Objective::Oral anticoagulation is recommended for stroke prophylaxis in patients with non-valvular atrial fibrillation. Novel oral anticoagulants (NOACs) elicit better renal outcomes than warfarin. However, the differences among individual NOACs remain unclear. In this study, 3 commercially available NOACs—dabigatran, rivaroxaban, and apixaban were compared in terms of renal outcomes.Methods::By December 31, 2017, a search of a database of the New Territories West Cluster of the Hospital Authority of Hong Kong, China identified patients with non-valvular atrial fibrillation taking 1 of the 3 NOACs. Three cohorts (rivaroxaban vs. dabigatran, apixaban vs. dabigatran, and apixaban vs. rivaroxaban) were set up for comparison, and inverse probability of treatment weighting was used to balance the baseline characteristics. Patients were tracked until drug discontinuation or June 30, 2019 (study end date), whichever came first. The primary endpoint included a combination of a greater than 30% decline in the estimated glomerular filtration rate, acute kidney injury, doubling of serum creatinine, and renal failure. The Cox proportional hazards regression model was used for survival analysis. Results::A total of 1,153 patients were included in the analyses. Rivaroxaban was associated with a higher incidence of the primary endpoint compared to dabigatran (hazard ratio: 1.43, 95% confidence interval: 1.20-1.70, P < 0.001). Apixaban was associated with a lower risk compared to rivaroxaban in the analysis of the subgroup of patients with an estimated glomerular filtration rate ≥ 60 mL/(min·1.73 m 2) (hazard ratio: 0.62, 95% confidence interval: 0.31-0.94, P = 0.010). No significant differences were observed between dabigatran and apixaban. Conclusions::Rivaroxaban was associated with worse renal outcomes compared to dabigatran in the main cohort and compared to apixaban in the subgroup analysis. Variations in renal outcomes exist among the NOACs.

Objective::There is limited evidence regarding the choice of P2Y 12 receptor inhibitors as a component of dual antiplatelet therapy in patients with left main (LM) disease undergoing percutaneous coronary intervention (PCI). This study aimed to evaluate long-term clinical outcomes of ticagrelor- vs. clopidogrel-based dual antiplatelet therapy strategy in acute coronary syndrome (ACS) patients undergoing LM PCI. Methods::This is a post-hoc analysis from a prospective, single-center, real-world PCI registry. A total of 1,163 patients discharged post-ACS who underwent LM PCI and received ticagrelor or clopidogrel between March 2016 and March 2019 were included in the study. The primary endpoint was ischemic events at 12 months, including cardiac death, myocardial infarction, or stroke. Secondary outcomes included all-cause death and Bleeding Academic Research Consortium types 2, 3, and 5, and types 3 and 5 bleeding. Propensity score matching was used to adjust for bias due to confounders between the 2 groups.Results::The ticagrelor and clopidogrel groups comprised 529 (45.49%) and 634 (54.51%) patients, respectively. During the follow-up period, the rate of ischemic events was significantly lower with ticagrelor than with clopidogrel before (1.32% (7/529) vs. 3.63% (23/634), P = 0.013,6) and after propensity score matching (1.41% (6/425) vs. 4.00% (17/425), P = 0.020,1). The rates of all-cause death, Bleeding Academic Research Consortium-defined type 2, 3, and 5 bleeding, and type 3 and 5 bleeding were similar between the ticagrelor group and clopidogrel group before or after propensity score matching adjustment (all P > 0.05). Conclusion::Among patients with ACS undergoing LM PCI, ticagrelor use was associated with ischemic events benefit without excessive risk of bleeding at 12 months compared with clopidogrel.

