Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Mar · PMID 41866211
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To analyze the burden level, temporal trends, and gender and age disparities of alcoholic cardiomyopathy (ACM) in China from 1990 to 2021. Data were extracted from the Global Burden of Disease 2021 study database. Core...To analyze the burden level, temporal trends, and gender and age disparities of alcoholic cardiomyopathy (ACM) in China from 1990 to 2021. Data were extracted from the Global Burden of Disease 2021 study database. Core metrics for ACM in China-including prevalent cases, deaths, and disability-adjusted life years (DALYs)-were extracted. The absolute numbers, rates (per 100 000 population), and variation characteristics of the above mentioned disease burden parameters were analyzed by stratification according to age and gender. The Joinpoint regression model was employed to calculate the estimated annual percentage change and average annual percentage change for analyzing the segmented trends of disease burden. Decomposition analyses were conducted to attribute the changes in disease burden to three independent factors: population growth, population aging, and changes in epidemiological rates, so as to quantify the absolute contribution value and relative contribution ratio of each factor to the changes in disease burden. In 2021, the number of prevalent cases of ACM in China was 28 103 (95% uncertainty interval () 22 175-34 991), the number of deaths was 1 861 (95% 318-2 987), and the DALYs reached 64 746 person-years (95% 12 595-102 876 person-years). The corresponding rates were 1.98 (95% 1.56-2.46), 0.13 (95% 0.02-0.21), and 4.55 (95% 0.89-7.23) per 100 000 population, respectively. The prevalence of ACM in China in 2021 was 4.1-fold of that in 1990, while the mortality and DALYs rates were 3.3-fold and 2.8-fold of those in 1990, respectively. From 1990 to 2021, the average annual percentage change of prevalence, mortality, and DALY rate of ACM were 4.96% (95% confidence interval () 4.67%-5.25%), 3.94% (95% 3.63%-4.24%), and 3.65% (95% 3.36%-3.93%), respectively, showing an overall trend of initial increase followed by stabilization. Specifically, the annual percentage change peaked at 15.73% (95% 14.51%-16.96%) for prevalence during 2000-2004, 8.42% (95% 7.89%-8.96%) for mortality during 2004-2011, and 9.80% (95% 8.72%-10.89%) for DALYs during 2005-2009. The disease burden exhibited an inverted U-shaped distribution with age. The peaks of case number and prevalence emerged in the 45-54 years age group, whereas the peaks of death number and DALYs occurred in the 50-59 years age group. Across all age groups under 90 years, males bore a higher burden of ACM in terms of prevalence, mortality, and DALYs than females, with the overall prevalence, mortality, and DALY rate being 7.4-fold, 7.7-fold, and 12.1-fold those of females, respectively. Decomposition analysis revealed that epidemiological factors were the primary driver of changes in the burden of ACM in China (contribution ratio: 43.56%-67.17%), followed by population aging (19.98%-33.56%) and population growth (12.84%-22.88%). From 1990 to 2021, the disease burden of ACM in China increased significantly, driven jointly by epidemiological factors, population aging and population growth, with marked disparities in gender and age distribution. Middle-aged and elderly males were identified as the high-burden population. Targeted interventions for alcohol intake, strengthened health management of key populations, and effective implementation of prevention and control policies are urgently required to alleviate the health damage caused by this disease.
