ObjectiveTo investigate the correlation between serum levels of syndecan-1(SDC-1) and thrombospondin-1(THBS-1) and the no-reflow after percutaneous coronary intervention(PCI) in patients with acute ST segment elevation myocardial infarction(STEMI).MethodsA total of 394 patients with acute STEMI diagnosed and treated in the Cardiovascular Department of the First People's Hospital of Kunshan City, Jiangsu Province from January 2020 to December 2023 were selected as the study group. They were grouped into a reflow subgroup(n=308) and a no-reflow subgroup(n=86) based on whether blood flow was restored after PCI. Additionally, 402 healthy individuals who underwent physical examination were included as the control group. Enzyme linked immunosorbent assay(ELISA) was applied to measure the expression levels of serum SDC-1 and THBS-1 in different groups. Pearson/Spearman methods were applied to analyze the correlation between serum SDC-1 and THBS-1 expression and clinical data of patients with no-reflow. Logistic regression was applied to analyze the influencing factors of no-reflow occurrence after PCI surgery. Receiver operating characteristic(ROC) curves were plotted to analyze the potential value of serum SDC-1 and THBS-1 expression in predicting no-reflow occurrence after PCI in acute STEMI patients.ResultsCompared with the control group, the research group showed high expression of serum SDC-1 and THBS-1(t/P=170.052/<0.001, 62.118/<0.001). There were obvious differences in the length and number of coronary artery lesions between the no-reflow group and the reflow group(t/χ2/P=9.035/<0.001, 11.443/0.001). Compared with the reflow subgroup, the expression of serum SDC-1 and THBS-1 increased in the no-reflow subgroup(t/P=8.885/0.000, 8.754/0.000). The expression of serum SDC-1(r/rs/P=0.412/<0.001, 0.539/<0.001) and THBS-1 in acute STEMI patients with no-reflow after PCI was positively correlated with the length of coronary artery lesions and multi vessel coronary artery lesions(r/rs/P=0.457/<0.001, 0.582/<0.001).The length of coronary artery lesions, multi vessel coronary artery lesions, serum SDC-1, and THBS-1 in patients with acute STEMI were all risk factors for no-reflow after PCI[OR(95%CI)=3.363(1.450-7.794), 3.625(1.783-7.370), 4.391(2.722-7.084), 5.146(3.695-7.167)]. The area under the curve(AUC) for predicting no-reflow after PCI in acute STEMI patients based on the expression levels of serum SDC-1, THBS-1 and combined was 0.812, 0.770 and 0.882, respectively. The combined prediction efficiency of the two was better than that of each(Z/P=2.046/0.041, 3.274/0.001).ConclusionThe expressions of serum SDC-1 and THBS-1 are elevated in acute STEMI patients with no-reflow after PCI, they are risk factors for the no-reflow. The combination of the two has a high predictive value for the occurrence of no-reflow.

Objective To explore the prognostic factors of heart failure patients with reduced ejection fraction(HFrEF) complicated by coronary heart disease and to construct a corresponding prediction model. Methods The clinical data of 219 patients with HFrEF complicated with CHD admitted to hospital from January 2021 to June 2023 were retrospectively analyzed, and randomly divided into development set(146 cases) and test set(73 cases) according to 2:1 by computer generated random number method. The occurrence of major adverse cardiovascular events(MACE) was analyzed during follow-up. Patients with MACE and no MACE were included in the adverse outcome group and the good outcome group respectively. Compare the clinical data of development set and test set. The clinical data of poor outcome group and good outcome group were compared and developed. Logistic regression model was used to analyze the prognostic factors of HFrEF patients with CHD, and the regression equation and prognosis prediction model were established. The effectiveness of the model was evaluated by receiver operating characteristic curve(ROC). Results There was no significant difference in clinical data between the development set and the test set(P>0.05). Logistic regression model analysis showed that hyperuricemia, high CONUT score, high SYNTAX score, and poor out-of-hospital compliance were risk factors for poor prognosis in HFrEF patients with CHD(P<0.05), and left ventricular ejection fraction(LVEF) was a protective factor(P<0.05). A prognostic model for HFrEF patients with coronary heart disease was established based on the developed set Logistic regression analysis structure. ROC curve showed that the area under the curve(AUC) of the predictive model for predicting poor prognosis in the development set was 0.923(95%CI 0.867～0.960), the sensitivity was 0.938, and the specificity was 0.860. The predictive model predicted poor outcomes in the test set with an AUC of 0.904(95%CI 0.812～0.960), sensitivity of 0.900, and specificity of 0.830. Conclusion Hyperuricemia, high CONUT score, high SYNTAX score, and poor out-of-hospital compliance are risk factors for poor prognosis in HFrEF patients with CHD, and LVEF is a protective factor. The prediction model built based on the above factors has good efficacy in predicting poor prognosis in HFrEF patients with CHD.

