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Background Among patients with acute coronary syndrome and percutaneous coronary intervention, stress hyperglycemia ratio (SHR) is primarily associated with short-term unfavorable outcomes. However, the relationship between SHR and long-term worsen prognosis in acute myocardial infarction (AMI) patients admitted in intensive care unit (ICU) are not fully investigated, especially in those with different ethnicity. This study aimed to clarify the association of SHR with all-cause mortality in critical AMI patients from American and Chinese cohorts. Methods Overall 4,337 AMI patients with their first ICU admission from the American Medical Information Mart for Intensive Care (MIMIC)-IV database (n = 2,166) and Chinese multicenter registry cohort Cardiorenal ImprovemeNt II (CIN-II, n = 2,171) were included in this study. The patients were divided into 4 groups based on quantiles of SHR in both two cohorts. Results The total mortality was 23.8% (maximum follow-up time: 12.1 years) in American MIMIC-IV and 29.1% (maximum follow-up time: 14.1 years) in Chinese CIN-II. In MIMIC-IV cohort, patients with SHR of quartile 4 had higher risk of 1-year (adjusted hazard radio [aHR] = 1.87; 95% CI: 1.40–2.50) and long-term (aHR = 1.63; 95% CI: 1.27–2.09) all-cause mortality than quartile 2 (as reference). Similar results were observed in CIN-II cohort (1-year mortality: aHR = 1.44; 95%CI: 1.03–2.02; long-term mortality: aHR = 1.32; 95%CI: 1.05–1.66). In both two group, restricted cubic splines indicated a J-shaped correlation between SHR and all-cause mortality. In subgroup analysis, SHR was significantly associated with higher 1-year and long-term all-cause mortality among patients without diabetes in both MIMIC-IV and CIN-II cohort. Conclusion Among critical AMI patients, elevated SHR is significantly associated with and 1-year and long-term all-cause mortality, especially in those without diabetes, and the results are consistently in both American and Chinese cohorts.

Background Left ventricular pseudoaneurysm (LVP) is a rare complication, typically following a prior myocardial infarction. Clinical manifestations are diverse and non-specific, posing significant challenges for early diagnosis. Given the high risk of complete rupture, LVP is typically associated with poor prognosis, necessitating urgent surgery for survival. In the current LVP case, the patient presented with isolated chest pain, and further evaluation revealed non-obstructive coronary artery disease. To our knowledge, such cases are rare, and guidelines for LVP management—especially for chronic presentations—remain scarce. Case presentation A man in his 50s, complaining of recurrent chest pain over 8 months, was found to have a giant abnormal mass with rim calcification close to the posterior ventricle wall on chest computed tomography. Both contrast-enhanced echocardiography and cardiac magnetic resonance confirmed the diagnosis of a giant extensively calcified LVP in the inferolateral ventricle wall, as well as left ventricle enlargement and compromised systolic function. Coronary angiography revealed non-obstructed arteries. To prevent complete rupture, avoid systemic embolism, and improve cardiac function, the patient underwent successful surgical repair following a multidisciplinary team discussion and has achieved good subsequent recovery. Conclusion Our experience with successful surgical intervention in managing this unusual case of a chronic giant LVP provides compelling evidence that surgical repair should be considered a first-line treatment option for such patients.

Aim This study aimed to examine the relationships between remnant cholesterol (RC) and the risk of aortic aneurysm and dissection (AAD). Methods This prospective cohort study included 368,139 European adults from the UK Biobank. Additionally, the causal relationship between RC and AAD was investigated using Mendelian randomization (MR) analyses. Results During a median follow-up of 13.65 years, 1,634 cases of abdominal aortic aneurysm (AAA), 698 cases of thoracic aortic aneurysm (TAA), and 184 cases of aortic dissection (AD) were identified. Elevated RC levels were associated with an increased risk of AAA compared to the reference group ([highest vs. lowest RC levels]: adjusted hazard ratio (HR) = 1.65, 95% CI: 1.36–1.99). However, no significant association was observed between high RC levels and the risk of either TAA or AD. Two-sample MR analyses supported a significant causal effect of RC on AAA risk (odds ratio (OR) = 2.08, 95% CI: 1.70–2.56). The association between RC and AAA persisted after adjusting for the effects of RC-associated genetic variants on low-density lipoprotein cholesterol (LDL-C). In contrast, MR analyses did not indicate any causal associations between RC and TAA or AD. Conclusions Elevated RC was linked to a greater risk of developing AAA, with MR analyses confirming a causal relationship. These findings suggest that RC may function as a new biomarker for AAA and could be integral to strategies aimed at preventing AAA.

