Objective:To investigate the association of systemic immune-inflammation index(SII)and serum cysta-tin C(CysC)with the severity of acute pulmonary embolism(APE),and their predictive value for prognosis.Meth-ods:A total of 181 patients who were first diagnosed with APE in Cangzhou People's Hospital between January 2018 and January 2023 were retrospectively selected.The severity of APE was determined according to risk stratification criteria for pulmonary embolism,and the patients were divided into low-risk group(n=67),middle-risk group(n=81)and high-risk group(n=33).General clinical data and venous blood neutrophils,platelet and lymphocyte counts,CysC and other indicators were collected,and SII was calculated according to the formula.The relevant in-dicators were compared among three groups,and their correlation with the severity of APE was analyzed by Spearman correlation analysis.According to the prognosis,all APE patients were divided into favorable outcome group(n=129)and unfavorable outcome group(n=52).The general clinical data were compared and multivariate Cox regression analysis was used to study the influencing factors of unfavorable outcome in APE patients.The re-ceiver operating characteristic curve(ROC)was drawn to evaluate the predictive value of SII,CysC and their com-bination for the prognosis of APE patients.Nomogram model for prognosis was constructed.Results:Compared with patients in low-risk group,those in the middle-risk group and the high-risk group had significantly higher levels of serum creatinine,CysC and uric acid(P＜0.05 or＜0.01).The SII in the high-risk group was significant-ly higher than those of middle-risk group and low-risk group(P＜0.001 all).Spearman correlation analysis showed that serum creatinine,CysC,uric acid and SII were significant positively correlated with the severity of APE(r=0.356,0.358,0.233,0.353,P＜0.01 all).Compared with patients in the favorable outcome group,those in the unfavorable outcome group had significantly higher levels of D-dimer,serum creatinine,CysC,uric acid and SII(P＜0.01 all).There was a statistically significant difference in the severity of APE between the two groups(P=0.001).Multivariate Cox regression analysis showed that CysC,SII,and middle or high risk of disease severity were independent risk factors for unfavorable outcome in APE patients(HR=1.001～14.453,P＜0.05 or＜0.01).ROC curve indicated that the AUC of SII,CysC and their combination in predicting unfavorable outcome of APE patients were 0.815(95％CI 0.749～0.881),0.747(95％CI 0.661～0.832)and 0.878(95％CI,0.821～0.936),respectively.The combined AUC of the two was significantly higher than those of SII and CysC alone(Z=-2.234,-3.500,P＜0.05 or＜0.01).Based on the above independent risk factors,the AUC values of the 1-year and 3-year unfavorable outcome nomogram models were 92.9 and 88.2,respectively.The calibration prediction curve and the ideal curve fitted well.The decision curve showed that the model had a good net benefit.Conclusion:SII and CysC are significant positively correlated with the severity of APE and they are independent risk factors for unfavor-able outcome of APE,and the combination of the two indicators has a good predictive value for the prognosis of APE.The nomogram constructed has good accuracy and practicability.

Objective:To explore the effect of recombinant human brain natriuretic peptide(rhBNP)on the efficacy,inflammatory factors and cardiac function in patients with dilated cardiomyopathy(DCM)and chronic heart failure(CHF).Methods:This randomized controlled study enrolled 130 patients with DCM and CHF admitted to Dongy-ing District People's Hospital of Dongying City between February 2017 and December 2018.Patients were divided into intervention group(n=65)and control group(n=65).Patients in control group received conventional treat-ment,while those in the intervention group was given additional rhBNP treatment,both groups were treated for 4 weeks.The total effective rate,cardiac function indicators,levels of inflammatory factors and blood lipids,as well as incidence of adverse reactions,were compared between the two groups.Results:The total effective rate(95.38％vs.76.92％,P＜0.001)of the intervention group was significantly higher than that of the control group.After treatment,compared to patients in the control group,those in the intervention group had significant higher left ventricular ejection fraction(LVEF)[(53.21±3.57)％vs.(45.39±2.56)％]and interleukin(IL)-10[(79.55±13.98)pg/ml vs.(69.32±13.86)pg/ml],and significant lower left ventricular end-systolic diameter(LVESd)[(35.25±3.19)mm vs.(40.34±3.09)mm],left ventricular end-diastolic diameter(LVEDd)[(43.29±4.87)mm vs.(50.18±4.21)mm],IL-18[(212.19±24.28)pg/ml vs.(257.98±39.72)pg/ml],and high sensitive C reactive protein(hsCRP)[(11.39±2.29)mg/L vs.(16.59±2.83)mg/L](P＜0.001 all).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.753).Conclusion:The use of the rhBNP based on routine therapy for the treatment of dilated cardiomyopathy and chronic heart failure could effectively improve cardiac function and reduce levels of inflammatory factors.Additionally,it has a high safety profile.

