Atherogenic index of plasma (AIP) has been recommended as a marker of plasma atherogenicity. The impact of AIP on plaque characteristics is not fully understood. The study investigates the relationship between AIP and coronary plaque features in patients with acute coronary syndrome (ACS). From January 2016 to June 2017 pre-intervention optical coherence tomography (OCT) was performed in 522 ACS patients. AIP was defined as the base 10 logarithm of the ratio of the concentrations of triglyceride to high-density lipoprotein cholesterol. Patients were divided into four groups according to AIP quartiles. A total of 332 patients were included for the analysis. The prevalence of thin-cap fibroatheroma (TCFA) (group I [lowest] 9.09

Introduction: Previous studies have suggested a correlation between hearing loss (HL) and cortical alterations, but the specific brain regions that may be affected are unknown. Methods: Genome-wide association study (GWAS) data for 3 subtypes of HL phenotypes, sensorineural hearing loss (SNHL), conductive hearing loss, and mixed hearing loss, were selected as exposures, and GWAS data for brain structure-related traits were selected as outcomes. The inverse variance weighted method was used as the main estimation method. Results: Negative associations were identified between genetically predicted SNHL and brain morphometric indicators (cortical surface area, cortical thickness, or volume of subcortical structures) in specific brain regions, including the bankssts (beta=-0.006 mm, P=0.016), entorhinal cortex (beta=-4.856 mm(2), P=0.029), and hippocampus (beta=-24.819 cm(3), P=0.045), as well as in brain regions functionally associated with visual perception, including the pericalcarine (beta=-10.009 cm(3), P=0.013). Conclusion: Adaptive changes and functional remodeling of brain structures occur in patients with genetically predicted HL. Brain regions functionally associated with auditory perception, visual perception, and memory function are the main brain regions vulnerable in HL.

Aims: To perform an updated systematic review and meta-analysis of postoperative delirium (POD) after transcatheter aortic valve replacement (TAVR). Methods: We conducted a systematic literature search of PubMed, Embase, and Cochrane Library databases from the time of the first human TAVR procedure in 2002 until December 24, 2021, which was supplemented by manual searches of bibliographies. Data were collected on incidence rates, risk factors, and/or associated mortality of POD after TAVR. Pooled analyses were conducted using random effects models to yield mean differences, odds ratios, hazard ratios, and risk ratios, with 95% confidence intervals. Results: A total of 70 articles (69 studies) comprising 413,389 patients were included. The study heterogeneity was substantial. The pooled mean incidence of POD after TAVR in all included studies was 9.8% (95% CI: 8.7%-11.0%), whereas that in studies using validated tools to assess for delirium at least once a day for at least 2 consecutive days after TAVR was 20.7% (95% CI: 17.8%-23.7%). According to the level of evidence and results of meta-analysis, independent preoperative risk factors with a high level of evidence included increased age, male sex, prior stroke or transient ischemic attack, atrial fibrillation/flutter, weight loss, electrolyte abnormality, and impaired Instrumental Activities of Daily Living; intraoperative risk factors included non-transfemoral access and general anesthesia; and acute kidney injury was a postoperative risk factor. POD after TAVR was associated with significantly increased mortality (pooled unadjusted RR: 2.20, 95% CI: 1.79-2.71; pooled adjusted RR: 1.62, 95% CI: 1.25-2.10), particularly long-term mortality (pooled unadjusted HR: 2.84, 95% CI: 1.91-4.23; pooled adjusted HR: 1.88, 95% CI: 1.30-2.73). Conclusions: POD after TAVR is common and is associated with an increased risk of mortality. Accurate identification of risk factors for POD after TAVR and implementation of preventive measures are critical to improve prognosis.

