BACKGROUND:Our understanding of the correlation between postdischarge cancer and mortality in patients with coronary artery disease (CAD) remains incomplete. The aim of this study was to investigate the relationships between postdischarge cancers and all-cause mortality and cardiovascular mortality in CAD patients. METHODS:In this retrospective cohort study, 25% of CAD patients without prior cancer history who underwent coronary artery angiography between January 1, 2011 and December 31, 2015, were randomly enrolled using SPSS 26.0. Patients were monitored for the incidence of postdischarge cancer, which was defined as cancer diagnosed after the index hospitalization, survival status and cause of death. Cox regression analysis was used to explore the association between postdischarge cancer and all-cause mortality and cardiovascular mortality in CAD patients. RESULTS:A total of 4085 patients were included in the final analysis. During a median follow-up period of 8 years, 174 patients (4.3%) developed postdischarge cancer, and 343 patients (8.4%) died. A total of 173 patients died from cardiovascular diseases. Postdischarge cancer was associated with increased all-cause mortality risk (HR = 2.653, 95% CI: 1.727-4.076, P < 0.001) and cardiovascular mortality risk (HR = 2.756, 95% CI: 1.470-5.167, P = 0.002). Postdischarge lung cancer (HR = 5.497, 95% CI: 2.922-10.343, P < 0.001) and gastrointestinal cancer (HR = 1.984, 95% CI: 1.049-3.750, P = 0.035) were associated with all-cause mortality in CAD patients. Postdischarge lung cancer was significantly associated with cardiovascular death in CAD patients (HR = 4.979, 95% CI: 2.114-11.728, P < 0.001), and cardiovascular death was not significantly correlated with gastrointestinal cancer or other types of cancer. CONCLUSIONS:Postdischarge cancer was associated with all-cause mortality and cardiovascular mortality in CAD patients. Compared with other cancers, postdischarge lung cancer had a more significant effect on all-cause mortality and cardiovascular mortality in CAD patients.

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.

Aim: In this study, the predictive value of soluble growth stimulation expressed gene 2 protein (sST2) for long-term clinical outcomes in patients with acute heart failure (AHF) is assessed. In addition, the influence of a history of myocardial infarction on the levels of sST2 in patients with HF, as well as its impact on outcome events, is explored. We also aim to establish a specific standard for sST2 levels in this subgroup. Methods: We conducted an ambispective cohort study involving hospitalized patients with AHF, measuring their sST2 levels and following their progress over three years. The primary endpoint was major adverse cardiovascular events (MACEs), encompassing heart failure readmission and all-cause mortality over three years. Cox regression analysis was used to evaluate the prognostic significance of sST2 levels, along with a subgroup analysis using propensity score matching (PSM) to adjust for confounding variables. Receiver operating characteristic (ROC) curve analysis was utilized to determine the optimal sST2 threshold using Youden's J statistics, and a sensitivity analysis included Kaplan-Meier survival curves. Results: The study included 149 patients with a median age of 68 years, of whom 57% were male. Both univariate and multivariate Cox regression analyses confirmed sST2 as an independent predictor of MACEs. Post-PSM analysis, 124 samples were grouped by MI history ROC curve analysis revealed an area under the curve of 0.726 for predicting MACEs in patients with MI, demonstrating a significant predictive value for sST2 levels above 34 ng/mL, which correlated with increased readmission and mortality rates. In contrast, sST2 levels in patients without MI history showed no significant predictive relevance. Conclusion: sST2 has significant long-term predictive value for clinical outcomes in patients with AHF, particularly for those with a prior MI history, indicating a need for heightened clinical attention and thorough follow-up to mitigate long-term adverse cardiovascular outcomes.