Objective:To explore the application effect of emergency risk management in emergency treatment of pa-tients with acute myocardial infarction(AMI)and its safety.Methods:This randomized controlled study enrolled 103 AMI patients admitted in Haian People's Hospital between April 2020 and January 2023.Patients were divided into intervention group(n=51)and control group(n=52).Patients in intervention group received emergency risk management measures,while those in control group received routine management measures.Rescue quality,heart function,scores of Connor-Davidson resilience scale(CD-RISC),coronary self-management scale(CSMS)and incidence of adverse events were compared between two groups.Results:Compared to patients in the control group,those in intervention group had significant higher rescue success rate(96.0％vs.46.0％),and significant lower emergency stop time[(23.01±2.77)h vs.(36.61±3.00)h]and length of stay[(8.74±2.68)d vs.(15.52±2.91)d](P＜0.001 all).Compared with patients in the control group,those in the intervention group had significant lower cardiac troponin I(cTnI)[(0.48±0.28)ng/L vs.(1.05±0.57)ng/L],heart rate(HR)[(68.13±1.88)beats/min vs.(84.87±1.59)beats/min],left ventricular end-diastolic diameter(LVEDd)[(40.98±0.58)mm vs.(52.09±0.55)mm]and left atrial volume index(LAVI)[(27.07±0.58)ml/m2 vs.(36.86±0.65)ml/m2],and significant higher left ventricular ejection fraction(LVEF)[(67.93±0.56)％vs.(56.91±0.59)％](P＜0.001all).Compared with patients in the control group,those in the intervention group had significant higher scores of CD-RISC[(98.10±1.61)points vs.(71.33±1.87)points]and CSMS[(131.58±1.76)points vs.(111.82±1.75)points](P＜0.001 all),and significant lower incidence of adverse events(4.0％vs.16.0％,P=0.046).Conclusion:Emergency risk management may improve the rescue quality and en-hance cardiac function,and help to improve the psychological resilience and self-management ability in patients with acute myocardial infarction.

Objective:To investigate the predictive value of color Doppler ultrasound combined with electrocardio-gram for right heart dys function in patients with pulmonary heart disease(PHD).Methods:A total of 100 PHD patients admitted in Dongcheng Branch of First Affiliated Hospital of Anhui Medical University between January 2020 and December 2023 were retrospectively analyzed.According to results of 6min walking test(6MWT),pa-tients were divided into good right heart function group(n=64,≥350m)and right heart dysfunction group(n=36,＜350m).The indexes of cardiac color ultrasound[isovolumic relaxation time(IVRT),isovolumetric contraction time(IVCT)and right ventricular Tei index],ECG[24h mean R-R interval standard deviation(SDNN),normal R-R interval standard deviation per 5min(SDANN)and the ratio of low frequency components to high frequency components(LF/HF)]were compared between two groups.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of color Doppler ultrasound,ECG and their combination for right heart dys-function in PHD patients.Spearman correlation coefficient was used to analyze the association of color Doppler ul-trasound,ECG and their combination with right heart dysfunction in PHD patients.Results:Compared with those in good right heart function group,patients in right heart dysfunction group had significant higher IVRT[(120.64±14.08)ms vs.(97.87±10.93)ms],IVCT[(84.28±12.33)ms vs.(71.92±10.61)ms]and Tei index[(0.85±0.11)vs.(0.63±0.07)](P＜0.001 all),and significant lower SDNN[(75.52±12.58)ms vs.(85.58±11.75)ms],SDANN[(63.86±10.92)ms vs.(76.75±11.71)ms]and LF/HF[(1.33±0.19)vs.(1.84±0.27)](P＜0.001 all).ROC curve indicated that the AUC of color Doppler ultrasound combined ECG in diagnosing right heart dysfunction in PHD patients was 0.911(95％CI 0.838～0.959),which was significantly higher than those of color Doppler ultrasound[0.775(95％CI 0.681～0.853),Z=2.404,P=0.016]and ECG[0.688(95％CI 0.588～0.777),Z=3.968,P=0.001]alone.Spearman correlation analysis indicated that there was a significant positive correlation of color Doppler ultrasound(r=0.547),ECG(r=0.375)and their combination(r=0.810)with right heart dysfunction in PHD patients(P＜0.001 all),and the correlation between combined detection and right heart dysfunction in PHD patients was significantly higher.Conclusion:Color Doppler ultrasound combined with ECG possesses high diagnostic performance for right heart dysfunction in PHD patients.

