A 49-year-old woman with chronic total occlusion of the proximal left anterior descending (LAD) artery underwent a baseline 18 F-FAPI PET/CT, and showed no abnormal uptake in the coronary artery. New focal 18 F-FAPI activity appeared at the LAD stent ostium at 6 months and progressed by 1 year, preceding angiographically confirmed in-stent restenosis. This case demonstrates that 18 F-FAPI imaging may detect early fibro-inflammatory activity predictive of restenosis.

Cardioneuroablation (CNA) is a novel procedure that shows promising results in patients with functional bradyarrhythmia, including functional sinus node dysfunction (SND) and atrioventricular block (AVB). We performed a systematic review and meta-analysis to evaluate the efficacy and safety of CNA in this population. PubMed, Embase and Web of Science were searched from January 2005 to August 2025 following PRISMA guidelines. A single-arm proportion meta-analysis was performed using a random effects model. Nineteen observational studies comprising 482 patients with functional bradyarrhythmia who underwent CNA were included (mean age 38.1 ± 5.1 years; 55.7% male). Over a mean follow-up of 16.3 ± 3.6 months, the pooled recurrence rate was 13.1% (95% confidence interval [CI] 9.5% - 17.8%; I2 = 0%) and the pooled complication rate was 1.0% (95% CI 0.1% - 9.1%; I2 = 0%). Subgroup analyses suggested lower recurrence rates with functional SND (9.7% [6.3%-14.6%]; I2 = 0%), biatrial ablation (11.0% [6.7%-17.5%]; I2 = 10.7%), and the use of extracardiac noncontact vagal stimulation (ECVS) (8.3% [2.7%-22.9%]; I2 = 0%). No significant differences were observed among techniques used to identify ganglionated plexi (p = 0.938). Data synthesis indicated a non-significant trend towards increased heart rate, as well as shorter sinus node recovery time (SNRT) and corrected SNRT after CNA. These findings support that CNA may be effective and safe in functional SND and AVB; however, the overall certainty of evidence is low, and larger, well-designed clinical trials are required to inform future guideline recommendations.

BACKGROUND:Autonomic function may play a crucial role in the pathogenesis of vasovagal syncope (VVS). However, the characteristics of autonomic function across different VVS subtypes remain unclear. Deceleration capacity (DC), a novel vagal indicator, may offer improved discriminatory value. OBJECTIVE:To evaluate the ability of DC to distinguish between different subtypes of VVS. METHODS:Patients with VVS confirmed by a positive head-up tilt test were included. All heart rate variability (HRV) and DC data were obtained from 24-h Holter monitoring and analyzed among different subtypes using ANOVA, logistic regression, and ROC analyses. A DC-based subtype prediction model was further developed. RESULTS:Among 141 patients (40 ± 18 years; 54 males), 36 (25.5%) had cardioinhibitory VVS, 20 (14.2%) vasodepressor, and 85 (60.3%) mixed type. Significant differences across subtypes were observed in minimum HR, maximum HR, SDNN, VLF, LF/HF and DC (all p < 0.05). Among these parameters, DC showed the strongest discriminatory ability in differentiating patients with cardioinhibitory responses (cardioinhibitory and mixed types) from those without (vasodepressor type), outperforming traditional HRV indices (p < 0.05). A predictive model based on daytime DC achieved an AUC of 0.811 (95% CI: 0.731-0.89). Each 1-ms increase in daytime DC was associated with a 33.3% higher odds of a cardioinhibitory response. CONCLUSION:Baseline autonomic function varies among VVS subtypes and vagal indicators like DC might help predict patient subtypes.