Background Cancer and coronary artery disease (CAD) is reported to often co-exist in same individuals, however, whether cancer is directly associated with anatomical severity of CAD is rarely studied. The present study aimed to observe the relationship between newly diagnosed cancer and anatomical severity of CAD, moreover, to investigate effect of inflammation on the relationship of cancer with CAD. Methods 374 patients with newly diagnosed cancer who underwent coronary angiography (CAG) were enrolled. Through 1:3 propensity score matching (PSM) to cancer patients based on the age and gender among 51,106 non-cancer patients who underwent CAG, 1122 non-cancer patients were selected as control patients. Anatomical severity of CAD was assessed using SYNTAX score (SXscore) based on coronary angiographic image. SXscore ≤ 22 (highest quartile) was defined as SX-low, and SXscore > 22 as SX-high. The ratio of neutrophil to lymphocyte count (NLR) was used to describe inflammation level. Association between cancer and the anatomical severity of CAD was investigated using logistic regression. Results Univariate logistic regression analysis showed a correlation between cancer and anatomical severity of CAD (OR: 1.419, 95% CI: 1.083–1.859; P = 0.011). Cancer was associated with increased risk of SX-high after adjusted for common risk factors of CAD (OR: 1.598, 95% CI: 1.172–2.179, P = 0.003). Significant association between cancer and SX-high was revealed among patients with high inflammation (OR: 1.656, 95% CI: 1.099–2.497, P = 0.016), but not among patients with low inflammation (OR: 1.530, 95% CI: 0.973–2.498, P = 0.089). Conclusions Cancer was associated with severity of CAD, however, the association between the two diseases was significant among patients with high inflammation rather than among patients with low inflammation.

BackgroundCoronary slow flow (CSF) has gained significance as a chronic coronary artery disease, but few studies have integrated both biological and anatomical factors for CSF assessment. This study aimed to develop and validate a simple-to-use nomogram for predicting CSF risk by combining biological and anatomical factors.MethodsIn this retrospective case-control study, 1042 patients (614 CSF cases and 428 controls) were randomly assigned to the development and validation cohorts at a 7:3 ratio. Potential predictive factors were identified using least absolute shrinkage and selection operator regression and subsequently utilized in multivariate logistic regression to construct the nomogram. Validation of the nomogram was assessed by discrimination and calibration.ResultsN-terminal pro brain natriuretic peptide, high density lipoprotein cholesterol, hemoglobin, left anterior descending artery diameter, left circumflex artery diameter, and right coronary artery diameter were independent predictors of CSF. The model displayed high discrimination in the development and validation cohorts (C-index 0.771, 95% CI: 0.737-0.805 and 0.805, 95% CI: 0.757-0.853, respectively). The calibration curves for both cohorts showed close alignment between predicted and actual risk estimates, demonstrating improved model calibration. Decision curve analysis suggested high clinical utility for the predictive nomogram.ConclusionThe constructed nomogram accurately and individually predicts the risk of CSF for patients with suspected CSF and may be considered for use in clinical care.

This study aimed to investigate its clinical implications, risk factors, prognosis, and overall long-term outcomes. Demographic profiles, various clinical characteristics, and clinical outcomes were compared between 614 patients with coronary slow flow (CSF) and 428 patients with normal coronary artery. The incidence of CSF was found to be 2.65%. Significant differences were observed between patients with CSF and control subjects in terms of sex, chest tightness, hyperlipidemia, smoking history, alcohol consumption, age, height, weight, body mass index, diastolic blood pressure, heart rate, and body surface area (P < 0.05). CSF (hazard ratio: 1.531; 95% confidence interval: 1.064-2.202; p = 0.022) proved to be independent prognostic predictors of major adverse cardiovascular events (MACEs). Kaplan-Meier survival evaluations for MACEs presented a worser outcome for patients with CSF. Patients with CSF are at high risk for cardiovascular events and experience generally poor clinical outcomes.

