MicroRNA-322-5p protects against myocardial infarction through targeting BTG2.

BACKGROUND: Numerous studies have explored the therapeutic potential of microRNA (miR) in myocardial infarction (MI) treatment. This study focuses on the role of miR-322-5p in MI, particularly in its regulatory interaction with B-cell translocation gene 2 (BTG2). MATERIALS AND METHODS: Expression levels of miR-322-5p and BTG2 were assessed in a rat MI model. Adenovirus altering miR-322-5p or BTG2 expression were administered to MI rats. Evaluation included cardiac function, inflammation, myocardial injury, pathological changes, apoptosis, and NF-κB pathway-related genes in MI rats post-targeted treatment. The miR-322-5p and BTG2 targeting relationship was investigated. RESULTS: MI rats exhibited low miR-322-5p and high BTG2 expression in the myocardial tissues. Restoration of miR-322-5p enhanced cardiac function, alleviated inflammation and myocardial injury, mitigated pathological changes and apoptosis, and deactivated the NF-κB pathway in MI rats. BTG2 expression was negatively-regulated by miR-322-5p. Overexpressed BTG2 counteracted miR-322-5p-induced cardioprotection on MI rats. CONCLUSION: This study provides evidence that miR-322-5p protects against MI by suppressing BTG2 expression.

Sex Differences in Clinical Outcomes Associated With Quantitative Flow Ratio-Guided Percutaneous Coronary Intervention.

Background: FAVOR III China (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) reported improved clinical outcomes in quantitative flow ratio (QFR) relative to angiography-guided percutaneous coronary intervention (PCI), but the clinical impact of QFR-guided PCI according to sex remains unknown. Objectives: The authors sought to compare sex differences in the 2-year clinical benefits of a QFR-guided PCI strategy and to evaluate the differences in outcomes between men and women undergoing contemporary PCI. Methods: This study involved a prespecified subgroup analysis of the FAVOR III China trial, in which women and men were randomized to a QFR-guided strategy or a standard angiography-guided strategy. Sex differences in clinical benefit of the QFR guidance were analyzed for major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction, or ischemia-driven revascularization within 2 years. Results: A total of 1,126 women and 2,699 men were eligible and the occurrence of 2-year MACE was similar between women and men (10.3% vs 10.5%; P = 0.96). Compared with an angiography-guided strategy, a QFR-guided strategy resulted in a 7.9% and 9.7% reduction in PCI rates in men and women, respectively. A QFR-guided strategy resulted in similar relative risk reductions for 2-year MACE in women (8.0% vs 12.7%; HR: 0.62; 95% CI: 0.42-0.90) and men (8.7% vs 12.4%; HR: 0.69; 95% CI: 0.54-0.87) (Pinteraction = 0.61). Furthermore, QFR values were not significantly different between men and women with various angiographic stenosis categories. Conclusions: A QFR-guided PCI strategy resulted in improved MACE in both men and women at 2 years compared with an angiography-guided PCI strategy. The FAVOR III China Study [FAVOR III China]; (NCT03656848).

Association of triglyceride glucose-body mass index and hemoglobin glycation index with heart failure prevalence in hypertensive populations: a study across different glucose metabolism status.

BACKGROUND: The Triglyceride glucose-body mass index (TyG-BMI) and hemoglobin glycation index (HGI) are well-established surrogate markers for insulin resistance. Nevertheless, the extent to which these markers offer additive predictive value for heart failure (HF) prevalence in hypertensive populations, and their predictive utility across various diabetic statuses, remains to be clarified. Consequently, this study aimed to explore the independent and synergistic effects of TyG-BMI and HGI on HF risk among individuals with different diabetic statuses. METHODS: Data from the study population (n = 9847) were obtained from the National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression models were employed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) to assess the combined associations between TyG-BMI and HGI and the prevalence of HF across various diabetic statuses. RESULTS: In the total population, compared to the reference group (low TyG-BMI and low HGI), the OR (95% CI) for HF prevalence was 1.30 (1.04, 1.64) for the combination of low TyG-BMI and high HGI, 2.40 (1.76, 3.29) for high TyG-BMI and low HGI, and 3.47 (2.41, 4.99) for high TyG-BMI and high HGI. Interestingly, among normoglycemic individuals, higher TyG-BMI and HGI did not significantly increase the prevalence of HF. Conversely, in the prediabetic population, the OR (95%CI) for HF prevalence was 2.42 (1.69, 3.48) for the combination of high TyG-BMI and low HGI, and 4.30 (2.45, 7.54) for high TyG-BMI and high HGI. Similarly, in the diabetic population, the OR (95%CI) for HF prevalence was 2.22 (1.43, 3.45) for low TyG-BMI and high HGI, 4.04 (2.43, 6.73) for high TyG-BMI and low HGI, and 4.13 (2.25, 7.59) for high TyG-BMI and high HGI, compared to low TyG-BMI and low HGI. CONCLUSION: This study reveals that elevated TyG-BMI and HGI levels exert a synergistic impact on the prevalence of HF in hypertensive adults, especially in those with prediabetes and diabetes. Additionally, the presence of prediabetes and diabetes may amplify the detrimental combined effect of TyG-BMI and HGI on HF prevalence.

