Chengxing Shen

Background: Obstructive sleep apnea syndrome (OSAS) is an established risk factor for cardiovascular disease. Magnetocardiography (MCG) is an emerging non-invasive electrophysiological technique with potential value in cardiovascular assessment; however, its utility in evaluating OSAS severity remains unclear. This study aimed to characterize MCG features across different severities of OSAS and to evaluate their predictive performance for moderate-to-severe disease. Methods: This retrospective study enrolled OSAS patients between June 2023 and October 2024, all of whom underwent MCG examination. Patients were stratified by OSAS severity, and MCG parameters were compared between the normal-to-mild and moderate-to-severe groups. Baseline data, complete blood count, serum biochemical indicators, and MCG parameters were collected along with relevant clinical and laboratory data. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of moderate-to-severe OSAS, and receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of each parameter and the combined model. Results: Group comparisons revealed significant differences in traditional OSAS severity risk factors (sex, body mass index, etc.). Diastolic function indicators, including E/A ratio and left atrial size, also showed marked differences between groups, with the moderate-to-severe subgroup exhibiting larger left atria and a higher proportion of E/A ratio values below 1. Univariate analysis identified 35 MCG parameters that differed between groups, while multivariate regression retained four independent predictors (htrt, tmdf, RS-didma, and qr_rela_dist_neg_mode). ROC analysis indicated that T-wave- and QRS-wave-related indices had moderate predictive value; a combined model incorporating htrt, tmdf, and RS-didma showed superior area under the curve compared to any single parameter. Conclusion: MCG parameters demonstrate distinct characteristics across OSAS severity levels and yield favorable predictive performance for moderate-to-severe OSAS, positioning MCG as a promising non-invasive tool for early diagnosis. The observed changes in diastolic function markers may suggest underlying coronary microcirculatory alterations in patients with moderate-to-severe OSAS. Rigorously designed prospective studies are warranted to validate MCG as a standardized diagnostic modality for OSAS-related coronary microcirculation disorder.

Magnetocardiogram is a promising technology for future heart disease diagnosis and prognosis. However, there is no unified standard of magnetocardiogram in the normal population for further study and comparison. This study aimed to establish the magnetocardiogromics platform that could provide a well-acknowledged parameter library and its reference range in the normal population for future study. 93 cases were enrolled in study set for parameter reference range determination. Another 111 cases were used as validation. We built a library with 246 parameters with their reference range in the normal population. In addition, we established a standard process for future magnetocardiogram study. This is the first time that we proposed the concept of magnetocardiogromics, which standardized the parameter library and its reference range as well as establishing a unified analysis platform. Not applicable. The online version contains supplementary material available at 10.1186/s12880-025-02010-7.

Background: Early prediction of heart failure (HF) after acute myocardial infarction (AMI) remains a clinical challenge. There is a lack of studies investigating Thymosin α1 expression levels in AMI patients and its relationship with cardiac function post-AMI.Methods: This retrospective analysis included patients with AMI from December 2019 to February 2022. The baseline data of two groups were collected. Thymosin α1 expression level of peripheral blood plasma in AMI patients was examined by ELISA. Logistic regression analysis was applied to evaluate risk factors in-hospital cardiac dysfunction after emergency PCI in AMI patients. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of the biomarker.Results: A total of 307 hospitalized patients were enrolled in this study, divided into AMI group (n = 274) and non-AMI group (n = 33). The expression level of thymosin α1 in the AMI group was significantly higher than in the non-AMI group. The AMI patients were divided into two subgroups based on the EF values. The sample size was 64 (EF < 50%) and 210 (EF ≥ 50%), respectively. The expression of thymosin α1 in the EF ≥ 50% group was significantly higher than EF < 50% group. Spearman's correlation analysis demonstrated that thymosin α1 was positively correlated with the EF value. Logistic multivariate analysis suggested that thymosin α1, NT-proBNP, and creatine kinase were independent predictors of cardiac function after AMI. The AUC of thymosin α1, NT-proBNP, and creatine kinase was 0.614, 0.714, and 0.724, respectively.Conclusion: Thymosin α1 may serve as a potential biomarker to predict cardiac function following AMI. This study may provide novel insights into the potential therapeutic targets for HF following AMI.