Objective:To explore the value of dynamic changes in serum creatinine(SCr)and cardiac troponin I(cT-nI)levels in predicting the occurrence of heart failure in emcrgency patients with ST segment elevation myocardial in-farction(STEMI)after interventional treatment.Methods:A total of 186 patients with emergency STEMI admitted to Suzhou Ninth People's Hospital between January 2021 and January 2023 were enrolled and followed up for 1 year to record the incidence of heart failure.Receiver operating characteristic(ROC)curves were plotted to determine the optimal cut-off points of Scr,△SCr(absolute value of SCr on 7d after operation-baseline SCr),cTnI,and △cTnI(absolute value of cTnI on 7d after operation-baseline cTnI),and the value of each indicator in predicting heart failure.Results:After 1-year follow-up,the incidence of heart failure after percutaneous coronary intervention(PCI)was 27.78％(50/180).Compared with patients in no occurrence group,those in occurrence group had significant highcr △SCr[18.45(9.01,34.17)μmol/L vs.2.15(0.76,6.45)μmol/L],△cTnI[1.52(0.72,2.71)μg/L vs.0.56(0.15,1.43)μg/L](P＜0.001 all).ROC curve indicated that the optimal cut-off points of SCr,△SCr,cTnI and △cTnI were 113.235 μmol/L,8.595μmol/L,8.475 μg/L and 0.695μg/L,respectively.Multivariate Logistic regression analysis showed that baseline SCr≥113.235μmol/L,△SCr ≥8.595μmol/L,baseline cTnI ≥8.475 μg/L and △cTnI ≥0.695μg/L were independent risk factors for heart failure after PCI in emergency STEMI patients(OR=3.480～21.035,P＜0.01 all).Pearson correlation analysis indicated that baseline SCr was significantly positive associated with baseline cTnI(r=0.232,P=0.002).Conclu-sion:The dynamic changes of serum SCr and cTnI levels may predict the occurrence of heart failure in STEMI patients af-ter interventional treatment.

Objective:To explore the effect of multiple modified process management intervention on cardiac func-tion,psychological state,stress level,sleep quality and adverse events in patients with severe coronary atherosclerot-ic heart disease(CHD).Methods:This randomized controlled study enrolled 130 severe CHD patients who were treated in Affiliated Beijing Shijitan Hospital of Capital Medical University between January 2020 and May 2023.Patients were randomly divided into control group(n=65)and intervention group(n=65).Patients in the control group were treated with routine management intervention,while those in the intervention group were given addi-tional multiple modified process management interventions.Both groups were intervened for 4 weeks.Cardiac func-tion,levels of norepinephrine(NE)and cortisol(COR),scores of Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),General Comfort Questionnaire(GCQ),Pittsburgh Sleep Quality Index(PSQI),and the incidence of adverse events during intervention were compared between the two groups.Results:Compared to those in control group after intervention,patients in intervention group had significant higher left ventricular ejection fraction(LVEF)[(57.81±2.15)％vs.(50.11±2.99)％]and GCQ score[(95.88±5.37)points vs.(75.81±6.67)points](P＜0.001 all),and significant lower left ventricular end-diastolic volume(LVEDV)[(109.81±5.37)ml vs.(129.26±5.17)ml],left ventricular end-systolic volume(LVESV)[(50.85±3.08)ml vs.(66.02±3.77)ml],levels of NE[(61.56±5.49)pg/ml vs.(69.86±5.03)pg/ml],COR[(85.63±5.19)ng/ml vs.(92.28±6.57)ng/ml],scores of SAS[(30.06±5.19)points vs.(49.51±5.85)points],SDS[(31.86±4.51)points vs.(40.00±5.10)points]and PSQI[(8.72±1.58)points vs.(13.89±2.40)points],and incidence of ad-verse events(4.69％vs.23.44％)(P＜0.01 all).Conclusion:The multiple modified process management interven-tion may improve the cardiac function,adverse psychological state,stress level,sleep quality and reduce the inci-dence of adverse events in patients with severe CHD.