Elevation in mitral valve pressure gradient (MVPG) after mitral valve transcatheter edge-to-edge repair (M-TEER) is common, however, evidence on its prognosis is scarce and debatable. Thus, this study aims to investigate the impact of increased MVPG after M-TEER on outcomes. Studies reporting the associations between the elevated MVPG after M-TEER and outcomes were identified in a systematic search of published literatures. Associations were pooled by meta-analysis using a random-effects model. The primary outcome was the composite of all-cause mortality and heart failure (HF) hospitalization. Seven observational studies with 2,730 patients (mean age, 77.7 ± 9.3 years; male, 64.4%; functional mitral regurgitation [MR], 65.2%) were eligible for the present analysis. M-TEER was performed entirely using the MitraClip system (Abbott), followed by 29.7% of patients having increased MVPG. Elevated postprocedural MVPG was not associated with a higher risk of the primary outcome, compared to low MVPG [hazard ratio (HR) = 1.22; 95% confidence interval (CI) 0.95-1.58; p = 0.12; I2 = 53.5%). However, the prognosis of elevated MVPG was observed in degenerative MR patients (HR = 1.37; 95% CI 1.03-1.84; p = 0.03; I2 = 0%), whereas not in functional MR patients. Patients with low MVPG + high residual MR had a higher risk of the primary outcome than those with high MVPG + low residual MR after M-TEER (HR = 1.50; 95% CI 1.10-2.03; p = 0.01; I2 = 13%). In conclusion, elevated MVPG seems to predict adverse outcomes mainly in patients with degenerative MR. Future studies are needed to prove these findings.

目的：了解BMI对经导管主动脉瓣置换（TAVR）术后肾功能的影响。方法 :连续入选2017年5月至2020年11月,于北京安贞医院行TAVR的139例患者。收集患者临床资料，了解不同BMI患者术前临床特点，分析TAVR术后肾功能变化特点及BMI对TAVR术后肾功能的影像。结果 :Logistic回归分析显示BMI、LVEF、eGFR是术后AKR的影响因素。BMI ＜24kg/m~2的患者TAVR术后发生急性肾功能恢复（AKR）的比例明显高于BMI＞ 24 kg/m~2的患者（P＜0.05），急性肾功能损伤（AKI）的发生与BMI水平无相关性（P＞ 0.05）。无论是否术前存在CKD,BMI ＜24kg/m~2的患者发生AKR的比例明显高于BMI＞ 24kg/m~2的患者（P ＜0.05）。随着体重的增加AKR的比例逐渐降低（P ＜0.05）。结论 :BMI是TAVR术后肾功能改善的影响因素，BMI ＜24kg/m~2有利于TAVR术后肾功能改善。

目的 评估代谢综合征（MS）对行冠状动脉血运重建高龄患者全因死亡率的影响。方法 回顾性分析2016年2月至2018年10月于首都医科大学附属北京安贞医院行冠状动脉血运重建的566例≥80岁高龄冠心病（冠状动脉粥样硬化性心脏病）患者的临床资料，根据是否患有MS分为MS组和非MS组。对所有患者进行随访，记录患者的基线资料及随访期间全因死亡发生情况。分析患者全因死亡的危险因素。结果 MS组共纳入257例患者，其中225例（87.5%）住院期间行经皮冠状动脉介入（PCI）治疗、32例（12.5%）患者行冠状动脉旁路移植术（CABG）;非MS组共纳入309例患者，其中240例（77.7%）行PCI治疗、69例（22.3%）患者行CABG。MS组体重指数≥25.0 kg/m~2、糖尿病、高血压病、血脂异常、既往心肌梗死、慢性肾脏病、既往PCI、左心室射血分数＜50%及口服降糖药物比例均高于非MS组，差异均有统计学意义（均P＜0.05）。随访期间，MS组42例（16.3%）患者、非MS组24例（7.8%）患者死亡。Kaplan-Meier生存曲线分析结果显示，MS组患者的全因死亡率高于非MS组（Log-rank P=0.003）。调整混杂因素后，MS仍是行冠状动脉血运重建的高龄冠心病患者全因死亡的独立危险因素（风险比=1.715,95%置信区间：1.027～2.862,P=0.039）。结论 MS可增加行冠状动脉血运重建高龄患者的全因死亡率。

