Abstract:Aim To explore the relationship between fractional flow reserve (FFR) technical parameters and myocardial zymogram in patients with non-ST-segment elevation acute myocardial infarction (NSTEMI) and the predictive value of major adverse cardiovascular events (MACE). Methods A total of 136 NSTEMI patients admitted to Liaocheng Third Peoples Hospital from February 2017 to February 2020 were selected and all underwent percutaneous coronary intervention (PCI) under the guidance of FFR. According to whether MACE occurred 1 month after operation, all patients were divided into MACE group (n＝14) and non-MACE group (n＝122). The clinical data, myocardial enzyme spectrum indexes, quantitative coronary angiography (QCA) parameters, and FFR technical parameters were compared between the two groups. The correlation between FFR technical parameters and myocardial enzyme spectrum indexes and QCA parameters was analyzed. The Logistic regression equation was used to analyze MACE influencing factors. The receiver operating characteristic (ROC) curve and the area under curve (AUC) were used to analyze the myocardial zymogram indexes, QCA parameters, and FFR to predict the value of MACE. Results Compared with the non-MACE group, the proportion of patients aged ≥60 years old in the MACE group increased 0.55 times, the GRACE score increased 0.11 times, the cardiac troponin I (cTnI) level increased 0.38 times, the creatine kinase (CK) level increased 0.22 times, the creatine kinase isoenzyme-MB (CK-MB) level increased 0.24 times, and the stenosis degree increased 0.08 times, the lesion length increased 0.11 times, the FFR decreased 11.9%, and the minimum lumen area of criminal vessels decreased 12.8%, the difference was statistically significant (P＜0.05); FFR was negatively correlated with cTnI, CK, and CK-MB levels (P＜0.05); FFR was negatively correlated with stenosis and lesion length (P＜0.05); Logistic regression analysis showed that after adjusting for age, GRACE score, and culprit vessel minimum lumen area, myocardial zymogram indexes (cTnI, CK, CK-MB), QCA parameters (degree of stenosis, lesion length), and FFR were all related to the occurrence of MACE (P＜0.05); The AUC of MACE predicted by FFR was 0.885, the sensitivity was 92.86%, and the specificity was 65.88%. Conclusion There is a negative correlation between FFR and myocardial enzymes (cTnI, CK and CK-MB) levels in NSTEMI patients, and are related to the occurrence of MACE, which can predict the risk of MACE.

Abstract:Aim To explore the influencing factors of fat attenuation index of pericoronary adipose tissue (FAI-PCAT) when there is no local inflammation or mild inflammation of coronary artery, and to establish a regression model to predict the individual baseline values of FAI-PCAT. Methods Hospitalized patients who had no previous history of coronary heart disease and underwent coronary computed tomography angiography (CCTA) examination to exclude obstructive coronary artery disease in the First Affiliated Hospital of Harbin Medical University from January to December 2019 were included. The baseline data and clinical indexes such as sex, age, height, weight, past medical history, blood routine, blood glucose, and blood lipid were collected. The AW VolumeShare 4 CT working software was used to post-process the CCTA images by one doctor with more than 3 years of imaging experience, and FAI-PCAT and epicardial fat attenuation (EFat) were measured and recorded. Spearman correlation was used to analyze the correlation of factors. Multiple linear regression was used to analyze the influencing factors of FAI-PCAT and then established a regression model. Results A total of 103 patients with CCTA showing CAD-RADS 0～1 were included. The FAI-PCAT value is (－82.2±7.0) Hu, the EFat value is (－84.8±4.4) Hu. Correlation analysis showed that FAI-PCAT was significantly and positively correlated with EFat (P＜0.01), significantly and negatively correlated with lymphocyte to monocyte ratio (LMR), lymphocyte percentage (P＜0.01), and positively correlated with blood glucose level (P＜0.05). There was no correlation between FAI-PCAT and body mass index (BMI), blood lipid. The EFat was significantly and negatively correlated with BMI, triglyceride (TG), low density lipoprotein cholesterol/high density lipoprotein cholesterol (LDLC/HDLC), very low density lipoprotein cholesterol (VLDLC) (P＜0.01), and significantly and positively correlated with HDLC (P＜0.01), positively correlated with apolipoprotein A/apolipoprotein B (ApoA/ApoB) (P＜0.05). Multiple linear regression analysis showed that EFat value (X1), LMR (X2), and blood glucose level (X3) were the main influencing factors and prediction parameters of FAI-PCAT value when there was no local inflammation or mild inflammation of coronary artery, and the regression equation was =－25.466+0.686X1－0.9X2+1.207X3. Conclusion EFat value, LMR, and blood glucose level were the main influencing factors of FAI-PCAT value when there was no local inflammation or mild inflammation of coronary artery, and the regression model can predict the individual baseline values of FAI-PCAT.

