Bridging the gap in cardiac mass diagnosis: Advanced imaging, genetic associations, and biomarkers.

In this editorial we comment on the article by Huffaker et al published in a recent issue of the World Journal of Clinical Cases. We focus on cardiac tumors linked to genetic syndromes and the differential diagnosis of cardiac masses. As cardiomyocytes lack the ability to actively divide, primary cardiac tumors are extremely rare across all ethnicities and age groups. Once they occur, these tumors are often associated with genetic mutations and, occasionally, genetic syndromes. This underscores the importance of considering genetic mutations and syndromes when encountering these cases. The more common growths in the heart are thrombi and vegetations, which can mimic tumors, further making the differential diagnosis challenging. Among the imaging techniques, contrast-enhanced cardiac magnetic resonance imaging has the highest sensitivity for differential diagnosis. To aid in the differential diagnosis of cardiac masses, especially thrombi, appropriate utilization of biomarkers (i.e. D-dimer level) may provide pivotal clinical implications. Employing a multidisciplinary approach that integrates personal history, epidemiological insights, imaging findings, genetic markers, and biomarkers is therefore critical in the diagnostic process of cardiac masses.

Inhibition of neointimal hyperplasia in balloon-induced vascular injuries in a rat model by miR-22 loading Laponite hydrogels.

Percutaneous coronary intervention (PCI) is the mainstream treatment to widen narrowed or obstructed coronary arteries due to pathological conditions. However, the post-operational neointimal hyperplasia occurs because of endothelium denudation during surgical procedures and the following inflammation. MicroRNAs (miRs) are new therapeutics of great potential for cardiovascular diseases. However, miRs easily degrade in vivo. A vehicle that can maintain their bioactivities and extend their retention at the site of delivery is prerequisite for miRs to play their roles as therapeutic reagents. Here, we reported the use of the Laponite hydrogels to deliver miR-22 that are modulators of phenotypes of smooth muscle cells (SMCs). The Laponite hydrogels allow a homogenous distribution of miR-22 within the gels, which had the capacity to transfect SMCs in vitro. Upon the injection of the miR-22 incorporated in the Laponite hydrogels in vivo, miR-22 could be well retained surrounding arteries for at least 7 days. Moreover, the miR-22 loading Laponite hydrogels inhibited the neointimal formation, reduced the infiltration of the macrophages, and reversed the adverse vascular ECM remodeling after the balloon-induced vascular injuries by upregulation of miR-22 and downregulation of its target genes methyl-CpG binding protein 2 (MECP2). The application of the Laponite hydrogels for miR local delivery may offer a novel strategy to treat cardiovascular diseases.

Effect of mobile-based cognitive behavior therapy (CBT) on lowering of blood lipid levels in atherosclerotic cardiovascular disease (ASCVD) patients: study protocol for a multicenter, prospective, randomized controlled trial.

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) remains a major source of mortality in China. Convincing evidence has demonstrated that the reduction of low-density lipoprotein cholesterol (LDL-C) is correlated with lowering ASCVD risk. The efficacy of lifestyle management in lipid levels reduction has been confirmed in numerous studies. However, considering that low compliance to lifestyle management has limited the benefits of lowering lipid levels, cognitive behavior therapy (CBT) is proposed as a solution to improve clinical outcomes. The objective of this trial is to compare the LDL-C outcome in ASCVD patients receiving mobile device-based CBT to a control group, with both groups under standard pharmacological treatments. METHODS: This trial is designed as a multicenter, prospective randomized controlled trial with a 6-month follow-up. Mean LDL-C level and the percentage of different LDL-C levels, coefficient of variation of LDL, General Self-Efficacy Scale (GSEs), quality of life index (QL-index), etc., between the two groups at baseline, 1, 3, and 6 months will be measured. DISCUSSION: This trial should demonstrate that the implementation of mobile-based CBT intervention will be potentially effective in lowering LDL-C levels in ASCVD patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry ( ChiCTR2100046775 ) [registered: 2021/5/28].

Predictors and clinical significance of periprocedural myocardial infarction following rotational atherectomy.

OBJECTIVES: To investigate the potential predictors and clinical significance of periprocedural myocardial infarction (PMI), as defined by the latest Fourth Universal Definition of Myocardial Infarction (2018), following rotational atherectomy (RA). BACKGROUND: PMI is not uncommon in patients undergoing RA, although the predictors and prognostic impact are unknown. METHODS: Data from 229 consecutive patients who had undergone RA before drug-eluting stent (DES) implantation in a single center were analyzed. Patients' demographic information, clinical, angiographic, and procedural characteristics, and 1-year follow-up outcomes were collected retrospectively. RESULTS: The overall incidence of PMI in patients undergoing RA was 48.5%. Age (adjusted odds ratio [OR]: 1.024, 95% confidence interval [CI]: 1.001-1.047, p = 0.043) and ejection fraction (adjusted OR: 0.977, 95% CI: 0.962-0.993, p = 0.004) were independent predictors of PMI in RA, although PMI was not associated with an increased risk of major adverse cardiovascular and cerebrovascular events (MACCEs) at the 1-year follow-up in patients undergoing RA. CONCLUSION: Age and ejection fraction were independently associated with an elevated risk of PMI in patients undergoing RA. However, post-RA microinfarcts were not associated with an increased risk of MACCEs over the short-term follow-up period.