BACKGROUND:High levels of lipoprotein(a) [Lp(a)] are linked to adverse cardiovascular events. The significance of Lp(a) for the survival of octogenarians with coronary artery disease (CAD) after drug-eluting stent (DES) insertion is, however, not known. The purpose of the study is to investigated the connection between Lp(a) and outcome in octogenarians with CAD after DES implantation. METHODS:We retrospectively enrolled a total of 506 consecutive octogenarians with CAD and DES implantation in our institution between January 2015 to August 2018. Two patient groups were established: a low group with plasma Lp(a) lower than 50 mg/dL (n = 408) and a high group with values above 50 mg/dL (n = 98). RESULTS:After following up for a median of 31.53 ± 8.22 months, Kaplan-Meier curves indicated that poorer outcome censored for major cardiovascular events (MACE), myocardial infarction (MI), and target vessel revascularization (TVR) in the high group relative to the low group (log-rank test p = 0.001, p = 0.008, and p < 0.001, respectively). High Lp(a) independently predicted MACE (hazard ratio (HR) 1.90; 95% confidence interval (CI) 1.28-2.84; p = 0.002), MI (HR 2.74; 95% CI 1.23-6.11; p = 0.014), and TVR (HR 3.65; 95% CI 1.99-6.69; p < 0.001) after covariate adjustment. CONCLUSIONS:High Lp(a) was also significantly related to poor long-term outcome in octogenarians with CAD after DES implantation.

目的：越清高水平脂蛋白a[Lp（a）]与心血管疾病的不良预后密切相关，故本研究评估Lp（a）对行冠状动脉旋磨术患者全因死亡率的影响。方法：分析自2015年1月至2018年5月，在首都医科大学附属北京安贞医院心内科成功行冠状动脉旋磨术的309例冠心病患者，根据Lp（a）水平，将患者分为高Lp（a）组[n=55,Lp（a）＞50g/L]和低Lp（a）组[n=254,Lp（a）≤50g/L]，采用Kaplan-Meier生存曲线和Cox比例危险模型分析两组患者的全因死亡率。结果：高Lp（a）组血脂异常明显高于低Lp（a）组（P＜0.001）。平均随访（30.77±6.70）个月，Kaplan-Meier生存曲线显示,高Lp（a）组患者的全因死亡率明显高于低Lp（a）组（P=0.016），有统计学意义。调整混杂因素后，高Lp（a）出现全因死亡的（HR=2.107,95%CI:1.074～4.131,P=0.030）。结论：高Lp（a）明显增加行冠状动脉旋磨术冠心病患者的的全因死亡率。

Background and aims: although an association between metabolic syndrome (MS) and cardiovascular disease risk has been documented, the relationship in patients with complex calcified coronary lesions undergoing rotational atherectomy (RA) and drug-eluting stent(DES) insertion remains controversial. Here, the influence of MS on outcomes was assessed. Methods and results: we retrospectively included 398 patients who underwent RA and DES insertion for complex calcified coronary lesions in our institution between June 2015 and January 2019. The modified Adult Treatment Plan III was used to diagnose MS. The endpoint was major adverse cardiovascular events (MACEs), comprising mortality from all causes, myocardial infarction, and target vessel revascularization (TVR). In all, 173 (43.5%) patients had MS. MS was significantly associated with MACE over the 28.32 ± 6.79-month follow-up period (HR 1.783, 95% CI from 1.122 to 2.833) even after adjustment for other possible confounders. Conclusion: MS was frequently observed in patients treated with RA with DES insertion for complex calcified coronary lesions. MS independently predicted MACE in these patients.

