the cuff and IABP was the lowest, but when the C/A ratio was 85%-89%, the difference in the DBP was the lowest.

患者51岁男性,因"21年来头晕3次,晕厥1次"于2021年8月12日在南昌大学第二附属医院(我院)门诊就诊. 现病史:患者诉2000年8月出现久蹲突然起立后头晕表现,伴大汗淋漓、乏力,平卧10余分钟后自行缓解,但无意识丧失,无大小便失禁,无四肢抽搐,无恶心呕吐等不适.此后头晕、黑蒙反复发作3次,均与体位改变有关.

This study aimed to investigate the clinical characteristics and major adverse cardiovascular events (MACEs) of Chinese patients with premature acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This study was a secondary retrospective analysis involving 2114 ACS patients undergoing PCI at a single center in China. The patients were divided into two groups according to age (premature ACS group: ≤ 55 years in men, ≤ 65 years in women; nonpremature ACS group: > 55 years in men, > 65 years in women). The primary endpoint was all-cause death, and the secondary endpoint was a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, target vessel revascularization, and recurrent angina at follow-up, defined as MACEs. The incidence of all-cause death and MACEs was significantly lower in the premature than in the nonpremature ACS group (P < 0.001). Female sex, higher triglyceride levels, and higher low-density lipoprotein cholesterol levels were identified as independent risk factors that accelerated the development of ACS, whereas higher high-density lipoprotein cholesterol levels were identified as protective factors. Furthermore, in patients with premature ACS, non-ST-elevation ACS, cardiac insufficiency, multivessel disease, and left main lesion were risk factors for MACEs. Younger individuals, especially females, are advised to undergo early screening for the risk factors of premature ACS. Primary prevention of dyslipidemia should be more aggressively promoted at a young age. For premature ACS patients undergoing PCI, strengthened management and regular re-examinations are necessary to avoid adverse cardiovascular events as much as possible.

目的 分析血小板分布宽度(PDW)稳定性、变异性与持续性非瓣膜性心房颤动患者治疗目标范围内的时间百分比(TTR)的关系.方法 选取2020-2022年九江市第一人民医院收治的持续性非瓣膜性心房颤动患者121例为研究对象.收集患者的一般资料.所有患者在开始口服华法林进行抗凝治疗的前6个月中至少检测过3次PDW,计算TTR时再次检测PDW.通过前3次检测的PDW处于参考范围的次数判断PDW的稳定性,根据判断结果将患者分为极不稳定组(0次,30例)、不稳定组(1次,39例)、中等程度稳定组(2次,31例)、较高程度稳定组(3次,21例),并计算平均PDW.根据PDW变异率将患者分为低变异组(＜10%,53例)、中变异组(10%～＜20%,48例)、高变异组(≥20%,20例).持续性非瓣膜性心房颤动患者TTR达标影响因素分析采用多因素Logistic回归分析.结果 不稳定组TTR高于极不稳定组(P＜0.05);中等程度稳定组TTR、TTR达标率高于极不稳定组,TTR高于不稳定组(P＜0.05);较高程度稳定组TTR、TTR达标率高于极不稳定组、不稳定组、中等程度稳定组(P＜0.05).高变异组TTR达标率低于低变异组、中变异组(P＜0.05).多因素Logistic回归分析结果显示,平均PDW[OR=0.882,95%CI(0.812,0.958)]和PDW不稳定[OR=0.008,95%CI(0.001,0.058)]、中等程度稳定[OR=0.012,95%CI(0.002,0.072)]、较高程度稳定[OR=0.037,95%CI(0.007,0.193)]、高变异[OR=10.618,95%CI(1.316,85.652)]是持续性非瓣膜性心房颤动患者TTR达标的影响因素(P＜0.05).结论 PDW不稳定、中等程度稳定、较高程度稳定是持续性非瓣膜性心房颤动患者TTR达标的保护因素,而PDW高变异是其危险因素.

经导管主动脉瓣膜置换术(TAVR)是目前治疗外科手术禁忌的主动脉瓣狭窄患者的一种重要手段[1],但由于TAVR手术操作复杂,属于复杂高危介入手术,对于射血分数低下及心功能极差,甚至并发急性心力衰竭(心衰)的患者,常规TAVR手术风险较大,体外膜肺氧合(ECMO)等机械辅助循环装置可为此类患者提供手术条件.本文通过介绍南昌大学第二附属医院心血管内科2021年7月收治的1例预防性使用ECMO辅助下行TAVR治疗极高危主动脉瓣狭窄伴冠状动脉(冠脉)阻塞高风险病例,讨论目前ECMO辅助TAVR手术的应用情况以及现存的相关问题,报告如下.

