MCAFNet: multiscale cross-layer attention fusion network for honeycomb lung lesion segmentation.

Accurate segmentation of honeycomb lung lesions from lung CT images plays a crucial role in the diagnosis and treatment of various lung diseases. However, the availability of algorithms for automatic segmentation of honeycomb lung lesions remains limited. In this study, we propose a novel multi-scale cross-layer attention fusion network (MCAFNet) specifically designed for the segmentation of honeycomb lung lesions, taking into account their shape specificity and similarity to surrounding vascular shadows. The MCAFNet incorporates several key modules to enhance the segmentation performance. Firstly, a multiscale aggregation (MIA) module is introduced in the input part to preserve spatial information during downsampling. Secondly, a cross-layer attention fusion (CAF) module is proposed to capture multiscale features by integrating channel information and spatial information from different layers of the feature maps. Lastly, a bidirectional attention gate (BAG) module is constructed within the skip connection to enhance the model's ability to filter out background information and focus on the segmentation target. Experimental results demonstrate the effectiveness of the proposed MCAFNet. On the honeycomb lung segmentation dataset, the network achieves an Intersection over Union (IoU) of 0.895, mean IoU (mIoU) of 0.921, and mean Dice coefficient (mDice) of 0.949, outperforming existing medical image segmentation algorithms. Furthermore, experiments conducted on additional datasets confirm the generalizability and robustness of the proposed model. The contribution of this study lies in the development of the MCAFNet, which addresses the lack of automated segmentation algorithms for honeycomb lung lesions. The proposed network demonstrates superior performance in accurately segmenting honeycomb lung lesions, thereby facilitating the diagnosis and treatment of lung diseases. This work contributes to the existing literature by presenting a novel approach that effectively combines multi-scale features and attention mechanisms for lung lesion segmentation. The code is available at https://github.com/Oran9er/MCAFNet .

A novel method for noninvasive quantification of fractional flow reserve based on the custom function.

Boundary condition settings are key risk factors for the accuracy of noninvasive quantification of fractional flow reserve (FFR) based on computed tomography angiography (i.e., FFRCT). However, transient numerical simulation-based FFRCT often ignores the three-dimensional (3D) model of coronary artery and clinical statistics of hyperemia state set by boundary conditions, resulting in insufficient computational accuracy and high computational cost. Therefore, it is necessary to develop the custom function that combines the 3D model of the coronary artery and clinical statistics of hyperemia state for boundary condition setting, to accurately and quickly quantify FFRCT under steady-state numerical simulations. The 3D model of the coronary artery was reconstructed by patient computed tomography angiography (CTA), and coronary resting flow was determined from the volume and diameter of the 3D model. Then, we developed the custom function that took into account the interaction of stenotic resistance, microcirculation resistance, inlet aortic pressure, and clinical statistics of resting to hyperemia state due to the effect of adenosine on boundary condition settings, to accurately and rapidly identify coronary blood flow for quantification of FFRCT calculation (FFRU). We tested the diagnostic accuracy of FFRU calculation by comparing it with the existing methods (CTA, coronary angiography (QCA), and diameter-flow method for calculating FFR (FFRD)) based on invasive FFR of 86 vessels in 73 patients. The average computational time for FFRU calculation was greatly reduced from 1-4 h for transient numerical simulations to 5 min per simulation, which was 2-fold less than the FFRD method. According to the results of the Bland-Altman analysis, the consistency between FFRU and invasive FFR of 86 vessels was better than that of FFRD. The area under the receiver operating characteristic curve (AUC) for CTA, QCA, FFRD and FFRU at the lesion level were 0.62 (95% CI: 0.51-0.74), 0.67 (95% CI: 0.56-0.79), 0.85 (95% CI: 0.76-0.94), and 0.93 (95% CI: 0.87-0.98), respectively. At the patient level, the AUC was 0.61 (95% CI: 0.48-0.74) for CTA, 0.65 (95% CI: 0.53-0.77) for QCA, 0.83 (95% CI: 0.74-0.92) for FFRD, and 0.92 (95% CI: 0.89-0.96) for FFRU. The proposed novel method might accurately and rapidly identify coronary blood flow, significantly improve the accuracy of FFRCT calculation, and support its wide application as a diagnostic indicator in clinical practice.

Research on individualized distribution approach of coronary resting blood flow for noninvasive calculation of fractional flow reserve.

