Objectives:To investigate the association between cardiac magnetic resonance(CMR)structural parameters and myocardial fibrosis in patients with hypertrophic cardiomyopathy(HCM),and to assess their predictive value for major adverse cardiovascular events(MACE).Methods:A total of 120 patients with HCM who underwent CMR examination at Affiliated Hospital of Guangdong Medical University between December 2021 and December 2023 were retrospectively enrolled.Patients were divided into the MACE group and the non-MACE group.MACE included acute myocardial infarction,angina pectoris,stroke,heart failure,severe arrhythmia.The CMR parameters were compared between the two groups.The correlation between CMR structural parameters and the myocardial fibrosis index(number of myocardial fibrotic segments/total segment number×100%)was evaluated using the locally weighted scatterplot smoothing method(LOWESS).Multivariate Cox regression was performed to identify the influencing factors of MACE.Threshold effect analysis of CMR structural parameters was conducted,and receiver operating characteristic(ROC)curves were generated to evaluate the diagnostic performance of CMR structural parameters for MACE.Results:During a follow-up period of 12(5,30)months,a total of 78(65.0%)patients developed MACE(the MACE group),and the remaining 42(35.0%)patients were assigned to the non-MACE group.Compared with the non-MACE group,patients in the MACE group had significantly larger left atrial diameter,left ventricular end-diastolic maximum diameter,maximal interventricular septal thickness,maximal left ventricular wall thickness,and higher myocardial fibrosis index(all P<0.05).The LOWESS analysis showed significant positive correlations between the above CMR structural parameters and the myocardial fibrosis index(all Poverall<0.05).The multivariate Cox regression showed that the echocardiographic interventricular septal thickness OR=2.622,95%CI:1.537-3.033),left ventricular posterior wall thickness(OR=1.597,95%CI:1.353-2.420),as well as CMR-derived left atrial diameter(OR=1.623,95%CI:1.314-2.595),left ventricular end-diastolic maximum diameter(OR=1.927,95%CI:1.594-2.981),maximal interventricular septal thickness(OR=2.085,95%CI:1.426-2.563),and maximal left ventricular wall thickness(OR=2.306,95%CI:1.760-2.805)were independent predictors of MACE(all P<0.05).The threshold effect analysis revealed that the left atrial diameter,left ventricular end-diastolic maximum diameter,maximal interventricular septal thickness,and maximal left ventricular wall thickness were all positively associated with the risk of MACE(all Poverall<0.05).The ROC curve analysis demonstrated that among individual CMR parameters,maximal interventricular septal thickness had the highest predictive performance(AUC=0.86,95%CI:0.74-0.95;sensitivity was 83.67%,specificity was 78.87%).Combined structural parameters(left atrial diameter,left ventricular end-diastolic maximum diameter,maximal interventricular septal thickness,and maximal left ventricular wall thickness)provided superior predictive accuracy(AUC=0.91,95%CI:0.84-0.99;sensitivity was 86.22%,specificity was 76.26%).Conclusions:HCM patients with MACE exhibit distinct clinical and imaging features compared with those without MACE.CMR structural parameters,including left atrial diameter,left ventricular end-diastolic maximum diameter,maximal interventricular septal thickness,and maximal left ventricular wall thickness,are closely related to myocardial fibrosis and strongly associated with MACE risk.A composite index integrating these parameters shows high predictive value for MACE.

