Poor left ventricular ejection fraction (LVEF) is associated with an increased risk of left ventricular (LV) thrombus formation. However, the effect of LVEF on thrombus resolution remains unclear. We prospectively enrolled patients from 2020 to 2022 and retrospectively from 2010 to 2020 at the National Center for Cardiovascular Diseases, China. Patients with LV thrombus diagnosed within the last 3 months were included. The primary outcome was the resolution of LV thrombus at 12 weeks. Hazard ratios (HRs) and 95

OBJECTIVE:Gastrointestinal (GI) bleeding is a serious complication among patients with cardiovascular disease (CVD). This study aimed to evaluate sex differences in the odds of GI bleeding. METHODS:We analyzed data from an international case-control study of adults with CVD (n = 4721; 1807 women and 2914 men), conducted between September 3, 2015, and December 20, 2022. Cases presented with overt GI bleeding; controls had no prior GI bleeding. Baseline characteristics were compared by sex. Sequential multivariable logistic regression was used to assess the association between sex and GI bleeding, followed by sex-stratified analyses and tests for sex×factor interactions. RESULTS:Female sex was independently associated with lower adjusted odds of GI bleeding compared with male sex (aOR 0.82, 95% CI 0.72-0.95). While most established factors were associated with GI bleeding in both sexes, Coronary artery disease was associated with higher odds of GI bleeding only in women (aOR 1.44; P-interaction = 0.004). CONCLUSIONS:Among patients with CVD, female sex is independently associated with lower odds of GI bleeding. Several factors were shared between sexes, although some sex-specific associations were observed.

The Global Registry of Acute Coronary Events (GRACE) 2.0 risk score has been recommended in guidelines to orient therapeutic strategy and risk assessment for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). To evaluate the incremental value of computed tomography (CT)-based coronary atherosclerosis plaque burden to GRACE 2.0 score in refining the intermediate-term prognostic accuracy and risk stratification for emergency NSTE-ACS. In this prospective cohort study, from January 2017 to January 2021, NSTE-ACS individuals were enrolled and randomly divided into a developing and validation sets by 7:3. We estimated the correlations between GRACE 2.0 score and CT findings. The primary outcomes are the incremental prognostic value of CT for the GRACE 2.0 score’s efficacy in predicting 3-year mortality or myocardial infarction (MI). A total of 1248 consecutive NSTE-ACS patients undergoing CT scans were prospectively included. The risk of 3-year mortality or MI was greater in the higher CACS category (HR, 2.31 [95

BACKGROUND:Early reperfusion therapy is critical in patients with ST-segment elevation myocardial infarction (STEMI). However, limitations in resources and patient-level and system-level barriers delay the administration of reperfusion therapy. This study evaluated the impact of an integrated care strategy for STEMI management in China. METHODS:This prospective, multicentre, non-randomised controlled study consecutively enrolled patients with acute STEMI, who were admitted to eight tertiary hospitals in different regions of China (August 2015-February 2019). An integrated care model was used in four hospitals (intervention). This model mainly included regular community public education, skills training for the diagnosis and treatment of STEMI in percutaneous coronary intervention-incapable centres, referral system improvement and optimal green channel for primary percutaneous coronary intervention-capable centres. In the other four hospitals (control), usual care of acute myocardial infarction public management and medical health service was provided. The primary outcome was the proportion of patients receiving symptom-to-reperfusion within 12 hours. RESULTS:A total of 6817 patients with acute STEMI were analysed (age (mean±SD): 61±13 years; female: n=1242 (18.2%)). Of those, 2452 and 4365 patients were included in the intervention and control groups, respectively. Between 2015 and 2019, the rates of symptom-to-reperfusion within 12 hours and symptom-to-admission within 12 hours increased in the intervention group (from 65.3% to 91.4%; and from 74.2% to 96.4%, respectively; Ptrend=0.015 for both). In addition, there was no significant difference in door-to-balloon time within 90 min observed among the two groups (adjusted relative risk=0.96, 95% CI: 0.89 to 1.02; p=0.18). Moreover, the rates of in-hospital mortality and major adverse cardiac events exhibited a nearly onefold decrease in the intervention group versus the control group (p<0.001). CONCLUSIONS:Use of an integrated care model focusing on prehospital delay may increase the rate of timely treatment in areas with limited medical resources in China. TRIAL REGISTRATION NUMBER:NCT03928119.

