Background:The Venus A valve is a first-generation self-expanding valve used in China for transcatheter aortic valve replacement (TAVR). However, data on its efficacy and safety remain limited. The present study assessed the efficacy and safety of the Venus A valve in Chinese patients undergoing TAVR. Methods:A single-arm meta-analysis was performed, and relevant studies were systematically retrieved from PubMed, Embase, Web of Science, the Cochrane Library, ClinicalTrials.gov, and Google Scholar from inception until 1 June 2022. Domestic libraries were not searched due to data overlap. All study types evaluating the Venus A valve were considered for inclusion, except case reports or reviews. Non-English language studies or those without corresponding data were excluded. The Newcastle-Ottawa scale (NOS) was used to evaluate the included retrospective studies, and the methodological index for non-randomized studies (MINORS) was used to assess the included non-randomized study (single-arm study). The random-effects model was used to calculate the combined proportion and 95% confidence interval (CI) when I 2 was >50%; otherwise, a fixed-effect model was used. Publication bias was assessed using the Egger test, with P < 0.05 indicating potential bias. Results:This meta-analysis included 15 studies involving 1,144 Chinese patients who underwent TAVR with a Venus A valve. The device/procedure success rate was 90%. The mean transvalvular gradient decreased from 58.52 to 10.85 mmHg, and the peak jet velocity decreased from 4.86 s to 2.23 m/s. At the 30-day follow-up evaluation, the all-cause mortality rate was 3%. The requirement for a second valve accounted for 12% of cases. Major vascular complications were uncommon, as were major bleeding, stroke, acute kidney injuries, and new-onset atrial fibrillation. At the 1-year follow-up evaluation, the all-cause mortality rate was 7%. The incidence of new permanent pacemaker implantation in patients with bicuspid aortic valves was 16%, and the all-cause mortality rate was 8% at the 30-day follow-up evaluation. Conclusions:Despite its relatively high requirement for a second valve, the Venus A valve is feasible for Chinese patients undergoing TAVR. Its effectiveness and safety were demonstrated by a high device/procedure success rate, immediate hemodynamic improvement, and low incidence of complications.

BACKGROUND:Vulnerable plaque rupture is a major mechanism underlying acute coronary events, but imaging-based risk assessment using individual plaque features remains limited. The histology-derived vulnerability index (VI) integrates multiple plaque components and is associated with adverse cardiovascular outcomes but requires ex vivo assessment. Optical coherence tomography (OCT) enables high-resolution in vivo plaque characterization, and the OCT-derived index of plaque attenuation (IPA) may provide a quantitative measure of integrated plaque vulnerability. AIMS:This study aimed to determine the association between OCT-derived IPA and histological VI and to identify the histological plaque components contributing to IPA. METHODS:In 240 coronary blocks from 10 human cadaveric hearts, co-registered OCT and histology were performed. IPA was calculated from attenuation images. Histology quantified necrotic core, collagen, α-SMA+ area, and macrophages (CD68+, CD206+). Associations were assessed using correlation and multivariable regression. RESULTS:IPA at a 9 mm-1 threshold (IPA9) correlated with VI (r = 0.714, p < 0.001) and discriminated high-VI blocks (AUC = 0.852). CD68+ macrophage area (β = 17.20, p < 0.001) and necrotic core (β = 1.39, p = 0.013) predicted higher IPA, whereas collagen and α-SMA+ area were inversely associated. CD206+ areas were not independently related with IPA, but the CD206+/CD68+ ratio significantly improved IPA model performance (ΔR2 = 0.023, p = 0.004). CONCLUSIONS:OCT-derived IPA closely corresponds to histological VI and is primarily driven by necrotic core and pro-inflammatory macrophage infiltration. IPA may serve as a clinically obtainable quantitative OCT marker for integrated assessment of inflammation-weighted plaque vulnerability.

