Bo Zheng

Background: Fabry disease (FD) is a rare X-linked lysosomal storage disorder and also a rare cause of coronary stenosis. We present a case of coronary stenosis in a 39-year-old man with FD, including optical coherence tomography (OCT) imaging findings. Case summary: A 39-year-old man was admitted with unstable angina. He had been previously diagnosed with FD through α-galactosidase A enzyme activity testing and genetic analysis. Coronary angiography (CAG) revealed 90% stenosis in the proximal left anterior descending artery (pLAD). The pre-procedural CAG-based fractional flow reserve (caFFR) was 0.57, and the CAG-based index of microcirculatory resistance (caIMR) was 14.4. Drug-coated balloon angioplasty was performed, achieving post-procedural stenosis of 0%, with caFFR improving to 0.86 and caIMR decreasing to 9.4. He had no traditional atherosclerotic cardiovascular disease risk factors. Although CAG indicated 90% stenosis of the pLAD, OCT imaging did not demonstrate typical atherosclerotic or fibrocalcific plaques. However, based on the patient’s clinical features, OCT findings, and previous literature, we could not definitively determine the specific aetiology of the coronary stenosis (FD, coronary atherosclerosis, or both). During a 2-year follow-up, he remained angina-free. Discussion: Although OCT may aid in differentiating FD-related coronary involvement due to its high resolution and ability to detect FD-compatible changes, it cannot reliably determine whether the fibrous plaque morphology and loss of layered architecture are attributable to FD-related coronary pathology or premature atherosclerosis, representing a fundamental imaging limitation.

It remains unclear whether a fixed‐period increase in the triglyceride glucose‒waist height ratio (TyG‒WHtR) index, an indicator of short‐term metabolic worsening, is associated with future cardiovascular disease (CVD) risk. To investigate this, we conducted a prospective cohort study in a Beijing community‐based population in China, enrolling participants without a history of stroke or myocardial infarction (MI). The primary outcome was major adverse cardiovascular events (MACEs), defined as a composite of MI, stroke, and cardiovascular death. We employed Cox proportional hazards models with landmark analysis to evaluate the association. Among 3466 individuals followed for a median of 7.52 years since 2014, 270 MACE events occurred. Our analysis suggested a potential threshold effect, with CVD risk increasing more markedly when the TyG–WHtR increase exceeded approximately 0.400. Using this cutoff, individuals with a higher two‐year increase in TyG–WHtR had a 30% higher risk of MACE (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.00–1.69) compared to those with lower increase. Landmark analysis revealed no significant association during the first 2 years; however, beyond this period, the association emerged, with an HR of 1.41 (95% CI 1.06–1.89). Further mediation analysis revealed that concurrent changes in mean arterial pressure (MAP) explained 30.4% of the association between changes in TyG–WHtR and MACEs. In conclusion, an increase in TyG–WHtR reflecting short‐term metabolic worsening, is associated with an increased MACE risk, and this relationship appears to be partly mediated by changes in MAP.

Pericoronary adipose tissue (PCAT) attenuation, a non-invasive marker of coronary inflammation, predicts adverse cardiovascular events. However, the extent of localized inflammation at the culprit lesion site in acute coronary syndrome (ACS) has not been systematically quantified. We aimed to meta-analyze the difference in PCAT attenuation between culprit and non-culprit lesions in patients with ACS. We systematically searched PubMed and Embase for studies comparing PCAT attenuation between culprit and non-culprit lesions/vessels in ACS patients. A random-effects model was used to calculate the pooled mean difference (MD). Pre-specified subgroup and meta-regression analyses were performed to explore heterogeneity. Twelve studies with 826 patients were included. Meta-analysis was performed in 11 studies comprising 12 cohorts (461 culprit/731 non-culprit lesions and 388 culprit/487 non-culprit vessels). PCAT attenuation was significantly higher around culprit sites compared to non-culprit sites (MD 4.95 HU, 95% CI: 2.62–7.27, p < 0.001), with substantial heterogeneity (I²=89%). Subgroup analysis revealed a significantly greater effect size when PCAT was measured at the perilesional level (MD 7.50 HU) versus the vessel level (MD 2.43 HU). Meta-regression identified the analysis lesion unit (p = 0.002) and ACS subtype (p = 0.003) as major sources of heterogeneity. This meta-analysis provides consistent evidence that culprit lesions in ACS are characterized by a measurable and highly localized increase in pericoronary inflammation. A perilesional measurement approach may better capture this focal inflammatory signal, highlighting the potential of PCAT attenuation for identifying culprit lesion in ACS. The online version contains supplementary material available at 10.1186/s12872-026-05785-x.