Background The ultrasonic flow ratio (UFR) can identify the functional severity of coronary stenosis, but it is unclear whether it can improve the diagnostic accuracy of intravascular ultrasound (IVUS) in determining coronary stenosis hemodynamics in vessels with a single stenosis. This study investigated the diagnostic performance of IVUS‐derived parameters in identifying functionally significant coronary stenosis in a vessel with a single stenosis. Methods Seventy vessels with a single stenosis in 68 patients were analyzed. All vessels underwent IVUS and determination of the Murray law‐based quantitative flow ratio (μQFR). IVUS images were used to determine the UFR. The correlation between UFR and μQFR was assessed using Spearman's method, Bland–Altman plots, and receiver operating characteristic (ROC) analysis. Risk factors were determined using univariate logistic regression analysis and multivariate stepwise logistic regression analysis. Results UFR showed a good correlation with μQFR (r = 0.87, p < 0.001). With μQFR as the reference, the diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of UFR were 98.57%, 95.24%, 100.00%, 100.00%, and 98.00%, respectively. With UFR/μQFR concordance, lesion length, minimal lumen diameter, and diameter stenosis in quantitative coronary angiography (QCA), minimal lumen area, plaque burden, and plaque volume in IVUS showed good diagnostic efficiency in determining the functional significance of coronary stenosis in a vessel with single stenosis. Multiple logistic regression models, including lesion length and diameter stenosis in QCA, and minimal lumen area in IVUS, provided superior predictive efficacy for physiologically significant ischemia. Conclusions UFR has a good correlation with μQFR. Without fractional flow reserve and μQFR, IVUS‐derived parameters and QCA derived parameters have relevant diagnostic efficiency in identifying the hemodynamic significance of coronary stenosis in a vessel with single stenosis. This developed a morphometric assessment for functional evaluation of coronary stenosis with intravascular ultrasound and ultrasonic flow ratio in vessels with single stenosis; the results demonstrated ultrasonic flow ratio (UFR) has a good correlation with the Murray law‐based quantitative flow ratio (uQFR). Without fractional flow reserve (FFR) and uQFR, IVUS‐ and QCA‐derived parameters have excellent diagnosis efficiency in identifying the hemodynamic significance of coronary stenosis in a vessel with single stenosis.

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) often requires plaque modification for device delivery. While rotational atherectomy (RA) and excimer laser coronary atherectomy (ELCA) are established adjuncts, their comparative efficacy and safety remain underexplored in Chinese populations. This single-center retrospective study included 75 consecutive CTO-PCI patients treated with ELCA (  = 25) or RA (  = 50). Procedural success, complications, and major adverse cardiovascular and cerebrovascular events (MACCE) were analyzed over a median 17.5-month follow-up. Multivariable Cox regression adjusted for calcification severity, lesion length, ISR-CTO, and diabetes mellitus. RA was preferred for moderate/severe calcification (76% vs. 48%,  = 0.020), while ELCA dominated in ISR-CTO (20% vs. 2%,  = 0.024) and lesions >20 mm (56% vs. 30%,  = 0.044). Procedural success was comparable (RA 90% vs. ELCA 84%,  = 0.706). Procedure-related complications differed: RA had two coronary perforations (4% vs. 0%,  = 0.130), whereas ELCA showed a trend toward more transient slow/no-reflow (12% vs. 0%,  = 0.061). MACCE rates remained similar (19% vs. 13.3%,  = 0.815; adjusted HR 1.53, 95% CI 0.35-6.65,  = 0.569). Both techniques exhibited comparable procedural duration and radiation exposure (all  > 0.05). ELCA incurred higher total costs (US11,147 vs. 9,267,  = 0.007), driven by laser catheter expenses; however, procedural costs became comparable after excluding catheter-related expenditures (  = 0.210). In Chinese CTO-PCI, ELCA and RA demonstrate lesion-specific utility-ELCA for ISR-CTO and long lesions, RA for calcified lesions-with comparable midterm safety. Procedural costs of ELCA and RA were equivalent in Device-excluded costs analysis.