Objective: This study aimed to investigate the associations between dynamic C-reactive protein-triglyceride-glucose index (CTI) trajectories and incident cardiovascular disease (CVD) in middle-aged and older adults across cardiovascular-kidney-metabolic syndrome (CKM) stages 0-3, with a particular focus on comparing the effects of increasing versus decreasing CTI trajectories, even when cumulative exposure was similar. Methods: This prospective cohort study utilized data from the China Health and Retirement Longitudinal Study. CTI was calculated from high-sensitivity C-reactive protein, triglycerides, and fasting glucose. An optimal risk-stratification threshold for baseline CTI was identified by selecting the cut-off that maximized separation of survival outcomes in Cox regression and was used to classify participants into four CTI trajectory groups. Cox proportional hazards models were applied to evaluate the associations of CTI trajectories and cumulative CTI with incident CVD among participants in CKM stages 0-3, adjusting for potential confounders. Exploratory analyses compared clinical and lifestyle characteristics between the stable high and high to low CTI groups. Results: A baseline CTI value of 8.5 was identified as the optimal threshold for CVD risk stratification and used to define CTI trajectories. Among 3,580 participants (45.3% male; mean age 58.2 years) followed for a median of 5 years, participants in the highest tertile of cumulative CTI had a significantly increased risk of incident CVD compared to those in the lowest tertile (HR 1.29, 95% CI 1.04-1.59). When examining changes in CTI, participants whose CTI decreased from high to low exhibited a significantly reduced risk of incident CVD compared with those with persistently high CTI (HR 0.74, 95% CI 0.57-0.97). In contrast, those whose CTI increased from low to high showed a similar risk to the stable high group (HR 0.86, 95% CI 0.69-1.08), despite having similar cumulative CTI exposure. Exploratory analyses comparing the stable high and high to low groups suggested that keeping or returning a normal waist circumference and having higher total physical activity levels were associated with a greater likelihood of CTI decreasing from high to low. Conclusions: Among individuals with CKM stages 0-3, both high cumulative CTI and unfavorable CTI trajectories are associated with increased CVD risk, whereas a decline from high to low CTI is linked to risk reduction.

OBJECTIVE:The aim of this study was to evaluate the clinical forecasting potential of the Metabolic Score for Insulin Resistance (METS-IR) as a reliable predictor for in-stent restenosis (ISR) among patients receiving percutaneous coronary intervention (PCI). METHODS:A total of 818 patients undergoing repeat coronary angiography for recurrent chest pain after percutaneous coronary intervention from 2022 to 2025 were retrospectively collected. Clinical, blood and angiography-related data were analyzed. The predictive efficacy of METS-IR was assessed through both univariate and multivariate logistic regression analyses, along with receiver operating characteristic curves, for the evaluation of ISR (defined as 50% luminal narrowing) and severe ISR (defined as 70% luminal narrowing). RESULTS:There was a significant correlation between METS-IR and ISR. Patients with ISR >50% had higher METS-IR (42.30 ± 7.54 vs. 40.17 ± 6.31, p < 0.001), as did those with ISR >70% (43.05 ± 7.84 vs. 40.19 ± 6.29, p < 0.001). ISR prevalence increased with progressively across METS-IR tertiles (p < 0.001). Multivariate analysis confirmed METS-IR as an independent predictor of ISR (OR 1.28 for ISR >50%, 1.51 for ISR >70%, p < 0.05). ROC analysis identified an optimal METS-IR cutoff of 42.27 for ISR >50% and ISR >70% (sensitivity 50%, specificity 63%). Furthermore, incorporating the tertiles of METS-IR into the fully adjusted model significantly enhanced the ability to discriminate ISR. CONCLUSION:Our findings established that elevated METS-IR levels were strongly correlated with an increased risk of in-stent restenosis, with a markedly pronounced impact on severe ISR (>70%). METS-IR can serve as a straightforward and practical predictor for risk stratification after coronary stent implantation.

AIM:Remnant cholesterol (RC) has been recognized as a modifiable risk factor for cardiovascular disease (CVD). However, the association between long-term changes in RC during follow-up and incident CVD remains underexplored, with most research focusing on baseline RC levels. METHODS:Data for this prospective cohort study were derived from the China Health and Retirement Longitudinal Study (CHARLS). RC levels were calculated using the Friedewald equation. Changes in RC, cumulative RC, and the change in RC (ΔRC) were assessed by comparing RC levels at Waves 1 and 3. Cox proportional hazard models, adjusted for potential confounders, were used to evaluate the impact of baseline and dynamic RC levels on incident CVD risk. RESULTS:Among 3,866 participants (46.23% male, mean age: 57.50 years) followed for 5.0 years, participants with initially high RC who decreased to low levels showed reduced CVD risk (HR 0.71, 95% CI 0.54-0.94). Those with low baseline RC escalating to high levels showed similar risk (HR 0.85, 95% CI 0.68-1.06) compared to consistently high RC levels. Highest tertile cumulative RC significantly increased CVD risk (HR 1.37, 95% CI 1.11-1.69). Among high baseline RC participants, those in the lowest ΔRC tertile had reduced CVD risk (HR 0.68, 95% CI 0.52-0.89). CONCLUSIONS:Longitudinal RC increases were associated with higher CVD risks, while RC reductions were associated with decreased risks. RC monitoring and management may contribute to CVD risk assessment and prevention, though further research with direct RC measurement and clinically validated outcomes is needed.