Introduction: Magnetocardiography (MCG), as a high-sensitivity, non-contact and non-invasive technology, is assumed to detect weak electrophysiological changes. MCG can detect early signs of myocardial ischemia that may be missed by other diagnostic tools. Present research aims to evaluate the possibility of using MCG to detect left ventricular hypertrophy (LVH).Methods: The study included 481 participants, categorized into two groups according to echocardiographic criteria: the LVH group and the non-LVH group. We evaluated the performance of the MCG-derived diagnostic model for detecting LVH in the retrospective cohort and performed external validation in the prospective cohort. Using echocardiography as the reference standard, we assessed the model's area under the curve (AUC) value, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy.Results: MCG parameters (S_B5 + R_D3, QRS area, QRS-T area, DM₅₀, TT_MA) were incorporated into a logistic regression model, which produced an AUC of 0.844 (95% CI: 0.792–0.895) for the retrospective cohort. The sensitivity, specificity, PPV, NPV, and accuracy were 72.2%, 85.8%, 67.3%, 88.4%, and 81.9%. In the prospective cohort, the model exhibited an AUC of 0.782 (95% CI: 0.697–0.866), and the sensitivity, specificity, PPV, NPV, and accuracy were 63.6%, 86.5%, 74.5%, 79.4%, and 77.8%, respectively.Conclusion: Besides myocardial ischemia, MCG also provides useful information suggestive of LVH.

Objective: Rotational atherectomy is an effective method for treating severe coronary artery calcification; however, several challenges in its clinical application persist. This study aimed to compare the safety and effectiveness of rotational atherectomy combined with cutting balloon (RACB) versus rotational atherectomy with plain balloon (RAPB) in patients with heavily calcified coronary lesions. Methods: This retrospective observational cohort study included 326 patients who underwent rotational atherectomy at Shanghai Sixth People’s Hospital from January 2016 to December 2022. Patients were divided into two groups (RACB and RAPB) on the basis of the type of balloon used. The primary outcome was the incidence of major adverse cardiovascular events (MACE) 1 year after percutaneous coronary intervention. Propensity score matching (PSM) was applied to minimize bias, and survival analyses were performed with the Cox proportional hazards model. Results: The procedural complication rates of the patients in the RACB and RAPB groups were comparable. Baseline covariates were balanced between groups after adjustment via PSM. Patients receiving RACB during their procedures had a lower MACE rate during the first postprocedural year in the unadjusted analysis (6.7% vs 16.2%, P < 0.05) and after adjustment with PSM (5.6% vs 16.1%, P < 0.01). The Kaplan–Meier survival curves revealed hazard ratios of 0.44 (95% CI: 0.23–0.82; P < 0.05) for the unadjusted model and 0.36 (95% CI: 0.17–0.76; P < 0.01) for the PSM-adjusted model. Conclusion: Performing RACB before stent implantation was demonstrated to be a safe and effective strategy for managing severely calcified coronary lesions.

A 69-year-old woman was referred for cardiac evaluation after a health check-up electrocardiogram revealed T-wave deflections. She had no history of cardiac evaluations, treatments, or significant cardiovascular risk factors. Transapical echocardiography revealed an aneurysm in the muscular portion of the interventricular septum without a left-to-right shunt. Coronary angiography confirmed normal coronary arteries. Left ventricular angiography is shown in the Supplementary video . Advanced imaging with cardiac computed tomography angiography and magnetic resonance imaging (MRI) further revealed a large aneurysm in the muscular interventricular septum, with a diameter comparable to that of the thoracic aorta and no evidence of thrombosis. Given the absence of symptoms and haemodynamic impact, a conservative management approach was adopted, including lifestyle modifications, routine cardiac monitoring, and regular follow-up. Prophylactic anticoagulation was considered but deemed unnecessary because of the absence of thrombosis, stable haemodynamic status, and lack of additional risk factors. Although this decision could increase the risk of thrombus formation, normal blood flow within the aneurysm prevents antithrombotic therapy, thereby reducing the risk of bleeding. The patient was scheduled for echocardiography every six months to monitor the aneurysm, with MRI as needed. Throughout the follow-up period, the patient remained asymptomatic with no new findings, thus adhering to the original monitoring plan. Muscular interventricular septal aneurysms are rare in adults and often diagnosed incidentally.¹ They are primarily linked to congenital factors from embryonic development, with genetic and environmental influences also playing a role. Acquired causes, such as myocardial infarction or trauma, are less common. In this case, unlike others associated with coronary disease or septal defects,^2,3 the patient had normal coronary arteries and no history of heart disease, suggesting a congenital origin with slow progression. Despite being asymptomatic, there remains a risk of complications such as thromboembolism or arrhythmias, necessitating personalized follow-up every 6–12 months, with surgical intervention reserved for significant aneurysm enlargement or complications (Figure 1).