Objective:This systematic review and meta-analysis aims to evaluate the effect of traditional Chinese medicine(TCM)combined with acupuncture on chronic heart failure(CHF).Methods:CNKI,CBM,VIP,Wanfang database,the Cochrane Library,PubMed and Embase databases were searched for randomized controlled trials that com-pare the clinical efficacy between TCM combined acupuncture therapy and routine western medical treatment on CHF from establishment to July 23rd,2024.Results:A total of 14 studies were included in the final analysis.Compared to patients in control group,those in trial group had significant higher total effective rate[OR=3.84,95％CI(2.58,5.72),P＜0.001]and left ventricular ejection fraction[MD=4.69,95％CI(3.74,5.63),P＜0.001],and significant lower left ventricular end-systolic diameter[MD=-3.35,95％CI(-5.24,-1.46),P＜0.001],left ventricular end-diastolic diameter[MD=-3.54,95％CI(-5.08,-2.00),P＜0.001],levels of N terminal pro brain natriuretic peptide[SMD=-1.72,95％CI(-2.28,-1.15),P＜0.001],high sensitive C reactive protein[MD=-6.73,95％CI(-10.16,-3.31),P＜0.001],tumor necrosis factor-α[SMD=-3.77,95％CI(-6.08,-1.45),P=0.001]and interleukin-6[SMD=-1.52,95％CI(-2.21,-0.82),P＜0.001].Conclusion:Traditional Chinese medicine combined with acupuncture may improve the cardiac structure and function,reduce the level of NT-proBNP,and has a certain effect of inhibiting micro-inflammation in patients with chronic heart failure.

Objective:To explore the relationship between the prognostic nutritional index(PNI)and the prevalence of coronary heart disease(CHD)in adults.Methods:A cross-sectional analysis was conducted based on the 2017-2020 National Health and Nutrition Examination Survey(NHANES)database.A total of 12,141 adult participants were initially included and divided into CHD group and control group according to the disease status questionnaire.PNI was calculated using serum albumin level and lymphocyte count.Multivariable logistic regression was applied to explore the association between PNI and the prevalence of CHD in adults.Subgroup analysis was conducted to assess whether this association remained consistent across different populations.A restricted cubic spline model was con-structed to clarify the dose-response relationship between PNI and CHD prevalence in adults.Results:Among the 3,894 adult participants,200(5.14％)had CHD.The PNI level in CHD patients was significantly lower than that of the control group[(49.20±8.59)vs.(51.57±4.80),P＜0.001].Multivariable logistic regression analysis showed that,after adjustment for sex,age,race,marital status,body mass index(BMI),hypertension,diabetes and family history of cardiovascular disease,an increase in PNI was still independently associated with a lower prev-alence of CHD(odds ratio[OR]=0.92,95％CI 0.89～0.94,P＜0.001).The dose-response relationship indica-ted a negative linear correlation between PNI and CHD prevalence(P＜0.001).Subgroup analysis showed that the association between PNI and CHD differed significantly across BMI,hypertension and diabetes subgroups(P for in-teraction＜0.05 or＜0.01).Conclusion:Increasing PNI was significantly associated with a lower prevalence of CHD in adults,and this association was more pronounced in specific high-risk populations,such as those with obe-sity,hypertension,and diabetes.Our findings suggest that maintaining good nutritional status is of great significance in reducing the risk of CHD.

