1.Mechanisms of Renshentang in Treating AS via Regulation of Endothelial Cell Inflammation Based on TRPV1
Ce CHU ; Yulu YUAN ; Zhen YANG ; Xuguang TAO ; Xiangyun CHEN ; Zhanzhan HE ; Yuxin ZHANG ; Yongqi XU ; Wanping CHEN ; Peizhang ZHAO ; Wenlai WANG ; Hongxia ZHAO
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(6):46-53
ObjectiveTo investigate the mechanisms by which Renshentang treats atherosclerosis (AS) in mice, focusing on the regulation of endothelial inflammatory responses mediated by transient receptor potential vanilloid subtype 1 (TRPV1). MethodsAn AS model was established in apolipoprotein E knockout (ApoE-/-) mice fed a high-fat diet. The mice were randomly divided into a simvastatin group (0.02 g·kg-1·d-1) and low-, medium-, and high-dose Renshentang groups (1.77, 3.54, 7.08 g·kg-1·d-1), with 12 mice in each group. ApoE-/- mice were fed a high-fat diet and treated simultaneously. C57BL/6J mice fed a normal diet served as the normal group (n=9). After continuous administration for 12 weeks, mice were anesthetized and the aortas were collected. Oil Red O staining was used to observe lipid plaque formation in the aorta. Hematoxylin-eosin (HE) staining was performed to examine pathological changes in the aortic root. Immunohistochemistry was used to analyze the levels of pro-inflammatory factors tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), as well as the expression of TRPV1, phosphorylated phosphoinositide 3-kinase (p-PI3K), and phosphorylated protein kinase B (p-Akt) in the aortic root. Real-time quantitative polymerase chain reaction (Real-time PCR) was used to detect endothelial nitric oxide synthase (eNOS) mRNA expression in the aorta, and Western blot was used to detect TRPV1 protein expression. ResultsCompared with the normal group, the model group showed a significant increase in aortic plaque formation (P<0.01) and significantly elevated levels of TNF-α and IL-1β in the aortic root (P<0.01). The expression levels of TRPV1, p-PI3K, and p-Akt were decreased (P<0.05, P<0.01), and eNOS mRNA expression was reduced (P<0.05, P<0.01). Compared with the model group, all Renshentang groups significantly reduced aortic plaque formation (P<0.01), significantly decreased TNF-α and IL-1β levels (P<0.01), and markedly increased the expression levels of TRPV1, p-PI3K, p-Akt, and eNOS mRNA (P<0.05, P<0.01). ConclusionRenshentang may inhibit endothelial inflammation and suppress the formation of AS by increasing TRPV1 protein expression and up-regulating the PI3K/Akt/eNOS signaling pathway, which may be one of the molecular mechanisms underlying its therapeutic effect against AS.
2.Renshentang Alleviates Atherosclerosis in Mice by Targeting TRPV1 to Regulate Foam Cell Cholesterol Metabolism
Yulu YUAN ; Ce CHU ; Xuguang TAO ; Zhen YANG ; Xiangyun CHEN ; Zhanzhan HE ; Yongqi XU ; Yuxin ZHANG ; Peizhang ZHAO ; Wanping CHEN ; Hongxia ZHAO ; Wenlai WANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(17):11-19
ObjectiveTo explore the effects of Renshentang on atherosclerosis (AS) in mice based on the role of transient receptor potential vanilloid1 (TRPV1) in regulating cholesterol metabolism in foam cells. MethodsNine SPF-grade 8-week-old C57BL/6J mice were set as a normal group, and 60 ApoE-/- mice were randomized into model, positive drug (simvastatin, 0.02 g·kg-1·d-1), and low-, medium-, and high-dose (1.77, 3.54, 7.08 g·kg-1·d-1, respectively) Renshentang groups (n=12) according to body weight. The normal group was fed with a normal diet, and the other groups were fed with a high-fat diet and given corresponding drugs by oral gavage for the modeling of AS. The mice were administrated with corresponding drugs once a day for 12 weeks. After the last administration and fasting for 12 h, the aorta was collected. Plaque conditions, pathological changes, levels of total cholesterol (TC), triglcerides (TG), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C), and the expression of TRPV1, liver X receptor (LXR), inducible degrader of the low-density lipoprotein receptor (IDOL), and low-density lipoprotein receptor (LDLR) in the aortic tissue were observed and detected by gross oil red O staining, HE staining, Western blot, immunohistochemistry, and real-time PCR. ResultsCompared with the normal group, the model group presented obvious plaque deposition in the aorta, raised levels of TC, TG, and LDL-C in the serum (P<0.01), up-regulated expression level of LDLR in the aorta (P<0.01), lowered level of HDL-C in the serum, and down-regulated expression levels of TRPV1, LXR, and IDOL in the aorta (P<0.05, P<0.01). Compared with the model group, the positive drug and Renshentang at different doses alleviated AS, elevated the levels of HDL-C, TRPV1, LXR, and IDOL (P<0.05, P<0.01), while lowering the levels of TC, TG, LDL-C, and LDLR (P<0.05, P<0.01). ConclusionRenshentang has a lipid-lowering effect on AS mice. It can effectively reduce lipid deposition, lipid levels, and plaque area of AS mice by activating TRPV1 expression and regulating the LXR/IDOL/LDLR pathway.