Background:Medical informatics accumulated vast amounts of data for clinical diagnosis and treatment. However, limited access to follow-up data and the difficulty in integrating data across diverse platforms continue to pose significant barriers to clinical research progress. In response, our research team has embarked on the development of a specialized clinical research database for cardiology, thereby establishing a comprehensive digital platform that facilitates both clinical decision-making and research endeavors. Methods:The database incorporated actual clinical data from patients who received treatment at the Cardiovascular Medicine Department of Chinese PLA General Hospital from 2012 to 2021. It included comprehensive data on patients' basic information, medical history, non-invasive imaging studies, laboratory test results, as well as peri-procedural information related to interventional surgeries, extracted from the Hospital Information System. Additionally, an innovative artificial intelligence (AI)-powered interactive follow-up system had been developed, ensuring that nearly all myocardial infarction patients received at least one post-discharge follow-up, thereby achieving comprehensive data management throughout the entire care continuum for high-risk patients. Results:This database integrates extensive cross-sectional and longitudinal patient data, with a focus on higher-risk acute coronary syndrome patients. It achieves the integration of structured and unstructured clinical data, while innovatively incorporating AI and automatic speech recognition technologies to enhance data integration and workflow efficiency. It creates a comprehensive patient view, thereby improving diagnostic and follow-up quality, and provides high-quality data to support clinical research. Despite limitations in unstructured data standardization and biological sample integrity, the database's development is accompanied by ongoing optimization efforts. Conclusion:The cardiovascular specialty clinical database is a comprehensive digital archive integrating clinical treatment and research, which facilitates the digital and intelligent transformation of clinical diagnosis and treatment processes. It supports clinical decision-making and offers data support and potential research directions for the specialized management of cardiovascular diseases.

OBJECTIVES:Excimer laser coronary angioplasty (ELCA) is a safe and effective method for lesion preparation. However, its impact on clinical outcomes in patients with in-stent restenosis (ISR) undergoing drug-coated balloon (DCB) angioplasty remains unclear. This study aims to evaluate the effect of ELCA-based lesion preparation on the clinical outcomes of ISR patients treated with standard DCB angioplasty. METHODS:In this prospective, single-center, randomized controlled trial, patients with ISR were randomized 1:1 to either ELCA (+) or ELCA (-). The ELCA (+) group received ELCA for lesion preparation followed by standard DCB angioplasty, while the ELCA (-) group received standard DCB angioplasty alone. The primary endpoint was the rate of target lesion revascularization (TLR) within 1 year. Safety was also evaluated. RESULTS:A total of 110 patients were randomized to either the ELCA (+) group (n = 55) or the ELCA (-) group (n = 55). The mean age of the study participants was 64.5 years, 89 (80.9%) were men and 51 (46.4%) had diabetes mellitus. The procedure was successful in all patients. The primary endpoint event occurred in five patients (cumulative incidence, 9.1%) in the ELCA (+) group and in 13 patients (cumulative incidence, 23.6%) in the ELCA (-) group (HR, 0.38; 95% CI, 0.15-0.95; p = 0.038). CONCLUSIONS:Lesion preparation with ELCA before DCB angioplasty is a safe and effective strategy for patients with ISR, associated with a lower incidence of TLR compared to standard DCB angioplasty alone. However, due to the limited sample size and single-center design, these findings should be considered hypothesis-generating. Future validation requires confirmation through multicenter studies with larger patient populations. TRIAL REGISTRATION:Unique identifier: ChiCTR2300068962.

