Background: Invasive coronary angiography is the gold standard for assessing in-stent restenosis (ISR) in patients with coronary artery disease. However, the predictive value of non-invasive Tissue Doppler Imaging (TDI) to evaluate patients with ISR has not been studied extensively. Methods: A total of 41 patients (19 with acute myocardial infarction and 22 with stable angina pectoris) who received percutaneous coronary intervention (PCI) were enrolled in the study. Time-to-peak velocities (TpV) of 12 non-apical segments of the left ventricle, by pulse wave TDI echocardiography, were obtained within two days prior to the PCI and six months later. Results: A 12-segmental mean TpV ≥ 279.6 ms at six months after PCI was able to detect ISR (odds ratio: 2.09, 95% CI 1.004–4.352, p = 0.049). Moreover, a significant decrease in the standard deviation of TpV was demonstrated in patients without ISR (85.8 ± 44.8 vs. 60.3 ± 31.7 ms, p = 0.001), but not in patients with ISR (97.7 ± 53.3 vs. 91.2 ± 52.6 ms, p = 0.57). Conclusions: Pulse-wave TDI echocardiography is a promising tool in the detection of ISR six months after PCI in patients with coronary artery disease.

Background: Heart failure (HF) remains a leading cause of morbidity and mortality globally, necessitating the identification of reliable prognostic biomarkers to guide therapeutic interventions. Recent clinical observations have underscored phenylalanine (PHE) as a prognostic marker in HF, although the mechanisms involving inter-organ crosstalk remain understood. Methods: This study adopted a dull approach, with a retrospective analysis of 550 HF patients to establish the prognostic value of pre-discharge PHE levels and a study on the inter-organ crosstalk of PHE among 24 patients. We analyzed the correlations between PHE concentrations and clinical outcomes, alongside a comprehensive examination of PHE metabolism across the skeletal muscle, liver, heart, kidney, and lung. Results: In the clinical prognostic analysis of 550 patients hospitalized for acute decompensated HF, elevated PHE levels (≥65.6 μM) were significantly and independently associated with increased all-cause mortality during a median follow-up of 4.5 years (log rank = 36.7, p < 0.001), underscoring its value as a prognostic marker in HF. The inter-organic crosstalk study elucidated the mechanism associated with PHE elevation in patients with HF, characterized by an increase in PHE output in skeletal muscle and a decrease in hepatic and cardiac PHE uptakes. Notably, PHE concentration gradients across these organs were correlated with HF severity, such as the NYHA functional class, B-type natriuretic peptide levels, and the presence of acute HF. Conclusions: Our findings confirm the prognostic significance of PHE in patients with HF and unveil the complex metabolic interplay among key organs that contribute to PHE dysregulation. These insights not only reinforce the importance of metabolic monitoring in HF management but also open avenues for therapeutic targets.

Background Scrub typhus is an infectious disease that affects multiple organs. However, the long-term cardiovascular (CV) risk in survivors remains unknown. Method A retrospective cohort study used administrative claims data from the National Health Insurance Research Database (NHIRD) to investigate the CV risk of scrub typhus survivors from January 1, 2010, to December 31, 2015. People who had prior CV events before the diagnosis of scrub typhus were excluded. The CV outcomes of interest were acute myocardial infarction (AMI), heart failure hospitalization (HFH), hemorrhagic or ischemic stroke, new-onset atrial fibrillation (AF), aneurysm or dissection of aorta, venous thromboembolism (VTE), and CV death. Result A total of 2,269 patients with scrub typhus and without a prior CV event were identified (mean age 47.8±16.1 years, 38.0% female). The health control cohort (n=2,264) was selected to compare by the frequency matching with age, gender, and co-morbidities with patients with scrub typhus. The incidence of HFH, new-onset AF, and total events was significantly higher among patients with scrub typhus than the control cohort with an adjusted hazard ratio (aHR) of 1.97, 95% confidence interval (CI) 1.13-3.42 for HFH; 2.48, 95% CI: 1.23-5.0 for new-onset AF; 1.43, 95% CI: 1.08-1.91 for total CV events, respectively. The event rates of other outcomes were similar between the two groups. Conclusion In the cohort study, survivors of scrub typhus are at heightened risk of subsequent CV events, especially for HFH and new-onset AF. These findings serve as an important reminder to physicians regarding the significant CV risk that remains present following acute scrub typhus infection.