Background It is currently unclear whether erythropoietin (EPO) has value in predicting the prognosis of acute aortic syndrome (AAS). Methods A real-world analysis was conducted on the relationship between EPO and AAS outcomes. The primary end points were all-cause mortality and aortic-related mortality. The major adverse cardiac and cerebral events included all-cause mortality, acute myocardial infarction, stroke, and secondary procedures. Serum EPO concentration was examined using the Quantikine Human EPO ELISA. Results A total of 254 AAS patients were recruited, of whom 73 died. The median time of follow-up was 18.1 months. In Cox regression analysis, log EPO (hazard ratio [HR]: 2.491, P < 0.001), Stanford type A (HR: 3.003, P < 0.001), and treatment with surgery/thoracic endovascular aortic repair (TEVAR; HR: 0.283, P < 0.001) were independent predictors of all-cause mortality. In Kaplan-Meier curves, patients with EPO ≤16 IU/mL had significantly higher survival and event-free rates. Nomograms indicated that log EPO had the greatest contribution to AAS prognosis. In subgroup analysis, log EPO was an important prognostic indicator for patients with type A AAS and those treated without surgery/TEVAR. In correlation analyses, EPO was positively correlated with C-reactive protein, interleukin (IL)-4, IL-6, and monocytes and negatively correlated with albumin. The maximum diameter of the ascending aorta was positively correlated with EPO in AAS and aortic dissection (AoD) patients. The false lumen diameter and false lumen area were positively correlated with EPO in AoD patients. Conclusion The serum EPO level is closely associated with the adverse outcomes of AAS and has good prognostic value.

Background:Transcatheter edge-to-edge repair (TEER) has become an effective alternative for treating degenerative mitral regurgitation (DMR) in patients at high surgical risk. The SQ-Kyrin-M TEER system (SQ-Kyrin-M system) is a novel TEER device developed in China. This study aimed to evaluate the feasibility, safety, and 12-month clinical efficacy of the SQ-Kyrin-M system in patients with high-risk degenerative mitral regurgitation. Methods:In this prospective, multicenter, single-arm study (ClinicalTrials.gov: NCT06467110), 120 patients with symptomatic DMR (grade ≥3+) had the device implanted. The primary endpoint was the clinical success rate at 12 months. Secondary endpoints included technical, device, and procedural success rate; New York Heart Association (NYHA) class improvement; Kansas City Cardiomyopathy Questionnaire (KCCQ) score change; and mitral regurgitation (MR) reduction. Safety endpoints encompassed all-cause mortality, cardiovascular mortality, and major adverse event rate. Results:A total of 120 patients received the TEER procedure across 25 participating sites in China; the mean age was 71.9 years, and the mean Society of Thoracic Surgeons (STS) risk score was 9.3. At 12 months, the Kaplan-Meier estimates were 82.5% for clinical success, 7.6% for all-cause mortality, and 10.8% for major adverse events; MR ≤2+ and MR ≤1+ were achieved in 91.7 and 70.4% of the patients, respectively; 88.9% of patients were in NYHA class I or II; and KCCQ score had improved by 18.9 points. Favorable left ventricular remodeling was observed with sustained reductions in left ventricular end-diastolic and end-systolic volumes. Conclusions:This study demonstrates that the SQ-Kyrin-M system is a safe and effective therapeutic option for DMR patients.

