Chronic total occlusion (CTO) of the coronary artery remains a major challenge in interventional cardiology. Although percutaneous coronary intervention (CTO–PCI) restores perfusion, patients remain at high risk of 1-year major adverse cardiovascular events (MACE). Traditional linear models fail to capture complex nonlinear and interactive effects among clinical and procedural factors. To address this, we developed an interpretable Naive Bayes model using a hybrid feature selection strategy combining expert knowledge with machine learning techniques. We retrospectively analyzed 1069 CTO–PCI patients treated at Xijing Hospital (2018–2021). Three feature selection methods—manual (clinical), algorithmic (Lasso, random forest), and hybrid—were compared. After evaluating multiple machine learning (ML) algorithms, Naive Bayes achieved the best balance between accuracy and interpretability. Dimensionality reduction (principal component analysis [PCA], random forest importance) and model interpretation (SHapley Additive exPlanations [SHAP], Local Interpretable Model-agnostic Explanations [LIME]) were applied. Model performance was assessed via area under the curve (AUC), accuracy, recall, F1-score, and decision curve analysis (DCA). The hybrid selection strategy yielded superior performance (AUC 0.8281, accuracy 77.46

Heart failure with reduced ejection fraction (HFrEF) patients remain at substantial risk despite quadruple guideline-directed medical therapy (GDMT [ARNI + SGLT2 inhibitor + β-blocker + MRA]). Data on vericiguat in stable HFrEF patients without recent worsening heart failure receiving contemporary quadruple GDMT are limited. This observational study aimed to explore the efficacy and safety of vericiguat in this population. A total of 450 adult patients with LVEF < 45

PURPOSE:Compared with long-term dual antiplatelet therapy (DAPT, aspirin with clopidogrel or ticagrelor), short-term DAPT followed by single antiplatelet therapy (SAPT, clopidogrel or ticagrelor) has demonstrated superiority in reducing bleeding risk while maintaining non-inferior in cardiovascular benefits in coronary heart disease (CHD) after successful percutaneous coronary intervention (PCI). However, no prospective study has explored the benefits of this short-term regimen on patients with chronic total occlusion (CTO) undergoing PCI. METHODS:Consecutive patients who underwent successful elective CTO-PCI were prospectively enrolled from April 2019 to May 2021. After receiving 1-month DAPT, all patients were divided into two groups: SAPT group (followed by clopidogrel or ticagrelor monotherapy) and DAPT group (continued with dual antiplatelet therapy). Detailed baseline characteristics, angiographic and procedural details, and 1-year follow-up data were collected. The endpoints were major adverse cardiovascular events (MACE) and bleeding. RESULTS:A total of 701 patients who underwent successful CTO-PCI were enrolled, among whom 330 patients (47.1%) received DAPT and 371 patients (52.9%) received SAPT (clopidogrel or ticagrelor) after 1-month DAPT. Compared with patients receiving DAPT, patients in the SAPT (clopidogrel or ticagrelor) group had a lower rate of previous stroke, fewer left anterior descending coronary artery (LAD) lesions and contrast volume, and fewer lesions per patient, but longer lesion length (P < 0.05). The incidence of MACE (14.5% versus 15.4%; p = 0.742) was not significantly different between the two groups. The DAPT group showed a higher incidence of minor bleeding (BARC types 1 or 2; 12.7% versus 2.3%, p < 0.001) than SAPT (clopidogrel or ticagrelor), while no difference was found for major bleeding (BARC types 3 or 5; 1.2% versus 2.3%, p = 0.261). CONCLUSIONS:Compared with standard 12-month DAPT, 1-month DAPT followed by clopidogrel or ticagrelor monotherapy resulted in lower bleeding risks and similar cardiovascular benefits in CTO-PCI patients.

