Objective To explore the relationship between CT quantitative left heart structure parameters and recurrence after hypertrophic cardiomyopathy(HCM)and atrial fibrillation(AF)radiofrequency ablation(RFCA).Methods A total of 120 patients with HCM and AF admitted to our hospital from April 2021 to June 2023 were selected.Patients were divided into the relapse group and the non-recurrence group according to whether RFCA recurred 6 months after operation.All patients underwent CT examination,and left ventricular ejection fraction(LVEF),left atrial ejection fraction(LAEF),left atrial volume index(LAVI)and left atrial auricular volume of the two groups were analyzed.The clinical data of patients were collected.Logistic regression model was used to analyze the influencing factors of postoperative recurrence of RFCA in HCM patients with AF.Receiver operating characteristic curve(ROC)curve was used to analyze the predictive efficacy of left heart structure parameters for postoperative recurrence of RFCA in HCM patients with AF.Results The volume levels of LAVI and left auricle were higher in the relapsed group than those in the non-relapsed group,and the level of LAEF was lower than those in the non-relapsed group(P＜0.05).Logistic regression analysis showed that persistent atrial fibrillation,LAVI and high left atrial appendage volume were independent risk factors for postoperative recurrence in HCM patients with AF(P＜0.05),and high LAEF was protective factor(P＜0.05).The results of ROC curve analysis showed that the AUC value of LAVI,LAEF and left atrial appendage volume in predicting recurrence after RFCA in patients with HCM and AF was 0.902,which was higher than that of 0.789,0.755 and 0.675 of each individual test.The combined prediction efficiency of the three tests was higher than that of each single test(Z=2.177,2.555 and 3.628,P＜0.05).Conclusion High level of LAVI and left atrial appendage volume and low level of LAEF are risk factors for postoperative recurrence of RFCA.The combined detection of the three methods has high predictive value for postoperative recurrence of RFCA in HCM patients with AF.

Objective To investigate the correlation between serum TNF super family 15(TNFSF15),growth differentiation factor 11(GDF11)and in-stent restenosis(ISR)in patients with unstable angina pectoris(UAP)undergoing percutaneous coronary intervention(PCI).Methods A total of 350 UAP patients who underwent PCI treatment in the Second Hospital of Qinhuangdao from January 1,2020 to January 1,2021 were collected as observation subjects,and they were separated into non-ISR group(n=246)and ISR group(n=104)based on whether they had experienced ISR.ELISA was applied to determine the levels of serum TNFSF15 and GDF11,ROC curve was applied to analyze the predictive value of serum TNFSF15 and GDF11 levels for postoperative ISR in UAP patients after PCI,and multivariate Logistic regression was used to analyze the factors affecting the occurrence of ISR in UAP patients after PCI.Results Compared with the non-ISR group,the ISR group showed an increase in blood glucose,smoking history and LDL-C levels(t/χ2=22.908,18.869,47.337),as well as elevated serum TNFSF15 levels(16.97±1.51 pg/ml vs 18.35±1.62pg/ml)and GDF11 levels(157.72±16.13pg/ml vs 174.11±18.65 pg/ml)decreased(t=7.429,7.811),and the differences were statistically significant(all P<0.001).The AUC(95%CI)of serum TNFSF15 and GDF11 in dependently and jointly predicting ISR after PCI in UAP patients were 0.764(0.716～0.808),0.781(0.734～0.823)and 0.849(0.807～0.885),respectively,and the joint prediction of the two was higher than the individual prediction(Z=4.365,3.257,all P<0.001).Multivariate Logistic regression analysis of serum TNFSF15,the level of GDF11 was a protective factor for ISR in UAP patients after PCI(Wald χ2=11.000,36.321,all P<0.05).Conclusion The serum levels of TNFSF15 and GDF11 decreased in UAP patients with postoperative ISR after PCI,which have good predictive value for the occurrence of ISR in UAP patients after PCI.