BACKGROUND & AIMS:Gastrointestinal bleeding (GIB) is common in patients with cardiovascular (CV) disease, but a complete understanding of subsequent outcomes is unknown. We assessed outcomes after GIB in patients with CV disease. METHODS:INTERBLEED is an international multicenter prospective study comparing adults with CV disease (coronary or peripheral arterial disease, heart failure, atrial fibrillation, cerebrovascular disease, or venous thromboembolic disease) with GIB to those without. Outcomes included major adverse cardiovascular events (MACE; myocardial infarction, stroke, or CV-related death), all-cause death, and recurrent GIB at 12 months. Multivariable regression modelling yielded odds ratios (ORs) with 95% confidence intervals (CIs), and reverse Kaplan-Meier curves were created. RESULTS:A total of 3814 patients were enrolled: 1612 patients with GIB and 2202 without. On multivariable analyses, patients with CV disease experiencing GIB were more likely to die within 12 months (OR, 2.29; 95% CI, 1.24-4.19). GIB was associated with recurrent GIB (OR, 4.28; 95% CI, 2.80-6.53) but not MACE. However, resumption of antithrombotic therapy between 4 and 7 days (OR, 0.37; 95% CI, 0.17-0.83) or 8 and 30 days (OR, 0.37; 95% CI, 0.17-0.81) after GIB were associated with lower odds of MACE within 12 months compared with discontinuation or lack of resumption within 60 days. Any antithrombotic use after enrollment was associated with lower all-cause death (OR, 0.45; 95% CI, 0.28-0.71). Neither antithrombotic use nor early resumption was associated with higher odds of recurrent GIB. CONCLUSIONS:GIB in patients with CV disease is independently associated with subsequent morbidity and mortality. Patterns in antithrombotic resumption were associated with outcomes. Further research into optimal antithrombotic management after GIB is essential.

Subcortical stroke induces widespread connectivity changes between cortical and subcortical regions, which may underpin the ensuing behavioral dysexecutive symptoms. This study therefore investigated the cortical structural connectivity that were related to behavioral dysexecutive symptoms using fiber connectivity density (FiCD) mapping, an approach which combines white matter (WM) fiber tractography and cortex reconstruction. The relationships between cortical structural connectivity of significant clusters and its corresponding cortical thickness (CT), and clinical variables were also evaluated based on region-of-interest analysis. Sixty-four subcortical stroke patients with high-resolution T1-weighted imaging and diffusion tensor imaging were enrolled and the behavioral dysexecutive symptoms were assessed using the dysexecutive questionnaire. The FiCD of the left superior parietal gyrus was positively associated with cognitive executive processing (CTT1 time, r = 0.570, p = 0.047; CVFT total correct, r = 0.582, p = 0.047; CVFT total response, r = 0.605, p = 0.040). Similary, the FiCD of the right superior parietal gyrus was also positively associated with cognitive executive processing, (CTT1 time, r = 0.639, p = 0.034). Conversely, negative correlations were observed between the FiCD and CT of the right (r = -0.612 p = 0.045) superior parietal gyrus.