BACKGROUND AND OBJECTIVES: The distribution of coronary resting blood flow is critical for accurately calculating the computed tomography (CT) angiography-derived fractional flow reserve (FFRCT). However, the diagnostic accuracy of FFRCT calculated by the fixed exponents between two risk factors and coronary resting blood flow, including myocardial mass and diameter of the coronary artery branch, was insufficient compared with invasive fractional flow reserve (FFR). In this study, we proposed the individualized distribution of coronary resting blood flow based on coronary ultrasound blood flow measurement, to improve the diagnostic accuracy of FFRCT calculation. METHODS: Five risk factors and an unknown coefficient K were integrated to calculate the individualized distribution of coronary resting blood flow. The K value was fit using the least square method based on coronary ultrasound blood flow measurement results of 30 volunteers. We developed a novel approach for calculating the individualized distribution of coronary resting blood flow and applied it to calculate FFRCT (FFRCTI). Then, we tested the performance of the individualized distribution approach by comparing it with the approach proposed by Taylor based on coronary ultrasound blood flow measurement results of 13 volunteers. Finally, we tested the diagnostic accuracy of FFRCT calculated by two approaches in invasive FFR of 121 vessels with coronary stenosis. RESULTS: We identified five risk factors and 6.83×10-5 for K value, including cardiac output, mean arterial pressure, myocardial mass, coronary artery volume, and diameter of the coronary artery branch, to calculate the individualized distribution of coronary resting blood flow. The mean square error of the individualized distribution approach (0.0088) was significantly less than that of the approach proposed by Taylor (0.0799). The diagnostic accuracy of FFRCTI calculated by the individualized distribution approach (91.74%) was higher than that of the approach proposed by Taylor (FFRCTT) (82.64%). CONCLUSIONS: The individualized distribution approach of coronary resting blood flow can significantly improve the diagnostic accuracy of FFRCT calculation compared with invasive FFR, and support its wide clinical application for diagnosing myocardial ischemia caused by coronary stenosis.

Uterine hemangiopericytoma with cardiac involvement and pulmonary metastasis: A case report and literature review.

Uterine hemangiopericytoma is extremely rare. This article describes a case of uterine hemangiopericytoma. The tumor involved the parauterine vein; extended into the inferior vena cava, right cardiac cavity, and pulmonary artery; and metastasized to the lungs. It was irregular in shape and exhibited the string-of-beads sign on echocardiography, and it was tightly attached to the right ventricular surface and pulmonary artery wall. The patient underwent tumor resection without adjuvant treatment. A pelvic nodule was found 3 months postoperatively and was considered a recurrent lesion.

Assessment of Cardiac Function and Ventricular Mechanical Synchronization in Left Bundle Branch Area Pacing by Speckle Tracking and Three-Dimensional Echocardiography.

Real-time 3-dimensional echocardiography combined with speckle tracking was used in this study. A total of 90 patients with normal left ventricular ejection fraction were divided into 3 groups according to the pacing site: left bundle branch area pacing (LBBAP), right ventricular septal pacing (RVSP) or right ventricular apical pacing (RVAP). Procedure duration (90 ± 18 vs 61 ± 6.6 vs 58 ± 5.6 minutes, p = 0.015), Fluoroscopy duration (15.5 ± 5.4 vs 4.8 ± 2.2 vs 4 ± 1.9 minutes, p = 0.004), and ventricular capture threshold at implantation (0.8 ± 0.3 vs 0.6 ± 0.2 vs 0.6 ± 0.1 V, p = 0.002) were significantly increased in patients that received LBBAP compared with RVSP or RVAP. At 4 weeks of follow-up, brain natriuretic peptide levels were significantly lower (22 [12 to 59] vs 135 [86 to 231] vs 235 [147 to 428] pg/ml, p = 0.04), paced QRS duration was significantly shorter (115 ± 26 vs 134 ± 28 vs 157 ± 29 ms, p = 0.012), and global longitudinal strain (-19.4 ± 2.4 vs -19.3 ± 3.4 vs -17.3 ± 3.5%, p = 0.026) and systolic dyssynchrony index (2.5 ± 0.3 vs 5.9 ± 0.9 vs 7.7 ± 1.2, p = 0.001), longitudinal absolute maximum difference of time to peak strain (17 [6 to 68] vs 117 [71 to 173] vs 126 [79 to 178] ms, p <0.0001), and circumferential absolute maximum difference of time to peak strain (76 [32 to 129] vs 148 [117 to 208] vs 161 [118 to 266] ms, p = 0.005) were significantly lower in patients that received LBBAP compared with RVSP or RVAP. In conclusion, LBBAP can provide a more physiological ventricular activation pattern than RVSP or RVAP and results in good left ventricular electrical and mechanical synchronization.