Objective To explore the relationship between CT quantitative left heart structure parameters and recurrence after hypertrophic cardiomyopathy(HCM)and atrial fibrillation(AF)radiofrequency ablation(RFCA).Methods A total of 120 patients with HCM and AF admitted to our hospital from April 2021 to June 2023 were selected.Patients were divided into the relapse group and the non-recurrence group according to whether RFCA recurred 6 months after operation.All patients underwent CT examination,and left ventricular ejection fraction(LVEF),left atrial ejection fraction(LAEF),left atrial volume index(LAVI)and left atrial auricular volume of the two groups were analyzed.The clinical data of patients were collected.Logistic regression model was used to analyze the influencing factors of postoperative recurrence of RFCA in HCM patients with AF.Receiver operating characteristic curve(ROC)curve was used to analyze the predictive efficacy of left heart structure parameters for postoperative recurrence of RFCA in HCM patients with AF.Results The volume levels of LAVI and left auricle were higher in the relapsed group than those in the non-relapsed group,and the level of LAEF was lower than those in the non-relapsed group(P＜0.05).Logistic regression analysis showed that persistent atrial fibrillation,LAVI and high left atrial appendage volume were independent risk factors for postoperative recurrence in HCM patients with AF(P＜0.05),and high LAEF was protective factor(P＜0.05).The results of ROC curve analysis showed that the AUC value of LAVI,LAEF and left atrial appendage volume in predicting recurrence after RFCA in patients with HCM and AF was 0.902,which was higher than that of 0.789,0.755 and 0.675 of each individual test.The combined prediction efficiency of the three tests was higher than that of each single test(Z=2.177,2.555 and 3.628,P＜0.05).Conclusion High level of LAVI and left atrial appendage volume and low level of LAEF are risk factors for postoperative recurrence of RFCA.The combined detection of the three methods has high predictive value for postoperative recurrence of RFCA in HCM patients with AF.

Objective To investigate the correlation between serum TNF super family 15(TNFSF15),growth differentiation factor 11(GDF11)and in-stent restenosis(ISR)in patients with unstable angina pectoris(UAP)undergoing percutaneous coronary intervention(PCI).Methods A total of 350 UAP patients who underwent PCI treatment in the Second Hospital of Qinhuangdao from January 1,2020 to January 1,2021 were collected as observation subjects,and they were separated into non-ISR group(n=246)and ISR group(n=104)based on whether they had experienced ISR.ELISA was applied to determine the levels of serum TNFSF15 and GDF11,ROC curve was applied to analyze the predictive value of serum TNFSF15 and GDF11 levels for postoperative ISR in UAP patients after PCI,and multivariate Logistic regression was used to analyze the factors affecting the occurrence of ISR in UAP patients after PCI.Results Compared with the non-ISR group,the ISR group showed an increase in blood glucose,smoking history and LDL-C levels(t/χ2=22.908,18.869,47.337),as well as elevated serum TNFSF15 levels(16.97±1.51 pg/ml vs 18.35±1.62pg/ml)and GDF11 levels(157.72±16.13pg/ml vs 174.11±18.65 pg/ml)decreased(t=7.429,7.811),and the differences were statistically significant(all P<0.001).The AUC(95%CI)of serum TNFSF15 and GDF11 in dependently and jointly predicting ISR after PCI in UAP patients were 0.764(0.716～0.808),0.781(0.734～0.823)and 0.849(0.807～0.885),respectively,and the joint prediction of the two was higher than the individual prediction(Z=4.365,3.257,all P<0.001).Multivariate Logistic regression analysis of serum TNFSF15,the level of GDF11 was a protective factor for ISR in UAP patients after PCI(Wald χ2=11.000,36.321,all P<0.05).Conclusion The serum levels of TNFSF15 and GDF11 decreased in UAP patients with postoperative ISR after PCI,which have good predictive value for the occurrence of ISR in UAP patients after PCI.

Objective:To investigate the effects of preoperative ticagrelor application on postoperative NF-κB signa-ling pathway,platelet aggregation and myocardial microcirculatory perfusion in patients with acute myocardial in-farction(AMI)and multivessel lesions undergoing percutaneous coronary intervention(PCI).Methods:A total of 120 AMI patients with multivessel lesions treated in our hospital were selected,randomly and equally divided into clopidogrel group and ticagrelor group.Corresponding drugs were given in each group before and after PCI.NF-κB signaling pathway related indexes,platelet aggregation rate,myocardial microcirculatory indexes before and af-ter medication,and incidence of major adverse cardio-and cerebrovascular events(MACCE)were observed and compared between two groups.Results:On 7d after PCI,compared with clopidogrel group,there were significant reductions in corrected TIMI frame count(CTFC)of left anterior descending(LAD)[(23.83±2.69)vs.(20.48± 3.05)],left circumflex(LCX)[(20.93±2.82)vs.(18.35±2.37)]and right coronary artery(RCA)[(23.68± 3.15)vs.(21.13±2.79)]in ticagrelor group,P=0.001 all;compared with clopidogrel group after 30d treatment,there were significant reductions in platelet maximum aggregation rate,maximum depression amplitude of ST seg-ment,ST segment depression time,24h ischemia onset times,levels of Toll-like receptor 4(TLR4)protein,NF-κB protein,tumor necrosis factor(TNF)-a and interleukin(IL)-6 in ticagrelor group,P=0.001 all.There was no significant difference in incidence rate of MACE between two group within six months,P=0.186.Conclu-sion:Ticagrelor can improve myocardial microcirculation,inhibit platelet aggregation,and reduce inflammatory re-sponse in AMI patients with multivessel lesions,and the mechanism may be related to the inhibition of NF-κB sig-naling pathway activity by ticagrelor.