Introduction:In China, evidence regarding cerebral embolic protection device (CEPD) use during transcatheter aortic valve replacement (TAVR) for severe aortic stenosis treatment is limited. This study evaluated the TriGUARD 3 (TG3) CEPD performance in patients undergoing TAVR. Methods:Data from two studies were pooled: the CEPD group was derived from a multicenter TG3 trial in China, whereas the control group was obtained from a single-center registry. All participants underwent transfemoral TAVR and completed pre- and postoperative diffusion-weighted magnetic resonance imaging (DW-MRI). The primary outcome was total cerebral ischemic lesion volume on DW-MRI. Results:No significant difference was observed between groups in total lesion volume {CEPD [n = 62] vs. control [n = 56]; 256.53 [interquartile range (IQR), 44.12-667.99] vs. 271.88 [IQR, 96.10-650.87]; p = 0.456}. Median regression analysis in the overall cohort showed no significant association between CEPD use and total lesion volume (p = 0.181). Nonetheless, among patients with bicuspid aortic valve (BAV) stenosis, the CEPD group demonstrated significantly lower total lesion volume [165.43 (IQR, 32.96-311.13) vs. 309.38 (IQR, 96.10-788.49); p = 0.025], average lesion volume [61.3 (IQR, 23.44-89.65) vs. 93.75 (IQR, 51.73-137.07); p = 0.019], and maximum single-lesion volume [89.65 (IQR, 28.13-174.02) vs. 164.14 (IQR, 75.00-365.08); p = 0.019]. Median regression revealed that CEPD use was significantly associated with reductions in total, average, and maximum single-lesion volumes (median differences: -406.1, -82.2, and -137.6; all p < 0.05), independent of age, sex, hypertension, diabetes, valve type, and pre-dilatation. Conclusion:In patients with severe aortic stenosis undergoing transfemoral TAVR, TG3 CEPD did not significantly reduce the total lesion volume on DW-MRI. In the BAV subgroup, an association was observed between device use and reductions in total, average, and maximum single-lesion volumes. This exploratory finding is hypothesis-generating and should be further elucidated in larger randomized studies.

AIMS:Previous analyses of the relationship between blood pressure (BP) and heart failure (HF) outcomes have primarily used baseline values rather than longitudinal measurements. We aimed to elucidate associations between longitudinal BP and clinical outcomes in patients with HF with reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF). METHODS AND RESULTS:We conducted a comprehensive analysis of 28 406 patients from eight trials, evaluating time-dependent BP categorized by tertiles and per 10 mmHg increments in BP on outcomes. The primary endpoint was the time to the first occurrence of a composite endpoint comprising cardiovascular death or HF hospitalization. Multivariate Cox regression analysis revealed a J-shaped relationship between BP and the composite outcome in HFrEF. Specifically, compared with the middle-level systolic BP (SBP), low SBP was associated with a higher risk of the composite endpoint (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.60-1.82; p < 0.001) and high SBP showed a non-significant change in risk (HR 1.07, 95% CI 0.97-1.18; p = 0.187). Conversely, a U-shaped relationship was observed in HFmrEF and HFpEF. Low SBP was linked to a higher risk of the composite endpoint (HR 1.74, 95% CI 1.47-2.07; p < 0.001), and high SBP similarly increased the risk (HR 1.77, 95% CI 1.45-2.17; p < 0.001). CONCLUSIONS:The relationship between BP and HF outcomes is non-linear and closely tied to left ventricular ejection fraction. Low SBP consistently predicts a poor prognosis, whereas high SBP is associated with an increased risk in HFmrEF and HFpEF but not in HFrEF.