Homozygous familial hypercholesterolemia in China: Genetic and clinical characteristics from a real-world, multi-center, cohort study.

BACKGROUND: There is a lack of large-scale data on the clinical and genotype characteristics of homozygous familial hypercholesterolemia (HoFH) patients in Asia. OBJECTIVE: To define the characteristics of phenotypic and genetic HoFH probands from mainland China. METHODS: We collected data from patients with suspected HoFH from ten clinical hospitals across mainland China from 2003 to 2019. Clinical data and DNA testing were obtained in all patients. The Kaplan-Meier method was used to generate survival curves, and the groups were compared with the log-rank test. RESULTS: A total of 108 unrelated probands with suspected HoFH (mean age 14.9 years) were included. The three most common variants were W483X (c.1448 G>A), A627T (c.1879 G>A), H583Y (c.1747 C>T). The majority (64.8%) were compound heterozygotes (n = 70), 23 (21.3%) were true HoFH patients. True HoFH showed higher LDL-C levels compared to compound HoFH (16.8±3.6 mmol/L vs. 15.0±3.1 mmol/L, P = 0.022). During follow-up, only 21.2% patients exhibited an LDL-C reduction of more than 50%. Kaplan-Meier analysis showed that the true HoFH probands had significantly worse survival rates compared to other genotype probands (13-year survival; 20.3% vs. 76.7%, respectively; P = 0.016). In addition, true HoFH shows that 2.8-fold (P = 0.022) increase any death and 3.0-fold (P = 0.023) increase cardiovascular death risk in relative to other FH. CONCLUSIONS: This report shows that HoFH has devastating consequences, and that patients are often only diagnosed after they have been exposed to severely elevated LDL-C for years. Systematic screening and early intensive treatment are an absolute requirement for these young individuals with HoFH.

Change and impact of left ventricular global longitudinal strain during transcatheter aortic valve implantation.

BACKGROUND: Although transcatheter aortic valve implantation (TAVI) is a safe and effective treatment for aortic stenosis, it still carries some risks, such as valve leaks, stroke, and even death. The left ventricular global longitudinal strain (LVGLS) measurement may be useful for the prediction of adverse events during this operation. AIM: To explore the change of LVGLS during TAVI procedure and the relationship between LVGLS and perioperative adverse events. METHODS: In this study, 61 patients who had undergone percutaneous transfemoral TAVI were evaluated by transthoracic echocardiography. Before surgery, data on left ventricular ejection fraction (LVEF) and LVGLS were collected separately following balloon expansion and stent implantation. Difference in values of LVGLS and LVEF during preoperative balloon expansion (pre-ex), preoperative stent implantation (pre-im) and balloon expansion-stent implantation (ex-im) were also examined. Adverse events were defined as perioperative death, cardiac rupture, heart arrest, moderate or severe perivalvular leakage, significant mitral regurgitation during TAVI, perioperative moderate or severe mitral regurgitation, perioperative left ventricular outflow tract obstruction, reoperation, and acute heart failure. RESULTS: The occurrence of perioperative adverse events was associated with differences in pre-ex LVGLS, but not with difference in pre-ex LVEF. There were significant differences between pre-LVGLS and ex-LVGLS, and between pre-LVGLS and im-LVGLS (P = 0.037 and P = 0.020, respectively). However, differences in LVEF were not significant (P = 0.358, P = 0.254); however differences in pre-ex LVGLS were associated with pre-LVGLS (P = 0.045). Compared to LVEF, LVGLS is more sensitive as a measure of left heart function during TAVI and the perioperative period. Moreover, the differences in LVGLS were associated with the occurrence of perioperative adverse events, and changes in LVGLS were apparent in patients with undesirable LVGLS before the surgery. Furthermore, LVGLS is useful to predict changes in cardiac function during TAVI. CONCLUSION: Greater attention should be paid to the patients who plan to undergo TAVI with normal LVEF but poor LVGLS.

