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Background Hyperuricemia (HUA) has been proved as a predictor of worse outcomes in patients with coronary artery disease. Here, we investigated the prognostic value of HUA in a distinct population with myocardial infarction with nonobstructive coronary arteries (MINOCA). Methods A total of 1179 MINOCA patients were enrolled and divided into HUA and non-HUA groups. HUA was defined as a serum uric acid level ≥ 420 μmol/L in men or ≥ 357 μmol/L in women. The primary study endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, nonfatal stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan–Meier, Cox regression, and receiver-operating characteristic analyses were performed. Results Patients with HUA (prevalence of 23.5%) had a significantly higher incidence of MACE (18.7% vs. 12.8%; p  = 0.015) than patients without during the median follow-up of 41.7 months. HUA was closely associated with an increased risk of MACE even after multivariable adjustment (hazard ratio 1.498, 95% confidence interval: 1.080 to 2.077; p  = 0.016). HUA remained a robust risk factor of MACE after propensity score matching analysis. Moreover, HUA showed an area under the curve (AUC) of 0.59 for predicting MACE. Incorporation of HUA to the thrombolysis in myocardial infarction (TIMI) score yielded a significant improvement in discrimination for MACE. Conclusions HUA was independently associated with poor prognosis after MINOCA. Routine assessment of HUA may facilitate risk stratification in this specific population.

Obstructive sleep apnea (OSA) is much common and associated with worse clinical outcomes in patients with hypertrophic cardiomyopathy (HCM), however, the diagnosis of OSA in HCM is still insufficient. We aim to investigate the clinical predictors of OSA in a large series of patients with HCM. A total of 589 patients with HCM who underwent sleep evaluations were retrospectively enrolled. Data from clinical characteristics and polysomnography studies were recorded. OSA was present in 346 patients (58.7%). Patients who had OSA were older, more likely to be male and had more clinical comorbidities such as hypertension, atrial fibrillation and cardiac remodeling. Multivariate logistic analyses showed that male, age, body mass index, hypertension and left ventricular outflow tract obstruction were significant factors associated with OSA. The area under the ROC curve (AUC) was 0.78 (95% CI 0.74–0.82; P < 0.001). These factors were also able to identify moderate to severe OSA with an AUC of 0.77 (95% CI 0.73–0.81; P < 0.001). These findings suggest that identifying HCM patients with high risk for OSA is feasible using characteristics from clinical practices and clinicians should have no hesitate to conduct sleep test in these patients.

Objective: We aimed to conduct a meta-analysis of treatments for large vessel coronary artery disease between drug-coated balloons and drug-eluting stents. Method: We searched databases including PubMed, Web of Science, Cochrane, CNKI, and Wanfang, and selected randomized controlled trials (RCTs) or cohort studies which compared drug-coated balloons (DCBs) with drug-eluting stents (DESs). The reference vessel diameter (RVD) should be greater than 2.75 mm. The results of 12 studies with a total of 2634 patients were included in this meta-analysis. Results: The results showed that the DCB group was not inferior to the DES group in terms of the incidence of target lesion revascularization (TLR). (RR = 1.25, 95% CI: [0.84, 1.85], p = 0.27, I2 = 0%), and the incidence of bleeding events in the DCB group was lower than that in the DES group (RR = 0.30, 95% CI: [0.15, 0.59], p = 0.0004). The results also showed that the post-intervention minimal lumen diameter (MLD) in the DCB group was smaller than that in the DES group. (RR = −0.37, 95% CI: [−0.59, −0.16], p = 0.0007), but the follow-up MLD in the DCB group was not less than that in the DES group (RR = −0.03, 95% CI: [−0.14,−0.08], p = 0.61). Additionally the DCB group had less late lumen loss (LLL) compared with the DES group. (RR = −0.31, 95% CI: [−0.60, −0.02], p < 0.0001). Conclusion: This meta-analysis confirms that in the early and late stages after percutaneous coronary intervention (PCI), DCB is not inferior in efficacy and safety to DES for de novo large coronary lesions with RVD > 2.75 mm.