Background:Gestational diabetes mellitus (GDM) prevalence is rising in China, necessitating an understanding of knowledge, attitudes, and practices (KAP) among affected women to inform interventions. Methods:This cross-sectional study (June 2020-June 2024) surveyed 3,426 Chinese women with GDM, aged 20-60 years, from urban and rural prenatal clinics across Qingdao city, China. A validated 25-item KAP questionnaire used a three-option response format (yes, no, maybe). Data were collected via WeChat in urban areas and paper-based surveys in rural regions (89% response rate), analyzed using chi-square tests and binary logistic regression. Results:Significant KAP gaps emerged: 63% recognized GDM's link to complications, but only 50% understood its comprehensive management, with 38% aware of eye exams and 40% of foot care needs. Practice adherence was poor-36% monitored blood glucose, 38% limited alcohol, and 53% practiced foot care, despite 59% adhering to medications. Attitudinally, 64% believed health-focused behavior drives management, yet only 36% viewed personal accountability as key, with 39% feeling providers understood their concerns. Intriguingly, younger women (20-30 years) were more open to education (OR 2.67, 95% CI 1.94-3.69, p < 0.001), while illiteracy (OR 88.7, 95% CI 34.7-249, p < 0.001) and older age (51-60 years: OR 12.7, 95% CI 8.79-18.4, p < 0.001) predicted poor outcomes. Positive attitudes were protective (OR 0.19, 95% CI 0.15-0.24, p < 0.001). Conclusion:These findings reveal entrenched KAP barriers in GDM management, underscoring the need for innovative, equity-driven interventions-integrating accessible education, community empowerment, and digital tools-to enhance outcomes and reduce the GDM burden in China.

BACKGROUND:Existing guidelines emphasize the importance of initial fluid resuscitation therapy in sepsis management. However, in previous meta-analyses, there have been inconsistencies in differentiating between spontaneously breathing and mechanically ventilated septic patients. OBJECTIVE:To consolidate the literature on the predictive accuracy of changes in the inferior vena cava diameter (∆IVC) for fluid responsiveness in septic patients. METHODS:The Embase, Web of Science, Cochrane Library, MEDLINE, PubMed, Wanfang, China National Knowledge Infrastructure (CNKI), Chinese Biomedical (CBM) and VIP (Weipu) databases were comprehensively searched. Statistical analyses were performed with Stata 15.0 software and Meta-DiSc 1.4. RESULTS:Twenty-one research studies were deemed suitable for inclusion. The sensitivity and specificity of ∆ IVC were 0.84 (95% CI 0.76, 0.90) and 0.87 (95% CI 0.80, 0.91), respectively. With respect to the distensibility of the inferior vena cava (dIVC), the sensitivity was 0.79 (95% CI 0.68, 0.86), and the specificity was 0.82 (95% CI 0.73, 0.89). For collapsibility of the inferior vena cava (cIVC), the sensitivity and specificity values were 0.92 (95% CI 0.83, 0.96) and 0.93 (95% CI 0.86, 0.97), respectively. CONCLUSION:The results indicated that ∆IVC is as a dependable marker for fluid responsiveness in sepsis patients. dIVC and cIVC also exhibited high levels of accuracy in predicting fluid responsiveness in septic patients.

OBJECTIVE:To explore age-related differences in coronary artery lesions, lesion characteristics, and short-term prognosis in acute coronary syndrome (ACS) patients. METHODS:A retrospective analysis was conducted on 198 ACS patients (February 2019-January 2024). Patients were grouped by age: < 40 years (low-age), 40-60 years (middle-age), and > 60 years (high-age). We compared clinical data, coronary angiography results, lesion characteristics, and short-term major adverse cardiac event (MACE) occurrence across the groups. Pearson or Spearman correlation was used to assess relationships, and ROC curves were employed to evaluate the predictive ability for MACE. RESULTS:The high-age group had significantly higher Gensini scoring and Global Registry of Acute Coronary Events (GRACE) scores (both P < 0.001), more diseased branches, and a higher proportion of non-calcified plaques. MACE incidence was highest in the high-age group. Age correlated positively with hypertension, hyperlipidemia, triglycerides, Gensini score, GRACE score, and the number of diseased branches, and negatively with hemoglobin levels (all P < 0.05). Age showed the strongest predictive ability for short-term MACE (AUC: 0.673, sensitivity: 71.0%). CONCLUSION:Elderly ACS patients exhibit more severe coronary lesions and a higher incidence of MACE. Age is a significant predictor of short-term MACE and correlates with various clinical and angiographic indicators.