BACKGROUND FAVOR III China (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) reported improved clinical outcomes in quantitative flow ratio (QFR) relative to angiography-guided percutaneous coronary intervention (PCI), but the clinical impact of QFR-guided PCI according to sex remains unknown. OBJECTIVES The authors sought to compare sex differences in the 2-year clinical benefits of a QFR-guided PCI strategy and to evaluate the differences in outcomes between men and women undergoing contemporary PCI. METHODS This study involved a prespecified subgroup analysis of the FAVOR III China trial, in which women and men were randomized to a QFR-guided strategy or a standard angiography-guided strategy. Sex differences in clinical benefit of the QFR guidance were analyzed for major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction, or ischemia-driven revascularization within 2 years. RESULTS A total of 1,126 women and 2,699 men were eligible and the occurrence of 2-year MACE was similar between women and men (10.3% vs 10.5%; P = 0.96). Compared with an angiography-guided strategy, a QFR-guided strategy resulted in a 7.9% and 9.7% reduction in PCI rates in men and women, respectively. A QFR-guided strategy resulted in similar relative risk reductions for 2-year MACE in women (8.0% vs 12.7%; HR: 0.62; 95% CI: 0.42-0.90) and men (8.7% vs 12.4%; HR: 0.69; 95% CI: 0.54-0.87) (Pinteraction = 0.61). Furthermore, QFR values were not significantly different between men and women with various angiographic stenosis categories. CONCLUSIONS A QFR-guided PCI strategy resulted in improved MACE in both men and women at 2 years compared with an angiography-guided PCI strategy. The FAVOR III China Study [FAVOR III China]; (NCT03656848) (JACC: Asia 2024;4:201-212) (c) 2024 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Electrocardiograms (ECGs) are a cheap and convenient means of assessing heart health and provide an important basis for diagnosis and treatment by cardiologists. However, existing intelligent ECG diagnostic approaches can only detect up to several tens of ECG terms, which barely cover the most common arrhythmias. Thus, further diagnosis is required by cardiologists in clinical settings. This paper describes the development of a multi-expert ensemble learning model that can recognize 254 ECG terms. Based on data from 191,804 wearable 12-lead ECGs, mutually exclusive–symbiotic correlations between hierarchical multiple labels are applied at the loss level to improve the diagnostic performance of the model and make its predictions more reasonable while alleviating the difficulty of class imbalance. The model achieves an average area under the receiver operating characteristics curve of 0.973 and 0.956 on offline and online test sets, respectively. We select 130 terms from the 254 available for clinical settings by considering the classification performance and clinical significance, providing real-time and comprehensive ancillary support for the public.

Aim: Intracoronary murmur results from turbulent flow due to coronary artery narrowing. This study evaluated the diagnostic performance of a method for acoustic analysis of turbulent murmur caused by coronary artery stenosis in coronary artery disease (CAD) in Chinese populations.Method: Patients admitted to the cardiovascular department of the Sixth Medical Center of the Chinese People’s Liberation Army General Hospital between September 2021 and June 2022 for elective coronary angiography were prospectively enrolled. A digital electronic stethoscope was used to record heart sounds before angiography. Quantitative coronary angiography (QCA) served as the “gold standard” for CAD diagnosis to evaluate the diagnostic performance of the acoustic analysis method for CAD.Results: A total of 452 patients had complete QCA and heart sound data. The final interpretation results of the acoustic analysis method indicated 310 disease cases and 142 normal results. Increasing the cut-off values of coronary artery diameter stenosis from 30% to 50%, 70%, and 90% increased the sensitivity and NPV of the acoustic analysis method; the sensitivity was 75.6%, 81.9%, 83.3%, and 85.7%, respectively; the NPV was 33.1%, 57.0%, 69.7%, and 88.0%, respectively; the specificity and PPV decreased (specificity of 75.8%, 70.4%, 51.0%, and 37.5%, respectively; PPV of 95.2%, 89.0%, 69.4%, and 32.9%, respectively); and the AUC values were 0.757, 0.762, 0.672, and 0.616, respectively. The sensitivity of the acoustic analysis method for one-vessel disease was 86.6% when the cut-off value was 50%. The sensitivity for identifying left anterior descending coronary artery lesions was best, at 90.7%. The sensitivity for identifying isolated coronary artery branch lesions was 66.7%, whereas the sensitivity for identifying three-vessel disease in multi-vessel coronary artery lesions was better, at 82.9%.Conclusion: Acoustic analysis of turbulent murmur caused by coronary artery stenosis for diagnosis of CAD may have favorable performance in the Chinese population. This method has good performance in CAD diagnosis with a cut-off coronary artery diameter for stenosis of 50%.