Background: Depression is a common mental health issue that can lead to various physical and psychological diseases. However, the relationship between depressive symptoms and premature death remains unclear. Methods: In this study, we used data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 to assess the relationship between depressive symptoms and premature mortality and the potential influence of mitochondrial function on this relationship. The Patient Health Questionnaire-9 (PHQ-9) was used to assess the severity of depressive symptoms. Mortality data were obtained from the National Death Index (NDI). Mitochondrial function was assessed by measuring methylmalonic acid (MMA) levels. Multivariate logistic regression was used to assess the association between depressive symptoms and premature mortality, controlling for demographic, lifestyle, and disease-related factors. Restricted cubic splines were plotted, and propensity score matching (PSM) was used to create balanced groups. Finally, mediation analysis was performed to investigate the mediating role of MMA in the association between depressive symptoms and premature mortality. Results: This study included a total of 6599 participants. The results showed a substantial positive association (odds ratio [OR] = 1.452; 95 % confidence interval [CI], 1.038-2.031; p < 0.05) between depressive symptoms and premature mortality. The significance of this relationship was maintained after PSM analysis (OR = 2.370; 95 % CI, 1.749-3.212; p < 0.01). Mediation analysis showed that MMA partially mediated this relationship, with a mediation proportion of 4.1 %. Conclusion: This study indicates that depressive symptoms significantly increases the risk of premature death and mitochondrial dysfunction partially mediates this positive relationship. Additional prospective and experimental studies are warranted to verify these findings.

BACKGROUND AND AIMS:The present study aimed to evaluate the early and 1-year outcomes of using percutaneous mechanical circulatory support (MCS) devices in patients undergoing high-risk chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS:We conducted a prospective registry cohort study that enrolled patients undergoing high-risk elective CTO-PCI with MCS device support and patients without MCS device support. The primary endpoint was major adverse cardiac events (MACE) at 1-year follow-up. RESULTS:A total of 2349 patients were enrolled, comprising 151 in the MCS group and 2198 in the non-MCS group. Compared with the non-MCS group, the MCS group exhibited a lower left ventricular ejection fraction (LVEF) (41.6 ± 10.4% vs. 50.4 ± 8.0%, p < 0.001) and a higher prevalence of two-vessel CTO (30.5% vs. 18.7%, p < 0.001) and three-vessel CTO (5.3% vs. 1.4%, p < 0.001). After propensity score matching (PSM), 137 patients in each group with comparable propensity scores were included for analysis. The cohort had a mean age of 65.97 ± 10.00 years, with 83.94% male participants. The most common MCS devices were IABP alone (66.42%), followed by ECMO + IABP (26.28%) and ECMO alone (7.30%). The MCS group demonstrated significantly higher technical success rates than the non-MCS group (95.62% vs. 87.59%, p = 0.027) but comparable procedural success rates (86.13% vs. 83.94%, p = 0.611). Complete revascularization rates were significantly higher in the MCS group (89.05% vs. 66.42%, p < 0.001). No differences occurred in 1-year MACE incidence or its components between groups, and MCS device use showed no correlation with 1-year MACE risk. CONCLUSIONS:MCS-supported CTO-PCI improves technical success rates and complete revascularization achievement rates during the index procedure. However, MCS is associated with a significantly higher incidence of in-hospital MACE and device-related complications, despite showing no significant difference in 1-year MACE rates compared to conventional CTO-PCI.

BACKGROUND:With a 3D model reconstructed from coronary angiography, intracoronary blood flow can be calculated using a computational fluid dynamics (CFD) model with fractional flow reserve (FFR) measured pressure as boundary conditions. AIMS:The aim of this study is to investigate the clinical feasibility of this method by evaluating its ability to identify myocardial ischemia diagnosed by SPECT myocardial perfusion imaging (MPI). METHODS:Patients who underwent both SPECT-MPI and coronary angiography with FFR within 1 week were enrolled. Based on the summed stress score (SSS) and summed difference score (SDS) of SPECT MPI, myocardial ischemia in individual coronary territories was identified. Mean flow rate (Q), total flow resistance (TFR), absolute microvascular resistance (AMR) and their corresponding resting state indices were computed using the novel CFD model. RESULTS:A total of 52 patients with 53 vessels were investigated. Based on SPECT MPI, 23 patients (43.4%) were associated with abnormal MPI. Q was significant higher in normal MPI group compared with abnormal MPI group (59.68 ± 40.33 mL/min vs. 25.67 ± 21.55 mL/min, p < 0.001). The TFR were significantly lower in normal MPI group (TFR: 1898.25 ± 951.55 mmHg min/L vs. 4786.31 ± 3056.18 mmHg min/L, p < 0.001). The ROC-AUC of Q and TFR for discriminating normal and abnormal MPI were 0.876 (95% CI: 0.783-0.970, p < 0.001) and 0.854 (95% CI: 0.745-0.963, p < 0.001). CONCLUSIONS:Intracoronary flow assessed by the novel CFD based method has shown promise in accurately identifying patients with abnormal SPECT MPI, offering a convenient and quantitative approach for assessing coronary physiology.