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Mar · PMID 41866210
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To investigate the role of Rap1GAP in myocardial hypertrophy and fibrosis and its potential mechanism. In animal experiments, 20 cardiac-specific Rap1GAP knockout mice (Rap1GAP) and 20 Rap1GAP homozygous floxed mice (Ra...To investigate the role of Rap1GAP in myocardial hypertrophy and fibrosis and its potential mechanism. In animal experiments, 20 cardiac-specific Rap1GAP knockout mice (Rap1GAP) and 20 Rap1GAP homozygous floxed mice (Rap1GAP), aged 6-8 weeks, were divided into four groups: Rap1GAP+saline group, Rap1GAP+saline group, Rap1GAP+AngⅡ group, and Rap1GAP+AngⅡ group. Echocardiography was used to assess cardiac function in each group. HE staining was performed to observe the overall structure and cellular morphology of myocardial tissue. Wheat germ agglutinin staining was used to measure the cross-sectional area of cardiomyocytes. Masson staining and Sirius red staining were employed for quantitative analysis of myocardial fibrosis levels and collagen proportion. Western blot was used to detect the protein expression levels of Rap1GAP, α-smooth muscle actin (α-SMA), atrial natriuretic peptide (ANP), β-myosin heavy chain (β-MHC), collagen type Ⅰ, collagen type Ⅲ, transforming growth factor-β1 (TGF-β1), phosphorylated extracellular regulated kinase (p-ERK), extracellular regulated kinase (ERK), phosphorylated c-Jun N-terminal kinase (p-JNK), c-Jun N-terminal kinase (JNK), phosphorylated p38 mitogen-activated protein kinase (p-p38), p38 mitogen-activated protein kinase (p38), phosphorylated nuclear factor κB (p-NF-κB), and nuclear factor κB (NF-κB) in myocardial tissue. In cell experiments, primary cardiomyocytes and cardiac fibroblasts were isolated from 1-3-day-old Wistar rat neonates. Rap1GAP expression was knocked down by transfecting Rap1GAP small interfering RNA (si-Rap1GAP), and cells were divided into si-control (negative control siRNA)+saline group, si-Rap1GAP+saline group, si-control+AngⅡ group, and si-Rap1GAP+AngⅡ group. Rap1GAP was overexpressed by infecting with Rap1GAP adenovirus (Ad-Rap1GAP), and cells were divided into Ad-GFP (GFP empty vector adenovirus)+saline group, Ad-Rap1GAP+saline group, Ad-GFP+AngⅡ group, and Ad-Rap1GAP+AngⅡ group. For inhibitor rescue experiments, cardiac fibroblasts infected with Ad-Rap1GAP or Ad-GFP were treated with 10 μmol/L p38 inhibitor (SB203580) or TGF-β1 inhibitor (pirfenidone), forming Ad-Rap1GAP+AngⅡ+SB203580 group, Ad-Rap1GAP+Ang+pirfenidone group, Ad-GFP+AngⅡ+SB203580 group and Ad-GFP+Ang+pirfenidone group. Immunofluorescence staining was used to detect the expression levels of Rap1GAP, α-SMA, and proliferating cell nuclear antigen (PCNA) in cells. Dihydroethidium staining was employed to measure reactive oxygen species (ROS) levels. Western blot was used to detect the expression levels of target proteins (consistent with animal experiments). In animal experiments, compared with the Rap1GAP+AngⅡ group, the Rap1GAP+AngⅡ group showed larger left ventricular end-diastolic diameter and left ventricular end-systolic diameter, while the cardiomyocyte surface area, myocardial fibrosis ratio and myocardial collagen volume ratio were smaller. Additionally, the expression levels of ANP, β-MHC, collagen type Ⅰ, collagen type Ⅲ, and α-SMA were lower (all <0.05). Proteomic analysis revealed differences in the protein expression profiles of myocardial tissue between the Rap1GAP+AngⅡ group and the Rap1GAP+AngⅡ group at biological process, cellular component, and molecular function. In cell experiments, compared with the si-Rap1GAP+AngⅡ group, the si-control+AngⅡ group exhibited larger cardiomyocyte cross-sectional area, as well as higher expression levels of ANP, β-MHC, collagen type Ⅰ, collagen type Ⅲ and α-SMA, and a higher proportion of PCNA-positive cells (all <0.05). Compared with the Ad-GFP+AngⅡ group, the Ad-Rap1GAP+AngⅡ group showed larger cardiomyocyte cross-sectional area, higher expression levels of the aforementioned proteins, and a higher proportion of PCNA-positive cells (all <0.05). Furthermore, the relative expression levels of p-ERK/ERK, p-JNK/JNK, p-p38/p38, p-NF-κB/NF-κB proteins, and ROS levels in cardiomyocytes or cardiac fibroblasts were higher in the si-control+AngⅡ group than in the si-Rap1GAP+AngⅡ group (all <0.05), while these indices were higher in the Ad-Rap1GAP+AngⅡ group than in the Ad-GFP+AngⅡ group (all <0.05). Meanwhile, the ROS level, proportion of PCNA-positive cells, and expression levels of TGF-β1, p-ERK/ERK, p-JNK/JNK, p-p38/p38, collagen type Ⅰ, collagen type Ⅲ, and α-SMA proteins in cardiac fibroblasts were lower in the Ad-GFP+Ang+SB203580 group than in the Ad-GFP+AngⅡ group (all <0.05). The same trend was observed in the Ad-GFP+AngⅡ+pirfenidone group, with all aforementioned indices lower than those in the Ad-GFP+AngⅡ group (all <0.05). Rap1GAP may mediate cardiomyocyte hypertrophy by regulating the mitogen-activated protein kinase signaling pathway and the expression of its downstream target NF-κB. Meanwhile, Rap1GAP may promote myocardial fibrosis by inducing ROS production and activating the TGF-β1/mitogen-activated protein kinase signaling pathway.