[Echocardiographic manifestation and analysis of TGFBR1 gene variant in a Chinese patient with Loeys-Dietz syndrome].

OBJECTIVE: To explore the genetic basis for a patient with aortic root aneurysm and valve insufficiency. METHODS: The patient was subjected to whole exome sequencing (WES) with a focus on the analysis of genes related to aortic aneurysm and other genetic diseases involving the cardiovascular system. Suspected pathogenic site was validated by Sanger sequencing of the patient and his family members. RESULTS: WES has revealed a heterozygous c.830T>C variant (NM_001130916.3) in the patient, which was not detected among healthy members of his family. SIFT, PolyPhen2 and Mutation Taster predicted the variant to be disease causing, resulting in destruction of the structure and function of the TGFBR1 protein. Based on the American College of Medical Genetics and Genomics (ACMG) guidelines, the variant was predicted to be likely pathogenic (PM1+PM2+PM6+PP3+PP4). CONCLUSION: The c.830T>C variant of the TGFBR1 gene probably underlay the disease in the proband. Above finding has enriched the spectrum of TGFBR1 gene variants in Chinese population.

Research on the Method of Predicting Fractional Flow Reserve Based on Multiple Independent Risk Factors.

The use of diameter stenosis (DS), as revealed by coronary angiography, for predicting fractional flow reserve (FFR) usually results in a high error rate of detection. In this study, we investigated a method for predicting FFR in patients with coronary stenosis based on multiple independent risk factors. The aim of the study was to improve the accuracy of detection. First, we searched the existing literature to identify multiple independent risk factors and then calculated the corresponding odds ratios. The improved analytic hierarchy process (IAHP) was then used to determine the weighted value of each independent risk factor, based on the corresponding odds ratio. Next, we developed a novel method, based on the top seven independent risk factors with the highest weighted values, to predict FFR. This model was then used to predict the FFR of 253 patients with coronary stenosis, and the results were then compared with previous methods (DS alone and a simplified scoring system). In addition to DS, we identified a range of other independent risk factors, with the highest weighted values, for predicting FFR, including gender, body mass index, location of stenosis, type of coronary artery distribution, left ventricular ejection fraction, and left myocardial mass. The area under the receiver-operating characteristic curve (AUC) for the newly developed method was 84.3% (95% CI: 79.2-89.4%), which was larger than 65.3% (95% CI: 61.5-69.1%) of DS alone and 74.8% (95% CI: 68.4-81.2%) of the existing simplified scoring system. The newly developed method, based on multiple independent risk factors, effectively improves the prediction accuracy for FFR.

Branch flow distribution approach and its application in the calculation of fractional flow reserve in stenotic coronary artery.

OBJECTIVE: To calculate fractional flow reserve (FFR) based on computed tomography angiography (i.e., FFRCT) by considering the branch flow distribution in the coronary arteries. BACKGROUND: FFR is the gold standard to diagnose myocardial ischemia caused by coronary stenosis. An accurate and noninvasive method for obtaining total coronary blood flow is needed for the calculation of FFRCT. METHODS: A mathematical model for estimating the coronary blood flow rate and two approaches for setting the patient-specific flow boundary condition were proposed. Coronary branch flow distribution methods based on a volume-flow approach and a diameter-flow approach were employed for the numerical simulation of FFRCT. The values of simulated FFRCT for 16 patients were compared with their clinically measured FFR. RESULTS: The ratio of total coronary blood flow to cardiac output and the myocardial blood flow under the condition of hyperemia were 16.97% and 4.07 mL/min/g, respectively. The errors of FFRCT compared with clinical data under the volume-flow approach and diameter-flow approach were 10.47% and 11.76%, respectively, the diagnostic accuracies of FFRCT were 65% and 85%, and the consistencies were 95% and 90%. CONCLUSIONS: The mathematical model for estimating the coronary blood flow rate and the coronary branch flow distribution method can be applied to calculate the value of clinical noninvasive FFRCT.

Prognostic value of coronary flow velocity reserve in patients with homozygous familial hypercholesterolemia.