目的 探讨慢性肾脏病（CKD）对行经皮冠状动脉介入（PCI）术高龄冠心病（冠状动脉粥样硬化性心脏病）患者预后的影响。方法 回顾性分析2016年1月至2018年12月在首都医科大学附属北京安贞医院成功行PCI术且完成随访的536例≥80岁冠心病患者的临床资料和随访资料。根据患者术前估算肾小球滤过率（eGFR）分为2组：观察组eGFR＜60 ml/（min·1.73 m~2）,199例；对照组eGFR≥60 ml/（min·1.73 m~2）,337例。eGFR＜60 ml/（min·1.73 m~2）定义为CKD。比较2组性别、年龄、合并症、冠心病家族史、既往史、心功能和应用药物情况等术前基线临床资料，以及术后主要不良心血管事件（MACE）包括全因死亡、心肌梗死和靶血管再次血运重建（TVR）发生情况，分析CKD对预后的影响。结果 观察组年龄，合并高血压病、糖尿病、吸烟，既往心肌梗死史、脑卒中史和左心室射血分数＜50%比例均高于对照组（均P＜0.05）,2组男性、血脂异常、冠心病家族史、PCI史、冠状动脉旁路移植史和应用药物情况比较差异均无统计学意义（均P＞0.05）。术后随访（22±5）个月，观察组MACE、全因死亡、TVR发生率均高于对照组[27.6%（55/199）比14.0%（47/337）、16.1%（32/199）比5.3%（18/337）、13.6%（27/199）比6.2%（21/337）]（均P＜0.05）,2组心肌梗死发生率比较差异无统计学意义（P＞0.05）。Cox回归分析结果显示，调整了性别、年龄、合并症、冠心病家族史、既往史、心功能和应用药物情况后，CKD仍为接受PCI高龄冠心病患者术后发生MACE（比值比=1.517,95%置信区间：1.005～2.289,P=0.047）、全因死亡（比值比=2.094,95%置信区间：1.147～3.821,P=0.016）和TVR（比值比=2.098,95%置信区间：1.176～3.745,P=0.013）的独立危险因素，但不是发生心肌梗死的影响因素（P＞0.05）。结论 CKD是行PCI术高龄冠心病患者预后不良的独立影响因素。

目的:观察伊伐布雷定治疗射血分数降低性心力衰竭(HFrEF)的临床疗效及对左心室功能、生命质量的影响.方法:选取北京安贞医院心内科住院及门诊就诊的112例,LVEF≤40％的心力衰竭患者,分为IVB组(53例)和对照组(59例),根据心力衰竭指南给予两组患者标准化治疗;观察组在此基础上,因存在β受体阻滞剂使用剂量受限,或者β受体阻滞剂已达到最大靶剂量,窦性心律仍≥70次/min的情况,加用伊伐布雷定治疗(起始剂量为2.5mg/次,2次/d,最大使用剂量为7.5mg/次,2次/d,心率控制在60次/min左右.连续用药治疗3个月.观察两组治疗前后心率、NT-proBNP、LVEF、LVESD、LVEDD、6min步行距离(6MWD)、明尼苏达心功能不全生命质量量表(MLHFQ)变化及两组发生的不良反应.结果:治疗3个月后,两组患者心率均有所降低,IVB组下降明显优于对照组[(65.42±5.15)vs.(74.69±6.38)次/min,P＜0.01].两组NT-proBNP水平均有明显降低,且IVB组降低更加显著[(402.60±185.93)vs.(708.99±221.07)ng/L,P＜0.01].两组心脏重构指标(LVEF、LVEDD),IVB 组改善更显著(P＜0.01).LVEF 升高[(50.2±5.8)％vs.(41.6±5.3)％];LVEDD 缩小[(52.6±6.3)vs.(59.5±6.8)mm,P＜0.01].两组患者 6MWD 均有增加,IVB组增加更加显著,[(391.67±23.59)vs.(317.40±2567)mm,P＜0.01].MLHFQ 评分均降低,IVB组降低更加明显,[(37.6±8.2)vs.(49.1±8.6),P＜0.01].两组用药期间不良反应较少,主要的不良反应为心动过缓,予以调整药物剂量后心动过缓可以纠正,且两组差异无统计学意义(P＞0.05).结论:在标准化心力衰竭治疗的基础上加用伊伐布雷定,可更加有效降低HFrEF患者的心率、NT-proBNP水平、改善心功能、提高生命质量,且安全性良好,是治疗HFrEF安全有效的药物.

