Epicardial adipose tissue (EAT) and pericardial adipose tissue (PAT) are anatomically close to the myocardium and may influence cardiovascular pathology. Thus, in this study, we aim to assess whether EAT and PAT volumes were associated with coronary artery calcification score (CCS) in patients with suspected coronary artery disease (CAD), especially in overweight and obese individuals.

We included consecutive patients with suspected CAD in whom EAT volume, PAT volume, and CCS were measured via computed tomography between September 2015 and June 2017 at the Affiliated Hospital of Chengde Medical University, China. Logistic regression models were applied to analyze the risk factors for CCS ≥ 100 Agatston units (AU) and in different body mass index (BMI) subgroups.

EAT and PAT volumes were noted to be higher in people with BMI ≥ 24 kg/m², BMI ≥ 28 kg/m², hyperlipidemia, hypertension, diabetes, stroke, and CCS ≥ 100 AU (P < 0.05). After adjusting for the traditional CAD factors, we found that EAT and PAT volumes were independent risk factors for CCS ≥ 100 AU (odds ratio, 3.001; 95% confidence interval, 1.900-4.740, P < 0.001). In patients with CCS ≥ 100 AU, the EAT and PAT volumes were noted to be greater in the BMI ≥ 24 kg/m² and BMI ≥ 28 kg/m² subgroups than in the BMI < 24 kg/m² and BMI < 28 kg/m² subgroups, respectively (P < 0.05).

Our results indicate that EAT and PAT volumes may be clinical predictors for a CCS ≥ 100 AU, especially in overweight and obese individuals.

This study aims to evaluate the effectiveness and feasibility of the "Grade III Level A hospital-community hospital family" -based management model.

A total of 164 rural patients who underwent percutaneous coronary intervention (PCI) were randomly divided into a control group and an intervention group according to the random number table. By comparing the two groups of patients' dependence, cardiovascular risk factors control, improvement of bad habits, and the occurrence of major adverse cardiovascular events (MACE), the management mode was evaluated. χ² test, t test, and rank sum test were used in the analysis, and P < 0.05 was considered statistically significant.

There were 74 patients in the intervention group and 90 in the control group. The completion of follow-up in the intervention group was higher than that in the control group (97.3% versus 88.9%, P < 0.05). After 3 months of intervention, the levels of fasting blood glucose, glycosylated hemoglobin, total cholesterol, triglycerides, low-density lipoprotein, and systolic blood pressure in the intervention group were lower than those in the control group, and the level of high-density lipoprotein was higher than those in the control group (P < 0.05). The drug dependence of the intervention group was higher than that of the control group (P < 0.05). The incidence of MACE in the intervention group was lower than that in the control group (P < 0.05).

This management mode can effectively improve patient dependency, control cardiovascular risk factors, and reduce the incidence of recent MACE, which is of great significance for the long-term prognosis of patients after PCI.

Cardiogenic shock (CS) is a condition associated with high morbidity and mortality. Our study aimed to perform a risk score for in-hospital mortality that allows for stratifying the risk of death in patients with CS.

This is a retrospective analysis, which included 135 patients from a Spanish university hospital between 2011 and 2020. The Santiago Shock Score (S3) was created using clinical, analytical, and echocardiographic variables obtained at the time of admission.

The in-hospital mortality rate was 41.5%, and acute coronary syndrome (ACS) was the responsible cause of shock in 60.7% of patients. Mitral regurgitation grade III-IV, age, ACS etiology, NT-proBNP, blood hemoglobin, and lactate at admission were included in the score. The S3 had good accuracy for predicting in-hospital mortality area under the receiver operating characteristic curve (AUC) 0.85 (95% confidence interval (CI) 0.78-0.90), higher than the AUC of the CardShock score, which was 0.74 (95% CI 0.66-0.83). Predictive power in a cohort of 131 patients with profound CS was similar to that of CardShock with an AUC of 0.601 (95% CI 0.496-0.706) versus an AUC of 0.558 (95% CI 0.453-0.664). Three risk categories were created according to the S3: low (scores 0-6), intermediate (scores 7-10), and high (scores 11-16) risks, with an observed mortality of 12.9%, 49.1%, and 87.5% respectively (P < 0.001).

The S3 score had excellent predictive power for in-hospital mortality in patients with nonprofound CS. It could aid the initial risk stratification of patients and thus, guide treatment and clinical decision making in patients with CS.