Abstract Aims This study sought to assess the effect of treatment of sacubitril/valsartan (S/V) on improving cardiac function and reversing cardiac remodelling in patients with acute coronary syndrome (ACS) complicated with heart failure with reduced ejection fraction after percutaneous coronary intervention (PCI). Methods and results We enrolled 275 ACS patients with reduced left ventricular ejection fraction after PCI. The patients were divided into the routine and S/V groups according to the treatment drugs. The symptoms, N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) concentrations, echocardiographic parameters [left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), left ventricular end‐diastolic volume index (LVEDVI), and left ventricular end‐systolic volume index (LVESVI)], major adverse cardiac events (MACEs), and adverse reactions were recorded at baseline and 6 months after treatment when a clinical follow‐up was performed. The S/V group was further divided into prespecified subgroups including unstable angina (UA) group, non‐ST‐elevation myocardial infarction (NSTEMI) group, and ST‐elevation myocardial infarction (STEMI) group according to the type of ACS. We analysed the changes in LVEF, LVMI, LVEDVI, LVESVI, and NT‐proBNP in both groups and evaluated the correlation between the changes in the above variables (ΔLVEF, ΔLVMI, ΔLVEDVI, ΔLVESVI, and ΔNT‐proBNP). Cox regression model was used to assess the independent risk factors of MACE. Prespecified subgroup analyses were also conducted. Compared with baseline, LVEF increased significantly (P < 0.05), NT‐proBNP, LVMI, and LVESVI decreased significantly in both groups after 6 months (P < 0.05), and LVEDVI decreased significantly in the S/V group (P = 0.001). In the S/V group, ΔLVEF (t = −2.745, P = 0.006), ΔNT‐proBNP (P = 0.009), ΔLVEDVI (t = 4.203, P = 0.001), and ΔLVESVI (t = 3.907, P = 0.001) were significantly improved than those in the routine group. In the S/V group, ΔLVEF was negatively correlated with ΔNT‐proBNP (r = −0.244, P = 0.004), ΔLVMI (r = −0.190, P = 0.028), ΔLVEDVI (r = −0.173, P = 0.045), and ΔLVESVI (r = −0.261, P = 0.002). In Cox regression model analysis, ΔLVEF {hazard ratio [HR] = 0.87 [95% confidence interval (CI) 0.80–0.95], P = 0.003}, ΔLVEDVI [HR = 1.04 (95% CI 1.01–1.06), P = 0.013], and ΔLVESVI [HR = 1.04 (95% CI 1.01–1.08), P = 0.026] were independent risk factors for MACE. Subgroup analysis showed that ΔLVEF (t = 6.290, P = 0.001), ΔLVEDVI (t = 2.581, P = 0.011), and ΔNT‐proBNP (P = 0.019) in the NSTEMI group were significantly improved than those in the UA group, ΔLVEDVI in the NSTEMI group was significantly better than that in the STEMI group (t = −3.365, P = 0.001), and ΔLVEF in the STEMI group was significantly better than that in the UA group (t = −3.928, P = 0.001). There was a significant difference in the survival probability without MACE among the three groups in the analysis of the Kaplan–Meier curve (P = 0.042). The incidence of MACE in the UA group was significantly higher than that in the NSTEMI group (32.4% vs. 6.3%, P = 0.004). Conclusions The cardiac function is improved and cardiac remodelling is reversed significantly after treatment of S/V in ACS patients with reduced left ventricular ejection fraction after PCI, and the improvement is more obvious than the routine group. There is a significant negative correlation between the change in LVEF and the changes in NT‐proBNP, LVMI, LVEDVI, and LVESVI. The increase of LVEF and the decrease of LVEDVI and LVESVI are protective factors to improve the prognosis. Patients with myocardial infarction and reduced left ventricular ejection fraction might benefit more from the initiation of S/V as first‐line heart failure treatment after PCI.

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/).

目的 明确冠心病患者新发恶性肿瘤情况及其与冠心病患者全因死亡的相关性,为优化冠心病患者临床综合管理策略提供依据.方法 根据纳入排除标准,通过SPSS 25.0 随机抽取 2011 年 1 月 1 日至 2015 年 12 月 31 日在中国人民解放军总医院第一医学中心心血管内科住院,首次行冠状动脉造影并明确诊断为冠心病的患者 4625 例,收集患者基线资料,并对患者出院后的肿瘤情况和死亡情况进行随访.根据随访结局有无发生死亡,分为生存组(n=3385)和死亡组(n=335).采用Cox回归分析明确新发恶性肿瘤与冠心病患者全因死亡的相关性.采用SPSS 25.0 软件进行数据分析.根据数据类型,组间比较分别采用t检验、非参数检验及χ2 检验.结果 随访成功患者 3720 例(80.4％),中位随访时间为 9(8,10)年;其中发生恶性肿瘤 150 例(4.0％),全因死亡 335 例(9.0％);死亡的冠心病患者中新发恶性肿瘤 40 例(11.9％),生存的冠心病患者中新发恶性肿瘤 110 例(3.3％),2 组新发肿瘤发生率差异有统计学意义(P＜0.05).死亡组和生存组患者的年龄≤65 岁,身体质量指数≥24kg/m2,左主干、左前降支、左回旋支及右冠状动脉狭窄程度、Gensini评分(＞20 分)比较,差异均有统计学意义(均P＜0.05);患者合并高血压、高血脂、肾功能不全、气管炎/肺气肿比例,差异均有统计学意义(均P＜0.05);2 组患者的血红蛋白水平、中性粒细胞/淋巴细胞、甘油三酯、凝血酶原活动度、血浆纤维蛋白原、国际标准化比值、尿素氮、肌酐、丙氨酸氨基转移酶、左心室射血分数、肌钙蛋白T、血清脑利钠肽比较,差异均有统计学意义(均P＜0.05).Log-rank检验显示,在随访时间内,发生肿瘤的冠心病患者的累积生存率显著低于未发生肿瘤的冠心病患者(P＜0.001).多因素校正后,Cox回归分析显示新发恶性肿瘤使冠心病患者全因死亡风险增加 3.815 倍(95％CI 2.362～6.164;P＜0.001).结论 死亡的冠心病患者新发恶性肿瘤发生率显著高于生存的冠心病患者,冠心病患者新发恶性肿瘤显著影响冠心病患者长期生存预后.