3.Renshentang Alleviates Atherosclerosis in Mice by Targeting TRPV1 to Regulate Foam Cell Cholesterol Metabolism
Yulu YUAN ; Ce CHU ; Xuguang TAO ; Zhen YANG ; Xiangyun CHEN ; Zhanzhan HE ; Yongqi XU ; Yuxin ZHANG ; Peizhang ZHAO ; Wanping CHEN ; Hongxia ZHAO ; Wenlai WANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(17):11-19
ObjectiveTo explore the effects of Renshentang on atherosclerosis (AS) in mice based on the role of transient receptor potential vanilloid1 (TRPV1) in regulating cholesterol metabolism in foam cells. MethodsNine SPF-grade 8-week-old C57BL/6J mice were set as a normal group, and 60 ApoE-/- mice were randomized into model, positive drug (simvastatin, 0.02 g·kg-1·d-1), and low-, medium-, and high-dose (1.77, 3.54, 7.08 g·kg-1·d-1, respectively) Renshentang groups (n=12) according to body weight. The normal group was fed with a normal diet, and the other groups were fed with a high-fat diet and given corresponding drugs by oral gavage for the modeling of AS. The mice were administrated with corresponding drugs once a day for 12 weeks. After the last administration and fasting for 12 h, the aorta was collected. Plaque conditions, pathological changes, levels of total cholesterol (TC), triglcerides (TG), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C), and the expression of TRPV1, liver X receptor (LXR), inducible degrader of the low-density lipoprotein receptor (IDOL), and low-density lipoprotein receptor (LDLR) in the aortic tissue were observed and detected by gross oil red O staining, HE staining, Western blot, immunohistochemistry, and real-time PCR. ResultsCompared with the normal group, the model group presented obvious plaque deposition in the aorta, raised levels of TC, TG, and LDL-C in the serum (P<0.01), up-regulated expression level of LDLR in the aorta (P<0.01), lowered level of HDL-C in the serum, and down-regulated expression levels of TRPV1, LXR, and IDOL in the aorta (P<0.05, P<0.01). Compared with the model group, the positive drug and Renshentang at different doses alleviated AS, elevated the levels of HDL-C, TRPV1, LXR, and IDOL (P<0.05, P<0.01), while lowering the levels of TC, TG, LDL-C, and LDLR (P<0.05, P<0.01). ConclusionRenshentang has a lipid-lowering effect on AS mice. It can effectively reduce lipid deposition, lipid levels, and plaque area of AS mice by activating TRPV1 expression and regulating the LXR/IDOL/LDLR pathway.
4.Alleviation of hypoxia/reoxygenation injury in HL-1 cells by ginsenoside Rg_1 via regulating mitochondrial fusion based on Notch1 signaling pathway.