Objectives:To analyze the effects of prone position ventilation in patients receiving extracorporeal membrane oxygenation(ECMO).Methods:A systematic search was conducted in databases including CNKI,Wanfang Data,China Biomedical Literature Database,PubMed,Embase,Cochrane Library,and Web of Science,from the inception of each database to October 2024,to identify studies on prone position ventilation for ECMO patients.Two researchers independently screened the literature,extracted data,and assessed the quality of the studies.Meta-analysis was performed using RevMan 5.4 software.Results:A total of 10 studies were included in this analysis,comprising 2 randomized controlled trials and 8 cohort studies.A total of 1 513 patients were included,674 were in the prone position ventilation group and 839 were in the supine position ventilation group.Analysis results of 6 studies showed that compared with supine position ventilation,prone position ventilation could increase the successful weaning rate of ECMO(OR=1.47,95%CI:1.07-2.01,P=0.02).Analysis results of 8 studies showed that compared with supine position ventilation,prone position ventilation could prolong the duration of ECMO treatment(mean difference[MD]=4.86 days,95%CI:0.95-8.77,P=0.01).Analysis results of 6 studies showed that the length of stay in the intensive care unit in the prone position ventilation group was significantly longer than that in the supine position ventilation group(MD=5.16 days,95%CI:1.08-9.25,P=0.01).Analysis results of 5 studies showed that the total length of hospital stay in the prone position ventilation group was significantly longer than that in the supine position ventilation group(MD=7.72 days,95%CI:2.10-13.34,P<0.01).Analysis results of 6 studies showed that compared with supine position ventilation,prone position ventilation could prolong the duration of mechanical ventilation(MD=6.06 days,95%CI:0.63-11.49,P=0.03).Prone position ventilation had no obvious advantage in improving patient survival rate.Conclusions:Prone position ventilation can improve the successful weaning rate from ECMO and prolong the duration of ECMO treatment as well as the duration of mechanical ventilation,but it has no significant impact on patient survival rate.Due to the generally small sample size in the studies,further research with larger sample sizes is needed to confirm the effective impact of prone position ventilation in patients receiving ECMO treatment.

Objectives:To analyze and summarize the clinical experience of the Y-incision technique in aortic root enlargement surgery.Methods:A retrospective analysis was conducted based on the data of 53 patients who underwent aortic root enlargement using the Y-shaped incision technique by the same surgical team from January to December 2024.The primary endpoint of the study was the efficacy of the technique,as measured by the enlargement size of the valve annulus.The secondary endpoint focused on the safety of the procedure,specifically the incidence of major complications,including re-sternotomy due to bleeding,third-degree atrioventricular block,and major adverse cardiovascular events(MACE).MACE included cardiovascular death,myocardial infarction,stroke,and re-aortic valve intervention.Echocardiography was performed at 3 months after discharge.Root blood flow compliance was analyzed by computer fluid dynamics.Results:Among the 53 patients,30 were male(56.6%),with a mean age of(59.3±13.3)years(range:13-81 years).Five cases(9.4%)were reoperations.Biological valves were replaced in 36 cases(67.9%),and mechanical valves in 17 cases(32.1%).The intraoperatively measured mean native annulus diameter was(20.5±2.2)mm,the post-root enlargement implanted valve size was(25.4±2.5)mm,with a mean enlargement of(4.9±1.5)mm.The mean cardiopulmonary bypass time was(159.9±46.1)minutes,aortic cross-clamp time was(123.3±35.6)minutes,postoperative intensive care unit stay was(2.6±3.0)days,and invasive mechanical ventilation duration was(18.3±29.7)hours.One case(1.9%)required re-exploration for postoperative bleeding.One case(1.9%)developed transient postoperative elevation of cardiac troponin I,and coronary computed tomography angiography(CTA)confirmed asymptomatic compression of the coronary ostium.Follow-up at 1 month showed normal coronary blood flow.No third-degree atrioventricular block or MACE occurred in the entire cohort.Postoperative computer fluid dynamics analysis showed that the high-speed blood flow at the root disappeared after the operation,the blood flow compliance was improved,and no signs of tilt of the prosthetic valve were found.The mean follow-up was(6.2±2.7)months.The follow-up completion rate was 100%,and no death occurred during the follow-up.Both the aortic prosthetic valve and mitral valve functioned well,there was no dysfunction caused by mitral curtain injury.One case of moderate patient-prosthesis mismatch(PPM)occurred in a reoperation patient,there was no severe PPM post surgery.Compared with the preoperative values,left ventricular ejection fraction,peak transaortic valve flow velocity,and the degree of mitral regurgitation all significantly improved at 3 months after discharge(all P<0.001).Conclusions:The Y incision technique is safe and effective for aortic root enlargement,enabling the implantation of larger-diameter prosthetic valves and providing better hemodynamic outcomes.Further follow-up is required to assess its long-term efficacy.

