Background:Coronary magnetic resonance angiography (CMRA) is limited by respiratory motion artifacts, for which diaphragmatic navigation (dNAV) is commonly applied. Myocardial navigation offers a direct motion-tracking alternative, but its performance in different anatomical placements remains underexplored. This study aimed to compare the image quality and clinical feasibility of diaphragmatic and myocardial navigation approaches at 3.0 T. Methods:Thirty-three healthy volunteers underwent CMRA with four navigators: dNAV, left ventricle navigation (LvNAV), right atrial navigation (RaNAV), and apex navigation (ApNAV). Acquisition efficiency, scan duration, success rate, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were analyzed for major coronary segments: right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCX). Two observers independently scored image clarity and sharpness (4-point scale) for segments. Interobserver agreement was assessed via intra-class correlation coefficient (ICC). Results:LvNAV and RaNAV both achieved a 100% technical completion rate (30/30). This was higher than the technical completion rates for ApNAV (97%, 29/30) and dNAV (90%, 27/30), with the latter two groups experiencing failures due to navigator drift. Scan durations showed no significant differences (dNAV: 478.70±104.68 s; LvNAV: 469.62±102.64 s; P=0.332). LvNAV yielded the highest SNR and CNR (P<0.05). Proximal and mid segments of the RCA, LAD, and LCX showed comparable visualization between dNAV and LvNAV (P>0.05), whereas distal segment visibility was reduced mainly with RaNAV and ApNAV, with dNAV and LvNAV preserving better distal visualization. Coronary visualization rates differed significantly (χ2=76.563, P<0.001), with dNAV and LvNAV outperforming other techniques. Conclusions:Myocardial navigation, particularly LvNAV, yields superior image quality and visualization performance comparable to dNAV, representing a promising alternative under conditions requiring enhanced motion stability. Personalized navigator selection based on respiratory patterns may further optimize CMRA outcomes.

BACKGROUND:Left Ventricular Remodeling (LVR) in hypertension involves both structural and electrophysiological alterations. Magnetocardiography (MCG) non-invasively measures cardiac magnetic fields, potentially reflecting these changes. This study aimed to explore the association between MCG parameters and established Echocardiographic (ECHO) indices of concentric left ventricular remodeling in hypertensive patients. METHODS:In this cross-sectional study, 220 hypertensive patients underwent both ECHO and 9-channel MCG. Patients were categorized based on ECHO into Non-LVR (n = 105) and concentric remodeling groups (n = 115). Fifteen MCG parameters derived from the QRS complex and R-wave were analyzed. Correlations between MCG and ECHO parameters (Left Ventricular Mass Index [LVMI], Interventricular Septal thickness [IVSd], Left Ventricular Posterior Wall thickness [LVPWd], Relative Wall Thickness [RWT]) were assessed. A multivariate associative model combining selected MCG parameters was developed in a 70% subset (n = 154), and its association with ECHO-defined concentric structural phenotype was tested in a separate 30% validation subset (n = 66). RESULTS:After rigorous correction for multiple testing, several MCG parameters demonstrated statistically significant correlations with specific ECHO indices. The maximum current moment of the QRS complex (QRS_MCM) showed positive correlations with IVSd (r = 0.388, p < 0.00083), LVPWd (r = 0.333, p < 0.00083), and RWT (r = 0.392, p < 0.00083). The relative timing parameters QRS_CA ratio and QRS_FMA ratio exhibited significant positive correlations with both IVSd and RWT (r = 0.299-0.339, all p < 0.00083). Patients in the ECHO-defined concentric remodeling group exhibited a distinct MCG profile characterized by increased current moments, altered current angles, and higher depolarization timing ratios compared to the Non-LVR group. The multivariate associative model, incorporating QRS_MCM, R_CA, QRS_CA ratio, and QRS_FMA ratio, showed a strong association with concentric structural phenotype in the development set (AUC = 0.887, 95% CI 0.832-0.942). Critically, this association remained robust and significant when the model was applied to the independent validation set (AUC = 0.856, 95% CI 0.763-0.948). The internal validation confirmed the stability of this associative pattern, though the model is not intended for clinical diagnostic use. CONCLUSION:Specific magnetocardiographic parameters, particularly those reflecting the global strength of ventricular depolarization (QRS_MCM) and the relative timing of electrical events within the cardiac cycle, are significantly and robustly associated with echocardiographic indices of concentric left ventricular remodeling in hypertension. These cross-sectional findings establish a measurable link between MCG-based electrophysiological features and concentric structural alterations in hypertensive patients. Further prospective studies are needed to explore the temporal relationship between electrical and structural remodeling and to determine whether MCG offers insights beyond those obtainable from simpler, more widely available tools such as the ECG.

