Jing Dong

Background: Non-invasive identification of coronary stenosis in stable coronary artery disease (CAD) patients lacking regional wall motion abnormalities (RWMA) remains challenging. This study aimed to develop and validate a myocardial work-derived nomogram for predicting significant coronary stenosis in these patients. Methods: In this retrospective study, 181 consecutive patients with angiographically confirmed CAD, preserved LVEF (≥55%), and no resting wall motion abnormalities were enrolled. Global myocardial work efficiency (GWE) was assessed using echocardiographic pressure–strain loop analysis. A multivariable-derived nomogram incorporating GWE and clinical biomarkers was developed and externally validated for predicting severe coronary stenosis. Results: The nomogram incorporating GWE, lipoprotein-associated phospholipase A2 (LP-PLA2), N-terminal pro brain natriuretic peptide (NT-proBNP), and serum creatinine (Scr) demonstrated favorable discrimination in both the training set (AUC 0.916, 95% CI 0.866–0.952) and validation set (AUC 0.911, 95% CI 0.853–0.951), with good calibration (mean absolute error: 1.9% vs 3.2% in training vs validation, respectively). Decision curve analysis confirmed clinical utility across all probability thresholds. Conclusions: Our nomogram provides a non-invasive tool for preoperative risk stratification and optimizes the use of invasive diagnostics in stable CAD patients without RWMA.

Background: Patients with atrial fibrillation (AF) and atrial septal defect (ASD) face elevated thromboembolic risks, yet evidence on combined left atrial appendage closure (LAAC) and ASD closure remains limited. We aimed to assess the feasibility and safety of a “one-stop” strategy for simultaneous LAAC and ASD closure.Methods: A retrospective analysis included 40 patients with non-valvular AF and ASD undergoing combined procedures (2016–2024). Procedural success, complications, and long-term outcomes (mean follow-up: 1,194.3 days) were analyzed.Results: All procedures were technically successful. No major complications (stroke, device embolization, or death) occurred during follow-up. Peri-device leak (PDL) was observed in 19 patients (47.5%), with only one case of device-related thrombus (resolved with anticoagulation).Conclusion: The “one-stop” approach is a safe and effective strategy for stroke prevention in AF patients with ASD, particularly those unsuitable for long-term anticoagulation.