Anion exchange membrane fuel cells (AEMFCs) represent a promising class of clean energy devices, with their performance being critically dependent on the efficiency of the cathode oxygen reduction reaction (ORR) catalyst. Manganese-cobalt spinel (Mn1.5Co1.5O4, MCS) has been demonstrated to be a highly active ORR catalyst. Herein, we report a strategy of incorporating Cu (MCCS) and Fe (MCFS) into MCS to form ternary spinel oxides for tuning ORR activity. Among them, MCS exhibits the best ORR performance, with a half-wave potential (E1/2) of 0.736 V vs. RHE in 0.1 M KOH and a peak power density (PPD) of 248.3 mW·cm−2 for the fuel cell test. In contrast, MCCS and MCFS show divergent behaviors in a rotating disk-ring electrode (RRDE) and fuel cell tests. X-ray diffraction (XRD) analyses and X-ray photoelectron spectroscopy (XPS) analyses reveal that the introduction of Cu2+ and Fe3+ induces a phase transformation in the spinel structure, leading to a reduction in oxygen vacancies and an increase in the valence state of Mn, thereby degrading catalytic activity. However, the incorporation of these elements also modulates the hydration capability of the catalysts, which is critical for the ion and charge transfer in the fuel cell environment and has been validated in the distribution of relaxation time (DRT) analysis of the fuel cell test. This study provides a valuable strategy for designing and synthesizing low-cost, highly efficient, and stable ternary spinel electrocatalysts for AEMFC applications, and bridges the gap between RRDE evaluation and fuel cell testing through DRT analysis.

Background The pathophysiology of isolated coronary artery ectasia (CAE) with the coronary slow flow (CSF) phenomenon is still unclear. The purpose of this study was to investigate the risk factors for isolated CAE complicated with CSF. Methods A total of 126 patients with isolated CAE were selected retrospectively. The patients were grouped into the no CSF (NCSF) group (n = 55) and the CSF group (n = 71) according to the corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC). Data on demographics, laboratory measurements, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), CTFC and diameters of three coronary arteries were collected. Results The proportions of males (84.5% vs. 61.8%, p  = 0.004) and patients with a smoking history (63.4% vs. 43.6%, p  = 0.021) were higher in the CSF group than in the NCSF group. The neutrophil-to-lymphocyte ratio (NLR) (2.08(1.68–3.21) vs. 1.89 ± 0.58, p  = 0.001), mean diameter of coronary arteries (mean D) (5.50 ± 0.85 vs. 5.18 ± 0.91, p  < 0.001), and uric acid (URIC) level (370.78 ± 109.79 vs. 329.15 ± 79.71, p  = 0.019) were significantly higher in the CSF group, while the lymphocyte-to-monocyte ratio (LMR) (4.81 ± 1.66 vs. 5.96 ± 1.75, p  < 0.001) and albumin (ALB) level (44.13 ± 4.10 vs. 45.69 ± 4.11, p  = 0.036) were lower. Multivariable logistic analysis showed that the LMR (odds ratio: 0.614, 95% CI: 0.464–0.814, p  = 0.001), mean D (odds ratio: 2.643, 95% CI: 1.54–4.51, p < 0.001) and URIC level (odds ratio: 1.006, 95% CI: 1.001–1.012, p  = 0.018) were independent predictors of CSF in CAE. Conclusions The LMR was a negative independent predictor of CSF in isolated CAE, while URIC level and mean D were positive independent predictors.