Background:Previous studies have demonstrated a correlation between mental disorders and hypertension. However, the direction of this association and the specific risk factors that mediate the causal effects remain unknown. The present study aimed to investigate the causal relationship between mental disorders and hypertension, as well as identify the risk factors that mediate it. Methods:We used univariate Mendelian randomization (UVMR) and multivariate Mendelian randomization (MVMR) to evaluate the causal relationship between depression, anxiety, or panic attacks and hypertension using the summarized statistics from eleven extensive genome-wide association studies in European populations. Furthermore, MVMR was used to evaluate seven potential mediators of this association and calculate their mediated proportions. The robustness of our findings was evaluated using sensitivity analyses. Results:UVMR analysis revealed that genetically predicted higher risk of depression (OR: 1.140, 95%CI: [1.075, 1.210], p < 0.001), anxiety (OR: 2.679, 95%CI: [1.328, 5.408], p < 0.01), and panic attacks (OR: 1.054, 95%CI: [1.016, 1.092], p < 0.01) were associated with increased risk of hypertension. Higher risk of hypertension was also associated with higher risk of depression (OR: 1.101, 95%CI: [1.009, 1.202], p < 0.05). Of seven candidate mediators, two met the screening criteria and were included in the mediation MR analyses. The MVMR analysis revealed that even after adjusting for depression, there was a persistent causal relationship between type 2 diabetes and hypertension (OR: 1.010, 95%CI: [1.005, 1.015], p < 0.001). Similarly, the causal relationship between smoking and hypertension remained significant after accounting for depression (OR: 1.037, 95%CI: [1.015, 1.060], p < 0.001). Mediation analyses indicated that diabetes and smoking have mediation effects of 8.71% and 5.79% between depression and hypertension, with mediation proportions of 41.7% and 27.7%, respectively. Conclusion:This study provided compelling evidence supporting a bidirectional phenotypic association between depression and hypertension, while highlighting diabetes and smoking as significant mediators in the association's pathway to hypertension development.

To assess the safety and efficacy of dabigatran-based triple antithrombotic (TAT) regimen in patients after percutaneous coronary intervention (PCI) with atrial fibrillation (AF). A multicenter, open-label, randomized controlled trial across 50 Chinese hospitals enrolled nonvalvular AF patients after coronary stenting. Participants were randomly assigned to receive dabigatran (110 mg twice/daily) or warfarin-based TAT regimen (dabigatran or warfarin with aspirin and clopidogrel) for 1 month and then convert to dual antithrombotic therapy (dabigatran or warfarin with clopidogrel) for 6 months. The primary safety endpoint was the first occurrence of clinically relevant bleeding (BARC types 2–5). Secondary endpoints included net adverse clinical events (NACEs) and major or clinically relevant non-major bleeding (CRNB). And the efficacy endpoint was the major adverse cardiac and cerebral events (MACCEs). The study was terminated early due to COVID-19 impacting recruitment. A total of 540 patients were enrolled. BARC types 2–5 bleeding occurred in 8.0 https://clinicaltrials.gov/show/NCT03536611 ).

Previous studies have reported that mitochondrial DNA copy number (mtDNA-CN) of blood was associated with a series of aging-related diseases. However, it remains unknown whether mtDNA-CN can be a potential biomarker of acute aortic syndromes (AASs). The mtDNA-CN in blood of 190 male patients with AAS and 207 healthy controls were detected by standardized real-time quantitative PCR-based assay. The mtDNA sequencing data of blood and myocardial muscle in 134 individuals were used to analyze mtDNA somatic mutations in blood. mtDNA-CN in peripheral blood was negatively correlated with age of individuals. Further analysis based on next-generation sequencing data demonstrated numbers and heteroplasmy of mtDNA mutations were positively correlated with age. Remarkably, mtDNA-CN of patients with AAS was lower than that of healthy controls. Logistic regression also showed that mtDNA-CN was independently associated with risk of AAS. During follow-up, patients with the lowest mtDNA-CN quartile had a hazard ratio of 2.543 for all-cause-mortality and 1.964 for composite end points compared with the other patients. Moreover, multivariate Cox regression indicated that lowest mtDNA-CN quartile was independently associated with all-cause mortality in patients with AAS. Our study demonstrated a negative correlation between mtDNA-CN and age. Moreover, lower mtDNA-CN in peripheral blood was significantly associated with higher risk and worse prognosis of AAS. It provided crucial evidence supporting the potential of mtDNA-CN as a novel biomarker of AAS.