Abstract:Aim To investigate the correlation between coronary artery stenosis, calcification score and coronary hemodynamics in patients with coronary heart disease based on the CT-fractional flow reserve (CT-FFR) of artificial intelligence. Methods The clinical and coronary CT angiography (CCTA) datas of 206 patients with suspected coronary heart disease in the Affiliated Hospital of Qinghai University from September 2020 to April 2021 were included in this study retrospectively. The CT-FFR, coronary artery calcification score and stenosis degree of coronary artery were analyzed by artificial intelligence software, including left anterior descending artery, left circumflex branch and right coronary artery. The patients were divided into two groups according to the CT-FFR value. The vessels with CT-FFR≤0.8 were divided into functional meaning group, and the rest are non-functional meaning group. The correlations between coronary artery stenosis and calcification score and coronary hemodynamics were analyzed. Results 365 blood vessels from 206 patients were included in the study,and there were 139 blood vessels in the functional meaning group and 226 blood vessels in the non-functional meaning group. Degree of coronary stenosis (r＝－0.473, P＜0.001) and calcification score (r＝－0.369, P＜0.001) were negatively correlated with CT-FFR, and the calcification score was weakly correlated with the degree of stenosis (r＝0.141,P＝0.007). Compared with non-functional meaning group, the age of onset was older, and the proportion of male patients, hypertension, smoking history were significantly higher than those in the non-functional meaning group. Conclusion Degree of coronary stenosis and calcification score are important factors affecting coronary hemodynamics, CT-FFR is helpful for the functional evaluation of CCTA in coronary artery disease.

Abstract:Aim To study the diagnostic and prognostic value of head and neck computed tomography angiography (CTA) combined with ambulatory arterial stiffness index in acute cerebral watershed infarction (ACWI). Methods 292 patients who met the diagnostic criteria of ischemic cerebrovascular disease in the Department of Neurology of Baoding Second Central Hospital from July 2018 to September 2020 were prospectively collected. All patients were examined by diffusion weighted imaging (DWI). According to the results of DWI, patients were divided into ACWI group (n＝134) and non-ACWI group (n＝158). All patients underwent head and neck CTA examination and neck ultrasound, to detect the presence, nature and location of carotid plaque and the stenosis, location and stenosis of head and neck vessels in patients. The prognosis of the patients was evaluated with the NIHSS. The general clinical data, NIHSS score at admission and discharge, ambulatory arterial stiffness index (AASI), vascular stenosis in the head and neck, location and stenosis were compared between the two groups. Multivariate analysis was conducted using Logistic regression model. Pearson test was used to analyze the correlation between AASI and head and neck CTA in patients with ACWI. ROC curve was used to evaluate the detection index of CTA in the head and neck and the effect of AASI on ACWI, and the factors affecting the prognosis of patients with ACWI were analyzed by establishing Cox proportional hazard regression model. Results Mean arterial pressure was the protective factor of ACWI on admission (P＜0.05). The degree of internal carotid artery (ICA) stenosis on the lesion side, the stenosis degree of MCA on the lesion side, the stenosis of multiple vessels on the lesion side and AASI were independent risk factors for ACWI (P＜0.05). ASSI was positively correlated with the degree of ICA stenosis, the degree of MCA stenosis and the number of stenotic vessels (P＜0.001). The diagnostic value of head and neck CTA combined with AASI in ACWI was greater than that in ACWI alone (P＜0.05). NIHSS score at discharge, focal side severe ICA stenosis, focal side MCA severe stenosis, lesion side multivessel stenosis and AASI were the key risk factors affecting the prognosis of ACWI patients (P＜0.05). Conclusion The degree of ICA stenosis on the lesion side, the stenosis degree of MCA on the lesion side, the stenosis of multiple vessels on the lesion side and AASI are independent risk factors for ACWI. Clinically, head and neck CTA combined with AASI can be used for early diagnosis and treatment of ACWI patients and improve the prognosis of the patients.

