Objectives:To investigate the prognostic value of the CHA2DS2-VASc and R2CHA2DS2-VASc scores in patients with atrial fibrillation(AF)and heart failure(HF).Methods:Patients with AF and HF from hospitals diagnosed by the Heart Failure Center in Guangdong Province between January 2017 and December 2021 were selected.Major adverse cardiovascular events(MACE)were used as the follow-up endpoint.Statistical methods such as the area under the receiver operating characteristic(ROC)curve(AUC),net reclassification index(NRI),and integrated discrimination improvement(IDI)were applied to evaluate the predictive value of the CHA2DS2-VASc and R2CHA2DS2-VASc scores in patients with AF and HF.Results:A total of 1 839 patients were enrolled in this study,comprising 703 patients in the MACE group and 1 136 patients in the non-MACE group.Compared with the non-MACE group,the MACE group exhibited significantly advanced age,higher prevalence of New York Heart Association class Ⅳ and coronary artery disease,lower diastolic blood pressure and estimated glomerular filtration rate levels,and elevated serum N-terminal pro-B-type natriuretic peptide concentrations(all P<0.05).Additionally,significantly lower proportions of patients in the MACE group received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors,beta-blockers,mineralocorticoid receptor antagonists,or anticoagulant therapy(all P<0.05).Multivariable logistic regression analysis revealed that each 1-point increment in both CHA2DS2-VASc and R2CHA2DS2-VASc scores was associated with approximately 10%increased risk of MACE.ROC curve analysis demonstrated that the AUC values for predicting MACE in AF patients with HF were 0.555(95%CI:0.528-0.582,P<0.001)for CHA2DS2-VASc and 0.576(95%CI:0.549-0.608,P<0.001)for R2CHA2DS2-VASc,indicating marginally superior discriminatory capacity of the R2CHA2DS2-VASc score.Delong's test confirmed statistically significant differences between the two scoring systems(P=0.001).The R2CHA2DS2-VASc score demonstrated a NRI of 0.259(95%CI:0.166-0.352,P<0.001)and an IDI of 0.007(95%CI:0.005-0.010,P<0.001)compared with the conventional CHA2DS2-VASc score.Although the R2CHA2DS2-VASc score exhibited slightly better predictive accuracy and outcome discrimination capacity than the original scoring system,both scores demonstrated suboptimal clinical predictive performance.Conclusions:Both the R2CHA2DS2-VASc and CHA2DS2-VASc scores show suboptimal performance for predicting the risk of MACE in patients with AF and HF,and the predicting performance of R2CHA2DS2-VASc score is marginally superior to CHA2DS2-VASc score in this patient cohort.

Enhanced External Counterpulsation(EECP)is a non-invasive auxiliary circulation technique that enhances blood perfusion to vital organs such as the heart and brain by elevating diastolic blood pressure in the aorta.It has demonstrated substantial effectiveness in treating ischemic heart disease.However,the application of EECP in ischemic cerebrovascular disease is not widely used both domestically and internationally.Its,indications,influencing factors,and operational procedures lack standardization.Therefore,this expert taskforce comprehensively reviewed relevant literature and combined clinical experience to summarize and propose recommendations for EECP in treating ischemic cerebrovascular disease.This document outlines the working principles,biological effects,and impact of EECP on cerebral blood flow autoregulation.It also proposes indications,influencing factors,treatment protocols,and monitoring indicators for EECP in ischemic cerebrovascular disease,advocating for the establishment of EECP centers with neurological specialties and conducting clinical trials to explore the efficacy and safety of EECP in treating ischemic cerebrovascular disease,thereby expanding its clinical applications.

The China Cardiovascular Health and Disease Report 2024 has recently been released,offering a comprehensive and detailed assessment of the current status of cardiovascular diseases(CVD)and their associated risk factors in China.The report reveals that the number of CVD cases,as well as the overall and age-standardized incidence rates,continue to increase.Among these conditions,atherosclerotic cardiovascular disease(ASCVD)constitutes a major contributor to CVD-related mortality.Although ASCVD is largely preventable and controllable,the management of key modifiable risk factors-such as smoking,obesity,hypertension,dyslipidemia,and diabetes-remains suboptimal.This article systematically summarizes the prevalence,current management practices,and evidence-based prevention strategies for each major ASCVD risk factor,aiming to reinforce for clinicians the impor-tance of not only treating established ASCVD but also proactively guiding patients in the prevention and control of its underlying risk factors,thereby reducing the overall burden of ASCVD in terms of both prevalence and mortality.