Importance:The permanent metallic occluders used for atrial septal defect (ASD) closure are associated with risks of late complications and may impede access to the left atrium. Bioresorbable occluders have the potential to address these limitations but have yet to be validated in randomized clinical trials. Objective:To evaluate whether a bioresorbable occluder is noninferior to a metallic occluder based on its efficacy and safety for transcatheter ASD closure. Design, Setting, and Participants:This multicenter, noninferiority, open-label randomized clinical trial included participants with secundum ASD. Enrollment occurred from May 8, 2021, to August 3, 2022, at 10 hospital sites in China. The 2-year follow-up period ended in September 2024. Interventions:Participants were randomized in a 1:1 ratio to receive a bioresorbable occluder (n = 116) or a metallic occluder (n = 114). Main Outcomes and Measures:The primary outcome was the success rate of ASD closure at 6 months (closure success was defined as procedural success with a residual shunt diameter of ≤2 mm, which was assessed using transthoracic echocardiography). At the 2-year follow-up, the occluder groups were compared regarding the success of ASD closure and the device-related adverse events. The degradation profile of the bioresorbable occluder was assessed at 2 years. Results:Of the 230 participants randomized, implantation was not attempted in 1 participant in the bioresorbable occluder group due to a small femoral vein, leaving 229 (median age, 14.1 years [IQR, 7.0 to 37.3 years]; 68% were female). At 6 months, the success rate of ASD closure was 96.5% (111 of 115 patients) for the bioresorbable occluder group vs 97.4% (111 of 114 patients) for the metallic occluder group (between-group difference, -0.8 percentage points [95% CI, -5.0 to 3.7]; P < .001 for noninferiority). At 2 years, there were no statistically significant between-group differences in ASD closure success (94.8% [109/115] in the bioresorbable occluder group vs 96.5% [110/114] in the metallic occluder group; P = .75), or in device-related adverse events (2.6% [3/115] vs 3.5% [4/114], respectively; P = .72). The rate of degradation at 2 years was approximately 99.8% for the bioresorbable occluder. Conclusions and Relevance:A bioresorbable occluder is noninferior to a metallic occluder for ASD closure, with near-complete degradation by 2 years. These findings suggest that a bioresorbable occluder could be a valuable addition to the options for transcatheter ASD closure. Trial Registration:chictr.org.cn Identifier: ChiCTR2100044408.

Transcatheter aortic valve replacement (TAVR) was initially used to treat aortic stenosis (AS), and gradually expanded into aortic regurgitation (AR) treatment. Scholars worldwide have explored the use of marketed transfemoral TAVR (TF-TAVR) valves for AR patients, offering another option for high-risk surgical patients. However, AR presents distinct challenges compared to AS, including anatomical differences, valve selection, procedural nuances, and complication profiles. Overall, TF-TAVR for AR is more complex with lower success rate than for AS. In order to promote the safe and standardized TF-TAVR for AR in China, the Structural Heart Disease Group of Chinese College of Cardiovascular Physician drafted this consensus. The writing expert team focused on key clinical challenges in TF-TAVR for AR patients, combining evidence from literature up to September 1, 2023, to formulate nine core viewpoints. These encompass indications, valve selection, preoperative evaluation, intraoperative techniques, complication prevention and management, postoperative care, and other aspects.

Sodium–glucose cotransporter-2 inhibitors (SGLT2i) have been proven to prevent decline in kidney function and failure. Whether SGLT2i affect the risk of contrast-associated acute kidney injury (CA-AKI) remains uncertain. Use of SGLT2i was assessed in consecutive diabetics undergoing coronary angiography (CA) or percutaneous coronary intervention (PCI) from January 2020 to May 2023 at a tertiary hospital in Chongqing, China. Propensity-matched analysis was used to adjust for baseline variables. CA-AKI was defined by the Acute Kidney Injury Network (AKIN) as creatinine increase ≥ 0.3 mg/dl (26.4 μmol/l), or a percentage increase in the serum creatinine level of ≥ 50