Gu CH, Cui CY, Wei CH
… +4 more, Liu HF, Ma YL, Yuan JJ, Tian XQ
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Mar · PMID 41866209
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To quantitatively evaluate left ventricular myocardial work in patients with mitral valve prolapse with severe regurgitation (MVPSR) and normal left ventricular ejection fraction (LVEF) using pressure-strain loop (PSL) t...To quantitatively evaluate left ventricular myocardial work in patients with mitral valve prolapse with severe regurgitation (MVPSR) and normal left ventricular ejection fraction (LVEF) using pressure-strain loop (PSL) technology, and explore its predictive value for the duration of patients' postoperative stay in the intensive care unit (ICU). MVPSR patients with normal LVEF who were treated at Fuwai Huazhong Cardiovascular Hospital from May 2023 to June 2025 were included as the MVPSR group. All patients underwent cardiac valve repair or valve replacement surgery and underwent echocardiography before surgery. Subjects who were matched for gender, age, body mass index as well as comorbidities, and underwent echocardiography during the same period, and were excluded from MVPSR were selected as the non-MVPSR group. Left ventricular global longitudinal strain, longitudinal strain peak time dispersion and global work index, global work efficiency (GWE), global constructive work, global wasted work, as well as the longitudinal strain and work parameters for each segment (basal, mid, and apical segments) were assessed using PSL technology. The duration of ICU stay for patients in the MVPSR group after mitral valve surgery were recorded, and a prolonged ICU stay was defined as a duration >48 hours. The differences in left ventricular myocardial work parameters between the two groups were compared, and the impact of GWE on the duration of patients' early postoperative ICU stay was analyzed using a multifactor linear regression model. Receiver operating characteristic curve analysis was applied to evaluate the predictive performance of GWE for prolonged ICU stay. There were 80 patients in the MVPSR group, aged (58.9±12.3) years, including 61 males. There were 58 patients in the non-MVPSR group, including 31 healthy subjects, aged (54.8±15.3) years, including 36 males. The postoperative ICU stay time in the MVPSR group was (37.0±16.8) hours. Compared with the non-MVPSR group, the MVPSR group had lower global work index, GWE and global constructive work, and higher global wasted work; the work efficiency and constructive work in the basal, intermediate and apical segments were all lower, and the wasted work was higher; the longitudinal strain and work index in the basal segment were both lower (all <0.05). The results of the multi-factor linear regression model analysis showed that GWE was an independent influencing factor for postoperative ICU stay duration in MVPSR patients (=-2.89, 95% -5.43--0.34, =0.030). The area under the curve for GWE in predicting prolonged ICU stay time was 0.850 (95% 0.729-0.970). The receiver operating characteristic curve showed that the optimal cutoff value for GWE for predicting prolonged ICU stay was 92.5%, namely GWE≤92.5% predicting prolonged stay in ICU, with a sensitivity of 76.2% and a specificity of 82.4%. Patients with MVPSR and normal LVEF exhibit varying degrees of alterations in global and segmental left ventricular myocardial work parameters. GWE is negatively correlated with postoperative ICU length of stay and has certain predictive value for prolonged ICU stay after surgery.
Chen X, Lin YW, Su ML
… +9 more, Chen X, Meng FQ, Huang HB, Yao YE, Yan PP, Wen HM, Wu XJ, Wang B, Wang Y
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Mar · PMID 41866208
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To preliminarily investigate the clinical feasibility, early efficacy, and safety of transcatheter edge-to-edge repair (TEER) in patients with acute mitral regurgitation caused by papillary muscle rupture complicating ac...To preliminarily investigate the clinical feasibility, early efficacy, and safety of transcatheter edge-to-edge repair (TEER) in patients with acute mitral regurgitation caused by papillary muscle rupture complicating acute myocardial infarction (AMI). The study is a retrospective case series. A retrospective analysis was conducted on clinical data of 12 patients with AMI complicated by papillary muscle rupture and severe mitral regurgitation who underwent TEER at Xiamen Cardiovascular Hospital affiliated to Xiamen University from December 2021 to October 2024. Collected data included demographic characteristics, diagnostics and treatment processes, in-hospital outcomes data. Procedural success of TEER was defined as successful grasping of the anterior and posterior mitral leaflets and reduction of mitral regurgitation to grade 2+or less. Patients were followed up for 30 days post-procedure to evaluate survival status and the severity of mitral regurgitation. The mean age of the patients was 67.4 years, with 10 males. Eleven patients were diagnosed with ST-segment elevation myocardial infarction, and 11 out of 12 cases involved complete rupture of the posteromedial papillary muscle. Cardiogenic shock was present in 10 patients and the median Society of Thoracic Surgeons score was 51.9%. Procedural success was achieved in all 12 patients, with mitral regurgitation reduced to ≤2+immediately post-procedure. Eleven patients survived to discharge, and no device-or procedure-related complications occurred during the perioperative period. During the follow-up period, 2 patients died and 1 was readmitted for acute heart failure. At the 30-day follow-up, 9 patients maintained a mitral regurgitation grade of ≤2+. TEER is technically feasible for treating acute severe mitral regurgitation caused by papillary muscle rupture following AMI. It can effectively reduce mitral regurgitation and improve hemodynamic status in selected high-risk patients in the short term. However, these findings necessitate further validation through larger-scale multicenter studies and long-term follow-up.