ObjectiveTo explore the effects of different sodium-glucose co-transporter 2(SGLT2) inhibitors combined with diuretics on renal function, cardiac function, and clinical safety in patients with chronic heart failure(CHF).MethodsA randomized, open-label, single-center prospective clinical cohort study was conducted. A total of 96 CHF patients admitted to the Second Department of Cardiology, Second People's Hospital of Kashgar, from June 2022 to December 2023 were selected as the research subjects and divided into three groups using a random number table: the dapagliflozin group(n=32), the canagliflozin group(n=32), and the control group(n=32). All patients received conventional basic treatment for heart failure. Additionally, the dapagliflozin group was treated with dapagliflozin, the canagliflozin group with canagliflozin, and the control group without any extra medication. All patients were followed up after 3 months of continuous treatment. Observations included cardiac function-related indicators[left ventricular ejection fraction(LVEF), left ventricular mass index(LVMI), left ventricular remodeling index(LVRI)], heart failure-related serological markers [plasma brain natriuretic peptide(BNP), N-terminal pro-brain natriuretic peptide(NT-proBNP)], ventricular remodeling-related indicators[cystatin C(CysC), fibroblast growth factor 23(FGF23), matrix metalloproteinase 9(MMP-9)], inflammatory factors[C-reactive protein(CRP), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α)], renal function indicators[serum creatinine(SCr), blood urea nitrogen(BUN), glomerular filtration rate(GFR)], and drug-related adverse reactions.ResultsAfter treatment, the LVEF, LVRI, and GFR of the three groups were higher than before treatment, while the levels of LVMI, BNP, NT-proBNP, CysC, FGF23, MMP-9, SCr, and BUN was lower. The changes in cardiac function indicators, heart failure-related serological markers, ventricular remodeling-related indicators, and renal function indicators in the dapagliflozin and canagliflozin groups were greater than those in the control group(F/P=13.740/<0.001, 6.415/0.002, 8.520/<0.001, 12.184/<0.001, 15.945/<0.001, 14.927/<0.001, 12.330/<0.001, 8.755/<0.001, 20.388/<0.001, 12.055/<0.001, 10.196/<0.001), but="" there="" was="" no="" statistically="" significant="" difference="" between="" the="" dapagliflozin="" and="" canagliflozin="" p="">0.05). After treatment, the serum levels of CRP, IL-6, and TNF-α in the three groups were lower than before treatment, but there was no statistically significant difference between the groups(F/P=0.101/0.904, 1.449/0.442, 0.021/0.979). There were no statistically significant differences in the incidence of adverse events among the three groups(χ2/P=0.571/0.751).ConclusionBoth dapagliflozin and canagliflozin combined with SGLT2 inhibitors on top of basic treatment can effectively improve cardiac and renal function in CHF patients, significantly reduce inflammation levels, heart failure-related serological markers, and the degree of ventricular remodeling. The combined use of different types of SGLT2 inhibitors shows high clinical safety and may have significant clinical application value for improving long-term prognosis in CHF patients.

ObjectiveTo explore the diagnostic value of color Doppler ultrasound(CDU) combined with serum cysteine-rich 61(Cyr61) and angiopoietin like protein 3(ANGPTL3) in patients with chronic heart failure(CHF).MethodsEighty-six cases of CHF patients admitted to the Department of Cardiology of the Northwest University Affiliated Hospital Xi'an No.3 Hospital, from December 2020 to December 2023 were selected as the study group, and the patients were divided into 58 cases of subgroups of class Ⅱ-Ⅲ and 28 cases of subgroup of class Ⅳ according to the cardiac function grading of the New York Heart Association(NYHA). Another 86 cases were selected as healthy control group from the same period of hospital health checkups. Enzyme-linked immunosorbent assay(ELISA) was used to determine serum Cyr61 and ANGPTL3 levels; Pearson correlation analysis was used to analyze the correlation between serum Cyr61 and ANGPTL3 levels and cardiac function indexes; multifactorial logistic regression was used to analyze the influencing factors of CHF patients; and subjects' work characteristics(ROC) curves were used to evaluate the CDU and serum Cyr61, ANGPTL3 levels for the diagnostic value of