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This study aimed to evaluate the association of lipoprotein(a) levels with platelet aggregation and thrombogenicity in patients undergoing percutaneous coronary intervention (PCI), and to investigate the ischemic outcome on this population. Lipoprotein(a) and modified thrombelastography were measured in 6601 consecutive patients underwent PCI on dual antiplatelet therapy. Cox proportional regression analysis was applied to illustrate the ischemic events in a 2-year follow up. The mean levels of lipoprotein(a) were 29.0 mg/dl. Patients with higher lipoprotein(a) levels had significantly accelerated fibrin generation (lower K time and bigger α angle) and greater clot strength (higher maximum amplitude (MA)) than patients with lower lipoprotein(a) levels (P <.001). Moreover, the higher lipoprotein(a) group also exhibited significantly higher adenosine diphosphate (ADP) induced platelet aggregation (MAADP) by thrombelastography platelet mapping assay than lower lipoprotein(a) group. Cox regression analyzes revealed that patients with higher lipoprotein(a) levels had a 16% higher risk of major adverse cardiovascular and cerebrovascular events (HR 1.159, 95%CI: 1.005–1.337, P =.042) compared with patients with lower lipoprotein(a) levels. This association persisted after adjustment for a broad spectrum of risk factors (HR 1.174, 95%CI: 1.017–1.355, P =.028). High plasma lipoprotein(a) levels were associated with increased platelet aggregation and ischemic events in patients underwent PCI. Lipoprotein(a) might indicate the need for prolonged antiplatelet therapy. [ABSTRACT FROM AUTHOR]

To analyze factors associated with unplanned revascularization (UR) risk in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). A total of 10,640 cases with CAD who underwent PCI were analyzed. Multivariate COX regressions and competing risk regressions were applied. The patients who underwent UR following PCI in 30 days, 1, and 2 years accounted for 0.3%, 6.5%, and 8.7%, respectively. After multivariate adjustment, the number of target lesions [hazard ratio (HR) = 2.320; 95% confidence interval (CI) : 1.643–3.277; P < 0.001], time of procedure (HR = 1.006; 95% CI: 1.001–1.010; P = 0.014), body mass index (HR = 1.104; 95% CI: 1.006–1.210; P = 0.036), incomplete revascularization (ICR) (HR = 2.476; 95% CI : 1.030–5.952; P = 0.043), and age (HR = 1.037; 95% CI: 1.000–1.075; P = 0.048) were determined as independent risk factors of 30-day UR. Factors, including low-molecular-weight heparin or fondaparinux (HR = 0.618; 95% CI : 0.531–0.719; P < 0.001), second-generation durable polymer drug-eluting stent (HR = 0.713; 95% CI : 0.624–0.814; P < 0.001), left anterior descending artery involvement (HR = 0.654; 95% CI : 0.530–0.807; P < 0.001), and age (HR = 0.992; 95% CI : 0.985–0.998; P = 0.014), were independently associated with decreased two-year UR risk. While, Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score (HR = 1.024; 95% CI : 1.014–1.033; P < 0.001) and ICR (HR = 1.549; 95% CI : 1.290–1.860; P < 0.001) were negatively associated with two-year UR risk. Specific factors were positively or negatively associated with short- and medium-long-term UR following PCI. [ABSTRACT FROM AUTHOR]

Abstract Objective The predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with stable coronary artery disease (SCAD) in the drug-eluting stent era is not yet clear. We aimed to evaluate the prognostic value of NT-proBNP in SCAD patients after percutaneous coronary intervention (PCI). Methods We examined 4,293 consecutive SCAD patients who underwent PCI between January 2013 and December 2013 in Fuwai Hospital, China. The primary endpoint was all-cause death. NT-proBNP levels were measured before PCI using Elisa kits (Biomedica, Austria). The indication for PCI was based on the degree of coronary stenosis and evidence of ischemia. Results Among 3,187 SCAD patients with NT-proBNP data, after a 2-year follow-up, NT-proBNP levels were predictive for all-cause death in the SCAD population [area under the receiver operating characteristic curve, 0.768; 95% confidence interval (CI), 0.687–0.849; P < 0.001]. At the optimum cutoff point of 732 pg/mL, the sensitivity and specificity of death was 75.0% and 72.3%, respectively. In a multivariable Cox regression model, the death hazard ratio was 6.43 (95% CI , 2.99–13.82; P < 0.001) for patients with NT-proBNP levels ≥ 732 pg/mL, compared with < 732 pg/mL. Conclusion NT-proBNP is a strong predictor of 2-year death with SCAD after PCI in the drug-eluting stent era. [ABSTRACT FROM AUTHOR]