目的 探讨腹带干预对老年患者餐后低血压的预防作用.方法 选取2020-03至2021-03在解放军总医院第一医学中心心内科收治的住院患者,入院后监测餐前餐后血压,按PPH诊断标准纳入分组,共80例患者入选.按随机数字表法分为对照组和腹带干预组,每组40例,对照组患者予以常规治疗,腹带干预组患者除常规治疗外餐前30 min采用腹带进行干预.比较两组患者餐后收缩压、餐后舒张压、生活质量评分及满意度.结果 与对照组比较,腹带干预组患者餐后低血压的发生率(21.94％)明显低于对照组(79.44％),差异有统计学意义(P<0.01);腹带干预组满意度(97.50％)明显高于对照组(87.50％),差异有统计学意义(P<0.05);腹带干预组患者一般健康、社会功能、生理职能、精神健康、躯体疼痛、精力、情感职能均显著高于对照组(P<0.001).结论 餐前加压腹带干预可明显降低老年餐后低血压的发生率,提高患者生活质量和满意度.

BackgroundBlood-test-based methods of distinguishing between acute aortic syndromes (AASs) and non-ST-elevation myocardial infarction (NSTEMI) during the troponin-blind period of <2–3 h of symptom onset have not been studied previously. We aimed to explore whether routine biomarkers might facilitate differential diagnosis.MethodsData were retrospectively collected from 178 patients with AASs and 460 patients with NSTEMI within 3 h of onset. Differential risk factors related to AASs were identified by univariate and multivariate logistic regression analyses for patients with onset <2 h and onset ≥2 h, respectively, in the cardiac troponin (cTn) cohort. Nomograms were established in the cTn cohort as a training set and validated in the high-sensitivity cTn cohort. To assess the utility of the models in clinical practice, decision curve analyses were performed.ResultsD-dimer, fibrinogen, and age were identified as differential risk factors for AASs with the onset of <2 h. D-dimer at an optimal cutoff level of 281 ng/mL for AASs had a sensitivity of 86.4% and a specificity of 91.3%. A nomogram was developed and validated with areas under the curve (AUC) of 0.934 (95% CI: 0.880–0.988) and 0.952 (95% CI: 0.874–1.000), respectively. D-dimer, neutrophil, bilirubin, and platelet were the differential risk factors for AASs with the onset of ≥2 h. D-dimer at an optimal cutoff level of 385 ng/mL has a sensitivity of 91.8% and a specificity of 91.3%. The AUC of the second nomogram in the training set and the validation set were 0.965 (95% CI: 0.942–0.988) and 0.974 (95% CI: 0.944–1.000), respectively.ConclusionTime-dependent quality of D-dimer should be considered for discriminating AASs from NSTEMI. Both nomogram models may have a clinical utility for evaluating the probability of AASs.