Background: Secreted frizzled-related protein 5 (SFRP5) is a novel adipokine that has been found to be closely associated with metabolic and cardiovascular diseases. We investigated serum SFRP5 levels during the acute phase and their predictive value for the prognosis of acute aortic dissection (AAD). Methods: In total, 152 AAD patients and 164 controls were enrolled in this study. Serum SFRP5 levels were measured using an enzyme-linked immunosorbent assay (ELISA). AAD patients were divided into high-SFRP5 and low-SFRP5 groups based on the optimal cutoff value and followed up for prognosis. The primary endpoint was all-cause mortality, and the secondary endpoint focused on AAD-related events (including AAD-related mortality and unplanned reoperations). Results: Serum SFRP5 levels were significantly higher in AAD patients than in non-AAD controls, regardless of whether they had Stanford type A or B AD. Multivariate logistic regression analysis revealed an independent association between SFRP5 and the presence of AAD (adjusted OR 1.267, 95 % CI 1.152–1.394; p < 0.001). The receiver operating characteristic curve demonstrated that the optimal cutoff value for SFRP5 to predict the presence of AAD was 10.26 ng/mL (AUC 0.7241, sensitivity 49.34 %, specificity 87.20 %). Notably, serum SFRP5 levels of patients in the death group were significantly higher than those in the survival group. Compared with patients in the low-SFRP5 group, those in the high-SFRP5 group exhibited a significantly increased risk of all-cause mortality (HR 9.540, 95 % CI 2.803–32.473; p < 0.001) and AAD-related events (HR 6.915, 95 % CI 2.361–20.254; p < 0.001) during the follow-up period. Conclusion: Serum SFRP5 levels were significantly elevated in the acute phase of AAD, and high serum SFRP5 levels were independently associated with poor AAD prognosis. These results suggest that serum SFRP5 level during the acute phase may be an effective biomarker and therapeutic target for the prognosis of AAD.

The erythroblast transformation-specific related gene (ERG) is expressed in hematopoietic stem and progenitor cells and endothelial cells. This study aimed to investigate if ERG rs2836411 is a novel genetic locus associated with anemia and aortic dissection (AD). A case-control trial was conducted to evaluate the association between ERG rs2836411 polymorphism, anemia, and AD risk. The ERG rs2836411 polymorphism was analyzed using Sanger dideoxy chain termination sequencing on genomic DNA extracted from whole blood. Serum erythropoietin (EPO) and interleukin-6 (IL-6) concentrations were measured by enzyme-linked immunosorbent assay (ELISA). 119 preoperative AD patients and 119 healthy controls were enrolled, with age and sex matched. Anemia was found independently associated with AD presence (Odds ratio (OR) 20.82, p < 0.001). Remarkably, T carriers (CT + TT) of ERG rs2836411 were associated with anemia in AD patients (OR 2.81, p = 0.013) but not in controls. After adjusting for conventional risk factors including age, sex, smoking and hypertension status, T carriers (CT + TT) were independently associated with AD presence (OR 2.20, p = 0.015), but were not associated if anemia was further adjusted. While EPO concentration was higher in AD patients and was associated with AD presence (OR 1.09, p = 0.006), no difference in EPO levels was observed between the ERG genotypes of AD patients. T carriers (CT + TT) of ERG rs2836411 are independently associated with anemia and AD presence. The association between ERG rs2836411 polymorphism and susceptibility to AD may be mediated by anemia. Further studies are warranted to validate whether this association is causal.

