2024年 · 第04卷第04期

Objective: Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) filled an important data gap by showing a significant reduction of ischemic cardiovascular events in a ticagrelor plus aspirin cohort compared with placebo plus aspirin cohort among patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) but without a history of myocardial infarction. This study aims to evaluate the applicability of the THEMIS results in a real-world clinical setting in China. Methods: This retrospective, observational cohort study used data from the Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD) study which enrolled participants who were hospitalized between November 2012 and December 2013. The 24-month cumulative incidence of major adverse cardiovascular event (MACE), major bleeding, and all-cause death in patients with T2DM and CAD (T2DM-CAD), T2DM and stable CAD (SCAD)(T2DM-SCAD), and T2DM and SCAD without prior myocardial infarction or stroke (THEMIS-like) were analyzed. Results: Data from 13,296 patients with CAD were included; the T2DM-CAD, T2DM-SCAD, and THEMIS-like cohorts comprised 3,344 (25.2%), 949 (7.1%), and 509 (3.8%) patients, respectively. The corresponding 24-month cumulative incidence of major bleeding was 38 (1.1%), 16 (1.7%), and 8 (1.6%), and that of MACEs was 250 (7.5%), 87 (9.2%), and 29 (5.7%), and all-cause death was 181 (5.4%), 84 (8.9%), 29 (5.7%), respectively. The risk of MACE in the THEMIS-like cohort was approximate to that in the THEMIS trial (7.7% vs. 8.5% in ticagrelor and placebo group, respectively). Conclusion: The incidence of MACE was substantial in the THEMIS-like cohort, suggesting that cardiovascular risk for future events correlates with the presence of cardiovascular disease across the CAD risk continuum.

Objective: To explore the approach of minimally invasive transthoracic intramyocardial cellular transplantation under echocardiographic guidance to promote ischemic myocardial repair in a preclinical big-animal study. Methods: Female Guangxi Bama miniature pigs (weight: 25–30 kg) were randomly allocated into the sham group, untreated myocardial infarction (MI) group (MI group), the MI and surgical intramyocardial injection (SIM) group (MI-SIM group), and the MI and transthoracic echocardiography-guided percutaneous intramyocardial injection (TTEPIM) group (MI-TTEPIM group) (n = 4 each) using a lottery method. A swine MI model was established in the 3 groups excluding the sham group, and human induced pluripotent stem cell-derived cardiomyocytes (hiPS-CM) labeled with the herpes simplex virus type-1 thymidine kinase reporter gene (hiPS-CMTK+) were transplanted by SIM in MI-SIM group and TTEPIM in MI-TTEPIM group. The operation time, postoperative recovery time of animals and volume of blood loss were collected for comparison between MI-SIM group and MI-TTEPIM group. 9-(4-[18F] fluoro-3-(hydroxymethyl) butyl) guanine positron emission tomography/computed tomography imaging was performed to track the hiPS-CMTK+ in vivo. Cardiac function and morphology were evaluated by echocardiography. Results: The operation time and postoperative recovery time of MI-TTEPIM group were significantly shorter than those of MI-SIM group ((28.3 ± 3.6) min vs. (97.0 ± 6.7) min, P < 0.001; (1.3 ± 0.3) d vs. (7.5 ± 0.9) d, P < 0.001). MI-TTEPIM also showed significantly lesser volume of blood loss during cell transplantation than MI-SIM group ((4.3 ± 0.8) mL vs. (47.0 ± 4.1) mL, P < 0.001). The transplanted cells could be traced more accurately in vivo in MI-TTEPIM than in MI-SIM. The circumferential strain of intervention region in the MI-TTEPIM group (–25.07% ± 0.27%) was significantly higher than that of the MI-SIM (–20.39% ± 0.67%) and MI groups (–19.68% ± 0.67%), respectively (P < 0.01). Conclusion: A minimally invasive TTEPIM protocol with stem cells for treating the ischemic myocardium was established in this study. Transplantation of hiPS-CMTK+ with this method could promote the recovery of the circumferential strain of the ischemic myocardium. The findings of this study lay a foundation for the clinical transformation of this auxiliary means of treatment in the future.

Objective: Eosinophils (EOS) are inflammatory innate immune cells that play an important role in arterial thrombogenesis. There is a paucity of data on whether EOS levels have an impact on long-term outcomes following ST-segment elevation myocardial infarction (STEMI). This study aimed to investigate the impact of EOS count on the clinical outcomes of STEMI patients who underwent emergency percutaneous coronary intervention (PCI). Methods: This is a retrospective multicenter cohort study. A total of 754 patients with STEMI who required emergency PCI at 5 centers were screened between October 2015 and November 2016. Patients were divided into 2 groups based on EOS count: EOS count <0.02 × 109/L group (n = 264) and EOS count ≥0.02 × 109/L group (n = 490). Baseline demographic characteristics, clinical information, and medical test data were collected at study entry. The primary endpoint was all-cause death. The secondary endpoint was a major adverse cardiac event. Multivariablete Cox regression analysis was performed to identify the independent predictors of all-cause death, with a follow-up period of 5 years. Results: The incidence of all-cause death (14.8% vs. 7.6%, P = 0.002) and major adverse cardiac event (20.1% vs. 13.1%, P = 0.011) were significantly higher in EOS count <0.02 × 109/L group compared with ≥0.02 × 109/L group. Multivariablete Cox regression analysis showed that an EOS count <0.02 × 109/L, age ≥65 years, previous heart failure, previous stroke, and left ventricular ejection fraction ≤ 40% were independent predictors of all-cause death in patients with STEMI who underwent an emergency PCI. Conclusions: Low EOS counts were associated with all-cause mortality in STEMI patients who underwent emergency PCI.

