Chinese Society of Digestive Endoscopy, Chinese Medical Association, Chinese Society of Gastroenterology, Chinese Medical Association, Chinese Society of Cardiology, Chinese Medical Association
Liang Y, Qiu YM, Liu ZF
… +9 more, He J, Zhou Z, Yan LQ, Lu X, Yang Y, Wang H, Wu ZZ, Ning ZX, Xia WH
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Jun · PMID 42324107
·
Publisher ↗
To explore the role and molecular mechanism of peroxiredoxin 1 (PRDX1) in hypertension-induced endothelial dysfunction. (1) Bioinformatics analysis: A total of 40 C57BL/6J mice aged 8-10 weeks (20-25 g) were randomly di...To explore the role and molecular mechanism of peroxiredoxin 1 (PRDX1) in hypertension-induced endothelial dysfunction. (1) Bioinformatics analysis: A total of 40 C57BL/6J mice aged 8-10 weeks (20-25 g) were randomly divided into the saline group and angiotensin Ⅱ (AngⅡ, 0.8 mg·kg⁻¹·d⁻¹) group, with 20 mice in each group. After 4 consecutive weeks of intervention, mice were sacrificed, and thoracic aortic tissues were collected for transcriptome sequencing. Gene Ontology functional annotation and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis were performed on differentially expressed genes. (2) Cell experiments: Human umbilical vein endothelial cells (HUVECs) were divided into the control group (endothelial cell culture medium) and the AngⅡ intervention group (medium containing 10⁶ mol/L AngⅡ). Wound healing assay, cell adhesion assay, and Transwell assay were used to assess cell migration and adhesion. Lentiviral or small interfering RNA (siRNA) transfection was performed to achieve PRDX1 overexpression and knockdown, respectively. The overexpression experiment was divided into the LV-NC (negative control lentivirus) group, Ang Ⅱ+LV-NC group, LV-PRDX1 (PRDX1 overexpression lentivirus) group and Ang Ⅱ+LV-PRDX1 group. The knockdown experiment was divided into the NC-siRNA (negative control siRNA) group, si-PRDX1 group, NC-siRNA+rapamycin (50 nmol/L) group and si-PRDX1+rapamycin group. Immunofluorescence staining was applied to detect intracellular reactive oxygen species level. Quantitative reverse transcription-polymerase chain reaction was used to detect the mRNA expression levels of PRDX1 and mammalian target of rapamycin (mTOR). Western blot was adopted to determine the total protein and phosphorylation levels of PRDX1, mTOR, p70 ribosomal S6 kinase (p70S6K) 1 and endothelial nitric oxide synthase (eNOS). Co-immunoprecipitation assay was used to verify the protein interaction between PRDX1 and mTOR. Nitrate reductase method was used to measure cellular nitric oxide (NO) content. (3) Animal experiments: Forty C57BL/6J mice aged 8-10 weeks (20-25 g) were used to construct the PRDX1 overexpression model via adeno-associated virus serotype 9 (AAV9) vector. Mice were assigned into 4 groups with 10 animals per group: saline+AAV9-GFP (empty vector) group, saline+AAV9-PRDX1 (recombinant virus) group, AngⅡ+AAV9-GFP group, and AngⅡ+AAV9-PRDX1 group. Systolic blood pressure and diastolic blood pressure of mice in each group were dynamically monitored at day 0, 7, 14, 21 and 28 after modeling. Plasma NO level was detected by the nitrate reductase method. After sacrifice, isolated thoracic aortic tissues were subjected to morphological and pathological staining analysis, and a microvascular tension measurement system was used to evaluate the acetylcholine-mediated endothelium-dependent vasodilation function. (1) Bioinformatics analysis: Transcriptome sequencing revealed that numerous differentially expressed genes were identified in the thoracic aorta of mice in the AngⅡ group compared with the saline group. These genes were mainly enriched in biological processes closely associated with oxidative stress, such as reactive oxygen species metabolism and oxidative phosphorylation regulation. (2) Cell experiments: Compared