The China Cardiovascular Health and Disease Report 2024 has recently been released,offering a comprehensive and detailed assessment of the current status of cardiovascular diseases(CVD)and their associated risk factors in China.The report reveals that the number of CVD cases,as well as the overall and age-standardized incidence rates,continue to increase.Among these conditions,atherosclerotic cardiovascular disease(ASCVD)constitutes a major contributor to CVD-related mortality.Although ASCVD is largely preventable and controllable,the management of key modifiable risk factors-such as smoking,obesity,hypertension,dyslipidemia,and diabetes-remains suboptimal.This article systematically summarizes the prevalence,current management practices,and evidence-based prevention strategies for each major ASCVD risk factor,aiming to reinforce for clinicians the impor-tance of not only treating established ASCVD but also proactively guiding patients in the prevention and control of its underlying risk factors,thereby reducing the overall burden of ASCVD in terms of both prevalence and mortality.

Objectives:To investigate the prognostic value of the CHA2DS2-VASc and R2CHA2DS2-VASc scores in patients with atrial fibrillation(AF)and heart failure(HF).Methods:Patients with AF and HF from hospitals diagnosed by the Heart Failure Center in Guangdong Province between January 2017 and December 2021 were selected.Major adverse cardiovascular events(MACE)were used as the follow-up endpoint.Statistical methods such as the area under the receiver operating characteristic(ROC)curve(AUC),net reclassification index(NRI),and integrated discrimination improvement(IDI)were applied to evaluate the predictive value of the CHA2DS2-VASc and R2CHA2DS2-VASc scores in patients with AF and HF.Results:A total of 1 839 patients were enrolled in this study,comprising 703 patients in the MACE group and 1 136 patients in the non-MACE group.Compared with the non-MACE group,the MACE group exhibited significantly advanced age,higher prevalence of New York Heart Association class Ⅳ and coronary artery disease,lower diastolic blood pressure and estimated glomerular filtration rate levels,and elevated serum N-terminal pro-B-type natriuretic peptide concentrations(all P<0.05).Additionally,significantly lower proportions of patients in the MACE group received angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors,beta-blockers,mineralocorticoid receptor antagonists,or anticoagulant therapy(all P<0.05).Multivariable logistic regression analysis revealed that each 1-point increment in both CHA2DS2-VASc and R2CHA2DS2-VASc scores was associated with approximately 10%increased risk of MACE.ROC curve analysis demonstrated that the AUC values for predicting MACE in AF patients with HF were 0.555(95%CI:0.528-0.582,P<0.001)for CHA2DS2-VASc and 0.576(95%CI:0.549-0.608,P<0.001)for R2CHA2DS2-VASc,indicating marginally superior discriminatory capacity of the R2CHA2DS2-VASc score.Delong's test confirmed statistically significant differences between the two scoring systems(P=0.001).The R2CHA2DS2-VASc score demonstrated a NRI of 0.259(95%CI:0.166-0.352,P<0.001)and an IDI of 0.007(95%CI:0.005-0.010,P<0.001)compared with the conventional CHA2DS2-VASc score.Although the R2CHA2DS2-VASc score exhibited slightly better predictive accuracy and outcome discrimination capacity than the original scoring system,both scores demonstrated suboptimal clinical predictive performance.Conclusions:Both the R2CHA2DS2-VASc and CHA2DS2-VASc scores show suboptimal performance for predicting the risk of MACE in patients with AF and HF,and the predicting performance of R2CHA2DS2-VASc score is marginally superior to CHA2DS2-VASc score in this patient cohort.