Comparing the clinical outcomes of single vs. systematic dual stenting strategies for unprotected left main bifurcation lesion: a systematic review and meta-analysis.

Introduction: The optimal percutaneous coronary intervention (PCI) strategy for coronary left main (LM) bifurcation lesions remains controversial. This meta-analysis compared the medium and long-term follow-up clinical outcomes of single vs. systematic dual stenting strategies of LM bifurcation lesions. Methods: We systematically identified studies published within 5 years comparing single vs. systematic double stenting strategies for LM bifurcation lesions. The primary endpoint was medium-term (1 year) and long-term (at least 3 years) all-cause death. Secondary outcomes included major adverse cardiovascular events (MACEs), target lesion revascularization (TLR), overall occurrence of stent thrombosis (ST), cardiovascular (CV) mortality, and myocardial infarction (MI). Results: Two randomized controlled trials and nine observational studies with 7,318 patients were included in this meta-analysis. In terms of the medium-term follow-up clinical outcomes, our pooled analysis showed that use of the systematic dual stenting strategy was associated with a lower ST risk (odds ratio [OR] = 0.43, 95% confidence interval [CI]: 0.20-0.89, P = 0.02) and cardiac death risk (OR = 0.43, 95% CI: 0.21-0.89, P = 0.02) compared to the single stenting strategy; there was no significant difference between the two strategies regarding rates of all-cause death, MACE, TLR, and MI. Patients with long-term follow-up showed comparable observed clinical outcomes between the two strategies. Most importantly, for patients with true LM bifurcation, the risk of all-cause death, ST, and CV mortality following the systematic dual stenting strategy was significantly lower than the single stenting strategy. Conclusions: For patients with LM bifurcation lesions, both the systematic dual stenting strategy and single stenting strategy demonstrated comparable results in terms of all-cause mortality during medium-term and long-term follow-up. However, the systematic dual stenting strategy showed a tendency towards lower incidence of ST and CV mortality compared to the single stenting strategy during medium-term follow-up. Consequently, the systematic dual stenting strategy yielded superior clinical outcomes for patients with LM bifurcation lesions.

Monocyte-to-high-density lipoprotein ratio as a predictor for patients with Takayasu arteritis and coronary involvement: a double-center, observational study.

Background: The implication of the monocyte-to-high-density lipoprotein ratio (MHR) in Takayasu arteritis (TAK) remains unclear. Objective: We aimed to assess the predictive value of the MHR to identify coronary involvement with TAK and determine the patient prognosis. Methods: In this retrospective study, 1,184 consecutive patients with TAK were collected and assessed, and those who were initially treated and with coronary angiography were enrolled and classified according to coronary involvement or no involvement. Binary logistic analysis was performed to assess coronary involvement risk factors. Receiver-operating characteristic analysis was used to determine the MHR value to predict coronary involvement in TAK. Major adverse cardiovascular events (MACEs) were recorded in patients with TAK and coronary involvement within a 1-year follow-up, and Kaplan-Meier survival curve analysis was conducted to compare MACEs between them stratified by the MHR. Results: A total of 115 patients with TAK were included in this study, and 41 of them had coronary involvement. A higher MHR was found for TAK with coronary involvement than for TAK without coronary involvement (P = 0.014). Multivariate analysis showed that the MHR is an independent risk factor for coronary involvement in TAK (odds ratio: 92.718, 95% confidence interval (CI): 2.813-3056.291, P = 0.011). With the best cut-off value of 0.35, the MHR identified coronary involvement with 53.7% sensitivity and 68.9% specificity [area under the curve (AUC): 0.639, 95% CI: 0.544-0.726, P=0.010] and identified left main disease and/or three-vessel disease (LMD/3VD) with 70.6% sensitivity and 66.3% specificity (AUC: 0.704, 95% CI: 0.612-0.786, P = 0.003) in TAK. Combined with other variables, the MHR identified coronary involvement with 63.4% sensitivity and 90.5% specificity (AUC: 0.852, 95% CI: 0.773-0.911, P < 0.001), and identified LMD/3VD with 82.4% sensitivity and 78.6% specificity (AUC: 0.827, 95% CI: 0.720-0.934, P < 0.001) in TAK. A total of 39 patients with TAK and coronary involvement were followed up for 1 year, and 5 patients suffered a MACE. Those with an MHR >0.35 had a higher MACE incidence than their counterparts with an MHR ≤0.35 (χ2 = 4.757, P = 0.029). Conclusions: The MHR could be a simple, practical biomarker for identifying coronary involvement and LMD/3VD in TAK and predicting a long-term prognosis.

Short-Term Risk Stratification of Non-Flow-Limiting Coronary Stenosis by Angiographically Derived Radial Wall Strain.