with the control group, HUVECs in the AngⅡ intervention group presented decreased protein and mRNA levels of PRDX1, as well as elevated phosphorylation levels of mTOR and p70S6K1 (all <0.05). Compared with the LV-NC group, the LV-PRDX1 group showed higher PRDX1 mRNA expression, lower reactive oxygen species levels, enhanced cell migration and adhesion capacities, and increased NO content (all <0.05). In contrast with the AngⅡ+LV-NC group, the AngⅡ+LV-PRDX1 group exhibited reduced phosphorylation levels of mTOR and p70S6K1 and increased eNOS phosphorylation level (all <0.05). In addition, relative to the NC-siRNA group, the si-PRDX1 group had higher reactive oxygen species levels and elevated phosphorylation of mTOR and p70S6K1, accompanied by decreased NO content, reduced eNOS phosphorylation, and weakened cell migration and adhesion abilities (all <0.05). Compared with the si-PRDX1 group, the above abnormal changes were partially reversed in the si-PRDX1+rapamycin group (all <0.05). Co-immunoprecipitation assay confirmed a protein interaction between PRDX1 and mTOR. (3) Animal experiments: In comparison with the saline+AAV9-GFP group, the AngⅡ+AAV9-GFP group had higher systolic and diastolic blood pressure, lower plasma NO level, thicker thoracic aortic media, increased collagen deposition, disordered arrangement of elastic fibers, and impaired endothelium-dependent vasodilation in response to acetylcholine (all <0.05). Notably, the AngⅡ+AAV9-PRDX1 group showed lower systolic and diastolic blood pressure, alleviated pathological damage of the thoracic aorta, improved endothelium-dependent vasodilation function, and higher plasma NO level than the AngⅡ+AAV9-GFP group (all <0.05). PRDX1 can inhibit the excessive activation of the mTOR/p70S6K signaling pathway by scavenging reactive oxygen species and promoting NO production, thereby regulating eNOS activity and ameliorating endothelial dysfunction and vascular injury under hypertensive conditions. Targeted regulation of the PRDX1/ROS/mTOR/p70S6K signaling axis is expected to provide a novel therapeutic target and intervention strategy for the prevention and treatment of hypertensive vascular diseases.
Zhou D, Wang LL, Lian XQ
… +12 more, Yang WJ, Zhu LY, Wang YN, Xu J, Zhang HY, Tian ZX, Jiang MD, Zhou WL, Zheng TT, Zhao SH, Fan XH, Lu MJ
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Jun · PMID 42324106
·
Publisher ↗
To evaluate the predictive value of the 2025 appropriate use criteria (AUV) for implantable cardioverter defibrillators (ICD) jointly issued by the American College of Cardiology/American Heart Association and other soci...To evaluate the predictive value of the 2025 appropriate use criteria (AUV) for implantable cardioverter defibrillators (ICD) jointly issued by the American College of Cardiology/American Heart Association and other societies, for sudden cardiac death (SCD) in patients with dilated cardiomyopathy (DCM), and to explore the incremental value of cardiac magnetic resonance (CMR) tissue characterization in SCD risk stratification. This was a single-center, retrospective study that consecutively enrolled DCM patients who underwent CMR with late gadolinium enhancement (LGE) and T1 mapping at Fuwai Hospital, Chinese Academy of Medical Sciences from February 2012 to September 2021. According to the 2025 ICD appropriate use criteria and LGE extent, patients were divided into three groups: AUC-appropriate with LGE<7.2% (AUC-A+LGE<7.2%) group, AUC-appropriate with LGE≥7.2% (AUC-A+LGE≥7.2%) group, and AUC-maybe appropriate (AUC-M) group. Baseline data and CMR parameters were collected, and all patients were followed up. Predictors of the SCD composite endpoint were identified using Cox proportional hazards regression, and the clinical efficacy of LGE and extracellular volume fraction (ECV<31.8% or ≥31.8%) for SCD risk stratification was