Chen YX, Liu HM, Zhao HY
… +7 more, Liu SH, Wang MX, Liu LQ, Liu JR, Li HX, Wu SL, Wu YT
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Mar · PMID 41866207
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To investigate the association between baseline cumulative atherogenic index of plasma and the risk of new-onset cardiovascular disease in middle-aged and young populations. A total of 35 212 populations under 60-years...To investigate the association between baseline cumulative atherogenic index of plasma and the risk of new-onset cardiovascular disease in middle-aged and young populations. A total of 35 212 populations under 60-years old with complete physical examination in 2006 and 2010 from the Kailuan Study were retrospectively enrolled. Complete atherogenic index of plasma data were extracted and populations were grouped by cumulative atherogenic index of plasma quartile: Q1 group (<-0.80, =8 803), Q2 group (-0.80-<-0.19, =8 803), Q3 group (-0.19-<0.49, =8 803), Q4 group (≥0.49, =8 803). The study subjects were followed up, with the endpoint defined as the occurrence of new-onset cardiovascular disease, defined as myocardial infarction and stroke. The follow-up period began after the physical examination in 2010 and ended at the date of the endpoint event or December 31, 2022, whichever came first. Cox proportional hazard regression model was used to analyze the impact of cumulative atherogenic index of plasma on the risk of new-onset cardiovascular disease and its subtypes, with trend tests conducted. Stratification was performed based on hypertension status, diabetes status, and low-density lipoprotein cholesterol (LDL-C) levels (<3.4 mmol/L or ≥3.4 mmol/L) to examine multiplicative interactions with the cumulative atherogenic index of plasma, and Cox proportional hazards regression analysis was subsequently conducted. Among 35 212 participants, 26 636 (75.6%) were male, with an age of (45.4±8.3) years. Cardiovascular disease occurred in 2 075 cases (5.9%), of which 390 (1.1%) had myocardial infarction and 1 725 (4.9%) had stroke. During a follow-up of (11.5±2.0) years, the incidence densities of new-onset cardiovascular disease from Q1 to Q4 groups were 3.08, 4.70, 5.55 and 7.23 per 1 000 person-years, respectively. Cox proportional hazard regression model showed that, compared with the Q1 group, after adjusting for confounding factors, the (95%) of cardiovascular disease in Q2, Q3 and Q4 groups were 1.27 (1.10-1.48), 1.33 (1.14-1.56), 1.43 (1.19-1.72), respectively, the differences were statistically significant (all <0.05). The risk of cardiovascular disease showed an increasing trend across the Q1 to Q4 groups (<0.001). In the endpoint-specific analyses for myocardial infarction and stroke, stroke demonstrated a similar trend (=0.002), while no statistically significant difference was observed for myocardial infarction (=0.465). Subgroup analysis showed that there were potential multiplicative interactions between different levels of LDL-C, the presence or absence of hypertension or diabetes, and the cumulative atherogenic index of plasma (all for interaction<0.05). In a low-risk population with LDL-C<3.4 mmol/L, non-hypertensive, or non-diabetic, the cardiovascular disease risk in the Q4 group increased by 48%, 59%, and 49% compared to the Q1 group (all <0.05), respectively. In the middle-aged and young populations, a high level of cumulative atherogenic index of plasma is associated with an increased risk of cardiovascular disease. This elevated risk is independent of the effects of traditional risk factors and remains significant even among low-risk populations.
