Cardiomyopathy is a group of myocardial disorders that are clinically common and characterized by complex etiologies,heterogeneous clinical manifestations,adverse prognoses and strong associations with genetics.In recent years,significant advances and breakthroughs have been achieved in its definition,classification,precise diagnosis,and individualized treatment.This guideline integrates the latest evidence,systematically elucidates the definition,classification,etiologies and pathogenesis of various types of cardiomyopathy,and offers recommendations for diagnosis,treatment and management,with the aim to improve the clinical practice level of cardiomyopathy in China.

Objectives:This study aims to investigate the incidence,characteristics and clinical outcomes of vagal response(VR)during pulmonary vein isolation(PVI).Methods:A total of 702 patients with nonvalvular atrial fibrillation(AF)who received the first PVI radiofrequency ablation in Central China Fuwai Hospital from January 2022 to December 2023 were consecutively enrolled.PVI was initiated from right superior pulmonary vein(RSPV),followed by other pulmonary veins(PVs).The VR was defined as atrioventricular block(AVB),asystole or a 50%increase in the RR interval.Results:Among 702 patients with AF,380 patients(54.1%)were paroxysmal AF and 322 patients(45.9%)were persistent AF.77 patients(11.0%)developed 81 VR episodes,which were more common in paroxysmal group than in persistent AF group(19.5%vs.0.9%,P<0.001).VR manifestations included 51 sinus arrest(63.0%),26 sinus bradycardia(32.1%),and 4 atrioventricular block(AVB,4.9%).Most VR episodes were observed in the left superior ganglionated plexi(67[82.7%]).Paroxysmal AF(OR=18.667,95%CI:6.638-52.491,P<0.001),body mass index(BMI)≥28.0 kg/m2(OR=2.361,95%CI:1.376-4.051,P=0.002)and left ventricular ejection fraction(LVEF)≥62.0%(OR=1.964,95%CI:1.119-3.447,P=0.019)were independent risk factors of VR.During a mean of(13.0±7.1)months follow up,among paroxysmal AF patients,6 patients(8.1%)with VR and 33 patients(10.8%)without VR experienced AF recurrence(P=0.496).Kaplan-Meier curves estimated that the AF-free survival rate was similar between VR group and non-VR group among paroxysmal AF patients(log-rank P=0.735).Conclusions:The most common sites of VR when initiating PVI from right RSPV occur in left superior ganglionated plexi.Paroxysmal AF,BMI≥28.0 kg/m2 and LVEF≥62.0%are independent risk factors of VR.VR does not affect AF-free survival.

Several famous evidence-based clinical trials failed to demonstrate that tight glycaemic control of type 2 diabetes could reduce the risk of macrovascular complications of diabetes.This casts doubt on whether"glucose-lowering therapy remains as a central task in the management of cardiovascular complications in type 2 diabetes".Data from 40-year follow-up of the UK Prospective Diabetes Study(UKPDS)and 30-year follow-up of Da Qing Diabetes Prevention Study showed that cardiovascular diseases complication benefit from the'legacy effect'of early intensive glycaemic control persisted for many years after completion of the initial intervention trial.It reminds us of that early interruption of the'glycation-oxidation-arteriosclerosis'cardiovascular continuum remains an important strategy in the prevention and treatment of cardiovascular disease in type 2 diabetes.

Objectives:To investigate the predictive value of epicardial fat volume(EFV)and atrioventricular groove fat thickness(AVGT)—morphological biomarkers of epicardial adipose tissue—for major adverse cardiovascular events(MACE)in patients with dilated cardiomyopathy(DCM).Methods:This study enrolled 216 DCM patients.EFV and AVGT were obtained from cardiac magnetic resonance imaging(CMR).Patients were divided into event-free group(n=142)and event group(n=74)based on MACE occurrence during follow-up.Receiver operating characteristic(ROC)curve analysis was used to determine optimal cutoff values.Survival differences were assessed using Kaplan-Meier analysis,Cox proportional hazards regression analysis was used to identify independent risk factors,and restricted cubic spline(RCS)models were used to evaluate dose-response relationships.Results:AVGT and EFV were significantly higher in the event group than in event-free group(both P<0.05).ROC analysis identified optimal MACE-predicting cutoffs as follows:AVGT≥7.74 mm(area under the curve[AUC]=0.57)and EFV≥78.6 ml(AUC=0.62).Kaplan-Meier analysis revealed significantly lower MACE-free survival rates in patients with AVGT≥7.74 mm and EFV≥78.6 ml(both P<0.05).Cox regression analysis confirmed that AVGT(HR=2.18,95%CI:1.34-3.54)and EFV(HR=1.81,95%CI:1.11-2.96)were independent MACE risk factors(both P<0.05)in this patient cohort.RCS models demonstrated the significant linear associations between EFV/AVGT and MACE risk(bothoverall P<0.05).Conclusions:EFV and AVGT,the non-invasive imaging biomarkers quantifying and characterizing fat distribution,are independently correlated with elevated MACE risk in DCM patients.These metrics serve as potential prognostic indicators,enriching risk stratification indicators for early identification of high-risk patients and guiding personalized medication strategies.