BACKGROUND:This study aimed to evaluate the medium-term prognostic implications of cardiac magnetic resonance (CMR) imaging in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA). METHODS:A systematic literature search of Embase, PubMed, and The Cochrane Library was performed. Eligible studies reported outcomes of CMR-assessed MINOCA with a mean follow-up period of >6 months. The primary endpoint was all-cause death. Secondary endpoints included cardiac death, reinfarction, and cardiovascular rehospitalisation. The pooled effect sizes with 95% confidence interval (CIs) were estimated using a random effect model. RESULTS:A total of 3,050 patients from twenty-one studies were included in the meta-analysis. The prevalence of myocarditis, "true" myocardial infarction, Takotsubo cardiomyopathy, and normal CMR imaging was 36%, 25%, 14%, and 19%, respectively. Pooled data showed that the annualised event rates for all-cause mortality, cardiac mortality, reinfarction, and cardiovascular rehospitalisation were 1.01% (95% CI 0.59%-1.51%), 0.06% (95% CI 0.00%-0.39%), 0.68% (95% CI 0.18%-1.38%), and 5.67% (95% CI 3.11%-8.85%), respectively. Compared with patients with a diagnosis of myocarditis on CMR, patients with Takotsubo cardiomyopathy (RR 7.11; 95% CI 3.04-16.66) and "true" myocardial infarction (RR 3.82; 95% CI 1.65-8.86) were associated with a significantly higher risk of all-cause mortality, whereas a similar risk of all-cause mortality was observed in patients with normal imaging (RR 1.01; 95% CI 0.28-3.59). No association was found between CMR diagnoses and the risk of secondary endpoints in MINOCA. CONCLUSIONS:In patients with MINOCA assessed by CMR, the overall absolute incidence rates of mortality and reinfarction were low. However, certain imaging diagnoses were associated with a higher risk of all-cause mortality, with most deaths attributed to non-cardiac causes. Additionally, these patients experienced a high burden of cardiovascular rehospitalisation. REGISTRATION:PROSPERO (CRD42022323615).

Background Scarce data exist regarding the occurrence of mitral valve interference after transcatheter aortic valve replacement (TAVR) with Venus-A valve implantation. Several case reports have noted that the anterior mitral leaflet (AML) is mechanically affected by the prosthesis frame, particularly when implanted in a low position. This study aimed to investigate the potential factors influencing the clinical outcomes of AML interference after Venus-A valve implantation.Methods We retrospectively included 20 severe aortic valve stenosis patients who had undergone TAVR and had been implanted with the Venus-A valve at our hospital between October 2020 and June 2021. Pre- and post-procedural CT scans were used for the FEops HEARTguide simulation. Anatomically influencing factors were measured using the 3mensio software and derived from the FEops HEARTguide. The prosthesis-AML interference (PAI) was defined when it met both of two criteria:1) significant interference and limited AML movement shown by transthoracic or transoesophageal echocardiography, and 2) more than half cell intersection between the simulated Venus-A valve and the reconstructed AML revealed by the FEops HEARTguide. Anatomical factors and clinical outcomes were compared between the PAI and non-PAI groups.Results Nine PAI patients and 11 non-PAI cases were identified. PAI was associated with shorter mitral-aortic annulus distance (2.7±1.7 mm vs 5.0±2.2 mm, P = 0.019), larger prosthesis valve size ( P = 0.013), deeper implantation (12.2±3.3 mm vs 6.2±2.9 mm at non-coronary cusp side, P < 0.001) and less calcification of non-coronary cusp (median calcification score, 52.2 mm3 vs 156.0 mm3, P = 0.046). Regarding the clinical impact, PAI was associated with a higher rate of moderate or severe perivalvular leakage before discharge than those associated with the absence of PAI, with no difference in haemodynamic parameters and incidence of adverse events at the 30-day and 12-month follow-ups between the groups.Conclusions Interference between the Venus-A prosthesis valve and AML after TAVR was associated with a shorter mitral-aortic annulus distance, larger prosthesis usage, greater implantation depth, and less calcification of the non-coronary cusp. However, further studies are required to explore its long-term clinical impact.### Competing Interest StatementNic Debusschere and Giorgia Rocatello are employees of Feops NV. Sihang Cheng is an employee of Venus Medtech. The other authors report no disclosures of competing interest.### Funding StatementThis work was funded by the Chongqing Talents Project (Jin Jun) and Young Doctor Incubation Program of Xinqiao Hospital (2022YQB094).### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This study was approved by the Research Ethics Committee of the Second Affiliated Hospital (Xinqiao Hospital) of the Army Military Medical University, and the requirement for informed consent was waived because of its retrospective design.I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesThe raw/processed data required to reproduce these findings cannot be shared at this time as the data also forms part of an ongoing study.