Objectives:To analyze the trends in the disease burden of ischemic heart disease(IHD)attributable to kidney dysfunction globally and in China from 1990 to 2021,and to project the trend changes up to 2040.Methods:Based on the Global Burden of Disease Study 2021,the deaths and disability adjusted life years(DALY)of IHD attributable to kidney dysfunction,along with their corresponding age standardized rates were visualized and estimated annual percentage change(EAPC)were calculated.Spearman's rank correlation was employed to evaluate the correlation between the Socio-demographic Index(SDI)and disease burden indicators(age standardized death rate/DALY rate).Decomposition analysis based on the population-aging-epidemiology decomposition method was used to analyze related driving factors,and a Bayesian age-period-cohort model was applied to project future trends.Results:From 1990 to 2021,the age standardized death rates and DALY rates of IHD attributable to kidney dysfunction showed a decreasing trend globally.The EAPC of age standardized death rate was-1.45%(95%CI:-1.49%to-1.42%),and the EAPC of age standardized DALY rate was-1.29%(95%CI:-1.34%to-1.25%).In China,the age standardized death rates and DALY rates of IHD attributable to kidney dysfunction showed an upward trend from 1990 to 2021.The EAPC of age standardized death rate was 0.86%(95%CI:0.40%to 1.32%),and the EAPC of age standardized DALY rate was 0.45%(95%CI:0.06%to 0.84%).Compared with 1990,although the age standardized death rates and DALY rates of Chinese males and females showed an upward trend in 2021,but their age standardized death rates and DALY rates reached the peak in 2005 and then decreased year by year.The age standardized death rates and DALY rates of males were always higher than those of females globally and in China.The death rates and DALY rates of males and females increased gradually with age globally.The number of male deaths peaked at the age of 75-84,and the number of female deaths peaked at the age of 85-94;Male DALY peaked at the age of 65-74,and female DALY peaked at the age of 75-84.Similarly,the mortality rates and DALY rates of males and females in China also increased gradually with age.The number of deaths of males and females peaked at the age of 85-94;Male DALY peaked at the age of 65-74,and female DALY peaked at the age of 75-84.The growth of global mortality rates and DALY rates was mainly attributed to population growth and aging,while aging was the main driving factor in China.The global age standardized death rate(r=-0.169 4,P<0.000 1)and DALY rate(r=-0.278 4,P<0.000 1)were significantly negatively correlated with SDI.It is predicted that by 2040,the global and Chinese age standardized DALY rates would decrease to 543.71/100 000 and 333.64/100 000 respectively,and the age standardized DALY rate of males would continue to be higher than that of females.Conclusions:From 1990 to 2021,the age standardized death and DALY rates of IHD attributed to kidney dysfunction decreased significantly globally,while showed an upward trend in China.It is projected that by 2040,the disease burden of IHD attributable to kidney dysfunction would decline both globally and in China.In the future,interventions should focus on elderly populations and high-risk male groups to effectively control the disease burden of IHD attributable to kidney dysfunction.

Objectives:To investigate the epidemiological characteristics and ethnic differences of cardiovascular-kidney-metabolic syndrome(CKM)among the Hani,Dai,Bai,and Lisu populations in Yunnan Province,and to provide evidence for developing effective prevention and control strategies for CKM.Methods:A cross-sectional survey was conducted among four ethnic minority groups.A total of 3 906 permanent residents aged 18 years and older were enrolled using a multistage cluster random sampling method.CKM stages(0-4)were defined based on the 2023 American Heart Association criteria,stages 3-4 were classified as advanced CKM.Descriptive statistics and chi-square tests were used to compare the prevalence of CKM stages across ethnic groups.Modified Poisson regression was applied to estimate relative risk(RR)and 95%confidence intervals(CI)for factors associated with advanced CKM.Results:The prevalence rates of CKM stage 1 and above among the Hani,Dai,Bai and Lisu ethnic groups were 80.1%,87.3%,84.8%and 67.8%,respectively.The prevalence of CKM was generally higher in males than in females,and the prevalence of CKM increased significantly with age.The Dai ethnic group had the highest prevalence of advanced CKM(24.7%,95%CI:22.1%-27.4%),while the Lisu ethnic group had the lowest prevalence of advanced CKM(13.7%,95%CI:11.5%-15.9%).Modified Poisson regression analysis showed that older age and higher body mass index were common risk factors for advanced CKM across all four ethnic groups.Additionally,except for the Lisu ethnic group,the other three ethnic groups had specific individual risk factors:among the Hani ethnic group,low educational attainment(RR=2.18,95%CI:1.12-4.25)and low income(RR=1.47,95%CI:1.00-2.18)were the primary risk factors of CKM.Among the Dai ethnic group,smoking(RR=1.60,95%CI:1.07-2.37)and a family history of cardiovascular disease(RR=1.61,95%CI:1.14-2.27)are the primary risk factors of CKM.Among the Bai ethnic group,male gender(RR=0.48,95%CI:0.29-0.79)was the primary risk factor of CKM.Conclusions:The prevalence of CKM stage 1 or higher is relatively high among the four minority ethnic groups in Yunnan province.There are significant differences in staging characteristics and primary risk factors across ethnic groups,necessitating the development of stratified,differentiated intervention strategies to achieve precise prevention and control and ethnic health equity in terms of CKM.

