Ding X, Zhou YF, Zhou H
… +4 more, Yuan Y, Yang L, Chen SH, Wu SL
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Feb · PMID 41688185
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Analyze the trends in the prevalence, treatment, and control of cardiovascular risk factors among young adults in the Kailuan Study. This was a prospective cohort study including young adults aged 18 to 44 years, based...Analyze the trends in the prevalence, treatment, and control of cardiovascular risk factors among young adults in the Kailuan Study. This was a prospective cohort study including young adults aged 18 to 44 years, based on health examination data from the Kailuan Study from 2006 to 2020. Data on five cardiovascular risk factors were collected, including hypertension, diabetes, high cholesterol, obesity, and smoking. Crude rates were estimated using the Clopper-Pearson method, standardized rates were calculated using the direct standardization method, adjusted rates were obtained using generalized linear models, and trends were assessed using the Cochran-Armitage test. Across seven examination waves in 2006-2007, 2008-2009, 2010-2011, 2012-2013, 2014-2015, 2016-2017, and 2018-2020, 27 278, 24 546, 21 228, 26 971, 24 515, 16 102, and 16 704 young adults were included, respectively. The standardized prevalence of hypertension and the standardized detection rate of smoking decreased from 17.4% and 26.1% in 2006-2007 to 11.1% and 20.3% in 2018-2020, respectively (both <0.001). The standardized prevalence of diabetes remained stable at approximately 2.5% in 2006-2020 (=0.942). Standardized prevalence of high cholesterol and obesity increased from 7.4% and 15.0% to 8.7% and 18.0%, respectively (both <0.001). Among young adults with hypertension, adjusted treatment rates showed an overall increasing trend (<0.001), whereas control rates fluctuated but demonstrated an overall decreasing trend (<0.001). Among young adults with diabetes, the adjusted treatment rate showed an overall declining trend (=0.004), whereas the control rate fluctuated during the study period without a statistically significant overall trend (=0.336). Males had a higher risk of hypertension, diabetes, high cholesterol, and obesity compared with females (all 0.001). From 2006 to 2020, the prevalence of high cholesterol and obesity increased among young adults in the Kailuan Study, whereas the prevalence of diabetes remained relatively stable and rates of hypertension and smoking declined. The treatment rate for hypertension improved over time, whereas that for diabetes decreased; Overall, hypertension control rates declined, whereas diabetes control rates exhibited a fluctuating trend. Overall, males exhibited higher risks for major cardiovascular risk factors.
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Feb · PMID 41688184
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To explore the role and underlying mechanisms of transient receptor potential vanilloid 4 (TRPV4) in pressure overload-induced myocardial fibrosis in fetal tetralogy of Fallot (TOF). Fetal cardiac samples diagnosed by p...To explore the role and underlying mechanisms of transient receptor potential vanilloid 4 (TRPV4) in pressure overload-induced myocardial fibrosis in fetal tetralogy of Fallot (TOF). Fetal cardiac samples diagnosed by prenatal echocardiography or postmortem examination were retrospectively collected from Qingdao University Affiliated Women and Children's Hospital between May 2022 and July 2024, including 4 cases in the Tetralogy of Fallot (TOF) group and 4 cases in the structurally normal heart control group. Histological analysis of myocardial hypertrophy, fibrosis, and collagen content was performed on collected right ventricular wall tissues using hematoxylin-eosin (HE), Masson＇s trichrome, and Sirius red staining. Immunohistochemistry was used to detect the expression levels of TRPV4, Ras homolog gene family member A (RhoA), and Rho-associated coiled-coil containing protein kinase 1 (ROCK1) in myocardial tissues, while Western blot was applied to measure the expression of Collagen Ⅰ, Collagen Ⅲ, and α-smooth muscle actin (α-SMA). In vitro, human umbilical vein endothelial cells (HUVEC) at passages 3 to 6 were seeded on hydrogel-coated plates with different stiffnesses (8 kPa, 50 kPa) and divided into 8 kPa, 50 kPa, and 50 kPa+TRPV4 inhibitor (pretreated with a TRPV4 antagonist) groups. Small interfering RNA targeting TRPV4 (siTRPV4) and negative control siRNA (siNC) were transfected into HUVECs to establish TRPV4-knockdown models. These cells were then seeded on hydrogel plates of varying