患者女性,77岁.以"高血压12年,血压控制良好"为主诉而定期随诊. 现病史:患者于2009年诊断为高血压,最高血压为 180/88 mmHg(1 mmHg=0.133 kPa).一直服用硝苯地平控释片30 mg 1次/d,缬沙坦氢氯噻嗪片80mg,1次/d.近2年自备电子血压计,并坚持血压测量,家庭血压基本上在120～130/60～70 mmHg水平,脉率在70～80次/min.查体:体温36.6℃,脉搏117次/min,呼吸18次/min.右上臂血压为171/69 mmHg.发育营养良好,检查合作;胸廓无畸形,肺部听诊无明显异常.心界不扩大,心律齐,心率117次/min,无杂音;腹部和四肢未见异常.既往史:否认糖尿病,无烟酒嗜好.睡眠正常,性情开朗,自述无心理应激因素存在.个人史和婚育史无特殊记载.

目的 探究利奈唑胺与万古霉素对于老年感染性心内膜炎的治疗效果及安全性.方法 选取 2020 年 1 月至2022 年1 月景德镇市中医医院、南昌大学第二附属医院心血管内科收治的60 例老年感染性心内膜炎患者,随机分为研究组、对照组各30 例,研究组实施利奈唑胺治疗,对照组实施万古霉素治疗,比较两组治疗前临床状况、治疗效果、细菌清除情况及不良反应发生情况.结果 两组术前临床状况无统计学差异(P>0.05).研究组治疗活动总有效率高于及细菌清除率显著高于对照组(P<0.05),研究组不良反应发生率显著更低(P<0.05).结论 利奈唑胺与万古霉素在老年感染性心内膜炎病患治疗活动中都能够取得良好的治疗效果,相较于万古霉素而言,利奈唑胺在整体疗效及细菌清除效果方面的优势更明显,且用药后相关不良反应少,有较好的安全性.

Abstract The relationship between weight-adjusted-waist index (WWI, a newly developed obesity index) and peripheral arterial disease (PAD) is unclear. We aimed to explore the association between WWI and the prevalence of PAD in US adults. A total of 7,344 participants (males: 50.60%; females: 49.40%) from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) were included in this study. WWI was calculated as waist circumference (WC) divided by the square root of weight. PAD was defined as an ankle-brachial index < 0.90 in either leg. The prevalence of PAD was 7.84%, which was respectively 3.72%, 7.23%, and 12.58% in WWI tertiles 1–3 (P < 0.001). WWI was positively associated with an elevated likelihood of PAD (OR = 1.25, 95% CI: 1.06–1.48), and the association was robust in stratified subgroups (all P for trend > 0.05). For male participants, there was a nearly linear relationship between WWI and PAD (OR = 1.35, 95% CI: 1.01–1.82). However, non-linear positive relationships were detected in females with an inflection point of 10.98 cm/√kg. A positive association was observed on the left of the inflection point (OR = 2.71, 95% CI: 1.27–5.78), while the association on the right was of no statistical significance (OR = 1.01, 95% CI: 0.77–1.33). In summary, WWI was significantly associated with an increased likelihood of PAD in US adults, with a differential association between males and females.

患者,女性,24岁.以"主动脉缩窄(coarctation of the aorta,CoA)术后3年,妊娠9周,发现血压高2天"为主诉而就诊.现病史:患者2018年10月5日因"活动后胸闷、气促"于在当地医院行心脏彩色多普勒超声(彩超)检查提示:先天性心脏病(congenital heart disease,CHD)(未见资料).后就诊我院,测上臂血压 188/84 mmHg(1 mmHg=0.133 kPa),下肢血压不详,查心脏彩超提示:二尖瓣前叶脱垂并重度关闭不全、CoA、动脉导管未闭(patent ductus arterio-sus,PDA)、右心室流出道狭窄、肺动脉高压(pulmo-nary arterial hypertension,PAH),后收住我院心脏大血管外科.