In recent years,the Ross procedure has been increasingly applied in the treatment of aortic valve disease in children and young patients.However,right ventricular outflow tract(RVOT)reconstruction in this procedure often relies on allogeneic or artificial materials,which may lead to complications such as calcification and valve dysfunction.This article reports a case of protective Ross procedure using completely autologous tissue to construct a right ventricular-pulmonary artery(RV-PA)conduit.The patient was an 11-year-old male who presented with severe aortic stenosis combined with regurgitation.During the operation,his dilated ascending aortic wall and fresh pericardium were used to construct an autologous valved conduit for RV-PA reconstruction.This innovative technique achieves RV-PA reconstruction without allogeneic tissue,provides a new technical approach for the Ross procedure.Short-term results are satisfactory and the medium-and long-term outcomes require further follow-up verification.

This article reports the first case of percutaneous closure of patent foramen ovale(PFO)using a biodegradable occluder under echocardiography guidance.The patient is a 43-year-old female diagnosed with PFO-related stroke.The procedure was successfully completed under echocardiography guidance without complications.During the 48-month follow-up period,the patient experienced no recurrent strokes,and the occluder was fully degraded.

Hypertension is a major global risk factor for cardiovascular disease but has a low control rate.This paper compares the"grading,staging,and typing"management concepts in the latest Chinese and foreign hypertension guidelines and explores their implications for China's cardiovascular prevention and control.Despite differences among countries in hypertension classification,cardiovascular risk stratification,and antihypertensive treatment timing and targets,all guidelines follow the"grading,staging,and typing"concept.Given China's national conditions,this concept can enhance hypertension management precision,optimize medical resource allocation,and boost the development of cardiovascular precision medicine.

