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Effect of negative remodeling of the side branch ostium on the efficacy of a two-stent strategy for distal left main bifurcation lesions:an intravascular ultrasound study

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Journal of Geriatric cardiology 2024年第5期21卷 506-522页

作者： Yi XU Tian XU Jia-Cong NONG Xiao-Han KONG meng-Yao ZHAO Zhi-Jing GAO Yi-Fei WANG Wei YOU Pei-Na mENG Yu-He ZHOU Xiang-Qi WU Zhi-ming WU mei-En ZHAN Yan-Qing WANG De-Feng PAN Fei YE department of cardiology Nanjing First HospitalNanjing Hospital Affiliated to Nanjing Medical UniversityNanjing Medical UniversityNanjingChina department of cardiology Clinical Medicine School of Nanjing UniversityNanjingChina department of cardiology Tianchang People’s HospitalTianchangChina department of cardiology the Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina

OBJECTIVES To investigate whether negative remodeling(NR)detected by intravascular ultrasound(IVUS)of the side branch ostium(SBO)would affect in-stent neointimal hyperplasia(NIH)at the one-year follow-up and the clinical outcome of target lesion failure(TLF)at the long-term follow-up for patients with left main bifurcation(Lmb)lesions treated with a two-stent strategy.mETHODS A total of 328 patients with de novo true complex Lmb lesions who underwent a 2-stent strategy of percutaneous coronary intervention(PCI)treatment guided by IVUS were enrolled in this study.We divided the study into two phases.Of all the patients,48 patients who had complete IVUS detection pre-and post-PCI and at the 1-year follow-up were enrolled in phase I analysis,which aimed to analyze the correlation between NR and in-stent NIH at SBO at the 1-year follow-up.If the correlation was confirmed,the cutoff value of the remodeling index(RI)for predicting NIH≥50%was analyzed next.The phase II analysis focused on the incidence of TLF as the primary endpoint at the 1-to 5-year follow-up for all 328 patients by grouping based on the cutoff value of RI.reSULTS In phase I:according to the results of a binary logistic regression analysis and receiver operating characteristic(ROC)analysis,the RI cutoff value predicting percent NIH≥50%was 0.85 based on the ROC curve analysis,with a sensitivity of 85.7%,a specificity of 88.3%,and an AUC of 0.893(0.778,1.000),P=0.002.In phase II:the TLR rate(35.8%vs.5.3%,Pmore in-stent NIH post-PCI for distal Lmb lesions with a 2-stent strategy,and NR with RI≤0.85 is linked to percent NIH area≥50%at the 1-year follow-up and more TLF at the 5-year follow-up.

关键词： lesions remodeling intravascular

Effect of Guanxin Danshen Dripping Pills on Coronary Heart Disease Comorbid with Depression or Anxiety: The ADECODE-real World Study

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Chinese Journal of Integrative medicine 2024年第5期30卷 443-448页

作者： WU Shi-hao SHI Wei-qi LI Yu-hang LIU Ru-hui HU Da-yi ZHENG Li-qiang mA Wen-lin department of Geriatric medicine Tongji HospitalSchool of MedicineTongji UniversityShanghai 200065China department of cardiology Tongji HospitalSchool of MedicineTongji UniversityShanghai 200065China department of cardiology Peking University People's HospitalBeijing 100044China School of Public Health Shanghai Jiao Tong UniversityShanghai 200030China

Objective: To evaluate the efficacy of Guanxin Danshen Dripping Pill(GXDSDP) in treating anxiety and depression in patients with coronary heart disease(CHD). methods: A total of 1,428 patients diagnosed with CHD screened for anxiety, depression, and quality of life(QOL) at baseline received 0.4 g of GXDSDP treatment 3 times per day and returned for monthly reassessment. Patients were recruited after stable treatment for CHD and received assessment of General Anxiety Disorder-7(GAD-7), Patient Health Questionnaire-9(PHQ-9), and Seattle Angina Questionnaire(SAQ) for evaluating anxiety, depression, and QOL.Patients were followed up 3 times, once every 4 weeks, during outpatient visits for 12 weeks. results: At the third follow-up(F3), the anxiety symptom of 63.79%(673/1,055) of the patients improved to sub-clinical level, and the GAD-7 score improved significantly(8.11 vs. 3.87, Pressive symptoms improved to sub-clinical level, with a significant improvement in PHQ-9 score(8.69 vs. 4.41, Pmproved at the end of treatment compared to those at baseline(all Pmitation(31.17 vs. 34.14), anginal stability(2.74 vs. 4.14), anginal frequency(8.16vs. 9.10), treatment satisfaction(13.43 vs. 16.29), and disease perception(8.69 vs. 11.02). Conclusions: A fixed dosage of GXDSDP may be a potential treatment option for CHD patients comorbid with anxiety or depression.(registration No. ChiCTR2100051523)