Coronary functional assessment plays a critical role in guiding decisions regarding coronary revascularization. Traditional methods for evaluating functional myocardial ischemia, such as invasive procedures or those involving radiation, have their limitations. Echocardiographic myocardial strain has emerged as a non-invasive and convenient indicator. However, the interpretation of strain values can be subject to inter-operator variability. Artificial intelligence (AI) and machine learning techniques may promise to reduce the variability. By training AI algorithms on a diverse range of echocardiographic data, including strain values, and correlating them with ischemia, it may be possible to develop a robust and automated diagnostic tool. This study aims to provide a non-invasive and effective solution for automated myocardial ischemia detection that can be used in clinical practice. To construct the machine learning model, we used an automatic left ventricular endocardium tracing tool to extract myocardial strain data and integrated it with six clinical features. A coronary angiography-derived fractional flow reserve (caFFR) ≤ 0.80 was defined as the indicator of myocardial ischemia. A total of 636 suspected coronary artery disease subjects were enrolled in this pilot study, where 282 cases (44.3%) had myocardial ischemia. These subjects were randomly divided into training (n = 508) and testing (n = 128) sets at a 4:1. Using ensemble-learning algorithms to train and optimize the model, its diagnostic performance versus caFFR was diagnostic accuracy 85.9%, sensitivity 88.9%, specificity 83.1%, positive predictive value 83.6%, negative predictive value 88.5%. The optimized model achieved an area under the receiver operating characteristic curve (AUC) of 0.915 (95% confidence interval [CI] 0.862–0.968). Our machine learning prototype model based on echocardiographic myocardial strain shows promising results in detecting myocardial ischemia. Further studies are needed to validate its robustness and generalizability on larger patient populations. Graphical Abstract Summary of the machine learning model for detecting myocardial ischemia based on echocardiographic myocardial strain. CAD coronary artery disease, caFFR coronary angiography-derived fractional flow reserve, AUC area under the receiver operating characteristic curve

Background: It is generally accepted that for patients with multivessel disease and myocardial infarction, complete revascularization is preferable than culprit‐only revascularization. However, existing studies comparing coronary physiology‐guided versus angiography‐guided complete revascularization percutaneous coronary intervention (PCI) present conflicting conclusions. Methods: The investigation involved a comprehensive search of PubMed/Medline, Embase, and the Cochrane library for studies comparing coronary physiology‐guided with angiography‐guided PCI in patients with MI‐MVD. Clinical endpoints, including major adverse cardiovascular events, all‐cause mortality, recurrent MI, major adverse cardiac and cerebral event, planned revascularization, repeated revascularization, average stent number per patient, heart failure, and contrast nephropathy during any follow‐up period post PCI, were considered for analysis. Odds ratios (ORs) and mean differences with 95% confidence intervals (CIs) were calculated for binary and continuous variables, respectively. The analyses were conducted using Review Manager 5.1. Results: Our analysis included a total of 2493 patients from 5 studies. The physiology‐guided PCI group exhibited a lower rate of planned revascularization (OR: 0.10, 95% CIs: 0.07–0.14, p ≤ 0.001, and I ² = 96.6%) and average stent number per patient (mean difference: −0.47, 95% CIs: −0.56–−0.38, p ≤ 0.001, and I ² = 58.6%). However, there were no significant differences between the two groups regarding major adverse cardiac event (MACE) (OR: 0.89, 95% CIs: 0.63–1.26, p = 0.520, and I ² = 67.8%), all‐cause mortality (OR: 0.65, 95% CIs: 0.38–1.12, p = 0.120, and I ² = 50.5%), recurrent MI (OR: 0.74, 95% CIs: 0.28–2.00, p = 0.558, and I ² = 77.2%), major adverse cardiac and cerebral event (MACCE) (OR = 0.77, 95% CIs: 0.43–1.37, p = 0.378, and I ² = 0%), repeated revascularization (OR = 1.47, 95% CIs: 0.54–3.99, p = 0.452, and I ² = 76.5%), heart failure (OR: 1.04, 95% CIs: 0.43–2.56, p = 0.924, and I ² = 0%), and contrast nephropathy (OR: 1.26, 95% CIs: 0.27–5.81, p = 0.766, and I ² = 0%). Conclusions: Among patients with MI‐MVD, physiology‐guided PCI appeared to reduce the need for planned revascularization without triggering repeated revascularization, leading to fewer stents compared with angiography‐guided PCI. Other prespecified clinical outcomes including MACE, all‐cause mortality, recurrent MI, MACCE, heart failure, and contrast nephropathy were not significantly different between these two approaches.