BACKGROUND:MicroRNAs (miRNAs) are closely related to cardiovascular diseases, including chronic heart failure (CHF). Endothelial dysfunction can lead to heart failure. The purpose of this study was to evaluate the clinical significance of miR-1285-3p in CHF patients, with the aim of identifying a novel and effective biomarker for CHF. At the same time, we investigated the effect of miR-1285-3p on vascular endothelial cells. METHODS:Total RNA was extracted from plasma samples of 106 CHF patients and 106 healthy individuals. Quantitative Real-time PCR (qRT-PCR) was used to detect the expression of miR-1285-3p. The diagnostic accuracy of miR-1285-3p was tested by receiver operating characteristic (ROC) curve. Evaluated the related risk factors of CHF using logistic analysis. The proliferation and apoptosis of human umbilical vein endothelial cells (HUVECs) were detected by transfecting miR-1285-3p mimic or miR-1285-3p inhibitor in vitro using CCK8 and flow cytometry. Effect of miR-1285-3p on the angiogenesis of HUVECs were detected by in vitro angiogenesis assay. RESULTS:miR-1285-3p is upregulated in CHF patients, demonstrating the ability to distinguish CHF patients from healthy individuals, with high sensitivity (83.0%) and specificity (93.4%). In vitro experiments revealed that transfection of miR-1285-3p mimic inhibited endothelial cell proliferation, accelerated apoptosis, and inhibited endothelial cell angiogenesis, which was reversed by transfection with miR-1285-3p inhibitor. CONCLUSION:miR-1285-3p is upregulated in CHF and may serve as a new effective biomarker for CHF diagnosis, which can inhibit HUVECs angiogenesis.

Early detection of coronary microvascular dysfunction (CMD) in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), is challenging. The index of microcirculatory resistance (caIMR), derived from computational pressure-fluid dynamics (CPFD), allows practical assessment of CMD using only routine coronary angiography. However, the prognostic implications of combining caIMR with microvascular obstruction (MVO) identified through cardiac magnetic resonance (CMR) imaging are unclear. This retrospective study investigates the utility of CPFD-caIMR and CMR-derived MVO in predicting major adverse cardiovascular events (MACEs) in 292 STEMI patients who underwent primary PCI, followed by caIMR and CMR evaluations. Patients were stratified into four groups based on caIMR thresholds (≤ 40 U or > 40 U) and the presence/absence of MVO. The primary endpoint was MACEs, defined as cardiac death, recurrent myocardial infarction, target vessel revascularization, or heart failure readmission. Overall, 101/292 patient exhibited discordant caIMR and MVO results. Specifically, 103 patients had caIMR ≤ 40 U without MVO, while 88 patients showed caIMR > 40 U with MVO. Multivariate analysis identified both caIMR > 40 U and MVO as independent predictors of MACEs, with an HR of 3.572 for each unit increase in CPFD-caIMR > 40 U. Combination of CPFD-caIMR and MVO significantly enhanced predictive accuracy. CPFD-caIMR is a reliable, minimally invasive tool for identifying microvascular dysfunction. Combination with CMR-derived MVO improves risk stratification in STEMI patients following PCI, holding promise for the early identification of high-risk patients, enabling targeted and personalized management.

MicroRNAs (miRNAs) are closely related to cardiovascular diseases, including chronic heart failure (CHF). Endothelial dysfunction can lead to heart failure. The purpose of this study was to evaluate the clinical significance of miR-1285-3p in CHF patients, with the aim of identifying a novel and effective biomarker for CHF. At the same time, we investigated the effect of miR-1285-3p on vascular endothelial cells. Total RNA was extracted from plasma samples of 106 CHF patients and 106 healthy individuals. Quantitative Real-time PCR (qRT-PCR) was used to detect the expression of miR-1285-3p. The diagnostic accuracy of miR-1285-3p was tested by receiver operating characteristic (ROC) curve. Evaluated the related risk factors of CHF using logistic analysis. The proliferation and apoptosis of human umbilical vein endothelial cells (HUVECs) were detected by transfecting miR-1285-3p mimic or miR-1285-3p inhibitor in vitro using CCK8 and flow cytometry. Effect of miR-1285-3p on the angiogenesis of HUVECs were detected by in vitro angiogenesis assay. miR-1285-3p is upregulated in CHF patients, demonstrating the ability to distinguish CHF patients from healthy individuals, with high sensitivity (83.0