BACKGROUND:Cardioneuroablation has been proposed to be effective in patients with vasovagal syncope, whereas the preferred ablation strategy is undetermined. OBJECTIVES:This study aimed to determine the preferred ablation strategy of cardioneuroablation between the left atrial (LA) and the bilateral atrial (BiA) approach. METHODS:This study was a prospective randomized clinical trial to compare the efficacy of 2 ablation strategies for patients with vasovagal syncope. The participants were randomly assigned to either the LA or BiA ganglion plexus ablation group in a 1:1 ratio. RESULTS:Eighty participants (37 men [46.2%]; age 38 ±16 years) were enrolled, with 40 participants in each group. The efficacy was 87.5% in the LA group (95% CI: 76.8 to 98.2%) and 90% (95% CI: 80.7 to 99.7%) in the BiA group (P = 0.723; P for noninferiority = 0.001). Compared to the BiA group, LA group reduced the average procedure time by 13 minutes (95% CI: 6-20 minutes), the average x-ray dosage by 5.7 mGy (95% CI: 2.1-9.3 mGy), the average ablation lesions by 4 (95% CI: 2-6), and ablation time by 125 seconds (95% CI: 60-190 seconds). No significant difference was observed in presyncope recurrence rate (15% vs 10%; P = 0.498), quality of life (78.7 ± 13.6 vs 80.9 ± 10.6; P = 0.417), mean heart rate (79 ± 11 vs 77 ± 9; P = 0.391), and response to head-up tilt test (57.1% vs 62.2%; P = 0.664) between groups at 12 months. CONCLUSIONS:The LA approach's efficacy was noninferior to the BiA approach, whereas the LA approach showed the added benefit of reduced procedure time, a smaller ablation lesion, and smaller x-ray dosage. (Different Catheter Ablation Strategy in Vasovagal Syncope; NCT05573178).

Current treatment strategies for vasovagal syncope (VVS) patients recommended by the guidelines are diverse, but effects of these therapies are still unsatisfactory with respective limitations on the indications. Cardioneuroablation (CNA), an innovative and promising therapy, has shown potently effective against syncopal recurrences in numerous observational studies. Recently, a single‐center randomized clinical trial has reported CNA was superior to non‐pharmacologic therapy for VVS patients. Therefore, this study is designed to compare the efficacy of CNA with pharmacologic treatment in a multicenter and randomized fashion. The Cardioneuroablation versus Midodrine in Patients with Vasovagal Syncope (CAMPAIGN) study is an international multicenter, prospective, open-label, randomized controlled trial. The recurrent VVS patients with a positive response to tilt testing despite sufficient conventional treatment will be predominantly enrolled at different medical centers in China, Russia, and Turkey. All eligible participants will be randomized in a ratio of 1:1 to treatment with CNA versus midodrine, and followed up for 12 months after randomization. Approximately 184 subjects are projected to enroll from April 2023 to December 2024 with follow-up until 2025. The primary endpoint is the recurrence rate of syncope at 12 months of follow-up. The secondary endpoints are comprised of quality of life assessed with the Impact of Syncope on Quality of Life, tilt-induced syncope, blood pressure, cardiac deceleration capacity, and heart rate variability. A prospective and multicenter clinical trial to compare outcomes of CNA with drug therapy is still lacking. The CAMPAIGN study will provide outcome-based evidence for VVS treatment strategy. Clinicaltrials.gov: NCT05803148 (Date: March 9, 2023).

Increased vagal activity plays a prominent role in vasovagal syncope (VVS). The aim of this study was to characterize vagal function in VVS by evaluating the heart rate (HR) deceleration capacity (DC) and the HR deceleration runs (DRs) in patients with VVS between attacks. A total of 188 consecutive VVS patients were enrolled in the study, of whom 129 had positive head-up tilt test (HUTT); 132 healthy participants were enrolled as controls. DC, DRs (DR2, i.e., episodes of 2 consecutive beat-to-beat HR decelerations), and the sum of DR8-10 (very long DR [VLDR]) were calculated using 24-h electrograms. Clinical characteristics, DC, and DRs were compared among syncope groups and controls. Patients with VVS had higher DC (10.63 ± 2.1 vs. 6.58 ± 1.7 ms; P < 0.001) and lower minimum HR and DR6-10 than controls. No significant differences in DC or DR6-10 were found between the patients with positive and those with negative HUTT results. In multivariate logistic regression analysis, minimum HR ≥ 40 bpm (odds ratio [OR] 0.408, 95

