Cardiovascular continuum refers to the process in which high-risk factors lead to atherosclerosis, rupture of atherosclerotic vulnerable plaque causes acute myocardial infarction, and arrhythmia, cardiac failure or even death may occur after myocardial infarction. It has complicated and continuous pathological characteristics including multiple factors, causal relationship under multi-link effect, progressive development, sudden event and serious consequence. This study inherits and innovates TCM thought of "preventing disease occurrence and disease progress", proposes a new concept of systematic intervention by "treatment of the underlying disease and prevention before disease onset", uses ying-wei theory of Chinese medicine to guide multidimensional data mining in ancient and modern medical records, reveals progress, pathogenic characteristics and medication laws of cardiovascular continuum, innovatively explains the treatment principle of "regulating ying and wei in case of heart injury" as described in Nan Jing, and develops clinical medication regimen for systematic intervention of cardiovascular continuum.

ObjectiveTo investigate the effects of proprotein convertase subtilisin/kexin type-9(PCSK9) inhibitors on lipid profiles, liver and renal function, and recurrent cardiovascular events in patients after myocardial infarction.MethodsA total of 106 patients with acute myocardial infarction who were treated at the Renmin Hospital of Wuhan University from 2020 to 2023 were retrospectively collected for this study. Patients were divided into a control group(n=53) and an observation group(n=53) according to the treatment plan. Patients in the control group received statin therapy for lipid-lowering treatment, while patients in the observation group received PCSK9 inhibitors in addition to statin therapy. Both groups of patients received continuous medication for one month and underwent follow-up examinations. The lipid levels, liver and renal function, and echocardiographic parameters before and after treatment were compared between the two groups.ResultsAfter treatment, the levels of TCh, LDL-C were lower than before treatment in two groups, and the TCh and LDL-C levels in the observation group were lower than those in the control group(t/P=3.656/<0.001,4.342/<0.001), 2="" and="" the="" levels="" of="" tg="" was="" lower="" than="" before="" treatment="" in="" observation="" group.="" there="" no="" significant="" difference="" between="" comparison="" hdl-c="" groups="" after="" p="">0.05). After treatment, the levels of ALT and AST in 2 groups were lower than before treatment(t/P=3.877/<0.001, 5.082/<0.001, 10.172/<0.001, 13.644/<0.001), 2="" but="" there="" was="" no="" difference="" in="" the="" alt="" levels="" between="" groups="" after="" p="">0.05). There was no difference in the renal function index in 2 groups after treatment and in both 2 groups before and after treatment(P>0.05). After treatment, the level of LVEF was higher in the observation group(t/P=3.542/0.001), and IVSD in the 2 groups were lower than before treatment(t/P=3.005/0.004,3.042/0.004). The incidence of cardiovascular adverse events in the observation group was 3.8%, lower than 20.8% in the control group(χ2/P=7.102/0.008).ConclusionPCSK9 inhibitors can significantly reduce lipid levels and the rate of cardiovascular adverse events in patients with Acute Myocardial Infarction(AMI) and improve cardiac function, with no significant impact on liver and renal function.

