中华心血管病杂志最新文献

Objective: To investigate the feasibility of transcatheter edge-to-edge repair (TEER) using a short-clip strategy for patients with moderate-to-severe or greater degenerative mitral regurgitation caused by commissural prolapse. Methods: This retrospective study included patients with severe mitral regurgitation secondary to commissural prolapse who underwent TEER at the Second Affiliated Hospital of Zhejiang University School of Medicine between September 2022 and July 2024. Preoperative clinical and imaging data, intraoperative details, procedural outcomes, and 1-month postoperative follow-up results were collected. Results: A total of 19 patients were enrolled, aged (74.1±6.1) years, including 12 males. Among them, 10 patients had external commissural prolapse, and 9 patients had internal commissural prolapse. Preoperatively, all patients exhibited severe mitral regurgitation (4+), with an effective regurgitant orifice area of (0.55±0.17) cm², left atrial volume of (104.77±36.57) ml, left ventricular end-diastolic volume of (102.29±32.47) ml, left ventricular end-diastolic dimension of (5.34±0.59) mm, and prolapse width of (1.18±0.34) cm. All procedures utilized short clips (NTR or NTW clips) to target the prolapsed commissural region and were completed successfully without intraoperative complications. At 1-month follow-up, no mortality, stroke, single-leaflet device attachment, myocardial infarction, or unplanned mitral reintervention occurred. Mitral regurgitation severity improved to ≤2+ in all patients, with left atrial volume of (74.49±33.83) ml, left ventricular end-diastolic volume of (85.90±18.05) ml, and left ventricular end-diastolic dimension of (4.93±0.37) mm (all P<0.05). Conclusion: The short-clip strategy, focusing on precise clip placement at the commissural interface, is feasible and effective for TEER in patients with severe mitral regurgitation due to commissural prolapse.

Objective: To evaluate the feasibility of transjugular transcatheter tricuspid valve replacement (TTVR) using the LuX-Valve Plus system (Ningbo Jenscare Scientific, China) for the treatment of severe tricuspid regurgitation in real-world clinical settings. Methods: This prospective study enrolled 81 patients with severe ricuspid regurgitation (≥3+) who underwent TTVR with the LuX-Valve Plus system at the Department of Cardiology, West China Hospital of Sichuan University between May 2022 and March 2024. Among them, 44 patients were from a compassionate-use study, and 37 were from two premarket clinical trials. Baseline clinical data, preprocedural imaging, procedural outcomes, and postprocedural follow-up data were collected. The primary endpoint events included device success, procedural success, and 30 d composite adverse events. Results: The age of the cohort was (74.5±7.8) years, with 54 females (67%). Device success and procedural success rates were both 90% (73/81). Post-procedural tricuspid regurgitation improved, with a 6% (5/81) incidence of moderate-to-severe paravalvular leakage. The rate of permanent pacemaker implantation was 12% (10/81), of which 5% (4/81) had pre-existing indications for pacemaker implantation. Major bleeding events occurred in 10% (8/81) of patients, and the 30 d composite endpoint rate was 25% (20/81). Conclusion: TTVR using the LuX-Valve Plus system demonstrates promising feasibility for high-risk surgical patients with severe tricuspid regurgitation, effectively reducing or eliminating regurgitation with acceptable safety. However, challenges remain in reducing risks of major adverse events, including permanent pacemaker implantation and severe bleeding.

Objective: To investigate the value of serum microRNA (miRNA) levels in the early diagnosis of acute aortic dissection (AAD). Methods: (1) Human umbilical vein endothelial cells (HUVEC) were transfected with hsa-miR-744-5p mimic and its negative control mimic, and cell proliferation and migration were assessed using the CCK-8 assay and wound healing assay. (2) A total of 40 patients diagnosed with AAD by whole-aorta CT angiography in the Emergency Department of the First Affiliated Hospital of Xinjiang Medical University from January 2020 to January 2022 were enrolled as the AAD group. The time interval between chest pain onset and blood sample collection was less than 24 hours. Meanwhile, 40 age- and sex-matched healthy individuals undergoing routine physical examinations were selected as the control group. The initial blood samples were collected from AAD patients upon admission, while fasting blood samples were collected from the control group. Based on our previous research findings, the top 10 miRNAs with the highest fold-change (>1) and the most significant upregulation were identified. Through a literature review, three miRNAs (miR-206, miR-143-3p, and miR-744-5p) were selected as target miRNAs. Laboratory test results, including D-dimer levels, were collected from both groups. The relative expression levels of target miRNAs in both groups were measured using quantitative real-time polymerase chain reaction (qRT-PCR). Spearman correlation analysis was performed to assess the correlation of target miRNA expression levels. Receiver operating characteristic (ROC) curves were plotted to calculate the area under the curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. Results: (1) The CCK-8 assay showed that compared with HUVEC transfected with negative control mimic, HUVEC transfected with hsa-miR-744-5p exhibited lower absorbance values at all time points (all P<0.05). The wound healing assay indicated that the relative migration rate of HUVEC transfected with hsa-miR-744-5p mimic was significantly lower (P<0.05). (2) The D-dimer level significantly differed between the AAD group and the control group (1 737.0 (660.5, 3 297.5) μg/L vs. 66.0 (34.0, 89.0) μg/L, P<0.001). The expression levels of all three miRNA in the serum of AAD patients were significantly upregulated compared with the control group by qRT-PCR (all P<0.05). Spearman correlation analysis revealed positive correlations between miR-206 and miR-744-5p (r=0.508, P<0.001), miR-143-3p and miR-744-5p (r=0.695, P<0.001), and miR-206 and miR-143-3p (r=0.651, P<0.001). All three miRNAs had diagnostic value for AAD in ROC analysis, with miR-206 demonstrating the highest diagnostic accuracy (67.50%) and a specificity of 92.5%. The combined detection of miRNA improved diagnostic accuracy, with miR-206+miR-143-3p achieving a