To analyze the clinical value of plasma insulin-like factor 6 (INSL6) in predicting the risk of acute aortic syndromes (AAS) and adverse outcomes.

A retrospective case-control trial was conducted on 194 AAS patients admitted to Department of Cardiovascular Diseases of Second Affiliated Hospital of Army Medical University between April 2021 and June 2023. Another 194 sex-, age- and BMI-matched individuals without aortic diseases were recruited from the health examination center between December 2021 and January 2024. Their plasma INSL6 level was measured with ELISA, and the general clinical data and results of some laboratory tests were collected and compared between the 2 groups. Spearman correlation analysis was used to assess the relationship between plasma INSL6 and other variables, receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficacy of INSL6 for AAS occurrence, multivariate conditional logistic regression model was utilized to analyze the association between plasma INSL6 and AAS onset, and Kaplan-Meier survival curve and multivariate Cox proportional hazards regression model was applied to analyze the relationship between acute-phase plasma INSL6 level and adverse prognosis in AAS patients.

The plasma INSL6 level was significantly higher in AAS patients at acute phase than the control individuals [704.40 (481.32~1152.62) vs 141.24 (107.60~163.72) pg/mL, P<0.001], but no statistical difference was observed in the level among the patients with different AAS subtypes (aortic dissection, intramural hematoma, and penetrating aortic ulcer). Spearman correlation analysis showed that the plasma INSL6 level was positively correlated with platelet count (r=0.325, P<0.001) and hemoglobin concentration (r=0.186, P=0.009), and negatively with IL-6 (r=-0.182, P=0.011), INF-γ (r=-0.283, P<0.001), and D-dimer levels (r=-0.195, P=0.006). Multivariate conditional logistic regression analysis revealed that plasma INSL6 level was independently associated with the occurrence of AAS (OR=28.634, 95%CI: 7.267~112.820, P<0.001). ROC curve analysis further confirmed that the optimal cutoff value of plasma INSL6 in predicting AAS was 259.425 pg/mL, with a sensitivity of 95.9% and a specificity of 98.5% at this threshold. Kaplan-Meier curve analysis demonstrated that AAS patients with low INSL6 level had significantly lower cumulative survival rates (P=0.020) and event-free survival rates (P=0.004) than those with high INSL6 level (P<0.05). Multivariate COX regression analysis revealed that, after adjusting for sex, age, systolic blood pressure, ST classification, and surgical treatment, acute-phase INSL6 level was independently associated with all-cause mortality (HR: 0.999, 95%CI: 0.999~1.000, P=0.023), AAS-related mortality (HR: 0.999, 95%CI: 0.998~1.000, P=0.012), and composite endpoint events (HR: 0.999, 95%CI: 0.999~1.000, P=0.026) in AAS patients during follow-up.

Plasma INSL6 level is closely associated with the occurrence and adverse prognosis of AAS, and the indicator is expected to be an effective biomarker for diagnosing AAS and predicting its prognosis.

To investigate the risk factors associated with post-implantation syndrome（PIS）in Stanford type B aortic dissection（TBAD）patients undergoing thoracic endovascular aortic repair（TEVAR）and the relationship of PIS with short-term outcomes.

A case-control trial was conducted on the clinical data of patients undergoing TEVAR treatment for TBAD in our department from December 2013 to December 2022. They were divided into 2 groups based on the occurrence of PIS. Independent risk factors were analyzed according to the different clinical characteristics between the 2 groups. The overall 30-day mortality following TEVAR was assessed in both groups. Kaplan-Meier survival curves were utilized to evaluate the 30-day postoperative survival. Logistic regression models were constructed to investigate the relationship between PIS and overall mortality occurring within 30 d after TEVAR.

A total of 373 TBAD patients, with an average age of 57.9±12.1 years and a male ratio of 77.5%（289 cases）, were enrolled in this study. There were 106 cases（28.4%）experiencing PIS following TEVAR. Significantly larger proportions of implanted stents ≥2, operation duration ≥2 h and implantation of polyethylene terephthalate（PET）-coverted stents were observed in the PIS group than the non-PIS group（P<0.05）. Multivariate logistic regression analysis suggested that implanted stents ≥2（OR=1.886, 95%CI: 1.049~3.389, P=0.034）, operation duration ≥2 h（OR=1.938, 95%CI: 1.147~3.275, P=0.013）and implantation of PET-coverted stents（OR=2.131, 95%CI: 1.263~3.597, P=0.005）were independent risk factors for PIS after TEVAR. Within 30 d after TEVAR, 15（4.0%）cases dead, including 10（9.4%）from the PIS group and 5（1.9%）from the non-PIS group. Kaplan-Meier survival curve indicated a significantly lower survival in the PIS group（Log-rank P=0.000 7）. The results of multivariate logistic regression model indicated that cystatin C（OR=1.486, 95%CI: 1.053~2.097, P=0.024）and PIS（OR=5.628, 95%CI: 1.836~17.248, P=0.002）were independent risk factors for 30-day mortality after TEVAR in TBAD patients.

Implanted stents ≥2, operation duration ≥2 h and implantation of PET-coverted stents are closely associated with the occurrence PIS in TBAD patients after TEVAR. Cystatin C level and PIS are primary risk factors for poor 30-day prognosis after TEVAR.

To investigate the early changes of left ventricular end-diastolic diameter（LVEDD）in patients with severe aortic valve stenosis（AS）after transcatheter aortic valve replacement（TAVR）and the effect of the changes on the prognosis of TAVR.

A single-center retrospective cohort study was performed on 113 severe AS patients undergoing TAVR treatment in our hospital from December 2017 to December 2021. When the improvement of postoperative to preoperative LVEDD≥1.8 mm was defined as early LVEDD improvement by echocardiography, the patients were divided into improvement group and non-improvement group. After the patients were followed up in 1 year after TAVR through clinic or telephone visits, their clinical data on cardiac ultrasound, electrocardiogram, and surgery-related complications were collected. The endpoints were major adverse cardiovascular events（MACE）, including 1-year all-cause mortality, myocardial infarction or angina, and heart failure-related hospitalization.

The average age of the patients was 71.2±6.5 years, and 59（52.2%）of them were female. The postoperative（4 d after TAVR on average）LVEDD was 48.9±6.5 mm, significantly shorter than that preoperatively（50.7±7.3 mm, P<0.001）. There were 53 patients obtaining early improvement of LVEDD before discharge, accounting for 46.9% of the discharged patients. Univariate Cox regression analysis found that preoperative diabetes（HR: 2.635, 95%CI: 1.013~6.858, P=0.047）and postoperative pacemaker implantation（HR: 3.518, 95%CI: 1.336~9.263, P=0.011）were risk factors for MACE at 1 year, and early improvement of LVEDD was a protective factor（HR: 0.176, 95%CI: 0.052~0.601, P=0.006）. Multivariate Cox analysis indicated that early LVEDD improvement was still an independent protective factor for MACE at 1 year（HR: 0.231, 95%CI: 0.062~0.857, P=0.029）.

LVEDD can be improved to various degrees in the early stage after TAVR, and the cumulative risk of developing MACE at 1 year in patients with early improvement of LVEDD is lower than that of patients without improvement.