ObjectiveThis research is to analyze the connection between NHHR and CKD occurrence using NHANES from 2001 to 2018. It will evaluate the feasibility of NHHR as a tool for predicting CKM syndrome and offer valuable insights for personalized treatment approaches within the U.S. population.MethodsData from 16,575 individuals aged 20 to 69 years were analyzed, having excluded those who were pregnant and individuals with incomplete data. CKM syndrome was characterized by the simultaneous presence of CKD and Cardiometabolic Syndrome (CMS). For the statistical analysis, weighted logistic regression models were applied, accounting for variables such as age, gender, ethnicity, educational background, marital status, lifestyle factors, and preexisting health conditions. Differently, restricted cubic splines (RCS) were applied to investigate any possible nonlinear relationships between NHHR and CKM in the study.ResultsThe research revealed that the occurrence of CKM syndrome was more prevalent among individuals aged 60 and older, with women representing 55.36% of those affected. Additionally, NHHR levels were notably elevated in CKM patients when compared to those without CKM (p < 0.0001). As NHHR increased, the prevalence of CKM also rose, with the highest prevalence in the highest NHHR quartile (Q4: 36.06%). A positive connection between NHHR and CKM was indicated by multivariable logistic regression, especially in the upper quartiles of NHHR (Q3 and Q4). Moreover, RCS analysis displayed a noteworthy nonlinear connection between NHHR and CKM occurrence. The subgroup analysis uncovered significant interactions influenced by BMI and Hypertension.ConclusionWith the rising global prevalence of CKM syndrome, early identification of high-risk individuals using NHHR could inform targeted prevention and intervention strategies. Future research should focus on validating NHHR in diverse populations and exploring its clinical utility, as well as examining its relationship with other biomarkers of metabolic dysfunction to better understand CKM syndrome’s complex pathophysiology.

Epicardial adipose tissue (EAT) is associated with microvascular obstruction (MVO). However, its association with new-onset atrial arrhythmias after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is unclear. We investigated the correlation of cardiac magnetic resonance (CMR)-measured EAT with MVO and its effect on new-onset atrial arrhythmias after PCI in patients with STEMI. This study employed a single-centre retrospective design. Patients diagnosed with STEMI who underwent CMR after PCI between January 2019 and January 2023 were consecutively included and followed-up regularly. Participants were categorised based on whether they developed new-onset atrial arrhythmia after PCI. In comparison to the non-arrhythmia group, the atrial arrhythmia group exhibited higher values for age, heart rate, peak hs-TnT, peak NT-proBNP, EATV, LAES, LAED, and MVO, alongside reduced LVEF. A positive association was identified between EATV and MVO. Univariate analysis using logistic regression revealed that age, heart rate, hs-TnT level, NT-proBNP level, LVEF, EATV, LAES, LAED, and MVO were significant risk factors for atrial arrhythmia. Multivariate logistic regression analysis further identified age, LAES, EATV, and MVO as independent predictors of atrial arrhythmia. ROC curve analysis produced AUC values of 0.690 for age, 0.584 for LAES, 0.607 for MVO, and 0.769 for EATV. The EATV demonstrated a strong positive relationship with MVO after PCI in patients with STEMI. Age, LAES, EATV, and MVO were independent predictors of new-onset atrial arrhythmias and exhibited substantial prognostic significance.

Intramyocardial hemorrhage (IMH) after ST-segment elevation myocardial infarction (STEMI) reperfusion increases the risk of major adverse cardiovascular events (MACE). We aimed to integrate a coronary angiography-derived index of microcirculatory resistance (caIMR) with clinical features in a nomogram model for predicting IMH in patients with STEMI following primary percutaneous coronary intervention (PCI). A retrospective study included 309 STEMI patients admitted at Xuzhou Medical University for primary PCI from 2022 to 2023 in training and validation cohorts. Their caIMR was calculated from coronary angiography images and IMH was assessed by cardiac Magnetic Resonance (CMR). A nomogram was constructed through logistic regression analyses. Predictive accuracy, calibration, and clinical usefulness were validated by an area under the curve (AUC) of the receiver operating characteristic (ROC) curve, calibration curves, and decision curve analysis (DCA), respectively. All statistical tests were two-sided. A total of 247 patients were assigned to the training cohort and 62 to the validation cohort randomly. A nomogram was established using two independent predictors of IMH derived from multivariable analysis: caIMR and left ventricular ejection fraction (LVEF). The AUC for the nomogram was 0.844 (95