Hui-Yu ZHANG ; Xiao-Shan CUI ; Yuan-Yuan CHEN ; Gao-Jie XIN ; Ce CAO ; Zi-Xin LIU ; Shu-Juan XU ; Jia-Ming GAO ; Hao GUO ; Jian-Hua FU
China Journal of Chinese Materia Medica 2025;50(10):2711-2718
This paper explored the specific mechanism of ginsenoside Rg_1 in regulating mitochondrial fusion through the neurogenic gene Notch homologous protein 1(Notch1) pathway to alleviate hypoxia/reoxygenation(H/R) injury in HL-1 cells. The relative viability of HL-1 cells after six hours of hypoxia and two hours of reoxygenation was detected by cell counting kit-8(CCK-8). The lactate dehydrogenase(LDH) activity in the cell supernatant was detected by the lactate substrate method. The content of adenosine triphosphate(ATP) was detected by the luciferin method. Fluorescence probes were used to detect intracellular reactive oxygen species(Cyto-ROS) levels and mitochondrial membrane potential(ΔΨ_m). Mito-Tracker and Actin were co-imaged to detect the number of mitochondria in cells. Fluorescence quantitative polymerase chain reaction and Western blot were used to detect the mRNA and protein expression levels of Notch1, mitochondrial fusion protein 2(Mfn2), and mitochondrial fusion protein 1(Mfn1). The results showed that compared with that of the control group, the cell activity of the model group decreased, and the LDH released into the cell culture supernatant increased. The level of Cyto-ROS increased, and the content of ATP decreased. Compared with that of the model group, the cell activity of the ginsenoside Rg_1 group increased, and the LDH released into the cell culture supernatant decreased. The level of Cyto-ROS decreased, and the ATP content increased. Ginsenoside Rg_1 elevated ΔΨ_m and increased mitochondrial quantity in HL-1 cells with H/R injury and had good protection for mitochondria. After H/R injury, the mRNA and protein expression levels of Notch1 and Mfn1 decreased, while the mRNA and protein expression levels of Mfn2 increased. Ginsenoside Rg_1 increased the mRNA and protein levels of Notch1 and Mfn1, and decreased the mRNA and protein levels of Mfn2. Silencing Notch1 inhibited the action of ginsenoside Rg_1, decreased the mRNA and protein levels of Notch1 and Mfn1, and increased the mRNA and protein levels of Mfn2. In summary, ginsenoside Rg_1 regulated mitochondrial fusion through the Notch1 pathway to alleviate H/R injury in HL-1 cells.
Ginsenosides/pharmacology*
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Receptor, Notch1/genetics*
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Signal Transduction/drug effects*
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Mice
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Animals
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Mitochondrial Dynamics/drug effects*
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Mitochondria/metabolism*
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Cell Line
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Reactive Oxygen Species/metabolism*
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Oxygen/metabolism*
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Cell Hypoxia/drug effects*
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Cell Survival/drug effects*
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Membrane Potential, Mitochondrial/drug effects*
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Humans
5.SCREENING AND EXPRESSION ANALYSIS OF GENES ASSOCIATED WITH INNATE IMMUNITY IN RESPONSE TO DENV2 INFECTION IN AEDES ALBOPICTUS
Yang ZHOU ; Man-Jin LI ; Jin CHENG ; Ya-Ming ZOU ; Ding ZHU ; Ce-Jie LAN ; Yuan SHEN
Acta Parasitologica et Medica Entomologica Sinica 2025;32(3):153-159,178
Objective Aedes albopictus is the primary vector of the dengue virus.Screening and the analysis of immune-related genes in DENV2-infected Ae.albopictus provides a scientific basis for further research on blocking the extrinsic incubation period of the dengue virus.Methods Through the approach of literature mining,thirty-three potential immune-related genes were screened from species such as Aedes aegypti and Anopheles gambiae,which have a close genetic relationship with Ae.albopictus.The protein—protein interaction(PPI)analysis is employed to explore the interaction relationship of the proteins encoded by genes.The alterations in mRNA expression levels of the relevant genes in DENV2-infected Ae.albopictus midgut were detected using the qRT-PCR method.Results The PPI results indicates that TLR and Spz of Ae.albopictus;Rel1,Rel2,DefC,Spz,PIWI,Ago2,DOME and HOP of Ae.aegypti;and Rel1,Rel2,CACT,STAT and DOME of An.gambiae exhibit PPI relationships.After Ae.albopictus was infected with DENV2,10 genes showed significant difference in expression.Ago3(7.39,P<0.05),DOMEa(1.63,P<0.01),DOMEb(21.29,P<0.001),and TLRb(1.61,P<0.05)were significantly up-regulated.Rel1(0.62,P<0.001),CACTl(0.65,P<0.001),Rel2a(0.65,P<0.01),Rel2b(0.24,P<0.001),GATAa(0.64,P<0.01)and DefC(0.28,P<0.05)were significantly down-regulated.Conclusions The concordance of Ae.albopictus with Ae.aegypti was higher than that with An.gambiae.DOMEb,Ago3,Rel2b and DefC,can serve as the preferred target genes for subsequent studies on DENV2 immune blockade.