Background The prevalence of coronary artery disease (CAD) continues to increase among young Chinese adults. Current smoking has been recognized as a major risk factor for premature CAD, and hyperhomocysteinaemia (HHcy) has also been suggested to be associated with CAD progression. However, the combined effect of current smoking and HHcy on the severity of coronary artery stenosis in young adults is still uncertain. Methods We consecutively collected young patients (18–35 years of age), diagnosed with CAD and underwent coronary angiography (CAG) at Anzhen Hospital between January 2013 and May 2020. HHcy was defined as serum homocysteine (Hcy) level > 15 µmol/L. The severity of coronary artery stenosis was evaluated by Gensini Score. The co-effect of current smoking and HHcy on CAD severity as well as the relationship between plasma Hcy, pack-years of smoking and CAD severity were assessed by multivariate linear regression analysis. Results A total of 989 participants (mean age, 33 years; 96.2% male) fulfilling the criteria were enrolled in this study. Patients with both HHcy and current smoking accounted for 39.1% of all the subjects. Multivariate liner analysis indicated both serum Hcy levels ( β 0.302; 95% CI 0.141–0.462; P < 0.001) and pack-years of smoking ( β 0.523; 95% CI 0.265–0.781; P < 0.001) were independently associated with the severity of coronary artery stenosis after adjusting for other traditional confounders. In addition, serum Hcy levels were correlated with pack-years of smoking in young CAD patients ( r = 0.116, P = 0.001). Moreover, combination of HHcy and current smoking was suggested to have higher risk for CAD severity ( β 17.892; 95% CI 11.314–24.469; P < 0.001), compared with HHcy ( β 7.471; 95% CI 0.009–14.934; P = 0.048) or current smoking ( β 7.421; 95% CI 0.608–14.233; P = 0.033) alone. Conclusion Combination of HHcy and smoking is independently associated with the severity of CAD in young patients ≤ 35 years of age.

Background: Transcatheter aortic valve implantation (TAVI) has achieved satisfactory outcomes in the selected patients with bicuspid aortic valve (BAV), predominately type 1 BAV (~90%). However, there are few reports about the safety and efficacy of TAVI in type 0 BAV. Therefore, in the current study, we aimed to compare procedural and 30-day outcomes after TAVI between type 0 and type 1 BAV.Methods: Studies comparing the outcomes of TAVI in Sievers type 0 vs. type 1 BAV were retrieved from PubMed, EMBASE, Cochrane Library, and Web of Science from inception to May 2021. The data were extracted regarding the study characteristics and outcomes. The odds ratios (ORs) with 95% CIs were pooled for procedural and 30-day outcomes.Results: Six observational studies were included with determined type 0 BAV in 226 patients and type 1 BAV in 902 patients. The patients with type 0 BAV were slightly younger, had larger supra-annular structure, and more frequently implanted self-expanding prosthesis compared with type 1 BAV. In the pooled analyses, the patients with type 0 BAV had a similar incidence of procedural death (OR = 2.6, 95% CI 0.7–10.3), device success (OR = 0.6; 95% CI 0.3–1.3), and ≥ mild (OR = 0.8; 95% CI 0.4–1.6) or moderate (OR = 0.9, 95% CI 0.4–1.8) paravalvular leak, whereas significantly higher mean aortic gradient (mean difference = 1.4 mmHg, 95% CI 0.03–2.7) and increased coronary compromise risk (OR = 7.2; 95% CI 1.5–34.9), compared with type 1 BAV. Meanwhile, the incidence of death (OR = 1.2; 95% CI 0.5–3.1), stroke (OR = 0.5; 95% CI 0.1–2.4), and new pacemaker (OR = 0.6; 95% CI 0.2–2.2) at 30 days were not significantly different between the BAV morphologies (p > 0.05). The treatment effect heterogeneity across the studies for the above outcomes were low.Conclusions: The patients with type 0 BAV appear to have similar short-term outcomes after TAVI compared with type 1 BAV. Whereas, TAVI for type 0 BAV aortic stenosis might lead to an elevated coronary obstruction risk and suboptimal aortic valvular hemodynamics.