BACKGROUND The COVID-19 pandemic accelerated the adoption of home-based cardiac telerehabilitation (HBCTR), yet evidence on the role of intensified self-management in outcomes for acute coronary syndrome (ACS) patients remains limited. MATERIAL AND METHODS In this single-center retrospective cohort study (2019-2021), 1627 ACS patients were stratified into 2 groups: those who finished a self-management-centric HBCTR (SMCCRF) plan, and the SMCCR-unfinished (SMCCRNF) group (≥1 missed tele-coaching sessions). The primary outcome was major adverse cardiac events (MACEs); secondary outcomes included self-perceived disease awareness assessed by the Coronary Artery Disease Education Questionnaire-Short Version (CADEQ-SV), behavioral metrics (medication adherence, physical exercise), and risk factor control. Propensity score matching (1: 1, calliper=0.1 standard deviation) generated 619 matched pairs. RESULTS Over a median follow-up of 23.39 months, the SMCCRF group had lower MACEs rates compared to the SMCCRNF group (7.43% vs 18.74%; HR 0.43, 95% CI 0.30-0.60; P<0.001), with consistent benefits across subgroups. Secondary outcomes favored the SMCCRF group, including higher CADEQ-SV scores at 12 and 36 months (P=0.02), better medication and exercise adherence (both P<0.001), and improved control of blood pressure, low-density lipoprotein cholesterol, and smoking cessation (all P<0.01). However, changes in cardiac function were similar between the 2 groups, and fluctuations of the aforementioned secondary outcomes were observed during long-term follow-up. CONCLUSIONS SMCCR was associated with reduced cardiovascular risk and enhanced behavioral outcomes in ACS patients during the pandemic, suggesting a dose-dependent relationship between missed sessions and adverse outcomes. The findings support integrating self-management strategies into post-ACS care, pending validation in prospective trials.

Objective The aim of this study is to develop a nomogram model for predicting the occurrence of intramyocardial hemorrhage (IMH) in patients with Acute Myocardial Infarction (AMI) following Percutaneous Coronary Intervention (PCI). The model is constructed utilizing clinical data and the SYNTAX Score (SS), and its predictive value is thoroughly evaluated. Methods A retrospective study was conducted, including 216 patients with AMI who underwent Cardiac Magnetic Resonance (CMR) within a week post-PCI. Clinical data were collected for all patients, and their SS were calculated based on coronary angiography results. Based on the presence or absence of IMH as indicated by CMR, patients were categorized into two groups: the IMH group (109 patients) and the non-IMH group (107 patients). The patients were randomly divided in a 7:3 ratio into a training set (151 patients) and a validation set (65 patients). A nomogram model was constructed using univariate and multivariate logistic regression analyses. The predictive capability of the model was assessed using Receiver Operating Characteristic (ROC) curve analysis, comparing the predictive value based on the area under the ROC curve (AUC). Results In the training set, IMH post-PCI was observed in 78 AMI patients on CMR, while 73 did not show IMH. Variables with a significance level of P < 0.05 were screened using univariate logistic regression analysis. Twelve indicators were selected for multivariate logistic regression analysis: heart rate, diastolic blood pressure, ST segment elevation on electrocardiogram, culprit vessel, symptom onset to reperfusion time, C-reactive protein, aspartate aminotransferase, lactate dehydrogenase, creatine kinase, creatine kinase-MB, high-sensitivity troponin T (HS-TnT), and SYNTAX Score. Based on multivariate logistic regression results, two independent predictive factors were identified: HS-TnT (Odds Ratio [OR] = 1.61, 95% Confidence Interval [CI]: 1.21–2.25, P = 0.003) and SS (OR = 2.54, 95% CI: 1.42–4.90, P = 0.003). Consequently, a nomogram model was constructed based on these findings. The AUC of the nomogram model in the training set was 0.893 (95% CI: 0.840–0.946), and in the validation set, it was 0.910 (95% CI: 0.823–0.970). Good consistency and accuracy of the model were demonstrated by calibration and decision curve analysis. Conclusion The nomogram model, constructed utilizing HS-TnT and SS, demonstrates accurate predictive capability for the risk of IMH post-PCI in patients with AMI. This model offers significant guidance and theoretical support for the clinical diagnosis and treatment of these patients.

To investigate the impacts of circ_0069094 on acute coronary syndrome. Real-time polymerase chain reaction was used to detect the expression levels of circ_0069094, and its diagnostic performance was evaluated using ROC curve. Spearman's method was performed for correlation analysis. The levels of SOD, MDA, vWF in ACS rat models were assessed by commercial kits. The activities of H/R cell models were detected by CCK-8, Transwell, flow cytometry. The GO and KEGG were performed to analyze the function of targeted genes of miR-484. The concentration of circ_0069094 was decreased in patients with ACS, ACS rat models and H/R HUVEC models. The dysfunction of SOD, MDA, vWF, LVIDs, LVDD, and LVEF in the ACS models was regulated by the increase of circ_0069094. The viability, migration, apoptosis of the H/R models were regulated by circ_0069094. MiR-484 was a ceRNA of circ_0069094 and mediated the function of circ_0069094.