In recent years, there have been significant improvements in the management of acute aortic dissection, including screening, diagnosis, and surgical options. However, acute aortic dissection represents a serious cardiovascular disease associated with a high risk of early mortality and significant morbidity in those who emerge from the emergency phase. Considerable progress has been made in the last decade in improving our understanding of the pathophysiology of this disorder. The current classifications of acute aortic dissection have faced challenges. There is a growing scientific consensus in favor of a classification that integrates existing features based on both morphological and functional criteria. The location and size of the initial tear in the innermost layer of the aorta determine the main cause of the aortic dissection. This tear causes the middle layer of the aortic wall to rupture and affects the size of the effected area. It is crucial to determine the necessary course of action for the patient, which may involve emergency surgery, endovascular intervention, or the most appropriate conservative care. The management and monitoring of acute aortic dissection is a constantly evolving field of research. This review provides an overview of preventing, recognizing, and treating life-threatening acute aortic dissections.

Objective::Elderly individuals are at high risk for stroke. With China transitioning into an aging society, it is essential to implement measures to prevent stroke in the middle-aged and elderly. This study aimed to investigate the prevalence and associated factors of stroke in middle-aged and older Chinese individuals using national survey data from the China Health and Retirement Longitudinal Study.Methods::This cross-sectional study used data from the 2015 China Health and Retirement Longitudinal Survey. Participants without complete data on stroke and its associated factors—including demographics, health behaviors, and disease-related factors—were excluded. Independent samples t-test and χ2 test were used to examine differences in associated factors between the stroke and non-stroke groups. Variables with P-values ≤0.1 in all univariate comparisons were included in the final binary logistic regression model to identify the independent factors associated with stroke. Results::A total of 11,969 participants were included in this study. The prevalence of stroke in middle-aged and older individuals in China was 2.170%. The most significant factors associated with stroke included smoking (odds ratio (OR): 1.471, 95% confidence interval (CI): 1.132-1.913), alcohol consumption (OR: 0.548, 95%CI: 0.405-0.743), nap time ≥30 min and < 60 min (OR: 0.502, 95%CI: 0.296-0.851), nap time ≥60 min and <90 min (OR: 0.703, 95%CI: 0.505-0.978), hypertension (OR: 3.310, 95%CI: 2.515-4.357), dyslipidemia (OR: 1.874, 95%CI: 1.446-2.428), and diabetes (OR: 1.424, 95%CI: 1.052-1.927).Conclusion::This study reveals a high prevalence of stroke in middle-aged and older people in China. Several factors, including smoking, alcohol consumption, nap time, hypertension, dyslipidemia, and diabetes, were identified as significant associated factors of stroke prevalence in this population. These findings can inform the development of stroke prevention strategies and health planning for middle-aged and older adults and provide insights for future research.

Objective::This study aimed to assess the impact of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor treatment immediately after percutaneous coronary intervention (PCI) on the myocardial salvage index (MSI) in patients with anterior ST-segment elevation myocardial infarction (STEMI) 5-10 d after the procedure.Methods::The early PCSK9 inhibitor thERapy Following pErcutaneous Coronary inTervention (PERFECT) trial is a prospective randomized controlled trial. From January 2021 to December 2023, 32 patients with anterior STEMI from Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and Shanghai Tenth People’s Hospital were enrolled in the PERFECT trial. Patients were randomly assigned in a 1∶1 ratio to the PCSK9 inhibitor group ( n = 16) or the control group ( n = 16), and their baseline data were collected. Patients in the PCSK9 inhibitor group (ie, alirocumab group) received a subcutaneous injection of PCSK9 inhibitor (alirocumab, 75 mg) immediately after PCI based on conventional treatment. In the control group, patients received only conventional treatment. The primary endpoint was the MSI measured by cardiovascular magnetic resonance 5-10 d after PCI. The secondary endpoints included the left ventricular ejection fraction measured by cardiovascular magnetic resonance 5-10 d after PCI and the time to peak of creatine kinase isoenzyme-MB and high-sensitivity cardiac troponin T. Safety endpoints included any clinical adverse events that occurred during the 6-month follow-up period. Results::Baseline data during admission showed no intergroup significance. No significant difference in MSI (55.54% ± 14.80% vs. 44.72% ± 15.42%, P = 0.056) and left ventricular ejection fraction (51.24% ± 8.91% vs. 44.99% ± 8.84%, P = 0.060) was observed. Additional, there was no significant difference in the time to peak of creatine kinase isoenzyme-MB ((12.97 ± 5.67) h vs. (14.31 ± 7.04) h, P = 0.557) and high-sensitivity cardiac troponin T ((21.03 ± 12.46) h vs. (21.44 ± 9.99) h, P = 0.920) between the 2 groups. During the 6-month follow-up period, only 1 patient in the PCSK9 inhibitor group developed cerebral hemorrhage 6 months after PCI. Conclusions::Early treatment with alirocumab did not exhibit a significant increase in MSI at 5-10 d in patients with anterior STEMI. Larger trials are necessary to evaluate the impact of early administration of PCSK9 inhibitors after myocardial infarction.