assessed using Kaplan-Meier survival analysis. A total of 741 DCM patients were enrolled, aged (47.0±14.3) years, with 581 (78.4%) males. There were 447 patients in the AUC-A+LGE<7.2% group, 162 in the AUC-A+LGE≥7.2% group, and 132 in the AUC-M group. Over a follow-up of 53.4 (32.9, 74.8) months, the SCD composite endpoint occurred in 78 patients (10.5%). Multivariable Cox regression analysis identified left atrial volume index (=1.005, 95% 1.001-1.009, =0.015), right ventricular ejection fraction (=0.976, 95% 0.963-0.990, <0.001), LGE≥7.2% (=4.308, 95% 2.633-7.050, <0.001), and ECV≥31.8% (=2.719, 95% 1.515-4.878, <0.001) were predictors of the SCD composite endpoint. Kaplan-Meier analysis showed no significant difference in SCD risk between the AUC-A+LGE<7.2% group and AUC-M group (log-rank =0.269). Further stratification revealed that patients with ECV<31.8% in the AUC-A+LGE<7.2% subgroup had an extremely low annual SCD event rate of 0.6%, representing a truly low-risk population accounting for 35.8% (265/741) of the total cohort. In contrast, the annual SCD event rate in the AUC-A+LGE≥7.2% group was as high as 5.5%. CMR myocardial tissue characterization parameters (LGE and ECV) provide significant incremental prognostic value to the 2025 ICD appropriate use criteria, enabling precise re-stratification of SCD risk in DCM patients and facilitating optimized clinical decision-making for primary prevention with ICD implantation.
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Jun · PMID 42324105
·
Publisher ↗
To investigate the impact of the mismatch between respiratory event frequency and hypoxic burden on cardiovascular outcomes in patients with obstructive sleep apnea (OSA). This study enrolled 3 754 adult OSA patients fr...To investigate the impact of the mismatch between respiratory event frequency and hypoxic burden on cardiovascular outcomes in patients with obstructive sleep apnea (OSA). This study enrolled 3 754 adult OSA patients from the Sleep Heart Health Study, a prospective cohort study. Respiratory event frequency and hypoxic burden were assessed using the apnea-hypopnea index (AHI) and the percentage of time spent with oxygen saturation below 90% (T90), respectively. Patients were stratified into three groups based on the tertile alignment of AHI and T90: the matched group (AHI and T90 in the same tertile), the AHI-dominant group (AHI in a higher tertile than T90), and the T90-dominant group (T90 in a higher tertile than AHI). The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, myocardial infarction, heart failure, and revascularization. Cox regression analysis was used to explore the association between AHI-T90 matching status and MACE. Kaplan-Meier survival analysis was performed to compare the prognosis among the groups. Restricted cubic spline (RCS) analysis was used to evaluate the association between the relative difference of AHI and T90 and MACE. The age of the participants was 65 (57, 74) years, and 1 997 (53.2%) were men. Among them, 1 745 (46.5%) patients exhibited an AHI-T90 mismatch. There were 2 009 patients in the matched group, 882 in the AHI-dominant group, and 863 in the T90-dominant group. During a mean follow-up of 10.3 years, 974 patients (25.9%) experienced MACE. Kaplan-Meier curves showed that the incidence of MACE was significantly higher in the mismatch groups compared to the matched group (both <0.05). Multivariable Cox regression analysis demonstrated that the AHI-dominant group (=1.173, 95% 1.004-1.369, =0.044) and the T90-dominant group (=1.187, 95% 1.016-1.386, =0.031) were independently associated with MACE. RCS revealed that the risk of MACE was lowest when the relative difference between AHI and T90 was minimal. Mismatch between respiratory event frequency and hypoxic burden represents a distinct OSA phenotype associated with a higher incidence of MACE.