IntroductionWhile coronary wave intensity analysis (cWIA) offers a promising way to assess myocardial and microvascular function by decomposing microvascular-originated backward waves, its clinical utility is currently limited by complex data acquisition and unclear influence of varying hemodynamic factors (adenosine, stenosis and vessel type).MethodsThis study introduces an angiography-based cWIA method and clarifies how those hemodynamic factors impact cWIA parameters. This retrospective study included 124 patients with 125 target vessels, for which beat-to-beat cWIA was successfully performed at rest and during adenosine-induced hyperemia.ResultsOur analysis revealed a strong and significant correlation between cumulative backward compression wave intensity (cBCW) and cumulative backward decompression wave intensity (cBDW) in both resting (rho = 0.846, 95%CI: 0.786 to 0.891, p < 0.001) and hyperemic states (rho = 0.768, 95%CI: 0.681 to 0.833, p < 0.001). Compared to rest, adenosine-induced hyperemia significantly increased cBCW (1.88 ± 1.46 ×104 W/m2s vs. 2.31 ± 1.74 × 104 W/m2s, p < 0.001) and peak backward compression wave intensity (pBCW) (4.30 ± 4.61 ×105 W/m2s2 vs. 5.21 ± 4.68 × 105 W/m2s2, p = 0.008), while significantly decreasing peak backward decompression wave intensity (pBDW) (5.41 ± 6.06 × 105 W/m2s2 vs. 3.99 ± 4.64 × 105 W/m2s2, p < 0.001), with no significant effect on cBDW. Neither functional stenotic lesions nor vessel type [left anterior descending coronary artery (LAD) or right coronary artery (RCA)] significantly impacted quantitative parameters of the microvascular-originated backward waves.DiscussionThe clinical feasibility of a convenient cWIA method was validated, and the impact of various hemodynamic factors on quantitative parameters of cWIA were analyzed, providing strong support for the clinical application of cWIA.

There are always concerns regarding the durability of subintimal stenting after contemporary chronic total occlusion (CTO) recanalization. This prospective, multicenter clinical trial aimed to compare extraplaque (EP) and intraplaque (IP) tracking for long-term clinical outcomes after CTO recanalization. After IVUS assessment of the wire crossing position, the patients were divided into two groups: (1) the EP group with subintimal length (SL) > 10 mm; and (2) the IP group with intraplaque or minor extraplaque (SL ≤ 10 mm). The primary endpoint was binary in-segment restenosis (ISR), and the secondary endpoint was the occurrence of major adverse cardiac events. Angiographic follow-up (FU) was scheduled at 13 months, and clinical FU was continued up to 3 years. A total of 257 successful CTO patients were enrolled. The mean CTO length in the EP group was 46.6 ± 16.1 mm, and the median extraplaque length was approximately 24.5 mm. The J-CTO score was higher (p<0.001). Angiographic FU at 13 months showed that both groups had similar cumulative rates of ISR (p = 0.704). In the 3-year clinical follow-up, the cumulative incidence of target vessel revascularization (TVR) in both groups and across different tracking techniques showed no significant difference (p > 0.05). Independent predictors of ISR were a total stent length >50 mm and a wire crossing time >2 hours, while multivessel lesions showed an independent association with 3-year TVR. The specific long extraplaque tracking had comparable angiographic and long-term clinical outcomes to intraplaque tracking, regardless of the crossing technique used.