Red cell distribution width (RDW) has been shown to be an independent risk factor for increased cardiovascular mortality, heart failure, and cardiovascular disease. However, the association between RDW and long-term clinical outcomes in patients with chronic coronary syndrome (CCS) remains uncertain. In this study, a total of 2,881 CCS patients who underwent their first percutaneous coronary intervention (PCI) and who had available data on pre-procedural RDW between 2002 and 2016 were enrolled. Of these, 1,827 without anemia and severe renal dysfunction were divided into quartiles based on their RDW values. The primary endpoint was a composite of all-cause death and non-fatal myocardial infarction. As a result, patients in the higher RDW quartile groups were more likely to be older and have chronic kidney disease. During a median follow-up of 6.2 years, 209 (11.4%) events were identified. Kaplan-Meier curves showed the highest RDW quartile group had a clearly higher incidence of the primary endpoint (log-rank P = 0.0002). The highest RDW group had a significantly higher risk of cardiovascular events compared with the lowest RDW group, even after adjustment for other risk factors (hazard ratio 1.95, 95% confidence interval 1.04-3.67, P = 0.04). Increasing RDW as a continuous variable was also associated with the incidence of the primary endpoint (hazard ratio 1.46 per 1% increase, 95% confidence interval 1.24-1.69, P < 0.0001). In conclusion, this study demonstrated that increased RDW was associated with worse clinical outcomes after elective PCI. Assessing pre-PCI RDW may be useful for risk stratification of CCS.

We investigated the relationship between heart failure and malnutrition, inflammation, and thyroid function and evaluated the predictive potential of these markers for major adverse cardiovascular events (MACEs).

This study included 454 patients aged over 65 years with heart failure as the main diagnosis for 18 months follow-up. The nutritional and inflammatory status were assessed using the geriatric nutritional risk index (GNRI) and neutrophil-to-lymphocyte ratio (NLR), respectively. Free triiodothyronine (FT3) in thyroid hormone was divided into low, medium, and high FT3. Older patients were divided into two groups according to whether they had endpoint events. Differences in nutrition, inflammation, and thyroid hormone were compared between the two groups. The prognostic value of the combination of GNRI, NLR, and FT3 was analyzed.

Older patients in the MACEs (+) group had lower levels of GNRI and FT3 and higher NLR than those in the MACEs (−) group. Low GNRI and FT3 and high NLR were associated with MACEs (P < 0.05). Multivariate Cox regression analysis revealed that low FT3 was an independent predictor of MACEs (P < 0.05). Regardless of how the LVEF changed, when patients had low GNRI and FT3 and high NLR risk factors, the risk of developing MACEs significantly increased. The addition of GNRI, NLR, and FT3 to the basic model significantly increased the predictability of MACEs in patients.

Low GNRI and FT3 and high NLR were associated with MACEs. The combination of GNRI, NLR, and FT3 increased the predictive value of MACEs in older patients with heart failure.

Metabolic syndrome (MetS) is one focus of healthcare system reform in Japan. We examined the effects of changes in individual risk factors over time on the incidence of major adverse cardio-cerebrovascular events (MACCE) in adults under the age of 50 years. Study participants under the age of 50 with neither hypertension nor hyperglycemia at baseline were analyzed. We used a parametric proportional hazard model to determine the effect of changes in abdominal circumference, blood pressure, serum lipids, and blood glucose on the incidence of MACCE.

A total of 6,125 women and 6,403 men were subject to the analyses. The incidence rate of MACCE per 1,000 person-years was 1.17 for women and 2.42 for men. In men under the age of 50, an increase in abdominal circumference was associated with an increase in MACCE incidence (hazard ratio per 1 cm increase: 1.10; 95% confidence interval [CI], 1.04-1.17), whereas no statistically significant association was observed in women. Compared with Visit 1, if the abdominal circumference increased by 4 cm at Visit 3, the hazard ratio for developing MACCE was approximately 1.5 (hazard ratio 1.48; 95% CI, 1.18-1.86). In men under the age of 50, increases in abdominal circumference and systolic blood pressure were associated with an increased risk of developing MACCE, regardless of the degree of obesity at baseline. Therefore, encouraging young adults to improve their health before developing MetS may reduce the risk of MACCE.

Myocardial flow reserve (MFR) derived from ¹³N-ammonia positron emission tomography (PET) is used to predict adverse cardiac events in patients with coronary artery disease (CAD). Right ventricular global longitudinal strain (RVGLS) measured by magnetic resonance imaging (MRI) is used to evaluate RV function and predict cardiac events. This study aimed to evaluate the prognostic value of MFR and RVGLS measured by hybrid ¹³N-ammonia PET/MRI in patients with CAD.

Sixty-one patients who underwent ¹³N-ammonia PET/MRI were analyzed. The end points were defined as a composite of all-cause death, myocardial infarction, sustained ventricular arrhythmia, hospitalization due to decompensated heart failure, and revascularization. At a follow-up of 2.8 ± 1.9 years, 21 events had occurred. Kaplan-Meier analysis showed that the event-free rate was significantly lower in the group with MFR < 1.80 than in that with MFR ≥ 1.80 (P < 0.001). Additionally, the event-free rate was significantly lower in the group with RVGLS > −18.22% than in that with RVGLS ≤ −18.22% (P = 0.025). After dividing the patients into 4 groups by the median MFR and the median RVGLS, the event-free rate was lowest in the combined group of MFR < 1.80 and RVGLS > −18.22% than any other groups (P < 0.001). In a Cox proportional hazard analysis, MFR and RVGLS were independent predictors of cardiac adverse events in the patients with CAD.