BACKGROUND: Coronary flow velocity reserve (CFVR) can provide useful quantitative information on the functional status of coronary artery circulation, and an impaired CFVR (< 2.0) was associated with a significant increase in the occurrence of cardiac events. Coronary artery disease (CAD) is the leading cause of death in homozygous familial hypercholesterolemia (HoFH), but the relationship between impaired CFVR and outcome in HoFH has never been discussed before METHODS: To explore the long-term prognostic value of CFVR in patients with HoFH, 39 HoFH patients with CFVR data (mean age with 16.7 years) were enrolled from the Genetic and Imaging of Familial Hypercholesterolemia in Han Nationality Study. All patients were divided into impaired CFVR (CFVR < 2.0, n = 17) and preserved CFVR (CFVR≥2.0, n = 22) group. Follow-up was performed until a major adverse cardiac event (MACE) occurred or up to June 30, 2020 RESULTS: During a median follow-up of 89 months, 16 events were registered, 12 of which were occurred in the impaired CFVR group and four occurred in the preserved CFVR group. The event-free survival rate of impaired CFVR group was significantly lower than that in the preserved CFVR group (29.4% vs 81.8%, P < .001), and CFVR < 2.0 was independently associated with prognosis before and after adjustment for related risk factors (HR 5.197, 95% CI 1.669 to 16.178, P = .004 and HR 5.488, 95% CI 1.470 to 20.496, P = .011, respectively) CONCLUSIONS: an impaired CFVR predicts a worse outcome in HoFH. CFVR shows an independent value in the prediction of long-term outcome in HoFH.

Speckle-Tracking Echocardiography for Detecting Subclinical Left Ventricular Dysfunction in Patients With Familial Hypercholesterolemia.

Myocardial ischemia and left ventricular dysfunction have been documented in young adults with familial hypercholesterolemia. We investigated whether speckle-tracking echocardiography can be used to detect subclinically impaired global and regional myocardial function in patients with this lipid disorder. This single-center study included 47 patients with familial hypercholesterolemia and 37 healthy control subjects who underwent transthoracic Doppler echocardiography and speckle-tracking echocardiography from January 2003 through December 2016. Conventional echocardiographic and strain parameters in the 2 groups were analyzed and compared. Left ventricular dimensions were significantly larger at end-diastole (P=0.02) and end-systole (P=0.013), left ventricular walls were significantly thicker (P <0.0001), and the early transmitral/early diastolic mitral annular velocity ratio was significantly higher (P=0.006) in the patient group than in the control group. In the patient group, global longitudinal and circumferential strain values were significantly lower (P <0.0001) and global radial strain values significantly higher (P=0.006); all segmental longitudinal strain (P <0.04) and most segmental circumferential strain values (P ≤0.01) were significantly lower; and some segmental radial strains, especially at the apex, were significantly higher (P ≤0.04). However, average longitudinal, circumferential, and radial strains in the different segments of the 3 main coronary artery territories were significantly lower in the patient group (P <0.01). Global longitudinal strain (r=0.561; P=0.001) and global circumferential strain (r=0.565; P <0.0001) were inversely correlated with low-density-lipoprotein cholesterol levels. We conclude that speckle-tracking echocardiography can be used to detect subclinical global and regional systolic abnormalities in patients with familial hypercholesterolemia.

Supravalvular Aortic Stenosis and the Risk of Premature Death Among Patients With Homozygous Familial Hypercholesterolemia.

Patients with homozygous familial hypercholesterolemia (HoFH) have a high risk for premature death. Supravalvular aortic stenosis (SVAS) is a common and the feature lesion of the aortic root in HoFH. The relation between SVAS and the risk of premature death in patients with HoFH has not been fully investigated. The present study analysis included 97 HoFH patients with mean age of 14.7 (years) from the Genetic and Imaging of Familial Hypercholesterolemia in Han Nationality Study. During the median (±SD) follow-up 4.0 (±4.0) years, 40 (41.2%) participants had SVAS and 17 (17.5%) participants experienced death. The proportion of premature death in the non-SVAS and SVAS group was 7.0% and 32.5%, respectively. Compared with the non-SVAS group, SVAS group cumulative survival was lower in the HoFH (log-rank test, p <0.001). This result was further confirmed in the multivariable Cox regression models. After adjusting for age, sex, low density lipoprotein cholesterol (LDL_C)-year-score, lipid-lowering drugs, cardiovascular disease, and carotid artery plaque, SVAS was an independent risk factor of premature death in HoFH on the multivariate analysis (hazard ratio 4.45; 95% confidence interval, 1.10 to 18.12; p = 0.037). In conclusion, a significantly increased risk of premature death was observed in HoFH patients with SVAS. Our study emphasized the importance of careful and aggressive management in these patients when appropriate.