BACKGROUND: Deferred revascularization of mildly stenotic coronary vessels based exclusively on physiological evaluation is associated with up to 5% residual incidence of future adverse events at 1 year. OBJECTIVES: We aimed to evaluate the incremental value of angiography-derived radial wall strain (RWS) in risk stratification of non-flow-limiting mild coronary narrowings. METHODS: This is a post hoc analysis of 824 non-flow-limiting vessels in 751 patients from the FAVOR III China (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients With Coronary Artery Disease) trial. Each individual vessel had ≥1 mildly stenotic lesion. The primary outcome was vessel-oriented composite endpoint (VOCE), defined as the composite of vessel-related cardiac death, vessel-related myocardial infarction (nonprocedural), and ischemia-driven target vessel revascularization at 1-year follow-up. RESULTS: During 1-year follow-up, VOCE occurred in 46 of 824 vessels, with a cumulative incidence of 5.6%. Maximum RWS (RWSmax) was predictive of 1-year VOCE with an area under the curve of 0.68 (95% CI: 0.58-0.77; P < 0.001). The incidence of VOCE was 14.3% in vessels with RWSmax >12% vs 2.9% in those with RWSmax ≤12%. In the multivariable Cox regression model, RWSmax >12% was a strong independent predictor of 1-year VOCE in deferred non-flow-limiting vessels (adjusted HR: 4.44; 95% CI: 2.43-8.14; P < 0.001). The risk of deferred revascularization based on combined normal RWSmax and Murray-law-based quantitative flow ratio (µQFR) was significantly reduced compared with µQFR alone (adjusted HR: 0.52; 95% CI: 0.30-0.90; P = 0.019). CONCLUSIONS: Among vessels with preserved coronary flow, angiography-derived RWS analysis has the potential to further discriminate vessels at risk of 1-year VOCE. (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients With Coronary Artery Disease [FAVOR III China Study]; NCT03656848).

Global Burden and Improvement Gap of Non-Rheumatic Calcific Aortic Valve Disease: 1990-2019 Findings from Global Burden of Disease Study 2019.

The aim of this study was to explore the most updated changing trends of non-rheumatic calcific aortic valve disease (nrCAVD) and reveal possible improvements. We analyzed the age-standardized rates (ASRs) of prevalence, incidence, disability-adjusted life-years (DALYs), and mortality trends of nrCAVD from 1990 to 2019 using data from the Global Burden of Disease (GBD) study 2019. The relations between ASRs and socio-demographic index (SDI) were analyzed with Pearson's correlation coefficients. Decomposition and frontier analysis were employed to reveal the contribution proportion of influence factors and regions where improvement can be achieved. In 2019, there were 9.40 million (95% uncertainty interval (UI): 8.07 to 10.89 million) individuals with nrCAVD globally. From 1990 to 2019, the prevalence rate of nrCAVD increased by 155.47% (95% IU: 141.66% to 171.7%), with the largest increase observed in the middle SDI region (821.11%, 95% UI: 709.87% to 944.23%). Globally, there were no significant changes in the mortality rate of nrCAVD (0.37%, 95% UI: -8.85% to 7.99%). The global DALYs decreased by 10.97% (95% UI: -17.94% to -3.46%). The population attributable fraction (PAF) of high systolic blood pressure increased in the population aged 15-49 years, while it declined slightly in population aged 50+ years. Population growth was the main contributing factor to the increased DALYs across the globe (74.73%), while aging was the driving force in the high-SDI region (80.27%). The Netherlands, Finland, Luxembourg, Germany, and Norway could reduce DALY rates of nrCAVD using their socio-demographic resources. According to these results, we revealed that the burden of nrCAVD increased markedly from 1990 to 2019 in high-SDI and high-middle-SDI regions. There was a downward trend in the mortality due to nrCAVD since 2013, which is possibly owing to profound advances in transcatheter aortic valve replacement. Some countries may reduce burdens of nrCAVD using their socio-demographic resources.

2-Year Outcomes of Angiographic Quantitative Flow Ratio-Guided Coronary Interventions.