The simultaneous assessment of MFR and RVGLS by ¹³N-ammonia PET/MRI revealed the feasibility of precise risk stratification for cardiac events in patients with CAD.

D-dimer is a common measurable coagulation marker that is associated with the risk of thrombotic events in vascular diseases. However, the impact of D-dimer on long-term mortality in coronary artery disease (CAD) patients remains unclear. This study investigated the association between D-dimer and long-term all-cause, cardiac and cancer mortality in CAD patients. Continuous 1,440 patients with CAD who underwent percutaneous coronary intervention (PCI) and survived to discharge were enrolled. These patients were divided into 3 groups based on plasma D-dimer levels at admission. Baseline D-dimer levels were grouped by tertiles: first (D-dimer < 0.7 μg/mL, n = 455), second (0.7 ≤ D-dimer < 1.2, n = 453), and third (1.2 ≤ D-dimer, n = 532). In a Kaplan-Meier analysis (mean follow-up periods 1,572 days), all-cause, cardiac and cancer mortalities were significantly higher in the third tertile than others (P < 0.001, P < 0.001 and P < 0.001, respectively). In multivariable Cox proportional hazard analyses after adjusting for confounding factors, a high D-dimer level was an independent predictor of all-cause, cardiac, non-cardiac and cancer mortalities (HR 3.23, P < 0.001; HR 3.06, P = 0.008; HR 3.11, P = 0.026). In a subgroup analysis, there were no interactions except for the gender subgroup in cancer mortality. In patients with CAD after PCI, high D-dimer levels were associated with long-term all-cause, cardiac and cancer mortality.

This study aimed to evaluate the effects of chronic remote ischemic conditioning (CRIC) on atrial fibrillation burden in patients with an implanted pacemaker. Sixty-six patients with permanent pacemakers were randomly divided into the CRIC group and control group after 4 weeks of screening. CRIC treatment was performed twice daily for 12 weeks. The remote ischemic conditioning protocol consisted of 4 × 5 minutes inflation/deflation of the blood pressure cuff applied in the upper arm to create intermittent arm ischemia. Sixty-one patients (31 patients in the CRIC group and 30 patients in the control group) completed the study. CRIC was well tolerated by patients after 12 weeks of treatment. The burden of atrial fibrillation (AF) in the CRIC group decreased significantly at 4 weeks compared with that at 0 weeks (14.7% ± 18.5% versus 17.0% ± 20.7%, P < 0.001), which further decreased at 12 weeks compared with that at 0 weeks (8.6% ± 10.2% versus 17.0% ± 20.7%, P < 0.001) and that at 4 weeks (8.6% ± 10.2% versus 14.7% ± 18.5%, P < 0.001), which was not observed in the control group. AF burden also reduced significantly after 12-week CRIC compared with that in the control group (8.6% ± 10.2% versus 17.6% ± 19.5%, P = 0.013). Repeated measurement ANOVA showed that the changes in AF burden were associated with CRIC instead of time (P < 0.01). In addition, there were trends that the longest duration of AF and cumulative numbers of atrial high-rate episodes (AHREs) reduced after 12-week CRIC. This study suggests that a 12-week course of CRIC treatment could reduce AF burden in patients with permanent pacemakers, supporting the widespread use of CRIC in the daily lives of these patients, which needs to be verified in the future.

Pulmonary vein isolation (PVI) with a balloon-based visually guided laser ablation (VGLA) is regarded as a useful therapeutic tool for treating atrial fibrillation (AF). The clinical efficacy of a VGLA has never been fully investigated in patients with left common pulmonary vein (LCPV). We investigated the procedural safety as well as clinical usefulness of VGLA in patients with LCPV.

This study consisted of 130 consecutive patients who underwent VGLA of de novo nonvalvular paroxysmal AF.

Eleven patients (8.5%) had an LCPV (ostium maximal average diameter: 27.5 ± 4.9 mm, ostium minimal average diameter: 17.7 ± 3.5 mm). Nine out of 11 (81.8%) LCPVs were successfully occluded and isolated at the ostium with a VGLA-guided PVI. The ablation procedure time was significantly shorter in the patients with than without an LCPV (61.5 ± 15.4 versus 86.9 ± 32.9 minutes, P = 0.01). There was no difference regarding the atrial tachyarrhythmia recurrence between those with and without an LCPV (P = 0.18). A total of 15 patients underwent a redo procedure, but reconnections were not observed in any of the LCPV patients.

The VGLA-guided PVI was a useful therapeutic tool even in patients with an LCPV. The presence of an LCPV might not be associated with an increased risk of any atrial tachyarrhythmia recurrence.

Waon therapy is a form of thermal treatment in a dry sauna developed by Tei. Although Waon therapy is reportedly effective for chronic heart failure (CHF) patients, not all patients respond to the therapy. The reason for this ineffectiveness has not been fully clarified. The cardio-ankle vascular index (CAVI) is an index of arterial stiffness of the arterial tree from the origin of the aorta to the ankle, and it is thought to reflect some of the afterload of the left ventricle. We investigated the effects of Waon therapy on CAVI and plasma brain natriuretic peptide (BNP) level to clarify the usefulness of CAVI during Waon therapy.