Swollen heart in COVID-19 patients who progress to critical illness: a perspective from echo-cardiologists.

AIMS: Cardiac complications are common and associated with mortality in critically ill patients with COVID-19; however, the diagnostic and prognostic implications of critical care echocardiography (CCE) have not been studied. METHODS AND RESULTS: A cohort of 43 patients with COVID-19 who were in the intensive care unit (ICU) underwent bedside CCE during their disease course. Demographic, clinical, and survival data were collected. The echocardiographic analyses revealed high frequencies of pericardial effusion (90.7%), increased left ventricular mass index (60.5%), elevated relative wall thickness (76.7%), and reduced left ventricular stroke volume index (LVSVi; 53.5%) and cardiac index (51.2%). Twenty-two (51.2%) patients died in the ICU. In multivariate Cox regression, the strongest predictor of in-ICU death was decreased cardiac index [hazard ratio (HR), 0.67, 95% confidence interval (CI), 0.45-0.98; P = 0.041], after adjusting for male sex, shock status, high-sensitivity cardiac troponin I, and N-terminal pro-B-type natriuretic peptide. Negative associations with mortality were observed for LVSVi (HR, 0.91, 95% CI 0.85-0.96; P = 0.002), tricuspid annular plane systolic excursion (HR, 0.74, 95% CI 0.64-0.84; P < 0.001), and S' (HR, 0.78, 95% CI 0.69-0.88; P < 0.001). Kaplan-Meier analyses indicated that reductions in LVSVi, cardiac index, TAPSE, and S' were associated with a shorter survival time. CONCLUSIONS: Pericardial effusion and increased ventricular mass in COVID-19 might indicate a swollen heart. Both left and right heart dysfunction and a reduced cardiac index may lead to an increased risk of mortality. Clinicians should pay special attention to cardiac haemodynamic disorders in critical patients with COVID-19.

Features of Sitosterolemia in Children.

Sitosterolemia is a rare lipid metabolism disease with heterogeneous manifestations. Atherosclerosis can occur in children, and therefore, early detection, diagnosis, and treatment of this disease are important. We studied 18 pediatric patients with sitosterolemia who showed a significant increase in plasma lipid levels and analyzed their clinical, biochemical, and genetic characteristics. We recorded the initial serum lipid results and clinical manifestations of the patients. Lipid and plant sterol levels were measured after homozygous or compound heterozygous mutations of ABCG5 or ABCG8 were identified by genetic testing. Plasma plant sterol levels were analyzed by gas chromatography. Fourteen cases of sitosterolemia were examined by ultrasound and echocardiography. The initial total cholesterol and low-density lipoprotein levels of the children were significantly increased, but then markedly decreased after diet control or drug treatment, and even reached normal levels. Carotid atherosclerosis and aortic valve regurgitation were present in three of 14 patients. Serum lipid levels of children with sitosterolemia and xanthomas were notably higher than those without xanthomas. There were no significant differences in clinical manifestations between patients with different genotypes. In conclusion, sitosterolemia should be considered in children with hyperlipidemia who do not present with xanthomas, especially with a significant increase in total cholesterol and low-density lipoprotein levels. There does not appear to be a correlation between clinical phenotype and genotype.

Association between ideal cardiovascular health score trajectories and arterial stiffness: the Kailuan Study.

Some studies have shown that a higher ideal cardiovascular health score (CVHS) predicts a lower incidence of arterial stiffness. Few studies have used multiple measurements of CVHS to examine the impact of CVHS on arterial stiffness. The current study aimed to identify the long-term patterns in CVHS trajectory and to explore the association between CVHS trajectory and arterial stiffness. The study cohort consisted of 18,854 participants from the Kailuan Study who were followed up for five physical examinations over 8.10 years. Five discrete CVHS trajectories were identified among the participants: low-stable (8.10%), low-moderate (6.84%), moderate-low (23.46%), moderate-stable (39.83%), and elevated-stable (21.77%). After adjustment for confounding factors, generalized linear model analysis showed that CVHS trajectory group correlated negatively with brachial-ankle pulse wave velocity (baPWV). Compared with the low-stable group, the low-moderate group, moderate-low group, moderate-stable group, and elevated-stable group had B values of -41.81, -24.11, -86.79, and -169.54, respectively. We also used logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for CVHS trajectory groups and arterial stiffness. In fully adjusted models, ORs were 0.76 (95% CI: 0.62-0.94) for the low-moderate group, 0.80 (95% CI: 0.67-0.97) for the moderate-low group, 0.51 (95% CI: 0.42-0.62) for the moderate-stable group, and 0.23 (95% CI: 0.18-0.29) for the elevated-stable group compared with the low-stable group. The results were consistent across a number of sensitivity analyses. In conclusion, the higher long-term attainment and the improvement of CVHS were negatively associated with baPWV and could reduce the risk of arterial stiffness. Our study emphasizes the importance of optimizing CVH throughout life to prevent the incidence of arterial stiffness.