stiffness and divided into 8 kPa, 50 kPa, siNC, and siTRPV4 groups. Western blot was used to assess the expression levels of TRPV4, RhoA, ROCK1, Collagen Ⅰ, Collagen Ⅲ, α-SMA, CD31, vascular endothelial cadherin (VE-cadherin), and endothelial-mesenchymal transition (EndMT)-related regulatory proteins (p-Smad2 and the transcription factor Slug). HE staining revealed cardiomyocyte hypertrophy in the right ventricular wall of the TOF group compared with the control group, accompanied by varying degrees of myocardial disarray. Masson＇s trichrome staining indicated a higher percentage of fibrotic area in the right ventricular myocardium of the TOF group, and Sirius red staining showed a larger collagen deposition area (all <0.05). Compared with the control group, the TOF group exhibited significantly higher protein expression of Collagen Ⅰ, Collagen Ⅲ, and α-SMA, along with enhanced positive signal intensity for TRPV4, RhoA, and ROCK1 (all <0.05). In vitro experiments, compared with the 50 kPa group, both the 8 kPa group and the 50 kPa+TRPV4 inhibitor group had lower expression levels of Collagen Ⅰ, Collagen Ⅲ, α-SMA, p-Smad2, Slug, TRPV4, RhoA, and ROCK1, while expression levels of CD31 and VE-cadherin were higher (all <0.05). Similarly, the siTRPV4 group showed lower expression of Collagen Ⅰ, Collagen Ⅲ, α-SMA, TRPV4, RhoA, ROCK1, Slug and p-Smad2, and higher expression of CD31 and VE-cadherin compared with the 50 kPa group (all <0.05). In contrast, no significant differences in the expression of these proteins were observed between the siNC group and the 50 kPa group (all >0.05). The right ventricle myocardium of TOF fetuses exhibits evident myocardial fibrosis. Mechanical stimulation induced by high-pressure load activates TRPV4, which may mediate EndMT in cardiac vascular endothelial cells through regulation of the RhoA/ROCK1 signaling pathway. This mechanism may represent one of the primary pathological contributors to myocardial fibrosis development.
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Feb · PMID 41688183
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Evaluate the safety and efficacy of permanent endocardial pacemaker implantation in infants. This study was designed as a retrospective cohort study. Infants with complete atrioventricular block who underwent endocardia...Evaluate the safety and efficacy of permanent endocardial pacemaker implantation in infants. This study was designed as a retrospective cohort study. Infants with complete atrioventricular block who underwent endocardial permanent pacemaker implantation at Fujian Children's Hospital from 2021 to 2023 were selected. Clinical, electrocardiographic, echocardiographic, pacemaker parameters data and implantation-related adverse events were collected and analyzed during follow-up. Eight infants were enrolled, with a surgical age of 5.8 (3.0, 7.0) months and a body weight of 5.6 (5.2, 7.0) kg. Three (3/8) were male. Etiologies included congenital complete atrioventricular block (=5) and acquired complete atrioventricular block (=3). The preoperative QTc interval was (469±38) ms, with a left ventricular end diastolic diameter Z score of 1.83±1.58, and a left ventricular ejection fraction of (62.1±15.7)%. Intraoperative pacemaker parameters were as follows: threshold 0.5-1.3 V/0.4 ms, sensing amplitude 2.0-21.2 mV, and impedance 500-700 Ω. Over a follow-up of 16.0 (6.0, 21.8) months, significant improvements were observed at the 3-month postoperative assessment: QTc interval shortened to (427±29) ms, left ventricular end diastolic diameter Z score decreased to 0.20±1.00, and left ventricular ejection fraction increased to (64.9±4.1)%. At 6 months postoperatively, the threshold was 0.4-1.0 V/0.4 ms, sensing amplitude 4.9-10.1 mV, and impedance 521-1 462 Ω. Notably, patients with preoperative cardiac dysfunction (=1), significant left ventricular dilation (=5), or prolonged QTc with ventricular arrhythmias (=5) showed essentially normal recovery. One patient developed moderate-to-severe tricuspid regurgitation one week after surgery, which was successfully reduced to mild-to-moderate following a secondary procedure for lead repositioning two weeks later. All eight patients demonstrated good pocket healing, with no instances of ipsilateral upper limb swelling or formation of superficial collateral vessels during the follow-up period. No implant-related adverse events occurred. Permanent endocardial pacemaker implantation in infants demonstrates acceptable safety and efficacy profiles. This treatment can be attempted with strict control of surgical indications and meticulous operation.
