Objective To evaluate the efficacy of transcatheter mitral valve edge-to-edge repair using the domestic NovoClasp system in patients with primary moderate-to-severe mitral regurgitation(MR).Methods A retrospective analysis was conducted on 19 patients with primary MR who underwent transcatheter mitral valve edge-to-edge repair using the domestic NovoClasp system at the Cardiac Center,The First Hospital of Hebei Medical University,and completed a 6-month follow-up.All patients underwent a complete preoperative examination,and the safety and efficiency of surgery were evaluated.The safety indicators included immediate success rate of mitral valve clip,clip displacement,mitral stenosis,heart block,acute heart failure,stroke,access vessel rupture,cardiac tamponade,postoperative MR ≥2+,major bleeding,and death.The efficiency indicators included N-terminal pro-B-type natriuretic peptide(NT-proBNP),soluble growth stimulation expressed gene 2(sST2),left ventricular ejection fraction,left ventricular end diastolic diameter,degree of MR,mean mitral transvalvular pressure gradient,mitral valve opening area,and left atrial anteroposterior diameter at various time points(before surgery and at 7 days,3 months,and 6 months after surgery).Results Safety indicators after surgery showed that the immediate success rate of valve implantation was 100％,including in one patient who received two mitral valve clamps and one who suffered from acute stroke(acute cerebral infarction in the right parietal lobe and left parietal-occipital lobe)after surgery.There were no cases of clamps displace-ment,mitral stenosis,heart block,acute heart failure,access vessel rupture,cardiac tamponade,postoperative MR ≥2+,major bleeding,or death.The effectiveness indicators after surgery showed that the degree of MR significantly improved 7 days after surgery compared with that before surgery(Z=5.466,P＜0.001).Clinical symptoms improved significantly after surgery,with proportion of NYHA Ⅰ-Ⅱ(9 cases,47.4％)significantly higher than that before surgery(1 case,5.3％),and 17 patients(89.5％)of NYHA Ⅰ-Ⅱ achieved good thera-peutic effect as assessed 6 months after surgery.The level of NT-proBNP decreased significantly 7 days after surgery compared with that before surgery(P=0.001);it then gradually decreased during follow-ups.sST2 significantly decreased 3 months after surgery compared with that before surgery(P=0.001),with a gradually decreasing trend thereafter.The left ventricular end-diastolic diameter showed a sig-nificant difference before and 6 months after surgery(P=0.006).The average mitral valve transvalvular pressure gradient was significantly different before and 7 days after surgery(P=0.001),and there was little change within 6 months after surgery.The mitral valve opening area showed a significant difference before and 7 days after surgery(P=0.001),with little change within 6 months after surgery.There were no significant differences in the left ventricular ejection fraction and left atrial anteroposterior diameter before and within 6 months after surgery.Conclusion The transcatheter mitral valve edge-to-edge repair using the domestic NovoClasp system is safe and effective for the treatment of primary moderate-to-severe MR.

Objective To evaluate the efficacy of transcatheter mitral valve edge-to-edge repair using the domestic NovoClasp system in patients with primary moderate-to-severe mitral regurgitation(MR).Methods A retrospective analysis was conducted on 19 patients with primary MR who underwent transcatheter mitral valve edge-to-edge repair using the domestic NovoClasp system at the Cardiac Center,The First Hospital of Hebei Medical University,and completed a 6-month follow-up.All patients underwent a complete preoperative examination,and the safety and efficiency of surgery were evaluated.The safety indicators included immediate success rate of mitral valve clip,clip displacement,mitral stenosis,heart block,acute heart failure,stroke,access vessel rupture,cardiac tamponade,postoperative MR ≥2+,major bleeding,and death.The efficiency indicators included N-terminal pro-B-type natriuretic peptide(NT-proBNP),soluble growth stimulation expressed gene 2(sST2),left ventricular ejection fraction,left ventricular end diastolic diameter,degree of MR,mean mitral transvalvular pressure gradient,mitral valve opening area,and left atrial anteroposterior diameter at various time points(before surgery and at 7 days,3 months,and 6 months after surgery).Results Safety indicators after surgery showed that the immediate success rate of valve implantation was 100％,including in one patient who received two mitral valve clamps and one who suffered from acute stroke(acute cerebral infarction in the right parietal lobe and left parietal-occipital lobe)after surgery.There were no cases of clamps displace-ment,mitral stenosis,heart block,acute heart failure,access vessel rupture,cardiac tamponade,postoperative MR ≥2+,major bleeding,or death.The effectiveness indicators after surgery showed that the degree of MR significantly improved 7 days after surgery compared with that before surgery(Z=5.466,P＜0.001).Clinical symptoms improved significantly after surgery,with proportion of NYHA Ⅰ-Ⅱ(9 cases,47.4％)significantly higher than that before surgery(1 case,5.3％),and 17 patients(89.5％)of NYHA Ⅰ-Ⅱ achieved good thera-peutic effect as assessed 6 months after surgery.The level of NT-proBNP decreased significantly 7 days after surgery compared with that before surgery(P=0.001);it then gradually decreased during follow-ups.sST2 significantly decreased 3 months after surgery compared with that before surgery(P=0.001),with a gradually decreasing trend thereafter.The left ventricular end-diastolic diameter showed a sig-nificant difference before and 6 months after surgery(P=0.006).The average mitral valve transvalvular pressure gradient was significantly different before and 7 days after surgery(P=0.001),and there was little change within 6 months after surgery.The mitral valve opening area showed a significant difference before and 7 days after surgery(P=0.001),with little change within 6 months after surgery.There were no significant differences in the left ventricular ejection fraction and left atrial anteroposterior diameter before and within 6 months after surgery.Conclusion The transcatheter mitral valve edge-to-edge repair using the domestic NovoClasp system is safe and effective for the treatment of primary moderate-to-severe MR.