Background: The computational pressure-fluid dynamics applied to index of microcirculatory resistance, derived from coronary angiography (CPFD-caIMR) is a promising alternative method of IMR to evaluate the prognosis of STEMI patients. This study aim to evaluate the incremental value CPFD-caIMR and MVO in predicting MACE after patients with undergoing primary percutaneous coronary PPCI. Methods: A total of 292 patients who met the inclusion criteria were selected retrospectively from 1107 STEMI patients from January 2019 to January 2021 in Affiliated Hospital of Xuzhou Medical University in China. All patients with STEMI underwent CPFD-caIMR and MVO assessment. The patients were categorized into four groups based on CPFD-caIMR and MVO presence: 1) CPFD-caIMR ≤40U without MVO; 2) CPFD-caIMR >40U without MVO; 3) CPFD-caIMR ≤40U with MVO; and 4) CPFD-caIMR >40U with MVO. The primary endpoint of the study was MACE, defined as cardiovascular or all-cause deaths, non-fatal MI, revascularization including target vessel reconstruction, heart failure readmission. Results: Within the included 292 patients, a notable proportion of 101 cases (34.6%) revealed discrepancies between CPFD-caIMR and MVO. Among these, 103 patients (35.3%) exhibited CPFD-caIMR values of ≤40 without MVO, while 88 patients (30.1%) displayed CPFD-caIMR values of >40 with MVO on CMR. Both MVO (HR: 2.750, p=0.033) and CPFD-IMR>40U (HR: 3.572, p=0.001]) were predictors of MACE over 12 months. Specifically, for every 1-unit increase in CPFD-IMR>40U, MACE increased by 3.572 units. Furthermore, ROC curve analysis demonstrated that CPFD-caIMR>40U (AUC, 0.724, p＜0.001) and MVO (AUC, 0.667, p=0.001) were effective in predicting MACE. Notably, combined CPFD-caIMR and MVO increased the area under the curve for MACE to 0.820, p<0.001). Over 12 month of follow-up, Group 4 (HR: 8.765, p <0.001) but not Group 3 (HR: 3.474, p=0.029), Group 2(HR:3.554, p=0.045) had worse clinical outcomes compared with those with no significant CMD in Group 1. Conclusion: CPFD-caIMR is a novel method for noninvasive detection of microvascular reperfusion failure, and CPFD-caIMR > 40U can predict the prognosis of STEMI patients.When combined with CMR, CPFD-caIMR > 40U can be used to further stratify the risk of STEMI and to identify high-risk patients who may require more aggressive treatment during follow-up.

目的 通过与冠状动脉造影(CAG)比较,应用血管内超声(IVUS)评价StentViz技术在冠状动脉(冠脉)弥漫性长病变支架植入术中的应用价值.方法 纳入2019年11月1日至2020年12月31日于徐州医科大学附属医院经CAG检查证实冠脉弥漫性长病变患者50例为研究对象,随机分为CAG组(n=25)和StentViz组(n=25).术前使用定量冠脉造影(QCA)对两组CAG相关指标(最小管腔直径、参考血管直径、直径狭窄率)进行测量并比较其差异性;在第1枚支架释放后,CAG组和StentViz组分别在常规CAG和StentViz实时指导下定位串联的支架,由同一位介入医师评估到位满意后,释放支架,选择合适的后扩球囊及压力后扩张支架.术后使用QCA对两组的相关指标(最小支架直径、最大支架直径、平均支架直径)进行测量并比较其差异性;术后两组均行IVUS检查测量串联支架重叠部分的长度、支架的最小、最大直径,比较两组在支架的定位(支架串联重叠部分的长度)及扩张性(支架的扩张指数)的差异性.结果 术前经QCA测量,StentViz组和CAC组在最小管腔直径、参考血管直径、直径狭窄率上均无统计学差异(P＞0.05),术后经QCA测量,StentViz组和CAG组在最小支架直径、最大支架直径、平均支架直径上均无统计学差异(P＞0.05),术后经IVUS测量,在两组的最小支架直径、最大支架直径和平均直径无统计学差异的前提下(P＞0.05),StentViz组的支架偏心指数小于CAG组[(0.16±0.08)vs.(0.22±0.09),P=0.027],StentViz组的支架扩张指数大于CAG组[(0.84±0.08)vs.(0.78±0.09),P=0.027],StentViz组支架扩张优于CAG组.StentViz组串联支架重叠部分长度明显小于CAG组[(1.22±0.32)mm vs.(2.20±0.37)mm,P=0.001].结论 与常规CAG指导冠脉长病变支架植入相比,StentViz可更加清晰的显示支架影,有效指导支架的定位及扩张.