Background Although there are cardiac interventional procedures, certain transradial access complications might be life-threatening. Case presentation A 67-year-old male was admitted for coronary angiography due to chest tightness and shortness of breath on exertion. Hours after the right transradial access angiography, the patients complained the right side of chest pain. Emergent chest X-ray revealed a giant mass in the right chest. The right radial artery was reaccessed and subsequent arteriograms confirmed that the presence of a rupture of the branch of right internal mammary artery. Simultaneously, a microcoil was implanted to seal the perforation. The perforation caused a thoracic hematoma measuring 13.8 cm × 6.7 cm, along with a decrease in hemoglobin concentration from 14.1 g/dL to a minimum of 7.8 g/dL. Additionally, the drainage of the hematoma and red blood cells transfusion were carried out. Further, the patient underwent ascending aortic replacement, aortic valve replacement, mitral valve replacement, and thoracic hematoma removal. Postoperative echocardiography showed that the prosthetic valves were properly positioned and functioning normally. The patient recovered well after the surgery and remained event-free during the latest 14moth follow-up period. Conclusions Vascular perforation and subsequent hematoma might occur due to guidewire maneuvering during transradial approach. Awareness of prevention, early recognition and management of access complications may help reduce the occurrence and severity of complications related to the transradial approach.

Objective To investigate the risk factors associated with post-implantation syndrome (PIS) in Stanford type B aortic dissection (TBAD) patients undergoing thoracic endovascular aortic repair (TEVAR) and the relationship of PIS with short-term outcomes. Methods A case-control trial was conducted on the clinical data of patients undergoing TEVAR treatment for TBAD in our department from December 2013 to December 2022. They were divided into 2 groups based on the occurrence of PIS. Independent risk factors were analyzed according to the different clinical characteristics between the 2 groups. The overall 30-day mortality following TEVAR was assessed in both groups. Kaplan-Meier survival curves were utilized to evaluate the 30-day postoperative survival. Logistic regression models were constructed to investigate the relationship between PIS and overall mortality occurring within 30 d after TEVAR. Results A total of 373 TBAD patients, with an average age of 57.9±12.1 years and a male ratio of 77.5% (289 cases), were enrolled in this study. There were 106 cases (28.4%) experiencing PIS following TEVAR. Significantly larger proportions of implanted stents ≥2, operation duration ≥2 h and implantation of polyethylene terephthalate (PET)-coverted stents were observed in the PIS group than the non-PIS group (P < 0.05). Multivariate logistic regression analysis suggested that implanted stents ≥2 (OR=1.886, 95%CI: 1.049~3.389, P=0.034), operation duration ≥2 h (OR=1.938, 95%CI: 1.147~3.275, P=0.013) and implantation of PET-coverted stents (OR=2.131, 95%CI: 1.263~3.597, P=0.005) were independent risk factors for PIS after TEVAR. Within 30 d after TEVAR, 15 (4.0%) cases dead, including 10 (9.4%) from the PIS group and 5 (1.9%) from the non-PIS group. Kaplan-Meier survival curve indicated a significantly lower survival in the PIS group (Log-rank P=0.000 7). The results of multivariate logistic regression model indicated that cystatin C (OR=1.486, 95%CI: 1.053~2.097, P=0.024) and PIS (OR=5.628, 95%CI: 1.836~17.248, P=0.002) were independent risk factors for 30-day mortality after TEVAR in TBAD patients. Conclusion Implanted stents ≥2, operation duration ≥2 h and implantation of PET-coverted stents are closely associated with the occurrence PIS in TBAD patients after TEVAR. Cystatin C level and PIS are primary risk factors for poor 30-day prognosis after TEVAR.

