Objective:To investigate whether changes in CT pulmonary angiography (CTPA) parameters before and after balloon pulmonary angioplasty (BPA) are correlated with treatment effects in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods:A retrospective study was conducted, including patients with CTEPH who underwent BPA treatment at Beijing Anzhen Hospital from November 2021 to Febbruary 2024. Clinical data and CTPA parameters were analyzed before the initial BPA session and at least 6 months after the final BPA session. Clinical data included WHO functional class, 6-minute walk distance (6MWD), and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. The CTPA parameters included the widest diameter of the pulmonary artery diameter (dPA), ascending aorta diameter (dAA), the widest transverse diameter of the right atrium (dRA), the widest short-axis diameter of the right ventricle (dRV), the widest short-axis diameter of the left ventricle (dLV), and the diameter of right ventricular free wall thickness(dRVW). Multiple linear regression was applied to identify variables associated with the decrease in mean pulmonary artery pressure (mPAP) among the CTPA parameters.Results:All CTEPH patients underwent a total of 115 BPA treatments. Postoperatively, the WHO functional class of the patients improved compared to preoperative levels ( χ2=5.01, P<0.001), 6MWD improved ( t=4.50, P<0.001), and NT-proBNP levels decreased ( Z=4.47, P<0.001). Hemodynamic parameters, including mPAP, pulmonary vascular resistance, cardiac output, and cardiac index, were significantly improved postoperatively (all P<0.001). CTPA-related parameters, including dPA, dRA, dRV, dRVW, dPA/dAA, dRV/dLV, and dRA/dPA, significantly decreased compared to preoperative values (all P<0.001). Multiple linear regression analysis showed that the decrease in dPA ( β=0.314, P=0.037) and dRA ( β=0.334, P=0.046) were significantly correlated with the improvement in mPAP. Conclusions:Exercise tolerance, hemodynamics, and CTPA parameters in patients with CTEPH significantly improved after BPA treatment. The decrease in dPA and dRA were significantly correlated with the improvement in mPAP, suggesting that CTPA is a potentially novel, objective, effective, and noninvasive method for evaluating the therapeutic efficacy of BPA.

Objectives:To explore the correlation between angiography-derived microcirculatory resistance(AMR)and microvascular obstruction(MVO)extent,and AMR's predictive value for ventricular remodeling in patients with ST-segment elevation myocardial infarction(STEMI)post-primary percutaneous coronary intervention(PCI).Methods:This retrospective study included STEMI patients who underwent PCI at Beijing Anzhen Hospital from April 2019 to January 2023.Patients underwent acute and follow-up cardiac magnetic resonance(CMR)examinations 3-7 days and 3 months post-PCI.Ventricular remodeling was defined as a 20%or more increase in left ventricular end-diastolic volume at follow-up.Patients were divided into ventricular remodeling and non-ventricular remodeling groups.Baseline clinical characteristics,AMR values and CMR indices of both groups were compared.Pearson's correlation coefficient was used to explore the correlation between AMR and MVO extent on CMR.Logistic regression and receiver operating characteristic curve analysis were employed to evaluate the predictive performance of AMR for ventricular remodeling.Results:A total of 168 STEMI patients([56.4±11.4]years,139[82.7%]males)were included,with 49(29.2%)in the ventricular remodeling group and 119(70.8%)in the non-ventricular remodeling group.AMR was positively correlated with MVO extent on CMR(r=0.42,P<0.01).Compared to the non-ventricular remodeling group,patients in the ventricular remodeling group exhibited a higher AMR value(3.00[2.56,3.52]mmHg?s/cm vs.2.48[2.20,2.74]mmHg?s/cm,1 mmHg=0.133 kPa,P<0.01).Multivariate logistic analysis showed that AMR was independently associated with ventricular remodeling post-PCI in STEMI patients.For every 0.2 mmHg·s/cm increase in AMR,the risk for ventricular remodeling increased 45.1%(adjusted OR=1.451,95%CI:1.228-1.714,P<0.01).Area under the curve of AMR for predicting ventricular remodeling was 0.769.Conclusions:AMR is positively correlated with MVO extent and is an independent predictor for ventricular remodeling in STEMI patients post-PCI.