Objective:To investigate the clinical application value of left ventricular myocardial strain obtained by cardiac MR (CMR) in recent major adverse cardiovascular events (MACE) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).Methods:From January 2020 to December 2020, a total of 163 patients successfully underwent primary PCI and underwent CMR examination within one week after surgery at Affiliated Hospital of Xuzhou Medical University. The scan sequences included rapid balance-fast field echo and late-gadolinium enhancement. CVI42 post-processing software was used to analyze and measure the left ventricular myocardial strain indices, including left ventricular global longitudinal strain (GLS), left ventricular global circumferential strain (GCS), and left ventricular global radial strain (GRS). According to the results of the 1-year follow-up after surgery, the patients were divided into the MACE group ( n=28) and the non-MACE group ( n=135). For continuous variables with a normal distribution, the t test of two independent samples was used for comparisons between groups. For continuous variables with an abnormal distribution, the variables were compared and analyzed by the rank sum test. For categorical variables, the χ 2 tests were used for between-group comparisons. Cox regression was used to analyze the prognostic value of myocardial strain on the development of MACE in patients with STEMI. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of myocardial strain parameters, and the optimal cut-off value was evaluated by calculating the Youden index. Results:The GLS, GCS, and GRS of the MACE group were (-10.4±3.3)%, [-11.9 (-14.5, -9.3)]%, and (18.3±6.3)%, respectively, and those of the non-MACE group were (-13.7±3.4)%, [-14.6 (-16.4, -11.7)]%, and (22.3±6.1)%, respectively. The difference between the two groups was statistically significant ( t/ Z=-4.71, -3.04, 3.21, P<0.05). Multivariate Cox regression analysis showed that GLS was an independent predictor of MACE (HR=1.546, 95%CI 1.180-2.027, P=0.002). The ROC curve analysis showed that GLS had the largest area under the curve (AUC) (AUC=0.754, 95%CI 0.658-0.851, P<0.001), with a cut-off value of -12.45%. Its diagnostic sensitivity was 71.4%, and the specificity was 67.4%. The value was better than that of the traditional predictor of STEMI prognosis, namely, left ventricular ejection fraction (AUC=0.680, 95%CI 0.567-0.793, P=0.003). Conclusion:GLS of CMR is an independent predictor of MACE in STEMI patients undergoing primary PCI.

Objective:To explore the predictive value of systemic immune-inflammation index (SII) and small and dense low-density lipoprotein-cholesterol (sdLDL-C) on contrast-induced acute kidney injury (CI-AKI) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI).Methods:This retrospective analysis included 674 STEMI patients who underwent emergency PCI in Affiliated Hospital of Xuzhou Medical University from November 2019 to October 2021, all patients were divided into a training cohort ( n=450) and validation cohort ( n=224) at a ratio of 2∶1 according to the chronological sequence. The patients in the training cohort were further divided into CI-AKI group ( n=92) and non-CI-AKI group ( n=358). Information at admission and emergency blood biochemical indexes were collected, and the SII was calculated. Multifactorial logistic regression analysis was used to explore the independent factors influencing the occurrence of CI-AKI in STEMI patients undergoing emergency PCI in the training cohort and a predictive model was established. Receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test were used to evaluate the model discrimination and calibration. Results:The prevalence of CI-AKI was 20.4% (92/450). Age, proportion of women, sdLDL-C, urea, baseline creatinine, uric acid, neutrophil count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and SII were significantly higher in the CI-AKI group than in the non-CI-AKI group (all P<0.05), and left ventricular ejection fraction (LVEF), high-density lipoprotein cholesterol, estimated glomerular filtration rate (eGFR) and lymphocyte count were significantly lower in the CI-AKI group than in the non-CI-AKI group (all P<0.05). The results of multifactorial logistic regression analysis showed that age ( OR=1.046, P=0.001), LVEF ( OR=0.916, P<0.001), sdLDL-C ( OR=4.754, P<0.001), uric acid ( OR=1.012, P=0.007), eGFR ( OR=0.994, P=0.002), and lnSII ( OR=2.471, P<0.001) were independent determinants of CI-AKI after emergency PCI in STEMI patients. ROC curve analysis showed that area under the curve (AUC) for the diagnosis of CI-AKI was 0.688 with a sensitivity of 73.9% and specificity of 61.5% for the SII cut-off point of 1 179.07×10 9/L. The AUC for the diagnosis of CI-AKI was 0.709 with a sensitivity of 65.2% and specificity of 77.4% for the sdLDL-C cut-off point of 1.147 mmol/L. The AUC for the diagnosis of CI-AKI was 0.847 with a sensitivity of 88.0% and a specificity of 70.6% for the combination of SII and sdLDL-C with age, LVEF, uric acid and eGFR. The Hosmer-Lemeshow test (χ2=6.913, P=0.546) proved the goodness of fit of the model. Conclusions:SII and sdLDL-C have significant clinical value in the prediction of CI-AKI. SII and sdLDL-C combined with age, LVEF, uric acid and eGFR could further improve the predictive efficacy of CI-AKI.