The three-dimensional (3D) reconstruction of the coronary artery from angiographic images is crucial for diagnosing and treating coronary artery disease. However, accurate reconstruction is challenging due to the non-simultaneous acquisition of angiographic images and the complex motion patterns of coronary arteries. State-of-the-art methods typically involve a two-stage process: manual selection of corresponding point pairs for spatial geometric calibration, followed by centerline reconstruction. However, overlap and foreshortening in 2D images complicate point selection, often requiring repeated adjustments, and the lack of sufficient point pairs can lead to reconstruction failure. In this paper, we propose a one-stage automatic approach that integrates calibration and 3D centerline reconstruction, eliminating the need for manual calibration. For each angiographic image, we constructed a 3D deformable curve corresponding to the 2D vessel centerline, strictly constrained by the projection lines. Unlike traditional methods that minimize 2D reprojection errors, our approach minimizes the 3D spatial distance between two 3D curves, simultaneously optimizing the spatial transformation and the two deformable 3D curves. The transformation is optimized through iterative curves registration, while the curves are evolved based on a cosine representation method. Both processes occur simultaneously and mutually reinforce each other, resulting in high-precision 3D reconstruction without manual calibration. The proposed approach was validated on 45 phantom and 107 clinical data. The mean space error was 0.085 ± 0.085 mm for phantom data; and the mean reprojection error was 0.060 ± 0.027 mm for clinical data. Results demonstrated that our approach achieves state-of-the-art accuracy while eliminating the need for manual intervention.

Background A novel computational fluid dynamics (CFD) based method was proposed for the measurement of intracoronary mean flow rate ( Q ) and absolute microvascular resistance ( AMR ) by combining coronary angiography and routine fractional flow reserve (FFR) measurement. The aim of this study is to explore the potential of the proposed method to assess the presence of coronary microvascular dysfunction (CMD). Methods Patients without hemodynamically significant coronary artery stenosis or those after a successful PCI were enrolled. Rest SPECT myocardial perfusion imaging (MPI) was employed as evidence for assessing the presence of CMD. Based on the sum rest score of target vessel ( SRSTV ), patients were divided into normal MPI group ( SRSTV ≤ 1) and abnormal MPI group ( SRSTV > 1). Q and AMR were obtained with a CFD based method during rest and hyperemia condition, and receiver operating characteristic (ROC) curve analyses were performed for discriminating patients with normal MPI and with abnormal MPI. Results A total of 57 patients with 61 target vessels were investigated. Based on SRSTV , 22 patients (38.6%) with 23 target vessels (37.7%) were associated with abnormal MPI. Compared with abnormal MPI group, the AMR was significantly lower in normal MPI group (1.97 ± 1.50 mmHg·s/ml vs 3.41 ± 2.30 mmHg·s/ml, p = 0.011), and the Q was significant higher in normal MPI group (0.94 ± 70 mmHg·s/ml vs 0.56 ± 0.50 mmHg·s/ml, p = 0.025). According to ROC curve analysis, the ROC-AUC of Q and AMR for discriminating normal MPI and abnormal MPI was 0.720(95% CI: 0.591–0.828, p = 0.001) and 0.731(95% CI: 0.602–0.836, p = 0.001). Conclusions The new CFD based method provides an easy and accurate way to measure the intracoronary flow rate and absolute microvascular resistance, and constitutes a new opportunity for assessing the presence of CMD.

