Regeneration of the heart:f rom molecular mechanisms to clinical therapeutics

Heart injury such as myocardial infarction leads to cardiomyocyte loss,fibrotic tissue deposition,and scar formation.These changes reduce cardiac contractility,resulting in heart failure,which causes a huge public health burden.Military personnel,compared with civilians,is exposed to more stress,a risk factor for heart diseases,making cardiovascular health management and treatment innovation an important topic for military medicine.So far,medical intervention can slow down cardiovascular disease progression,but not yet induce heart regeneration.In the past decades,studies have focused on mechanisms underlying the regenerative capability of the heart and applicable approaches to reverse heart injury.Insights have emerged from studies in animal models and early clinical trials.Clinical interventions show the potential to reduce scar formation and enhance cardiomyocyte proliferation that counteracts the pathogenesis of heart disease.In this review,we discuss the signaling events controlling the regeneration of heart tissue and summarize current therapeutic approaches to promote heart regeneration after injury.

The impact of female sex hormones on cardiovascular disease:from mechanisms to hormone therapy

Cardiovascular disease remains the leading cause of mortality in women,yet it has not raised the awareness from the public.The pathogenesis of cardiovascular disease differs significantly between females and males concerning the effect of sex hormones.Estrogen and progestogen impact cardiovascular system through genomic and non-genomic effects.Before menopause,cardiovascular protective effects of estrogens have been well described.Progestogens were often used in combination with estrogens in hormone therapy.Fluctuations in sex hormone levels,particularly estrogen deficiency,were considered the specific risk factor in women’s cardiovascular disease.However,considerable heterogeneity in the impact of hormone therapy was observed in clinical trials.The heterogeneity is likely closely associated with factors such as the initial time,administration route,dosage,and formulation of hormone therapy.This review will delve into the pathogenesis and hormone therapy,summarizing the effect of female sex hormones on hypertension,pre-eclampsia,coronary heart disease,heart failure with preserved ejection fraction,and cardiovascular risk factors specific to women.

Updates of developments in interventional therapy for elderly patients with cardiovascular diseases

Cardiovascular diseases(CVD)are the leading cause of death in the world and one of the most common diseases in the elderly,with high prevalence and poor prognosis,which seriously affect the health of the elder patients.One report showed that global deaths from CVD increased from 12.4 million in 1990 to 19.8 million in 2022,reflecting the global population growth and aging,as well as the impact of metabolic,environmental,and behavioral risks.[1]With the progress of aging population,the burden of CVD in the elderly in China has increased year by year,and factors including multiple complications,organ function decline,and high complication rate have made the interventional treatment of CVD in the elderly one of the difficulties and focuses in the field of cardiology in China.

Feasibility and clinical benefits of the double-ProGlide technique for hemostasis after cryoballoon atrial fibrillation ablation with uninterrupted oral anticoagulants

OBJECTIVE To access the efficacy and safety of the double-ProGlide technique for the femoral vein access-site closure in cryoballoon ablation with uninterrupted oral anticoagulants(OAC),and its impact on the electrophysiology laboratory time as well as hospital stay after the procedure in this observational study.METHODS Patients with atrial fibrillation undergoing cryoballoon ablation with uninterrupted OAC at Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing,China from May 2019 to May 2021 were enrolled in this study.From October 2020,double-ProGlide technique was consistently used for hemostasis(ProGlide group),and before that conventional manual compression was utilized(manual compression group).The occurrence of vascular and groin complications was accessed during the hospital stay and until the three-month follow-up.RESULTS A total of 140 participants(69.30%of male,mean age:59.21±10.29 years)were evaluated,70 participants being in each group.Immediate hemostasis was achieved in all the patients with ProGlide closure.No major vascular complications were found in the ProGlide group while two major vascular complications were occurred in the manual compression group.The incidence of any groin complication was obviously higher in subjects with manual compression than patients with ProGlide devices(15.71%vs.2.86%,P=0.009).In addition,compared with the manual compression group,the ProGlide group was associated with significantly shorter total time in the electrophysiology laboratory[112.0(93.3–128.8)min vs.123.5(107.3–158.3)min,P=0.006],time from sheath removal until venous site hemostasis[3.8(3.4–4.2)min vs.8.0(7.6–8.5)min,P<0.001],bed rest time[8.0(7.6–8.0)h vs.14.1(12.0–17.6)h,P<0.001]and hospital stay after the procedure[13.8(12.5–17.8)h vs.38.0(21.5–41.0)h,P<0.001].CONCLUSIONS Utilization of the double-ProGlide technique for hemostasis after cryoballoon ablation with uninterrupted OAC is feasible and safe,which has the clinical benefit in reducing the total electrophysiology laboratory time and the hospital stay length after the procedure.