关键词： Guanxin Danshen Dripping Pill coronary heart disease depression anxiety quality of life Chinese medicine

Protein C deficiency with venous and arterial thromboembolic events

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World Journal of Clinical Cases 2024年第12期12卷 2000-2003页

作者： Nan Zhang Dong-Kun Sun Xu Tian Xin-Yu Zheng Tong Liu department of cardiology Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular DiseaseTianjin Institute of CardiologyThe Second Hospital of Tianjin Medical UniversityTianjin 300211China

Protein C(PC)is a key component of the vitamin K-dependent coagulation pathway.It exerts anticoagulant effects by inactivating factors V and VIII.Acquired or inherited PC deficiency results in a prothrombotic state,with presentations varying from asymptomatic to venous thromboembolism.However,there has been an increasing number of reports linking PC deficiency to arterial thromboembolic events,such as myocardial infarction and ischemic stroke.This editorial focuses on the association between PC deficiency and thromboembolism,which may provide some insights for treatment strategy and scientific research.

关键词： Protein C deficiency Venous thromboembolism myocardial infarction Editorial Arterial thromboembolism

Overview of the Association Between Non-Alcoholic Fatty Liver Disease and Hypertension

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cardiology Discovery 2024年第1期4卷 30-37页

作者： Niki S.Kakouril Costas G.Thomopoulos Eirini P.Siafi Angeliki E.Valatsoul Kyriakos S.Dimitriadis Iliana P.mani Sotirios P.Patsilinakos Dimitrios m.Tousoulis Konstantinos P.Tsioufis First department of cardiology Medical SchoolNational and Kapodistrian University of AthensHippokration HospitalAthens 11527Greece department of cardiology Elena Venizelou HospitalAthens 11521Greece department of cardiology General Hospital Agia OlgaAthens 14233Greece

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, and its prevalence is rising. NAFLD is closely associated with metabolic syndrome, with both conditions sharing common clinical characteristics such as obesity, insulin resistance, type 2 diabetes mellitus, hypertension, and hypertriglyceridemia. Several observational studies have evaluated the relationship between NAFLD and hypertension, with the overall evidence suggesting a bidirectional relationship. It is hypothesized that activation of the sympathetic nervous and renin-angiotensin systems, observed in NAFLD with or without insulin resistance promotes the development of hypertension. In patients with hypertension, activation of these systems can lead to hepatic fibrosis and progressive inflammation through increased oxidative stress and activation of hepatic stellate cells and Kupffer cells. The present review examines the pathophysiologic and clinical evidence supporting the bidirectional association between NAFLD and hypertension.

关键词： Hypertension Non-alcoholic fatty liver disease Insulin resistance Sympathetic nervous system metabolic syndrome

Oral anti-coagulants use in Chinese hospitalized patients with atrial fibrillation

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Chinese medical Journal 2024年第2期137卷 172-180页

作者： Jing Lin Deyong Long Chenxi Jiang Caihua Sang Ribo Tang Songnan Li Wei Wang Xueyuan Guo man Ning Zhaoqing Sun Na Yang Yongchen Hao Jun Liu Jing Liu Xin Du Louise morgan Gregg C.Fonarow Sidney C.Smith Jr Gregory Y.H.Lip Dong Zhao Jianzeng Dong Changsheng ma On behalf of CCC-AF investigators department of cardiology Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China National Clinical research Center for Cardiovascular Diseases Beijing 100029 China department of Epidemiology Beijing Anzhen HospitalCapital Medical UniversityBeijing Institute of HeartLung and Blood Vessel DiseasesBeijing 100029China International Quality Improvement department American Heart AssociationDallasTX 07076USA Division of cardiology Geffen School of Medicine at University of CaliforniaLos Angeles CA 90024USA Division of cardiology University of North CarolinaChapel HillNC 27599USA department of cardiology Liverpool Centre for Cardiovascular ScienceUniversity of Liverpool and Liverpool Heart&Chest HospitalLiverpool L143PEUK department of Clinical medicine Aalborg UniversityAalborg 9000Denmark 不详