BackgroundAccurate measurement of pulsatile blood flow in the coronary arteries enables coronary wave intensity analysis, which can serve as an indicator for assessing coronary artery physiology and myocardial viability. Computational fluid dynamics (CFD) methods integrating coronary angiography images and fractional flow reserve (FFR) offer a novel approach for computing mean coronary blood flow. However, previous methods neglect the inertial effect of blood flow, which may have great impact on pulsatile blood flow calculation. To improve the accuracy of pulsatile blood flow calculation, a novel CFD based method considering the inertia term is proposed.MethodsA flow resistance model based on Pressure-Flow vs.Time curves is proposed to model the resistance of the epicardial artery. The parameters of the flow resistance model can be fitted from the simulated pulsating flow rates and pressure drops of a specific mode. Then, pulsating blood flow can be calculated by combining the incomplete pressure boundary conditions under pulsating conditions which are easily obtained in clinic. Through simulation experiments, the effectiveness of the proposed method is validated in idealized and reconstructed 3D model of coronary artery. The impacts of key parameters for generating the simulated pulsating flow rates and pressure drops on the accuracy of pulsatile blood flow calculation are also investigated.ResultsFor the idealized model, the previously proposed Pressure-Flow model has a significant leading effect on the computed blood flow waveform in the moderate model, and this leading effect disappears with the increase of the degree of stenosis. The improved model proposed in this paper has no leading effect, the root mean square error (RMSE) of the proposed model is low (the left coronary mode:≤0.0160, the right coronary mode:≤0.0065) for all simulated models, and the RMSE decreases with an increase of stenosis. The RMSE is consistently small (≤0.0217) as the key parameters of the proposed method vary in a large range. It is verified in the reconstructed model that the proposed model significantly reduces the RMSE of patients with moderate stenosis (the Pressure-Flow model:≤0.0683, the Pressure-Flow vs.Time model:≤0.0297), and the obtained blood flow waveform has a higher coincidence with the simulated reference waveform.ConclusionsThis paper confirms that ignoring the effect of inertia term can significantly affect the accuracy of calculating pulsatile blood flow in moderate stenosis lesions, and the new method proposed in this paper can significantly improves the accuracy of calculating pulsatile blood flow in moderate stenosis lesions. The proposed method provides a convenient clinical method for obtaining pressure-synchronized blood flow, which is expected to facilitate the application of waveform analysis in the diagnosis of coronary artery disease.

目的 观察复合策略在慢性完全闭塞（CTO）病变经皮冠状动脉介入治疗(PCI中的应用结果，评价其有效性和安全性。方法 连续纳入2018年1月至2020年12月于中国人民解放军空军军医大学第一附属医院心血管内科接受单名经验丰富术者实施CTO-PCI的患者，收集其临床特征、冠状动脉造影特征、术中结果、院内结局等资料，分析总成功率、不同日本多中心CTO注册研究（J-CTO）评分的治疗结果、复合策略应用结果、失败原因以及院内主要不良心脑血管事件（MACCE）发生率。结果 共891例患者接受1 010例次CTO-PCI，男性比例87.3%，平均年龄（61±11）岁，平均J-CTO评分为（2.5±1.2）分。总体CTO-PCI成功率为94.8%（957/1 010）,J-CTO≤1分、=2分、≥3分CTO-PCI的成功率分别为99.5%（205/206）、96.9%（222/229）、92.2%（530/575）。平均使用策略（1.2±0.5）次，首选策略中，正向最为常用（85.0%,858/1 010），其次是逆向（13.0%,131/1 010）和正向夹层重入（ADR;2.1%,21/1 010）。正向、逆向、ADR最终CTO-PCI成功率分别为74.6%（648/869）、83.2%（227/273）、84.5%（82/97），在总成功CTO-PCI中的占比分别为67.7%（648/957）、23.7%（227/957）、8.6%（82/957）。院内MACCE发生率为0.9%（9/1010）。中位导丝操控时间为29（10,60）min,PCI时间为102（69,145）min,X线透视时间为47（34,68）min，对比剂用量为350（270,430）ml，辐射剂量为3.3（2.1,4.8） Gy，空气比释动能-面积乘积为31（21,46）Gy·cm2。结论 经验丰富的术者遵循复合策略实施CTO-PCI，可获得很高的成功率及较低的院内MACCE发生率。