BACKGROUND: In the multicenter, randomized, sham-controlled FAVOR (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) III China trial, quantitative flow ratio (QFR)-based lesion selection improved 1-year clinical outcomes compared with conventional angiographic guidance for percutaneous coronary intervention (PCI). OBJECTIVES: The purpose of this study was to determine whether the benefits of QFR guidance persist at 2 years, particularly for patients in whom QFR changed the revascularization strategy. METHODS: Eligible patients were randomized to a QFR-guided strategy (PCI performed only if QFR ≤0.80) or a standard angiography-guided strategy. Major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), or ischemia-driven revascularization occurring within 2 years were analyzed in the intention-to-treat population. RESULTS: Among 3,825 randomized participants, 2-year MACE occurred in 161 of 1,913 (8.5%) patients in the QFR-guided group and in 237 of 1,912 (12.5%) patients in the angiography-guided group (HR: 0.66; 95% CI: 0.54-0.81; P < 0.0001), driven by fewer MIs (4.0% vs 6.8%; HR: 0.58; 95% CI: 0.44-0.77; P = 0.0002) and ischemia-driven revascularizations (4.2% vs 5.8%; HR: 0.71; 95% CI: 0.53-0.95; P = 0.02) in the QFR-guided group. Landmark analysis showed consistent results within the first year and between 1-2 years (Pint = 0.99). Although the 2-year MACE rate was lower in the QFR-guided group in both patients with and without revascularization strategy changes, the extent of outcome improvement was greater (Pint = 0.009) among those patients in whom the preplanned PCI strategy was modified by QFR. CONCLUSIONS: QFR-guided lesion selection improved 2-year clinical outcomes compared with standard angiography guidance. The benefits were most pronounced among patients in whom QFR assessment altered the planned revascularization strategy. (FAVOR III China Study [The Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease] NCT03656848).

Coronary Intervention Guided by Quantitative Flow Ratio vs Angiography in Patients With or Without Diabetes.

BACKGROUND: The clinical utility of the quantitative flow ratio (QFR), a novel angiography-based index for the functional assessment of coronary stenoses, has recently been demonstrated in patients undergoing percutaneous coronary intervention (PCI). OBJECTIVES: This study aimed to ascertain whether the beneficial outcomes of QFR guidance for lesion selection during PCI is affected by diabetes status. METHODS: This substudy from the FAVOR III China trial, in which diabetes was one of the prespecified factors for stratified randomization, compared clinical outcomes of QFR-guided vs angiography-guided PCI lesion selection according to the presence of diabetes. The primary endpoint was the 1-year risk of major adverse cardiac events (MACE) (a composite of all-cause death, myocardial infarction, or ischemia-driven revascularization). RESULTS: Among 3,825 patients enrolled, 1,295 (33.9%) had diabetes, 347 (26.8%) of whom were treated with insulin. Baseline characteristics were well balanced between treatment arms in both diabetic and nondiabetic patients. Compared with standard angiography-based lesion selection, the QFR-guided strategy consistently reduced the risk of 1-year MACE in both diabetic patients (6.2% vs 9.6%; HR: 0.64; 95% CI: 0.43-0.95) and nondiabetic patients (5.6% vs 8.3%; HR: 0.66; 95% CI: 0.49-0.89) (Pinteraction = 0.88). Among patients in whom PCI was deferred after QFR, the risk of 1-year MACE was similar in patients with and without diabetes (4.5% vs 6.2%; P = 0.51). CONCLUSIONS: A QFR-guided lesion selection strategy improves PCI outcomes compared with standard angiography guidance in patients both with and without diabetes. (The Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease [FAVOR III China Study]; NCT03656848).

Papillary and Trabecular Muscles Have Substantial Impact on Quantification of Left Ventricle in Patients with Hypertrophic Obstructive Cardiomyopathy.

Patients with obstructive hypertrophic cardiomyopathy (HOCM) have large papillary and trabecular muscles (PTMs), which are myocardial tissue. PTMs are usually excluded from the myocardium and included in the left ventricular (LV) cavity when determining LV mass (LVM) and volumes using cardiac magnetic resonance (CMR). This conventional method may result in large distortion of LVM and other indices. We investigated 74 patients with HOCM undergoing CMR imaging. LV short-axis cine images were obtained. LV contours were drawn using two different methods: (1) the conventional method, where PTMs were included in the LV cavity; and (2) the mask method, which includes the TPMs in the LV myocardium. The LV end-diastolic volume (LV-EDV), LV end-systolic volume (LV-ESV), LV ejection fraction (LVEF), and the LVM were then calculated. Fasting NT-proBNP and CK-MB levels were measured with ELISA. In patients with HOCM, mass of PTMs (MOPTM) was 47.9 ± 18.7 g, which represented 26.9% of total LVM. Inclusion of PTMs with the mask method resulted in significantly greater LVM and LVM index (both p < 0.0001) in comparison with those measured with the conventional method. In addition, the mask method produced a significant decrease in LV-EDV and LV-ESV. LVEF was significantly increased with the mask method (64.3 ± 7.9% vs. 77.2 ± 7.1%, p < 0.0001). MOPTM was positively correlated with BMI, septal wall thickness, LVM, LV-EDV, and LV-ESV. LVEF was inversely correlated with MOPTM. In addition, MOPTM correlated positively with NT-proBNP (r = 0.265, p = 0.039) and CK-MB (r = 0.356, p = 0.002). In conclusion, inclusion of PTMs in the myocardium has a substantial impact on quantification of the LVM, LV-EDV, LV-ESV, and LVEF in patients with HOCM. The effects of the PTMs in women was greater than that in men. Furthermore, the MOPTM was positively associated with NT-proBNP and CK-MB. The PTMs might be included in the myocardium when measuring the LV volumes and mass of patients with HOCM. At present, the clinical and prognostic meaning and relevance of the PTMs is not clear and should be further studied.