Objectives:To explore the correlation between angiography-derived microcirculatory resistance(AMR)and microvascular obstruction(MVO)extent,and AMR's predictive value for ventricular remodeling in patients with ST-segment elevation myocardial infarction(STEMI)post-primary percutaneous coronary intervention(PCI).Methods:This retrospective study included STEMI patients who underwent PCI at Beijing Anzhen Hospital from April 2019 to January 2023.Patients underwent acute and follow-up cardiac magnetic resonance(CMR)examinations 3-7 days and 3 months post-PCI.Ventricular remodeling was defined as a 20%or more increase in left ventricular end-diastolic volume at follow-up.Patients were divided into ventricular remodeling and non-ventricular remodeling groups.Baseline clinical characteristics,AMR values and CMR indices of both groups were compared.Pearson's correlation coefficient was used to explore the correlation between AMR and MVO extent on CMR.Logistic regression and receiver operating characteristic curve analysis were employed to evaluate the predictive performance of AMR for ventricular remodeling.Results:A total of 168 STEMI patients([56.4±11.4]years,139[82.7%]males)were included,with 49(29.2%)in the ventricular remodeling group and 119(70.8%)in the non-ventricular remodeling group.AMR was positively correlated with MVO extent on CMR(r=0.42,P<0.01).Compared to the non-ventricular remodeling group,patients in the ventricular remodeling group exhibited a higher AMR value(3.00[2.56,3.52]mmHg?s/cm vs.2.48[2.20,2.74]mmHg?s/cm,1 mmHg=0.133 kPa,P<0.01).Multivariate logistic analysis showed that AMR was independently associated with ventricular remodeling post-PCI in STEMI patients.For every 0.2 mmHg·s/cm increase in AMR,the risk for ventricular remodeling increased 45.1%(adjusted OR=1.451,95%CI:1.228-1.714,P<0.01).Area under the curve of AMR for predicting ventricular remodeling was 0.769.Conclusions:AMR is positively correlated with MVO extent and is an independent predictor for ventricular remodeling in STEMI patients post-PCI.

Objective:To investigate whether changes in CT pulmonary angiography (CTPA) parameters before and after balloon pulmonary angioplasty (BPA) are correlated with treatment effects in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods:A retrospective study was conducted, including patients with CTEPH who underwent BPA treatment at Beijing Anzhen Hospital from November 2021 to Febbruary 2024. Clinical data and CTPA parameters were analyzed before the initial BPA session and at least 6 months after the final BPA session. Clinical data included WHO functional class, 6-minute walk distance (6MWD), and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. The CTPA parameters included the widest diameter of the pulmonary artery diameter (dPA), ascending aorta diameter (dAA), the widest transverse diameter of the right atrium (dRA), the widest short-axis diameter of the right ventricle (dRV), the widest short-axis diameter of the left ventricle (dLV), and the diameter of right ventricular free wall thickness(dRVW). Multiple linear regression was applied to identify variables associated with the decrease in mean pulmonary artery pressure (mPAP) among the CTPA parameters.Results:All CTEPH patients underwent a total of 115 BPA treatments. Postoperatively, the WHO functional class of the patients improved compared to preoperative levels ( χ2=5.01, P<0.001), 6MWD improved ( t=4.50, P<0.001), and NT-proBNP levels decreased ( Z=4.47, P<0.001). Hemodynamic parameters, including mPAP, pulmonary vascular resistance, cardiac output, and cardiac index, were significantly improved postoperatively (all P<0.001). CTPA-related parameters, including dPA, dRA, dRV, dRVW, dPA/dAA, dRV/dLV, and dRA/dPA, significantly decreased compared to preoperative values (all P<0.001). Multiple linear regression analysis showed that the decrease in dPA ( β=0.314, P=0.037) and dRA ( β=0.334, P=0.046) were significantly correlated with the improvement in mPAP. Conclusions:Exercise tolerance, hemodynamics, and CTPA parameters in patients with CTEPH significantly improved after BPA treatment. The decrease in dPA and dRA were significantly correlated with the improvement in mPAP, suggesting that CTPA is a potentially novel, objective, effective, and noninvasive method for evaluating the therapeutic efficacy of BPA.