OBJECTIVE:The study sought to assess the effectiveness and safety of the novel P60 Vivolight frequency-domain optical coherence tomography (OCT) system (Shenzhen Vivolight Medical Device & Technology). METHODS:A total of 90 patients were enrolled from 3 institutions. The pullbacks were performed with both the P60 Vivolight OCT system and the Ilumien Optis OCT system (Abbott Vascular). The primary endpoint was the clear stent length (CSL). Device safety was assessed by the record of serious procedure-related or postprocedure adverse events. The secondary endpoints were the average lumen area of stent, clear image length (CIL), system stability, and imaging catheter operability. RESULTS:The mean relative errors of CSL were 3.30% (95% confidence interval [CI], -0.71 to 7.31) in the full analysis set (FAS) and 0.83% (95% CI, -1.79 to 3.45) in the per-protocol set (PPS). The mean relative errors of the average lumen area of stent were 2.20% (95% CI, 0.70 to 3.80) in the FAS and 1.55% (95% CI, 0.30 to 2.80) in the PPS. No difference was observed in the percentage of obtaining >24 mm of CIL (93.18% in the P60 Vivolight group vs 95.45% in the Ilumien Optis group; P=.48). There were no serious procedure-related or postprocedure adverse events. CONCLUSIONS:The feasibility and safety of the novel Vivolight OCT system is equivalent to that of the Ilumien Optis OCT system.

目的 研究可穿戴式心电图相对于标准12导联心电图诊断急性冠脉综合征(ACS)的准确性.方法 选取2018年10月至2019年10月于解放军总医院心血管内科就诊的112例患者,入院后同时间段内使用可穿戴式心电图与标准12导联心电图采集并最终诊断为ACS的心电图数据.分析心电图质量,采用SPSS 25.0软件对两种心电图诊断符合率、ST段改变情况进行统计分析.结果 112例ACS患者中,ST段抬高型心肌梗死(STEMI)20例(17.86％),非ST段抬高型心肌梗死(NSTEMI)34例(30.56％),不稳定型心绞痛(UAP)58例(51.78％).以标准12导联心电图为金标准,可穿戴式心电图诊断敏感性为98.57％,特异性为95.24％,阳性预测值97.18％,阴性预测值97.56％,诊断符合率97.32％.肢体导联和胸前导联在ST段变化符合率分别为98.21％(110/112)、98.21％(110/112).STEMI患者和NSTEMI患者各导联ST段变化幅度无统计学差异(P>0.05),UAP患者可穿戴式心电图相对于标准12导联心电图ST段I、V2、V4上移,差异具有统计学意义(P<0.05),其余导联ST段变化幅度无统计学差异(P>0.05).结论 在ACS定性诊断中,可穿戴式心电图与标准12导联心电图一致性高,具有很好的临床应用价值.对于UAP患者,ST段I、V2、V4存在定量差异,但不影响疾病定性诊断.

Background Adequate hydration remains the mainstay of contrast‐induced nephropathy prevention, and nitrates could reduce cardiac preload. Hypothesis This study aimed to explore the adequate hydration with nitrates for patients with chronic kidney disease (CKD) and congestive heart failure (CHF) to reduce the risk of contrast‐induced nephropathy (CIN) and at the same time avoid the acute heart failure. Methods Three hundred and ninty‐four consecutive patients with CKD and CHF undergoing coronary procedures were randomized to either adequate hydration with nitrates ( n = 196) or to routine hydration (control group; n = 198). The adequate hydration group received continuous intravenous infusion of isosorbide dinitrate combined with intravenous infusion of isotonic saline at a rate of 1.5 mL/kg/h during perioperative period. The definition of CIN was a 25% or 0.5 mg/dL rise in serum creatinine over baseline. This trial is registered with www.clinicaltrials.gov , number NCT02718521. Results Baseline characteristics were well‐matched between the two groups. CIN occurred less frequently in adequate hydration group than the control group (12.8% vs 21.2%; P = 0.018). The incidence of acute heart failure did not differ between the two groups (8 [4.08%] vs 6[3.03%]; P = 0.599). Cumulative major adverse events (death, myocardial infarction, stoke, hospitalization for acute heart failure) during the 90‐day follow‐up were lower in the adequate hydration with nitrates group ( P = 0.002). Conclusions Adequate hydration with nitrates can safely and effectively reduce the risk of CIN in patients with CKD and CHF.