Previous studies have reported elevated cardiac troponin T (cTnT) in patients with inclusion body myositis due to skeletal myopathy. Although the trends of cTnT have been reported in some cases, the onset of elevation has barely been reported. In this case, elevated cTnT in a patient diagnosed with inclusion body myositis is discussed. The routine laboratory tests of a 68-year-old male patient showed a positive cTnT test. Eight months later, he developed symptoms of myasthenia gravis. Subsequently, after a series of examinations, the patient was diagnosed with inclusion body myositis. Despite a transient decrease in cTnT levels following intravenous immunoglobulin treatment, the levels rapidly rebounded and continued to rise, suggesting continued progression of skeletal muscle damage in inclusion body myositis. It was concluded that the elevated cTnT was due to re-expression of cTnT in the damaged skeletal muscles of inclusion body myositis. This suggests that dynamic monitoring of cTnT levels in inclusion body myositis patients may predict the progression of myositis and promote timely treatment.

With the increasing use of nirmatrelvir-ritonavir in older COVID-19 patients, adverse drug reactions due to drug-drug interactions have become more frequent. This report describes a patient who experienced severe bradycardia and hypotension following the concurrent use of heart rate-control medications and nirmatrelvir-ritonavir during an active COVID-19 infection. This suggests that clinicians should be cautious when dealing with nirmatrelvir-ritonavir and try their best to avoid serious adverse reactions.

Objective::This study aimed to evaluate the immune cell populations in patients with acute myocardial infarction (AMI).Methods::The keyword "myocardial infarction" was searched in the Gene Expression Omnibus database, and only transcriptomes from peripheral blood studies of patients with AMI within 12 h of symptom onset were included. Patients without myocardial infarction from the same database were included in the control group. The differential analysis of expressed genes, the enrichment of metabolic pathways associated with the significant genes, and the proportions and absolute values of immune cells between 2 groups (AMI and control) were analyzed. To validate the findings, neutrophil and lymphocyte counts were obtained from blood counts and correlated with creatine kinase-MB levels in 22 patients with AMI from Hospital Geral Roberto Santos.Results::Two microarray datasets from the Gene Expression Omnibus database were analyzed, containing a total of 31 eligible blood transcriptome samples. These samples included 14 patients with AMI and 17 non-infarcted patients (control group). Patients with AMI showed significant gene expression differences compared to the control group ( P < 0.05). The enrichment analysis of the significant genes revealed an association with immune cells. The proportions of cell populations in patients with AMI from both datasets revealed an increase in neutrophils and a decrease in T and B lymphocytes, which were statistically significant ( P = 0.018, P = 0.047, respectively). The analysis of absolute cell numbers demonstrated higher neutrophil values and lower T cell values in patients with AMI compared to the control group (all P < 0.05 in GSE61144 and GSE60993 datasets). The data from Hospital Geral Roberto Santos showed that the percentage of neutrophils showed a positive correlation ( r = 0.5, P = 0.018), while the percentage of lymphocytes showed a negative correlation ( r = -0.45, P = 0.034) with creatine kinase-MB levels in patients with AMI. Conclusion::This study suggests that data derived from differential cell counts could serve as an additional parameter to diagnose AMI. Neutrophilia and lymphopenia in AMI should not be used as isolated parameters, but they indicate the need for further investigation, particularly in patients with uncertain diagnoses.