Atrial fibrillation (AF) is the most common arrhythmia and potentially increase the risk of embolic stroke and aggravate progressive heart failure in patients with hypertrophic cardiomyopathy (HCM). Recent studies demonstrated that epicardial adipose tissue (EAT) was closely associated with AF in general population. However, the relationship between EAT and AF in HCM patients remains unclear. A total of 93 consecutive patients with hypertrophic obstructive cardiomyopathy (HOCM) at Fuwai Hospital were enrolled in our study. There were 18 patients with AF and 75 patients without it. Cardiac magnetic resonance (CMR) imaging was performed in all participants. EAT volume (EATV) and left atrial volume (LAV) were determined by E-3D medical model software. HOCM patients with AF had significantly greater EATV index (EATVI, P < 0.001), LAV index (LAVI, P < 0.001) and left ventricular end-systole volume index (LVESVI, P = 0.039), and lower left ventricular ejection fraction (LVEF, P = 0.002). In multivariable logistic regression analysis, EATVI, LAVI, and LVEF remained independent determinants of AF occurrence (OR = 1.023, 95% CI, 1.003–1.043, P = 0.023, OR = 1.043, 95% CI, 1.012–1.075, P = 0.006, and OR = 0.887, 95% CI, 0.818–0.962, P = 0.004, respectively). Furthermore, receiver operating characteristic (ROC) curve analysis demonstrated that integration of EATVI, LAVI and LVEF provided better discriminatory performance for incident AF in HOCM patients with a high sensitivity of 94.4% and a specificity of 69.3% (AUC = 0.864, 95% CI, 0.771–0.958, P < 0.001). EATVI is an independent predictor of the presence of AF, and integration of EATVI, LVEF and LAVI determined by CMR provide greater discriminatory performance for identifying AF in HOCM patients.

There are controversies on optimal stenting strategy regarding true left main (LM) bifurcation lesions. The present study compared 1- and 2-stenting strategy for patients with true LM bifurcation lesions as differentiated by DEFINITION criteria. 928 patients with true LM bifurcation lesions (Medina 1,1,1 or 0,1,1) treated with DES were enrolled consecutively. 297 (32.0%) patients were identified as complex LM bifurcation, and 631 (68.0%) patients into simple LM bifurcation group according to DEFINTION criteria. Patients in complex vs. simple LM bifurcation group had significantly higher major adverse cardiac event (MACE, including cardiac death, myocardial infarction [MI] and ischemia-driven target vessel revascularization) rate at 30 days (7.8% vs. 4.0%, p = 0.01), 1 year (10.3% vs. 6.4%, p = 0.04), and numerically at 3 years (14.2% vs. 10.1%, p = 0.07), which was mainly driven by increased MI. Moreover, patients in the 2-stent strategy group had strong trend towards lower incidence of cardiac death in both complex LM bifurcation group (2.0% vs. 5.9%, p = 0.08) and simple LM bifurcation group (1.9% vs. 4.5%, p = 0.07). In conclusion, the complex bifurcation lesion criteria established in DEFINITION study was able to risk-stratify LM bifurcation patients. Two-stent technique yielded numerically lower 3-year cardiac mortality regardless of LM bifurcation complexity.

Advances in tumor diagnosis and treatment, especially the use of targeted therapies, have remarkably improved the survival rate of patients with renal cell carcinoma (RCC), accompanied by higher hypertension (HTN) incidence among patients with RCC, reflecting the coming of a cardio-oncologic era. Therefore, for patients with RCC and HTN simultaneously, finding risk factors for the comorbidity and giving better clinical treatment have been urgent problems. In this review, we thoroughly investigated risk factors for the comorbidity of HTN and RCC based on preclinical and clinical studies. Firstly, RCC and HTN may have common risk factors, such as obesity, smoking, and other modifiable lifestyles. Secondly, RCC and HTN may lead to each other directly or indirectly by their therapies. We then discussed measures of reducing the comorbidity and treatment of HTN in patients with RCC. We also discussed the deficiency of current studies and pointed out future directions. In conclusion, this review aims to deepen the understanding of cardio-oncology and bring benefit to the population who are at high risk of getting or have already got RCC and HTN simultaneously.