Zhai HB, Sun MY, Wang ZL
… +3 more, Zhang DH, Qiu MH, Han YL
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Jun · PMID 42324104
·
Publisher ↗
To investigate the clinical characteristics and antithrombotic treatment strategies in patients with acute ST-segment elevation myocardial infarction (STEMI) who develop new-onset atrial fibrillation during the acute pha...To investigate the clinical characteristics and antithrombotic treatment strategies in patients with acute ST-segment elevation myocardial infarction (STEMI) who develop new-onset atrial fibrillation during the acute phase and undergo emergency percutaneous coronary intervention (PCI), and to evaluate the association between new-onset atrial fibrillation and prognosis in STEMI patients. This retrospective cohort study consecutively enrolled 142 STEMI patients with atrial fibrillation who underwent coronary angiography and emergency PCI via the emergency green channel at the Department of Cardiology, General Hospital of Northern Theater Command from March 2016 to March 2022. Patients were divided into two groups based on the presence of new-onset atrial fibrillation: the prior atrial fibrillation group (=61) and the new-onset atrial fibrillation group (=81). Clinical baseline data, in-hospital and long-term antithrombotic strategies after discharge, and adverse events during follow-up were recorded and compared between the two groups. Multivariate Cox regression analysis was used to assess the association between new-onset atrial fibrillation and adverse outcomes. The mean age of the 142 STEMI patients was (68.0±11.5) years, with 104 males accounting for 73.2%. New-onset atrial fibrillation accounted for 57.0% (81/142) of the patients. Compared with the prior atrial fibrillation group, patients in the new-onset atrial fibrillation group were younger, had a lower prevalence of diabetes and previous stroke, and had lower CHADS-VASc and HAS-BLED scores. Additionally, a higher proportion of patients in the new-onset atrial fibrillation group presented with Killip class Ⅳ at admission. During hospitalization, the new-onset atrial fibrillation group had a higher proportion of amiodarone use and lower prescription rates of angiotensin-converting enzyme inhibitors or angiotensin Ⅱ receptor blockers. Regarding long-term antithrombotic strategies after discharge, patients in the new-onset atrial fibrillation group more frequently received dual antiplatelet therapy (67 (82.7%) vs. 37 (60.7%)), while those in the prior atrial fibrillation group more often received anticoagulation combined with dual antiplatelet therapy (20 (32.8%) vs. 8 (9.9%), <0.05). During 12-month follow-up, the incidence of net adverse clinical events was 18.5% (15/81) in the new-onset atrial fibrillation group and 24.6% (15/61) in the prior atrial fibrillation group, with no significant difference between the two groups (>0.05). Multivariate Cox regression analysis confirmed that new-onset atrial fibrillation was not independently associated with adverse outcomes (=0.73, 95%: 0.31-1.69, =0.459). More than half of the STEMI patients with atrial fibrillation undergoing emergency PCI had new-onset atrial fibrillation, characterized by a lower prevalence of diabetes and stroke, as well as a greater likelihood of receiving dual antiplatelet therapy as the long-term post-discharge antithrombotic strategy. However, new-onset atrial fibrillation was not independently associated with adverse outcomes.
Lin YJ, Dong ZC, Yang YX
… +2 more, Liu H, Zhang B
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Jun · PMID 42324103
·
Publisher ↗
To investigate through stratified analyses based on complete blood count-derived inflammatory markers, the effects of tirofiban on in-hospital all-cause mortality and one-year composite endpoint events in patients with S...To investigate through stratified analyses based on complete blood count-derived inflammatory markers, the effects of tirofiban on in-hospital all-cause mortality and one-year composite endpoint events in patients with ST-segment elevation myocardial infarction (STEMI) receiving dual antiplatelet therapy with aspirin and clopidogrel. This retrospective cohort study consecutively enrolled 3 420 patients with STEMI who underwent percutaneous coronary intervention at the First Affiliated Hospital of Dalian Medical University from January 2006 to December 2016. Patients were divided into a tirofiban group (=1 086) and a control group (=2 334) according to perioperative tirofiban use. Propensity score nearest-neighbor matching (1∶2) was applied to control for confounding bias, successfully matching the tirofiban group(=925) and the control group (=1 237). Baseline clinical data were collected for both groups. Logistic