Objectives:To investigate the impact of the Micra AV leadless pacemaker on cardiac function.Methods:A total of 76 patients who received the implantation of Micra AV leadless pacemaker due to sick sinus syndrome or atrioventricular block at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from September 2022 to April 2023 were included in this study.Among them,26 patients(34.2%)had sick sinus syndrome,and 50 patients(65.8%)had atrioventricular block.The patients were followed up for 1 year postoperatively.Cardiac function was evaluated by echocardiography,and the parameters of the pacemaker were collected through the outpatient clinic programming system.Results:After a follow-up of 120(87,181)days,compared with the preoperative state,the left ventricular ejection fraction(LVEF)decreased postoperatively([66.6±5.6]%vs.[63.8±5.2]%,P<0.001),and the cardiac output increased[(4.3±1.2)L/min vs.(5.3±1.5)L/min,P<0.001].There were no statistically significant differences in various cardiac function indexes of patients with sick sinus syndrome between the postoperative and preoperative states(all P>0.05).Compared with the preoperative state,in patients with atrioventricular block,the LVEF decreased postoperatively([67.0±5.1]%vs.[63.4±4.4]%,P<0.001),the cardiac output increased([4.2±1.1]L/min vs.[5.2±1.2]L/min,P<0.001),and the left ventricular end-diastolic diameter decreased[(49.9±5.4)mm vs.(48.6±5.0)mm,P=0.044].Firth's logistic regression analysis indicated that the preoperative LVEF(for every 1%increase,OR=1.56,95%CI:1.12-2.17,P=0.001),stroke volume(for every 1 ml increase,OR=1.15,95%CI:1.04-1.28,P=0.001),body mass index(for every 1 kg/m2 increase,OR=1.49,95%CI:1.02-2.17,P=0.020),and hypertension(OR=12.71,95%CI:1.11-145.13,P=0.039)were independent risk factors for the decrease in LVEF after surgery in patients with atrioventricular block.After the implantation of the MciraTM AV leadless pacemaker,the overall atrioventricular synchrony rate was 81.2%(68.8%,89.0%).The atrioventricular synchrony rates of patients with sick sinus syndrome and those with atrioventricular block were 70.6%(59.5%,83.4%)and 82.4%(74.2%,89.3%)respectively(P<0.05).Firth's logistic regression analysis indicated that sick sinus syndrome(OR=0.26,95%CI:0.07-0.89,P=0.029)and preoperative LVEF(for every 1%increase,OR=1.18,95%CI:1.03-1.35,P=0.015)were independent predictive factors for the atrioventricular synchrony rate>80%.Conclusions:There are differences in the impacts of the Micra AV leadless pacemaker on the LVEF and atrioventricular synchrony rate between patients with sick sinus syndrome and those with atrioventricular block.The preoperative LVEF,stroke volume,body mass index,and hypertension have independent predictive effects on the decrease in postoperative LVEF in patients with atrioventricular block.Sick sinus syndrome and preoperative LVEF are independent predictive factors for the atrioventricular synchrony rate>80%after surgery.

Objectives:QT interval prolongation during treadmill test exercise is one of the clinical feature of patients with long QT syndrome(LQTS).This study aimed to explore the feasibility and efficacy of treadmill exercise testing as an auxiliary diagnosis tool for LQTS in clinical practice.Methods:We enrolled normal healthy individuals,common cardiovascular disease patients,and clinically diagnosed or suspected LQTS patients,who underwent treadmill exercise test from July 2023 to July 2024 at Fuwai Hospital.A special treadmill exercise testing procedure was designed to record the QT interval correction(QTc)intervals of the twelve lead electrocardiogram at 6 time points when performing the exercise tablet,including supine,sitting,standing,peak exercise,and recovery at 1-minute and 4-minute.The differences in QTc intervals among healthy group,cardiovascular diseases group,and suspected LQTS group were compared.Results:A total of 80 cases were consecutively enrolled,including 37 normal healthy controls,25 patients with common cardiovascular disease,and 18 patients with suspected LQTS.The QTc intervals at 6 points did not differ significantly between normal healthy controls and patients with cardiovascular disease,with QTc intervals less than 480 ms at all measurement.For patients with suspected LQTS,67.7%(12/18)of these patients presented a QTc interval≥480 ms at the 4-minute during recovery period.Among them,5 cases were confirmed to have pathogenic gene mutations of LQTS by genetic testing(including 1 case with a lying electrocardiogram QTc interval of 489 ms diagnosed with LQTS 1 type and a QTc interval of 636 ms during the 4-minute recovery period after exercise);5 clinically diagnosed patients(negative or undetectable in genetic testing)with a Schwartz score≥4,and the remaining 2 patients had a Schwartz score of 3.The remaining 5/18 patients,include 2 patients with clinical Schwartz scores≥4 and 3 patients with clinical suspicion(Schwartz scores 2-3)had a 4 min QTc interval of 445-480 ms during exercise recovery.Another patient with clinical suspicion(Schwartz score 3)had a 4 min QTc interval of<445 ms during exercise recovery and a negative genetic test at a later stage.Receiver operating characteristic curve analysis showed a sensitivity of 83.3%and specificity of 98.4%for QTc interval≥482 ms during the 4-minute recovery period of exercise as the LQTS diagnostic cutoff.Conclusions:This study results suggest that this special treadmill exercise testing protocol is effective in identifying LQTS and has strong feasibility and generalizability for clinical practice.