Background: Data regarding the impact of successful chronic total occlusion treated with percutaneous coronary intervention (CTO‐PCI) on symptoms and quality of life (QOL) in elderly patients (≥75 years) are unknown. This prospective study aimed to assess whether successful CTO‐PCI could improve the symptoms and QOL in elderly patients (≥75 years). Methods and Results: Consecutive patients who underwent elective CTO‐PCI were prospectively enrolled and subdivided into 3 groups based on age: age<65 years, 65 years≤age<75 years, and age≥75 years. The primary outcomes included symptoms, as assessed with the New York Heart Association functional class and Seattle Angina Questionnaire, and QOL, as assessed with the 12‐Item Short‐Form Health Survey questionnaire, at baseline, 1 month, and 1 year after successful CTO‐PCI. Of 1076 patients with CTO, 101 were age≥75 years (9.39%). Hemoglobin, estimated glomerular filtration rate, and left ventricular ejection fraction levels all decreased with increasing age, and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) increased. The proportion of dyspnea and coronary lesions, including multivessel disease, multi‐CTO lesion, and calcification were higher in elderly patients. Procedural success rate, intraprocedural complications, and in‐hospital major adverse cardiac events were not statistically different in the 3 groups. Importantly, symptoms, including dyspnea and angina, were markedly improved regardless of age at 1‐month and 1‐year follow‐up ( P <0.05). Likewise, successful CTO‐PCI significantly improved QOL at 1‐month and 1‐year follow‐up ( P <0.01). Additionally, the incidence of major adverse cardiac events and all‐cause mortality at 1‐month and 1‐year follow‐up was not statistically different in the 3 groups. Conclusions: Successful PCI was beneficial and feasible to improve symptoms and QOL in patients ≥75 years of age with CTO.

Diabetes was commonly seen in chronic total occlusion (CTO) patients but data regarding the impact of successful percutaneous coronary intervention (PCI) on clinical outcome of CTO patients with diabetes was controversial. And importantly, no studies have compared quality of life (QOL) after CTO-PCI in patients with and without diabetes. Consecutive patients undergoing elective CTO-PCI were prospectively enrolled from Apr. 2018 to May 2021. Patients were subdivided into 2 groups: Diabetes and No Diabetes. Detailed baseline characteristics, assessment of symptoms and QOL, angiographic and procedural details, in-hospital complications, and 1 month and 1 year follow-up data were collected. These data were analyzed accordingly for risk predictors of clinical outcome in patients who have diabetes and received successful CTO-PCI. A total of 1076 patients underwent CTO-PCI attempts. Diabetes was present in 374 (34.76%) patients, who had more hypertension, previous PCI and stroke. Regarding the coronary lesions, diabetic patients suffered more LCX lesion, multivessel disease, number of lesions per patient, blunt stump, calcification and higher J-CTO score (p < 0.05). In-hospital major adverse cardiac event (MACE) (4.13% vs. 5.35%; p = 0.362) was similar in the two groups. At 1 month and 1 year follow-up after successful CTO-PCI, the incidence of MACE and all-cause mortality were also similar in the two groups (p > 0.05). Number of lesions per patient was an independent risk factor of MACE and all-cause mortality (p < 0.001) 1 year after successful CTO-PCI. Symptom and QOL were markedly improved regardless of diabetes both at 1 month and 1 year follow-up, and importantly, patients with diabetes showed similar degrees of improvement to those without diabetes (P > 0.05). Successful CTO-PCI could represent an effective strategy improving clinical outcome, symptoms and QOL in CTO patients with diabetes.

Objective: Adiponectin (APN) circulates as high‐molecular weight (HMW), medium‐molecular weight (MMW), and low‐molecular weight (LMW) forms. Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. Currently, the role of LMW, MMW, and HMW APN remains largely unclear in NAFLD. Methods: We examined the variation of these forms and analyzed the related clinical characteristics in NAFLD. A total of 63 male NAFLD patients (mean age: 43.00 ± 6.10 years) and 70 healthy male subjects (mean age: 42.53 ± 7.98 years) were included in the study. Total APN and other clinical characteristics were measured. The changes in HMW, MMW, and LMW APN were determined in NAFLD patients and NAFLD patients on a high‐fat diet, and the association between the groups was further analyzed. Results: Decreased levels of total APN and three APN isoforms were found in NAFLD. Significantly decreased levels of HMW ( P < .01) and MMW ( P < .001) were observed in NAFLD of high‐fat diet patients. In NAFLD patients, height ( R = −.270, P = .032) and N‐epsilon‐(carboxymethyl) lysine ( R = −.259, P = .040) significantly correlated with total APN. HMW APN was significantly associated with fasting plasma glucose ( R = .350, P = .016), alanine aminotransferase ( R = −.321, P = .029), and aspartate aminotransferase ( R = −.295, P = .045). Additionally, MMW APN was significantly associated with total cholesterol ( R = .357, P = .014) and high‐density lipoprotein ( R = .556, P < .0001). Low‐density lipoprotein ( R = −.283, P = .054) was also clearly associated with LMW APN in NAFLD patients. Conclusion: These results suggest that HMW and MMW APN may be involved in the pathogenesis and progression of NAFLD.

Accurate measurement of intracoronary blood flow rate is of great significance for the diagnosis of ischemic heart disease (IHD). Computational fluid dynamic (CFD) method, combining coronary angiography images and fractional flow reserve (FFR), provides a new way to calculate the mean flow rate. However, due to the incomplete boundary conditions obtained by FFR, side branches were ignored which was likely to have a significant impact on the accuracy. In this paper, a novel CFD based method for calculating the mean intracoronary flow rate under incomplete pressure boundary conditions was proposed, in order to improve the accuracy by including the side branches. A pressure-flow curve based flow resistance model was employed to model resistance of the epicardial arteries. A series of steady flow simulations were performed to extract the parameters of the flow resistance model, which implicitly specified constraints for splitting flow between branches and thus enabled the mean intracoronary blood flow rate to be calculated in two or more branches under incomplete pressure boundary conditions. Simulation experiments were designed to validate the proposed method in both idealized and reconstructed 3D models of coronary branches, and the impact of the assumed coefficient of the Murray's Law for splitting flow between branches was also investigated. The mean percentage error of the proposed method was +2.05%±0.04% for idealized models and +2.24%±0.01% for reconstructed models, and it was much lower than that of the method ignoring side branches (+38.48%±10.45% for idealized models and +30.54%±6.12% for reconstructed models). When the assumed coefficient of the Murray's Law was inconsistent with the real blood flow condition, the percentage errors still maintained less than about 3.00%. The proposed method provided an easy and accurate way to measure the mean intracoronary flow rate and would facilitate the accurate diagnosis of IHD.