6.Effect and Mechanism of Chinese Medicine in Treatment of Osteoporosis
Yulu YUAN ; Zhen YANG ; Wei DING ; Ce CHU ; Xuguang TAO ; Xiangyun CHEN ; Zhanzhan HE ; Peizhang ZHAO ; Yongqi XU ; Yuxin ZHANG ; Hongxia ZHAO ; Wenlai WANG
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(4):290-298
Osteoporosis (OP) is a common bone disease affecting the quality of life and causing huge medical burden to the patients and society. The occurrence of OP is mainly caused by excessive bone resorption and insufficient bone formation, which are directly influenced by external calcium ion balance. Calcium imbalance can impair bone integrity, reduce the calcium supply to the bone, and lower the calcium content in the bone, thus triggering OP. Drugs are the main anti-OP therapy in modern medicine, which, however, may cause adverse reactions and drug dependence. Chinese medicines have good clinical effects and high safety in treating OP, being suitable for long-term use. Recent studies have shown that Chinese medicines can alleviate estrogen deficiency, regulate bone cell and calcium metabolism, which is crucial for the formation and development of OP. The transient receptor potential cation channel superfamily V members 5 and 6 (TRPV5 and TRPV6, respectively) affect bone homeostasis by mediating the transmembrane calcium ion transport in the intestine (TRPV6) and kidney (TRPV5). Therefore, TRPV5/6 is one of the key targets to understand the anti-OP mechanisms of the effective parts of Chinese medicines, which is worthy of further study. This paper summarizes the research results about the anti-OP effects of Chinese medicines in the last two decades, especially the mechanism of regulating calcium metabolism, aiming to provide new ideas for the basic research, clinical application, and drug development of OP treatment.
7.Correlation between enlarged perivascular space and cerebral venous reflux in recent small subcortical infarcts within the lenticulostriate artery territory
Zhengrong WU ; Ke ZHANG ; Ce ZONG ; Hongbing LIU ; Kai LIU ; Yanhong WANG ; Yuming XU ; Yuan GAO
Chinese Journal of Neurology 2024;57(3):241-247
Objective:To summarize the incidence of cerebral venous reflux (CVR) in patients with recent small subcortical infarct (RSSI) and explore its correlation with enlarged perivascular spaces (EPVS).Methods:Patients with RSSI in the lenticulostriate artery admitted to the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2022 were included. The baseline demographic data, medical history, and laboratory results of the patients were collected. CVR was assessed by time-of-flight magnetic resonance angiography. Patients were stratified into 2 groups based on the presence (CVR group) or absence of CVR (non-CVR group), and baseline characteristics as well as laboratory test results were compared between the 2 groups. The location and number of EPVS were evaluated using a visual grading scale, with EPVS with higher scores defined as high-grade EPVS (HEPVS). Simultaneous evaluation of cerebral white matter hyperintensities and lacunar infarctions was conducted, followed by intergroup comparisons. The relationship between EPVS and CVR was studied using multiple Logistic regression analysis.Results:A total of 571 patients with RSSI in the lentiform artery area were ultimately included, including 180 females (31.5%). Their age was (59.37±12.87) years. Among them, 73 patients (12.8%) exhibited CVR based on imaging findings, so the incidence of CVR was 12.8%. In comparison between the CVR group ( n=73) and the non-CVR group ( n=498), the proportion of females [21.9% (16/73) vs 32.9% (164/498), χ 2=3.578, P=0.059] was lower and the proportion of history of smoking [38.4% (28/73) vs 27.7% (138/498), χ 2=3.499, P=0.061] was higher in the CVR group, but without statistical significance. Additionally, the history of alcohol consumption [34.2% (25/73) vs 21.7% (108/498), χ 2=5.621, P=0.018] and the proportion of patients with concomitant HEPVS in the basal ganglia area [41.1% (30/73) vs 25.3% (126/498), χ 2=7.999, P=0.005] was higher in the CVR group with statistical significance. Multiple Logistic regression analysis showed that HEPVS in the basal ganglia region remained independently associated with CVR ( OR=1.988, 95% CI 1.190-3.320, P=0.009). Conclusion:EPVS in the basal ganglia region is significantly associated with CVR in the RSSI population, suggesting that venous dysfunction may be closely related to the formation of EPVS.