BACKGROUND Cardioneuroablation (CNA) has shown encouraging results in patients with vasovagal syncope (VVS). However, data on different subtypes was scarce. METHODS This observational study retrospectively enrolled 141 patients [mean age: 40 ± 18 years, 51 males (36.2%)] with the diagnosis of VVS. The characteristics among different types of VVS and the outcomes after CNA were analyzed. RESULTS After a mean follow-up of 4.3 ± 1.5 years, 41 patients (29.1%) experienced syncope/pre-syncope events after CNA. Syncope/pre-syncope recurrence significantly differed in each subtype (P = 0.04). The cardioinhibitory type of VVS had the lowest recurrence rate after the procedure (n = 6, 16.7%), followed by mixed (n = 26, 30.6%) and vasodepressive (n = 9, 45.0%). Additionally, a significant difference was observed in the analyses of the Kaplan-Meier survival curve (P = 0.02). Syncope/pre-syncope burden was significantly reduced after CNA in the vasodepressive type (P < 0.01). Vasodepressive types with recurrent syncope/pre-syncope after CNA have a lower baseline deceleration capacity (DC) level than those without (7.4 ± 1.0 ms vs. 9.0 ± 1.6 ms, P = 0.01). Patients with DC < 8.4 ms had an 8.1 (HR = 8.1, 95% CI: 2.2–30.0, P = 0.02) times risk of syncope/pre-syncope recurrence after CNA compared to patients with DC ≥ 8.4 ms, and this association still existed after adjusting for age and sex (HR = 8.1, 95% CI: 2.2–30.1, P = 0.02).CONCLUSIONS Different subtypes exhibit different event-free rates. The vasodepressive type exhibited the lowest event-free rate, but those patients with DC ≥ 8.4 ms might benefit from CNA.

Background: Female patients are underrepresented in randomized controlled clinical trials and registries of ventricular arrhythmia (VA). Personalized prevention and therapies require an understanding of sex differences in risk factors and prognosis of VA. Objective: We aimed to assess sex differences in the incidence, risk factors, and mortality of VA in congestive heart failure (HF) patients. Methods: This study included 10,889 patients (mean [SD] age, 73.8 [13.4] years; 5917 [53.8%] male) with congestive HF, of which 1555 (14.3%) patients developed VA during hospitalization. VA incidence, potential risk factors, and in-hospital mortality were evaluated in both sexes. Results: Men were more strongly associated with incident VA compared with women (odds ratio [OR]: 2.006, 95% CI: 1.790-2.248, p < 0.001). Thirteen potential predictors, which accounted for 91.0% of the risk of VA in men and 88.2% in women, were included in this study. There were significant interactions by sex in the asso-ciation between incident VA, atrial fibrillation (AF) (relative risk ratio = 0.730, 95% CI: 0.571-0.933, interaction p = 0.012), and non-ischemic cardiomyopathy (NICM) (relative risk ratio = 1.391, 95% CI: 1.029-1.872, interaction p = 0.030). Congestive HF patients developed with VA had an approximately 1.5-fold risk of in -hospital mortality, which was not affected by sex. Conclusions: In congestive HF patients, incident VA was an independent risk factor of in-hospital mortality, and male sex was strongly associated with an increased risk of VA. Awareness of sex differences in the association of AF and NICM with VA may enhance therapeutic decisions, thus improving their clinical outcomes.

BACKGROUND Renal denervation (RDN) is a promising treatment based on catheter intervention for patients with refractory hypertension. However, the effect in patients with isolated systolic hypertension (ISH) remains controversial. The aim of this meta-analysis was to determine the blood pressure lowing effect of RDN in patients with ISH compared with combined systolic/ diastolic hypertension (CH) patients. METHODS PubMed, Embase, Cochrane and ClinicalTrials.gov were searched for prospective clinical studies that included RDN. The outcomes of interest were the change of 24-hour ambulatory systolic blood pressure (SBP) from baseline. We used the fixed effects model to calculate weighted mean difference (WMD) with 95% confidence interval (CI). RESULTS Six trials were included, with 1405 participants, including 597 patients with ISH and 808 patients with CH. Mean follow-up was five months. The reduction of 24-hour ambulatory SBP was significantly greater for the CH patients than the ISH patients (WMD = 3.89, 95% CI: 2.32-5.45, P < 0.0001). RDN also showed a greater reduction in office SBP in the CH patients compared to the ISH patients (WMD = 10.24, 95% CI: 4.24-15.74, P = 0.0003). And the effect was independent of age, length of follow-up, and ablation device. CONCLUSIONS RDN provides superior blood pressure control in the CH patients compared with the ISH patients, and the CH patients may be the best suitable population for which RDN is indicated.