OBJECTIVE:To assess the safety and effectiveness of intravascular lithotripsy (IVL) treatment for de novo coronary lesion involving severely calcified vessels in a Chinese population.METHODS:The Clinical Trial of the ShOckwave Coronary IVL System Used to Treat CalcIfied Coronary ArtEries (SOLSTICE) was a prospective, single-arm, multicentre trial. According to the inclusion criteria, patients with severely calcified lesions were enrolled in the study. IVL was used to perform calcium modification prior to stent implantation. The primary safety endpoint was freedom from major adverse cardiac events (MACEs) at 30 days. The primary effectiveness endpoint was procedural success, defined as successful stent delivery with residual stenosis < 50% by core lab assessment without in-hospital MACEs. The morphological changes of calcium modification were assessed by optical coherence tomography (OCT) before and after IVL treatment.RESULTS:Patients (n = 20) were enrolled at three sites in China. Severe calcification by core lab assessment was present in all lesions, with a mean calcium angle and thickness of 300 ± 51° and 0.99 ± 0.12 mm (by OCT), respectively. The 30-day MACE rate was 5%. Both primary safety and effectiveness endpoints were achieved in 95% of patients. The final in-stent diameter stenosis was 13.1% ± 5.7% with no patient had a residual stenosis < 50% after stenting. No serious angiographic complications (severe dissection grade D or worse, perforation, abrupt closure, slow flow/no-reflow) observed at any time during the procedure. OCT imaging demonstrated visible multiplane calcium fracture in 80% of lesions with a mean stent expansion of 95.62% ± 13.33% at the site of maximum calcification and minimum stent area (MSA) of 5.34 ± 1.64 mm2.CONCLUSIONS:The initial coronary IVL experience for Chinese operators resulted in high procedural success and low angiographic complications consistent with prior IVL studies, reflecting the relative ease of use of IVL technology.

目的 探讨急性冠脉综合征(ACS)合并恶性肿瘤患者经皮冠状动脉介入(PCI)后的临床特点及其预后.方法 回顾性分析2011年2月至2018年7月于解放军总医院第一医学中心心内科住院治疗的67例急性冠脉综合征合并恶性肿瘤患者的临床资料,患者行PCI后根据其结局将其分为生存组(n=54)和死亡组(n=13),采用多因素Logistic回归分析探讨影响其死亡的危险因素.结果 67例患者完成随访,其中死亡13例(19.4％).死亡组糖尿病患者占比(χ2=4.05)及吸烟患者占比(χ2=3.69)均高于生存组,差异均具有统计学意义(P<0.05);死亡组患者血清脑钠肽(BNP)水平高于生存组(t=2.08,P<0.05),而体质指数(BMI,t=-1.28)、血小板(PLT)计数(t=-2.10)均低于生存组,差异具有统计学意义(P<0.05).多因素Logistic回归分析结果表明,吸烟、糖尿病、血清BNP水平升高、血小板计数减少是急性冠脉综合征合并肿瘤PCI后患者死亡的独立危险因素(P均<0.05),术前双联抗血小板负荷量可降低死亡发生的结局,为预后的保护因素(P<0.05).结论 急性冠脉综合征合并肿瘤行PCI后患者预后不良,其死亡的危险因素包含传统的冠状动脉粥样硬化性心脏病(冠心病)危险因素如吸烟、糖尿病等,此外,血清BNP水平升高、血小板计数减少等是其死亡的独立危险因素,应给予针对性的医疗干预以改善预后.

Abstract Background With the advancement of the world population aging, more attention should be paid to the prognosis of elderly patients with acute coronary syndrome (ACS). Triglyceride-glucose (TyG) index is a reliable indicator of insulin resistance (IR) and is closely related to traditional risk factors of cardiovascular disease (CVD). However, the effect of TyG index on the prognosis of long-term adverse events in elderly ACS patients has not been reported. This study evaluated the prognostic power of TyG index in predicting adverse events in elderly ACS patients. Methods In this study, 662 ACS patients > 80 years old who were hospitalized from January 2006 to December 2012 were enrolled consecutively and the general clinical data and baseline blood biochemical indicators were collected. The follow-up time after discharge was 40–120 months (median, 63 months; interquartile range, 51‒74 months). In addition, the following formula was used to calculate the TyG index: Ln [fasting TG (mg/dL) × FBG (mg/dL)/2], and patients were divided into three groups according to the tertile of the TyG index. Results The mean age of the subjects was 81.87 ± 2.14 years, the proportion of females was 28.10%, and the mean TyG index was 8.76 ± 0.72. The TyG index was closely associated with the traditional risk factors of CVD. In the fully-adjusted Cox regression model, the Hazard ratio (95% CI) of all-cause mortality (in tertile 3) was 1.64 (1.06, 2.54) and major adverse cardiac event (MACE) (in tertile 3) was 1.36 (1.05, 1.95) for each SD increase in the TyG index. The subgroup analyses also confirmed the significant association of the TyG index and long-term prognosis. Conclusion The TyG index is an independent predictor of long-term all-cause mortality and MACE in elderly ACS patients.