As the essential amino acids, branched-chain amino acid (BCAA) from diets is indispensable for health. BCAA supplementation is often recommended for patients with consumptive diseases or healthy people who exercise regularly. Latest studies and ours reported that elevated BCAA level was positively correlated with metabolic syndrome, diabetes, thrombosis and heart failure. However, the adverse effect of BCAA in atherosclerosis (AS) and its underlying mechanism remain unknown. Here, we found elevated plasma BCAA level was an independent risk factor for CHD patients by a human cohort study. By employing the HCD-fed ApoE-/- mice of AS model, ingestion of BCAA significantly increased plaque volume, instability and inflammation in AS. Elevated BCAA due to high dietary BCAA intake or BCAA catabolic defects promoted AS progression. Furthermore, BCAA catabolic defects were found in the monocytes of patients with CHD and abdominal macrophages in AS mice. Improvement of BCAA catabolism in macrophages alleviated AS burden in mice. The protein screening assay revealed HMGB1 as a potential molecular target of BCAA in activating proinflammatory macrophages. Excessive BCAA induced the formation and secretion of disulfide HMGB1 as well as subsequent inflammatory cascade of macrophages in a mitochondrial-nuclear H2O2 dependent manner. Scavenging nuclear H2O2 by overexpression of nucleus-targeting catalase (nCAT) effectively inhibited BCAA-induced inflammation in macrophages. All of the results above illustrate that elevated BCAA promotes AS progression by inducing redox-regulated HMGB1 translocation and further proinflammatory macrophage activation. Our findings provide novel insights into the role of animo acids as the daily dietary nutrients in AS development, and also suggest that restricting excessive dietary BCAA consuming and promoting BCAA catabolism may serve as promising strategies to alleviate and prevent AS and its subsequent CHD.

目的 探索基于常规教学+"雨课堂+翻转课堂"的混合式教学在医学本科生《血压测量》实践课程中的应用和效果.方法 以《血压测量》课程为例,针对2018级五年制临床、航医、医学心理学专业159名学员采取常规教学模式上课(对照组),2019级五年制口腔、基础医学专业50名学员,采取常规教学+"雨课堂"模式上课(实验1组),2019级五年制临床、航医、医学心理学专业53名学员,采用常规教学+"雨课堂+翻转课堂"混合教学授课(实验2组).通过随堂测验得分、教学效果和学员评价等三项维度开展课堂调查分析,综合比较不同教学模式的有效性.结果 与常规教学比较,采用常规教学+"雨课堂+翻转课堂"混合教学授课学生在随堂测验得分、课堂教学评价和学生评价三个方面均明显更高(P＜0.05,P＜0.01).结论 使用基于常规教学+"雨课堂+翻转课堂"的混合教学模式不仅能提高学生血压测量技能,而且加强了学生对临床医学知识的掌握和学习的主动性,有效提高教学质量.

1临床资料 患者,女性,77岁.主诉:气短、气喘1月余,加重10d.患者1月前劳累后出现气促、气短、口唇和指甲发绀,伴双下肢水肿、乏力、腹胀、纳差,无咳嗽、咳痰、咯血等症状,遂就诊于富平县医院治疗,诊断为"肺心病",给予吸入"信必可"后症状改善.10 d前无诱因气短、气喘加重,出现夜间阵发性呼吸困难,坐位或半卧位可缓解,自觉在安静状态下亦有体力活动完全受限,遂来我院诊治,胸部CT示:左肺下叶条索灶,右侧膈肌升高.肺动脉血管成像未见异常.肺灌注成像提示左肺上叶尖端血流灌注减低;四肢血管超声提示双下肢皮下组织水肿增厚;心脏超声提示,三尖瓣收缩期可见约1 mm关闭不全间隙,彩色血流提示:三尖瓣反流,长度 4.1 cm,面积 5.5 cm2,容积 6.4 ml,Vmax 374 cm/s,Pgmax 56 mmHg(1 mmHg=0.133 kPa).脉冲多普勒录得舒张期正向双峰层流频谱,E峰86 cm/s,A峰113 cm/s,E/A＜1.肺动脉收缩压约62 mmHg肺功能提示极重度混合性通气功能障碍,支气管舒张试验阴性,动脉血气提示:PO253 mmHg、PCO242 mmHg.呼出气 NO 浓度均值:15 ppb.见表1.