Aims: To assess the association and the predictive value of plasma homocysteine (Hcy) levels with LA/LAA thrombus in non-valvular Atrial fibrillation (AF) patients with low CHA2DS2-VASc score.Methods and results: Eight hundred and eighty-eight consecutive patients in non-valvular AF with CHA2DS2-VASc score of 0 and 1 were enrolled. All patients routinely underwent transthoracic echocardiography and transoesophageal echocardiography. A total of thirty-two patients had LA/LAA thrombus. Compared with patients without LA/LAA thrombus, plasma Hcy levels were significantly higher in patients with LA/LAA thrombus (16.5 ± 4.8 mmol/L vs. 13.4 ± 4.1 mmol/L, P = 0.009). In multivariate analysis, Hcy was independently associated with LA/LAA thrombus (OR 1.048, 95% CI 1.007-1.090, P = 0.022). Hcy demonstrated a significant predictive value with area under the curve of 0.722 (95% CI 0.662-0.781, P < 0.001). The optimal cut-off point for Hcy predicting LA/LAA thrombus was 13.5 mmol/L (sensitivity 67%, specificity 65%). Patients with Hcy ≥13.5 mmol/L had higher prevalence of LA/LAA thrombus compared with those with Hcy <13.5 mmol/L (6.1% vs. 2.1%, P < 0.001). Elevated Hcy significantly increased the risk of LA/LAA thrombus in patients with CHA2DS2-VASc score of 0 and 1 (OR 11.789, 95% CI 1.437-96.746, P = 0.022; OR 2.256, 95% CI 1.007-5.155, P = 0.048, respectively).Conclusion: Elevated plasma Hcy increases the risk of LA/LAA thrombus in non-valvular AF patients with low CHA2DS2-VASc score, thus it should be taken into account in prediction of thromboembolism. [ABSTRACT FROM AUTHOR]

The aims of this study were to assess the associations between parity and metabolic syndrome (MetS) and its components and to evaluate the effects of body mass index (BMI) on these associations. A total of 5,674 women were enrolled from Jidong and Kailuan communities (Tangshan, Hebei) in Northern China. All participants completed standardized questionnaires, physical examination, and biochemical measurements. Logistic regression analysis was used to test the associations. Compared with women with parity of one, nulliparous women had decreased odds ratios (ORs); those with parity of two had odds of abdominal obesity [OR = 1.45, 95% confidence interval (CI) 1.17–1.81, P < 0.001], high blood pressure (OR = 1.26, 95% CI : 1.03–1.54, P = 0.025), elevated fasting glucose levels (OR = 1.36, 95% CI : 1.03–1.79, P = 0.029), and MetS (OR = 1.39, 95% CI : 1.13–1.73, P = 0.002); and those with parity of three or more had increased odds of elevated triglyceride levels (OR = 1.42, 95% CI : 1.04–1.94, P = 0.027) and MetS (OR = 1.50, 95% CI : 1.10–2.05, P = 0.011) after complete adjustment for confounders. Furthermore, BMI and age subgroups partially modified the associations between parity and MetS and its components. Parity is positively associated with MetS and select components in women. BMI is an important modifier involved in the associations between parity and MetS. [ABSTRACT FROM AUTHOR]

Introduction: This study explored the ability of high-sensitivity C-reactive protein (hs-CRP) and glycosylated hemoglobin A1c (HbA1c) to predict adverse cardiac and cerebrovascular outcomes in patients with chronic coronary syndromes (CCS) undergoing percutaneous coronary intervention (PCI)., Methods: In total, 4083 consecutive patients with CCS undergoing PCI were investigated throughout 2013 at a single center. The primary endpoint was all-cause death at the 5-year follow-up. Hs-CRP and HbA1c data were collected on admission., Results: The highest quartile of hs-CRP had a significantly increased the risk of all-cause death, with an adjusted HR of 1.747 (95 % CI 1.066-2.863), while, there was no difference in all-cause death among the groups of HbA1c after adjustment, with an adjusted HR of 1.383 (95 % CI 0.716-2.674). The highest quartiles for hs-CRP and HbA1c in the study population had a significantly increased risk of major adverse cardiac and cerebrovascular events (MACCE), with an adjusted hazard ratios (HR) of 1.263 (95 % confidence intervals [CI] 1.032-1.545) for hs-CRP and an adjusted HR of 1.417 (95 % CI 1.091-1.840) for HbA1c. Remarkably, the incidence of all-cause death and that of MACCE were significantly increased when both hs-CRP and HbA1c were elevated (HR 1.971, 95 % CI 1.079-3.601, P = 0.027 and HR 1.560, 95 % CI 1.191-2.042), P = 0.001, respectively). Addition of hs-CRP and HbA1c to conventional risk factors significantly improved prediction of the risk of all cause death (net reclassification index 0.492, P < 0.001; integrated discrimination improvement 0.007, P = 0.011) and MACCE (net reclassification index 0.160, P < 0.001; integrated discrimination improvement 0.006, P < 0.001)., Conclusions: Hs-CRP and HbA1c can serve as independent predictors of MACCE in patients with CCS undergoing PCI. Furthermore, a combination of hs-CRP and HbA1c could predict all cause death and MACCE better than each component individually., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Ltd.)