Significance and Determinants of Plasma Apelin in Patients With Obstructive Hypertrophic Cardiomyopathy.

Background: Recent studies suggest apelin has multiple protective effects in some cardiovascular diseases. However, there are few data concerning apelin levels in patients with obstructive hypertrophic cardiomyopathy (OHCM) or the relationship between apelin levels and severity of OHCM. Methods: We studied 88 patients with OHCM and 32 control subjects with matched age and sex distribution. Complete medical history was collected and related examinations were performed. Cardiac magnetic resonance (CMR) and echocardiography were employed to characterize cardiac morphology and function. Plasma apelin was measured by enzyme-linked immunosorbent assay (ELISA). Results: Plasma apelin levels were significantly lower in patients with OHCM than those in control subjects (96.6 ± 34.3 vs. 169.4 ± 62.5 µg/L, p < 0.001). When patients with OHCM were divided into two groups according to the mean value of plasma apelin, patients with lower apelin levels (plasma apelin ≤ 96.6 µg/L) had greater septal wall thickness (SWT; 25.6 ± 5.5 vs. 23.2 ± 4.3 mm, p = 0.035) and less right ventricular end-diastolic diameter (RVEDD; 20.4 ± 3.3 vs. 23.0 ± 3.6 mm, p = 0.001). Consistently, plasma apelin levels were inversely correlated with SWT (r = -0.334, p = 0.002) and positively correlated with RVEDD (r = 0.368, p < 0.001). Besides, plasma apelin levels were inversely correlated with Ln (NT-proBNP) (r = -0.307, p = 0.008) and positively correlated with body mass index (BMI; r = 0.287, p = 0.008). On multivariate analysis, the SWT was independently associated with decreasing plasma apelin, while the RVEDD was independently associated with increasing plasma apelin. Conclusion: Plasma apelin levels are reduced in patients with OHCM. The apelin levels are inversely related to SWT and positively related to RVEDD.

Different Antiplatelet Strategies for Radial Artery Protection After Transradial Coronary Angiography-A Prospective Observational Cohort Study.

Introduction: Radial artery occlusion (RAO) after transradial access is a common thrombotic complication. A meta-analysis has proven that RAO incidence in transradial coronary angiography (TRCA) settings was significantly higher than that in percutaneous coronary intervention settings. This prospective observational cohort aimed to evaluate radial artery protection after TRCA with different antiplatelet strategies. Methods: A total of 2,316 patients undergoing TRCA was enrolled and divided into two groups: single-antiplatelet and dual-antiplatelet groups. Radial artery patency was evaluated by ultrasound before, at 24 h, and 30 days after TRCA. The primary endpoint was RAO incidence at 30 days after TRCA. Results: A total of 66 RAO was found on ultrasonography at 30-day follow-up (incidence: 2.8%). In the dual-antiplatelet group, the rate of RAO was significantly lower compared with the single-antiplatelet group (1.8 vs. 4.0%; odds ratio (OR): 0.41; 95% confidence interval (CI): 0.24-0.70; p = 0.001). The rate of self-recanalization in the dual-antiplatelet group was significantly higher than that in the single-antiplatelet group (73.68 vs. 44.12%, p < 0.001). However, there was no statistical difference in delayed occlusion of radial artery between the two groups (0.5 vs. 0.2%, p = 0.140). Unexpectedly, this study also showed no significant difference in bleeding risk between the groups. Conclusion: Dual-antiplatelet therapy for 1 month after TRCA was associated with a reduced risk of RAO and deemed safe.

Prevalence and Vascular Distribution of Multiterritorial Atherosclerosis Among Community-Dwelling Adults in Southeast China.