CHF patients (n = 21) treated with Waon therapy (2 weeks of 10 sessions) were divided into two groups: responders with an improved BNP level (n = 11) and nonresponders with no improvement in BNP (n = 10). CAVI was measured using Vasela 1500.

A significant decrease in CAVI (median and interquartile range) was observed in the responder group (from 10.3 [9.6, 11.6] to 9.6 [8.6, 10.3], P = 0.021), whereas no change was observed in the nonresponder group (from 9.6 [8.6, 10.5] to 9.5 [9.1, 11.2], P = 0.919). The incidence of rehospitalization or cardiac death due to heart failure was significantly higher in patients in whom Waon therapy was ineffective at 12 months of follow-up (log-rank P = 0.001).

The effectiveness of Waon therapy in CHF patients may be reflected by the improvement in CAVI.

It is known that the angle between the aorta and the septum on the long axis in two-dimensional echocardiography is different between individuals in the community. The relationship between aortoseptal angle (AoSA), age, and diastolic dysfunction has been mentioned in a couple of articles. We aimed to investigate if this angle is directly related to duration of hypertension (HT), regardless of age factor.

The data of 1294 patients who applied to the cardiology outpatient clinic and whose AoSAs were recorded and analyzed retrospectively. SPSS 20 was entered, and the correlation of AoSA with age, duration of HT, and other data was investigated.

A significant correlation was found between AoSA, duration of HT, age, and diameter of the ascending aorta. A partial correlation was sought for when age was taken under control, and then a significant correlation was found between AoSA, duration of HT, and the diameter of the ascending aorta.

The aorta is known to lengthen depending on the age and duration of HT. This elongation shows that the aortic root, the free end of the aorta, is progressing toward the ventricle. This situation narrows the angle between the septum and aorta. As a result, one can have an idea about the duration of HT in patients by looking at the narrowing in the AoSA.

Oxidative stress plays a crucial role in the progression of heart failure (HF). We surveyed the fraction of human mercaptalbumin [f (HMA) ], an indicator of the redox state of human serum albumin (HSA), in patients with HF and examined whether f (HMA) is associated with the severity of HF.

We enrolled consecutive elderly patients hospitalized for acute HF or exacerbation of HF. The redox state of HSA was measured by the high-performance liquid chromatography with postcolumn bromocresol green method using serum samples collected close to discharge. First, the distribution of f (HMA) in HF was compared to that in community-dwelling elderly individuals (n = 125; median age, 80 years) as a control group analyzed in a previous study. Overall, 133 patients (median age, 81 years; 75 men) were included. Patients with HF showed a lower level of f (HMA) than those of the control group (55.0% [IQR 47.7-61.3] versus 66.3% [IQR 62.8-70.0], P < 0.001]. Multiple regression analysis showed a negative correlation between f (HMA) and log-transformed B-type natriuretic peptide (standardized beta = −0.19).

Patients with HF showed lower f (HMA) than those in the control group. Additionally, f (HMA) was related to HF independently with log-transformed B-type natriuretic peptide in the multivariate regression analysis, suggesting that f (HMA) is a biomarker that reflects the redox state in HF patients.

Sarcopenia, a progressive and systemic skeletal muscle disorder, is closely related with the incidence of cardiovascular disease (CVD) and CVD-related mortality, but its association with cardiac structure and function during aging remains unclear, particularly in the absence of serious cardiovascular diseases. This study aimed to investigate the correlation of muscle mass and muscle strength, the main components of sarcopenia, with left ventricular mass and function in Chinese subjects.

A total of 265 men and 70 women (aged 25-95 years) without serious diseases that could have pronounced impact on muscle and/or cardiovascular system were included. Left ventricular mass and function were assessed by echocardiography and muscle mass and grip strength were evaluated by dual-energy X-ray absorptiometry and a Jamar hand dynamometer, respectively.

Grip strength and left ventricular diastolic function, rather than left ventricular mass, demonstrated age-dependent decline in both genders. Muscle mass in males and left ventricular systolic function in females declined with age. In the multivariate-adjusted model, grip strength rather than the relative appendicular skeletal muscle mass (RASM) was positively associated with E/A ratio (r = 0.154, P = 0.019) and e´-av (r = 0.175, P = 0.008), but was negatively correlated with E/e´-av ratio (r = −0.136, P = 0.038). No significant correlation was observed between RASM, grip strength and left ventricular mass, left ventricular ejection fraction or left ventricular fractional shortening. Higher grip strength is independently associated with better left ventricular diastolic function in Chinese during aging.