Malnutrition is associated with increased incidence of heart failure (HF). Left ventricular (LV) remodeling is one of the most important processes in the occurrence and evolution of HF. However, the association between nutritional status and LV remodeling is not well known. The study aimed to investigate the association between malnutrition and LV remodeling. The study was a retrospective observation study. We included patients from the registry of Cardiorenal Improvement study from January 2007 to December 2018 at Guangdong Provincial People's Hospital. The primary endpoint was LV remodeling, defined as an absolute decrease in LV ejection fraction ≥10% after discharge compared with baseline. Nutritional status was assessed by the Controlling Nutritional Status (CONUT) score. Eligible patients were divided into absent-mild malnutrition group (CONUT score ≤4) and moderate-severe malnutrition group (CONUT score >4). Univariable and multivariable logistic regression was performed to verify the association between malnutrition and left ventricular remodeling. A total of 7,217 patients (mean age 61.3±10.5 years, 71.7% male) were included in the final analysis, among which 712 (9.9%) had LV remodeling. The incidence of LV remodeling in moderate-severe malnutrition group was significantly higher than that in absent-mild malnutrition group (12.9% vs. 9.5%, p=0.002). In multivariable logistic regression, moderate-severe malnutrition group was significantly associated with 1.69-fold increased risk of LV remodeling after adjusting confounders (OR: 1.69, CI: 1.32–2.16). Similar results were observed in subgroup stratified by age, gender, and coronary artery disease. Nearly one eighth of patients were classified as moderate-severe malnutrition, 12% of whom had LV remodeling. Moderate-severe malnutrition was associated with 69% increased risk of LV remodeling. Further studies are needed to prospectively evaluate the nutrition-oriented managements on outcomes in LV remodeling.

The relationship between the optical flow ratio (OFR) and clinical outcomes in patients with coronary artery disease (CAD) after percutaneous coronary stent implantation (PCI) remains unknown. To examine the correlation between post-PCI OFR and clinical outcomes in patients with CAD following PCI. Patients who underwent optical coherence tomography (OCT) guided PCI at Guangdong Provincial People's Hospital were retrospectively and continuously enrolled. Clinical data, post-PCI OCT characteristics, and OFR measurements were collected and analyzed to identify predictors of target vessel failure (TVF) after PCI. Among 354 enrolled patients, 26 suffered TVF during a median follow-up of 484 (IQR: 400-774) days. Post-PCI OFR was significantly lower in the TVF group than in the non-TVF group (0.89 vs. 0.93;  = 0.001). In multivariable Cox regression analysis, post-PCI OFR (HR per 0.1 increase: 0.60; 95% CI: 0.41-0.89;  = 0.011), large stent edge dissection (HR: 3.85; 95% CI: 1.51-9.84;  = 0.005) and thin-cap fibroatheroma (TCFA) (HR: 2.95; 95% CI: 1.19-7.35;  = 0.020) in the non-stented segment were independently associated with TVF. In addition, the inclusion of post-PCI OFR to baseline characteristics and post-PCI OCT findings improved the predictive power of the model to distinguish subsequent TVF after PCI (0.838 vs. 0.796;  = 0.028). The post-PCI OFR serves as an independent determinant of risk for TVF in individuals with CAD after PCI. The inclusion of post-PCI OFR assessments, alongside baseline characteristics and post-PCI OCT findings, substantially enhances the capacity to differentiate the subsequent manifestation of TVF in CAD patients following PCI.

The study aimed to investigate the diagnostic accuracy of Murray law-based quantitative flow ratio (μQFR) from a single angiographic view in patients with abnormal cardiac structure, left ventricular diastolic dysfunction, and valvular regurgitation. μQFR is a novel fluid dynamics method for deriving fractional flow reserve (FFR). In addition, current studies of μQFR mainly analyzed patients with normal cardiac structure and function. The accuracy of μQFR when patients had abnormal cardiac structure, left ventricular diastolic dysfunction, and valvular regurgitation has not been clear. This study retrospectively analyzed 261 patients with 286 vessels that underwent both FFR and μQFR prior to intervention. The cardiac structure and function were measured using echocardiography. Pressure wire-derived FFR ≤0.80 was defined as hemodynamically significant coronary stenosis. μQFR had a moderate correlation with FFR (  = 0.73,  < 0.001), and the Bland-Altman plot presented no difference between the μQFR and FFR (0.006 ± 0.075,  = 0.192). With FFR as the standard, the diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of μQFR were 94.06% (90.65-96.50), 82.56% (72.87-89.90), 99.00% (96.44-99.88), 97.26 (89.91-99.30), and 92.96% (89.29-95.44), respectively. The concordance of μQFR/FFR was not associated with abnormal cardiac structure, valvular regurgitation (aortic valve, mitral valve, and tricuspid valve), and left ventricular diastolic function. Coronary hemodynamics showed no difference between normality and abnormality of cardiac structure and left ventricular diastolic function. Coronary hemodynamics demonstrated no difference among valvular regurgitation (none, mild, moderate, or severe). μQFR showed an excellent agreement with FFR. The effect of abnormal cardiac structure, valvular regurgitation, and left ventricular diastolic function did not correlate with the diagnostic accuracy of μQFR. Coronary hemodynamics showed no difference in patients with abnormal cardiac structure, valvular regurgitation, and left ventricular diastolic function.