Background: Acute myocardial infarction (AMI) is the most severe manifestation of coronary heart disease (CHD), and timely and effective opening of the culprit vessels has been effective in reducing its mortality, but long-term death still threatens the life of patients. Therefore, finding biomarkers to predict death post-myocardial infarction (MI) is crucial. The aim of our study is to find biomarkers that predicted long-term death in Chinese AMI patients. Methods: This retrospective analysis included patients with AMI from 1 January 2017 to 30 September 2019. All patients were followed up at least 4 years. Propensity score matching was used to mitigate the influence of nonrandom selection in MI-survival and MI-death groups. Cox analysis was applied for analyzing the risk factors of death post-MI. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of biomarkers. Results: Of the 1,059 AMI patients analyzed, 130 died during follow-up. After propensity matching, there were 116 patients in each of the two groups. In addition to the traditional risk factors for long-term death post-MI, two important risk factors platelet distribution width (PDW) [hazard ratio (HR) =1.210, 95% confidence interval (CI): 1.080–1.356, P=0.001] and fibrinogen (HR =1.218, 95% CI: 1.027–1.444, P=0.02) were found. The area under the curve (AUC) of PDW and fibrinogen was 0.604 (P=0.007) and 0.684 (PConclusions: PDW and fibrinogen seem to be useful as biomarkers for long-term death prediction post-MI. The current research provides new insight into the prevention and treatment of death in Chinese patients post-MI.

Objective: The purpose of this study was to evaluate the effect of choroidal thickness and tear vascular endothelial growth factor A (VEGFA) as biomarkers of coronary artery disease (CAD). Methods: This study was a retrospective observational case–control trial. A total of 637 patients who underwent coronary angiography to assess their coronary artery status were included. The patients were divided into two groups: 200 people in the No CAD group and 437 people in the CAD group. We evaluated the choroidal thickness of the right foveal membrane in all patients through optical coherence tomography angiography examination. We also collected tear samples from patients to measure VEGFA. The ROC curve and its area under the curve (AUC) were used for analysis. Results: The central foveal choroid in the No CAD group was significantly thicker than that in the CAD group (289.09 μm ± 38.41; 229.03 μm ± 33.44, P < 0.01). The tear VEGFA in the CAD group was higher than that in the No CAD group (706.15 ng/mL ± 147.42; 419.66 ng/mL ± 105.85, P < 0.01). Spearman analysis showed that the correlation between choroidal thickness and Gensini score was –0.7387 (P < 0.01). The correlation between tear VEGFA level and Gensini score was 0.8636 (P < 0.01). Taking choroidal thickness and tear VEGFA as independent variables, we obtained AUC = 0.9647 (95% CI 0.9506–0.9789, P < 0.01) through binary logic regression and ROC curve analysis. Conclusion: The combination of choroidal thickness and tear VEGFA in patients can serve as a clinical marker of CAD and its severity.

The clinical significance of central beyond brachial blood pressure (BP) remains unclear. In patients who underwent coronary angiography, the authors explored whether elevated central BP would be associated with coronary arterial disease (CAD) irrespective of the status of brachial hypertension. From March 2021 to April 2022, 335 patients (mean age 64.9 years, 69.9% men) hospitalized for suspected CAD or unstable angina were screened in an ongoing trial. CAD was defined if a coronary stenosis of ≥50%. According to the presence of brachial (non‐invasive cuff systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) and central (invasive systolic BP ≥130 mmHg) hypertension, patients were cross‐classified as isolated brachial hypertension (n = 23), isolated central hypertension (n = 93), and concordant normotension (n = 100) or hypertension (n = 119). In continuous analyses, both brachial and central systolic BPs were significantly related to CAD with similar standardized odds ratios (OR, 1.47 and 1.45, p < .05). While categorical analyses showed that patients with isolated central hypertension or concordant hypertension had a significantly higher prevalence of CAD and the Gensini score than those with concordant normotension. Multivariate‐adjusted OR (95% confidence interval [CI]) for CAD was 2.24 (1.16 to 4.33, p = .009) for isolated central hypertension and 3.02 (1.58 to 5.78, p < .001) for concordant hypertension relative to concordant normotension. The corresponding OR (95% CI) of a high Gensini score was 2.40 (1.26–4.58) and 2.17 (1.19–3.96), respectively. In conclusion, regardless of the presence of brachial hypertension, elevated central BP was associated with the presence and severity of CAD, indicating that central hypertension is an important risk factor for coronary atherosclerosis.

Revascularization therapy significantly improves the outcomes of patients with left main coronary artery disease (LMCAD), compared with medical therapy alone. For many years, coronary artery bypass grafting (CABG) has been the primary and standard treatment strategy. However, with advances in percutaneous coronary intervention (PCI) techniques and improvements in patients’ outcomes, there is growing evidence supporting PCI for LMCAD. In this review, we aim to integrate the available evidences on advances in PCI treatment for LMCAD and provide guidance for further clinical practice.