Intrastent haematoma after treatment with a drug-eluting balloon for in-stent restenosis: a case report.

BACKGROUND: Intrastent haematoma after dilatation of in-stent restenosis (ISR) is rarely reported and the optimal treatment for this condition remains unclear. CASE SUMMARY: We present the case of an 87-year-old man with in-stent subtotal occlusion of left circumflex. He experienced chest pain after drug-eluting balloon was released in the stent. Intravascular ultrasound revealed intrastent haematoma, which was not relieved with a cutting balloon but completely sealed by an Endeavor Resolute stent. DISCUSSION: Intrastent haematoma after dilatation of ISR is rare. Reimplantation of stent seems the best method to solve this problem. Intravascular ultrasound imaging may provide insight into the cause of ISR and guide the treatment.

Prediction of presence and severity of coronary artery disease using prediction for atherosclerotic cardiovascular disease risk in China scoring system.

BACKGROUND: Coronary artery disease (CAD) is one of the leading causes of death and disease burden in China and worldwide. A practical and reliable prediction scoring system for CAD risk and severity evaluation is urgently needed for primary prevention. AIM: To examine whether the prediction for atherosclerotic cardiovascular disease risk in China (China-PAR) scoring system could be used for this purpose. METHODS: A total of 6813 consecutive patients who underwent diagnostic coronary angiography were enrolled. The China-PAR score was calculated for each patient and CAD severity was assessed by the Gensini score (GS). RESULTS: Correlation analysis demonstrated a significant relationship between China-PAR and GS (r = 0.266, P < 0.001). In receiver operating characteristic curve analysis, the cut-off values of China-PAR for predicting the presence and the severity of CAD were 7.55% with a sensitivity of 55.8% and specificity of 71.8% [area under the curve (AUC) = 0.693, 95% confidence interval: 0.681 to 0.706, P < 0.001], and 7.45% with a sensitivity of 58.8% and specificity of 67.2% (AUC = 0.680, 95% confidence interval: 0.665 to 0.694, P < 0.001), respectively. CONCLUSION: The China-PAR scoring system may be useful in predicting the presence and severity of CAD.

Comparison of rotational atherectomy and modified balloons prior to drug-eluting stent implantation for the treatment of heavily calcified coronary lesions.

ABSTRACT: The optimal strategy for lesion preparation in heavily calcified coronary lesions (HCCL) prior to drug-eluting stent (DES) implantation remains debatable. This study sought to compare the performance of rotational atherectomy (RA) and modified balloon (MB)-based strategy in patients with HCCL receiving current-generation DES.This retrospective study comprised 564 consecutive patients who underwent RA (n = 229) or MB (n = 335) for HCCL at our hospital and were treated with DES. Baseline clinical and angiographic data was obtained from our database. Patients were clinically monitored for the occurrence of any adverse events during the hospitalization. One-year follow-up was conducted by either telephone contact or outpatient visits. 1:1 propensity score matching (PSM) was performed to balance the baseline covariates. After PSM, the clinical outcomes between the 2 groups were compared.After PSM, except more target lesion in right coronary artery existing in the RA group (P = .008), no significant statistical differences were shown in regard of the other angiographic and procedural characteristics of the 2 groups. Strategy success rates were all 100% in both groups. In the unadjusted Cox proportional hazard analysis, participants with RA had a significantly lower risk of target lesion revascularization (TLR) (hazard ratio, HR 0.275, 95% confidence intervals, CI 0.119-0.635, P = .003) and major adverse cardiac event (MACE) (HR 0.488, 95% 0.277-0.859, P = .013). After adjusting for potential confounding variables, RA was significantly associated with TLR (HR 0.32, 95% 0.12-0.853, P = .023), but no longer significantly associated with MACE (HR 0.674, 95% 0.329-1.381, P = .282).In patients with HCCL, lesion preparation with RA was safe and could improve strategy success rate. There was lower rate of TLR with RA, however, no significant difference was found in the MACE rate at 1-year follow-up between RA and MB-based strategy.

Association of ABO blood groups with the severity of coronary artery disease: a cross-sectional study.

OBJECTIVE: To investigate whether ABO blood groups is associated with the severity of coronary artery disease (CAD). METHODS: Between January 2015 and December 2017, 1425 first diagnosed CAD patients confirmed by selective coronary angiography were recruited into this cross-sectional study, and their baseline characteristics, ABO blood groups, Gensini score were collected. Multiple linear regression analysis was performed to test the association between the severity of CAD and ABO blood groups. RESULTS: The Gensini score was significantly higher in the blood group A than in the non-A groups (41.2 ± 32 vs. 38 ± 27; P = 0.026). After adjusting for age, male, smoking, family history of CAD, hypertension, diabetes mellitus and hypercholesterolemia, multivariate linear regression indicated that blood group A was associated with the severity of CAD (ß = 3.298, 95% CI: 0.91-6.505, P = 0.044). In diabetes group, A blood type was also associated with increased Gensini score (P = 0.02) after adjusting for age, male, family history of CAD, hypercholesterolemia, smoking and hypertension. CONCLUSION: In this cross-sectional study, the data indicated that blood group A was an independent risk factor of severity of CAD in Chinese population and Chinese patients with type 2 diabetes.