目的:探讨重度主动脉瓣狭窄(AS)患者行经导管主动脉瓣置换术(TAVR)后,超声心动图参数及功能性二尖瓣反流(FMR)的转归情况,以及影响FMR预后的相关因素.方法:回顾性分析2017年6月至2020年7月,首都医科大学附属北京安贞医院收治的142例接受TAVR治疗的重度AS合并FMR患者,分析基线信息,比较手术前后超声心动图参数及FMR的转归,通过Logistic回归分析影响FMR转归的因素.结果:TAVR术后FMR中62.7％的患者二尖瓣反流较术前改善.超声心动检查中LAD、室间隔厚度(ⅣS)、主动脉瓣上流速(Vmax)、主动脉瓣最大压差(Peak-AVG)、LVEDD、LVESD、左室后壁厚度(LVPW)、主动脉窦部、肺动脉压力、肺动脉最大流速均较术前有明显改善(P＜0.05),而LVEF、升主动脉内径较术前无改变.Logistic回归分析显示LAD、LVPW、Vmax、二尖瓣术前反流分级、术前合并冠心病为影响FMR改善的预测因素.结论:TAVR治疗可改善重度AS合并FMR患者的二尖瓣反流,而LAD、LVPW、Vmax、二尖瓣术前反流分级、术前合并冠心病是影响TAVR术后FMR转归的危险因素.

Background The prevalence of acute coronary syndrome (ACS) continues to increase among young Chinese adults. Homocysteine (HCY) has been suggested as a promoter of atherosclerosis leading to coronary artery disease (CAD). Yet, it remains uncertain whether HCY is associated with the ACS and the severity of coronary artery stenosis in young adults. Methods Young patients (18–35 years of age) diagnosed with ACS who underwent coronary angiography (CAG) at Anzhen Hospital between January 2013 and June 2019 were assigned to the ACS group. As confirmed by CAG during the same period, an equivalent age-matched population without CAD was assigned to the non-CAD group. A serum HCY level > 15 µmol/L was defined as hyperhomocysteinemia (HHCY). The Gensini score assessed the severity of coronary artery stenosis. Results A total of 1103 participants, including 828 ACS patients and 275 non-CAD subjects, were enrolled in this study. Young ACS patients had higher level of serum HCY and greater prevalence of HHCY compared with non-CAD subjects [for HCY, 16.55 (11.93–29.68) vs 12.50 (9.71–17.42), P < 0.001; for HHCY prevalence, 62.08% vs 26.18%, P < 0.001]. Multivariate logistic regression analysis with the stepwise method indicated that HHCY was an independent predictor associated with the presence of ACS, after adjusting for traditional confounders (OR, 4.561; 95% CI, 3.288–6.327; P < 0.001). Moreover, young ACS patients with HHCY had increased prevalence of ST-segment elevation myocardial infarction (STEMI) ( P = 0.041), multi-vessel disease ( P = 0.036), and decreased value of left ventricular ejection fraction (LVEF) ( P = 0.01). Also, the HCY level was significantly correlated with Gensini Score in ACS patients (r = 0.142, P < 0.001). Conclusion HHCY is significantly associated with the presence of ACS and the severity of coronary artery stenosis in young adults ≤ 35 years of age.

Background: The prevalence of acute coronary syndrome (ACS) continues to increase among young Chinese adults. Homocysteine (HCY) has been suggested as a crucial promoter of atherosclerosis leading to coronary artery disease (CAD). Yet, it remains uncertain whether HCY is associated with the ACS and the severity of coronary artery stenosis in very young adults. Methods: Very young patients (18-35years of age) diagnosed with ACS who underwent coronary angiography (CAG) at Anzhen Hospital between January 2013 and June 2019 were assigned to the ACS group. An equivalent age-matched population without CAD, as confirmed by CAG during the same period, was assigned to the non-CAD group. A serum HCY level>15µmol/L was defined as hyperhomocysteinemia (HHCY). The Gensini score assessed the severity of coronary artery stenosis. Results: A total of 1,103 participants, including 828 ACS patients and 275 non-CAD subjects, were included in this study. Very young ACS patients had higher level of serum HCY and greater prevalence of HHCY compared with non-CAD subjects [for HCY, 16.55 (11.93- 29.68) vs 12.50 (9.71- 17.42), P <0.001; for HHCY prevalence, 62.08% vs 26.18%, P <0.001]. Multivariate logistic regression analysis with the stepwise method indicated that HHCY was an independent predictor associated with the presence of ACS, after adjusting for traditional confounders (OR, 4.393; 95% CI, 3.171-6.087; P <0.001). Moreover, young ACS patients with HHCY had increased prevalence of ST-segment elevation myocardial infarction (STEMI) ( P =0.041), multi-vessel disease ( P =0.036), and decreased value of left ventricular ejection fraction (LVEF) ( P =0.01). Also, the HCY level was significantly correlated with Gensini Score in ACS patients (r=0.142, P <0.001). Conclusion: HHCY was significantly associated with the presence of ACS and the severity of coronary artery stenosis in very young patients ≤35 years of age.