AIMS:This study aimed to identify and quantify the importance of risk factors for gastrointestinal (GI) bleeding in patients with CV disease. METHODS:We conducted a case-control study in 9 countries in Asia, America, Europe, and Australia. Cases were patients with CV disease with GI bleeding. Controls were patients with CV without a history of GI bleeding. All participants completed a baseline standardized assessment. We calculated adjusted odds ratios (ORs) and average population attributable fractions (aPAFs) with 95% confidence intervals (CIs). RESULTS:Between September 2015 and December 2022, we enrolled 2,519 cases and 2,202 controls. Independent risk factors for GI bleeding were age (age 71+: OR 4.16, 95% CI 3.48-4.97; age 61-70: OR 1.69, 95% CI 1.39-2.04; age ≤60 as reference), underweight (OR 3.38, 95% CI 2.24-5.10; aPAF 1.6%, 95% CI 1.0-2.0%), current smoker (OR 1.31; 95% CI 1.09-1.58; aPAF 1.5%, 95% CI 0.6-2.5); chronic kidney disease (OR 1.86, 95% CI 1.62-2.14; aPAF 8.8%, 95% CI 7.0-9.6%), prior stroke (OR 1.56, 95% CI 1.30-1.88, aPAF 2.6%, 95% CI 1.2-4.0%), glucocorticoids (OR 1.71, 95% CI 1.34-2.16, aPAF 1.8%, 95% CI 1.3-2.9%), NSAIDs or COX-2 inhibitors (OR 1.82, 95% CI 1.45-2.29; aPAF 2.2%, 95% CI 1.3-3.0%), liver disease (OR 3.68, 95% CI 2.77-4.89; aPAF 3.5%, 95% CI 2.8-4.2%), peptic ulcer disease (OR 3.38, 95% CI 2.66-4.31; aPAF 4.8%, 95% CI 3.8-5.7%), diverticular disease (OR 1.81, 95% CI 1.46-2.24; aPAF 2.8%, 1.9-3.6%) and antithrombotic therapy within 6 months (aPAF 7.6%, 95% CI 4.3-12.8%). Overall aPAF adjusted for age, sex and region was 37.3% (95% CI 33.0-42.2%). CONCLUSION:Potentially modifiable risk factors are associated with only about one third of the aPAF for GI bleeding.

Objective: To assess the frequency of lymphocyte subsets and other laboratory indicators in paired cerebrospinal fluid (CSF) and peripheral blood (PB) samples from critically ill patients with intracerebral hemorrhage (ICH) who developed systemic inflammatory response syndrome (SIRS) following surgery. Introduction: Neuroinflammation and systemic inflammatory responses significantly contribute to secondary brain injury following ICH. Post-surgery SIRS is known to worsen clinical outcomes in ICH patients; however, the immune response in the CSF and PB has not been fully characterized. Understanding immunological changes in ICH patients with SIRS could lead to improved clinical management and prognostic outcomes. Methods: This study involved a retrospective analysis of data from patients with ICH who underwent surgery in the Neurological Intensive Care Unit (NICU) of Baoding No. 1 Hospital, Hebei Province, China, between January and July 2022. Patients were divided into SIRS and non-SIRS groups based on the clinical criteria. Demographic, clinical, and laboratory data, including lymphocyte subsets in CSF and PB, were collected and analyzed. This study compared lymphocyte subsets and other inflammatory markers between the SIRS and non-SIRS groups. Results: Patients with SIRS demonstrated higher systolic blood pressure (SBP) at admission, worse 90-day prognoses, elevated inflammatory markers, increased levels of complement proteins C3 and C4, and lower levels of immunoglobulin G (IgG) compared to patients without SIRS. Between 3-6 days post-surgery, SIRS patients showed higher percentages of CD3+T cells, CD4+T cells, and CD4+/CD8+ ratios in the CSF than nonSIRS patients. CD3+T cell percentages in the CSF were consistently higher than those in the PB and were independent of PB levels. In contrast, CD3-CD16+CD56+ natural killer (NK) cell percentages were lower in patients with SIRS. No significant differences in PB lymphocyte subsets were found between the two groups. A high CSF CD3+T cell percentage (>= 85.68 %) was identified as the strongest predictor of critical ICH with SIRS after surgery, with an appropriate use criterion (AUC) of 0.7742, sensitivity of 77.42 %, specificity of 76.19 %, and 95 % CI of 0.6655-0.8829 (P < 0.0001). Conclusion: Elevated levels of CD3+T lymphocytes in CSF are strongly associated with an increased risk of severe cerebral hemorrhage and SIRS following surgery. These findings suggest that monitoring CSF immune markers, particularly CD3+T lymphocytes, could serve as valuable predictors for the development of SIRS in critically ill ICH patients and inform post-surgical treatment strategies.