8.Linggui Zhugantang Treats Chronic Bronchitis in Rats via PLA2-TRPV1/TRPA1 Pathway
Wei DING ; Wenlai WANG ; Zhenhong LIU ; Xiangyun CHEN ; Zhanzhan HE ; Ce CHU ; Yulu YUAN ; Yongqi XU ; Yuxin ZHANG ; Peizhang ZHAO ; Zhen YANG ; Hongxia ZHAO
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(14):1-9
ObjectiveTo study the effect and mechanism of Linggui Zhugantang in treating chronic bronchitis (CB) induced by exposure to cigarette smoke combined with tracheal instillation of lipopolysaccharide (LPS). MethodSixty SPF-grade SD rats were randomly divided into normal, model, dexamethasone (1 mg·kg-1), and high-, medium-, and low-dose (30.06, 15.03, 7.515 g·kg-1, respectively) Linggui Zhugantang groups by the body weight stratification method, with 10 rats in each group. Each group was administrated with 200 μL LPS (1 g·L-1) by tracheal instillation on days 1 and 14, respectively, while the normal group was administrated with an equal volume of normal saline. Except the normal group, the other groups were exposed to cigarette smoke on days 2-13 and 15-30 (10 cigarettes/time/30 min, twice/day) for the modeling of CB. The rats were administrated with corresponding drugs by gavage for 30 consecutive days from day 2 of modeling, and the mental status, behavior, and body weights of the rats were observed and measured. The wet/dry mass ratio (W/D) of the left lung was measured 30 days after modeling. Hematoxylin-eosin staining was employed to observe the pathological changes in the lung and bronchial tissues. The bronchial mucus secretion and goblet cell proliferation were observed by Alcian blue-periodic acid Schiff (AB-PAS) staining. The levels of mucin 5AC (MUC5AC), interleukin (IL)-13, IL-6, and tumor necrosis factor (TNF)-α in the serum were determined by enzyme-linked immunosorbent assay. The expression of phospholipase A2 (PLA2), transient receptor potential vanilloid receptor 1 (TRPV1), and transient receptor potential ankyrin 1 (TRPA1) in the lung tissue was quantitatively analyzed by immunohistochemistry and Western blot. ResultCompared with the normal group, the model group showcased abnormal mental status and behaviors, bloody secretion in the nose and mouth, the mortality rate of 40%, decreased body weight, severe lung bronchial structure damage, a large number of inflammatory mediators and inflammatory cell infiltration in the tube wall, hyperemia, edema, and fibroplasia, massive proliferation of goblet cells, excessive secretion and accumulation of mucus, stenosis and deformation of the lumen, and aggravation of pulmonary edema (P<0.01). In addition, the model group had higher levels of MUC5AC, IL-13, IL-6, and TNF-α in the serum and higher expression of PLA2 in the lung tissue than the normal group (P<0.01). Compared with the model group, the medication groups showed normal mental status and behaviors, reduced mortality rate, stable weight gain, reduced lung and bronchial injuries, decreased goblet cell proliferation and mucus secretion, and alleviated pulmonary edema (P<0.01). Furthermore, Linggui Zhugantang lowered the levels of MUC5AC, IL-13, IL-6, and TNF-α in the serum and down-regulated the protein levels of PLA2, TRPV1, and TRPA1 in the lung tissue (P<0.01). ConclusionLinggui Zhugantang can reduce the pulmonary inflammation and airway mucus hypersecretion in the rat model of chronic bronchitis. It may exert the effects of reducing inflammation and resolving phlegm by regulating the PLA2-TRPV1/TRPA1 pathway.