Hybrid data-driven framework for shale gas production performance analysis via game theory, machine learning, and optimization approaches

A comprehensive and precise analysis of shale gas production performance is crucial for evaluating resource potential,designing a field development plan,and making investment decisions.However,quantitative analysis can be challenging because production performance is dominated by the complex interaction among a series of geological and engineering factors.In fact,each factor can be viewed as a player who makes cooperative contributions to the production payoff within the constraints of physical laws and models.Inspired by the idea,we propose a hybrid data-driven analysis framework in this study,where the contributions of dominant factors are quantitatively evaluated,the productions are precisely forecasted,and the development optimization suggestions are comprehensively generated.More specifically,game theory and machine learning models are coupled to determine the dominating geological and engineering factors.The Shapley value with definite physical meaning is employed to quantitatively measure the effects of individual factors.A multi-model-fused stacked model is trained for production forecast,which provides the basis for derivative-free optimization algorithms to optimize the development plan.The complete workflow is validated with actual production data collected from the Fuling shale gas field,Sichuan Basin,China.The validation results show that the proposed procedure can draw rigorous conclusions with quantified evidence and thereby provide specific and reliable suggestions for development plan optimization.Comparing with traditional and experience-based approaches,the hybrid data-driven procedure is advanced in terms of both efficiency and accuracy.

Concomitant occurrences of pulmonary embolism and acute myocardial infarction in acute coronary syndrome patient undergoing percutaneous coronary intervention:a case report

Pulmonary embolism(PE),a form of venous thromboembolism,is a relatively frequent car-diovascular emergency,and a potentially life-threatening condition that needs prompt identification and treatment.[1]PE is often misdiagnosed or unrecogn-ized with many patients experiencing atypical sympt-oms.[2,3]Early diagnosis and treatment of PE are import-ant.In this case,PE was found in a 73-year-old male pa-tient with three-vessel coronary artery disease who un-derwent percutaneous coronary intervention(PCI)for concomitant acute myocardial infarction(MI).

5’tiRNA-Pro-TGG,a novel tRNA halve,promotes oncogenesis in sessile serrated lesions and serrated pathway of colorectal cancer