Aims: The monocyte to high-density lipoprotein ratio (MHR), a novel marker of inflammation and cardiovascular events, has recently been found to facilitate the diagnosis of acute aortic dissection. This study aimed to assess the association of preoperative MHR with in-hospital and long-term mortality after thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection (TBAD). Methods: We retrospectively evaluated 637 patients with acute TBAD who underwent TEVAR from a prospectively maintained database. Multivariable logistic and cox regression analyses were conducted to assess the relationship between preoperative MHR and in-hospital as well as long-term mortality. For clinical use, MHR was modeled as a continuous variable and a categorical variable with the optimal cutoff evaluated by receiver operator characteristic curve for long-term mortality. Propensity score matching was used to diminish baseline differences and subgroups analyses were conducted to assess the robustness of the results. Results: Twenty-one (3.3%) patients died during hospitalization and 52 deaths (8.4%) were documented after a median follow-up of 48.1 months. The optimal cutoff value was 1.13 selected according to the receiver operator characteristic curve (sensitivity 78.8%; specificity 58.9%). Multivariate analyses showed that MHR was independently associated with either in-hospital death [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.16-3.85, P = 0.015] or long-term mortality [hazard ratio (HR) 1.78, 95% CI 1.31-2.41, P < 0.001). As a categorical variable, MHR > 1.13 remained an independent predictor of in-hospital death (OR 4.53, 95% CI 1.44-14.30, P = 0.010) and long-term mortality (HR 4.16, 95% CI 2.13-8.10, P < 0.001). Propensity score analyses demonstrated similar results for both in-hospital death and long-term mortality. The association was further confirmed by subgroup analyses. Conclusions: MHR might be useful for identifying patients at high risk of in-hospital and long-term mortality, which could be integrated into risk stratification strategies for acute TBAD patients undergoing TEVAR.

Objective: Anemia is frequent in patients with acute myocardial infarction (AMI), and the optimal red blood cell transfusion strategy for AMI patients with anemia is still controversial. We aimed to compare the efficacy of restrictive and liberal red cell transfusion strategies in AMI patients with anemia. Methods: We systematically searched PubMed, EMBASE, Web of Science, Cochrane Library, and Clinicaltrials.gov , from their inception until March 2021. Studies designed to compare the efficacy between restrictive and liberal red blood cell transfusion strategies in patients with AMI were included. The primary outcome was all-cause mortality, including overall mortality, in-hospital or follow-up mortality. Risk ratios (RR) with 95% confidence intervals (CI) were presented and pooled by random-effects models. Results: The search yielded a total of 6,630 participants in six studies. A total of 2,008 patients received restrictive red blood cell transfusion while 4,622 patients were given liberal red blood cell transfusion. No difference was found in overall mortality and follow-up mortality between restrictive and liberal transfusion groups (RR = 1.07, 95% CI = 0.82–1.40, P = 0.62; RR = 0.89, 95% CI = 0.56–1.42, P = 0.62). However, restrictive transfusion tended to have a higher risk of in-hospital mortality compared with liberal transfusion (RR = 1.22, 95% CI = 1.00–1.50, P = 0.05). No secondary outcomes, including follow-up reinfarction, stroke, and acute heart failure, differed significantly between the two groups. In addition, subgroup analysis showed no differences in overall mortality between the two groups based on sample size and design. Conclusion: Restrictive and liberal red blood cell transfusion have a similar effect on overall mortality and follow-up mortality in AMI patients with anemia. However, restrictive transfusion tended to have a higher risk of in-hospital mortality compared with liberal transfusion. The findings suggest that transfusion strategy should be further evaluated in future studies.