心血管疾病的致死率较高[1],早期发现有助于改善临床结局.心血管影像是检查心血管异常的重要依据,主要包括超声成像、磁共振成像(magnet-ic resonance imaging,MRI)、冠状动脉 CT 造影、放射性核素成像.

目的 系统评价创伤后肺栓塞成年患者使用静脉血管滤器的有效性和安全性.方法 检索PuMed、Embase、the Cochrane Library、中国知网、中国生物医学文献数据库、维普数据库、万方数据库建库至2022年3月关于创伤后肺栓塞患者使用静脉血栓滤器的随机对照实验(randomized controlled trials,RCT),由2名研究者对文献质量进行严格评价,按照纳入排除标准独立对文献进行筛选提取,采用RevMan5.3软件对数据进行Meta分析.结果 纳入RCT 6篇,共810例患者,装有静脉血管滤器的创伤后肺栓塞患者为试验组,无静脉血管滤器的患者为对照组.Meta分析结果显示,两组深静脉血栓和肺栓塞(95％CI:0.29～0.77,P=0.003,MD=0.480)发生率比较差异有统计学意义,但病死率比较差异无统计学意义.通过安置静脉血管滤器,预防肺栓塞的发生率试验组优于对照组(95％CI:0.59～2.78,P=0.520,MD=1.290),深静脉血栓的发生率试验组高于对照组(95％CI:1.06～2.32,P=0.020,MD=1.570).结论 综合文献分析证实,预防性安置静脉血管滤器可以显著降低创伤患者肺栓塞的发生率,但同时预防性安置血管静脉滤器会导致深静脉血栓发生率显著升高.

BackgroundTranscatheter aortic valve replacement (TAVR) in the treatment of patients with pure native aortic valve regurgitation (NAVR) has been based on the “off-label” indications, while the absence of aortic valve calcification and difficulty in anchoring was found to significantly increase the risk of prosthesis malposition. The aim of this study was to explore the anatomical predictors of severe prosthesis malposition following TAVR with the self-expandable Venus-A Valve among patients with NAVR.MethodsA total of 62 patients with NAVR who underwent TAVR with Venus-A Valve at four Chinese clinical centers were retrospectively observed. The clinical features, aortic multidetector computed tomography (MDCT) data, and clinical outcomes were compared between non-/mild malposition and severe malposition groups. Univariate logistic regression analysis was used to identify the risk factors of severe prosthesis malposition, and the receiver operating characteristic (ROC) curve was used to explore the predictive value of the risk factors.ResultsValve migration to ascending aortic direction occurred in 1 patient, and the remaining 61 patients (including 19 severe malposition cases and 42 non-/mild malposition cases) were included in the analysis. The diameter and height of the sinotubular junction (STJ) and STJ cover index (STJCI, calculated as 100%*STJ diameter/nominal prosthesis crown diameter) were all greater in the severe malposition group (all p < 0.05). Logistic regression showed that STJ diameter (OR = 1.23, 95% CI 1.04–1.47, p = 0.017), STJ height (OR = 1.24, 95% CI 1.04–1.47, p = 0.017), and STJCI (OR = 1.08, 95% CI 1.01–1.16, p = 0.032) were potential predictors for severe prosthesis malposition. The area under the ROC curve was 0.72 (95% CI 0.58–0.85, p = 0.008) for STJ diameter, 0.70 (95% CI 0.55–0.86, p = 0.012) for STJ height, and 0.69 (95% CI 0.55–0.83, p = 0.017) for STJCI, respectively. The cutoff value was 33.2 mm for STJ diameter (sensitivity was 84.2% and specificity was 65.8%), 24.1 mm for STJ height (sensitivity was 57.9% and specificity was 87.8%), and 81.0% for STJCI (sensitivity was 68.4% and specificity was 68.3%), respectively.ConclusionLarger and higher STJ, as well as greater STJ to valve crown diameter ratio, may help identify patients at high risk for severe prosthesis malposition among patients with NAVR undergoing TAVR with Venus-A prosthesis valve.