Enhanced External Counterpulsation(EECP)is a non-invasive auxiliary circulation technique that enhances blood perfusion to vital organs such as the heart and brain by elevating diastolic blood pressure in the aorta.It has demonstrated substantial effectiveness in treating ischemic heart disease.However,the application of EECP in ischemic cerebrovascular disease is not widely used both domestically and internationally.Its,indications,influencing factors,and operational procedures lack standardization.Therefore,this expert taskforce comprehensively reviewed relevant literature and combined clinical experience to summarize and propose recommendations for EECP in treating ischemic cerebrovascular disease.This document outlines the working principles,biological effects,and impact of EECP on cerebral blood flow autoregulation.It also proposes indications,influencing factors,treatment protocols,and monitoring indicators for EECP in ischemic cerebrovascular disease,advocating for the establishment of EECP centers with neurological specialties and conducting clinical trials to explore the efficacy and safety of EECP in treating ischemic cerebrovascular disease,thereby expanding its clinical applications.

A 36-year-old male patient was hospitalized due to persistent chest tightness and dyspnea last-ing over 10 days.An echocardiogram revealed significant aortic valve regurgitation,the presence of vegetation on the aortic valve,severe mitral valve regurgitation,and enlargement of both the left atrium and left ventricle.Follow-ing a comprehensive multidisciplinary consultation,the focus was directed towards the aortic valve vegetation as the primary concern,with particular attention given to the potential diagnosis of blood culture-negative infective endocarditis(IE)and non-bacterial thrombotic endocarditis,while differentiating it from rheumatic heart disease.Ultimately,the vegetation was excised during a surgical aortic valve replacement procedure,which facilitated histopathological examination,biological culture,and high-throughput metagenomic sequencing of pathogenic mi-croorganisms.The definitive diagnosis was established as aortic valve infective endocarditis(Q fever IE)leading by infection of Coxiella burnetii.

[Objective]To evaluate the changes in cardiac structure and ventricular function in patients with Ander-son-Fabry Disease(AFD)by two-dimensional speckle tracking echocardiography(2D-STE)and to explore the character-istics of their early cardiac involvement.[Methods]All 45 patients diagnosed with AFD in this observational study under-went routine ultrasonic cardiogram(UCG)examination and 2D-STE.The patients were divided into 2 groups based on UCG measurements:with left ventricular hypertrophy(interventricular septum or posterior left ventricular wall thickness≥12 mm)and without left ventricular hypertrophy.TomTec software was used to analyze the echocardiographic images,then the baseline data,UCG routine parameters and myocardial strain of the two groups were compared.[Results]The study in-cluded 27 males(60.0%)and 18 females(40.0%),with an average age of(32.33±16.11),17 cases(37.78%)with left ventricular hypertrophy and 28 cases(62.22%)without left ventricular hypertrophy.All patients had normal left ventricu-lar ejection fraction(LVEF)(>50%).Compared with those without left ventricular hypertrophy,patients with left ventric-ular hypertrophy had significantly more target organ involvement,significantly higher E/A and average E/E' ratios(P<0.05).No statistical difference was found in global and segmental longitudinal strain(LS),circumferential strain(CS)and radial strain(RS)of the endocardium and myocardium between the two groups(all P>0.05).There were lower abso-lute values of global and segmental LS and CS in the myocardium than in the endocardium(all P<0.05),and higher abso-lute values of LS and RS in the mid segment than in the basal and apical segments(all P<0.05).[Conclusions]There is no significant association between early systolic dysfunction and left ventricular wall thickness.2D-STE strain can be used to detect AFD in the early stage.Ventricular wall myocardium exhibits more serious involvement than endocardium and mid segment was less involved than the apical and basal segments.

Objectives:To explore the prognostic significances of geriatric nutrition risk index (GNRI), controlling nutritional status (CONUT), and prognostic nutritional index (PNI) in patients with heart failure.Methods:This was a retrospective study. Patients with heart failure admitted to the Department of Cardiology, the first affiliated hospital of Sun Yat-sen University from September 16, 2013 to December 28, 2017 were enrolled. Clinical data of patients were collected and patients were followed up. GNRI, CONUT and PNI scores of patients were calculated. Cox proportional risk model was used to evaluate the relationship between the above three nutritional status scores and the risk of all-cause death in patients with heart failure, and restricted cubic spline analysis was used to verify the relationship. Subgroup analysis was performed based on left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, number of heart failure comorbidities, systolic blood pressure, creatinine, body mass index, use of angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists, use of β-blockers, and use of spironolactone.Results:A total of 2 016 patients with heart failure aged (67.7±13.0) years old were enrolled, including 1 230 (61.0%) males. All patients were followed up until September 15, 2021. Multivariate Cox proportional hazard models showed that increased GNRI score was significantly associated with reduced risk of all-cause mortality in patients with heart failure ( HR=0.989, 95% CI 0.982-0.996, P=0.001), while CONUT and PNI scores were not associated with all-cause mortality (both P>0.05). Restricted cubic spline analysis showed no U-shaped relationship between the scores and all-cause death. Subgroup analysis suggested that the prognostic value of GNRI score was predominant in patients not using angiotensin-converting enzyme inhibitor/angiotensin receptor blocker ( Pinteraction=0.024), while there was no statistically significant difference between groups in other subgroup analyses ( Pinteraction>0.05). Conclusions:Increased GNRI score is associated with reduced risk of all-cause mortality in patients with heart failure and may serve as an effective tool to assess nutritional status in patients with heart failure.