ObjectiveTo investigate the correlation of serum neuromodulin 1(NRG1) and acyl-coenzyme A synthetase long chain family member 1(ACSL1) with the degree of coronary stenosis and prognosis in patients with acute myocardial infarction(AMI).MethodsFrom January 2021 to June 2023,203 patients with AMI admitted to the Department of Emergency Medicine of the Second Affiliated Hospital of Army Medical University were selected as AMI group and 105 healthy volunteers were selected as healthy control group. According to Gensini score, AMI patients were divided into mild coronary stenosis subgroup(63 cases), moderate coronary stenosis subgroup(81 cases) and severe coronary stenosis subgroup(59 cases). According to 1-year prognosis, they were divided into poor prognosis subgroup(52 cases) and good prognosis subgroup(151 cases). Serum NRG1 and ACSL1 levels were detected by enzyme-linked immunosorbent assay. Serum NRG1 and ACSL1 levels were detected by enzyme-linked immunosorbent assay. Spearman correlation analysis was used to analyze the correlation between Gensini score and serum NRG1 and ACSL1 levels in AMI patients. The relationship between serum NRG1 and ACSL1 levels and the prognosis of AMI patients was determined by multivariate unconditional logistic regression. Receiver operating characteristic curve was used to analyze the predictive efficiency of serum NRG1 and ACSL1 levels.ResultsCompared with the control group, the serum levels of NRG1 and ACSL1 in the AMI group were increased(t/P=15.801/<0.001,15.824/<0.001). The levels of serum NRG1 and ACSL1 in mild coronary stenosis subgroup, moderate coronary stenosis subgroup and severe coronary stenosis subgroup increased in turn(F/P=277.241/<0.001,423.452/<0.001). Gensini score was positively correlated with serum NRG1 and ACSL1 levels in AMI patients(rs/P=0.764/<0.001,0.772/<0.001). The incidence of poor prognosis in 203 patients with AMI was 25.62 %(52/203) after 1 year of follow-up. Compared with the good prognosis subgroup, the serum levels of NRG1 and ACSL1 in the poor prognosis subgroup were increased(t/P=7.040/<0.001,7.865/<0.001). The independent risk factors for poor prognosis in patients with AMI were high Gensini score, high ACSL1 and high NRG1[OR(95%CI)=1.041(1.019-1.062),1.272(1.120-1.443),1.337(1.193-1.497)].The area under the curve of serum NRG1 and ACSL1 levels combined to predict the poor prognosis of AMI patients was 0.899, which was greater than 0.783 and 0.786 predicted by serum NRG1 and ACSL1 levels alone(Z/P=3.730/<0.001,3.329/<0.001).ConclusionThe levels of serum NRG1 and ACSL1 in AMI patients are increased, which is related to the aggravation of coronary stenosis and poor prognosis. The combination of serum NRG1 and ACSL1 levels is more effective in predicting the prognosis of AMI patients.

ObjectiveTo investigate the correlation between serum long non-coding RNA cervical cancer high expression 1(LncRNA CCHE1), transcription factor 21(TCF21) and myocardial ischemia in patients with coronary heart disease(CHD) complicated with hypertension.MethodsA total of 110 CHD patients with hypertension admitted to the Cardiovascular Department of the Yulin First Hospital from December 2020 to December 2023 were selected as the hypertensive group and 110 CHD patients without hypertension as the non-hypertensive group. According to the occurrence of myocardial ischemia, the hypertension group was divided into 79 cases of myocardial ischemia subgroup and 31 cases of non-myocardial ischemia subgroup. The expression levels of serum LncRNA CCHE1 and TCF21 were determined by real-time fluorescence quantitative PCR; Pearson correlation analysis was used to analyze the correlation between serum LncRNA CCHE1, TCF21 expression levels and total myocardial ischemia burden(TIB); Multivariate logistic regression analysis was used to analyze the influencing factors of myocardial ischemia in CHD patients with hypertension; The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of serum LncRNA CCHE1 and TCF21 expression levels for myocardial ischemia in CHD patients with hypertension.ResultsThe expression level of serum LncRNA CCHE1 in the hypertension group was higher than that in the non-hypertension group, and the expression level of serum TCF21 was lower than that in the non-hypertension group(t/P=19.133/<0.001,17.259/<0.001); BMI, systolic blood pressure, proportion of three-vessel disease, serum Hcy level, TIB, serum