Background:: Accurate measurement of intracoronary blood flow rate is of great significance for the diagnosis of ischemic heart disease (IHD). Computational fluid dynamic (CFD) method, combining coronary angiography images and fractional flow reserve (FFR), provides a new way to calculate the mean flow rate. However, due to the incomplete boundary conditions obtained by FFR, side branches were ignored which was likely to have a significant impact on the accuracy. In this paper, a novel CFD based method for calculating the mean intra-coronary flow rate under incomplete pressure boundary conditions was proposed, in order to improve the ac-curacy by including the side branches. Methods: : A pressure-flow curve based flow resistance model was employed to model resistance of the epicardial arteries. A series of steady flow simulations were performed to extract the parameters of the flow resistance model, which implicitly specified constraints for splitting flow between branches and thus enabled the mean intracoronary blood flow rate to be calculated in two or more branches under incomplete pressure boundary conditions. Simulation experiments were designed to validate the proposed method in both idealized and reconstructed 3D models of coronary branches, and the impact of the assumed coefficient of the Murray's Law for splitting flow between branches was also investigated. Results:: The mean percentage error of the proposed method was +2.05%+/- 0.04% for idealized models and +2.24%+/- 0.01% for reconstructed models, and it was much lower than that of the method ignoring side branches (+38.48%+/- 10.45% for idealized models and +30.54%+/- 6.12% for reconstructed models). When the assumed coefficient of the Murray's Law was inconsistent with the real blood flow condition, the percentage errors still maintained less than about 3.00%. Conclusions: : The proposed method provided an easy and accurate way to measure the mean intracoronary flow rate and would facilitate the accurate diagnosis of IHD.

目的 探讨冠状动脉慢性完全闭塞(CTO)病变经皮冠状动脉介入治疗(PCI)对老年多支CTO病变患者症状和生活质量的影响.方法 连续纳入2018年4月至2021年4月于中国人民解放军空军军医大学第一附属医院成功接受择期CTO-PCI的多支CTO病变患者284例,并根据年龄分为老年组(＞65岁,106例)和非老年组(≤65岁,178例).收集两组患者的术前资料、术前生活质量评估、冠状动脉造影结果和术中数据、院内并发症及1个月和1年的随访数据.通过分析患者CTO-PCI术后1个月和1年后欧洲五维健康量表(EQ-5D)、生命质量SF-12量表和西雅图心绞痛量表(SAQ)分数与主要不良心血管事件(MACE)发生情况,评估成功CTO-PCI对老年多支CTO病变患者的生活质量和症状的影响.结果 老年组与非老年组成功行CTO-PCI术后1个月MACE发生率分别为15.53％和10.98％,术后1年MACE发生率分别为23.71％和15.95％,差异均无统计学意义(均P＞0.05).两组患者术后1个月和1年SAQ量表的心绞痛稳定性(SAQ-AS)、心绞痛频率(SAQ-AF)、治疗满意度(SAQ-TS)明显改善,老年组术后1个月和1年SAQ量表的疾病感知(SAQ-DP)也明显改善,差异均有统计学意义(均P＜0.05).老年组术后1年SAQ量表的身体限制(SAQ-PL)[0(-15.56,11.11)比2.22(-8.89,13.33),P=0.021]和SAQ-AS[12.50(0,50.00)比25.00(0,50.00),P=0.019]评分变化量小于非老年组,差异均有统计学意义.两组患者术后1个月和1年EQ-5D评分较术前均显著升高(均P＜0.05),但两组间比较差异均无统计学意义(均P＞0.05).两组患者术后1个月和1年SF-12量表的身体功能成分得分(PCS)均较术前升高(均P＜0.001),老年组术后1个月的心理功能成分得分(MCS)也较术前升高[(55.91±3.99)比(53.76±6.68),P=0.005],差异均有统计学意义.结论 成功的CTO-PCI可以显著缓解老年多支CTO病变患者症状并改善其生活质量,对老年多支CTO病变患者及时行CTO-PCI是相对安全且必要的.