Background:Oral anti-coagulants(OAC)are the intervention for the prevention of stroke,which consistently improve clinical outcomes and survival among patients with atrial fibrillation(AF).The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.methods:Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation(CCC-AF)registry,guideline-recommended OAC use in eligible patients was assessed.results:A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019,of whom 38,203 were at a high risk of stroke,9717 were at a moderate risk,and 4610 were at a low risk.On admission,only 20.0%(6075/30,420)of patients with a diagnosed AF and a high risk of stroke were taking OAC.The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population(adjusted odds ratio:0.54,95%confidence interval:0.43-0.68;Prescription rate of OAC was 45.2%(16,757/37,087)in eligible patients with high stroke risk and 60.7%(2778/4578)in eligible patients with low stroke risk.OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time(all Pmultivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies,including catheter ablation(adjusted odds ratio[OR]11.63,95%confidence interval[CI]10.04-13.47;Pmic drug use(adjusted OR 1.45,95%CI 1.38-1.53;P70%of AF patients were at a high risk of stroke.Although poor performance on guideline-recommended OAC use was found in this study,over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.registration:ClinicalTrials.gov,NCT02309398.

关键词： Atrial fibrillation Oral anti-coagulants OAC Stroke prevention Contraindication

multiple paradoxical embolisms caused by central venous catheter thrombus passing through a patent foramen ovale: A case report

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World Journal of Clinical Cases 2024年第4期12卷 842-846页

作者： Jian-Duan Li Nian Xu Qiang Zhao Biao Li Li Li department of cardiology Guangzhou Red Cross Hospital of Jinan UniversityGuangzhou 510235Guangdong ProvinceChina

BACKGROUND To date,this is the first case of a paradoxical embolism(PDE)that concurrently manifested in the coronary and lower limb arteries and was secondary to a central venous catheter(CVC)thrombus via a patent foramen ovale(PFO).CASE SUmmARY Here,we report a case of simultaneous coronary and lower limb artery embolism in a PFO patient carrier of a CVC.The patient presented to the hospital with acute chest pain and lower limb fatigue.Doppler ultrasound showed a large thrombus in the right internal jugular vein,precisely at the tip of the CVC.Transthoracic and transesophageal echocardiography confirmed the existence of a PFO,with inducible right-to-left shunting by the Valsalva maneuver.The patient was administered an extended course of anticoagulation therapy,and then the CVC was successfully removed.Percutaneous PFO closure was not undertaken.There was no recurrence during follow-up.CONCLUSION Thus,CVC-associated thrombosis is a potential source for multiple PDE in PFO patients.

关键词： Paradoxical embolism Central venous catheter Patent foramen ovale Acute myocardial infarction Case report

Effect of cytochrome P4502C19(CYP2C19)gene polymorphism and clopidogrel reactivity on long term prognosis of patients with coronary heart disease after PCI

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Journal of Geriatric cardiology 2024年第1期21卷 90-103页

作者： Cheng-Yan HU Yan-Ling WANG Zhen-Xing FAN Xi-Peng SUN Shuai WANG Zhi LIU department of Geriatrics Fu Xing HospitalCapital Medical UniversityBeijingChina department of cardiology Xuanwu Hospital Capital Medical UniversityBeijingChina Emergency department of Xuanwu Hospital Capital Medical UniversityBeijingChina

Objective To investigate the impact of CYP2C19 gene polymorphism on clopidogrel reactivity and its association with longterm clinical outcome in patients with coronary heart disease(CHD)undergoing percutaneous coronary intervention(PCI).methods In total,675 patients were enrolled.Based on the platelet inhibition rate,patients were categorized into two groups:clopidogrel low responsiveness(CLR)and normal clopidogrel responsiveness(NCR).The CLR group was divided into ticagrelor and clopidogrel group based on the antiplatelet drugs used in the follow-up treatment.Patients were classified into three groups(normal metabolizer,intermediate metabolizer,and poor metabolizer)based on the CYP2C19 genotype.We aimed to evaluate the impact of CYP2C19 gene polymorphism on clopidogrel reactivity.The cumulative rates of 12-month all-cause deaths,major adverse cardiovascular events(mACCEs),and bleeding events were calculated.results CLR was observed in 44.4%of the overall population.Significant differences were observed in the platelet inhibition rate of clopidogrel among the three metabolic genotypes(Pmonth follow-up,13 patients(1.9%)died and 96 patients(14.2%)experienced mACCEs.Patients with CLR(9.6%vs.11.7%vs.22.1%,Pmetabolizer(10.7%vs.16.4%vs.22.6%,P=0.026)experienced a higher rate of mACCEs.A mACCEs risk score between zero and two was calculated.The highest incidence of mACCEs significantly increased with the 2-positive results,and the area under the curve(AUC)was 0.712(95%CI:0.650-0.774,Pre was no significant difference between the group with a score of one and the occurrence of mACCEs(P>0.05).Conclusions Low response to clopidogrel in CHD patients is correlated with CYP2C19 gene polymorphism.CYP2C19 genotyping combined with platelet reactivity is an independent predictor of 12-months mACCEs in patients with clopidogrel treatment after PCI,which is better than either test alone.