Contrast-induced acute kidney injury (CI-AKI) is a major adverse effect caused by intravascular administration of iodinated contrast medium. Whether there is a difference in CI-AKI incidence between iso-osmolar (IOCM) and low-osmolar contrast media (LOCM) among diabetic patients is controversial. Randomized controlled trials comparing the nephrotoxic effects between IOCM and LOCM in diabetic patients with or without CKD (eGFR< 60 ml/min/1.73 m2) were included in the analysis. The incidence of CI-AKI was defined as an initial increase in serum creatinine (SCr) concentration of at least 0.5 mg/dl or a rise in creatinine of 25% from baseline. A total of 2190 patients were included, among whom 1122 patients received IOCM and 1068 received LOCM. When compared to LOCM, IOCM had no significant benefit in preventing CI-AKI (OR = 1.66, [CI: 0.97–2.84], P = 0.06, I2 = 54%). However, the difference between IOCM and LOCM was found when CI-AKI was defined as an absolute SCr increase (≥0.5 mg/dl) rather than a relative SCr increase (≥25%). Further analysis showed that LOCM resulted in more adverse events. Whether there is a difference of CI-AKI incidence between IOCM and LOCM in diabetic patients was related to the selected diagnostic criteria. The incidence of adverse events was significantly lower with IOCM when compared with LOCM. Therefore, we suggest that IOCM may be used in diabetic and CKD (eGFR< 60 ml/min/1.73 m2) patients.

Atrial fibrillation (AF), the most frequently encountered cardiac arrhythmia in the clinical setting and the foremost cause of stroke, results from a progressive decrease in atrial refractoriness. In addition, defective calcium signaling has been shown to play a central role in AF pathogenesis. Recently it was shown that the miR-106b-25 cluster is suppressed in patients with AF, which increased ryanodine receptor 2 (RyR2) expression. Expression of the miR-106b-25 cluster and RyR2 protein were determined in our institutional series of patients with AF. Hemodynamic properties, RyR2 binding, suppression of ATP2A2 (encoding ATPase sarcoplasmic/endoplasmic reticulum Ca2 + transporting 2) were also determined. We found that all patients had elevated RyR2 protein expression; however, a cohort of patients with AF had high miR-93, miR-106b, and miR-25 expression. There was no difference in hemodynamic properties, RyR2 binding, or suppression of ATP2A2 in either cohort of patients with AF when compared to patients with normal sinus rhythm (NSR). Immunoblot assay showed hyperactive Akt, S6K, and S6 kinases in patients with AF as compared to patients with NSR. Protein kinase C activation, as measured by PKC phosphorylation, was also hyperactive in patients with AF. Cumulatively, our findings show that RyR2 expression is regulated by multiple mechanisms including the miR-106b-25, and that PKC activation might provide novel clues to increased intracellular calcium levels during AF pathogenesis.

Dysfunction of cardiac cells under hypoxia has been identified as an essential event leading to myocytes functional failure. MiRNAs are importantly regulatory small-noncoding RNAs that negatively regulate gene expression through the direct binding of 3'-UTR region of their target mRNAs. Recent studies have demonstrated that miRNAs are aberrantly expressed in the cardiovascular system under pathological conditions. Pyruvate dehydrogenase kinase 1 (PDK1) is a kinase which phosphorylates pyruvate dehydrogenase to inactivate it, leading to elevated anaerobic glycolysis and decreased cellular respiration. In the present study, we report that miR-138 expressions were significantly suppressed under long exposure to hypoxia. In addition, overexpression of miR-138 protects human cardiac cells against hypoxia. We observed miR-138 inhibits glycolysis but promotes mitochondrial respiration through directly targetting PDK1. Moreover, we demonstrate that hypoxia induces cardiac cell death through increased glycolysis and decreased mitochondrial respiration. Inhibition of glycolysis by either glycolysis inhibitor or knockdown glycolysis enzymes, Glucose transportor 1 (Glut1) or PDK1 contributes to cardiac cells' survival. The cell sentivity to hypoxia was recovered when the PDK1 level was restored in miR-138 overexpressing cardiac cells. The present study leads to the intervention of novel therapeutic strategies against cardiac cells dysfunction during surgery or ischemia.