Zhao HZ, Sun Y, Zhang ZH
… +2 more, Zhou Z, Yin KL
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Feb · PMID 41688182
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To investigate the clinical characteristics, disease progression pattern, genetic variant features, and therapeutic effect of heart transplantation in a family with Danon disease. This study is a single-center retrospec...To investigate the clinical characteristics, disease progression pattern, genetic variant features, and therapeutic effect of heart transplantation in a family with Danon disease. This study is a single-center retrospective case analysis. A proband with Danon disease who was diagnosed and treated at Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between January 2009 and July 2024 and underwent heart transplantation was selected. Retrospective data were collected, including medical history, imaging findings (echocardiography, cardiac magnetic resonance), electrocardiogram, laboratory indicators, pathological examination results, and genetic testing results of the proband and her family members. Regular follow-up was conducted to evaluate the patient's disease progression and post-transplant recovery. The proband was a 23-year-old female with an onset age of 7 years. Initially, the patient presented with non-obstructive hypertrophic cardiomyopathy (maximum left ventricular wall thickness: 29 mm) accompanied by reduced diastolic function. At 19 years old, the disease progressed to dilated cardiomyopathy (left ventricular end-diastolic diameter: 61 mm; left ventricular ejection fraction: 35%). At 22 years old, she was diagnosed with end-stage heart failure (cardiac index: 2.4 L·min·m). Genetic testing revealed that the patient carried a pathogenic heterozygous variant of the LAMP2 gene c.459C>A (p.Cys153Ter). She underwent orthotopic heart transplantation at 22 years old, and during 3 years of post-transplant follow-up, her cardiac function remained normal (left ventricular ejection fraction >60%). The patient's mother carried the same genetic variant and underwent heart transplantation at 29 years old. Despite being female, the Danon disease patient in this case exhibited clinical features of rapidly progressive cardiomyopathy. Heart transplantation is an effective treatment for patients with end-stage Danon disease, with significant long-term therapeutic effects confirmed by post-transplant follow-up. Clinicians should be alert to the possibility of Danon disease in young patients with hypertrophic cardiomyopathy. Early genetic testing helps confirm the diagnosis and provides a basis for clinical intervention.
Li YY, Wang H, Ji C
… +5 more, Chai K, Li XL, Dong YG, Zhou JM, Yang JF
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Feb · PMID 41688181
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To investigate the clinical characteristics, etiology distribution, comorbidities and treatment strategies of hospitalized patients with heart failure in China from 2023 to 2024. This was a cross-sectional study. Data w...To investigate the clinical characteristics, etiology distribution, comorbidities and treatment strategies of hospitalized patients with heart failure in China from 2023 to 2024. This was a cross-sectional study. Data were derived from the China Heart Failure Registry. Hospitalized patients with heart failure who participated in the registry between January 1, 2023 and December 31, 2024 were enrolled in this study. According to left ventricular ejection fraction, the enrolled patients were divided into three groups: heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF). Clinical data of patients in each group were collected via a web-based online reporting system, including demographic data, causes of hospitalization, comorbidities, laboratory indicators, electrocardiography findings, echocardiography findings, and treatment strategies. A total of 250 936 heart failure patients were enrolled, with an age of (70.1±13.2) years; among them, 105 338 (41.98%) were female. Specifically, 87 490 cases were diagnosed with HFrEF (34.87%), 53 473 with HFmrEF (21.31%), and 109 973 with HFpEF (43.83%). Coronary heart disease was the most common etiology (62.18%, 156 038/250 936), precipitating factor for hospitalization (49.36%, 123 863/250 936), and comorbidity (65.95%, 165 491/250 936) among hospitalized heart failure patients. Before discharge, the utilization rate of renin-angiotensin system inhibitors was 82.96% (72 578/87 490) in HFrEF patients. The utilization rates of beta-blockers and mineralocorticoid receptor antagonists were 84.77% (74 161/87 490) and 90.57% (79 238/87 490), respectively. The overall utilization rate of sodium-glucose cotransporter 2 inhibitors was 61.83% (155 143/250 936). Stratified by heart failure subtype, the utilization rates were 75.67% (66 195/87 490) in HFrEF patients, 64.31% (34 388/53 473) in HFmrEF patients, and 49.61% (54 560/109 973) in HFpEF patients, with lower rates in HFmrEF and HFpEF patients compared with HFrEF patients (<0.001). The implantation rates of cardiac resynchronization therapy defibrillators, cardiac resynchronization therapy pacemakers, and implantable cardioverter defibrillators were 1.44% (1 262/87 490), 0.37% (323/87 490), and 1.35% (1 182/87 490), respectively, in HFrEF patients. The blood pressure control rate was 66.83% (8 822/13 201) in HFpEF patients under 60 years old. Among HFpEF patients complicated with coronary heart disease, the heart rate control rate was 36.46% (26 686/73 188). Among hospitalized patients with heart failure in China, HFpEF accounted for the largest proportion. Coronary heart disease was the most common etiology, the leading trigger for hospitalization, and the most prevalent comorbidity in this patient population. At discharge, the utilization rates of prognosis-improving medications remained high in HFrEF patients, whereas the application of device therapy was still insufficient. In HFpEF patients, the use of sodium-glucose cotransporter 2 inhibitors and the management of comorbidities remain areas in urgent need of optimizationin.
