Objective:To investigate the impact of imaging anatomical features on the prognosis of middle-aged and elderly patients with anomalous coronary artery originating from the opposite sinus (ACAOS).Methods:This retrospective cohort study enrolled patients aged ≥45 years who were diagnosed with ACAOS by coronary computed tomography angiography (CTA) at the Affiliated Hospital of Xuzhou Medical University between January 1, 2011, and December 31, 2018. Baseline clinical data and coronary CTA images were collected. Anatomic imaging features were extracted, including ACAOS subtype, course of the anomalous vessel, and ostial angle. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of acute myocardial infarction, cardiac death, and coronary revascularization. The Maxstat method was used to determine the cut-off values of specific anatomical features for predicting MACE risk. Cox proportional hazards models were employed to analyze the impact of these imaging features on MACE in middle-aged and elderly ACAOS patients.Results:A total of 203 patients were enrolled, aged (60.0(51.0, 66.0)) years, including 119 (58.6%) males. Over a follow-up of (98.2±30.9) months, 39 patients experienced MACE. Maxstat identified an optimal cut-off value of 34.3° for the ostial angle of the anomalous vessel. Multivariable Cox proportional hazards regression analysis revealed that the following factors were independent risk factors for MACE: left-sided ACAOS subtype ( HR=4.35, 95% CI 2.17-8.73, P<0.001), an interarterial course between the aorta and pulmonary artery ( HR=3.21, 95% CI 1.23-8.37, P=0.017), an anomalous vessel ostial angle <34.3° ( HR=2.62, 95% CI 1.18-5.77, P=0.017), and concomitant coronary artery disease ( HR=2.92, 95% CI 1.49-5.73, P=0.002). Conclusion:In middle-aged and elderly patients with ACAOS, the imaging anatomical features of a left-sided ACAOS subtype, an interarterial course, and an ostial angle <34.3° are independent risk factors for MACE.

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: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.

Objective:To investigate the impact of imaging anatomical features on the prognosis of middle-aged and elderly patients with anomalous coronary artery originating from the opposite sinus (ACAOS).Methods:This retrospective cohort study enrolled patients aged ≥45 years who were diagnosed with ACAOS by coronary computed tomography angiography (CTA) at the Affiliated Hospital of Xuzhou Medical University between January 1, 2011, and December 31, 2018. Baseline clinical data and coronary CTA images were collected. Anatomic imaging features were extracted, including ACAOS subtype, course of the anomalous vessel, and ostial angle. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of acute myocardial infarction, cardiac death, and coronary revascularization. The Maxstat method was used to determine the cut-off values of specific anatomical features for predicting MACE risk. Cox proportional hazards models were employed to analyze the impact of these imaging features on MACE in middle-aged and elderly ACAOS patients.Results:A total of 203 patients were enrolled, aged (60.0(51.0, 66.0)) years, including 119 (58.6%) males. Over a follow-up of (98.2±30.9) months, 39 patients experienced MACE. Maxstat identified an optimal cut-off value of 34.3° for the ostial angle of the anomalous vessel. Multivariable Cox proportional hazards regression analysis revealed that the following factors were independent risk factors for MACE: left-sided ACAOS subtype ( HR=4.35, 95% CI 2.17-8.73, P<0.001), an interarterial course between the aorta and pulmonary artery ( HR=3.21, 95% CI 1.23-8.37, P=0.017), an anomalous vessel ostial angle <34.3° ( HR=2.62, 95% CI 1.18-5.77, P=0.017), and concomitant coronary artery disease ( HR=2.92, 95% CI 1.49-5.73, P=0.002). Conclusion:In middle-aged and elderly patients with ACAOS, the imaging anatomical features of a left-sided ACAOS subtype, an interarterial course, and an ostial angle <34.3° are independent risk factors for MACE.

Objective To investigate the efficacy and safety of transcatheter arterial chemoembolization(TACE)for the treatment of locally recurrent breast cancer.Methods The clinical data of 57 patients with locally recurrent breast cancer from January 2018 to December 2020 were retrospectively analyzed.Twenty-four patients(group A)received TACE using adriamycin 12 mg/m2 and paclitaxel 45 mg/m2,which was accomplished by local perfusion into the tumor target blood vessels with microcatheter catheterization,the embolization material was Embosphere microspheres,and the embolization endpoint was occlusion of the main stem of the target vessel.Other 33 patients who received systemic chemotherapy using adriamycin 40 mg/m2 and paclitaxel 135 mg/m2 in the same period were collected as group B.The 6-month disease control rate(DCR),progression-free survival(PFS)and overall survival(OS)were compared between the two groups.Results Successful TACE was accomplished in all the 24 patients of group A,with a technical success rate of 100％.In group A,the 6-month DCR was 87.50％,the median PFS was 12 months,and the median OS was 22 months.In group B,the 6-month DCR was 63.63％,the median PFS was 9 months,and the median OS was 20 months.The differences in the 6-month DCR and the median PFS between the two groups were statistically significant(P=0.04 and P=0.03 respectively),while no statistically significant difference in the median OS existed between the two groups(P=0.21).The incidence of post-embolization syndrome in group A was 75％(18/24),the clinical symptoms included chest wall pain and mild fever,which disappeared 3 days after symptomatic treatment such as pain-relief and antipyretic medication,and no TACE-related serious complications such as target vessel injury,ectopic embolization of embolization materials or chest wall necrosis occurred in all patients.All patients were followed up for a mean period of(19.47±4.96)months(range of 8-24 months)Conclusion For the treatment of locally recurrent breast cancer,TACE is superior to systemic chemotherapy in short-term efficacy.TACE carries no intervention-related serious complications.However,more studies need to be conducted before its long-term efficacy and safety can be clarified.(J Intervent Radiol,2024,33:280-284)