Echocardiographic findings of cardiovascular involvement in Behçet's disease and post-operative complications after cardiac surgery.

OBJECTIVES: The aim of this study was to analyse the spectrum of echocardiographic findings in patients with cardiovascular involvement in Behçet's disease (BD) and followed up the post-operative complications. METHODS: We enrolled 26 BD patients who underwent first cardiac surgery in Anzhen Hospital, Beijing, China. Medical records and echocardiographic findings were retrospectively analysed. RESULTS: The 26 patients consisted of 4 women and 22 men. 22 (84.6%) of the patients were diagnosed with moderate/severe aortic regurgitation (AR). Some distinctive echocardiographic features with AR were observed, including prolapse of aortic cusps, vegetation-like mobile lesions, an echo-free space mimicking aortic root abscess and aortic aneurysm formation. 3 (11.5%) of the patients were diagnosed with isolated descending aortic aneurysm. 1(3.8%) of the patients was diagnosed with pulmonary artery aneurysm. BD was preoperatively diagnosed by clinicians in 20 patients. And 6 patients were diagnosed post-operatively by clinicians. In a total of 26 patients, post-operative complications occurred in 8 (30.7%) patients. The complications occurred in the 6 patients diagnosed post-operatively and 2 patients diagnosed pre-operatively. The post-operative complications of these patientsincluded aortic paravalvular leakage, coronary-graft anastmotic leakage and mitral paravalvular leakage. CONCLUSIONS: The most common echocardiographic feature of cardiovascular involvement in BD is severe aortic regurgitation with prolapse of aortic cusps, vegetation-like mobile lesions, an echo-free space mimicking aortic root abscess or aortic aneurysm formation. Accurate preoperative diagnosis of BD is beneficial to the choice of immunosuppressive therapy before and after surgery, which is likely to reduce postoperative complications especially for patients with severe lesions.

Characteristic Echocardiographic Manifestations of Behçet's Disease.

The objective of this study was to determine the characteristic echocardiographic manifestations of Behçet's disease. Ninety-seven Behçet's patients admitted to our hospital from January 2002 to December 2016 were retrospectively analyzed. There were 63 patients (64.9%) with cardiac involvement; these included 47 men (74.6%) and 16 women (25.4%). Of these 63 patients, most (74.6%) exhibited valvular lesions, especially aortic regurgitation. The primary characteristic manifestations of valves were cusp prolapse with aneurysmal changes, vegetation-like lesions and echo-free spaces within the annulus. Second (30.0%) were aortic lesions, including aortic dilation or aneurysm formation, aortic pseudoaneurysm and coronary sinus aneurysm. Other manifestations, such as cardiac thrombosis, coronary arterial pseudoaneurysm, pulmonary aneurysm and pericardial effusion, were rare. Cardiac involvement is not uncommon in Behçet's patients, especially in males, and it is characterized by valvular disease, especially aortic regurgitation. The diagnosis of Behçet's disease should be considered when evaluating patients with these characteristic echocardiographic manifestations.

A giant pseudoaneurysm of coronary artery in a young patient with Behçet's disease.

As an uncommon multisystem inflammatory disease, Behçet's syndrome is characterized by mouth and genital ulcers, skin lesions, and eye inflammation, which may also affect joints, blood vessels, central nervous system, or digestive tract. However, the inflammation of coronary artery is relatively rare. We thereby reported a young male of Behçet's syndrome presenting left anterior descending artery pseudoaneurysm with myocardial infarction. Surgical resection was performed with coronary bypass grafting.