Ding YD, Feng RX, Han JY
… +8 more, Lin L, Zhang Y, Zhao ZH, Wang WJ, Zhao TX, Zhou SJ, Xiong JH, Zeng Y
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Feb · PMID 41688180
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To develop and validate a deep learning model based on retinal fundus images for predicting the risk of long-term adverse cardiovascular events in patients with acute coronary syndrome (ACS). This multicenter diagnostic...To develop and validate a deep learning model based on retinal fundus images for predicting the risk of long-term adverse cardiovascular events in patients with acute coronary syndrome (ACS). This multicenter diagnostic study enrolled ACS patients from July 2021 to July 2023 at Beijing Anzhen Hospital, Beijing Daxing Hospital, Beijing Miyun Hospital, and the Second Affiliated Hospital of Hainan Medical University. Retinal fundus images were acquired. Patients underwent follow-up, with the primary endpoint defined as major adverse cardiovascular and cerebrovascular events (MACCE). Patients were divided into a development set and an external test set. A multimodal deep learning model based on Inception-Resnet-V2 was constructed. Predictive performance for MACCE was evaluated using the area under the receiver operating characteristic curve (). Patients were further stratified into low-and high-risk groups according to the optimal cutoff value derived from the receiver operating characteristic curve, and Kaplan-Meier survival curves were generated. Class activation mapping was used to analyze the retinal regions the model focused on during decision-making. A total of 4 703 ACS patients were included, with a median age of 59 years and 3 504 (74.51%) males. The development set comprised 1 521 patients, and the external validation set included 3 182 patients. The maximum follow-up duration was 883 days. The MACCE incidence rate was 27.42% (417/1 521) in the development cohort and 10.03% (319/3 182) in the external validation cohort. The model's for predicting MACCE was 0.709 (95% 0.676-0.742) in the development cohort and 0.644 (95% 0.613-0.675) in the external validation cohort. Kaplan-Meier survival curves demonstrated that the MACCE incidence was higher in the high-risk group than in the low-risk group in both the development and external validation cohorts (<0.05 for log-rank tests). Class activation mapping analysis revealed that the model focused on retinal vascular regions during decision-making. A deep learning model based on retinal fundus images effectively predicts long-term adverse cardiovascular event risk in ACS patients, demonstrating robust risk stratification capability and clinical interpretability. It holds promise as a noninvasive risk assessment tool.
Song S, Wang YJ, Fu D
… +6 more, Yin HJ, Zhou KN, Wang L, Zhang XH, Lou X, Cao F
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Feb · PMID 41688179
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To construct and preliminarily validate the four-dimensional cardiac mesh model based on cardiac magnetic resonance (CMR) imaging for the evaluation of cardiac structure and function in patients with cardiomyopathy. A t...To construct and preliminarily validate the four-dimensional cardiac mesh model based on cardiac magnetic resonance (CMR) imaging for the evaluation of cardiac structure and function in patients with cardiomyopathy. A total of 70 patients who underwent CMR examinations were enrolled from the UK Biobank database as the training set. A four-dimensional mesh model of the cardiac left and right ventricles was constructed using CMR images that passed quality control. Additionally, a validation set consisting of 30 patients who underwent CMR examinations at the First Medical Center of the Chinese People's Liberation Army General Hospital from March 2021 to October 2024 were included. These patients were classified into three groups based on clinical diagnosis: dilated cardiomyopathy (DCM) group, hypertrophic cardiomyopathy (HCM) group, and control group (no cardiomyopathy). The trained model was applied to analyze the CMR images of the validation set patients, calculating various cardiac structure and function parameters, including left ventricular volume index, left ventricular ejection fraction, left myocardial mass index, and strain. Differences in these parameters between the DCM or HCM groups and the control group were compared, and linear mixed models were used for statistical analysis of inter-group differences. The age of patients in the training set was (62.2±10.3) years, with 58 (83%) males. The age of patients in the validation set was (56.5±13.9) years, with 21 (70%) males, including 8 patients in the HCM group, 9 in the DCM group, and 13 in the control group. The left ventricular ejection fraction in the DCM group was lower than that in the control group ((39.34±3.73) % vs. (53.56±2.98) %, =0.006 3). The linear mixed model analysis showed that the left ventricular volume index and various strain parameters in the DCM group were significantly higher than those in the control group (all <0.001). The left myocardial mass index in the HCM group was higher than that in the control group ((94.21±9.10) g/m² vs. (56.36±11.33) g/m², <0.001). The analysis results of the linear mixed model were consistent with it (<0.001). The preliminary results confirm that the four-dimensional cardiac mesh model based on CMR imaging constructed in this study could integrate and evaluate multiple parameters of cardiac structure and function in patients with cardiomyopathy. It has the potential to become an intelligent imaging diagnostic tool for cardiac diseases.