Importance: Data are limited on the prevalence and vascular distribution of multiterritorial atherosclerotic plaque and stenosis in community populations. Objective: To investigate the prevalence and vascular distribution of multiterritorial atherosclerotic plaque and stenosis in older, community-dwelling populations in China. Design, Setting, and Participants: This cross-sectional study was based on the baseline survey from the Polyvascular Evaluation for Cognitive Impairment and Vascular Events (PRECISE) study, a population-based prospective cohort study that enrolled community-dwelling adults aged 50 to 75 years based on cluster sampling from 6 villages and 4 living communities of Lishui city in southeast China. Data were collected from May 2017 to September 2019 and analyzed from September to November 2021. Main Outcomes and Measures: Atherosclerotic plaque and stenosis at baseline were assessed in multiple vascular territories. Brain vessel wall magnetic resonance imaging (MRI) for intracranial and extracranial arteries; computed tomography angiography (CTA) for coronary, subclavian, aorta, renal, and iliofemoral arteries; and ankle-brachial index for peripheral arteries were performed at baseline survey. The extent of atherosclerosis was assessed according to the number of these 8 vascular sites affected, and polyvascular lesions were defined as at least 2 affected sites. Results: A total of 3433 of 4202 invited individuals consented to participate in the study. After excluding 366 participants with contraindications for MRI or CTA scanning, with life expectancies of 4 years of fewer, or with mental disease, a total of 3067 community-dwelling adults were enrolled. The mean (SD) age was 61.2 (6.7) years; 1640 (53.5%) were women, and 74 (2.4%) had prevalent ASCVD. Most participants (2870 [93.6%]) had atherosclerotic plaques in at least 1 vascular territory. Atherosclerotic plaques were mostly detected in the aorta (2419 [79.6%]) and iliofemoral arteries (2312 [75.8%]), followed by subclavian (1500 [49.8%]), coronary (1366 [44.9%]), extracranial (1110 [36.4%]), renal (873 [28.7%]), and intracranial (542 [17.7%]) arteries. A substantial proportion of participants (1180 [38.5%]) had arterial stenosis of 50% or greater, predominantly affecting the coronary (542 [17.8%]) and iliofemoral (527 [17.3%]) arteries. Polyvascular atherosclerotic plaque was observed in 2541 participants (82.8%), with 1436 (46.8%) with plaque affecting 4 or more vascular territories, and polyvascular stenosis was observed in 412 patients (13.4%). Conclusions and Relevance: In this study, atherosclerotic plaque was highly prevalent in the older community population in China, and a substantial proportion of individuals reach stenosis of 50% or greater.

Essen score in the prediction of cerebrovascular events compared with cardiovascular events after ischaemic stroke or transient ischaemic attack: a nationwide registry analysis.

BACKGROUND: The Essen risk score improves stratification of patients with acute ischemic stroke by early stroke recurrence. Recent study showed it could also predict myocardial infarction (MI). This study aimed to compare the Essen score's ability to predict cerebrovascular events with compared cardiovascular events. METHODS: We included patients with acute ischaemic stroke or transient ischaemic attack within seven days from the Third China National Stroke Registry. One-year cumulative event rates of combined vascular events (a composite of MI, stroke recurrence or vascular death) and cardiac events (a composite of MI, heart failure or cardiac death) was estimated using the Kaplan-Meier method. The predictive value of the Essen score was assessed with C-statistics. In multivariate Cox regression analyses, we assessed whether Essen score, etiological subtype and imaging parameters were associated with outcomes. RESULTS: Of 13,012 patients were included, the cumulative one-year event rates were 10.03% for combined vascular events and 0.77% for cardiac events, respectively. Compared with those with an Essen score < 3, patients with an Essen score ≥ 3 were more likely to have a subsequent combined vascular event [hazard ratio (HR) = 1.39, 95% CI: 1.24-1.55] and cardiac events (HR = 2.30, 95% CI: 1.53-3.44). The score tended to be more predictive of the risk of MI (C-statistic = 0.63, 95% CI: 0.55-0.71) and cardiac events (C-statistic = 0.62, 95% CI: 0.56-0.67) than stroke recurrence (C-statistic = 0.55, 95% CI: 0.54-0.57) and combined vascular events (C-statistic = 0.56, 95% CI: 0.54-0.57). In multivariable analysis after adjusted Essen score, patients with multiple acute infarctions or single acute infarctions and large artery atherosclerosis subtype were independently associated with an increased risk of combined vascular events. While the cardioembolism subtype was associated with an increased risk of cardiac events. CONCLUSIONS: The Essen score is potentially more suitable for risk stratification of cardiovascular events than cerebrovascular events. Moreover, future predictive tools should take brain imaging findings and cause of stroke into consideration.

Prediction Efficiency of MADIT-ICD Benefit Score for Outcome in Asian Patients with Implantable Cardioverter-Defibrillator.

Background: Not all patients with heart failure derive consistent benefit from prophylactic implantable cardioverter-defibrillator (ICD). We aimed to evaluate the role of MADIT-ICD benefit score in risk-stratifying in Asian patients with left ventricular ejection fraction (LVEF) ≤35%. Methods: In this two-center, retrospective study, a total of 136 patients with LVEF ≤35% who received an ICD for primary prevention were enrolled. The endpoints were defined as the ventricular tachycardia ≥200bpm (VT) or ventricular fibrillation (VF) and non-arrhythmic death. Based on the MADIT-ICD benefit score system, all patients were categorized into three groups: highest benefit group (n = 41), intermediate benefit group (n = 80), and lowest benefit group (n = 15). Results: Forty patients experienced VT/VF and seven died of non-arrhythmic causes during a median follow-up of 44.8 ± 28.9 months. Kaplan-Meier curves showed that patients in highest benefit group had a worse VT/VF occurrence compared to those in other groups. In the highest benefit group, the predicted risk of VT/VF was 17-fold higher than the risk of non-arrhythmic mortality (41.5% vs 2.4%, P < 0.001). In the intermediate benefit group, the predicted risk of VT/VF was 4.2-fold higher than the risk of non-arrhythmic mortality (26.3% vs 6.3%, P = 0.001). In the lowest benefit group, however, the difference in the corresponding predicted risks was attenuated without statistically significant (13.3% vs 5.1%, P = 0.56). Conclusion: We demonstrate that MADIT-ICD benefit score can be used for the assessment of ICD primary prevention benefits in Asian patients with LVEF ≤35%.