Objectives:To investigate the safety and efficacy of Cuffstent in the treatment of immediate type Ia endoleak during endovascular aneurysm repair(EVAR)of abdominal aortic aneurysm.Methods:The clinical data of 24 patients with immediate type Ia endoleak during EVAR treated with Cuffstent at the Second Xiangya Hospital of Central South University from January 2019 to December 2022 were retrospectively analyzed.There were 18 males and 6 females with a mean age of(70.3±7.1)years.Results:Of the 24 patients,22 underwent conventional proximal Cuffstent implantation,and 2 underwent fenestrated Cuffstent to preserve unilateral renal artery.Emergency EVAR was performed in 7 patients.The procedure was technically successful in all patients.Immediate disappearance of type Ia endoleak was achieved in 23 patients,whereas 1 patient exhibited mild persistent type Ia endoleak,which was managed conservatively with watchful follow-up.All the 24 patients finished an average of(39.0±15.1)months follow-up,and all patients were alive during the follow-up period.Two patients received aortic reintervention,and one patient received thoracic aortic stent graft implantation due to thoracic aortic penetrating ulcer,and one patient received abdominal aortic aneurysm resection and iliac artery stent implantation due to type II endoleak and iliac artery rupture,respectively.There were no other aorta-related complications and reintervention.Conclusions:Proximal addition of Cuffstent for the management of immediate type Ia endoleak during EVAR is safe and effective.

Objectives:We evaluated the clinical significance of unipolar electrogram and bipolar electrogram in guiding radiofrequency ablation for outflow tract ventricular premature contractions(PVC).Methods:Data were collected from 78 patients who underwent successful radiofrequency ablation of PVC.Pre-procedure electrocardiogram showed a LBBB morphology on inferior leads.In the included patients,the right-side ablation was performed at first,and if the ablation failed,the left-side ablation was then performed.According to the location of the successful ablation target,they were divided into unilateral ablation successful group and bilateral ablation successful group.The differences in the earliest bipolar local activation to QRS(LATBi),unipolar-dV/dTmax to QRS(LATUni),and local activation time were compared between the two groups.Furthermore,the electrogram characteristics predicting bilateral ablation were explored.Results:Patients were divided into unilateral ablation group(n=57)and bilateral ablation group(n=21)according to the ablation site.There were statistically significant differences in LATBi(25[21,30]ms vs.14[10,24]ms),LATUni(7[0,17]ms vs.-23[-41,-11]ms),and ΔLATBi-Uni(15[11,25]ms vs.44[25,56]ms)between the unilateral ablation group and the bilateral ablation group(all P<0.05).Multivariate regression analysis suggested that LATBi,LATUni,and ΔLATBi-Uni were independent predictors of the need for bilateral ablation.There was no significant difference between left and right LATBi,LATUni and ΔLATBi-Uni in the bilateral ablation group.LATUni≤-1 was the most accurate parameter for predicting the need for bilateral ablation(AUC=0.941;specificity 80.7%;sensitivity 100%).Conclusions:LATUni≤-1ms is a useful indicator for predicting the need for bilateral PVC ablation in this patient cohort.

Objectives:This study aims to establish a calcified aortic valve disease(CAVD)-related gene regulatory network,and clarify the impact of interactions between CAVD-related genes on CAVD.Methods:Differential expression gene method was used to screen candidate genes,and STRING software was used to construct protein-protein interaction networks for screened genes.The networks and genes with the highest scores were obtained.Monte Carlo method was used to rank the importance of genes in CAVD,and the top 1%genes were identified.Genes identified by these two methods are intersected to obtain the key genes.The correlation between the key genes and CAVD were confirmed by biological verification method.Then,key genes were used as query genes to establish CAVD gene regulatory module with a co-expression patterns-based gene regulatory network identifying method.Specifically,we first detected the underlying co-expression patterns of the seemingly uncorrelated genes,and then pieced the isolated gene pairs up into gene regulatory network with the help of the bridging genes.Finally,we verified the function of the established gene regulatory network through enrichment analysis and literature analysis.Results:We identified the CAVD gene regulatory network containing 211 genes from 18 084 candidate genes.Functional enrichment analysis indicate that the established gene regulatory network included genes with both known interactions and potential novel pathway interactions related to CAVD,serving as candidates for further experimental CAVD studies.Conclusions:Methodologically,the proposed method avoids the problem of complex computation,and relies only on available biological priors.It is also able to detect underlying co-expression patterns.The results will advance the understanding of the interactions of the CAVD-related genes and this method provides a novel way to identify underlying gene co-expression patterns in the setting of CAVD.