regression was used to analyze the association between tirofiban and in-hospital all-cause death, the 1-year composite endpoint event (including out-of-hospital all-cause death, ischemic stroke, nonfatal myocardial infarction, and readmission for heart failure), and Bleeding Academic Research Consortium type 3 or 5 bleeding risk. Furthermore, stratified analyses and interaction tests were performed based on complete blood count-derived inflammatory markers: neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, neutrophil-monocyte to lymphocyte ratio, systemic inflammatory response index, systemic immune-inflammation index (SII), and neutrophil-to-platelet ratio. After PSM, the tirofiban group had an age of (62.43±12.11) years and included 724 males (78.30%), while the control group had an age of (62.89±12.92) years and included 952 males (77.00%). Tirofiban use was associated with a significantly reduced risk of in-hospital all-cause death (=0.49, 95%: 0.32-0.74). The association with the 1-year composite endpoint event showed a protective trend but did not reach statistical significance (=0.64, 95%: 0.35-1.17). There was no statistically significant difference in the risk of Bleeding Academic Research Consortium type 3 or 5 bleeding between the two groups (>0.05). Exploratory stratified analysis showed that the protective association of tirofiban was more pronounced in the highest tertile groups of certain inflammatory markers. Notably, the interaction -value for SII on the 1-year composite endpoint event was 0.035, suggesting significant differences in tirofiban efficacy across SII levels,with greater benefits in the high SII group. Tirofiban significantly reduced in-hospital all-cause death, showed no significant effect on the 1-year composite endpoint, and did not increase bleeding risk. The protective association of tirofiban may be more evident in those with a high inflammatory burden. Complete blood count-derived inflammatory markers, such as SII, may serve as potential biomarkers for identifying suitable candidates for tirofiban.
Na K, Qiu MH, Wang ZH
… +3 more, Li J, Li Y, Han YL
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Jun · PMID 42324102
·
Publisher ↗
To evaluate the efficacy and safety of ticagrelor versus clopidogrel in real-world patients with acute coronary syndrome (ACS) without standard modifiable cardiovascular risk factors (SMuRF-less) following percutaneous c...To evaluate the efficacy and safety of ticagrelor versus clopidogrel in real-world patients with acute coronary syndrome (ACS) without standard modifiable cardiovascular risk factors (SMuRF-less) following percutaneous coronary intervention (PCI). This retrospective cohort study was based on a single-center, prospective PCI registry. SMuRF-less ACS patients (defined as the concurrent absence of hypertension, diabetes mellitus, hyperlipidemia, and current smoking at admission) who underwent PCI at the General Hospital of Northern Theater Command between March 2016 and March 2023 were consecutively enrolled. Patients were categorized into clopidogrel and ticagrelor groups based on the P2Y receptor inhibitor prescribed at discharge. The primary efficacy endpoint was major adverse cardiovascular events at 12 months, defined as a composite of cardiac death, myocardial infarction, or ischemic stroke. The primary safety endpoint was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding. Multivariable Cox proportional hazards regression models were used to compare outcomes between the two groups. A total of 3 323 SMuRF-less ACS patients were included (age (61.8±10.6) years; 1 120 (33.7%) female), comprising 2 694 (81.1%) in the clopidogrel group and 629(18.9%) in the ticagrelor group. Compared with the clopidogrel group, the ticagrelor group had a higher proportion of acute myocardial infarction, younger age, a higher proportion of males, and higher estimated glomerular filtration rate and hemoglobin levels (all <0.05). During the 12-month follow-up, the incidence of the primary efficacy endpoint, major adverse cardiovascular events, did not differ significantly between the ticagrelor and clopidogrel groups (1.4% (9/629) vs. 2.0% (55/2 694), =0.90, 95%: 0.43-1.87, =0.778). However, the ticagrelor group had a significantly higher incidence of the primary safety endpoint, Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, compared with the clopidogrel group (9.2% (58/629) vs. 5.9% (160/2 694), =1.79, 95%: 1.30-2.47, <0.001). Among SMuRF-less ACS patients undergoing PCI, ticagrelor did not reduce ischemic events compared with clopidogrel, but was associated with a significantly higher bleeding risk. Clopidogrel may represent a more appropriate P2Y₁₂ receptor inhibitor for this population.