The coronary slow flow phenomenon (CSFP) is a poorly recognized clinical entity characterized by delayed distal vessel opacification in the absence of epicardial coronary stenosis and presently lack of specific data on the clinical profile and outcome. We investigated a cohort of 429 patients who fulfilled the criteria for CSFP to explore the clinical feature, outcome, and risk factor of prognosis. Two teams (clinical center and core lab) were blind to patient data for the assessment of coronary angiograph using corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC). The study cohort consisted of 429 patients (294 men, 68.5%), aged from 30 to 78 years (mean, 54 years). Two hundred patients (46.6%) out of 429 patients had a history of hypertension, 72 (16.8%) had diabetes mellitus, and 222 (51.7%) had dyslipidemia. All the rates of agreement between two teams in evaluating whether normal flow (CTFC ≤ 27 frames) or slow flow (CTFC > 27 frames) were moderate (0.40 < κ < 0.75) for the three arteries. Follow-up (mean, 3.8 years) was done for 421 patients (98.1%). The major adverse cardiovascular events (MACE) occurred in 39 patients (9.3%) out of 421 patients. Multivariate analysis showed that the risk of MACE approximately doubles with age >50 years (hazard ratio (HR) = 2.2, 95% CI: 1.0 to 4.9, and P=0.042), hypertension (HR = 2.1, 95% CI: 1.1 to 4.2, and P=0.021), and dyslipidemia (HR = 2.0, 95% CI: 1.0 to 3.9, and P=0.042). CSFP affects predominantly patients at middle age and above but can occur in any age group; CSFP should be more concerned, particularly in patients >50 years old with hypertension and dyslipidemia.

目的探讨冠状动脉慢血流患者的临床特征、随访结果及预后相关因素。方法根据校正的心肌梗死溶栓试验（TIMI）血流计帧法（CTFC）,回顾性纳入北京安贞医院2010年1月至2016年12月造影并确定冠脉慢血流患者385例,分析其基线资料、临床表现及随访结果,并采用Cox生存分析对影响临床结局的危险因素进行分析。结果 （1）共纳入385例冠状动脉慢血流患者,其中男性263例（68.3%）,女性122例,平均年龄54.45岁（30~78岁）。其中高血压病史者181例（47.0%）,糖尿病史者64例（16.6%）,高脂血症史者200例（51.9%）,吸烟史者187例（49.1%）,饮酒史者89例（23.1%）,冠心病家族史者63例（16.3%）。（2）完成心电图检查的患者中,有ST段压低者31例（8.6%）,一过性ST段抬高者5例（1.4%）,非特异性ST-T改变者58例（16.0%）,完全性右束支传导阻滞者10例（2.8%）,完全性左束支传导阻滞者2例（0.6%）,心电图正常者264例（72.9%）;完成超声心动图检查的患者中有节段性室壁运动异常者12例（3.9%）,左心室肥厚者27例（8.7%）,左心室舒张末内径平均47.1 mm,平均射血分数为65.6%。（3）左前降支CTFC平均为32帧,左回旋支CTFC平均为46帧,右冠状动脉CTFC平均为46帧。（4）完成电话随访378例（98.2%）,平均随访时间为3.6（0.2~8.2）年,随访过程中有5例（1.3%）患者死亡,其中3例（0.8%）为心源性死亡;36例患者发生主要心血管不良事件（MACE）（9.5%）。单因素分析显示,MACE风险与性别、年龄、糖尿病、体重指数、吸烟等常见心血管危险因素无明显相关性,而与高血压存在相关性（P=0.023,HR=2.193,95%CI:1.096~4.389）。结论冠状动脉慢血流患者临床表现并不特异,但MACE发生率高,临床上应引起充分重视;高血压与冠状动脉慢血流患者MACE风险相关,应加强对这类患者的血压控制。