Objective: To explore the protective mechanism of resvertrol (RSV) suppressing the rapid electrical stimulation incurred oxidative stress injury in neonatal rats cardiomyocytes. Methods: The neonatal rats cardiac ifbroblasts and myocytes were isolated by double enzyme digestion and differential adhesion method, and the cardiomyocytes were randomly divided into 5 groups:①Control (CTR) group,②Rapid electrical stimulation (RES) group,③RES+APO group, cells were pretreated with NADPH oxidase inhibitor APO,④RES+RSV group,⑤RES+AIP group, cells were pretreated with CaMKII inhibitor AIP. In order to conifrm whether RSV protection was via MsrA-OX-CaMKⅡpathway, the cells were further divided into another 3 groups:①DMSO control group,②RSV+DMSO group,③RES+ RSV+DMSO group. The best dose of RSV was measured with Kit-8 by cardiomyocytes surviving condition, the optimal electrical stimulation time was detected with ELISA by Ang II level in conditioned medium. The level of reactive oxygen species (ROS) in cardiomyocytes was detected by flow cytometry, the protein expressions of MsrA, Nox4, Nox2, P22phox, OX-CaMK II and apoptosis related cleaved caspase-3 were observed by Western blot analysis.Results:①Compared with CTR group, RES group showed increased AngII secretion with increased protein expressions of Nox4, Nox2, P22phox, OX-CaMK II and cleaved caspase-3.②Compared with RES group, the RES+APO, RES+RSV, RES+AIP groups had decreased ROS level, the ROS was even lower in RES+RSV group.③Compared with RES group, the RES+APO, RES+RSV groups presented decreased protein expressions of Nox4, Nox2, P22phox, OX-CaMK II and cleaved caspase-3, while RES+AIP group only had decreased Nox2, OX-CaMK II and cleaved caspase-3.④Compared with DMSO control group, RES+ RSV+DMSO group had the lower level of cleaved caspase-3 expression. Conclusion: RSV has protective effect on rapid electrical stimulation incurred oxidative stress injury in neonatal rats cardiomyocytes, which might be via NADPH oxidase with the increased MsrA expression .

Objective To evaluate value of multi-indexes of real-time myocardial contrast echocardiography (RT-MCE) for the detection of coronary artery disease(CAD). Methods A total of 35 patients scheduled for coronary angiography underwent RT-MCE, and were undergone gated single photon emission computed tomography(gated-SPECT) after RT-MCE shortly. Coronary angiography was performed within one week of RT-MCE in all patients. All patients were divided CAD and no-CAD group. The observing indexes included: (1)The images of RT-MCE were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion by using the Qlab software; A,β and A×β were compared between two groups. The sensitivity and specificity of RT-MCE for detection of CAD were performance by ROC curves Gensini score were calculated in 22 patients. Then the correlation analysis was used for comparing the value of A,β and A×β with Gensini score. (2) The sensitivity and specificity of gated-SPECT and RT-MCE for assessment of CAD were calculated by 4 score method. (3) RT-MCE for the detection of coronary artery stenosis with multi-indexes. Results (1) A,β and A×β were significant difference between two groups. The cutoff of A,β and A×β was 4. 58,0. 64 and 2. 73,then the sensitivity and specificity of RT-MCE for detection of CAD were 86. 0% , 80. 2% , 88. 9% and 84.1 % , 64. 6% , 79. 9 % , respectively. The correlation index was - 0. 79, - 0. 51 and - 0. 76 comparing the results of A, β and A ×β with Gensini. (2) The sensitivity and specificity of gated-SPECT for assessment of CAD were 84. 8 % and 82. 7% ,respectively. (3) The sensitivity of multi-indexes RT-MCE increased, the sensitivity was 89. l%,90. 4% and 96.3% when combinated A and β,A and A×β,and β and A×β, respectively. Conclusions RT-MCE with multi-indexes has a valuable application for assessment of CAD. The severity of CAD could be evaluated by RT-MCE.