Background Anaemia is a common comorbidity in patients with chronic kidney disease (CKD) and heart failure (HF). Roxadustat has been approved for the treatment of anaemia in patients with CKD. However, its efficacy and safety in treating anaemia in patients with both CKD and HF remain unclear. We conducted a retrospective study with propensity score matching (PSM) to evaluate the efficacy and safety of roxadustat in this population. Methods This retrospective study enrolled patients diagnosed with HF comorbid with CKD and anaemia. The patients were divided into two groups: a roxadustat group and a control group. One-to-one PSM was used to balance baseline characteristics between the groups. The primary endpoint was the change in haemoglobin (Hb) at week 8. Secondary endpoints included Hb response, changes in haematocrit, iron parameters, echocardiographic parameters, B-type natriuretic peptides and lipid levels. Exploratory endpoints were mortality and rehospitalization rates over 30 days-2 years. Safety endpoints included the incidence of hyperkalaemia, liver damage and thrombotic events. Results A total of 1055 patients were screened. After PSM, 206 patients were included. Baseline characteristics were comparable between the matched cohorts. At week 8, the roxadustat group experienced a greater increase in Hb than the control group, with a difference of 0.8 g/dl (95% confidence interval 0.3-1.3; P = .003). The roxadustat group also demonstrated a higher Hb response (60.2% versus 28.2%; P < .001) and a greater increase in haematocrit (4.7 +/- 0.9% versus 2.8 +/- 0.6%; P = .008) than the control group. No significant differences were observed for other secondary endpoints. Thrombotic events were similar between the two groups and there were no differences in the risks of mortality or rehospitalization. Conclusions Roxadustat was effective in correcting and maintaining Hb levels in patients with anaemia, HF and CKD. It did not increase thrombotic and other adverse events, mortality or rehospitalization risks, making it a promising treatment option for anaemia in this population.

