Hao-Yu Wu

Despite advances in antihypertensive therapies, uncontrolled hypertension remains a major global health challenge, particularly among older adults. Ferropt

Ecdysterone (Ecd), an active ingredient in trianthema, has a strong anti‐inflammatory effect. This study aimed to explore the potential mechanism by which Ecd improves atherosclerosis (AS). Here, we systematically investigated the mechanism of Ecd in human umbilical vein endothelial cells (HUVECs) treated with oxidised low‐density lipoprotein (ox‐LDL). In ox‐LDL‐treated HUVECs, Ecd promoted HUVEC viability as well as inhibited ferroptosis and the secretion of inflammatory factors (TNF‐α, IL‐6 and IL‐1β). In addition, Ecd inhibited the expression of neutrophil cytoplasmic factor 2 (NCF2) and triggered the PI3K/AKT/Nrf2 signalling pathway, thereby alleviating the increase of ferroptosis in ox‐LDL‐treated HUVECs. More importantly, we constructed an AS mouse model by feeding ApoE^−/− mice with a high‐fat diet and found that Ecd treatment alleviated vasculopathy and arterial ferroptosis and inhibited the secretion of inflammatory factors in vivo, which could be reversed by overexpression of NCF2. Overall, this study showed that the protective effect of Ecd on AS is mainly achieved by inhibiting NCF2 and activating the PI3K/Akt/Nrf2 pathway to inhibit ferroptosis. Therefore, Ecd may be an effective drug to improve AS by inhibiting ferroptosis‐induced inflammation.

Fractional flow reserve (FFR) has become the gold standard for evaluating coronary lesion-specific ischemia. However, FFR is an invasive method that may cause possible complications in the coronary artery and requires expensive equipment, which limits its use. Promising noninvasive diagnostic methods, such as computed tomography angiography–derived FFR (CT-FFR) and the quantitative flow ratio (QFR), have been proposed. In this study, we evaluated the diagnostic performance of the QFR and CT-FFR in predicting coronary lesion-specific ischemia, with the FFR serving as the reference standard. Patients with suspected or known coronary artery disease who underwent coronary CT angiography revealing 30–90% diameter stenosis in the main coronary artery (≥ 2.0 mm reference diameter) were enrolled. The FFR was measured during invasive coronary angiography (within 15 days after coronary CT angiography). An FFR ≤ 0.8 was the reference standard for coronary lesion-specific ischemia. A total of 103 vessels from 92 consecutive patients (aged 59.8 ± 9.2 years; 60.9% were men) were evaluated. The diagnostic performance of a QFR ≤ 0.80 for predicting coronary lesion-specific ischemia demonstrated good diagnostic accuracy, sensitivity, and specificity (92.2%, 87.2%, and 96.4%, respectively), with an area under the receiver operating characteristic curve (AUC) of 0.987 (P < 0.0001). The diagnostic performance of a CT-FFR ≤ 0.80 for predicting coronary lesion-specific ischemia also demonstrated good diagnostic accuracy, sensitivity, and specificity (96.1%, 95.7%, and 96.4%, respectively), with an AUC of 0.967 (P < 0.0001). However, there was no significant difference in the AUC between a QFR ≤ 0.80 and a CT-FFR ≤ 0.80 for predicting coronary lesion-specific ischemia (P = 0.319). There was an excellent correlation between the QFR and FFR (r = 0.856, P < 0.0001). The CT-FFR and FFR also showed a good direct correlation (r = 0.816, P < 0.0001). The QFR and CT-FFR are strongly correlated with the FFR and can provide excellent clinical diagnostic performance for coronary lesion-specific ischemia detection.

Objective: The cause of syncope is generally determined based on clinical manifestations. There has been little discussion about the value of electrocardiograms for diagnosing neurally mediated syncope. The aim of this study was to test the predictive value of the isolated very low QRS voltage in tilt-table testing for suspected neurally mediated syncope in a Chinese population. Methods: This retrospective study enrolled patients with suspected neurally mediated syncope. Tilt-table testing was a part of the diagnostic examination. Each patient underwent echocardiography and electrocardiogram. isolated very low QRS voltage referred to a voltage of ⩽0.3 mV for the QRS complex in an isolated frontal lead or ⩽0.7 mV for the QRS complex in an isolated precordial lead. Results: In total, 157 patients were included in the tilt-table testing positive group, and 242 patients were included in the tilt-table testing negative group. Compared with the testing negative group, the testing positive group had more patients with isolated very low QRS voltage in the frontal leads ( p < 0.001). Moreover, for patients with isolated very low QRS voltage in the precordial leads, no significant difference was noted between the testing positive group and testing negative group ( p = 0.289). Isolated very low QRS voltage in the frontal leads demonstrated 84.08% sensitivity and 74.38% specificity for a positive tilt-table testing response. The area under the curve of isolated very low QRS voltage for a positive tilt-table testing response in frontal leads was 0.806 ( p < 0.0001). Conclusion: In patients with suspected neurally mediated syncope, isolated very low QRS voltage in the frontal leads is a parameter that can predict a positive tilt-table testing response. The presence of isolated very low QRS voltage in frontal leads can serve as a parameter for evaluating syncope patients.