BACKGROUND Transfer RNA(tRNA)-derived small RNAs(tsRNAs)are small fragments that form when tRNAs severe.tRNA halves(tiRNAs),a subcategory of tsRNA,are involved in the oncogenic processes of many tumors.However,their specific role in sessile serrated lesions(SSLs),a precancerous lesion often observed in the colon,has not yet been elucidated.AIM To identify SSL-related tiRNAs and their potential role in the development of SSLs and serrated pathway of colorectal cancer(CRC).METHODS Small-RNA sequencing was conducted in paired SSLs and their adjacent normal control(NC)tissues.The expression levels of five SSL-related tiRNAs were validated by q-polymerase chain reaction.Cell counting kit-8 and wound healing assays were performed to detect cell proliferation and migration.The target genes and sites of tiRNA-1:33-Pro-TGG-1(5′tiRNA-Pro-TGG)were predicted by TargetScan and miRanda algorithms.Metabolism-associated and immune-related pathways were analyzed by single-sample gene set enrichment analysis.Functional analyses were performed to establish the roles of 5′tiRNA-Pro-TGG based on the target genes.RESULTS In total,we found 52 upregulated tsRNAs and 28 downregulated tsRNAs in SSLs compared to NC.The expression levels of tiRNA-1:33-Gly-CCC-2,tiRNA-1:33-Pro-TGG-1,and tiRNA-1:34-Thr-TGT-4-M25′tiRNAs were higher in SSLs than those in NC,while that of 5′tiRNA-Pro-TGG was associated with the size of SSLs.It was demonstrated that 5′tiRNAPro-TGG promoted cell proliferation and migration of RKO cell in vitro.Then,heparanase 2(HPSE2)was identified as a potential target gene of 5′tiRNA-Pro-TGG.Its lower expression was associated with a worse prognosis in CRC.Further,lower expression of HPSE2 was observed in SSLs compared to normal controls or conventional adenomas and in BRAF-mutant CRC compared to BRAF-wild CRC.Bioinformatics analyses revealed that its low expression was associated with a low interferonγresponse and also with many metabolic pathways such as riboflavin,retinol,and cytochrome p450 drug metabolism pathways.CONCLUSION tiRNAs may profoundly impact the development of SSLs.5′tiRNA-Pro-TGG potentially promotes the progression of serrated pathway CRC through metabolic and immune pathways by interacting with HPSE2 and regulating its expression in SSLs and BRAF-mutant CRC.In the future,it may be possible to use tiRNAs as novel biomarkers for early diagnosis of SSLs and as potential therapeutic targets in serrated pathway of CRC.

Diagnostic accuracy of a deep learning approach to calculate FFR from coronary CT angiography

Background The computational fluid dynamics(CFD)approach has been frequently applied to compute the fractional flow reserve(FFR)using computed tomography angiography(CTA).This technique is efficient.We developed the DEEPVESSEL-FFR platform using the emerging deep learning technique to calculate the FFR value out of CTA images in five minutes.This study is to evaluate the DEEPVESSEL-FFR platform using the emerging deep learning technique to calculate the FFR value from CTA images as an efficient method.Methods A single-center,prospective study was conducted and 63 patients were enrolled for the evaluation of the diagnostic performance of DEEPVESSEL-FFR.Automatic quantification method for the three-dimensional coronary arterial geometry and the deep learning based prediction of FFR were developed to assess the ischemic risk of the stenotic coronary arteries.Diagnostic performance of the DEEPVESSEL-FFR was assessed by using wire-based FFR as reference standard.The primary evaluation factor was defined by using the area under receiver-operation characteristics curve(AUC)analysis.Results For per-patient level,taking the cut-off value<0.8 referring to the FFR measurement,DEEPVESSEL-FFR presented higher diagnostic performance in determining ischemia-related lesions with area under the curve of 0.928 compare to CTA stenotic severity 0.664.DEEPVESSEL-FFR correlated with FFR(R=0.686,P<0.001),with a mean di&ference of-0.006士0.0091(P=0.619).The secondary evaluation factors,indicating per vessel accuracy,sensitivity,specificity,positive predictive value,and negative predictive value were 87.3%,97.14%,75%,82.93%,and 95.45%,respectively.Conclusion DEEPVESSEL-FFR is a novel method that allows efficient assessment of the functional significance of coronary stenosis.

New predictors of in-stent restenosis in patients with diabetes mellitus undergoing percutaneous coronary intervention with drug-eluting stent