[Objective] To explore the safety and effectiveness of provisional stenting (PS) applied in patients with unprotected simple left main bifurcation lesions, and to observe the impact of this procedure on cardiac function, myocardial injury, and myocardial perfusion. [Methods] A retrospective analysis was made on 82 patients with unprotected simple left main bifurcation lesions who underwent elective stenting and completed a 3-month follow-up in the Department of Cardiology, Hebei Medical University First Hospital. All the patients underwent preoperative examinations, including rest dynamic single-photon emission computed tomography (D-SPECT) and regadenoson stress D-SPECT before and 3 months after surgery. The safety evaluation indicators for the surgery included immediate success rate of stent implantation, acute stent thrombosis, coronary no-reflow, branch involvement, branch acute occlusion, acute left heart failure, heart block, cardiac tamponade, major bleeding, and mortality. The effectiveness evaluation indicators included the minimum lumen area (MLA) of the left main trunk of coronary artery measured by intravenous ultrasound (IVUS) before and after surgery, as well as cardiac function indicators [brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD)] and myocardial injury indicators [creatine kinase isoenzyme-MB (CK-MB), cardiac troponin Ⅰ (cTn Ⅰ)] at day 1, day 7, 1 month, and 3 months before and after surgery. The myocardial perfusion evaluation indicators included the total myocardial perfusion score and total ischemic segment number under the 17-segment distribution of myocardial perfusion using rest D-SPECT and regadenoson stress D-SPECT before and 3 months after surgery. [Results] Safety indicators: immediate success rate of stent implantation (100%), 19 cases (23.1%) of circumflex branch involvement that underwent balloon anastomosis dilation, 1 case of acute branch occlusion, followed by double stent surgery using provisional stenting-T stenting (PS-T) technique. There were no cases of acute stent thrombosis, coronary reflow, acute left heart failure, cardiac block, cardiac tamponade, major bleeding, or death. Effectiveness indicators: the MLA of the left main trunk measured by postoperative IVUS showed significant improvement compared to the preoperative. BNP, CK-MB, and cTnⅠ showed significant improvement from day 7 after surgery compared to before. Myocardial perfusion indicators: the total score of myocardial perfusion and the total number of ischemic segments in the 17-segment distribution of the myocardium after 3 months of surgery were significantly better than before. [Conclusion] PS can improve heart function, myocardial injury, and myocardial perfusion in patients with unprotected simple left main bifurcation lesions.

Objective To evaluate the role of quantitative flow ratio(QFR)in percutaneous coronary intervention(PCI)by using regadenoson stress dynamic single-photon emission computed tomography(D-SPECT).Methods We selected 200 patients with unstable angina admitted to Department of Cardiology,Hebei Medical University First Hospital,from June 31,2021 to June 31,2023 for elective PCI.The patients were aged 57.56±8.23 years and were randomly divided into a conventional group(n=100)and a QFR group(n=100)according to a random number table.The trial was conducted using a double-blind method.The conventional group received PCI treatment based on the experience of the physician,while the QFR group received PCI treatment based on the QFR measurement results.All enrolled patients underwent pre-operative and 7-day post-operative D-SPECT stress imaging using regadenoson stress D-SPECT,and their images were acquired from short axis,vertical long axis,and horizontal long axis to calculate the total myocardial perfusion score and the total myocardial ischemia segment number under the distribution of 17 myocardial segments.Results There was no significant difference in the number of myocardial ischemia segments(7.59±3.14 vs.7.48±3.36,P=0.811)or the total myocardial perfusion score(15.87±7.61 vs.15.63±5.97,P=0.860)between the two groups before PCI.The number of myocardial ischemia segments(5.58±3.36 vs.6.51±2.14,P=0.020)and the total myocardial perfusion score(10.55±4.41 vs.12.96±6.50,P=0.002)in the QFR group were significantly better than those in the conventional group 7 days after PCI(P＜0.05).Conclusion Applying QFR guidance for PCI can better improve the degree of myocardial ischemia in patients.