Objective To investigate the risk factors for heart failure in patients with coronary atherosclerotic heart disease and to analyze the influence of different blood pressure levels on the risk of heart failure.Methods A total of 826 coronary atherosclerotic heart disease patients admitted to the Department of Cardiovascular Medicine of First Hospital of Qinhuangdao from October 2018 to October 2020 were selected as the research subjects.The patients were divided into the heart failure group(n=27)and the non-heart failure group(n=799)based on whether heart failure occurred.The clinical data of patients in the two groups were collected,and the risk factors for heart failure in patients with coronary atherosclerotic heart disease were analyzed by using the univariate and multivariate logistic regression.According to the history of hypertension,the patients were divided into the hypertension history group(n=522)and the normal blood pressure group(n=304),and according to the blood pressure levels,the patients were further divided into the normal blood pressure group(n=304),grade 1 hypertension group(n=102),grade 2 hypertension group(n=254)and grade 3 hypertension group(n=166).The cumulative incidence of heart failure of patients was compared among all groups,and the impact of hypertension history and blood pressure levels on the occurrence of heart failure in patients with coronary atherosclerotic heart disease was analyzed by using the multivariate Cox proportional hazards regression model.Results Univariate analysis showed that there were statistically significant differences in the proportion of advanced age,history of hypertension,history of smoking,coronary artery disease,hemoglobin level,proportion of left atrial enlargement,and proportion of left ventricular hypertrophy between the heart failure group and the non-heart failure group(P＜0.05);and there was no significant difference in gender,history of hyperlipidemia,body mass index,history of diabetes,albumin level,and serum creatinine level between the two groups(P＞0.05).Multivariate logistic regression analysis showed that the history of hypertension,advanced age,multivessel coronary artery disease(≥2 vessels),and left ventricular hypertrophy were risk factors for heart failure in patients with coronary atherosclerotic heart disease(P＜0.05).The cumulative incidence of heart failure in the hypertension history group and the normal blood pressure group was 3.63％(19/522)and 2.63％(8/304),respectively;and the cumulative incidence of heart failure in the hypertension history group was significantly higher than that in the normal blood pressure group(x2=6.792,P＜0.05).The cumulative incidence of heart failure in the normal blood pressure group,grade 1 hypertension group,grade 2 hypertension group,and grade 3 hypertension group was 2.63％(8/304),2.94％(3/102),3.54％(9/254),and 4.22％(7/166),respectively,showing an increasing trend,and there was a significant difference between each group(P＜0.05).In the Cox proportional hazards model,model 1(unadjusted for confounding factors),model 2(adjusted for age factors),and model 3(adjusted for confounding factors such as the history of hypertension,history of smoking,coronary artery distase,hemoglobin level,left atrial enlargement,and left ventricular hypertrophy on the basis of model 2)all showed that the history of hypertension was the risk factor for heart failure in patients with coronary atherosclerotic heart disease,and the higher the blood pressure level,the higher the risk of developing heart failure(P＜0.05).Conclusion The history of hypertension,advanced age,multi vessel coronary artery disease(≥2 vessels),and left ventricular hypertrophy are risk factors for heart failure in patients with coronary atherosclerotic heart disease,among which the history of hypertension has the greatest influence,and the probability of developing heart failure increases as the blood pressure grade increases.