目的:探讨自主神经活动评估指标与难治性血管迷走性晕厥(VVS)患者心脏去神经消融术后复发的相关性.方法:入选2017年8月至2020年5月在中国医学科学院阜外医院行心脏去神经消融术的难治性VVS患者147例,其中 38 例(25.8％)出现晕厥或晕厥前兆的复发(复发组),109 例(74.2％)未复发(未复发组).比较术后复发组与未复发组患者的心率变异性(HRV)、心率减速力(DC)、连续心率减速力(DRs)的差异性.结果:与未复发组相比,复发组患者男性比例更低(50.1％vs.26.3％,P=0.012),收缩压更低[(121.75±13.60)mmHg(1mmHg=0.133kPa)vs.(115.00±16.11)mmHg,P=0.004];复发组患者的基线全天DC[(10.33±3.01)ms vs.(8.28±4.01)ms,P=0.008]、日间DC[(10.09±3.13)ms vs.(7.97±4.12)ms,P=0.001]、夜间DC[(11.50±3.34)ms vs.(9.83±3.69)ms,P=0.020]均较低.两组患者的心率变异性分析—时域分析和频域分析相关指标差异均无统计学意义;两组患者的DRs指标全天连续心率减速力(ADR)1～ADR10 差异均无统计学意义(P均>0.05).多因素Logistic回归分析显示,性别、收缩压及日间DC是心脏去神经消融术后晕厥/晕厥前兆复发的独立危险因素.结论:VVS患者间存在迷走神经活动的差异.DC、HRV和DRs在自主神经功能评估中各有优势,相互补充.

Background: Mechanically ventilated patients with congestive heart failure (CHF) are at high-risk of mortality. We aimed to develop and validate a prediction model based on machine learning (ML) algorithms to predict hospital mortality in mechanically ventilated patients with CHF. Methods: Least absolute shrinkage and selection operator (LASSO) regression was used to identify the key features. Hyperparameters optimization (HPO) was conducted to modify the prediction model. The area under the receiver operating characteristic curve (AUC), accuracy, calibration curve and decision curve analysis were used to evaluate prediction performance. The final model was validated using an external validation set from another database. The prediction results were represented by a nomogram. Results: A total of 4530 qualified patients were included. Among 11 ML-algorithms, CatBoost showed the best prediction performance (AUC = 0.833). And 10 key features (10/63) were selected based on the LASSO regression. After HPO, the prediction performance of the CatBoost model based on the key features was significantly improved (AUCs: 0.805 vs. 0.821). Additionally, the CatBoost model also showed the satisfactory prediction performance in the external validation set (AUC = 0.806). Conclusion: The present study developed and validated a CatBoost model, which could accurately predict hospital mortality in mechanically ventilated patients with CHF.

目的 了解中国医师对于非维生素K拮抗剂口服抗凝药(NOAC)知识的掌握情况,为医学继续教育提供依据.方法 通过现场问卷调查收集2019年第三十届长城心脏病学会议参会医师信息,包括人口学资料、临床工作特点10道题目和NOAC知识20道题目.NOAC知识题目正确作答比例≥80％定义为知晓良好.结果 收集有效问卷578份.被调查医师中,华北地区医师数量最多(39.4％),男性占50.9％.NOAC知识知晓良好率为39.1％.知晓率较低问题包括:患者服药过量的处理措施(10.0％)、单次漏服药物危害(31.1％)、减低服药期间副作用发生率的方法(38.1％).多因素Logistic回归分析提示具有博士学位[优势比(OR)=3.70,95％置信区间(CI):1.49～9.17,P<0.01]、执业于三级甲等医疗机构(OR=1.51,95％CI:1.07～2.13,P<0.05)更倾向于知晓良好.执业地点位于西部地区更倾向于知晓不良(OR=0.42,95％CI:0.27～0.66,P<0.01).结论 中国医师所掌握的NOAC知识匮乏,尤其不了解过量服用时的处理措施、漏服危害及降低副作用发生率的方法.未来可针对特定人群开展NOAC相关知识继续教育.