9.Comparison on Rat Models of Acute Cerebral Infarction Due to Stasis Combined with Toxin Complicated with Cerebral-cardiac Syndrome
Mingjiang YAO ; Junyuan LI ; Yue LIU ; Ce CAO ; Guo YUAN ; Lei LI ; Jianxun LIU ; Yunling ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(1):112-119
ObjectiveTo observe and compare the electrocardiogram index, myocardial morphology, and connexin 43 (Cx43) expression of two rat models of acute cerebral infarction (ACI) due to stasis combined with toxin complicated with cerebral-cardiac syndrome (CCS), and to provide experimental evidence for the research on the occurrence mechanism of cardiac diseases induced by ACI and the clinical diagnosis and treatment of CCS. MethodSixty SPF-grade male SD rats were randomized into six groups (n=10): normal , syndrome of stasis combined with toxin induced by carrageenin combined with dry yeast (CA/Y), multi-infarct induced by micro-embolism (ME), middle cerebral artery occlusion (MCAO), CA/Y+ME, and CA/Y+MCAO groups. The model of syndrome of stasis combined with toxin was established by intraperitoneal injection with carrageenan (CA) at 10 mg·kg-1 on the first day and subcutaneous injection with dry yeast (Y) suspension (2 mg·kg-1) on the second day of modeling. Twenty-four hours after the modeling of ACI, the electrocardiograms (ECGs) of rats in each group were collected and the number/percentage (%) of abnormal ECG was calculated. The infarct area of the brain was evaluated by 2,3,5-triphenyltetrazolium chloride (TTC) staining, and myocardial injury was assessed by hematoxylin-eosin (HE) staining. Immumohistochemical staining and Western blot were employed to determine the expression of Cx43 in the myocardium. ResultA certain number of rats in each model group presented abnormal ECG. Compared with the normal group and CA/Y group, CA/Y+MCAO group had the highest rate of abnormal ECG (P<0.01). Compared with the normal, CA/Y, ME, and CA/Y+ME groups, the CA/Y+ME and CA/Y+MCAO groups showed decreased amplitudes of P-wave and T-wave, shortened P-R interval, and extended Q-T interval, which were particularly obvious in the CA/Y+MCAO group (P<0.05, P<0.01) and in accordance with the cerebral infarction area and pathological changes. The expression of Cx43 was up-regulated in both CA/Y+ME and CA/Y+MCAO groups, especially in the CA/Y+MCAO group (P<0.01). ConclusionThe two rat models of ACI due to stasis combined with toxin complicated with CCS can be used to study the mechanism of heart diseases caused by cerebrovascular diseases and the therapeutic effects of Chinese medicines with the functions of resolving stasis and detoxifying. Moreover, the CA/Y+MCAO method has higher abnormal electrocardiogram rate, severer myocardial pathological injury, and higher expression of Cx43 protein. The models can be chosen according to specific experimental purpose.
10.Implications of left atrial volume index in patients with three-vessel coronary disease: A 6.6-year follow-up cohort study
Ru LIU ; Lei SONG ; Ce ZHANG ; Lin JIANG ; Jian TIAN ; Lianjun XU ; Xinxing FENG ; Linyuan WAN ; Xueyan ZHAO ; Ou XU ; Chongjian LI ; Runlin GAO ; Rutai HUI ; Wei ZHAO ; Jinqing YUAN
Chinese Medical Journal 2024;137(4):441-449
Background::Risk assessment and treatment stratification for three-vessel coronary disease (TVD) remain challenging. This study aimed to investigate the prognostic value of left atrial volume index (LAVI) with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score II, and its association with the long-term prognosis after three strategies (percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], and medical therapy [MT]) in patients with TVD.Methods::This study was a post hoc analysis of a large, prospective cohort of patients with TVD in China, that aimed to determine the long-term outcomes after PCI, CABG, or optimal MT alone. A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai Hospital. A total of 7818 patients with available baseline LAVI data were included in the study. Baseline, procedural, and follow-up data were collected. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), which was a composite of all-cause death, myocardial infarction (MI), and stroke. Secondary endpoints included all-cause death, cardiac death, MI, revascularization, and stroke. Long-term outcomes were evaluated among LAVI quartile groups. Results::During a median follow-up of 6.6 years, a higher LAVI was strongly associated with increased risk of MACCE (Q3: hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.06-1.37, P = 0.005; Q4: HR 1.85, 95%CI 1.64-2.09, P <0.001), all-cause death (Q3: HR 1.41, 95% CI 1.17-1.69, P <0.001; Q4: HR 2.54, 95%CI 2.16-3.00, P <0.001), and cardiac death (Q3: HR 1.81, 95% CI 1.39-2.37, P <0.001; Q4: HR 3.47, 95%CI 2.71-4.43, P <0.001). Moreover, LAVI significantly improved discrimination and reclassification of the SYNTAX score II. Notably, there was a significant interaction between LAVI quartiles and treatment strategies for MACCE. CABG was associated with lower risk of MACCE than MT alone, regardless of LAVI quartiles. Among patients in the fourth quartile, PCI was associated with significantly increased risk of cardiac death compared with CABG (HR: 5.25, 95% CI: 1.97-14.03, P = 0.001). Conclusions::LAVI is a potential index for risk stratification and therapeutic decision-making in patients with three-vessel coronary disease. CABG is associated with improved long-term outcomes compared with MT alone, regardless of LAVI quartiles. When LAVI is severely elevated, PCI is associated with higher risk of cardiac death than CABG.

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