Rong Guo

Coronary atherosclerosis (CA) remains a leading cause of global mortality. Its progression is driven by complex immunometabolic dysregulation and marked spatial heterogeneity within atherosclerotic plaques, which together hinder the development of precise therapeutic interventions. This review proposes a nano-enabled closed-loop engineering framework for spatially precise intervention in CA. First, we systematically describe how multimodal omics technologies, including single-cell transcriptomics and spatial transcriptomics, can be leveraged to dissect plaque microenvironmental features and enable the precise identification of spatially specific therapeutic targets, such as NLR family pyrin domain-containing 3 (NLRP3) and triggering receptor expressed on myeloid cells 2 (TREM2). Building on this foundation, we focus on engineering design strategies for omics-guided nanomaterial-based intervention platforms, and comprehensively discuss stimulus-responsive nanodelivery systems (e.g., reactive oxygen species- and pH-sensitive carriers) combined with ligand modifications (e.g., intercellular adhesion molecule-1 (ICAM-1)/vascular cell adhesion molecule-1 (VCAM-1) targeting) to achieve site-specific delivery of drugs and nucleic acids to high-risk plaque regions. Furthermore, we highlight the synergistic role of three-dimensional (3D) printed biomimetic scaffolds within this framework, which provide mechanical support while enabling localized and sustained therapeutic release, thereby synergizing with nanocarriers to enhance treatment efficacy. Importantly, this review explores how artificial intelligence and digital twin technologies can integrate multi-omics data with patient-specific imaging information to guide the design of intervention platforms and the development of therapeutic strategies through predictive simulation and personalized optimization. By integrating nanotechnology, advanced manufacturing, and intelligent systems, this review delineates an engineering-driven pathway toward closed-loop, spatially adaptive, and precision intervention for CA.

Background: Free fatty acids (FFA) are promising biomarkers for the diagnosis and assessment of several diseases. They have been associated with cardiovascular diseases, such as insulin resistance, arteriosclerosis, myocardial dysfunction, cardiac arrhythmias, and sudden cardiac death; thus, it is important to study the relationship between FFA and atrial fibrillation (AF), especially whether FFAs can predict AF recurrence after catheter ablation. Methods: Patients with symptomatic paroxysmal or persistent AF undergoing radiofrequency catheter ablation for the first time were included in the study. Plasma FFA levels were measured upon admission and 3 months after ablation. Results: A total of 88 patients with AF (55 males, 33 females; mean age, 62.5 ± 8.7 years) were included for analysis. FFA levels upon admission in patients with paroxysmal and persistent AF were 0.38 ± 0.16 and 0.37 ± 0.15 mmol/L, respectively. During the 3-month follow-up after radiofrequency ablation, FFA concentration in patients with paroxysmal and persistent AF were 0.38 ± 0.18 and 0.36 ± 0.18 mmol/L, respectively. FFA concentration in patients with and without AF recurrence were 0.69 ± 0.07 and 0.33 ± 0.14 mmol/L, respectively. Kaplan–Meier analysis showed that AF recurrence was significantly higher in patients with FFA ≥0.53 mmol/L than in patients with FFA <0.53 mmol/L (p < 0.001). FFA concentration at 3 months post-ablation was an independent predictor of AF recurrence in patients who underwent catheter ablation (hazard ratio = 10.45, 95% CI [8.61–25.33], p = 0.03). Conclusion: Elevated postoperative FFA levels were closely related to AF recurrence at the 1-year follow-up, implying that postoperative FFA levels can be used as a predictive biomarker for AF recurrence. FFAs may be used as a new therapeutic target for the prevention and treatment of AF.

This article focuses on the Triglyceride-Glucose Body Mass Index (TyG-BMI) in diabetes and its associated cardiovascular complications. It elaborates on the basic concepts, current clinical practices, technological advancements, controversies, challenges, and future directions related to TyG-BMI. By integrating the findings from numerous studies, we aimed to provide a comprehensive understanding of the role of TyG-BMI in diabetes and cardiovascular disease research, diagnosis, and treatment, highlighting its significance and potential for improving the management of diabetic cardiovascular health.

Retinol-binding protein 4 (RBP4) has emerged as a critical adipokine involved in the pathophysiology of metabolic and cardiovascular diseases. Beyond its classical role in retinol transport, RBP4 influences insulin resistance, inflammation, lipid metabolism, mitochondrial function, and cellular apoptosis in both skeletal and cardiac muscles. Elevated levels of RBP4 are associated with obesity, type 2 mellitus diabetes, and cardiovascular diseases, making it a potential biomarker and therapeutic target. This comprehensive review elucidates the molecular mechanisms by which RBP4 affects skeletal and cardiac muscle physiology. We discuss its clinical implications as a biomarker for disease risk and progression, explore therapeutic strategies targeting RBP4, and highlight future research directions. Understanding the multifaceted roles of RBP4 could pave the way for novel interventions against metabolic and cardiovascular disorders.