Background/Aims: Endoplasmic reticulum (ER) stress is an important event in atherosclerosis. Recent studies have shown that ER stress deregulates cholesterol metabolism via multiple pathways. This study aimed to determine the relationship between ER stress and lipid metabolism and to verify that upregulation of miR-33 is involved in this process. Methods: An atherosclerosis model was established in apolipoprotein E-deficient (ApoE-/-) mice fed a Western diet, and THP-1 derived macrophages were used in this study. Hematoxylin-eosin and Oil Red O staining were used to quantify the atherosclerotic plaques. 1,1′-Dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate labeled oxidized low-density lipoprotein binding assay and a Cholesterol Efflux Fluorometric Assay Kit were used to observe cholesterol uptake and efflux. The mRNA and protein levels of biomarkers associated with ER stress and cholesterol metabolism in atherosclerotic plaques and macrophages were evaluated by real-time PCR and western blotting, respectively. Immunofluorescence was used to observe alterations of ABCA1 localization. Small interfering RNAs were used to knock down CHOP and miR-33 in macrophages to alter CHOP and miR-33 expression. Results: Atherosclerotic lesions and systemic lipid levels were ameliorated after inhibition of ER stress (tauroursodeoxycholic acid) in vivo. In vitro studies confirmed that ER stress regulated the lipid catabolism of macrophages by promoting cholesterol uptake, inhibiting cholesterol efflux, and modulating the expression of related transporters. CHOP contributed to lipid metabolism disorder following ER stress. Furthermore, over-expression of miR-33 was involved in ER stress that induced lipid metabolism disorder in macrophages. These findings support a model of ER stress induction by oxidized low-density lipoprotein that affects macrophage lipid catabolism disorder. Conclusion: Our data shed new light on the relationship between ER stress and lipid metabolism in vivo and in vitro, and confirm that upregulation of miR-33 is involved in this process. The relationship between ER stress and miR-33 represents a novel target for the treatment of atherosclerosis.

Background Obstructive sleep apnea(OSA) is a common disease in patients with acute coronary syndrome(ACS) and associated with an increased risk of fatal and nonfatal cardiovascular events. However, most patients in previous study were treated with bare metal stents and the sample sizes were relatively low. The goal of this study was to evaluate the influence of OSA on the severity and prognosis of patients admitted for ACS. Methods In this prospective cohort study, we enrolled patients with ACS who were hospitalized for coronary angiogram/percutaneous coronary intervention and undergone polysomnography. We divided the patients into two groups: moderate to severe OSA group [apnea-hypopnea index(AHI) > 15 events/h] and control group(AHI ≤ 15 events/h). They were followed up for up 32 months. Then, we compared the ACS severity and long-term major adverse cardiovascular events(MACE) in patients with different severity of OSA. Results Five hundred and twenty nine patients were included in the final analysis, with 76% of them being men and an average age of 59 ± 10 years. The overall mean AHI is 29 ± 19 events/h,70.5% of them(373/529) being with moderate to severe OSA and 29.5%(156/529) assign into control group. Compared with controls, patients with moderate or severe OSA exhibited a higher prevalence of hypertension as well as higher body mass index, SYNTAX score, Epworth score and length of hospitalization. With a median follow-up duration of 30 months, accumulative rate of MACE was also higher in patients with moderate or severe OSA than that in the control group(8.6% vs.3.2%, P = 0.028). After adjusting for baseline confounders by cox regression model, moderate to severe OSA was an independent risk factor of long-term MACE(P = 0.047, HR = 1.618, 95% CI: 1.069-3.869). Conclusions The results of this study demonstrate that moderate or severe OSA is correlated with disease severity and associated with worse long-term prognosis in ACS patients. The results raising the possibility that early diagnose and interventions of OSA could improve long-term outcomes in ACS patients.