Background Percutaneous coronary intervention （PCI） had become the major therapeutic procedure for coronary artery disease （CAD）, but the high rate of in-stent restenosis （ISR） still remained an unsolved clinical problem in clinical practice. Increasing evidences suggested that diabetes mellitus （DM） was a major risk factor for ISR, but the risk predictors of ISR in CAD patients with DM had not been well characterized. The aim of this study was to investigate the clinical and angiographic characteristic predictors significantly associated with the occurrence of ISR in diabetic patients following coronary stenting with drug-eluting stent （DES）. Methods A total of 920 patients with diabetes who diagnosed CAD and underwent coronary DES implantation at Beijing Anzhen Hospital in China were consecutively enrolled from January 2012 to December 2012. Of these, 440 patients underwent the second angiography within ≥ 6 months due to the progression of treated target lesions. Finally, 368 of these patients who met the inclusion and exclusion criteria were followed up by angiography after baseline PCI. According to whether ISR was detected at follow-up angiography, patients were divided into the ISR group （n = 74） and the non-ISR group （n = 294）. The independent predictors of ISR in patients with DM were explored by multivariate Cox＇s proportional hazards regression models. Results A total of 368 patients （260 women and 108 men） with a mean ages of 58.71 ± 10.25 years were finally enrolled in this study. Of these, ISR occurred in 74/368 diabetic patients （20.11%） by follow-up angiography. Univariate analysis showed that most baseline characteristics of the ISR and non-ISR group were similar. Patients in the ISR group had significantly higher serum very low density lipoprotein cholesterol （VLDL-C）, triglyceride （TG） and uric acid （UA） levels, more numbers of target vessel lesions, higher prevalence of multi-vessel disease, higher SYNTAX score, higher rate of previous but lower rate of drinking compared with patients in the non-ISR group. The independent predictors of ISR in patients with DM after DES implantation included VLDL-C （HR = 1.85, 95% CI： 1.24-2.77, P = 0.002）, UA （per 50 μmol/L increments, HR = 1.19, 95% CI： 1.05 1.34, P = 0.006）, SYNTAX score （per 5 increments, HR = 1.34, 95% CI： 1.03-1.74, P = 0.031） and the history ofPCI （HR = 3.43, 95% CI： 1.57-7.80, P = 0.003） by the multivariate Cox＇s proportional hazards regression analysis. Conclusions The increased serum VLDL-C and UA level, higher SYNTAX score and the history of previous PCI were independent predictors of ISR in patients with DM after coronary DES implantation. It provided new evidence for physi- cians to take measures to lower the risk oflSR for the better management of diabetic patients after PCI.

Elevated IL-37 levels in the plasma of patients with severe coronary arterycalcification

Background Coronary artery calcification （CAC） is a predictor of cardiovascular events and plaque burden and is closely associatedwith chronic inflammation. Intedeukin （IL）-37 is a newly discovered member of the IL-1 family and is considered an anti-inflammatorycytokine. Our recent study on mice indicated that IL-37 could attenuate atherosclerosis and vascular calcification, which suggests that IL-37could be associated with the development of atherosclerosis and related diseases. The aim of this study was to investigate if IL-37 plays arole in the progression of CAC in patients. Methods Two hundred participants with suspected cardiovascular disease were recruited. Thelevels of plasma IL-37, osteoprotegerin （OPG）, hypersensitive C-reactive protein （hsCRP） together with other biochemical parameters weremeasured, and a coronary calcium assessment was carried out by multi-detector row CT. A score of 〈 10 AU （Agatston units） denotes anabsence of CAC, a score of 11-100 AU denotes mild CAC, 101-400 denotes moderate CAC, and 〉 400 AU denotes severe CAC. ResultsOur initial data showed that there were no apparent differences in plasma IL-37 levels among patients with or without mild or moderate CAC.However, IL-37 levels were significantly increased in patients with severe CAC （P 〈 0.001）. Similar results were observed for plasma OPGand hsCRP levels. When IL-37 levels in patients with severe calcification were compared with that in all of the other non-severe CAC groups,it became apparent that there was a significant positive correlation between IL-37 level and severe CAC （r = 0.360, P 〈 0.001; OR = 1.033）using Spearrnan＇s correlation and binary logistic regression analysis. Conclusions This study demonstrates that the anti-inflammatory cy-tokine IL-37 is associated with high coronary calcium levels, suggesting that IL-37 expression may be caused by the activation ofinf/amma-tion and that IL-37 might become a predictor of severe CAC in the future, which requires further investigation.