LINC00460 Stimulates the Proliferation of Vascular Endothelial Cells by Downregulating miRNA-24-3p.

OBJECTIVE: To clarify the effect of LINC00460 on mediating the proliferative ability of vascular endothelial cells (ECs) by targeting microRNA-24-3p (miRNA-24-3p), thus influencing the progression of atherosclerotic diseases. METHODS: Relative levels of LINC00460 and miRNA-24-3p in ECs induced with different doses of ox-LDL (oxidized low density lipoprotein) for different time points were determined by quantitative real-time polymerase chain reaction (qRT-PCR). Influences of LINC00460 and miRNA-24-3p on the viability of ECs were assessed by Cell Counting Kit-8 (CCK-8) and 5-ethynyl-2'-deoxyuridine (EdU) assay. Through dual-luciferase reporter gene assay, the binding between LINC00460 and miRNA-24-3p was evaluated. At last, rescue experiments were performed to identify the function of the LINC00460/miRNA-24-3p axis in regulating the proliferative ability of ECs. RESULTS: LINC00460 was upregulated after ox-LDL treatment in a dose- and time-dependent manner. Viability of ECs gradually increased with the prolongation of ox-LDL treatment and the treatment of increased dose. The overexpression of LINC00460 enhanced the viability and EdU-positive rate in ECs treated with ox-LDL. miRNA-24-3p was the direct target of LINC00460, which was negatively regulated by LINC00460. miRNA-24-3p was downregulated with the prolongation of ox-LDL treatment. The overexpression of miRNA-24-3p could reverse the effect of LINC00460 on regulating the proliferative ability of ECs. CONCLUSIONS: LINC00460 regulates the proliferative ability of ECs and thus the occurrence and development of coronary atherosclerotic diseases by targeting miRNA-24-3p.

Impact of DPP-4 inhibitors on plasma levels of BNP and NT-pro-BNP in type 2 diabetes mellitus.

BACKGROUND: Dipeptidyl peptidase-4 inhibitors (DPP-4i) decrease glucose levels by regulating incretin peptides in type 2 diabetes mellitus (T2DM). This study aimed to determine the modulatory effect of DPP-4i on brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in patients with T2DM. METHODS: PubMed, Embase and the Cochrane Library were systematically searched to identify randomized controlled trials (RCTs) evaluating the impact of DPP-4i on BNP or NT-pro-BNP. A fixed- or random-effects model was used for quantitative analysis, according to the heterogeneity. Sensitivity analysis and publication bias were performed using standard methods. RESULTS: Nine trials with 3056 patients with T2DM were included. Meta-analysis revealed that DPP-4i did not significantly modulate the BNP (0.21 pg/mL, 95% CI - 2.36-2.79) or NT-pro-BNP level (- 7.34 pg/mL, 95% CI - 24.27-9.59). DPP-4i demonstrated no stronger effect on modulating BNP (5.17 pg/mL, 95% CI - 7.48-17.82) or NT-pro-BNP (- 9.95 pg/mL, 95% CI - 44.61-24.71) than active comparators. Pooled analysis was robust and stable after sensitivity analysis. CONCLUSIONS: DPP-4i exhibits no significant effect on modulating BNP or NT-pro-BNP and shows no stronger effect than traditional antidiabetic agents in T2DM.

Ferulic Acid Alleviates Oxidative Stress-Induced Cardiomyocyte Injury by the Regulation of miR-499-5p/p21 Signal Cascade.

OBJECTIVE: To investigate the protective effects and regulatory mechanisms of ferulic acid on oxidative stress-induced cardiomyocyte injury. METHODS: We established a cardiomyocyte oxidative stress cell model by H2O2 treatment and a mouse heart injury model by isoprenaline infusion of male C57BL/6 mice. Ferulic acid was applied to treat oxidative stress-induced cardiomyocyte injury. DHE staining was used to detect ROS production. DNA fragmentation, TUNEL assay, and cleaved caspase-3 were used to analyze cell apoptosis. Real-time PCR and Western blotting were used to analyze miRNA and protein levels to investigate the regulatory mechanisms of ferulic acid on oxidative stress-induced cardiomyocyte injury. RESULTS: Ferulic acid pretreatment significantly inhibited H2O2- and isoprenaline-induced oxidative stress and cell apoptosis by promoting miR-499-5p expression and inhibiting p21 expression. MiR-499-5p inhibition reversed the protective effects of ferulic acid. Further study found that ferulic acid could also attenuate isoprenaline-induced mouse heart fibrosis and cell apoptosis by reducing oxidative stress, inflammation, and apoptosis in vivo. CONCLUSIONS: We proved that ferulic acid protects cardiomyocytes from oxidative stress-induced injury by regulating the miR-499-5p/p21signaling pathway, which provides insight into the clinical application of ferulic acid in the treatment of cardiovascular diseases.

Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial.

BACKGROUND: Compared with visual angiographic assessment, pressure wire-based physiological measurement more accurately identifies flow-limiting lesions in patients with coronary artery disease. Nonetheless, angiography remains the most widely used method to guide percutaneous coronary intervention (PCI). In FAVOR III China, we aimed to establish whether clinical outcomes might be improved by lesion selection for PCI using the quantitative flow ratio (QFR), a novel angiography-based approach to estimate the fractional flow reserve. METHODS: FAVOR III China is a multicentre, blinded, randomised, sham-controlled trial done at 26 hospitals in China. Patients aged 18 years or older, with stable or unstable angina pectoris or patients who had a myocardial infarction at least 72 h before screening, who had at least one lesion with a diameter stenosis of 50-90% in a coronary artery with a reference vessel of at least 2·5 mm diameter by visual assessment were eligible. Patients were randomly assigned to a QFR-guided strategy (PCI performed only if QFR ≤0·80) or an angiography-guided strategy (PCI based on standard visual angiographic assessment). Participants and clinical assessors were masked to treatment allocation. The primary endpoint was the 1-year rate of major adverse cardiac events, a composite of death from any cause, myocardial infarction, or ischaemia-driven revascularisation. The primary analysis was done in the intention-to-treat population. The trial was registered with ClinicalTrials.gov (NCT03656848). FINDINGS: Between Dec 25, 2018, and Jan 19, 2020, 3847 patients were enrolled. After exclusion of 22 patients who elected not to undergo PCI or who were withdrawn by their physicians, 3825 participants were included in the intention-to-treat population (1913 in the QFR-guided group and 1912 in the angiography-guided group). The mean age was 62·7 years (SD 10·1), 2699 (70·6%) were men and 1126 (29·4%) were women, 1295 (33·9%) had diabetes, and 2428 (63·5%) presented with an acute coronary syndrome. The 1-year primary endpoint occurred in 110 (Kaplan-Meier estimated rate 5·8%) participants in the QFR-guided group and in 167 (8·8%) participants in the angiography-guided group (difference, -3·0% [95% CI -4·7 to -1·4]; hazard ratio 0·65 [95% CI 0·51 to 0·83]; p=0·0004), driven by fewer myocardial infarctions and ischaemia-driven revascularisations in the QFR-guided group than in the angiography-guided group. INTERPRETATION: In FAVOR III China, among patients undergoing PCI, a QFR-guided strategy of lesion selection improved 1-year clinical outcomes compared with standard angiography guidance. FUNDING: Beijing Municipal Science and Technology Commission, Chinese Academy of Medical Sciences, and the National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital.

Inhibition of the lncRNA DANCR attenuates cardiomyocyte injury induced by oxygen-glucose deprivation via the miR-19a-3p/MAPK1 axis.

Long noncoding RNAs (lncRNAs) have been considered as crucial regulators of acute myocardial infarction (AMI). In this study, to analyze the effect of differentiation antagonizing nonprotein coding RNA (DANCR) of lncRNA on cardiomyocyte damage in AMI, cardiomyocyte injury was induced by oxygen-glucose deprivation (OGD). Cell counting kit-8 (CCK-8) assay and flow cytometry were used to assess cell viability and apoptosis, respectively. Quantitative real-time PCR was used to measure the expression levels of DANCR and miR-19a-3p. Bioinformatics analysis and luciferase gene reporter assay were utilized to explore the relationship among DANCR, miR-19a-3p, and mitogen-activated protein kinase 1 (MAPK1). CCK-8 and TUNEL assays were used to explore the effects of DANCR alone or plus miR-19a-3p on the viability and apoptosis of OGD/R-exposed HL-1 cells. Western blot analysis was used to detect changes in the MAPK1/ERK1/2 pathway in HL-1 cells. We found that DANCR expression and miR-19a-3p level are negatively correlated as DANCR expression is increased, while miR-19a-3p level is decreased in AMI patients' serum and OGD/R-exposed HL-1 cells. DANCR knockdown increased miR-19a-3p level, and miR-19a-3p inhibition increased DANCR expression. Moreover, DANCR directly binds to miR-19a-3p. DANCR knockdown reduced viability but induced apoptosis in OGD/R-exposed HL-1 cells, while miR-19a-3p inhibition weakens these effects. Furthermore, MAPK1 is a target of miR-19a-3p. miR-19a-3p overexpression decreases MAPK1 and ERK1/2 in HL-1 cells, while miR-19a-3p inhibition increases MAPK1 and ERK1/2 in HL-1 cells. Moreover, DANCR knockdown reduces myocardium apoptosis in mice with the left anterior descending artery ligated. DANCR knockdown effectively restores myocardial cell apoptosis by regulating the miR-19a-3p/MAPK1/ERK1/2 axis.