Objective To evaluate the efficacy of recombinant human TNK tissue-type plasminogen activator and adenosine injection through guiding in treating acute ST-segment elevation myocardial infarction(ASTEMI)in emergency primary percutaneous coronary intervention(PPCI).Methods Patients with ASTEMI who chose to receive emergency PPCI were randomly divided into control group and treatment group according to a digital random table method.The control group received conventional treatment of PPCI.If the infarct-related artery(IRA)reached TIMI flow grade 3 after PPCI,the operation was terminated.If TIMI flow was ≤2,then a guide catheter to inject sodium nitroprusside,nitroglycerin,and tirofiban into the coronary artery to improve coronary microcirculation dysfunction(CMD)was applied until the IRA reached TIMI flow grade 3.The treatment group received the conventional treatment of PPCI,and after opening of the IRA during the operation,a guide catheter to inject recombinant human TNK tissue-type plasminogen activator(8 mg)and adenosine(200 pg)into the coronary artery was applied.If the IRA reached TIMI flow grade 3,the operation was terminated.If TIMI flow was ≤2,then adenosine injection was re-applied to improve CMD until the IRA reached TIMI flow grade 3.Observation indicators were as follows:① myocardial injury indicators:cardiac troponin Ⅰ(cTnⅠ),creatine kinase isoenzyme(CK-MB),and N-Terminal pro-brain natriuretic peptide(NT-pro BNP)levels before and 12 h,24 h,36 h,and 48 h after surgery;② myocardial perfusion indicators:corrected TIMI frame count(CTFC)after surgery and ST segment regression value(STR)at 90 min after surgery;③ degree of myocardial ischemia:rest D-SPECT+adenosine stress D-SPECT examination at day 3 after surgery,observation of myocardial perfusion total score under 17 segment distribution and myocardial ischemia total segment number;@adverse drug reactions at day 30 after surgery:subcutaneous ecchymosis,gingival bleeding,gastrointestinal bleeding,urinary bleeding,hemoglobin decline,and cerebral hemorrhage;⑤ major adverse cardiovascular events(MACE)at day 30 after surgery:cardiac death,myocardial infarction,heart failure,and target vessel revascularization.Results ① Myocardial injury indicators:There was no significant difference in the levels of cTnⅠ,CK-MB,or NT-pro BNP before surgery between the two groups(all P＞0.05).The myocardial injury indicators were significantly lower in the treatment group than in the control group at 12 hours after surgery(all P＜0.05),and then showed a downward trend.There was no significant difference between the two groups at 48 hours after surgery(all P＞0.05).② Myocardial perfusion indicators:CTFC in the treatment group was significantly better than that in the control group after surgery(P＜0.05).Using the rank sum test,the STR was significantly better in the treatment group than in the control group at 90 minutes after surgery(Z=2.437,P=0.014).③ myocardial ischemia:Both groups underwent rest D-SPECT+adenosine stress D-SPECT examination at 3 days after surgery.Under the distribution of 17 myocardial segments,the total score of myocardial perfusion and the total number of myocardial ischemia segments in the treatment group were significantly better than those in the control group(all P＜0.05).④ Adverse drug reactions 30 days after surgery:There was no significant difference in subcutaneous ecchymosis,gingival bleeding,gastrointestinal bleeding,urinary system bleeding,hemoglobin decline,or cerebral hemorrhage between the two groups(P＞0.05).⑤ MACE 30 days after surgery:There was no significant difference in cardiac death,myocardial infarction,heart failure,target vessel revascularization,or total MACE between the two groups(P＞0.05).Conclusion The intra-coronary injection of recombinant human TNK tissue-type plasminogen activator and adenosine injection through a guiding catheter in emergency PPCI is safe and effective for the treatment of ASTEMI.It can improve myocardial injury,myocardial perfusion,and myocardial ischemia.