Simplified rapid hydration has been proven to be non-inferior to standard hydration in preventing contrast-associated acute kidney injury among chronic kidney disease patients undergoing coronary angiography. The current investigation aimed to further confirm the feasibility and safety of the newly proposed hydration method-simplified rapid hydration (SH) in each risk stratification by Mehran risk score (MRS). Eligible patients (n = 954) randomized to the SH group and standard hydration group were allocated into 2 groups based on MRS: low to moderate-risk and high to very high-risk groups. Primary endpoints were the incidence of contrast-associated acute kidney injury (CA-AKI) and acute heart failure (AHF) (SH vs standard hydration). Secondary endpoints included serum creatinine (Scr), blood urea nitrogen (BUN), cystatin-C (Cys-C), and C-reactive protein (CRP) at 24 h, 48 h, and 72 h after PCI procedure, and the incidence of major adverse cardiac events (MACE). MRS was associated with a higher incidence of CA-AKI (OR = 1.101, 95%CI 1.049–1.156, P < 0.001). In the low to moderate-risk and high to very-high-risk groups, the incidence of CA-AKI in the SH and standard hydration group was 3.3% versus 4.9% (P = 0.5342), 10% versus 12% (P = 0.6392), respectively. Meanwhile, there might be subtle differences in renal function indexes and inflammatory indicators between SH and the control group at different time points. The preventive effect of SH in CA-AKI was similar to standard hydration regardless of MRS-guided risk stratification.

Background: Primary percutaneous coronary intervention (PPCI) has been widely recognized as the preferred treatment for ST-segment-elevation myocardial infarction (STEMI). However, substantial numbers of STEMI patients cannot receive timely PPCI. Early fibrinolysis followed by routine percutaneous coronary intervention (FPCI) has been proposed as an effective and safe alternative for eligible patients. To date, few studies have compared FPCI with PPCI in terms of microvascular reperfusion. This study aimed to evaluate the microvascular function of FPCI and PPCI. Methods: STEMI patients at the Peking University First Hospital and Miyun Hospital were enrolled in this retrospective study between January 2015 to December 2020. Microvascular function documented by the coronary angiography-derived index of microvascular resistance (caIMR) was measured at the final angiogram after revascularization. The primary end point was the caIMR of the culprit vessels. The secondary end points were in-hospital and follow-up major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal recurrent myocardial infarction, target-vessel revascularization (TVR), and non-fatal stroke/transient ischemic attacks (TIA). Details of the adverse clinical events were obtained from telephone interviews and electronic medical record systems until January 2022. Results: In total, 496 STEMI patients were enrolled in this cross-sectional retrospective study. Of these patients, 81 underwent FPCI, and 415 underwent PPCI. At the baseline, the PPCI patients had a higher-risk profile than the FPCI patients. The time from symptom onset to reperfusion therapy was significantly shorter in the FPCI group than the PPCI group (median 3.0 vs. 4.5 hours; Pvs. 40.33; Pvs. 82 (20.8%), P=0.048]. After propensity score matching to adjust for the imbalances at the baseline, the caIMR remained significant and the clinical outcomes did not differ significantly between the two groups. Conclusions: In eligible STEMI patients, clinically successful FPCI may be associated with better microvascular reperfusion and comparable clinical outcomes as compared with PPCI.

