Gu J, Fang D, Fu LW
… +3 more, Jing S, Hou M, Xie YH
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 May · PMID 42161628
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To investigate the effects of radiation bystander effect mediated by microRNA (miRNA)-134-5p/brain-derived neurotrophic factor (BDNF)/transforming growth factor-β1 (TGF-β1) pathway on cardiac fibroblasts, as well as the...To investigate the effects of radiation bystander effect mediated by microRNA (miRNA)-134-5p/brain-derived neurotrophic factor (BDNF)/transforming growth factor-β1 (TGF-β1) pathway on cardiac fibroblasts, as well as the protective effect of astragaloside Ⅳ (AST) against fibrotic injury. Rat cardiac fibroblasts were used, and a radiation bystander effect model was established via co-culturing cardiac fibroblasts irradiated with 2 Gy X-ray for 1 min with normal cardiac fibroblasts in a Transwell co-culture plate. The experiment was divided into 9 groups: control group (normal cardiac fibroblasts without additional intervention), AST group (normal cardiac fibroblasts pretreated with 5.1 μmol/L AST solution for 2 h), X-co group (irradiated cardiac fibroblasts co-cultured with normal cardiac fibroblasts), X-IN-co group (irradiated cardiac fibroblasts transfected with miRNA-134-5p inhibitor co-cultured with normal cardiac fibroblasts), X-inNC-co group (irradiated cardiac fibroblasts transfected with miRNA-134-5p inhibitor negative control co-cultured with normal cardiac fibroblasts), X-AST-co group (irradiated cardiac fibroblasts pretreated with 5.1 μmol/L AST for 2 h co-cultured with normal cardiac fibroblasts), MI-co group (cardiac fibroblasts transfected with miRNA-134-5p mimic co-cultured with normal cardiac fibroblasts), miNC-co group (cardiac fibroblasts transfected with miRNA-134-5p mimic negative control co-cultured with normal cardiac fibroblasts), and AST-MI-co group (cardiac fibroblasts transfected with miRNA-134-5p mimic co-cultured with cardiac fibroblasts pretreated with 5.1 μmol/L AST for 2 h). Flow cytometry was used to detect the reactive oxygen species (ROS) level in cardiac fibroblasts of each group; Cell Counting Kit-8 assay was used to measure cell proliferation capacity at different time points (0, 6, 12, 24, and 48 h); the thiobarbituric acid method was used to determine malondialdehyde (MDA) concentration; the water-soluble tetrazolium salt method was applied to detect superoxide dismutase (SOD) activity; quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) was used to detect the expression level of miRNA-134-5p; and Western blot was performed to measure the protein expression levels of BDNF, α-smooth muscle actin (α-SMA), TGF-β1, mothers against decapentaplegic homolog 2 (Smad2), and type Ⅰ collagen. Cell Counting Kit-8 assay showed that the cell viability in all groups was low at 6 h and peaked at 24 h. Compared with the control group, the bystander cells in the X-co group had higher expression levels of miRNA-134-5p, higher levels of ROS and MDA, lower levels of BDNF, and lower SOD activity (all <0.05); meanwhile, the protein levels of α-SMA, TGF-β1, Smad2 and type Ⅰ collagen in the bystander cells of the X-co group were higher than those in the control group (all <0.05). In comparison with the X-co group, the bystander cells in the X-IN-co group exhibited lower expression of miRNA-134-5p, reduced ROS level and MDA content, elevated BDNF level and SOD activity, as well as decreased protein levels of fibrotic factors including α-SMA, TGF-β1, Smad2 and type Ⅰ collagen (all <0.05). The levels of the aforementioned oxidative stress injury indicators and fibrotic factors in the bystander cells of the X-AST-co group were all lower than those in the X-co group (all <0.05). In addition, compared with the control group, the cardiac fibroblasts in the MI-co group had higher levels of miRNA-134-5p, α-SMA and TGF-β1, and lower BDNF level (all <0.05); while in comparison with the MI-co group, the cardiac fibroblasts in the AST-MI-co group presented with lower levels of miRNA-134-5p, TGF-β1 and α-SMA, and higher BDNF level (all <0.05). The miRNA-134-5p/BDNF/TGF-β1 pathway can mediate the radiation bystander effect and promote oxidative stress, transdifferentiation and profibrotic injury in cardiac fibroblasts. AST exerts a protective effect against radiation bystander effect-induced cardiac fibrotic injury by regulating this signaling pathway.