Liu WF, Duan YX, Qi ZZ
… +5 more, Wang KX, Qiu MH, Li J, Li Y, Han YL
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Feb · PMID 41688178
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To investigate the application value of cardiovascular age prediction based on large language model for prognostic assessment in patients with acute coronary syndrome (ACS). This retrospective cohort study included 47 2...To investigate the application value of cardiovascular age prediction based on large language model for prognostic assessment in patients with acute coronary syndrome (ACS). This retrospective cohort study included 47 249 ACS patients who were admitted to the Department of Cardiology at the General Hospital of Northern Theater Command and underwent percutaneous coronary intervention between November 2015 and May 2023. Cardiovascular age was predicted using a large language model for cardiovascular critical care developed by our institution, incorporating patients' demographic characteristics, medical history, and laboratory data. The difference between cardiovascular age and chronological age was calculated as the Age-Gap. Based on previous studies, patients were categorized into the high Age-Gap group (Age-Gap≥8 years) and the low Age-Gap group (Age-Gap<8 years). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiac death, myocardial infarction, stroke, and target vessel revascularization. Secondary endpoints included the individual components of MACCE and all-cause mortality. Pearson correlation analysis was used to assess the correlation between cardiovascular age and chronological age. Cox proportional hazards models were used to evaluate the association between Age-Gap and clinical outcomes, and restricted cubic spline analyses were applied to explore potential nonlinear relationships between Age-Gap and study endpoints. The chronological age was (61.1±10.4) years, the cardiovascular age was (69.5±10.8) years. There were 31 775 patients in the high Age-Gap group and 15 474 in the low Age-Gap group. Cardiovascular age was positively correlated with chronological age (=0.87, <0.000 1). The follow-up duration was 39.6 (24.0, 59.6) months. The incidence of MACCE was significantly higher in the high Age-Gap group than that in the low Age-Gap group (12.99% (4 127/31 775) vs. 7.86% (1 216/15 474), <0.000 1). After adjustment for age, sex, smoking status, and other confounders, Cox regression analysis showed that patients in the high Age-Gap group had a significantly increased risk of MACCE compared with those in the low Age-Gap group (=1.47, 95% 1.37-1.58, <0.000 1). Higher risks were also observed for cardiac death (=2.72, 95% 2.36-3.15, <0.000 1), myocardial infarction (=1.77, 95% 1.46-2.14, <0.000 1), stroke (=1.24, 95% 1.05-1.46, =0.010 9), and all-cause mortality (=2.01, 95% 1.81-2.23, <0.000 1). Restricted cubic spline analyses demonstrated a nonlinear association between Age-Gap and the risks of MACCE, cardiac death and all-cause mortality, with a marked increase in risk as Age-Gap increased (all <0.000 1; all <0.000 1). The application of large language model to predict cardiovascular age in ACS patients is feasible, and the Age-Gap exhibits a significant correlation with the risk of MACCE and mortality in this patient population. The cardiovascular age predicted by large language model offers a novel perspective for individualized risk assessment in ACS patients.
Chinese Society of Cardiology, Chinese Medical Association, Professional Committee of Cardiopulmonary Prevention and Rehabilitation of Chinese Rehabilitation Medical Association, Editorial Board of Chinese Journal of Cardiology
Zhonghua Xin Xue Guan Bing Za Zhi
· 2026 Feb · PMID 41688176
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