Aims: To assess the association and the predictive value of plasma homocysteine (Hcy) levels with LA/LAA thrombus in non-valvular Atrial fibrillation (AF) patients with low CHA2DS2-VASc score., Methods and Results: Eight hundred and eighty-eight consecutive patients in non-valvular AF with CHA2DS2-VASc score of 0 and 1 were enrolled. All patients routinely underwent transthoracic echocardiography and transoesophageal echocardiography. A total of thirty-two patients had LA/LAA thrombus. Compared with patients without LA/LAA thrombus, plasma Hcy levels were significantly higher in patients with LA/LAA thrombus (16.5 ± 4.8 mmol/L vs. 13.4 ± 4.1 mmol/L, P = 0.009). In multivariate analysis, Hcy was independently associated with LA/LAA thrombus (OR 1.048, 95% CI 1.007-1.090, P = 0.022). Hcy demonstrated a significant predictive value with area under the curve of 0.722 (95% CI 0.662-0.781, P < 0.001). The optimal cut-off point for Hcy predicting LA/LAA thrombus was 13.5 mmol/L (sensitivity 67%, specificity 65%). Patients with Hcy ≥13.5 mmol/L had higher prevalence of LA/LAA thrombus compared with those with Hcy <13.5 mmol/L (6.1% vs. 2.1%, P < 0.001). Elevated Hcy significantly increased the risk of LA/LAA thrombus in patients with CHA2DS2-VASc score of 0 and 1 (OR 11.789, 95% CI 1.437-96.746, P = 0.022; OR 2.256, 95% CI 1.007-5.155, P = 0.048, respectively)., Conclusion: Elevated plasma Hcy increases the risk of LA/LAA thrombus in non-valvular AF patients with low CHA2DS2-VASc score, thus it should be taken into account in prediction of thromboembolism.

Background: Elevated homocysteine (Hcy) has been reported to be associated with cardiovascular events in atrial fibrillation (AF) patients, while the age-related expression pattern of plasma Hcy in AF remains unknown. The study was aimed to investigate the effect of advanced age on plasma Hcy levels and its association with ischemic stroke in non-valvular AF patients., Methods: A total of 2562 consecutive patients with non-valvular AF and 535 controls were enrolled and divided into six age groups. Plasma Hcy levels were analyzed among different age groups, and the effect of advanced age on Hcy was investigated., Results: Plasma Hcy levels did not show any difference among groups aged below 65 years, while it increased sharply in patients aged 65-74 years and aged over 75 years (15.7 ± 4.6 µmol/L, 17.1 ± 4.9 µmol/L, both P < 0.01 compared with the first four age groups). Hcy was much higher in AF patients than in controls at the same age group (all P < 0.05). The proportion of patients with hyperhomocysteinemia increased gradually with age from 32.3%, 29.2%, 31.2%, 32.4%, 45.9%, to 51.4% in six age groups. The concentration of Hcy in AF patients with ischemic stroke increased progressively with age, and was higher than those without stroke at the same age. Logistic regression analysis demonstrated that age 65-74 years [odds ratios (OR): 1.742, 95% confidence interval (CI): 1.223-2.482, P = 0.002] and age ≥ 75 years (OR: 2.637, 95% CI: 1.605-4.335, P < 0.001) were significantly independent predictors of elevated plasma Hcy levels., Conclusions: Advanced age was significantly associated with elevated Hcy levels, which may provide a possible explanation for the progressive increase in ischemic stroke especially in elderly AF patients.

Background: In computational fluid dynamics (CFD) models for hemodynamics applications, boundary conditions remain one of the major issues in obtaining accurate fluid flow predictions., Objective: As an important part of the arterial circulation, microcirculation plays important roles in many aspects, such as substance exchange, interstitial fluid generation and inverse flow. It is necessary to consider microcirculation in hemodynamics modeling. This is a methodological paper to test and validate a new type of boundary condition never applied to microcirculation before., Methods: In order to address this issue, we introduce microcirculation as a seepage outlet boundary condition in computational hemodynamics. Microcirculation is treated as a porous medium in this paper. Numerical comparisons of the seepage and traditional boundary conditions are made., Results: The results show that the seepage boundary condition has significant impacts on numerical simulation. Under the seepage boundary condition, the fluctuation range of the pressures progressively rises in the artery zone. The results obtained from the traditional boundary condition show that the pressure fluctuation range gradually falls. In addition, the wall shear stresses under the traditional outlet boundary condition are much higher than those under the seepage outlet boundary condition., Conclusions: The proposed boundary condition is more suitable in hemodynamics modeling.

High blood viscosity often causes cardiovascular diseases, such as hypertension, atherosclerosis and thrombosis. It is proven that blood viscosity plays an important role in cardiovascular functions. In this paper, pulse wave characteristics with normal and high blood viscosities are presented in detail to evaluate how blood viscosity affects pulse wave propagation. A fluid-structure interaction is employed to solve for pulse wave characteristics. The results show that increased blood viscosity does not change the time delay of wave propagation. However, high viscosity reduces the velocity amplitude, while it enhances the pressure level. This study provides physical insight for evaluating blood viscosity leading potentially to pulse wave changes.