The fibrosis-4 index, albumin-bilirubin score and neutrophil-lymphocyte ratio are all prognostic markers in patients with heart failure. Recently, the FAN score, which includes all 3 of these markers, was developed as a useful risk stratification tool in patients with cancer. However, its cut-off values have not been validated for heart failure. We aimed to investigate the optimal cut-off and prognostic values of the FAN score in patients with heart failure. We analyzed 669 consecutive patients hospitalized with heart failure (age, 75.8 ± 11.3 years). Their median values of the fibrosis-4 index, albumin-bilirubin score, and neutrophil-lymphocyte ratio at discharge were 2.12, −2.25, and 2.41, respectively. The FAN score for heart failure (HF-FAN score) was calculated using these median values. The primary outcome was a composite of all-cause death and heart failure rehospitalization. Patients were divided into 4 groups according to HF-FAN scores of 0 (n = 112), 1 (n = 231), 2 (n = 242) and 3 (n = 84). Patients with HF-FAN scores of 3 were older, had higher brain natriuretic peptide levels, and larger inferior vena cava diameters. Kaplan-Meier analysis showed a direct correlation between higher HF-FAN scores and occurrence of the primary endpoint (log-rank P < 0.001). Cox proportional hazard analysis revealed a higher HF-FAN score was significantly associated with a worse prognosis even after adjustment for possible prognostic factors. Changing from the FAN score to HF-FAN score provided significant continuous net reclassification improvement. In conclusion, the HF-FAN score at discharge was useful for risk stratification in patients hospitalized with heart failure. The HF-FAN score might be more suitable for patients with heart failure than the FAN score.

Plasma B-type natriuretic peptide (BNP) is a practical tool with which to estimate hemodynamic status including intra-cardiac pressure in patients with heart failure (HF). However, plasma BNP levels cannot be measured immediately in an outpatient private clinic. We investigated the value of remote dielectric sensing (ReDS), a novel non-invasive electromagnetic energy-based tool to quantify lung fluid amount immediately, to predict plasma BNP levels.

Successive measurements of ReDS values and plasma BNP levels were performed in patients hospitalized to treat HF in a prospective manner. Correlations between ReDS values and plasma BNP levels were assessed.

A total of 117 datasets for HF patients were obtained in this prospective study. The median ReDS value was 28% (interquartile range: 25%, 34%) and the median plasma BNP level was 205 (86, 469) pg/mL, both of which had a slight correlation (r = 0.234, P = 0.011). Their correlation improved when those with a body mass index less than 18.5 (n = 23) were excluded (r = 0.278, P = 0.007).

ReDS might be a practical tool for estimating plasma BNP levels, particularly in outpatient private clinics where the immediate measurement of plasma BNP levels is not available.

There is limited information regarding the reference values for cardiopulmonary exercise testing (CPX) variables in patients with primary hypertension. Our aim was to provide such values. In this single-center, retrospective study, we included 635 patients (male, 53.7%; mean ± standard deviation age, 62.1 ± 12.6 years) who completed maximal ramp incremental CPX using cycle ergometry at the Rui An Hospital of Traditional Chinese Medicine from August 1, 2018, to December 31, 2021. The patients were classified into two groups based on pulse pressure (PP): (1) patients with a low PP ≤ 60 mmHg (n = 324) and (2) patients with a high PP > 60 mmHg (n = 311). Stepwise linear regression was used to fit the equations of the key CPX variables. CPX was self-interrupted owing to fatigue by 64.5% (low PP) and 72.0% (high PP) of patients (χ² analysis, P = 0.05). The anaerobic threshold (AT) could not be determined in 3.7% and 7.7%, respectively (χ² analysis, P = 0.038). Peak oxygen consumption (VO₂), carbon dioxide production, ventilation/minute, work rate, and VO₂ at the AT were associated with age, weight, and sex. Moreover, a high PP was associated with impaired anaerobic exercise ability, as indicated by the reduced peak VO₂, peak VE, and absolute peak work rate. Compared with prior research of a healthy population, patients with primary hypertension in this study exhibited impaired cardiopulmonary ability both at rest and during exercise, especially in the high PP group. The reference values and predictive equations for CPX variables provide a framework for interpreting the response to maximal ramp incremental cycle ergometry among older Chinese patients with primary hypertension.

Electrical muscle stimulation (EMS) is expected to be considered as an add-on therapy for the usual rehabilitation of patients with chronic heart failure (HF). However, it remains unclear whether EMS can reduce muscle volume loss in patients with acute HF (AHF) immediately after hospitalization. Therefore, the aim of this study was to investigate if EMS could reduce the lower-limb muscle volume loss in patients with AHF. In this single-center, retrospective, observational study, lower-limb skeletal muscle volume, quadriceps muscle layer thickness, and clinical events (worsening HF or kidney function) were evaluated in 45 patients with AHF (mean age, 77.4 ± 11.6 years, 31 males). All patients underwent EMS on the right leg, in addition to usual rehabilitation, for 20 minutes per day, 5 days per week, for 2 weeks. A two-factor (time × leg) analysis of variance was performed to compare the difference between the right leg (usual rehabilitation and EMS) and left leg (usual rehabilitation only). The skeletal muscle mass decreased by 11.6% ± 19.7% from baseline in the right leg and by 20.4% ± 16.1% in the left leg (interaction; F = 4.54, P = 0.036). The quadriceps muscle layer thickness decreased by 10.2% ± 7.1% from baseline in the right leg and by 13.5% ± 6.0% in the left leg (interaction; F = 10.50, P = 0.002). No clinical events were related to EMS. Results showed that EMS combined with usual rehabilitation for patients with AHF has the potential to inhibit muscle volume loss.

