Yue-Chun Li

Triglyceride-glucose (TyG) is a vital marker for assessing cardiovascular risk and insulin resistance (IR) in individuals with Type 2 diabetes mellitus (T2DM) or metabolic dysfunction-associated steatotic liver disease (MASLD). Nevertheless, the prognostic significance of TyG, especially in patients manifesting both conditions, is insufficiently characterized. In this study, the association between TyG and the occurrence of major adverse cardiovascular events (MACEs) in patients concurrently diagnosed with T2DM and MASLD was examined. In this retrospective cohort study, 1021 patients diagnosed with both T2DM and MASLD at Wenzhou Hospital from 2019 to 2022 were encompassed. To explore the non-linear association between TyG and outcomes, such as all-cause mortality (ACM) or MACEs, a cox proportional hazards model was employed. Additionally, subgroups were analyzed to assess the consistency across different demographic and clinical subgroups. Furthermore, mediation analyses were conducted to investigate the potential mediating effects of body roundness index (BRI) and estimated glomerular filtration rate (eGFR). Parallel supportive analysis was performed on a cohort of 1343 individuals from NHANES 1999-2018. Over a median follow-up of 53.4 months, 62 instances of ACM and 101 MACEs were documented. Cox proportional hazards regression analysis revealed that an elevated TyG was significantly associated with an increased risk of mortality (HR = 1.85, 95% CI: 1.25, 2.73) and MACEs (HR = 1.71, 95% CI: 1.26, 2.33). Subgroup analysis revealed that the association between TyG and the risk of MACE is more prominent among individuals below 60. Mediation analysis revealed that eGFR mediated 8.8% of the total effect of TyG on ACM and 10.6% of the effect on MACEs. BRI accounted for 6.2% of the total effect of TyG on ACM. Incorporating TyG into conventional risk models significantly enhanced the predictive accuracy. This study established a strong association between TyG and both ACM and MACEs in patients with T2DM and MASLD in the Wenzhou cohort, with TyG-ACM association independently validated in the NHANES cohort.

Background: The optimal catheter ablation strategy for non‐paroxysmal atrial fibrillation (non‐PAF) is controversial. We examined the safety, feasibility, and efficacy of a new treatment strategy for non‐PAF, defined as the Pulmonary vein isolation (PVI); left roof linear (RL), Mitral Isthmus linear (MIL), and left anterior SEptal linear (ASL) ablation; and leftatrial appendage (LAA) Device occlusion (PROMISED) procedure. Methods: One‐hundred forty‐two patients with non‐PAF underwent PVI + RL + ASL ablation with/without MIL ablation, combined with LAA occlusion (LAAO). The primary end point was atrial arrhythmia recurrence after a 3‐month blanking period. Results: Eighty‐two patients underwent the PROMISED procedure (MIL group) and 60 patients underwent PVI + RL + ASL ablation with LAAO without MIL ablation (Non‐MIL group). The baseline characteristics were similar between the two groups. No serious procedure‐related complications occurred during the procedure. Twelve months after a single procedure, atrial arrhythmia recurrence was observed in 17/82 patients (20.7%) in the MIL group versus 31/60 patients (51.7%) in the Non‐MIL group (hazard ratio [HR]: 0.327 and 95% confidence interval [CI]: 0.181–0.592; p < 0.001). No peridevice leak > 5 mm was observed during the 12‐month follow‐up. Overall, 85.2% of the patients discontinued oral anticoagulant therapy within 6 months after the procedure. One patient experienced stroke in the MIL group 10 months after the procedure and one experienced stroke in the Non‐MIL group 2 months after the procedure. Conclusion: In patients with non‐PAF, the MIL group, which underwent the PROMISED procedure, was associated with a lower observed 12‐month atrial arrhythmia recurrence rate without an apparent increase in complications.

Pulse pressure has been commonly used to assess atherosclerosis and cardiovascular outcomes with the defects of fluctuation. However, the pulse pressure index (PPI), a feasible alternative with the advantage of lower fluctuations, has not been sufficiently researched. This study included 10,796 participants over 65 years from the National Health and Nutrition Examination Survey 1999–2018. Cox proportional hazards models, restricted cubic splines and subgroup analysis were used to investigate the association between PPI in the elderly and all-cause and cardiovascular mortality. Subsequently, a prediction model for identifying coronary heart disease (CHD) in elderly individuals was developed using three machine learning algorithms. The impact of each feature on CHD was visualized in the optimal model after comparing the performances of the models. This study discovered that the highest levels of PPI were associated with a 28% increased all-cause [HR (95%CI) 1.28 (1.16, 1.42), P < 0.001] and a 36% increased risk of cardiovascular mortality [HR (95%CI) 1.36 (1.08, 1.72), P = 0.008] compared with the first quantile of PPI. The nonlinear relationships between PPI and mortality (all-cause: P for Nonlinear = 0.038; cardiovascular: P for Nonlinear = 0.005) were determined using restricted cubic spline curves. Among the three machine-learning models, random forest model showed the best performance (AUC 0.667 (0.638, 0.696)). In descending order of feature importance, PPI came in second place, with a positive relationship with CHD. This study indicated a positive correlation between PPI and long-term adverse cardiovascular outcomes among the elderly. Notably, PPI has considerable predictive power for recognizing CHD.

Background: Insulin resistance (IR) is closely correlated with a deficiency or decrease of testosterone levels in males. Cardiometabolic index (CMI) is correlated with various diseases correlated with IR. The primary objective of this study is to explore the correlation between CMI and testosterone levels in male adults.Methods: Data from the National Health and Nutrition Examination Survey (NHANES) during the period from 2013 to 2020 were analyzed through a cross-sectional design. CMI was calculated by multiplying waist-to-height ratio (WHtR) with the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C).Results: A total of 5012 subjects were included in the final analysis. After controlling confounding variables, multiple linear regression analysis indicated an independent negative correlation between CMI and testosterone levels (β= -6.40, 95% CI: -8.95, -3.86, Pp< 0.05 for all interactions). The area under the ROC curve (AUC) of CMI (AUC =0.724, 95% CI: 0.709–0.740) was the largest compared with those of TG/HDL and WHtR.Conclusion: Elevated CMI is significantly and negatively correlated with testosterone in male adults.