Although percutaneous pulmonary artery denervation (PADN) has demonstrated long-term benefits in combined post- and pre-capillary pulmonary hypertension, its usefulness for isolated post-capillary pulmonary hypertension (IpcPH) remains unclear. This report presents 2 cases of IpcPH due to left heart failure who underwent PADN treatment following an insufficient response to optimized conventional therapy. This case study illustrates how PADN, when combined with heart failure guideline-directed medical therapy, may represent a promising treatment option for IpcPH.

Objective::Pulmonary hypertension secondary to left heart failure is associated with an abnormal response to exercise and poor prognosis. The objective of this study is to develop an algorithm by using data from cardiopulmonary exercise testing (CPET) to assess the severity of pulmonary hemodynamics and predict clinical worsening and mortality in patients with heart failure.Methods::From April 2017 to December 2018, a total of 102 patients with heart failure who underwent CPET and invasive right heart catheterization participated in this prospective study. All enrolled patients had their clinical characteristics, hemodynamic parameters, and CPET results. Based on the CPET data namely peak oxygen uptake, the minute ventilation/carbon dioxide production slope, resting end-tidal carbon dioxide, oxygen uptake/work rate flattening, exercise oscillatory ventilation, and oxygen uptake efficiency slope, a Heart Failure Cardiopulmonary Exercise (HFCE) score was developed. The total score was then calculated to categorize patients into 3 groups: low score (0-3) ( n = 31), intermediate score (4-7) ( n = 45), and high score (8-14) ( n = 26). Clinical events were defined as all-cause death and rehospitalization for heart failure, which were recorded and tracked for at least 12 months. Pearson’s correlation coefficients were calculated to assess the relationship between the HFCE score and hemodynamic parameters, 6-minute walk distance, and N-terminal-pro hormone brain natriuretic peptide. Cox proportional hazards regression analysis was used to identify independent predictors of clinical events. Survival curves for clinical events were generated using the Kaplan-Meier method and compared among the 3 groups with different HFCE scores with a log-rank test. Results::The high HFCE score group had a higher prevalence of New York Heart Association class Ⅲ-Ⅳ (high score vs. intermediate score vs. low score: 85% (22/26) vs. 56% (25/45) vs. 45% (14/31), P = 0.008), higher N-terminal-pro hormone brain natriuretic peptide levels (high score vs. intermediate score vs. low score: (3,039 ± 2,171) ng/L vs. (2,039 ± 2,353) ng/L vs. (1,438 ± 947) ng/L, P = 0.035), lower 6-minute walk distance (high score vs. intermediate score vs. low score: (312 ± 79) m vs. (362 ± 84) m vs. (363 ± 76) m, P = 0.042) compared to intermediate score or low score. The high HFCE score correlated well with high levels of pulmonary vascular resistance ( r = 0.539, P < 0.01), pulmonary artery wedge pressure ( r = 0.292, P < 0.01), and mean pulmonary artery pressure ( r = 0.474, P < 0.01), as well as low levels of cardiac output ( r = -0.357, P < 0.01). Moreover, 46 patients developed composed clinical events at 12 months. In the multivariate model, the HFCE score was an independent predictor of composed clinical events (hazard ratio = 1.142, 95% confidence interval: 1.041-1.253, P = 0.005). Kaplan-Meier analysis showed a significantly higher probability of composed clinical events in patients with a higher HFCE score ( P log-rank = 0.004). Conclusion::The HFCE score—obtained through CPET—provides valuable prognostic information by indicating the severity of hemodynamics in patients with pulmonary hypertension secondary to left heart failure. It can likely serve as a reliable predictor for clinical worsening and mortality.