Objective:To evaluate the correlation and consistency between quantitative coronary flow fraction (QFR) and cardiac magnetic resonance imaging (CMR) in assessing myocardial ischemia in patients with coronary heart disease (CAD).Methods:A retrospective analysis was conducted on the data of coronary heart disease patients who underwent load CMR examination and coronary angiography at the Beijing Anzhen Hospital, Capital Medical University from August 2017 to March 2022. CMR examination includes cardiac cine, load/rest myocardial perfusion imaging, and delayed enhancement sequence. According to the results of CMR examination, the patient′s left ventricular myocardial segments were divided into normal segment group and abnormal segment group (further divided into ischemic segment group and infarcted segment group). On the basis of coronary angiography, an artificial intelligence based platform (AngioPlus system) was applied to calculate the preoperative coronary artery QFR value of patients undergoing percutaneous coronary intervention treatment. Kappa test was used to evaluate the consistency of QFR and CMR in diagnosing abnormal myocardium; Mann Whitney U test was used to compare the differences in QFR between groups; The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of QFR in diagnosing abnormal myocardium; Spearman correlation analysis was used to clarify the relationship between myocardial infarction area and QFR value of the supplying coronary artery in patients.Results:Among the 70 CAD patients enrolled, there were 60 males and 10 females, aged (54.1±11.1)years. At the vascular level, the consistency between QFR and CMR in diagnosing myocardial injury (including ischemia and infarction) is moderate (Kappa value=0.514). The sensitivity and specificity of detecting abnormal myocardial segments in CAD patients were 57% and 91%, respectively. The area under the curve (AUC) value of QFR predicting abnormal myocardium in CAD patients was 0.769, and the optimal cutoff value was QFR=0.865. At this time, the sensitivity and specificity of QFR predicting myocardial injury in CAD patients were 67.2% and 84.3%, respectively. The difference in vascular QFR between the normal segment group, ischemic segment group, and infarcted segment group was statistically significant ( P<0.001), with the infarcted segment group having significantly lower QFR values than the other two groups (all P<0.01). The range of myocardial infarction was negatively correlated with the QFR value of the supplying coronary artery ( r=-0.45, P<0.001). At the patient level, the consistency between QFR and CMR in diagnosing myocardial injury (including ischemia and infarction) was moderate (Kappa value=0.445), with a sensitivity of 74% and a specificity of 81% for diagnosing myocardial injury in CAD patients. Conclusions:Compared with CMR, QFR has better specificity in detecting myocardial injury in CAD patients. The QFR value of the infarcted segment group is significantly lower than that of the ischemic group and the normal group. The area of myocardial infarction is negatively correlated with the QFR value of the supplying coronary artery.

Objective:To explore the value of predicting new-onset heart failure events in patients with hypertrophic cardiomyopathy (HCM) using clinical and cardiac magnetic resonance (CMR) features based on machine learning algorithms.Methods:The study was a retrospective cohort study. Patients with a confirmed diagnosis of HCM who underwent CMR examinations at Beijing Anzhen Hospital from May 2017 to March 2021 were selected and randomly divided into the training set and the validation set in a ratio of 7∶3. Clinical data and CMR parameters (including conventional parameters and radiomics features) were collected. The endpoint events were heart failure hospitalization and heart failure death, with follow-up ending in January 2023. Features with high stability and P value<0.05 in univariate Cox regression analysis were selected. Subsequently, three machine learning algorithms—random forest, decision tree, and XGBoost—were used to build heart failure event prediction models in the training set. The model performance was then evaluated using the independent validation set, with the performance assessed based on the concordance index. Results:A total of 462 patients were included, with a median age of 51 (39, 62) years, of whom 332 (71.9%) were male. There were 323 patients in the training set and 139 in the validation set. The median follow-up time was 42 (28, 52) months. A total of 44 patients (9.5% (44/462)) experienced endpoint events (8 cases of heart failure death and 36 cases of heart failure hospitalization), with 31 events in the training set and 13 in the validation set. Univariate Cox regression analysis identified 39 radiomic features, 4 conventional CMR parameters (left ventricular end-diastolic volume index, left ventricular end-systolic volume index, left ventricular ejection fraction, and late gadolinium enhancement ratio), and 1 clinical feature (history of non-sustained ventricular tachycardia) that could be included in the machine learning model. In the prediction models built with the training set, the concordance indices for the random forest, decision tree, and XGBoost models were 0.966 (95% CI 0.813-0.995), 0.956 (95% CI 0.796-0.992), and 0.973 (95% CI 0.823-0.996), respectively. In the validation set, the concordance indices for the random forest, decision tree, and XGBoost models were 0.854 (95% CI 0.557-0.964), 0.706 (95% CI 0.399-0.896), and 0.703 (95%CI 0.408-0.890), respectively. Conclusion:Integrating clinical and CMR features of HCM patients through machine learning aids in predicting heart failure events, with the random forest model showing superior performance.