Background/aim: This study was aimed at evaluating 5-year effectiveness and safety in participants after XIENCE PRIME Everolimus Elution Coronary Stent System (EECSS) implantation. Materials and methods: From December 2013 to May 2014, 108 patients (127 lesions) were treated with the XIENCE PRIME EECSS. The entire follow-up included annual assessments for 5 years after treatment or until one of the clinical endpoints was reached. We evaluated the 5-year clinical outcomes with Kaplan-Meier analysis and the Cox regression model. Results: Nearly three-quarters of the participants were men (76.8%), and the average age was 65.6 ± 10.8 years. Bifurcation lesions accounted for 96.1% (122 lesions), and left main lesions accounted for 3.9% (five lesions), with a total count of 127 lesions. The cumulative rate of major adverse cardiac events was as follows: 1 year, 1.9%; 2 year, 4.0%; and 5 year, 10.0%. No definite or probable stent thrombosis was observed, and the rate of target lesion failure was only 3.3% over 5 years. The cumulative rate of major bleeding eventually increased to only 4.4%. Conclusions: The 5-year clinical outcomes were favorable in patients treated with XIENCE PRIME EECSS, and the incidence of stent thrombosis and target lesion failure was relatively low. The incidence of major bleeding gradually increased but remained moderate.

Background: Left atrial appendage (LAA) closure (LAAC) could prevent stroke in patients with atrial fibrillation. However, LAAC may impair the compliance of the left atrium and result in poor prognosis. This study aimed to comparatively evaluate the prognosis of LAAC among patients with different sizes of LAA orifice. Methods and Results: Three hundred two consecutive patients who underwent successful LAAC were included and divided into 4 groups based on LAA orifice size that was measured using transesophageal echocardiography. Clinical outcomes including thromboembolic events, major cardiocerebrovascular adverse events, and acute heart failure (AHF) were compared among 4 quartile groups and between propensity‐score matched groups of large and small LAAs. Through follow‐up of 39.6±8.4 months, survival of thromboembolic events was similar. Survival of major cardiocerebrovascular adverse events was significantly lower in the group with the largest LAA orifice (log‐rank P P =0.009). A large LAA orifice (by cutoff) could predict major cardiocerebrovascular adverse events (hazard ratio, 3.749 [95% CI, 2.074–6.779]) in most patients, except for subgroups of those aged P =0.010). Conclusions: Patients with a larger LAA orifice presented a worse prognosis after LAAC, including a higher incidence of AHF. A large LAA orifice could predict a post‐LAAC AHF event in most patients, except for young patients, patients with paroxysmal atrial fibrillation, and/or with failed rhythm/rate control. Registration: URL: clinicaltrials.gov ; Unique identifier: NCT04185142.

Background/aim: Visfatin has been reported to be closely related to cardiovascular diseases associated with inflammation, but the correlation between visfatin and ventricular arrhythmia (VA) has not been discussed yet. The study aims to explore the association between serum visfatin concentrations and VA in patients. Materials and methods: Sixty-seven hospitalized patients diagnosed with VA and 131 control subjects were enrolled in this crosssectional study between May 20, 2017 and November 8, 2019. Classification of VA types was based on the presence of structural heart disease (SHD). The patients? blood samples were collected to examine their serum levels of visfatin. Results were analyzed using analysis of variance and t-test. Furthermore, binary logistic regression analysis was used to validate whether elevated visfatin was independently associated with VA. Results: Compared with the controls (mean age, 64.2 ± 13.2 years; 71% of men), the patients with VA (68.2 ± 11.6 years, 58%) had higher serum levels of visfatin (1.80 ± 0.47 ng/mL versus 1.48 ± 0.41 ng/mL; p 10 mg/L) (OR = 4.123; 95% CI, 1.888?9.001, p < 0.001), and elevated visfatin level (>1.40 ng/L) (OR = 3.126; 95% CI, 1.544?6.328, p = 0.002) as independent risk factors with VA. Conclusion: Serum visfatin levels were significantly elevated in the patients with VA, and increased with the risk rating of VA.

Calcific aortic valve disease is a common cardiovascular disorder worldwide. This study aimed to investigate the correlation between plasma matrix metalloproteinase-28 (MMP-28) levels and the severity of calcific aortic valve stenosis. Calcific aortic valve stenosis patients who were admitted to the heart center of our hospital between January 2016 and January 2019 to undergo surgery were successively enrolled in this study (55 males and 24 females with an average age of 58.5±9.6). Information on echocardiography, plasma MMP-28 levels, and other clinical data of the patients was retrospectively collected. The average plasma MMP-28 level was 2.43±2.22 ng/mL (range, 0.22–8.27 ng/mL). Plasma MMP-28 levels in patients with mild (n=24), moderate (n=31), or severe (n=24) aortic valve stenosis were 0.74 (0.25–2.23), 1.46 (0.50–3.22), and 4.13 (1.54–6.18) ng/mL, respectively, indicating that the patients with severe aortic valve stenosis had significantly higher MMP-28 levels than the patients with moderate or mild aortic valve stenosis (both P<0.01). Regression analysis using the general linear model further revealed that plasma MMP-28 level was correlated with the peak blood flow velocity and mean pressure gradient of the transaortic valve, and the correlations were statistically significant (both P<0.01). MMP-28 level is significantly elevated in severe cases of calcific aortic valve stenosis. Moreover, plasma MMP-28 levels are positively correlated with the mean pressure gradients and peak blood flow velocity of the transaortic valve.