Objective To study the correlation between the abnormal perfusion area detected by resting+regadenoson stress D-SPECT and the severity of coronary arterial lesions.Methods One hundred patients needing coronary angiography and PCI admitted in the cardiology department of First Hospital of He-bei Medical University from April 1,2022 to April 1,2023 were selected as the study subjects.The resting+regadenoson loading examination was performed by using the special cardiac machine D-SPECT.The patients were divided into the mild ischemia group(range＜10％),moderate ischemia group(range 10％-20％)and severe ischemia group(range＞20％)according to the proportion of sparse or defect appearance in myocardi-al segmental radionuclide distribution during regadenoson stress D-SPECT in comparison with resting exami-nation.The coronary arterial angiography was performed.The Gensini score was calculated.Results The Gensini score in the severe ischemia group was(55.70±20.60)points,which was higher than(41.88±28.07)points in the moderate ischemia group and(39.71±21.40)points in the mild ischemia group,and the differences were statistically significant(P＜0.05).There was no statistically significant difference in the Gensini score between the mild ischemia group and moderate ischemia group(P＞0.05).The mean stent length in the severe ischemia group was(30.50±7.47)mm,which was significantly higher than(20.90±4.72)mm in the mild ischemia group and(23.50±3.87)mm in the moderate ischemia group,and the differ-ences were statistically significant(P＜0.05).There was no statistically significant difference in the mean stent length between the mild ischemia group and moderate ischemia group(P＞0.05).Conclusion The abnormal perfusion area detected by resting+regadenoson stress D-SPECT is conducive to evaluate the severity of coro-nary arterial lesions and the length of needing implantation stent.

Objective This study utilized regadenoson stress D-SPECT to evaluate the impact of remote ischemic precondi-tioning combined with adenosine injection in patients undergoing percutaneous coronary intervention(PCI)using D-SPECT imaging.Methods Three hundred patients requiring coronary angiography and stent implantation were randomly assigned into two groups utilizing the random number table method.The conventional treatment group(150 patients)and the experimental group(150 patients)received standard treatment for coronary heart disease PCI.The experimental group underwent two sessions of remote ischemic precon-ditioning on the day of PCI,wherein the left and right upper arms were inflated to 200 mmHg with continuous pressure for 5 minutes using a blood pressure cuff.Additionally,during the PCI procedure,adenosine was administered to the experimental group at a rate of 50 μg/(kg·min)until the end of the procedure,with other treatments aligning with the conventional treatment group.Each patient received a coronary SYNTAXⅡscore.Resting D-SPECT and regadenoson stress D-SPECT were employed to evaluate total myocardial perfusion score,total myocardial ischemia segments,and left ventricular ejection fraction across 17 segment distributions before and 7 days after PCI.Results Before PCI,the differences in the number of myocardial ischemic segments,total myocardial perfusion score,and left ven-tricular ejection fraction between the two patient groups were not statistically significant(P>0.05).However,7 days post-PCI,compared with the conventional treatment group,the experimental group exhibited significantly improved numbers of myocardial ischemic segments,total myocardial perfusion score,and left ventricular ejection fraction(P<0.05).Furthermore,the differences in adverse drug reactions between the two patient groups were not statistically significant(P>0.05).Conclusion The combined application of remote ischemic preconditioning and adenosine injection in patients undergoing PCI is deemed safe and effective.

Objective To evaluate the efficacy of transcatheter aortic valve replacement(TAVR)in patients with severe aortic valve stenosis.Methods This study included 46 patients with severe aortic valve stenosis who underwent TAVR and completed a six-month follow-up at the Heart Center of the First Hospital of Hebei Medical University between May 2020 and May 2023.All patients underwent a preoperative examination,mini-mental state examination(MMSE),the Montreal cognitive assessment scale(MOCA),and the following safety indicators of surgery,including immediate success rate of valve implantation,valve displacement,death,heart conduction block,perivalve leakage,coronary occlusion,stroke,approach vessel rupture,cardiac tamponade,aortic dissection,and massive bleeding.Effec-tiveness indicators included clinical symptoms,BNP,sST2,and cardiac color Doppler ultrasound preoperatively and one day,seven days,three months,and six months postoperatively.Cognitive function indicators(MMSE and MOCA),were used preoperatively and three and six months postoperatively.The efficacy of transcatheter aortic was evaluated using these indicators.Results The immediate success rate of valve implantation was 100％,with one case of valve displacement,four cases of new bundle branch block,two cases of perivalve leakage,two cases of stroke,one case of inlet vessel rupture,one case of major bleeding,and no deaths,coronary artery occlusion,car-diac tamponade,or aortic dissection.Clinical symptoms improved significantly postoperatively,with 30 cases of NYHA grades Ⅰ to Ⅱbeing significantly higher than the 18 cases preoperatively.The indicators of cardiac function,BNP,and sST2 significantly decreased,and the maximum aortic valve cross-valve flow velocity,aortic valve systolic cross-valve pressure difference,average aortic valve cross-valve pressure difference,and left ventricular end-diastolic diameter significantly improved.The MMSE and MOCA showed significant improve-ments three and six months postoperatively.Conclusion TAVR is a safe and effective method to improve cognitive function in patients with severe aortic stenosis.