目的:探讨中性粒细胞与淋巴细胞比值(NLR)及其联合N末端B型利钠肽原(NT-proBNP)对心力衰竭(心衰)患者预后的评估价值.方法:收集我院心内科2013年1月至2018年12月住院的7681例心衰患者的临床资料,建立回顾性数据库.最终入选患者7266例.根据患者入院时NLR值分为三组,低值组(<2.5909)2396例、中值组(2.5909～4.3889)2401例、高值组(>4.3889)2469例.平均随访3.2年(2～8年),终点事件设为全因死亡及心血管死亡.比较三组患者的基线资料.多因素Cox回归模型分析NLR对预后的影响;将NLR和NT-proBNP通过三分位法相互组合比较分析死亡风险比;ROC曲线对比NLR与NT-proBNP联合与二者独立应用对预后的评估价值,并且比较联合指标对不同射血分数心衰患者预后的预测能力.结果:临床资料比较提示NLR越高,患者状态越差,心衰越重.多因素Cox回归分析显示,NLR增加,心衰患者预后不良风险增加.NLR每增加1,全因死亡风险增加1.8％(HR=1.018,95％CI:1.012～1.024,P<0.001),心血管死亡风险增加1.9％(HR=1.019,95％CI:1.012～1.025,P<0.001).ROC曲线显示,NLR与NT-proBNP联合对心衰患者全因死亡和心血管死亡的预测价值优于独立应用NLR及NT-ProBNP.进一步按照不同心衰类型分析显示,联合指标对不同射血分数的心衰患者均有良好的预测价值.结论:NLR与心衰预后相关,NLR与NT-proBNP联合后预测价值更好.此外,联合指标对不同射血分数的心衰患者均有较好的预测价值.

心脏康复是心血管内科的新型亚专科,近年来发展迅速,专科医师人才紧缺.但由于我国存在重视程度不足、教育资源有限、心脏康复专业人员缺乏等问题,心脏康复医学教育的发展尚不完善,还需要进一步加强心脏康复专业医师教育培训,使之能与心血管疾病治疗技术的发展相适应.本文通过总结解放军总医院心脏康复专科医师长期和短期培训的体系建设过程中的经验和实践,以期对我国心脏康复专科医师培训有所借鉴和启发.

目的 探究早发冠心病的临床特征及发病危险因素.方法 采用1:1配对的病例对照研究模式,连续入选解放军总医院心血管病医学部2020年12月至2021年8月收治的120例早发冠心病患者作为观察组,120例中老年冠心病患者作为本次研究的对照组.采集两组患者的临床基本资料、实验室检查结果、冠状动脉造影和临床结局等数据,比较分析早发冠心病的临床特征及其发病相关危险因素.结果 两组患者高血压、糖尿病、高脂血症患病率不具有显著统计学差异(P>0.05).观察组患者体重指数(BMI)以及肥胖、一级亲属冠心病家族史、吸烟和熬夜占比分别为(27.27±4.29)kg/m2、40.83％、42.50％、68.33％、35.00％,均显著高于对照组,而同时合并2种以上代谢紊乱性疾病率为20.00％,显著低于对照组,均具有显著统计学差异(P<0.05).观察组患者血红蛋白(Hb)、红细胞计数(RBC)、白细胞计数(WBC)、淋巴细胞百分比(LYM％)、血小板计数(PLT)、白介素6(IL-6)、甘油三酯(TG)水平分别为(149.07±17.10)g/L、(4.88±0.55)×1012/L、(9.67±3.84)×109/L、(0.24±0.11)％、(244.73±78.01)×109/L、(12.94±5.42)pg/mL及(1.99±1.18)mmol/L,均显著高于对照组,而高密度脂蛋白胆固醇(HDL-C)水平为(0.96±0.23)mmol/L,低于对照组,均具有显著统计学差异(P<0.05).观察组患者左主干病变、三支血管病变、血管钙化病变及支架置入数分别为5.00％、27.50％、1.67％及(1.38±1.16)个,均显著低于对照组,具有显著统计学差异(P<0.05).多因素条件logistic回归模型显示,熬夜是观察组患者发病的独立危险因素(P<0.05).两组左心室射血分数(LVEF)≤50％患者数无显著统计学差异(P>0.05).而观察组LVEF≤35％患者数、主动脉球囊反搏术(IABP)植入数及院内死亡率分别为5.83％、0.00％及0.00％,均明显低于对照组,具有显著统计学差异(P<0.05).结论 除传统心血管危险因素外,肥胖、熬夜及冠心病家族史与早发冠心病发病密切相关.