Background: The impairment of microvascular injury on prognosis has increasingly drawn extensive awareness along with the high morbidity and mortality of ST-segment elevation myocardial infarction (STEMI) over recent years. The prognostic significance of computational pressure-fluid dynamics applied to index of microcirculatory resistance, derived from coronary angiography (CPFD-caIMR) in microvascular injury evaluation of STEMI patients remained inconclusive.Methods: A total of 213 patients who met the inclusion criteria were selected retrospectively from 1003 STEMI patients from February 2018 to February 2020. Propensity score matching (PSM) was thereafter finished. CPFD-caIMR of all patients was obtained off-line using the software (FlashAngio, Rainmed Ltd., Suzhou, China) after PPCI. The primary endpoint was to compare the CPFD-caIMR and the incidence of major adverse cardiovascular events (MACEs) between drug-coated balloons (DCB) and drug-eluting stents (DES) groups. The correlation between CPFD-caIMR and MACEs was analyzed, and the prognosis of patients with STEMI was evaluated by CPFD-caIMR by multivariate regression analysis.Results: Totally 213 STEMI patients with successful primary percutaneous coronary intervention (PPCI) were included, of whom 84 patients accepted DCB and 129 patients accepted DES respectively. Baseline characteristics and CPFD-caIMR were comparable between DCB and DES groups after PSM (62 patients in each group). CPFD-caIMR was not significantly different between two groups (DES vs. DCB: mean difference: 2.26, 95% CI -4.05 to 8.57, p = 0.45), and so was it when re-grouped by whether CPFD-caIMR > 40U or not (DES vs. DCB: 34.17% vs. 27.16%, p = 0.29). After a follow-up of 1 year, more MACEs occurred in DES group than DCB group (relative risk: 2.50, 95% CI 1.04 to 6.02, p = 0.04). The predictors of MACEs by multi-variate analysis found that, only time from symptom to balloon (p = 0.03) and time from door to balloon (p < 0.01) were independent predictors of MACEs, independent of treatment with DCB or DES intervention. Furthermore, CPFD-caIMR > 40U became an independent predictor of the combined events including cardiovascular deaths or heart failure readmission irrespective of PSM (odds ratio: 4.07, 95% CI: 1.06 to 7.66, p = 0.04).Conclusion: CPFD-caIMR was a promising method for prognosis, which can predict CV death or heart failure readmission in STEMI patients. DCB was a possible strategy in PPCI of STEMI patients, not inferior to DES based on microvascular injury evaluated by CPFD-caIMR.

Aim: To investigate the relationship between the incidence of contrast-induced acute kidney injury (CI-AKI) and the level of small dense low-density lipoprotein (sd-LDL) and systemic immune-inflammation index (SII) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI), and to further compare the predictive values of SII, sd-LDL and their combination for CI-AKI. Methods: A total of 674 patients were assigned to a training and a validation cohort according to their chronological sequence. The baseline characteristics of the 450 patients in the training cohort were considered as candidate univariate predictors of CI-AKI. Multivariate logistic regression was then used to identify predictors of CI-AKI and develop a prediction model. The predictive values of SII, sd-LDL and their combination for CI-AKI were also evaluated. Results: Multivariate logistic regression analysis showed that age, left ventricular ejection fraction (LVEF), sd-LDL, uric acid, estimated glomerular filtration rate (eGFR) and SII were predictors of CI-AKI. The area under the curve (AUC) of the prediction model based on the above factors was 0.846 [95% confidence interval (CI) 0.808–0.884], and the Hosmer-Lemeshow test (P = 0.587, χ2 = 6.543) proved the goodness of fit of the model. The AUC combining SII with sd-LDL to predict CI-AKI was 0.785 (95% CI 0.735–0.836), with a sensitivity of 72.8% and a specificity of 79.8%, and was statistically significant when compared with SII and sd-LDL, respectively. The predictive efficiency of combining SII with sd-LDL and SII were evaluated by improved net reclassification improvement (NRI, 0.325, P < 0.001) and integrated discrimination improvement (IDI, 0.07, P < 0.001). Conclusions: Both SII and sd-LDL can be used as predictors of CI-AKI in STEMI patients undergoing emergency PCI, and their combination can provide more useful value for early assessment of CI-AKI.