Background: The classic electrocardiogram (ECG) criteria have been applied to left ventricular hypertrophy (LVH) screening but have low sensitivity. Recently, the newly proposed Peguero-Lo Presti criterion has been proven to be more sensitive in detecting LVH in patients with hypertension than several current ECG criteria. The diagnostic value of the Peguero-Lo Presti criterion in hypertrophic cardiomyopathy (HCM) patients has not been fully evaluated. This study aims to test whether the new Peguero-Lo Presti criterion can improve the diagnostic performance in patients with HCM. Methods: This study included HCM patients and sex-and age-matched healthy control subjects. The diagnostic performance of the Peguero-Lo Presti criterion was evaluated along with the Sokolow-Lyon criterion, Cornell criterion, and total 12-lead voltage criterion. Results: Overall, 63 HCM patients and 63 controls were enrolled. The diagnostic accuracy, sensitivity and specificity of Peguero-Lo Presti criterion were 74.6%, 73.0% and 76.2%, respectively. The Peguero-Lo Presti criterion had the highest sensitivity, while the Cornell criterion and Sokolow-Lyon criterion had the highest specificity (96.8%). The area under the curve (AUC) showed that the Peguero-Lo Presti criterion was 0.809 (95% CI, 0.730–0.874; p < 0.0001), Sokolow-Lyon criterion was 0.841 (95% CI, 0.766–0.900) and total 12-lead voltage criterion was 0.814 (95% CI, 0.735–0.878). There was no significant difference in AUC between Peguero-Lo Presti criterion and Sokolow-Lyon criterion (p = 0.533), or Peguero-Lo Presti criterion and total 12-lead voltage criterion (p = 0.908). Receiver operator characteristic curve analysis of the Peguero-Lo Presti criterion showed an optimal cutoff of >3.15 mV for men (sensitivity: 63.9%; specificity: 80.0%) and >2.29 mV for women (sensitivity: 78.6%; specificity: 85.7%). Conclusions: The Peguero-Lo Presti criterion provides high sensitivity for ECG diagnosis of HCM patients and can be considered when applicable but this needs to be verified in a larger population.

A man in his 80s with recurrent syncope was admitted to the emergency department. The patient previously underwent an electrophysiological study (the exact procedure was unknown) in another hospital because of syncope, and the result did not suggest the need for pacemaker implantation. He denied a recent medical history of chest pain or dyspnea on exertion. On examination, his oxygen saturation while breathing room air was 98%, and his blood pressure was 120/76 mm Hg. The result of cardiopulmonary examination was unremarkable. Echocardiogram findings revealed a left ventricular ejection fraction of 54% with normal ventricular wall motion. Blood laboratory data, including serial high-sensitivity troponin, D-dimer, renal function, electrolytes, and blood glucose, were unremarkable. The results of the electrocardiogram (ECG) that was performed at admission was recorded (Figure, A). Identify all potential conflicts of interest that might be relevant to your comment. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. Err on the side of full disclosure. If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response. Not all submitted comments are published. Please see our commenting policy for details.

To the Editor This letter is in response to the Challenges in Clinical Electrocardiography report by Jay and colleagues¹ who described an interesting case of sodium-glucose cotransporter-2 inhibitor–associated euglycemic diabetic ketoacidosis and its effect on the electrocardiogram (ECG). We would like to commend the authors for sharing their observations and discussing ST-segment elevation mimicking acute myocardial infarction during euglycemic diabetic ketoacidosis. The case report is excellent; however, 3 points need further discussion. Identify all potential conflicts of interest that might be relevant to your comment. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. Err on the side of full disclosure. If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response. Not all submitted comments are published. Please see our commenting policy for details.

A patient in their 60s with no cardiovascular history presented to the emergency department with recurrent syncope. There was no reported seizure activity. The patient denied having chest pain, palpitations, or shortness of breath before syncope. Vital signs on admission revealed a blood pressure of 130/80 mm Hg, a respiratory rate of 17 breaths/min, a heart rate of 68 beats/min, and oxygen saturation of 98% on room air. Cardiopulmonary examination revealed no obvious abnormality. Results of a transthoracic echocardiogram showed that the left ventricular ejection fraction was 57% and the left ventricular wall movement was normal. Blood laboratory data, including glucose, renal function, electrolytes, thyroid function, and serial high-sensitivity troponin, were normal. Baseline 12-lead electrocardiogram (ECG) demonstrated sinus rhythm, complete right bundle branch block, and left posterior fascicular block (Figure, A). Identify all potential conflicts of interest that might be relevant to your comment. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. Err on the side of full disclosure. If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response. Not all submitted comments are published. Please see our commenting policy for details.

A man in his 60s with a history of chronic kidney disease and long-term peritoneal dialysis presented to the emergency department with heart palpitations and severe weakness of the upper and lower limbs. The patient’s medical history also included an inferior wall myocardial infarction in 2011, but unexplained syncope was denied, and he reported no family history of sudden cardiac death. On admission, the patient’s blood pressure was 160/80 mm Hg; heart rate, 102 beats per minute; and respiratory rate, of 20 breaths per minute. Examination of the limbs showed symmetrical weakness in the extremities. Cardiopulmonary examination showed no notable findings. The result of high-sensitivity cardiac troponin level testing was 0.03 ng/mL (reference, <0.02 ng/mL; to convert to μg/L, multiply by 1.0). A 12-lead electrocardiogram (ECG) was obtained on admission (Figure, A). Identify all potential conflicts of interest that might be relevant to your comment. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. Err on the side of full disclosure. If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response. Not all submitted comments are published. Please see our commenting policy for details.