Abstract:Aim To evaluate the safety and effectiveness of percutaneous coronary intervention via distal transradial artery access. Methods Pubmed, Embase, Web of Science, Cochrane Library, China Biomedical Service System (Sinomed), China Knowledge Network (CNKI), Wanfang Data Knowledge Service Platform (Wanfang Data), VIP and other databases were searched by computer. The search time limit was from Janurary 2017 to May 2020. Two researchers conducted a Meta-analysis after analyzing and evaluating according to the Cochrance bias risk assessment tool.Results A total of 1 617 articles were obtained in various databases and other channels according to a predetermined search strategy, excluding unreasonable research design, no control group or control group as other parts of blood vessels (such as femoral artery, etc.), animal experiments, reviews, systematic reviews, and case reports were excluded. 10 articles were finally selected, Meta analysis results showed that there was no significant difference in the success rate of coronary puncture, the radial artery spasticity, and local hematoma (P＞0.05). However, the the radial artery occlusion was lower (OR＝0.4,5%CI(0.8,0.69),Z＝3.56,P＜0.05) in the distal radial artery path than in the traditional radial artery pathology. Conclusion Distal transradial artery access is safer and more effective than traditional radial artery access for coronary artery intervention. It can reduce radial artery occlusion and can be used as an alternative branch of the traditional route.

Abstract:Aim To investigate the effect of renin-angiotensin system inhibitor (RASI) on long-term prognosis in patients with coronary heart disease (CHD) after contrast-associated acute kidney injury (CA-AKI). Methods A total of 1 526 patients with CHD diagnosed by coronary angiography and postoperative CA-AKI in Guangdong Provincial Peoples Hospital from January 2008 to December 2018 were included in this study. They were divided into RASI group (n＝984) and non-RASI group (n＝542) according to whether they took RASI or not. The primary end point was long-term all-cause death. Baseline clinical data were compared between the two groups. Kaplan-Meier method and COX regression analysis were used to evaluate the effect of RASI on long-term prognosis. Results The proportion of β-receptor blockers and statins used in the RASI group was higher than that in the non-RASI group (P＜0.01). During the median follow-up period of 4.75 years (quartile 2.82 years, 6.67 years), 332 patients died, and the all-cause mortality was 21.76%. Kaplan-Meier survival analysis showed that the mortality of RASI group was lower than that of non-RASI group (P＝0.001). Univariate and multivariate COX regression analysis showed that RASI treatment after discharge was significantly negatively correlated with all-cause death (P＝0.001, P＝0.034), and RASI was an independent protective factor for long-term all-cause death. Conclusions RASI is an independent protective factor for the long-term prognosis of CHD patients after CA-AKI. Long-term use of RASI therapy can reduce the all-cause death in patients with CHD and CA-AKI.

Abstract:Aim To study vertebral artery stenosis and its relationship with posterior circulation cerebral infarction after vertebral artery stenting (VAS), and to explore the risk factors of posterior circulation cerebral infarction. Methods Volume computed tomographic digital subtraction angiography (VCTDSA) was used to evaluate the vertebral artery stenosis in 134 patients with posterior circulation ischemia (PCI) after VAS. The patients were divided into two groups:45 cases in PCI symptom with vertebral artery stenosis group (PCI-V group) and 89 cases in simple PCI symptom group (PCI group). The correlation between vertebral artery stenosis and posterior circulation cerebral infarction was analyzed statistically, and the risk factors of posterior circulation cerebral infarction after VAS were analyzed by univariate analysis and multivariate analysis. Results In PCI-V group, there were 51 vertebral artery stenosis sites with an average stenosis rate of (82.1%±6.7%), including 6 cases of mild stenosis, 13 cases of moderate stenosis, 20 cases of severe stenosis and 6 cases of complete occlusion. There was significant difference in the incidence of posterior circulation cerebral infarction between PCI-V group and PCI group (χ2＝10.600, P＝0.001). The incidences of posterior circulation cerebral infarction of patients with moderate stenosis, severe stenosis and complete occlusion in PCI-V group were significantly higher than that of patients in PCI group (all P＜0.05). The results of univariate analysis showed that NIHSS score≥12, hyperhomocysteinemia and diabetes history were the risk factors for posterior circulation cerebral infarction in PCI-V patients. Logistic multivariate analysis showed that NIHSS score≥12, hyperhomocysteinemia and diabetes history were independent risk factors for posterior circulation cerebral infarction in PCI-V patients. Conclusions Posterior circulation cerebral infarction after VAS is related to vertebral artery stenosis. NIHSS score≥12, hyperhomocysteinemia and diabetes history are independent risk factors of posterior circulation cerebral infarction in patients with PCI and vertebral artery stenosis after VAS.