Despite quitting smoking, patients with acute coronary syndrome (ACS) still have an increased risk of cardiovascular events. Clonal hematopoiesis of indeterminate potential (CHIP), which may be induced by smoking, has been identified to be associated with the development of coronary artery disease. However, it is unclear whether CHIP has a detrimental effect on the poor prognosis of ACS patients even after smoking cessation. This single-center, prospective cohort study will recruit 1,029 ACS patients undergoing complete percutaneous coronary intervention. The enrolled patients will be categorized into 3 groups based on their smoking status at admission: current smoker, non-smoker, and previous smoker. Previous smokers are defined as patients who have quit smoking for at least 1 year before experiencing the index ACS event. Whole-exome sequencing will be performed to identify the occurrence of CHIP in each patient. The primary endpoint is major adverse cardiovascular and cerebrovascular events, defined as a composite of cardiac death, non-fatal myocardial infarction, ischemia-driven revascularization, hospitalization for heart failure, and ischemic stroke. The association between CHIP and the primary endpoint will be determined by using Cox proportional hazard regression. This study aims to investigate the association among smoking cessation, CHIP, and the prognosis of ACS patients to provide new insights into the impact of CHIP on ACS patients, particularly among those who have quit smoking. The results will be published following the STROBE in a peer-reviewed scientific journal (Trial registration number: NCT04987268).

The assessment of cardiac function using echocardiography has gained a strong foothold in clinical practice. Cardiac magnetic resonance (CMR) imaging harbors distinct advantages over echocardiography, as it is not affected by limitations of acoustic windows and operator dependence. CMR is also designed to non-invasively assess cardiac morphology, ventricular geometry, myocardial wall motion, and intra-cardiac flow quantification without the use of ionizing radiation. These inherent features make CMR appropriate for diagnosing cardiovascular diseases, monitoring patients after treatment, and providing longitudinal follow-up. In this paper, the state-of-the-art work that has demonstrated the aspects of cardiac function by CMR is reviewed, and acquisition techniques and clinical applications are covered.

A medical condition called cardiovascular disease (CVD) affects the heart or blood vessels, and about 40% of its causes can be attributed to genetic factors. The pathophysiology of CVD is still unknown despite numerous studies identifying important environmental and genetic factors. Genetic data research has significantly increased due to the application of genome-wide association studies. The utilization of artificial intelligence (AI) technology demonstrates clear advantages in managing intricate projects, outperforming traditional statistical methods in processing such data. The use of AI in the status of genetic research on CVD and medicine is briefly reviewed in the opening section of this article. Then, it gives a complete picture of how AI is used in genetic CVD research, including genetic data-driven diagnosis and prognosis, genetic variation analysis, gene expression profiles, gene interactions, and analysis of genes using knowledge bases. Even though much research has yielded significant findings, it is still early. The main disadvantages are database limitations, the underuse of AI in systematic biology analysis, and the lack of a theoretical framework for interpreting analysis results. The paper concludes with future directions and the significance of creating comprehensive, high-quality, large-sample-size data-sharing resources. Much research is going into how to use AI analysis techniques to help with development. Being creative with computers can help make new CVD intervention protocols and develop and test theoretical models.

Platelets play an important role in thrombosis caused by acute coronary syndrome and stroke. As the main platelet collagen receptor, platelet glycoprotein Ⅵ (GPⅥ) is an important modulator in the activation and aggregation of platelets at vascular injury sites. Recently, GPⅥ has been identified as a potent antithrombotic target. The structure, properties, functions, and downstream signaling of GPⅥ are reviewed; its relationship with bleeding, thrombosis, and other diseases are discussed; and potential of GPⅥ as a future antiplatelet therapeutic target is summarized in this article.

Occasionally, incessant ventricular tachycardia (VT) exhibits a narrow QRS complex pattern that could be misdiagnosed as supraventricular tachycardia. In this case, a 66-year-old woman was referred to the emergency department due to the worsen hemodynamic and incessant VT manifesting as a narrow QRS complex pattern that was initially misdiagnosed as supraventricular tachycardia, which was unresponsive to antiarrhythmic drugs. The electrocardiogram manifestation of VT was characterized by an rS configuration in lead V2 with Rs pattern in leads V1 and V3, and the R-wave amplitude of lead V1 and V3 was greater than that of lead V2, which was different from the typical electrocardiogram features of right bundle branch block. The patient was subsequently found to have suspected acute myocarditis when the cause of the disease was investigated. A combination of high-dose methylprednisolone, immunoglobulin and intra-aortic balloon pump was given immediately. Hemodynamics gradually stabilized, and ventricular tachycardia did not recur. The rS change in the V2 lead may be helpful to distinguish VT from supraventricular tachycardia.