Xi RY, Jia CX, Liu XR
… +5 more, Wang ZY, Liu JW, Wu YF, Jiang C, Du X
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 May · PMID 42161627
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To explore the causes of inadequate caloric intake for hospitalized patients with heart failure and its association with heart failure rehospitalization and cardiovascular death. This was an observational study. Patient...To explore the causes of inadequate caloric intake for hospitalized patients with heart failure and its association with heart failure rehospitalization and cardiovascular death. This was an observational study. Patients hospitalized for heart failure in Beijing Anzhen Hospital, Capital Medical University from January 2022 to April 2023 were enrolled. Dietary intake for 3 consecutive days during hospitalization was collected. Patients were divided according to the ratio of the mean actual calorie intake to the theoretical calorie requirement: the insufficient calorie intake group (ratio<0.7) and the sufficient calorie intake group (ratio≥0.7). Baseline clinical characteristics, calorie and nutrient intake, as well as the incidence of heart failure rehospitalization and cardiovascular death within 6 months after discharge were collected and compared between the two groups. Logistic regression models were used to analyze the association between calorie intake and the risk of heart failure rehospitalization and cardiovascular death. A total of 261 patients with heart failure were enrolled, with an age of 59 (48, 67) years, including 196 males (75.1%). There were 136 patients in the insufficient calorie intake group and 125 in the sufficient calorie intake group. Compared with the sufficient calorie intake group, the insufficient calorie intake group had higher proportions of male patients (116 cases (85.3%) vs. 80 cases (64.0%)), patients with no fixed income (83 cases (61.0%) vs. 24 cases (19.2%)), and higher CONUT scores (3 (2, 4) points vs. 1 (1, 3) points) (all <0.05). Follow-up results showed that the incidence of the composite endpoint of heart failure rehospitalization and cardiovascular death was higher in the insufficient calorie intake group than in the sufficient calorie intake group (26 cases (20.6%) vs. 12 cases (9.8%), =0.017). Multivariate logistic regression analysis showed that insufficient calorie intake was a risk factor for heart failure rehospitalization and cardiovascular death within 6 months after discharge (=2.450, 95% 1.164-5.158, =0.018). Male patients and those with no fixed income are more prone to insufficient calorie intake, which is accompanied by poorer nutritional status and higher CONUT scores. Furthermore, insufficient calorie intake is a risk factor for rehospitalization and cardiovascular death in patients with heart failure.
Wang JJ, Ze F, Li XB
… +7 more, Li D, Zhou X, Duan JB, Wu CC, He JS, Wang L, Yuan CZ
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 May · PMID 42161626
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To analyze the feasibility and safety of leadless pacemakers in elderly patients. This retrospective cohort study analyzed 140 patients who underwent leadless pacemaker implantation at People's Hospital of Peking Univer...To analyze the feasibility and safety of leadless pacemakers in elderly patients. This retrospective cohort study analyzed 140 patients who underwent leadless pacemaker implantation at People's Hospital of Peking University and People's Hospital of Henan Province between January 2020 and December 2023. The patients were categorized into a non-elderly group (age<75 years) and an elderly group (age≥75 years). The study compared and analyzed demographic information, clinical data, pacing parameters during the surgery and surgery-related complications between the two groups. Pacing parameters (threshold, sensing, and impedance) were monitored in both groups at 24 hours, 3 months, and 6 months post-procedure, and pacing-related complications were recorded. A total of 140 patients were enrolled, with a mean age of (73.6±13.2) years, including 83 males (59.3%). There were 64 patients in the non-elderly group and 76 patients in the elderly group. Compared to the non-elderly group, the elderly group had a lower body mass index, a higher proportion of comorbidities such as atrial fibrillation/atrial flutter, hypertension, coronary heart disease, and stroke, and a lower proportion of postoperative valvular diseases (all <0.05). The elderly group had a higher proportion of patients undergoing leadless pacemaker implantation for the first time (48.7% (37/76) vs. 21.9% (14/64), =0.001) and a lower rate of leadless pacemaker re-implantation after infection and lead removal (43.4% (33/76) vs. 65.6% (42/64), =0.006) than the non-elderly group. There were no significant differences in pacing parameters at the time of leadless pacemaker implantation between the two groups (all >0.05). All patients were successfully implanted with a leadless pacemaker, with only 1 case (0.7%) in the elderly group experiencing pericardial tamponade, which was resolved through puncture and drainage. Additionally, no notable disparities in pacing threshold, sensing, and impedance were observed during the 24-hour, 3-month, and 6-month follow-up periods between the two groups (all >0.05), and no pacemaker-related complications were observed. Implantation of a leadless pacemaker device in elderly patients (age≥75 years) is safe and effective.