Objective: To observe the efficacy of ticagrelor for treating elderly acute coronary syndrome (ACS) patients with elective PCI and having low response to clopidogrel; to explore the bleeding risks induced by ticagrelor replacement. Methods: A total of 945 ACS patients ≥ 65 years treated in our hospital from 2014-01 to 2017-01 were enrolled. All patients received aspirin and clopidogrel dual antiplatelet therapy (DAPT), thrombelastography (TEG) was used to detect platelet inhibition rate when DAPT ≥ 5 days. Based on platelet inhibition rate, the patients were divided into 2 groups:Ticagrelor replacement group, n=293 patients with low response to clopidogrel and switched to ticagrelor treatment, when adjusted DAPT ≥ 5 days, platelet inhibition rate was rechecked to compare the changes; Clopidogrel group, the patients were continuously treated by the same medication, n=652. The patients were followed-up for 3 months, bleeding events were evaluated by TIMI criteria and compared between 2 groups. Risk factors of ticagrelor induced bleeding were assessed by multivariate Logistic regression analysis. Results: Platelet inhibition rates in Ticagrelor replacement group were (51.70±42.90) %, (48.99±41.85) % and (55.08±25.70) % at (5-7) d, (8-14) d and (15-90) d ticagrelor treatment, which were higher than previous clopidogrel treatment (14.50±24.15) %, all P<0.05. The incidences of severe bleeding events were similar between 2 groups, P=0.96. Multivariate Logistic regression analysis presented that female (OR=4.329, P=0.000), low body weight (OR=0.817, P=0.039) and elevated fasting blood glucose (OR=1.251, P=0.028) were the independent risk factors for bleeding complication in ticagrelor treated elderly ACS patients. Conclusion: Compared with clopidogrel, ticagrelor may faster and more effectively inhibit platelet aggregation without increasing severe bleeding; female, low body weight and elevated fasting blood glucose were the independent risk factors for bleeding complication in ticagrelor treated elderly ACS patients with elective PCI.

Objective To investigate changes in the number and function of endothelial progenitor cells (EPCs) in elderly patients with permanent atrial fibrillation(AF).Methods This prospective study included 35 elderly patients in each the permanent atrial fibrillation group and the control group.The numbers of circulating CD34+/KDR+ cells in the two groups were determined by flow cytometry.After two sets of peripheral blood samples were taken,mononuclear cells were isolated through density gradient centrifugation and cultured in vitro.EPC colonies were identified by the methylthiazolyldipheny-tetrazolium(MTT) assay and adhesion assay.The proliferation,adhesion and vasculogenesis of EPC colonies were determined by Matrigel culture.Enzyme-linked immunosorbent assay and nitric acid reductase assay were used to measure the secretion of vascular endothelial growth factor (VEGF) and nitric oxide (NO) in EPCs.Results The numbers of CD34+/KDR+ cells were lower in the AF group than in the control group (20.0±12.7)/104 vs.(77.9±58.9)/104 (P＜0.05).The number of EPC colonies in the atrial fibrillation group was significantly lower than that in the control group (1.8 ± 0.6) CFU vs.(3.5 ± 0.8) CFU (P ＜ 0.01).The proliferation,adhesion and vasculogenesis of EPC colonies in the AF group decreased,compared with the control group (each P＜0.01 or 0.05).Paracrine secretion of VEGF in the AF group (27.4±9.9)ng/L was lower than that in the control group (41.9±7.3)ng/L (P＜0.01) and paracrine production of NO in the AF group also decreased (P＜0.05).Conclusions EPCs In elderly patients with permanent atrial fibrillation show decreased numbers and reduced proliferation,adhesion and vasculogenesis.Paracrine VEGF and NO secretion is down as well.

Objective To investingate the possible predictory of radial artery occlusion(RAO) after transradial approach and its preventive measures.Methods We prospectively assessed the occurrence of RAO in 669 consecutive patients undergoing transradial approach and 63 patients were excluded from the final study (24of them did not meet the inclusion criterium,31 patients converted to other artery approaches,6 patients lost clinical follow-up and 2 patients died).Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention.The risk factors of RAO including sex,body mass index (BMI),smoking,hypertension,diabetes,dyslipidemia,puncture site,vessel spasm,and artery diameter/ sheath ratio were evaluated using a multivariate model analysis.Results Among the 606 patients,RAO occurred in 56 patients.There were no differences in sex,age,BMI,coronary lesions,rates of vessel spasm,vessel length,medication given and operation time between the 2 group of patients with vs without ROA (all P＞0.05).Univariate logistic analysis showed puncture site at 0 cm away from radial styloid and artery diameter/sheath ratio ≤ 1 were possible risk factory and puncture site ＞ 4 cm from radial styloid was possible protective factor.Further multivariate analysis showed the odds ratio (OR) for occlusion risk at 0 cm and 1 cm were 9.65 (P=0.033) and 8.90 (P=0.040),respectively.The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤ 1 (OR=2.45,P=0.004).Conclusions Distal puncture sites (0-1 cm away from the radius styloid process) can lead to a higher rate of RAO.