Objective:To investigate the value of radiomics features derived from cardiac MR (CMR) cine images for predicting late gadolinium enhancement (LGE) in patients with hypertrophic cardiomyopathy (HCM).Methods:Firstly, a total of 300 HCM patients with definite diagnosis who underwent CMR examination in Beijing Anzhen Hospital from May 2017 to August 2021 were retrospectively included, and were divided into a training set and a test set with a proportion of 7∶3 using random stratified sampling method. Then, a total of 89 HCM patients with definite diagnosis who underwent CMR examination in Beijing Anzhen Hospital from January 2022 to May 2023 were included for external validation. The CVI42 software was used to obtain the cardiac function parameters. Intraclass correlation coefficient (ICC), Pearson correlation coefficient and least absolute shrinkage and selection operator (LASSO) were used to select radiomics features. Finally, LASSO regression and three machine learning algorithms (including support vector machine, linear discriminant analysis and naive Bayes) were used to build prediction models. The area under the receiver operating characteristic curve (AUC) was used to evaluate the prediction value of the model.Results:Totally 1 409 features were extracted from each patient, and 19 features were retained to build radiomics signature after dimension reduction. Although no significant differences among the four methods, the prediction performance and stability of LASSO regression were relatively good. The AUC was 0.795 (95%CI 0.735-0.855) in the training set, 0.765 (95%CI 0.668-0.862) in the test set and 0.721(95%CI 0.598-0.845) in the external validation set.Conclusions:The features extracted from CMR cine images can be used to predict LGE in HCM patients. LASSO regression is recommended for model construction.

Objective:To compare the effect of intracorporeal anastamosis and extracorporeal anastamosis on abdominal infection associated with laparoscopic right hemicolectomy.Methods:The clinical data of 210 patients with colon cancer who underwent laparoscopic right hemicolectomy in Dalian Third Peoples′s Hospital, Liaoning Province from January 2015 to December 2019 were analyzed retrospectively.Among them, 79 patients underwent intracorporeal anastamosis (intracorporeal anastamosis group) and 131 patients underwent extracorporeal anastamosis (extracorporeal anastamosis group). The perioperative indexes and postoperative abdominal infection were compared between the two groups.Results:In intracorporeal anastamosis group, the intraoperative bleeding was (45.2±4.2) mL, the operative time was (161.3±22.4) min, the number of lymph node dissection was (30.8±9.6), the postoperative exhaust time was (3.3±1.2) d, and the postoperative hospital stay was (7.6±0.5) d. In extracorporeal anastamosis group was (42.1±5.0) mL, (167.3±26.7) min, (32.9±8.6), (3.4±1.0) d and (7.5±0.6) d, respectively, there were no significant difference between the two groups (t value were 0.417, 0.207, 0.829, 0.338 and 0.293, respectively; P value were 0.699, 0.845, 0.231, 0.734 and 0.802, respectively). In intracorporeal anastamosis group, the incidence of abdominal infection (with anastomotic fistula)was 13.9%(11/79), the incidence of abdominal infection (without anastomotic fistula)was 10.1%(8/79), and in extracorporeal anastamosis group was 1.5%(2/131)and 0.8%(1/131), the differences were statistically significant (χ 2=12.805, 10.238; P=0.003, 0.008). In intracorporeal anastamosis group, the incidence of respiratory system infection was 1.3%(1/79), the incidence of urinary system infection was 2.5%(2/79), the incidence of surgical incision infection was 1.3%(1/79). In extracorporeal anastamosis group was 3.1%(4/131), 0.8%(1/131) and 3.1%(4/131), respectively.There were no significant difference between the two groups (χ 2 value were 0.662, 0.420 and 0.662, respectively; P value were 0.364, 0.587 and 0.364, respectively). Conclusion:Laparoscopic right hemicolectomy with intracorporeal anastamosis and extracorporeal anastamosis have the same surgical effect, but intracorporeal anastamosis may increase the risk of postoperative abdominal infection.