Wang BH, Chu HM, Feng MJ
… +10 more, Yu YB, Fu GH, Shen CJ, Jin H, Gao F, Yu LP, Fang RY, Jiang YX, Xu Y, Zhuo WD
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 May · PMID 42161625
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To investigate the feasibility and safety of intracardiac echocardiography (ICE)-guided left atrial appendage closure (LAAC) in patients with left atrial appendage thrombus (LAAT). This retrospective cohort study consec...To investigate the feasibility and safety of intracardiac echocardiography (ICE)-guided left atrial appendage closure (LAAC) in patients with left atrial appendage thrombus (LAAT). This retrospective cohort study consecutively included patients with LAAT who underwent LAAC guided by ICE in the First Affiliated Hospital of Ningbo University between May 2022 and December 2024. Demographic data, history of thromboembolic events, and history of bleeding events were collected. LAAC was performed using the LAmbre device under ICE guidance. Periprocedural complications were recorded. Thromboembolic events and bleeding events were recorded during follow-up. Follow-up transesophageal echocardiography was performed to detect peridevice leak and device-related thrombus. A total of 34 patients were enrolled, aged (67.2±9.6) years, including 28 males (82.4%). Among them, 14 patients had prior stroke/transient ischemic attack (TIA), and 2 experienced prior major bleeding. The LAmbre device was successfully implanted in all the patients guided by ICE. None experienced death, stroke/TIA, systemic embolism, pericardial effusion, or bleeding events. Access-site complications occurred in 3 patients. After a median follow-up of 395 (147, 653) days, none experienced death, stroke/TIA, or systemic embolism. During the follow-up period, a total of 4 bleeding events were recorded, comprising 2 major and 2 minor episodes. All patients completed transesophageal echocardiography follow-up at 6 months post-implantation, and no peridevice leak >3 mm was detected. Device-related thrombus was found in 1 patient. ICE-guided LAAC in patients with LAAT may be feasible and safe.
Wang DM, Pan L, Lu SW
… +8 more, Liu ZJ, Yang JZ, Qiu ZM, Yang SY, Xia QH, Zhao YC, Zhao RZ, Shi B
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 May · PMID 42161624
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Publisher ↗
To develop a nomogram based on plaque morphological features and derived computational physiological characteristics from optical coherence tomography (OCT) images, and to assess the prognostic value of the nomogram for...To develop a nomogram based on plaque morphological features and derived computational physiological characteristics from optical coherence tomography (OCT) images, and to assess the prognostic value of the nomogram for postoperative outcomes in patients with acute coronary syndrome (ACS). This retrospective cohort study included ACS patients hospitalized in the Affiliated Hospital of Zunyi Medical University between January 1, 2021 and December 31, 2023. All patients underwent OCT-guided percutaneous coronary intervention (PCI). Data were collected on baseline characteristics, laboratory indices, ancillary examination results, treatment regimens, angiographic data, OCT morphofunctional data. The primary endpoint event was major adverse cardiovascular events (MACE). LASSO regression was used to screen variables, and multivariable Cox regression was employed to establish a model and develop a nomogram. The predictive model was validated using receiver operating characteristic (ROC) curves, calibration curves, and clinical decision curves. Based on the median risk score calculated from the model in the entire cohort, patients were divided into a high-risk group (risk score≥-6.267) and a low-risk group (risk score<-6.267). Kaplan-Meier method was used to plot the survival curves for the two groups of patients. A total of 1 056 patients were enrolled, with a median age of 59 (52, 70) years, of whom 881 (83.4%) were male. The median follow-up duration was 687 days, and 133 (12.6%) patients experienced MACE. Four variables, including symmetry, lipid-fiber cap ratio, mean lumen area, and vascular-level optical flow ratio, were ultimately selected, and a nomogram model was constructed based on these variables. The ROC curve indicated that the area under the curve of this model for predicting MACE at 6, 12, and 18 months after PCI was 0.710, 0.702, and 0.697, respectively. The calibration curve and clinical decision curve demonstrated good consistency and clinical practicality of the model. The Kaplan-Meier survival curve showed that the MACE-free survival rate of patients in the high-risk group was lower than that of the low-risk group (<0.000 1). The nomogram model, established based on the plaque morphological features and computational physiological indicators in OCT images, possesses certain predictive value for the postoperative prognosis of ACS patients.