Backgrounds Decreased urine output (UO) is associated with adverse outcomes in certain patients, but this effect in patients admitted for cardiovascular diseases is still unproven. Moreover, the relationship between increased UO and prognosis is also unclear. Objective To investigate the relationship between decreased or increased UO and outcomes in patients with the cardiovascular intensive care unit (CICU). Methods This study was a retrospective cohort analysis based on the medical information mart for intensive care III (MIMIC-III) database. The patients' data were extracted from the Beth Israel Deaconess Medical Center (Boston, MA) between 2001 and 2012. With the initial 24-h UO range from 0.5 to 1.0 ml/kg/h as the reference, participants were divided into the several groups. The primary outcome was 30-day mortality. The secondary outcomes were 90-day mortality, ICU mortality, hospital mortality, use of mechanical ventilation (MV), and vasopressor agents in the first 24-h of ICU. The association between UO and mortality was assessed by multivariable logistic regression. Results A total of 13,279 patients admitted to CICU were included. Low UO (< 0.5 ml/kg/h) was strongly associated with 30-day mortality (unadjusted OR = 3.993, 95% CI: 3.447–4.625, p < 0.001), and very high UO (≥ 2.0 ml/kg/h) was also a significantly risk factor for 30-day mortality (Unadjusted OR = 2.069, 95% CI: 1.701–2.516, p < 0.001) compared with the reference. The same effects also were shown in the multivariable logistic regression, adjusted by age, gender, vital signs, common comorbidities, and use of diuretics, with an adjusted OR of 2.023 (95% CI: 1.693–2.417, p < 0.001) for low UO and 1.771 (95% CI: 1.389–2.256, p < 0.001) for very high UO. Moreover, both decreased UO and increased UO were risk factors for 90-day mortality, ICU mortality, hospital mortality, use of MV and vasopressor agents. Conclusion The decreased and increased UO both were significantly associated with short-term mortality, the relationship between UO and mortality was U-shape rather than linear.

Background Mechanical ventilation (MV) is widely used to relieve respiratory failure in patients with congestive heart failure (CHF). Prolonged MV (PMV) is associated with a poor prognosis. We aimed to establish a prediction model based on machine learning (ML) algorithms for the early identification of patients with CHF requiring PMV. Methods Twelve commonly used ML algorithms were used to build the prediction model. The least absolute shrinkage and selection operator (LASSO) regression was employed to select the key features. We examined the area under the curve (AUC) statistics to evaluate the prediction performance. Data from another database were used to conduct external validation. Results We screened out 10 key features from the initial 65 variables via LASSO regression to improve the practicability of the model. The CatBoost model showed the best performance for predicting PMV among the 12 commonly used ML algorithms, with favorable discrimination (AUC = 0.790) and calibration (Brier score = 0.154). Moreover, hospital mortality could be accurately predicted using the CatBoost model as well (AUC = 0.844). In the external validation, the CatBoost model also showed satisfactory prediction performance (AUC = 0.780), suggesting certain generalizability of the model. Finally, a nomogram with risk classification of PMV was shown in this study. Conclusion The present study developed and validated a CatBoost model, which could accurately predict PMV in mechanically ventilated patients with CHF. Moreover, this model has a favorable performance in predicting hospital mortality in these patients.