Current understanding of coronary artery calcification

Coronary artery calcification （CAC） is highly prevalent in patients with coronary heart disease （CHD） and is associated with major adverse cardiovascular events. There are two recognized type of CAC--intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary interven- tion have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD pa- tients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.

Obstructive sleep apnea is associated with severity and long-term prognosis of acute coronary syndrome

Background Obstructive sleep apnea （OSA） is a common disease in patients with acute coronary syndrome （ACS） and associated with an increased risk of fatal and nonfatal cardiovascular events. However, most patients in previous study were treated with bare metal stents and the sample sizes were relatively low. The goal of this study was to evaluate the influence of OSA on the severity and prognosis of patients admitted for ACS. Methods In this prospective cohort study, we enrolled patients with ACS who were hospitalized for coronary angiogram/percutaneous coronary intervention and undergone polysomnography. We divided the patients into two groups： moderate to severe OSA group [apnea-hypopnea index （AHI） 〉 15 events/h] and control group （AHI ≤ 15 events/h）. They were followed up for up 32 months. Then, we compared the ACS severity and long-term major adverse cardiovascular events （MACE） in patients with different severity of OSA. Results Five hundred and twenty nine patients were included in the final analysis, with 76% of them being men and an average age of 59 ＋ 10 years. The overall mean AHI is 29 ± 19 events/h, 70.5% of them （373/529） being with moderate to severe OSA and 29.5% （156/529） assign into control group. Compared with controls, patients with moderate or severe OSA exhibited a higher prevalence of hypertension as well as higher body mass index, SYNTAX score, Epworth score and length of hospitalization. With a median follow-up duration of 30 months, accumulative rate of MACE was also higher in patients with moderate or severe OSA than that in the control group （8.6% vs. 3.2%, P = 0.028）. After adjusting for baseline confounders by cox regression model, moderate to severe OSA was an independent risk factor of long-term MACE （P = 0.047, HR = 1.618, 95% CI： 1.069-3.869）. Conclusions The results of this study demonstrate that moderate or severe OSA is correlated with disease severity and associated with worse long-term prognosis in ACS patients. The results raising the possibility that early diagnose and interventions of OSA could improve long-term outcomes in ACS patients.

The serum anion gap is associated with disease severity and all-cause mortality in coronary artery disease

Objective To evaluate the associations between the serum anion gap （AG） with the severity and prognosis of coronary artery disease （CAD）. Methods We measured serum electrolytes in 18,115 CAD patients indicated by coronary angiography. The serum AG was calculated according to the equation： AG = Na^＋ [（mmol/L） ＋ K^＋ （mmol/L）] - [Cl^- （mmol/L） ＋ HCO3^- （mmol/L）]. Results A total of 4510 （24.9%） participants had their AG levels greater than 16 mmol/L. The serum AG was independently associated with measures of CAD severity, including more severe clinical types of CAD （P 〈 0.001） and worse cardiac function （P = 0.004）. Patients in the 4th quartile of serum AG （≥ 15.92 mmol/L） had a 5.171-fold increased risk of 30 days all-cause death （P 〈 0.001）. This association was robust, even after adjustment for age, sex, evaluated glomerular filtration rate [hazard ratio （HR）： 4.861, 95% confidence interval （CI）： 2.150–10.993, P 〈 0.001], clinical diagnosis, severity of coronary artery stenosis, cardiac function grades, and other confounders （HR： 3.318, 95% CI： 1.76–2.27, P = 0.009）. Conclusion In this large population-based study, our findings reveal a high percentage of increased serum AG in CAD. Higher AG is associated with more severe clinical types of CAD and worse cardiac function. Furthermore, the increased serum AG is an independent, significant, and strong predictor of all-cause mortality. These findings support a role for the serum AG in the risk-stratification of CAD.