Objectives:To evaluate the hemodynamic impact of different bypass grafting methods on the left anterior descending(LAD)artery using computational fluid dynamics,providing a theoretical basis for optimizing coronary artery bypass grafting.Methods:A patient-specific 3D coronary model was constructed using SimVascular software,including an in-situ internal mammary artery graft(model 1)and three free grafts of varying diameters(model 2:2 mm internal mammary artery free graft;model 3 and model 4:3 mm and 4 mm great saphenous vein free grafts).The hemodynamic parameters of the native artery and grafts were compared among the four bypass grafting models.Results:All four bypass grafting models supply sufficient blood flow for the severely stenosed LAD.LAD flow was slightly lower in the model 1.Free internal mammary artery grafts showed higher flow and wall shear stress.4 mm great saphenous vein free grafts presented with maximum flow but lowest shear stress,3 mm great saphenous vein free grafts offered better hemodynamic stability.Conclusions:Computational fluid dynamics analysis indicates that free internal mammary grafts could provide superior hemodynamics,while larger grafts result in lower shear stress,which might affect long-term graft patency.These findings thus provide experimental evidences useful for optimizing LAD bypass strategies.

Objectives:To explore the trends of cardiovascular disease(CVD)burden in China from 1990 to 2021 and to provide a basis for the scientific development of corresponding preventive and curative measures.Methods:Based on the Global Burden of Disease(GBD)2021 database,we conducted descriptive analyses of age-standardized incidence rate(ASIR),age-standardized prevalence rate(ASPR),disability-adjusted life years(DALY)and other indicators of CVD in China.Indicators were descriptively analysed,trends in CVD burden were analysed using the Joinpoint regression model,the burden of CVD was decomposed according to demographic,ageing and epidemiological changes,and changes in the burden of CVD in 2040 were predicted using the Bayesian age-period-cohort(BAPC)model.Results:In 2021,the ASIR,ASPR,DALY and DALY rates of CVD in China were 811.81 per 100 000,6 603.72 per 100 000,100.2087 million person-years and 5 120.06 per 100 000,respectively.Compared to 1990,the ASIR,ASPR,and DALYs increased by 3.56%,9.62%,and 58.42%,respectively,while the DALYs rate decreased by 36.59%.Additionally,the burden of CVD was higher in males than in females;the ASIR increased rapidly for the first time in 1995-2005,the ASPR increased rapidly from 2000 to 2004,and the DALYs rate increased rapidly from 2000 to 2004,and DALYs rates were generally on a downward trend,but showed a rapid upward trend in 1998-2004.Population growth and aging are the main factors leading to changes in DALYs,43.73%and 172.31%,respectively;in 2021,hypertension and environmental particulate matter are the top two risk factors for CVD in China;projections show that the number of CVD incidence,disease,and cases of DALYs in China in 2040 will be 28.7901 million,226.6148 million,and 169.4057 million person-years,respectively,and the number of cases is on the upward trend.Conclusions:The burden of CVD in China increased overall from 1990 to 2021,and the burden was higher in men than in women,mainly due to population growth,aging,and risk factors.High systolic blood pressure remains the main cause of CVD.

Objectives:This study aims to explore the causal relationships between immune cells and serum metabolites in the development of coronary heart disease(CHD)using Mendelian randomization(MR)methods.Methods:We conducted a two-sample MR analysis utilizing data from the FinnGen Project's genome-wide association study(GWAS)on CHD,alongside data on metabolites and immune cells from the GWAS catalog.For the identified associated metabolites,we further employed mediation MR methods to evaluate their mediating roles in the influence of immune cells on CHD.Results:The MR analysis indicated that three immune cells(IgD-CD24-%B cell,CD11b on CD14+monocyte,HLA DR on DC)had stable causal relationship with CHD(under the premise of inverse variance weighted[IVW]method P<0.05,both MR-Egger and weighted median methods also showed P<0.05).Furthermore,these immune cells were associated with CHD through four metabolites(N-acetylneuraminic acid levels,the ratio of desmethyltaurine to taurine,X-24801 and X-18779).Conclusions:This study reveals the causal relationships between immune cells and serum metabolites in the pathogenesis of CHD,providing new biomarkers for early prediction and risk assessment of CHD.