The aim of this study was to investigate the relationship between carotid plaque neovascularization and lipoprotein (a) [Lp (a)], lipoprotein-associated phospholipase A2 (Lp-PLA2) in elderly patients with carotid plaque stenosis. One hundred elderly patients with carotid plaque stenosis diagnosed in our hospital from January 2020 to January 2022 were retrospectively analyzed and divided into stable (n = 62) and unstable (n = 38) groups according to whether the plaque was stable or not. Plasma Lp (a), Lp-PLA2, apoA, and apoB levels were measured; intraplaque angiogenesis (IPN) scores were examined by contrast-enhanced ultrasound (CEUS) to assess IPN grade in patients; and Pearson correlation was used to analyze the relationship between plasma Lp (a) and Lp-PLA2 levels and plaque characteristics and angiogenesis. The maximum thickness and total thickness of carotid plaque in the unstable group were significantly greater than those in the stable group (P < 0.05); the IPN grade was mainly grade III and IV in the unstable group and grade II in the stable group, and the IPN score was significantly higher in the unstable group than in the stable group (P < 0.05); there was no significant difference in the plasma apoA and apoB levels between the two groups (P > 0.05), and the plasma Lp (a) and Lp-PLA2 levels were significantly higher in the unstable group than in the stable group (P < 0.05); the neovascular grade, plasma Lp-PLA2, and Lp (a) levels were significantly increased (P < 0.05); the plasma Lp (a) and Lp-PLA2 levels were positively correlated with the maximum plaque thickness, total plaque thickness, degree of stenosis, and angiogenesis (P < 0.05). The plasma levels of Lp (a) and Lp-PLA2 are positively correlated with intraplaque angiogenesis, and their levels can reflect the stability of carotid plaques.

Aging represents an independent risk factor affecting the poor prognosis of patients with acute myocardial infarction (AMI). This present research aimed to explore the molecular mechanism of myocardial injury in elderly AMI by animals and cells experiment. Our previous clinical study found the serum Cystatin C (Cys-C) increased in the elderly AMI population, while the mechanism underlying high Cys-C induced myocardial injury of AMI remains unclear. In the in-vitro study, we confirmed that Wnt/β-catenin could significantly reduce the expression of cytoplasmic Cys-C through transnuclear action, and highly attenuate the occurrence of mitochondrial oxidative stress injury induced via Cys-C/reactive oxygen species (ROS). Furthermore, the addition of exogenous Wnt3a and inhibition of Cys-C expression could effectively inhibit mitochondrial oxidative stress injury and relieve the acute myocardial hypoxia injury. These results indicate that Cys-C exerted damaging effects on the hypoxic aging cardiomyocyte through the ROS/mitochondrial signaling pathway. Inhibition of this pathway effectively reduced the apoptosis of aging cardiomyocytes. In the in-vivo study, we also explored the function of the Wnt/Cys-C pathway on the ischemic infarction heart. We confirmed that Wnt/β-catenin served as the upstream protective protein of this pathway, and the promotion of this pathway improved the cardiac structure and function of the elderly AMI mice effectively.

1临床资料 患者,男性,68岁,因"阵发性胸闷胸痛1个月,加重1周"入院.2020年8月初,患者每行走约100m即出现胸痛、胸闷症状,休息10min后缓解.同年8月20日休息时胸痛剧烈,伴灼热、大汗,持续约30min后缓解.8月28日就诊于我院门诊,查心电图示:窦性心律,V1～V2导联呈QS型,V1～V3导联ST段抬高,V1～V5导联T波倒置.超声心动图示:节段性室壁运动障碍,左室心尖部血栓形成,左室射血分数为52％.肌钙蛋白T0.274ng/ml,肌红蛋白及肌酸激酶同工酶水平正常,2020年9月1日以"急性冠状动脉综合征"收入院.