目的：比较采用Corsair微导管和CrossBoss导管引导的正向夹层重入（ADR）技术在冠状动脉慢性完全闭塞（CTO）病变经皮冠状动脉介入治疗（PCI）中的应用结果，验证Corsair微导管用于建立内膜下通道的安全性和有效性。方法：连续入选2016年4月至2020年12月于中国人民解放军空军军医大学第一附属医院心血管内科接受CTO PCI并使用Corsair微导管（Corsair组）或CrossBoss导管（CrossBoss组）引导的ADR患者141例，接受符合入选标准的CTO PCI 144例次。记录两组患者的临床资料、CTO靶病变特征、CTO PCI术中结果、院内主要不良心脑血管事件（MACCE）和并发症，并分析组间主要终点ADR技术成功率，次要终点导丝操控时间、PCI时间、策略使用次数、导丝用量、对比剂用量、院内MACCE和并发症的差异。结果：144例次CTO PCI入选本研究，Corsair组和CrossBoss组各72例次。Corsair组技术成功率（94.4%vs.77.8%,P=0.004）、ADR技术成功率（83.3%vs. 66.7%,P=0.021）均高于CrossBoss组，而策略使用次数[（2.0±0.6）次vs.（2.2±0.7）次，P=0.017]、导丝用量[（7±3）根vs.（9±3）根，P＜0.001]、导丝操控时间[71（48,103） min vs.85（57,139） min,P=0.027]均少于CrossBoss组，两组间PCI时间[146（114,193）min vs. 148（94,192）min,P=0.644]和对比剂用量[445（370,535） ml vs. 415（320,518） ml,P=0.313]差异均无统计学意义。院内MACCE发生率为4.2%（6/144）,ADR相关穿孔发生率为2.1%（3/144），分支丢失率为3.5%（5/144），两组间上述安全指标的差异均无统计学意义（P均＞0.05）。结论：相比CrossBoss导管，经验丰富的术者实施Corsair微导管引导的ADR，可获得更高的成功率，更少的策略和导丝使用数，更短的导丝操控时间，而院内MACCE和并发症发生率无差异。

目的 探讨干扰长链非编码RNA STX18-AS1(long non-coding RNA,LncRNA STX18-AS1)是否通过上调微小RNA-204(miR-204)的表达从而影响心肌细胞缺氧损伤.方法 体外培养心肌细胞H9C2,采用二氯化钴(CoCl2)处理心肌细胞建立细胞缺氧损伤模型,采用qRT-PCR检测CoCl2处理不同时间点STX18-AS1、miR-204 的表达量;实验设置对照组、模型组、si-NC组、si-STX18-AS1组、miR-NC组、miR-204组.采用甲基噻唑基四唑(MTT)检测细胞增殖活性;流式细胞术与TUNEL检测细胞凋亡率;采用生化试剂盒检测乳酸脱氢酶(LDH)活性、丙二醛(MDA)水平、超氧化物歧化酶(SOD)活性、过氧化氢酶(CAT)活性;双荧光素酶报告实验验证STX18-AS1、miR-204的靶向关系.结果 与对照组比较,在CoCl2处理6 h、12 h、18 h、24 h时模型组和si-NC组STX18-AS1表达水平升高(P＜0.01),miR-204表达水平降低(P＜0.01);与模型组、si-NC组比较,在CoCl2处理6h、12h、18h、24 h时si-STX18-AS1组STX18-AS1的表达水平降低(P＜0.01),miR-204的表达水平升高(P＜0.01);与对照组比,模型组、si-NC组细胞增殖活性降低(P＜0.01),细胞凋亡率及LDH活力、MDA的水平升高(P＜0.01),SOD、CAT的活力降低(P＜0.01);与模型组、si-NC组比较,si-STX18-AS1组细胞增殖活性升高(P＜0.01),细胞凋亡率及LDH活力、MDA的水平降低(P＜0.01),SOD、CAT的活力升高(P＜0.01);转染miR-204 mimics对心肌细胞增殖活性、凋亡及氧化应激的作用与转染si-STX18-AS1的作用相同;双荧光素酶报告实验证实STX18-AS1可靶向结合miR-204.结论 干扰STX18-AS1表达可能通过上调miR-204,抑制细胞凋亡、促进增殖,减轻CoCl2 诱导的心肌细胞氧化损伤.