关键词： CYP2C19 drugs PCI

Role of angiotensin receptor-neprilysin inhibitor in diabetic complications

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World Journal of Diabetes 2024年第5期15卷 867-875页

作者： Ying Liu Cun-Yu Lu Yi Zheng Yu-min Zhang Ling-Ling Qian Ku-Lin Li Gary Tse Ru-Xing Wang Tong Liu department of cardiology Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular DiseaseTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjin 300211China department of cardiology Xuzhou No.1 Peoples HospitalXuzhou 221005Jiangsu ProvinceChina department of cardiology Wuxi 9^(th)People’s Hospital Affiliated to Soochow UniversityWuxi 214062Jiangsu ProvinceChina department of cardiology Wuxi People’s Hospital Affiliated to Nanjing Medical UniversityWuxi 214023Jiangsu ProvinceChina School of Nursing and Health Studies Metropolitan UniversityHong Kong 999077China Kent and medway medical School Kent CT27NTCanterburyUnited Kingdom

Diabetes mellitus is a prevalent disorder with multi-system manifestations,causing a significant burden in terms of disability and deaths globally.Angio-tensin receptor-neprilysin inhibitor(ARNI)belongs to a class of medications for treating heart failure,with the benefits of reducing hospitalization rates and mortality.This review mainly focuses on the clinical and basic investigations related to ARNI and diabetic complications,discussing possible physiological and molecular mechanisms,with insights for future applications.

关键词： Angiotensin receptor-neprilysin inhibitor Diabetic mellitus Complication

Heterogeneous body compositions and all-cause mortality in acute coronary syndrome patients:a ten-year retrospective cohort study

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Journal of Geriatric cardiology 2024年第5期21卷 534-541页

作者： Guang-Zhi LIAO Lin BAI Yu-Yang YE Xue-Feng CHEN Xin-Ru HU Yong PENG department of cardiology West China HospitalSichuan UniversityChengduSichuanChina

BACKGROUND The association of different body components,including lean mass and body fat,with the risk of death in acute coronary syndrome(ACS)patients are unclear.mETHODS We enrolled adults diagnosed with ACS at our center between January 2011 and December 2012 and obtained fol-low-up outcomes via telephone questionnaires.We used restricted cubic splines(RCS)with the Cox proportional hazards model to analyze the associations between body mass index(BmI),predicted lean mass index(LmI),predicted body fat percentage(BF),and the value of LmI/BF with 10-year mortality.We also examined the secondary outcome of death during hospitalization.reSULTS During the maximum 10-year follow-up of 1398 patients,331 deaths(23.6%)occurred,and a U-shaped relationship was found between BmI and death risk(P_(nonlinearity)=0.03).After adjusting for age and history of diabetes,the overweight group(24≤BmIm^(2))had the lowest mortality(HR=0.53,95%CI:0.29-0.99).Predicted LmI and LmI/BF had an inverse linear relationship with a 10-year death risk(P_(nonlinearity)=0.24 and P_(nonlinearity)=0.38,respectively),while an increase in BF was associ-ated with increased mortality(P_(nonlinearity)=0.64).During hospitalization,31 deaths(2.2%)were recorded,and the associations of the indicators with in-hospital mortality were consistent with the long-term outcome analyses.CONCLUSION Our study provides new insight into the“obesity paradox”in ACS patients,highlighting the importance of considering body composition heterogeneity.Predicted LmI and BF may serve as useful tools for assessing nutritional status and predicting the prognosis of ACS,based on their linear associations with all-cause mortality.

关键词： patients mortality coronary