Abstract:Aim To research the connection between the changes of plasma platelet-derived growth factor C (PDGF-C) concentration and coronary heart disease and the degree of coronary artery disease. Methods The research includes 52 patients with acute coronary syndrome (ACS), 52 patients with stable angina pectoris (SAP), and 50 patients with normal angiography as the control group. Among patients with coronary heart disease (ACS and SAP), there were 60 cases of coronary artery multivessel disease, 25 cases of double vessel disease, and 19 cases of single vessel disease. The enzyme-linked immunosorbent assay (ELISA) method was used to determine the plasma PDGF-C concentration in each group of patients. The plasma PDGF-C concentration levels were compared between groups, and Spearman correlation analysis, Logistic regression analysis, and ROC curve were drawn. Results The concentration of PDGF-C in the ACS group and the SAP group was higher than that in the control group(P<0.05). The plasma PDGF-C concentration in the multivessel and double disease groups was higher than that in the single disease group(P<0.05). The results of Spearman correlation analysis indicated that there was a correlation between plasma PDGF-C concentration and Gensini score(r=0.163, P<0.05). Logistic regression analysis found that patients with high concentration of PDGF-C had a higher risk of coronary heart disease than patients with low concentration of PDGF-C (OR=1.6,5%CI 1.002~1.011). The area under the ROC curve of plasma PDGF-C concentration was 0.645, and the sensitivity was 77.88%.Conclusion High-concentration plasma PDGF-C may be a risk factor for coronary heart disease and may be related to the severity of coronary artery disease.

Abstract:Aim To observe the thickness variation of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) in type 2 diabetes mellitus (T2DM) patients. To analyze the correlation of retinal neural structure parameters and microcirculation parameters. Methods This was a cross-sectional retrospective study including 45 T2DM patients (71 eyes) and 36 healthy controls (68 eyes). The optical coherence tomography angiography (OCTA) was used to examine GCC thickness, RNFL thickness, microvascular density of retinal superior capillary plexus, retinal deep capillary plexus and choroidal capillary plexus. Then the RNFL and GCC thickness changes were observed in the diabetic retinopathy (DR) patients of different stages, furthermore, the correlation was analyzed between these parameters and microvascular density. Results Compared with the control group, the focal loss volume (FLV, P＝0.00) and global loss volume (GLV, P＝0.00) of GCC thickness increased significantly in NDR group (DM patients without DR), so FLV and GLV might be the potential sensitive parameters to assess early loss of retinal ganglion cell (RGC) in NDR patients. Compared with the control group, the RNFL thickness decreased initially in the inferior and nasal quadrant in the patients with mild non-proliferative DR (NPDR) and moderate NPDR (P＝0.00), implying the more susceptibility regions for RNFL loss. In the severe NPDR group, the nasal RNFL thickness were still thinner (P＝0.00), whereas the inferior and temporal RNFL thickness went up significantly, compared with the control group (P＝0.00). In the PDR group, RNFL and GCC thickness in most regions were thicker than the control group, which might be relevant to retina thickening caused by the edema of retina. This might be supported by the positive correlation between the GCC/RNFL thickness and the retinal thickness revealed by the Spearman correlation analysis. In addition, the GCC and RNFL thickness were negatively correlated with retinal superficial capillary plexus(SCP) density, the deep capillary plexus (DCP) density and choroidal capillary plexus (CCP) density. Conclusion Local loss of GCC occurred in advance of the presence of DR, FLV and GLV in GCC thickness might be the potential sensitive parameters to assess early loss of RGC. With the development and progress of DR, the RNFL thickness tends to drop down influentially, then goes up finally. Therefore, further prospective and longitudinal clinical researches are needed.

Abstract:Aim To explore the value of intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA) in the interventional therapy of borderline coronary lesions. Methods 60 patients with borderline coronary lesions(coronary artery stenosis between 40％～70％ confirmed by coronary angiography (CAG)) were enrolled. They were divided into QCA group(n=30, received QCA examination after CAG) and IVUS group (n=30, received IVUS detection after CAG). QCA and IVUS quantitative analysis were used to measure difference in reference vessel diameter, minimal lumen diameter, minimal lumen area, stenotic rates of diameter and area between two groups, and qualitative analysis was used to detect coronary plaques imaging morphology with IVUS. Finally, all the patients were followed up for 12 months. Incidence rate of major adverse cardiovascular events (MACE) during admission and follow-up were compared between two groups. Results Compared with QCA group, the ratio of lumen diameter stenosis ((57.80％±8.18％) vs (51.73%±7.91%)) and area stenosis ((67.01％±10.41％) vs (57.07%±10.71%)) were increased, while the ratio of minimum lumen area ((3.90±0.79) mm2 vs (4.14±0.60) mm2) was decreased in IVUS group (P＜0.05). Meanwhile there was no MACE during admission in two groups, but the incidence rate of MACE was significantly lower in IVUS group than that in QCA group since one month after follow-up started(P＜0.05). Conclusion Compared with QCA, IVUS can detect more severe stenosis rate of angiographical borderline lesions, more effectively detect “unstable” lesions, guide percutaneous coronary intervention of borderline lesion, reduce the occurrence of cardiovascular events, and improve the prognosis.