LncRNA CCHE1 expression level in the myocardial ischemia subgroup were higher than those in the non-myocardial ischemia subgroup, and serum TCF21 expression level was lower than that in the non-myocardial ischemia subgroup(t/P=3.524/0.001,2.705/0.008,12.265/0.002,5.280/<0.001,24.638/<0.001,15.994/<0.001,9.280/<0.001); Pearson correlation analysis showed that the expression level of serum LncRNA CCHE1 in CHD patients with hypertension was positively correlated with TIB(r=0.536,P<0.001), and the expression level of serum TCF21 was negatively correlated with TIB(r=-0.508,P<0.001); Multivariate Logistic regression analysis showed that three-vessel disease and high expression level of LncRNA CCHE1 were independent risk, factors for myocardial ischemia in CHD patients with hypertension[OR(95%CI)=3.465(1.534-7.833),1.743(1.135-2.678)], and high expression level of TCF21 was an independent protective factor[OR(95%CI)=0.528(0.312-0.895)]; The area under the curve(AUC) of serum LncRNA CCHE1, TCF21 expression levels and their combination in the diagnosis of myocardial ischemia in CHD patients with hypertension were 0.778,0.760 and 0.896, respectively. The AUC of the combination of the two was greater than that of serum LncRNA CCHE1 and TCF21 expression levels alone in the diagnosis of myocardial ischemia in CHD patients with hypertension(Z=2.636, 3.088,P=0.002,<0.001).ConclusionThe increased expression of serum LncRNA CCHE1 and the decreased expression of TCF21 in CHD patients with hypertension are related to myocardial ischemia. The combination of the two has a high value in the diagnosis of myocardial deficiency risk.

ObjectiveTo investigate the independent influencing factors of TCM and Western medicine of late recurrence after the first radiofrequency catheter ablation(RFCA) in patients with atrial fibrillation(AF), and construct a clinical prediction model.MethodsThree hundred and fourty-two patients with AF who underwent RFCA for the first time in the Cardiovascular Department of Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2018 to December 2022 were retrospectively selected as the study subjects. According to the occurrence of late recurrence, the included cases were divided into recurrence group(n=105)and non-recurrence group(n=237). Multivariate logistic regression analysis was used to analyze the influencing factors of late recurrence after the first RFCA in AF; A nomogram model was constructed to predict the late recurrence after the first RFCA in AF. The predictive effectiveness of the nomogram model was assessed by receiver operating characteristic(ROC) curve. The fit ability and calibration of the nomogram model was assessed by Hosmer-Lemeshow inspection and calibration curves.ResultsThe proportion of Qi deficiency pattern, Yin deficiency pattern, left atrial diameter(LAD), left ventricle diameter(LVD), and neutrophil to lymphocyte ratio(NLR) of patients with AF in the recurrence group were higher than those in the non-recurrence group, and the proportion of class III antiarrhythmics, statins, and Yiqi-Yangyin TCM injections in the recurrence group were lower than those in the recurrence group(t/χ2/P=6.355/0.012, 7.149/0.007, 5.445/<0.001, 3.063/0.002, 3.499/0.001, 10.542/0.001, 12.122/<0.001, 6.362/0.012). Multiple regression analysis identified that non-paroxysmal AF, early recurrence, Qi deficiency pattern, Yin deficiency pattern, large LAD and large NLR were independent risk factors for late recurrence after the first RFCA in AF[OR(95%CI)=2.103(1.071-4.127), 9.837(4.981-19.428), 2.414(1.265-4.603), 2.460(1.317-4.596), 1.117(1.047-1.192), 1.377(1.077-1.761)], and the use of statins and Yiqi-Yangyin TCM injections were independent protection factors[OR(95%CI)=0.208(0.104-0.413), 0.416(0.211-0.820)], and then construct a nomogram model. The verification results show that the area under of the ROC curve(AUC) for the prediction model was 0.863(95%CI=0.823-0.904).ConclusionNon-paroxysmal AF, early recurrence, LAD, NLR, Qi deficiency pattern, Yin deficiency pattern, use of statins, and use of Yiqi-Yangyin TCM injections are independently associated with late recurrence after the first RFCA in AF. The prediction model based on the above independent influencing factors has high predictive power, and can be used to obtain the corresponding predictive value of the risk of late recurrence after RFCA of AF according to the individual conditions.