Objective:To investigate the relationship between serum procollagen Ⅲ amino terminal peptide (PIIINP), collagen I carboxyl terminal cross-linking peptide (CTXI), high-sensitivity C-reactive protein (hs-CRP) and cardiac magnetic resonance (CMR) T 1 mapping value in patients with lone atrial fibrillation (AF). Methods:Fifty-five patients with lone AF in Beijing Anzhen Hospital from July 2017 to June 2018 were prospectively enrolled. Another 20 healthy volunteers were examined at the same time to provide normal reference range. All patients completed PIIINP, CTXI, hs-CRP and CMR examination within one week. CMR examination including cine, pre-contrast T 1 mapping, and late gadolinium enhancement sequences. We used t test, Mann-Whitney U test or chi square test to compare the difference of the above indexes between AF patients and the control group. Spearman correlation analysis was used to determine the associations between left ventricular native T 1 value and blood biomarker in AF patients. Results:All the patients were paroxysmal AF with an average age of (48±10) years, of which 46 (83.6%) were male. The PIIINP, CTXI, hs-CRP, left ventricular native T 1 value of AF patients were 5.83 (3.52, 12.40) ng/ml, 4.63 (3.31, 6.82) μg/ml, 3.41 (1.72, 6.61) mg/L and (1 261±23) ms, respectively, which all significant higher than those in healthy subjects (all P<0.05). The native T 1 value of left ventricular myocardium was positively correlated with PIIINP ( r=0.492, P<0.05) and hs-CRP ( r=0.516, P<0.05), but not with CTXI ( r=0.021, P>0.05). Conclusions:The PIIINP, CTXI and hs-CRP increased in patients with lone AF, PIIINP and hs-CRP were correlated with elevated native T 1 value of left ventricular myocardium.

Objective:To compare the effect of midcaudal combined approach and the cephalic middle approach in laparoscopic complete mesocolic excision (CME) in the treatment of right colon cancer complicated with incomplete intestinal obstruction.Methods:From January 2014 to January 2019, 90 patients with right colon cancer complicated with incomplete intestinal obstruction admitted to the Third People′s Hospital of Dalian were retrospectively analyzed.All patients underwent laparoscopic right hemicolectomy, CME plus D3 lymph node dissection.According to the choice of different surgical approaches, 44 patients were treated with the midcaudal combined approach (observation group) and the other 46 patients were treated with cephalic middle approach (control group). The intraoperative, postoperative and complications of the two groups were compared statistically.Results:Compared with the control group, the bleeding volume in the observation group was significantly reduced ((105.3±22.6) ml vs.(309.6±28.0) ml, t=13.698), the operation time was significantly shortened ((165.2±17.9) min vs.(219.5±21.5) min, t=8.327), and the differences were statistically significant (all P<0.05). There were no significant differences in the number of lymph nodes dissected ((21.4±7.8)vs.(20.4±6.6), t=0.534), the proportion of lymph nodes dissected≥12(86.4%(38/44)vs.84.8%(39/46), χ 2=0.208), the complications after operation(6.8%(3/44)vs.10.9%(5/46), χ 2=0.318), the length of hospital stay after operation ((11.8±1.6) d vs.(12.5±2.3) d, t=0.986), the difference was statistically significant (all P>0.05). Conclusion:It is safe and feasible to use the middle caudal approach in laparoscopic CME for right colon cancer complicated with incomplete ileus. Compared with the cephalic middle approach, it can reduce thebleeding volume and shorten the operation time.