Objective To evaluate the value of adenosine injection in paclitaxel eluting PTCA balloon catheter.Methods A total of 200 patients undergoing drug-coated balloon angioplasty were randomly divided into control group receiving conventional treatment after the procedure,and observation group receiving adenosine injection for 3 hours continuously.All patients underwent coronary SYNTAX II scoring,and CK-MB,NT-proBNP,hs-CRP levels were recorded before and after PTCA for 6 hours,12 hours,18 hours,and 24 hours.A dedicated Israeli cardiac machine D-SPECT was used for rest+stress myocardial perfusion radionuclide imaging before and after the PTCA for 7 days.The total myocardial perfusion score under rest+stress myocardial perfusion in 17 segments was observed,as well as the adverse drug reactions after the PTCA.Results There were no significant differences in clinical characteristics,concomitant medication upon admission,coronary SYNTAX II score and PTCA treatment,mean target vessel stenosis,mean balloon diameter and length,CK-MB,NT-proBNP,hs-CRP before PTCA,and total myocardial perfusion score values under resting and stress myocardial perfusion distribution in 17 segments between the two groups(P>0.05).The CK-MB,NT-proBNP,and hs-CRP values in the experimental group were significantly lower than those in the control group at 6,12,18,and 24 hours after PTCA(P<0.05);The total myocardial perfusion score under resting and stress myocardial perfusion distribution in 17 segments was signifi-cantly lower in the experimental group than in the control group at 7 days after PTCA(P<0.05);There was no significant difference in adverse drug reactions between the two groups of patients after PTCA(P>0.05).Conclusions The application of adenosine injection in patients after drug-coated balloon therapy significantly reduced the CK-MB,NT-proBNP,and hs-CRP values 24 hours after PTCA,as well as the total myocardial perfusion score under resting and stress myocardial perfusion distribution in 17 segments 7 days after PTCA,without increasing significant adverse reactions.

Objective To analyze the effect of Hedysari Radix Chinese herbal pieces treatment in acute inferior myocardial infarction patients undergoing percutaneous coronary intervention(PCI).Methods A total of 200 patients with acute inferior myocardial infarction undergoing emergency PCI admitted to department of cardiology of Shijiazhuang People's Hospital from March 31,2020 to March 31,2023 were selected as the study objects.The patients were randomly divided into a control group and a treatment group according to a digital random table method.The control group received routine treatment after PCI,and the patients drank 500 mL of warm water in the morning and afternoon every day,continuing this regimen for up to 30 days post-surgery.The treatment group took 10 g of Hedysari Radix Chinese Herbal pieces in 500 mL of boiling water in the morning and afternoon,soaking it and drinking it coolly and temperately,continuing to take it until 30 days after surgery.Blood pressure,Dopamine dosage,and duration were observed in all patients on 1-5 days after surgery.Major adverse cardiovascular event(MACE),such as cardiac death,myocardial infarction,heart failure,and re-admission were tracked in all patients within 30 days,and adverse reactions and clinical symptom improvement were followed up,using the somatic self-rating scale(SSS).Results The total Dopamine dose in the treatment group was significantly lower than that in the control group(mg:960.4±287.9 vs.1 160.4±610.5,P<0.05),and the duration of use was significantly shorter than that in the control group(hours:60.7±16.9 vs.71.6±20.4,P<0.05).The systolic blood pressure in the treatment group was significantly higher than that in the control group at 1 day after PCI[mmHg(1 mmHg≈0.133 kPa):96.8±19.5 vs.90.2±11.1,P<0.05],until 5 days after PCI(mmHg:106.3±14.4 vs.99.7±13.9,P<0.05),while the changes in diastolic blood pressure were not significant in both groups.The incidence of MACE in the treatment group was significantly lower than that in the control group within 30 days after PCI[4.0%(4/100)vs.13.0%(13/100),P<0.05],and the SSS score was also significantly lower than that in the control group(31.56±11.58 vs.40.72±18.67,P<0.05).Conclusion The effect of Hedysari Radix Chinese herbal pieces treatment can significantly improve clinical efficacy without significant adverse reactions.