Comparison of very-high-frequency ultrasound assessment of radial arterial wall layers after first and repeated transradial coronary procedures

Background Transradial coronary procedure （TRP） traumatizes the radial artery （RA）, especially resulting in changes to arterial wall morphology. This study explored the significance of the early onset of traumatic effects to wall layers of the RA following the first TRP （FTRP） and repeat TRP （RTRP） using very-high-frequency ultrabiomicroscopy （VHFUBM）. Methods A total of 1431 patients that re- ceived TRP were divided into the FTRP group that comprised 781 patients and the RTRP group that comprised 650 patients depending on the number of procedures. Two-dimensional RA images were acquired by 30-55 MHz ultrasound one day before and one day after the pro- cedure. Results After TRP, the incidence of intimal tears, medial dissections and external elastic lamina fracture were greater in the RTRP （P 〈 0.001）. The RTRP group showed significantly thicker intimal thickness （IT）, media thickness （MT）, adventitia thickness and all complex layer thicknesses as compared with the FTRP group （P 〈 0.001）. Conclusions Multivariate linear regression analysis discovered that repeated TRP and other observations were independent predictors of increased IT in post-operative RA. VHFUBM provides an approach to study structural and histopathological injury in the wall layers of RA which showed increased trauma to the RA following RTRP.

Intracardiac echocardiography in the diagnosis and closure of patent foramen ovale

Patent foramen ovale(PFO)which is caused by failed fusion of septum primum and septum secundum,is the first leading congenital heart abnormality,affecting about 25%of the general population.

Is it better to choose immediate dialysis treatment for renal transplant patients after PCI?

Administration of iodinated contrast agents can give rise to allergic/hypersensitivity reactions and contrast-induced nephropathy.In extremely rare cases,intravascularly administered iodinated contrast agents can trigger contrast-induced encephalopathy(CIE)in patients undergoing percutaneous coronary intervention(PCI).[1]Here,we describe the case of a male patient diagnosed with CIE after undergoing PCI with a non-ionic contrast agent,iodixanol.This is the first such case to be reported in a patient undergoing hemodialysis after kidney transplantation.

First-in-human evaluation of an independently developed Chinese robot-assisted system for percutaneous coronary intervention

BACKGROUND Several studies have proved the safety and feasibility of robot-assisted percutaneous coronary intervention(PCI)in reducing the occupational hazards of interventionists while achieving precision medicine.However,an independently developed robot-assisted system for PCI in China has not yet emerged.This study aimed to evaluate the safety and feasibility of a robot-assisted system for elective PCI in China.METHODS This preclinical trial included 22 experimental pigs and preliminarily supported the safety and feasibility of the ETcath200 robot-assisted system for PCI.Then,eleven patients with coronary heart disease who met the inclusion criteria and had clinical indications for elective PCI were enrolled.PCI was performed using a robot-assisted system.The primary outcomes were clinical success(defined as visual estimated residual stenosis<30%after PCI and no major adverse cardiovascular events during hospitalization and within 30 days after PCI)and technical success(defined as the ability to use the robot-assisted system to complete PCI successfully without conversion to the traditional manual PCI).RESULTS Eleven patients were included in this clinical trial.A drug-eluting stent with a diameter of 3 mm(interquartile range:2.75–3.5 mm)and a length of 26 mm(interquartile range:22–28 mm)was deployed in all patients.The clinical success rate was 100%,with no PCI-related complications and no in-hospital or 30-day major adverse cardiovascular events,and the technical success rate was 100%.CONCLUSIONS The results strongly suggest that the use of the independently developed robot-assisted system in China for elective PCI is feasible,safe,and effective.