In this study, we aim to investigate the clinical features and outcomes of multichanneled aortic dissection (MCAD) and double-channeled aortic dissection (DCAD) in acute type B aortic dissection (TBAD) patients who underwent thoracic endovascular aortic repair (TEVAR).

In total, 479 consecutive acute TBAD patients treated with TEVAR from April 2002 to May 2020 were retrospectively enrolled in this study. The MCAD group was defined as those of multichanneled morphology by initial computed tomography angiography (CTA) (n = 61), whereas the DCAD group was defined as those with double-channeled morphology by initial CTA (n = 418). The clinical and morphological characteristics and short-term and long-term adverse events (30-day and > 30 days) were recorded and evaluated.

No significant differences were noted between the 2 groups as regards demographics, comorbidity profiles, or initial feature of CTA. The incidence of true lumen compression was found to be significantly lower in the MCAD group compared with the DCAD group (8.2% versus 20.8%, P < 0.05). During the 65.37 ± 40.06 months of follow-up, there were no statistically significant differences in terms of 30-day mortality or the incidence of early adverse events between the 2 groups. The incidence rates of 5-year cumulative freedom from all-cause mortality and 5-year cumulative freedom from AD-related mortality were not significantly different between the MCAD and DCAD groups, whereas the 5-year cumulative freedom from adverse events were lower in the MCAD group compared to DCAD group (51.1% versus 72.5%, P < 0.05). In multivariate Cox regression models, only age > 60 years, pleural effusion, branch involvement, and length of the stent were independent predictors of mortality, whereas age > 60 years, pulse, pleural effusion, true lumen compression, widest diameter of the descending aorta, branch involvement, and length of stent were independent predictors of adverse aortic events.

No significant difference was noted between the MCAD and DCAD groups in the 5-year mortality following, whereas patients with MCAD were found to have significantly lower AD-related events than patients with DCAD in long-term follow-up.

High-intensity focused ultrasound (HIFU) can cause necrotic damage in deep tissues through thermal ablation and cavitation, without significant damage to the surrounding tissues. High blood perfusion of heart affects the energy deposition. This study aimed to evaluate the effect of cooling of coronary blood flow for HIFU ablation.

Continuous and pulsed HIFU (2000 J) at duty cycles of 100% and 25% were examined for their capacity to ablate the perfused porcine heart tissue in vitro. After ablation, grayscale changes and pathological features were observed or measured, and the area and volume of tissue necrosis were calculated.

The cardiomyocytes in the lesions underwent necrosis with a clear boundary. The endocardial surface was intact without necrosis. The three-dimensional morphology of the lesions appeared approximately as ellipsoids. With the increase in perfusion speed, the necrotic volume in the target area was gradually reduced.

HIFU has the potential to become a new minimally invasive surgery for ventricular septal myocardial ablation. Reduction of coronary blood flow can improve the ablation effect.

microRNA (miR) -22-3p has been confirmed to be engaged in the phenotype transformation and proliferation of vascular smooth muscle cells (VSMCs), which is intimately correlated with restenosis. The current research set out to explore the detailed mechanism and function of miR-22-3p in VSMC proliferation, phenotype transformation, and migration via the translocase of outer mitochondrial membrane (TOMM40). Peripheral blood samples were acquired from patients with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI), with subsequent quantitative reverse transcription (qRT) -polymerase chain reaction (PCR) and Western blot analyses of miR-22-3p and TOMM40 expression. After miR-22-3p-inhibitor, oe-TOMM40, and sh-TOMM40 were transfected into VSMCs, Cell Counting Kit (CCK) -8 assay, scratch test, and Western blot analysis were implemented to measure the VSMC proliferation, migration, and matrix metallopeptidase 9 (MMP9), α-smooth muscle actin (SMA), smooth muscle-myosin heavy chain (SM-MHC), and osteopontin (OPN) expressions, respectively. In addition, human umbilical vein endothelial cell (HUVEC) proliferation was examined by CCK-8 assay. The binding relationship between miR-22-3p and TOMM40 was assessed by dual luciferase reporter and RNA immunoprecipitation assays. The peripheral blood of patients with ISR after PCI had low expression of miR-22-3p and high expression of TOMM40. The mechanistic analysis reported the negative targeting relationship between miR-22-3p and TOMM40. Down-regulating miR-22-3p or up-regulating TOMM40 elevated the proliferation, migration, and phenotype transformation of VSMCs. miR-22-3p inhibitor had no evident impact on HUVEC proliferation. In addition, rescue assays displayed that TOMM40 silencing annulled miR-22-3p inhibition-enhanced VSMC proliferation, migration, and phenotype transformation. Conclusively, miR-22-3p could repress VSMC proliferation, phenotypic transformation, and migration by targeting TOMM40, which might be a possible treatment candidate for restenosis after PCI in patients with cardiovascular disease.