BACKGROUND Cardioneuroablation is an emerging therapy for refractory vasovagal syncope (VVS), but the standard enrollment criterion is undetermined. Mainstream studies empirically enroll patients with cardioinhibitory and mixed types of VVS on the basis of the head-up tilt (HUT). However, a variety of studies have shown that the results of HUT exhibit unpleasant reproducibility. OBJECTIVE We aimed to investigate the prognostic value of baseline deceleration capacity in patients with refractory VVS after cardioneuroablation. METHODS This study enrolled 123 patients (mean age 42.2 +/- 17.7 years; 54 males [43.9%]) with the diagnosis of VVS, of whom 16 patients had a negative result of HUT (13.0%), 8 (6.5%) had vasodepressive VVS, 32 (26.0%) cardioinhibitory VVS, and 67 (54.5%) mixed VVS. All patients underwent cardioneuroablation that was performed in the left atrium. RESULTS After a mean follow-up of 4.0 +/- 1.1 years, 33 patients experienced syncope/presyncope events (26.8%). Patients with recurrent syncope/presyncope have a lower baseline deceleration capacity level than do those without (8.9 +/- 3.2 ms vs 11.3 +/- 3.7 ms; P < .001). Each 1-ms increase in deceleration capacity had a 34% (95% confidence interval [CI] 12%-50%) reduced risk of syncope/presyncope recurrence after cardioneuroablation. Nighttime deceleration capacity had the highest discrimination value (area under the curve 0.757; 95% confidence interval 0.657-0.858). At a high-risk threshold of 51% (nighttime deceleration capacity at a cutoff of 9.9 ms), the nighttime deceleration capacity enrollment strategy additionally benefited 18 per 100 patients after cardioneuroablation without syncope/presyncope recurrence as compared with the HUT strategy in decision curve analyses. CONCLUSION Baseline nighttime deceleration capacity > 10 ms may act as an indication for cardioneuroablation in patients with refractory VVS.

目的 探讨伴心房颤动(房颤)的老老年高血压患者降压药服药依从性不良的影响因素.方法 连续入选2018年10月至2019年2月期间在阜外医院就诊的合并房颤的老老年高血压患者共110例.通过电子病历系统收集患者一般情况及临床资料,应用量表评估患者焦虑、抑郁、认知功能状态、社会支持度以及降压药服药依从性.根据依从性的不同将患者分为依从性良好组与依从性不良组.比较两组患者一般情况及临床资料,行Logistic回归分析明确依从性不良预测因素.结果 107例患者完成问卷,41.1％的患者服用降压药依从性不良.多因素Logistic分析提示,抑郁、认知功能损害为依从性不良的预测因素[优势比(odds ratio,OR)= 4.16,95％置信区间(confidence interval,CI)1.39～12.44,P＜0.05;OR=4.26,95％CI 1.39～12.98,P＜0.05],焦虑、开展服药自我提醒以及社会支持评分＞35分是依从性良好的预测因素(OR=0.23,95％CI0.08～0.69,P＜0.01;OR=0.17,95％CI0.04～0.62,P＜0.01;OR=0.16,95％CI 0.06～0.45,P＜0.01).结论 伴房颤的老老年高血压患者降压药服药依从性总体不良.抑郁和认知功能损害为依从性不良的预测因素,焦虑和开展服药自我提醒以及社会支持评分＞35分是依从性良好的预测因素.

目的:探讨不同性别患者发生血管迷走性晕厥(vasovagal syncope,VVS)的诱发因素和前驱症状的差异.方法:入选直立倾斜试验阳性的VVS患者128例(男性51例,女性77例),比较不同性别患者的晕厥诱因、前驱症状及对直立倾斜试验反应的差别.结果:(1)VVS诱因:排尿作为诱因的晕厥发生率男性高于女性(33.3％vs.5.2％,P=0.001);(2)VVS前驱症状:男性出汗(7.8％vs.18.2％,P=0.048)和胸闷(39.2％vs.66.2％,P=0.003)的发生率低于女性;(3)直立倾斜试验反应时间:药物激发阶段80％的直立倾斜试验阳性结局出现在7.5(5.0,10.0)min,女性患者出现阳性反应的时间早于男性患者(7.5 min vs.10.0 min,P=0.004).结论:女性VVS患者胸闷和出汗发生率高于男性;排尿作为诱因的晕厥发生率男性高于女性,男性混合型VVS的直立倾斜试验平均反应时间较女性延长.