Li JY, Luo JY, Xu ZM
… +3 more, Xue Y, Li Y, Han YL
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 May · PMID 42161623
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Publisher ↗
To investigate the relationship between fat attenuation index (FAI) measured by coronary computed tomography angiography (CCTA) and high-risk plaques in patients with acute coronary syndrome (ACS) and negative fractional...To investigate the relationship between fat attenuation index (FAI) measured by coronary computed tomography angiography (CCTA) and high-risk plaques in patients with acute coronary syndrome (ACS) and negative fractional flow reserve (FFR). This single-center cross-sectional study enrolled a total of 342 consecutive patients with a confirmed diagnosis of ACS, who underwent coronary angiography and had negative FFR results (>0.80) at the Department of Cardiology, General Hospital of Northern Theater Command, from January 2016 to December 2022. All patients underwent CCTA within 1 month before the onset of ACS. According to the CCTA findings of the target vessels, patients were divided into a high-risk plaque group (=165) and a non-high-risk plaque group (=177). Semi-automated software was used to evaluate the FAI centered on the culprit lesion. The FAI values were compared between the two groups. A multivariate logistic regression model was applied to explore the association between high-risk plaques and FAI. The diagnostic performance of the model was assessed using receiver operating characteristic curve analysis. The age of the patients was (64 (53, 78)) years, and there were 178 (52.0%) males. The FAI value was significantly higher in the high-risk plaque group than in the non-high-risk plaque group ((-79.79±9.10) HU vs. (-84.21±10.14) HU, =0.001). Multivariate logistic regression analysis revealed that FAI was independently associated with high-risk plaques (=1.056, 95% 1.022-1.092, =0.001). The receiver operating characteristic curve showed that the area under the curve of FAI for diagnosing CCTA high-risk plaques was 0.748, with a sensitivity of 64.4% and a specificity of 73.8%, and the optimal cutoff value of FAI for identifying CCTA high-risk plaques was -80.5 HU. The FAI measured by CCTA is independently associated with high-risk plaques in ACS patients with negative FFR.
Cui LN, Dai ZA, Fang C
… +13 more, Zhao JW, Dong FH, Chen JW, Kang D, Yang N, Sun M, Lin T, Yu H, Chen T, Wang YN, Hou JB, Dai JN, Yu B
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 May · PMID 42161622
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Publisher ↗
To evaluate the impact of intravascular imaging-guided versus angiography-guided stent implantation on clinical outcomes in patients with acute coronary syndrome (ACS). This study was a retrospective cohort study. Betwe...To evaluate the impact of intravascular imaging-guided versus angiography-guided stent implantation on clinical outcomes in patients with acute coronary syndrome (ACS). This study was a retrospective cohort study. Between January 2023 and October 2023, 3 220 ACS patients who underwent coronary stent implantation at the Second Affiliated Hospital of Harbin Medical University were consecutively enrolled. Patients were divided into intravascular imaging-guided group (=2 550) and angiography-guided group (=670) based on whether intravascular imaging was used during the procedure. Patients from both groups were matched through 1∶1 propensity score matching according to clinical and angiographic characteristics, yielding 625 patients in each group. The primary endpoint was 2-year major adverse cardiovascular events (MACE), including cardiac death, non-fatal myocardial infarction, and ischemia-driven revascularization. Cumulative event rates were estimated using the Kaplan-Meier method and compared with the log-rank test; subgroup analysis was performed based on the presence or absence of complex lesions. Cox proportional hazards regression models were used to evaluate the impact of intravascular imaging guidance on patient prognosis. The age of patients was (62.4±10.5) years, and 2 203 (68.4%) were male. Compared with the angiography-guided group, the intravascular imaging-guided group had fewer stents implanted, larger maximum diameters of both stents and post-dilation balloons, and a higher proportion of post-dilation (all <0.05). The intravascular imaging-guided group had a significantly lower cumulative incidence of 2-year MACE than the angiography-guided group (7.3% vs. 13.0%, <0.001); which was primarily attributed to a lower incidence of cardiac death (2.1% vs. 7.5%, <0.001) and non-fatal myocardial infarction (0.9% vs. 2.4%, =0.002). After propensity score matching, the intravascular imaging-guided group still had a lower risk of MACE, cardiac death, and non-fatal myocardial infarction compared with the angiography-guided group (all <0.05). Multivariable Cox regression analysis showed that intravascular imaging guidance was an independent protective factor for 2-year MACE (=0.61, 95% 0.44-0.85), non-fatal myocardial infarction (=0.45, 95% 0.21-0.96), and cardiac death (=0.44, 95% 0.27-0.71). Subgroup analysis further demonstrated that, regardless of lesion complexity, the cumulative incidence of MACE was lower in the intravascular imaging-guided group compared with the angiography-guided group (all <0.05), with no interaction effect observed (=0.928). Compared with angiography guidance, intravascular imaging-guided stent implantation significantly reduces the risk of 2-year MACE in ACS patients, regardless of the presence of complex lesions.