Gao G, Xu CB, Li RF
… +12 more, Zheng T, Shao JR, Wang XK, Liu PN, Wang G, Jiang LX, Qu G, Chen T, She JQ, Luo YB, Yuan ZY, Wu Y
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Mar · PMID 41866206
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To evaluate the safety and efficacy of an adeno-associated virus vector carrying an optimized human low density lipoprotein receptor (LDLR) gene (NGGT006) in the treatment of homozygous familial hypercholesterolemia (HoF...To evaluate the safety and efficacy of an adeno-associated virus vector carrying an optimized human low density lipoprotein receptor (LDLR) gene (NGGT006) in the treatment of homozygous familial hypercholesterolemia (HoFH) with LDLR mutations. This is an open-label, single-center, single-arm, non-randomized, investigator-initiated clinical trial. According to the dose-escalation principle, enrolled HoFH patients received a single injection of NGGT006 at three different doses: low dose (7.5×10 vg/kg), medium dose (1.5×10 vg/kg), or high dose (3.0×10 vg/kg). The primary endpoint of this study was the safety of NGGT006 treatment, evaluated by the incidence of drug-related adverse events and serious adverse events, and the efficacy of NGGT006 treatment, assessed by percentage and absolute changes in low density lipoprotein-cholesterol (LDL-C) levels. The early results of the first 3 patients after NGGT006 therapy in a 64-week follow-up were reported. The 3 patients were aged 29 to 33 years, including 2 males, and the baseline serum LDL-C levels ranged from 8.95 to 11.17 mmol/L. No effective reduction in LDL-C levels was observed in patients 1 and 2, who were treated with low dose and medium dose of NGGT006, respectively. Patient 3 treated with a high dose of NGGT006 showed a rapid and persistent decrease in LDL-C levels. At the 64-week follow-up, the LDL-C level reduced from 11.17 mmol/L to 0.28 mmol/L, with a relative change of 97.49% compared with baseline. During the entire follow-up period, there were no serious adverse events in any of the patients. Only adverse events graded 2 or lower occurred, such as liver enzyme elevation and mild fever. NGGT006 gene therapy is generally safe and well-tolerated in HoFH patients with LDLR mutations. High-dose NGGT006 treatment can significantly reduce LDL-C levels. Further research is needed to evaluate its long-term efficacy.
Zhang L, Zhou ZY, Zhou SD
… +3 more, Zhan SY, Zhang Y, Li JP
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Mar · PMID 41866205
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To analyze the utilization, intensity, and associated factors of lipid-lowering therapy in Chinese patients at high or very high risk of atherosclerotic cardiovascular disease (ASCVD). This nationwide hospital-based cro...To analyze the utilization, intensity, and associated factors of lipid-lowering therapy in Chinese patients at high or very high risk of atherosclerotic cardiovascular disease (ASCVD). This nationwide hospital-based cross-sectional study was led by Peking University First Hospital. Patients at high or very high risk of atherosclerotic cardiovascular disease (ASCVD) were recruited from 1 785 medical institutions across China between September 2022 and November 2024. Clinical data, including age, gender, and lipid profiles, were collected. We described the utilization status of lipid-lowering therapy and identified factors associated with the intensity of lipid-lowering therapy using multivariate logistic regression analysis. A total of 189 674 ASCVD patients were included in the final analysis (153 066 high-risk (80.7%); 36 608 very high-risk (19.3%)). Low density lipoprotein cholesterol attainment rates were low in both high-risk (25 542/153 066, 16.7%) and very high-risk (6 585/36 608, 18.0%) groups. Non-treatment rates were 36.9% (56 436/153 066) in high-risk and 14.4% (5 280/36 608) in very high-risk patients. Treatment in both groups was predominantly moderate-intensity statin monotherapy, while high-intensity treatment rates were low (5.0% high-risk (7 685/153 066); 17.0% very high-risk (6 240/36 608)). Multivariate analysis showed that age >75 (high-risk patients: =0.55, 95%: 0.49-0.61; very high-risk patients: =0.51, 95%: 0.46-0.57) and rural residence (high-risk patients: =0.69, 95%: 0.66-0.73; very high-risk patients: =0.64, 95%: 0.60-0.68) were significantly associated with lower treatment intensity. Women in the very high-risk group had a lower propensity to receive any lipid-lowering treatment (=0.62, 95%: 0.57-0.67) and high-intensity therapy (=0.90, 95%: 0.84-0.97). Patients with stroke (=0.41, 95%: 0.38-0.44) or peripheral arterial disease (=0.28, 95%: 0.22-0.36) received less high-intensity therapy compared to those with myocardial infarction and coronary heart disease. Significant clinical inertia and disparities in lipid-lowering therapy exist among Chinese patients at high-risk or very high-risk of ASCVD, characterized by low LDL-C attainment rates and insufficient use of guideline-recommended intensive regimens, especially among the elderly, rural residents, women, and patients with non-coronary ASCVD.