Prognostic significance of multiple triglycerides-derived metabolic indices in patients with acute coronary syndrome

BACKGROUND Triglyceride(TG)and its related metabolic indices,all recognized as surrogates of insulin resistance,have been demonstrated to be relevant to clinical prognosis.However,the relative value of these TG-related indices for predicting cardiovascular events among patients with acute coronary syndrome(ACS)has not been examined.METHODS The TG,the triglyceride-glucose(TyG)index,the atherogenic index of plasma,TG to high-density lipoprotein cholesterol ratio,and the lipoprotein combine index were assessed in 1694 ACS patients undergoing percutaneous coronary intervention.The primary endpoint was major adverse cardiovascular event(MACE),which was the composite of all-cause mortality,stroke,myocardial infarction,or unplanned repeat revascularization.RESULTS During a median follow-up of 31 months,345 patients(20.4%)had MACE.The risk of the MACE was increased with higher TG and the four TG-derived metabolic indices[TG-adjusted hazard ratio(HR)=1.002,95%CI:1.001-1.003;TyG index-adjusted HR=1.736,95%CI:1.398-2.156;atherogenic index of plasma-adjusted HR=2.513,95%CI:1.562-4.043;TG to high-density lipoprotein cholesterol ratio-adjusted HR=1.148,95%CI:1.048-1.258;and lipoprotein combine index-adjusted HR=1.009,95%CI:1.004-1.014;P<0.001 for all indices].TG and all the four indices significantly improved the predictive ability for MACE in addition to the baseline model.Among them,TyG index showed the best ability for predicting MACE compared with the other three indices from all the three measurements(P<0.05 for all comparison).CONCLUSIONS TG and TG-derived metabolic indices were all strongly associated with MACE among ACS patients undergoing percutaneous coronary intervention.Among all the indices,TyG index showed the best ability to predict the risk of MACE.

Genetically confirmed familial hypercholesterolemia in outpatients with hypercholesterolemia

Background Familial hypercholesterolemia （FH） is an autosomal dominant disorder of lipoprotein metabolism which can lead to premature coronary heart disease （pCHD）. There are about 3.8 million potential FH patients in China, whereas the clinical and genetic data of FH are limited. Methods Dutch Lipid Clinic Network （DLCN） criteria was used to diagnose FH in outpatients with hypercholesterolemia. Resequencing chip analysis combined with Sanger sequencing validation were used to identify mutations in the definite FH patients according to DLCN criteria. In silico analysis was conducted in mutations with previously unknown pathogenicity. Then, the novel mutant receptors were transfected into human embryo kidney 293 （HEK-293） cells. The binding and the internalization activities of the mu- tant receptors were analyzed by flow cytometry. Results The prevalence of definite FH in outpatients with hypercholesterolemia in this study is 3.2%. Using genetic testing, one homozygous FH （HoFH）, one heterozygous FH （HeFH） and three compound heterozygous FH patients were confirmed. Eight mutations in low-density lipoprotein receptor （LDLR） gene were identified, in which c.357delG was a novel mutation and co-segregated with the FH phenotype. Bioinformatic analysis confirmed that c.357delG was a pathogenic mutation. Furthermore, when compared with the wild-type LDLRs by flow eytometry analysis, the binding and internalization activities of c.357delG mutant LDLRs were reduced by 35% and 49%, respectively. Conclusions This study identified eight LDLR gene mutations in five patients with definite FH, in which c.357delG is a novel pathogenic mutation. These findings increase our understanding of the genetic spectrum of FH in China.

Excimer laser coronary atherectomy for a severe calcified coronary ostium lesion:A case report

BACKGROUND Percutaneous coronary intervention can be challenging for ostial coronary artery lesions due to calcium burden and elastic fiber content.Excimer laser coronary atherectomy(ELCA)is a less common treatment for severe calcified coronary ostium lesions.CASE SUMMARY An 81-year-old male presented to the Cardiology Department of Qingdao Municipal Hospital with a 1-year history of chest pain.Coronary angiography showed severe calcific stenosis(approximately 90%)in the right coronary artery ostium.The right coronary artery ostium was unable to be advanced using a 2.5 mm×12.0 mm balloon(NC Sprinter,Medtronic,United States)or dilated using a 2.0 mm×12.0 mm balloon(Sprinter,Medtronic,United States).The patient underwent successful ELCA and balloon dilation of the calcified coronary ostium lesion.CONCLUSION ELCA appears to be a safe and effective treatment for the management of severe calcified coronary ostium lesions.