Background To investigate the relationship between fragmented QRS (fQRS) quantified by a new method and myocardial fibrosis (MF) and the diagnostic value of quantitative fQRS (Q-fQRS) to detect MF in hypertrophic obstructive cardiomyopathy (HOCM) patients based on histological validation. Methods We performed a retrospective study that included 69 patients with HOCM who underwent ventricular septal surgery. Nine individuals who died from accidents were studied as a control reference for the histological parameters. Septal myocardium samples were subjected to Masson’s trichrome staining to quantify the collagen volume fraction (CVF). An fQRS pattern was defined as the presence of additional R waves or RSR’, evidenced by notched R or S wave on electrocardiography (ECG). The Q-fQRS was quantified as the total amount of deflections in the QRS complex in all 12 routine ECG leads together. Cardiac magnetic resonance imaging was conducted, and late gadolinium enhancement (LGE) was measured at 2, 4, 6 and 8 standard deviations (SDs). Results Of the 69 patients, fQRS was documented in 38 (55.1%) patients, the mean number of leads with fQRS was 3.7 ± 1.6, and the mean Q-fQRS was 17 ± 7.2. Compared with HOCM patients without fQRS, HOCM patients with fQRS had a higher CVF and more LGE at 6 SD ( P  < 0.001; P  = 0.040). Q-fQRS was correlated with CVF (r = 0.640, P  < 0.001), and Q-fQRS showed the best correlation with LGE measured at 8 SD (r = 0.379, P  = 0.002). Multivariate regression analyses revealed that Q-fQRS was independently associated with the extent of CVF in HOCM patients after adjusting for age, sex, body surface area and the extent of LGE at 6 SD ( P  < 0.001). When the patients were divided into subgroups with normal CVF or high CVF according to the CVF in controls, Q-fQRS and LGE at 6SD showed similar diagnostic value in detecting patients with high CVF, with sensitivities of 66.7% vs 68.6%, specificities of 76.7% vs 72.4%, and accuracies of 71% vs 70.3%. Conclusions HOCM patients with fQRS showed more extensive MF. Q-fQRS was an independent predictor for MF and had a good diagnostic value, with a sensitivity of 66.7% and specificity of 76.7%, in identifying patients with higher fibrotic burden.

Background Coronary angiography remains the gold standard for diagnosing coronary artery disease (CAD), but its invasive nature limits its applicability for widespread screening. Identifying non-invasive molecular markers could improve CAD classification and risk assessment. Methods We employed 5hmC-Seal technology to generate genome-wide 5-hydroxymethylcytosine (5hmC) profiles from plasma cell-free DNA (cfDNA) in 724 CAD patients, stratified into stable CAD (sCAD), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI) groups. Using machine learning algorithms, we identified inflammation-related 5hmC modifications associated with disease severity and constructed a classification model based on key hydroxymethylated markers. The model was validated internally and externally in an independent cohort of 167 patients. Results We found that inflammation-related differentially hydroxymethylated genes (DhMGs) were significantly associated with CAD severity, with enriched pathways linked to immune activation and inflammatory response regulation. A 19-marker panel of 5hmC-based features effectively distinguished CAD patients at different disease stages, with high classification accuracy (AUC = 0.913 in the internal validation cohort). External validation confirmed the robustness of the model, achieving AUCs of 0.784, 0.880, and 0.918 when differentiating between NCA vs. sCAD, sCAD vs. MI, and NCA vs. MI, respectively. Compared to traditional clinical indicators, the 5hmC-based model demonstrated superior discriminatory power for MI. Conclusions Our findings suggest that 5hmC modifications in cfDNA reflect CAD-related epigenetic changes and may serve as a promising biomarker for disease stratification. These results provide new insights into the epigenetic landscape of CAD and highlight the potential utility of 5hmC profiling for non-invasive disease monitoring. Further studies are warranted to validate these findings and explore their clinical implications.