Objective: To observe the etiology, comorbidities, clinical features and treatment patterns of hospitalized patients with heart failure (HF) in China. Methods: Data were collected prospectively on hospitalized patients with HF who were enrolled in China Heart Failure Center Registry Study from 169 participating hospitals from January 2017 to August 2018. In this cross-sectional study, patients were stratified by left ventricular ejection fraction (LVEF) category: heart failure with reduced ejection fraction (HFrEF, LVEF<40%); heart failure with mid-ranged ejection fraction (HFmrEF, 40%≤LVEF<50%) and heart failure with preserved ejection fraction (HFpEF, LVEF≥50%). The clinical data were collected, including demographic information, diagnosis, signs, electrocardiogram, echocardiography, laboratory tests, and treatment. Results: A total of 31 356 hospitalized patients with HF were included, 19 072 (60.8%) were males and the average age was (67.9±13.6) years old. The common causes of HF were hypertension (57.2%), coronary heart disease (54.6%), dilated cardiomyopathy (14.7%), valvular heart disease (9.2%). The common complications were atrial fibrillation/atrial flutter (34.1%), diabetes (29.2%), and anemia (26.7%). 32.8% of patients had a history of hospitalization for HF within the previous 12 months. There were 11 034 (35.2%) patients with HFrEF, 6 825 (21.8%) patients with HFmrEF and 13 497 (43.0%) patients with HFpEF. Compared with patients with HFpEF, patients with HFrEF had a lower systolic blood pressure ((124.7±21.1)mmHg(1 mmHg=0.133 kPa) vs. (134.9±22.9)mmHg), faster heart rate ((85±19) beats/minutes vs. (81±19)beats/minutes), and higher percentage of New York Heart Association (NYHA) class Ⅳ, smoking, alcohol, left bundle branch block, and QRS time≥130 ms, and higher levels of blood uric acid, BNP, and NT-proBNP (all P<0.05). Compared with patients with HFmrEF and HFrEF, patients with HFpEF were older, more women, and higher comorbidity burden including hypertension, atrial fibrillation/atrial flutter, anemia and chronic obstructive pulmonary disease (all P<0.05). HFmrEF took a mid-position between HFrEF and HFpEF in age, gender, heart rate, systolic blood pressure, hypertension, atrial fibrillation/atrial flutter, anemia, and chronic obstructive pulmonary disease (all P<0.05). Patients with HFmrEF had the highest proportion of coronary heart disease, myocardial infarction and percutaneous coronary intervention (all P<0.05). During hospitalization, loop diuretics were used in 90.2% of patients, and intravenous inotropics were used in 20.4% of patients. The use of ACEI/ARB/ARNI, β blockers and aldosterone receptor antagonists at discharge were 71.8%, 79.1% and 83.6% in HFrEF and 69.9%, 75.5% and 72.4% in HFmrEF, respectively. The use of digoxin at discharge was 25.3% (HFrEF 36.7%, HFmrEF 23.1%, HFpEF 17.0%). The rates of cardiac resynchronization therapy and implantable cardioverter defibrillator in HFrEF were 2.7% and 2.1%. Conclusions Among the hospitalized patients with HF in China, coronary heart disease and hypertension are the mostly prevalent causes. HFpEF accounts for a large proportion of hospitalized patients with HF. HFrEF, HFmrEF and HFpEF have different etiology and clinical features. In real-world, there are still large gaps in the effective application of the guideline recommended therapies to HF patients, especially the non-pharmacological therapy option, which needs to be improved further in China.