Circular RNAs (circRNAs) are a class of powerful regulators of gene expression. This study aimed to determine whether circTRRAP (hsa_circ_0081241) was implicated in the cardioprotective effects of salvianolic acid B (Sal B) against myocardial ischemia/reperfusion (I/R) injury and its associated mechanism.

Cell viability was analyzed using Cell Counting Kit-8 (CCK-8), and flow cytometry was conducted to evaluate cell cycle progression and cell apoptosis. The leakage of lactic dehydrogenase (LDH), production of malondialdehyde (MDA), and activity of superoxide dismutase (SOD) were measured using their corresponding commercial kits to analyze cell death and oxidative stress.

I/R treatment suppressed viability and cell cycle progression and induced the apoptosis and oxidative stress of AC16 cardiomyocytes, whereas Sal B protected AC16 cardiomyocytes against I/R injury. I/R upregulated circTRRAP expression, whereas Sal B dose-dependently reduced the circTRRAP level in AC16 cardiomyocytes. The protective effects of Sal B in I/R-induced AC16 cardiomyocytes were overturned by the overexpression of circTRRAP. CircTRRAP negatively regulated miR-214-3p expression by binding to it in AC16 cardiomyocytes. The circTRRAP overexpression-mediated effects were reversed by the addition of miR-214-3p mimics in AC16 cardiomyocytes. MiR-214-3p targeted the 3'-untranslated region (3'UTR) of SOX6, and SOX6 was regulated by the circTRRAP/miR-214-3p axis in AC16 cardiomyocytes. SOX6 knockdown overturned the circTRRAP overexpression-induced effects in AC16 cardiomyocytes.

In conclusion, the silence of circTRRAP was implicated in Sal B-mediated cardioprotective effects against I/R injury by regulating the miR-214-3p/SOX6 axis.

The combination of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and Impella, referred to as ECPELLA, is a powerful transient mechanical circulatory support for patients with severe cardiogenic shock (CS). During ECPELLA support, VA-ECMO loads the left ventricle (LV) and Impella unloads the LV. Therefore, evaluating the degree of LV unloading during ECPELLA may be a prerequisite to protect the injured myocardium. Here we report a patient with CS due to an inferior ST-elevation myocardial infarction in which the degree of LV unloading on ECPELLA was confirmed by direct LV pressure (LVP) measurement. After the percutaneous coronary intervention for the right coronary artery on ECPELLA, the aortic pressure became nonpulsatile and the peak systolic LVP was reduced at approximately 10 mmHg with 20 mA of the Impella motor current (MC) amplitude, which we referred to as the total LV unloading condition. We maintained the condition in the early phase of ECPELLA by monitoring the Impella MC amplitude at 20 mA and less with nonpulsatile aortic pressure. The patient was successfully weaned off VA-ECMO on day 3, and Impella was explanted on day 8. Prior to the Impella explant, the Impella MC amplitude increased more than 100 mA and the estimated pressure gradient between the aortic pressure and LVP was well matched with the directly measured LVP. In this case, the patient was successfully treated by ECPELLA with the total LV unloading condition, and we showed that the degree of LV unloading on ECPELLA can be estimated from the aortic pressure and Impella MC amplitude at given Impella flows.

Cardiac amyloidosis (CA) is a group of restrictive cardiomyopathies that have received increasing attention and awareness. With the advancement of noninvasive multimodality imaging techniques, the diagnostic efficacy and comprehensive assessment of CA have rapidly evolved. Here, we present two cases in which better diagnosis and evaluation were achieved using multimodality imaging techniques.

Two patients with CA were diagnosed with transthyretin CA and immunoglobulin light-chain CA using clinical data, laboratory tests, ultrasound, nuclear medicine, coronary CT angiography, and cardiovascular magnetic resonance, respectively. This not only elucidated the diagnosis of CA but also provided a comprehensive and in-depth diagnosis of these two patients with CA using noninvasive multimodality imaging techniques through the detection of cardiac morphology and size, left ventricular function, myocardial injury, and coronary microvascular function. The disease processes and characteristics of these patients were comprehensively evaluated, especially the classified diagnosis of CA via radionuclide ^99mTc-PYP imaging and measurement of coronary flow reserve via quantitative radionuclide myocardial perfusion imaging for the diagnosis and evaluation of CA.

Modern multimodality noninvasive imaging can complement each other's information and strengths and play important roles in the early diagnosis and treatment of patients with CA.

Sinus of Valsalva aneurysm (SVA) is a rare cardiovascular disease with male predominance. Recently, an association with aortic aneurysm and SVA has been revealed in periventricular nodular heterotopia patients with loss-of-function Filamin A (FLNA) mutations, which were located on chromosome X and almost exclusively affect females.

Among patients hospitalized for aortic surgery with aortic root diameter over 4.0 cm, next-generation sequencing was performed to investigate 30 candidate genes related to inherited aortic aneurysm syndromes and familial thoracic aortic aneurysm and dissection. The present report reviewed an electronic case database and identified two female cases of unruptured SVA with heterozygous FLNA truncating mutations.