目的 以血管内超声(IVUS)为"金标准",评估冠状动脉CT血管造影(CCTA)对经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的检测准确性.方法 回顾性收集同时期(4周内)行CCTA和IVUS检查的PCI术后患者的基本资料和影像学资料,共纳入60例患者的80处目标血管(血管内置入支架).根据患者置入支架内径将纳入病变分为A组(内径＞3.0 mm)和B组(内径≤3.0 mm),并根据病变所在节段(支架内部或支架边缘5 mm内)将A组/B组分为A1组/B1组(支架内部病变)和A2组/B2组(边缘病变),A1组加B1组为1组,A2组加B2组为2组.以IVUS判读结果为"金标准",评估CCTA对支架内病变的定量检测结果和对不同内径、不同节段ISR的诊断准确性.结果 CCTA对支架内病变的定量检测结果(最小管腔内径、平均血管内径、最小管腔面积、斑块面积、斑块长度、外弹力膜面积、斑块负荷和斑块体积)与IVUS定量检测结果呈显著正相关(P＜0.001).CCTA识别A组(n=41)ISR的特异性(92.86％)、灵敏性(92.59％)、准确性(92.68％)均较高,与IVUS结果一致性较好(Kappa=0.840,P＜0.001);CCTA识别B组(r=39)ISR的特异性(88.24％)、灵敏性(86.36％)、准确性(87.18％)低于A组,与IVUS结果一致性一般(Kappa=0.741,P＜0.001).CCTA对A组、B组的识别结果比较,差异无统计学意义(P=0.523);CCTA对1组、2组的识别结果比较,差异无统计学意义(P=0.212);CCTA对A2组、B2组的识别结果比较,差异无统计学意义(P=0.484);CCTA对A1组、B1组的识别结果比较,差异有统计学意义(P=0.011).结论 CCTA对ISR的定量检测结果准确性较好,识别内径＞3.0 mm的支架内部ISR和不同内径支架边缘ISR的结果可信度较高,但对内径≤3.0 mm的内部支架ISR的诊断结果不准确.

目的 探讨冠状动脉造影血流储备分数(caFFR)、冠状动脉造影微循环阻力指数(caIMR)对急性心肌梗死(AMI)患者药物球囊治疗预后的评估价值.方法 225例接受药物球囊治疗的AMI患者,均行冠状动脉造影,通过软件分析获得caFFR、caIMR.根据caFFR、caIMR将患者分为caFFR正常组179例、caFFR异常组46例,caIMR正常组187例、caIMR异常组38例.对患者进行为期1～5年的随访,记录患者随访期间终点事件发生情况.用受试者工作特征曲线评价caFFR、caIMR对AMI患者药物球囊治疗预后的评估效能.结果 随访期间患者终点事件发生率为13.78％.caFFR、caIMR异常组终点事件发生率(34.78％、55.26％)均高于caFFR、caIMR正常组(8.38％、5.35％),比较差异有统计学意义(P均<0.05).发生终点事件患者caFFR低于未发生终点事件患者,caIMR高于未发生终点事件患者(P均<0.05).caFFR、caIMR联合预测AMI患者药物球囊治疗后5年内终点事件的灵敏度、特异度分别为95.13％、92.66％,曲线下面积为0.853,高于二者单独预测的曲线下面积(0.690、0.750).结论 caFFR、caIMR联合检测对AMI患者药物球囊治疗预后有一定评估价值.

目的 探讨外周血中性粒细胞与淋巴细胞比值(NLR)和单核细胞与高密度脂蛋白比值(MHR)与青年急性非ST段抬高型心肌梗死(NSTEMI)患者中罪犯血管是否闭塞的相关性.方法 2018年8月至2020年12月徐州医科大学附属医院收治的青年NSTEMI患者36例,根据冠脉造影结果将其分为罪犯血管闭塞组和非闭塞组.比较两组一般临床资料、合并症及化验检查结果,分析两组患者的NLR和MNR与冠脉罪犯血管是否闭塞的相关性.结果 闭塞组中性粒细胞计数、单核细胞计数、胆固醇(TC)、肌钙蛋白(TNT)、NLR、MHR显著高于未闭塞组(P<0.05).多元线性回归分析显示,高水平NLR与MHR是罪犯血管闭塞的危险因素.结论 外周血NLR和MHR对预测青年NSTEMI患者中罪犯血管是否闭塞有一定价值.