This study aimed to determine the optimal high-sensitivity cardiac troponin I (hs-cTnI)-based algorithm for early diagnosis of non-ST-elevation myocardial infarction (NSTEMI) in Chinese patients. We prospectively enrolled 1,606 patients with suspected NSTEMI from three emergency departments across China, collecting blood samples at 0, 1, and 3 h post-admission. Patients were classified using the 0/1-h and 0/3-h algorithms. The 2015 and 2020 ESC 0/1-h algorithms rapidly triaged 70% of patients with high negative predictive value (NPV) (99.7%) and sensitivity (99.5%). The 0/3-h algorithm showed higher specificity (93.8%) but lower NPV (96.8%) and sensitivity (91.2%). An optimized 0/1-h algorithm improved specificity to 92.1% while maintaining high NPV (99.7%) and sensitivity (99.2%). Low 30-day and 180-day all-cause mortality and major adverse cardiac event (MACE) rates were observed in rule-out groups for all algorithms. The ESC 0/1-h algorithm is a safe and efficient triage method for patients with suspected NSTEMI, with optimization further enhancing specificity and efficiency for the Chinese population.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a common and debilitating mental disorder. Neuroimaging studies have highlighted that a dysfunctional default mode network (DMN) plays a key role in the pathophysiological mechanisms of OCD. However, findings of impaired DMN regions in OCD have been inconsistent. We used metaanalysis to identify functional magnetic resonance imaging (fMRI)-specific abnormalities of the DMN in OCD. METHODS: PubMed, Web of Science, and Embase were searched to screen resting-state fMRI studies of the amplitude of low-frequency fluctuation/fractional amplitude of low-frequency fluctuation (ALFF/fALFF) and regional homogeneity of the DMN in patients with OCD. Based on the activation likelihood estimation algorithm, we compared all patients with OCD and a control group in a primary meta-analysis and analyzed unmedicated OCD patients without comorbidities in secondary meta-analyses. RESULTS: A total of 26 eligible studies with 1219 patients with OCD (707 men) and 1238 healthy control participants (684 men) were included in the primary meta-analysis. We identified specific changes in brain regions of the DMN, mainly in the left medial frontal gyrus, bilateral superior temporal gyrus, bilateral inferior parietal lobule, bilateral precuneus, bilateral posterior cingulate cortex, and right parahippocampal gyrus. CONCLUSIONS: Patients with OCD showed dysfunction in the DMN, including impaired local important nodal brain regions. The parietal cingulate cortex/precuneus appeared to be the most affected regions within the DMN, providing valuable insights into understanding the potential pathophysiology of OCD and targets for clinical interventions.

In recent years, 5-Methoxytryptophan (5-MTP) has been identified as an endothelial factor with vaso-protective and anti-inflammatory properties. In this prospective cohort study, a total of 407 patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI) successfully were enrolled. A 1-year follow-up Kaplan–Meier survival analysis was used for evaluating the correlation between 5-MTP and major adverse cardiovascular event (MACE) while Cox proportional-hazards regression was used to identify predictive values of 5-MTP on MACE after AMI. Increased 5-MTP level led to a significant downtrend in the incidence of MACE (All Log-rank p < 0.05). Thus, a high baseline 5-MTP could reduce the 1-year incidence of MACE (HR = 0.33, 95

Background: The high-sensitivity C-reactive protein to high-density lipoprotein cholesterol ratio (CHR) is a novel biomarker associated with coronary artery disease (CAD) risk. This study aimed to analyze the relationship between CHR and contrast-induced acute kidney injury (CI-AKI). Methods: This retrospective cross-sectional research included 10,917 individuals who underwent PCI. CI-AKI was diagnosed using the Kidney Disease: Improving Global Outcomes (KIDIGO) standard. Univariate and multivariable logistic regression analyses were conducted to examine the association between CHR and CI-AKI, followed by a receiver operating characteristic (ROC) curve of participants to assess the clinical diagnostic performance of CHR on CI-AKI. Results: A total of 1037 patients (9.50%) developed CI-AKI after PCI. The age of individuals averaged 64.1 ± 11.1 years old, with 2511 females (23.0%). A multivariate logistic regression study revealed that higher CHR levels were linked to higher CI-AKI incidence rates ([Q4 vs. Q1]: odds ratio (OR) = 1.89, 95% confidence interval (CI) [1.42 to 2.54], p < 0.001). A restricted cubic spline analysis revealed a linear association between CHR and CI-AKI. ROC analysis indicated that CHR was an excellent predictor of CI-AKI (area under ROC curve = 0.606, 95% CI [0.588 to 0.624]). Conclusions: A high CHR level is strongly associated with increased CI-AKI incidence, suggesting that CHR may be an independent risk factor for CI-AKI. Clinical Trial registration: NCT05050877. https://clinicaltrials.gov/study/NCT05050877?tab=results.