Background: Nearly half of ST-segment elevation myocardial infarction (STEMI) patients present with significant multivessel coronary artery disease, they are at high risk of subsequent adverse events. Whether complete revascularization guided by coronary angiography-derived fractional flow reserve (caFFR) further reduces such events risk is not fully investigated. Methods: In this study, 367 consecutive STEMI patients who underwent successful primary percutaneous coronary intervention (PCI) were enrolled. caFFR of all three coronary vessels were measured, including 367 culprit vessels and 703 non-culprit vessels. Complete revascularization was defined as post-PCI caFFR > 0.8 of all three coronary vessels. The primary endpoint was major adverse cardiovascular events (MACE, a composite of cardiovascular death, non-fatal recurrent myocardial infarction, ischemia-driven revascularization and non-fatal stroke/transient ischemic attacks) during follow-up. Results: At a median follow-up of 3.8 years, MACE had occurred in 39 patients of the 220 (17.7%) in the complete revascularization group as compared with 49 patients of the 131 (37.4%) in the incomplete revascularization group (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.2–3.0; p = 0.005). The incomplete revascularization in culprit vessels evaluated by caFFR showed the highest risk for MACE occurrence. Conclusions: In STEMI patients with multivessel coronary artery disease, incomplete revascularization based on caFFR might contribute to identifying patients at high-risk. Background: Nearly half of ST-segment elevation myocardial infarction (STEMI) patients present with significant multivessel coronary artery disease, they are at high risk of subsequent adverse events. Whether complete revascularization guided by coronary angiography-derived fractional flow reserve (caFFR) further reduces such events risk is not fully investigated. Methods: In this study, 367 consecutive STEMI patients who underwent successful primary percutaneous coronary intervention (PCI) were enrolled. caFFR of all three coronary vessels were measured, including 367 culprit vessels and 703 non-culprit vessels. Complete revascularization was defined as post-PCI caFFR > 0.8 of all three coronary vessels. The primary endpoint was major adverse cardiovascular events (MACE, a composite of cardiovascular death, non-fatal recurrent myocardial infarction, ischemia-driven revascularization and non-fatal stroke/transient ischemic attacks) during follow-up. Results: At a median follow-up of 3.8 years, MACE had occurred in 39 patients of the 220 (17.7%) in the complete revascularization group as compared with 49 patients of the 131 (37.4%) in the incomplete revascularization group (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.2–3.0; p = 0.005). The incomplete revascularization in culprit vessels evaluated by caFFR showed the highest risk for MACE occurrence. Conclusions: In STEMI patients with multivessel coronary artery disease, incomplete revascularization based on caFFR might contribute to identifying patients at high-risk.

Introduction: The main aim of this study was to investigate the impact of isolated coronary microvascular disease (CMD) as diagnosed via various modalities on prognosis. Methods: A systematic literature review of PubMed, Embase, and Cochrane Library databases was conducted to identify relevant studies published up to March 2023. Included studies were required to measure coronary microvascular function and report outcomes in patients without obstructive coronary artery disease (CAD) or any other cardiac pathological characteristics. The primary endpoint was all-cause mortality, and the secondary endpoint was a major adverse cardiac event (MACE). Pooled effects were calculated using random effects models. Results: A total of 27 studies comprising 18,204 subjects were included in the meta-analysis. Indices of coronary microvascular function measurement included coronary angiography-derived index of microcirculatory resistance (caIMR), hyperemic microcirculatory resistance (HMR), coronary flow reserve (CFR), and so on. Patients with isolated CMD exhibited a significantly higher risk of mortality (OR: 2.97, 95% CI, 1.91–4.60, p < 0.0001; HR: 3.38, 95% CI, 1.77–6.47, p = 0.0002) and MACE (OR: 5.82, 95% CI, 3.65–9.29, p < 0.00001; HR: 4.01, 95% CI, 2.59–6.20, p < 0.00001) compared to those without CMD. Subgroup analysis by measurement modality demonstrated consistent and robust pooled effect estimates in various subgroups. Conclusion: CMD is significantly associated with an elevated risk of mortality and MACE in patients without obstructive CAD or any other identifiable cardiac pathologies. The utilization of various measurement techniques may have potential advantages in the management of isolated CMD.