Objective:To investigate the association of serum levels of micro RNA-126(miR-126),C-peptide,secreted phospholipase A2(sPLA2)with carotid atherosclerotic plaque(CAP)and prognosis in patients with coronary heart disease(CHD).Methods:A total of 114 patients with carotid atherosclerotic coronary heart disease(CAS-CHD)admitted to-Baoding Third Central Hospital between February 2020 and February 2021 were enrolled.Patients were divided into stable plaque group(n=68)and unstable plaque group(n=46)according to carotid ultrasound findings.Serum levels of miR-126,C-peptide and sPLA2 were compared between two groups.Pearson correlation analysis was used to determine the as-sociation of miR-126,C-peptide and sPLA2 with plaque Crouse score.Binary Logistic regression analysis was used to in-vestigate the association of miR-126,C-peptide and sPLA2 with unfavorable outcome.The predictive performance of the combined detection of miR-126,C-peptide,and sPLA2 for unfavorable outcome in CAS-CHD patients was evalua-ted using the receiver operating characteristic(ROC)curve analysis.Results:Compared with patients in the stable plaque group,those in the unstable plaque group had significant higher miR-126[(0.99±0.30)vs.(0.81±0.24)],carotid inti-ma-media thickness(IMT)[(1.67±0.42)mm vs.(1.31±0.51)mm]and plaque Crouse score[(5.93±1.42)points vs.(4.30±1.32)points](P＜0.001 all).Pearson correlation analysis indicated that miR-126,C-peptide and sPLA2 were positively correlated with plaque Crouse score(r=0.267,0.309,0.351,P＜0.01 all).Binary Logistic regression a-nalysis showed that age[odds ratio(OR)=1.509,95％CI 1.055～2.157],miR-126(OR=60.595,95％CI 1.252～2932.237),C-peptide(OR=2.870,95％CI 1.249～6.595),sPLA2(OR=1.068,95％CI 1.016～1.124)and plaque Crouse score(OR=4.491,95％CI 1.824～11.059)were independently associated with unfavorable outcome(P＜0.05 or＜0.01).The area under the joint prediction curve(AUC)was 0.898(95％CI 0.825～0.948),which was significantly higher than miR-126(AUC=0.722,95％CI 0.628～0.804),C-peptide(AUC=0.818,95％CI 0.732～0.886)and sPLA2(AUC=0.806,95％CI 0.719～0.876)alone(Z=3.140,3.161,2.930,P＜0.01 all).Conclusion:Serum miR-126,C-peptide and sPLA2 levels were significantly correlated with the severity of carotid atherosclerosis in coronary heart disease.Combined detection of these three biomarkers may predict unfavorable outcome in these patients.

Objective:To investigate the clinical efficacy of levocarnitine combined with fructose 1,6-diphosphate(FDP)on patients with viral myocarditis(VMC)and its effect on serum levels of aspartate aminotransferase(AST),lactate dehydrogenase(LDH)and cardiac troponin I(cTnI).Methods:This randomized controlled study enrolled 126 patients with VMC admitted to Xingyuan Hospital of Yulin between May 2020 and August 2021.Pa-tients were divided into control group(n=63)and intervention group(n=63).Patients in the control group re-ceived routine treatment comparing to those in the intervention group receiving additional FDP combined with levoc-arnitine,both groups were treated for 4 weeks.Left ventricular ejection fraction(LVEF),levels of AST,LDH,cTnI,creatine kinase(CK),creatine kinase isoenzyme MB(CK-MB)and therapeutic effective rate were com-pared between the two groups.Pearson correlation analysis was used to analyze the association of AST,LDH,cTnI levels with LVEF.Results:Compared with patients in control group after 4-week treatment,those in the inter-vention group had significant higher LVEF[(73.17±6.39)％vs.(63.30±6.04)％]and therapeutic effective rate(96.67％vs.80.00％)(P＜0.001 all),and significant lower levels of AST[(32.35±7.34)U/L vs.(48.22±8.40)U/L],LDH[(154.50±28.10)U/Lvs.(183.77±29.60)U/L],cTnI[(77.47±12.04)ng/ml vs.(96.12±15.33)ng/ml],CK[(181.47±8.93)U/L vs.(192.33±8.85)U/L],CK-MB[(24.25±2.19)U/L vs.(28.17±2.01)U/L](P＜0.001 all).Pearson correlation analysis indicated that AST,LDH and cTnI levels were significant negatively correlated with LVEF(r=-0.404,-0.231,-0.339,P＜0.05 or＜0.01).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.543).Conclusion:FDP combined with levocarnitine could significantly improve cardiac function,reduce the levels of AST,LDH and cTnI,and effectively improve therapeutic effective rate with good safety in patients with viral myocarditis.