Case 1 displaying a rare SVA phenotype involving left and noncoronary sinus harbored a nonsense variant p.Tyr1720Ter/c.5160C > G. Case 2 displayed right and noncoronary SVA with predominantly enlarged right coronary sinus, posterior mitral valve prolapse, and harbored a frameshift variant p.Val1724fs*68/c.5171_5172delTG. Both novel mutations resulted in the premature termination of filamin A with the loss of functional Rod 2 and dimerization region.

The present report raised the possibility of the presence of a cardiovascular onset form in the spectrum of FLNA hereditary diseases. The association between SVA and loss-of-function FLNA mutations indicates a unique etiology and pathogenesis among female patients, which requires further investigation to establish the linkage between FLNA variants and a wide spectrum of phenotypes.

The left ventricular (LV) apex is recommended as the first choice for positioning the epicardial pacing. We encountered a patient with congenital heart disease (CHD) showing hypokinesis of the LV apical pacing site after implantation of a pacemaker with epicardial leads. This phenomenon was revealed by the early shortening and systolic rebound stretch of the same lesion on two-dimensional speckle tracking echocardiography, which developed in the intraventricular dyssynchrony between the LV apex and base. Cardiac resynchronization therapy provided an excellent result around the hypokinetic lesion. It is wise to arrange detailed evaluations in each patient with complicated CHD, aiming at a successful treatment to enable ventricular synchronicity.

Hemorrhagic cardiac tamponade with blood clot formation in acute type A aortic dissection (AAAD) is extremely rare. We presented an 86-year-old female patient with hemorrhagic cardiac tamponade with blood clot formation in AAAD. In clinical practice, D-dimer is a promising biomarker with a threshold level of < 500 ng/mL to exclude aortic dissection. However, the present case was diagnosed with AAAD and died quickly despite the initial D-dimer of < 500 ng/mL. Throughout the process of exploring the final diagnosis, point-of-care transthoracic cardiac ultrasound is helpful to provide diagnostic clues.

The coronavirus infection 2019 (COVID-19) pandemic has led to the development of mRNA vaccines with proven efficacy. However, it remains unclear whether patients who developed pericarditis after the first COVID-19 mRNA would be fit to receive the second vaccination. Herein, we present the case of a 64-year-old man who visited our emergency department with substernal chest discomfort that began 4 days after his first mRNA COVID-19 vaccination. Acute pericarditis was diagnosed based on symptoms and ST-segment elevation on an electrocardiogram. Chest pain improved 2 days after treatment.

Since there are no guidelines on whether to administer an additional vaccination to a patient who developed pericarditis after the initial vaccination, we considered whether or not to administer the additional vaccination. We informed the patient about the risks and benefits and decided to administer the second dose. He did not experience any major adverse reactions. The indications for the second vaccination need to be thoroughly considered.

We are pleased to announce that the following 3 articles have been selected for the UEDA Heart Awards for the Year 2022.

FIRST PLACE

Chronic HDAC6 Activation Induces Atrial Fibrillation Through Atrial Electrical and Structural Remodeling in Transgenic Mice

Yohei Sawa, Naoko Matsushita, Sachiko Sato, Nanae Ishida, Maki Saito, Atsushi Sanbe, Yoshihiro Morino, Eiichi Taira, Mami Obara, Masamichi Hirose

Int Heart J 2021; 62 (3): 616-626.

SECOND PLACE

A Novel Titin Truncation Variant Linked to Familial Dilated Cardiomyopathy Found in a Japanese Family and Its Functional Analysis in Genome-Edited Model Cells

Kayoko Hirayama-Yamada, Natsuko Inagaki, Takeharu Hayashi, Akinori Kimura

Int Heart J 2021; 62 (2): 359-366.

THIRD PLACE

Cytokine Signaling and Matrix Remodeling Pathways Associated with Cardiac Sarcoidosis Disease Activity Defined Using FDG PET Imaging

Bryan D. Young, Hannah Moreland, Kelsie E. Oatmen, Lisa A. Freeburg, Zartashia Shahab, Erica Herzog, Edward J. Miller, Francis G. Spinale

Int Heart J 2021; 62 (5): 1096-1105.

Several errors (shown with underlines) in the following list appeared in the article entitled "Automatic Detection of Left Ventricular Dilatation and Hypertrophy from Electrocardiograms Using Deep Learning" by Takahiro Kokubo, Satoshi Kodera, Shinnosuke Sawano, Susumu Katsushika, Mitsuhiko Nakamoto, Hirotoshi Takeuchi, Nisei Kimura, Hiroki Shinohara, Ryo Matsuoka, Koki Nakanishi, Tomoko Nakao, Yasutomi Higashikuni, Norifumi Takeda, Katsuhito Fujiu, Masao Daimon, Hiroshi Akazawa, Hiroyuki Morita, Yutaka Matsuyama, and Issei Komuro (Vol. 63, 939-947, 2022).