CHF.ResultsSerum Cyr61, ANGPTL3 levels and left ventricular end-diastolic internal diameter(LVEDD) and left atrial diameter(LAD) were significantly higher and left ventricular ejection fraction(LVEF) was significantly lower in the study group than in the healthy control group(t/P=9.779/<0.001, 35.751/<0.001, 18.376/<0.001, 21.451/<0.001, 49.742/<0.001); serum Cyr61 and ANGPTL3 levels and LVEDD and LAD were significantly higher in the class IV subgroup of CHF patients than in the class Ⅱ-Ⅲ subgroup, and LVEF was significantly lower than in the class Ⅱ-Ⅲ subgroup(t/P=11.226/<0.001, 37.440/<0.001, 7.786/<0.001, 27.001/<0.001, 13.303/<0.001); serum Cyr61 and ANGPTL3 levels were positively correlated with LVEDD and LAD and negatively correlated with LVEF(r/P=0.501/<0.001, 0.510/<0.001,-0.522/<0.001, 0.515/<0.001, 0.517/<0.001,-0.532/<0.001); multifactorial logistic regression analysis showed that high Cyr61, high ANGPTL3, high LVEDD, and high LAD were independent risk factors for patients with CHF[OR(95%CI)=3.108(1.590-6.076), 4.378(2.011-9.533), 3.420(1.452-8.054), 2.058(1.429-2.963)], and high LVEF was an independent protective factor[OR(95%CI)=0.521(0.329-0.824)]; the AUCs for the diagnosis of CHF for LVEDD, LAD, LVEF, Cyr61, ANGPTL3 and the combination of the five were: 0.764, 0.832, 0.815, 0.810, 0.808, and 0.976, and the area under the curve(AUC) of the combination of the five was greater than the AUC of LVEDD, LAD, LVEF, Cyr61, and ANGPTL3 diagnosed alone(Z/P=2.527/0.031, 2.675/0.024, 2.689/0.020, 2.679/0.018, 2.680/0.023).ConclusionSerum Cyr61 and ANGPTL3 are greatly elevated in CHF patients, and CDU combined with serum Cyr61 and ANGPTL3 can improve the diagnostic value for CHF patients.

ObjectiveTo explore the value of high-resolution magnetic resonance imaging(high-resolution MR) combined with serum micrornA-140-3p(miR-140-3p) and micrornA-223-3p(miR-223-3p) in the assessment of the vulnerability of carotid atherosclerotic plaques.MethodsA total of 86 patients with carotid atherosclerosis admitted to the Department of Neurology of the First People's Hospital of Lianyungang City from January 2022 to December 2023 were selected as the study objects. According to the pathologically confirmed plaque status, the patients were divided into a plaque vulnerable group(42 cases) and a non-plaque vulnerable group(44 cases). The serum levels of miR-140-3p and miR-223-3p were detected by real-time fluorescence quantitative PCR(qRT-PCR). Kappa test was used to analyze the consistency of high-resolution MR Detection and gold standard in diagnosing vulnerable carotid atherosclerotic plaques. Multivariate Logistic regression was used to analyze the influencing factors of plaque vulnerability in patients with carotid atherosclerosis. Receiver operating characteristic(ROC) curve analysis of the diagnostic value of high-resolution MR, miR-140-3p and miR-223-3p in plaque vulnerability in patients with carotid atherosclerosis.ResultsThe serum miR-140-3p level in the plaque vulnerable group was lower than that in the non-plaque vulnerable group, and the serum miR-223-3p level was higher than that in the non-plaque vulnerable group(t/P=6.033/<0.001, 6.367/<0.001). there="" was="" no="" significant="" difference="" in="" arterial="" remodeling="" type="" and="" plaque="" distribution="" between="" the="" two="" p="">0.05). Kappa test showed that the high resolution MR Test was generally consistent with the gold standard in the diagnosis of vulnerable carotid atherosclerotic plaque(Kappa value=0.603). Multivariate Logistic regression analysis showed that high CRP and miR-223-3p were independent risk factors for vulnerable plaque in patients with carotid atherosclerosis[OR(95%CI)=1.685(1.051-2.702), 3.054(2.008-4.645)]. The high level of miR-140-3p was an independent protective factor[OR(95%CI)=0.752(0.616-0.918)]. The area under the curve(AUC) of plaque vulnerability in patients with carotid atherosclerosis diagnosed by high-resolution MR, miR-140-3p, miR-223-3p and their combination were 0.800, 0.860, 0.884 and 0.981, respectively. The AUC of the combination of the three was greater than that diagnosed by high-resolution MR, miR-140-3p and miR-223-3p alone(Z/P=4.537/<0.001, 2.980/0.003, 2.869/0.004).ConclusionHigh-resolution MR Combined with serum miR-140-3p and miR-223-3p detection can improve the diagnostic value of carotid atherosclerotic plaque vulnerability.