Objectives: The main goal of our research is to explore the effect of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) on left atrial (LA) phasic function in hypertrophic cardiomyopathy (HCM). Methods: The study included 13 patients who underwent PIMSRA in our hospital from. The function of LA including reservoir, conduit, and booster pump was analyzed and compared before and six months after PIMSRA in HCM patients. LA reservoir function parameters contain maximal LA volume (LAV max), minimal LA volume (LAV min), LA ejection fraction (LAEF), LA expansion index (LAEI), and reservoir strain; LA conduit function includes LA volume before atrial systole (LAV pre-A), LA passive volume, LA passive ejection fraction (LAPEF) and conduit strain; LA booster function involves LA booster volume, LA active ejection fraction (LAAEF) and LA contraction strain. Additionally, 20 healthy controls were selected to compare the LA function of HCM patients. Results: The preoperative LA reservoir and conduit function in HCM patients were significantly impaired compared with the control group, while the change in booster pump function was not obvious. HCM patients at six months after PIMSRA had remarkably enhanced reservoir and conduit function which were manifested by lower minimal LA volume (LAV min), higher LA ejection fraction (LAEF), LA expansion index (LAEI), reservoir, and conduit strain than before the operation, and the differences among these parameters between patients after PIMSRA and the healthy control group were not significant. However, with regard to LA contraction function, there was no significant improvement at 6 months after PIMSRA compared with before operation. Conclusion: PIMSRA is effective in the amelioration of LA reservoir and conduit function in patients with HCM, but not in a marked improvement of LA contraction function in these individuals in short term.

Objectives: To develop and validate the 4-year risk of type 2 diabetes mellitus among adults with metabolic syndrome. Design: Retrospective cohort study of a large multicenter cohort with broad validation. Settings: The derivation cohort was from 32 sites in China and the geographic validation cohort was from Henan population-based cohort study. Results: 568(17.63%) and 53(18.67%) participants diagnosed diabetes during 4-year follow- up in the developing and validation cohort, separately. Age, gender, body mass index, diastolic blood pressure, fasting plasma glucose and alanine aminotransferase were included in the final model. The area under curve for the training and external validation cohort was 0.824(95%CI, 0.759-0.889) and 0.732(95%CI, 0.594-0.871), respectively. Both the internal and external validation have good calibration plot. A nomogram was constructed to predict the probability of diabetes during 4-year follow-up, and on online calculator is also available for a more convenient usage (https://lucky0708.shinyapps.io/dynnomapp/). Conclusion: We developed a simple diagnostic model to predict 4-year risk of type 2 diabetes mellitus among adults with metabolic syndrome, which is also available as web-based tools (https://lucky0708.shinyapps.io/dynnomapp/).

Objectives：Apical aneurysm is a high-risk subgroup in hypertrophic cardiomyopathy (HCM). We aimed to explore the change of left ventricular (LV) function and myocardial fibrosis and the relationship between them and the formation of apical aneurysms in patients with HCM. Methods and results: The study enrolled 25 HCM patients without apical aneurysms and 20 HCM patients with apical aneurysms. The presence of an apical aneurysm was determined by echocardiography or CMR. LV function was assessed by speckle-tracking echocardiography and late gadolinium enhancement (LGE) was assessed by CMR. Patients with HCM in two groups had similar left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS). However, HCM patients with apical aneurysms had worse twist (7.49 ± 4.52° vs. 11.82 ± 5.55°, P=0.007), torsion (1.32 ± 0.81°/cm vs. 2.34 ± 0.98°/cm, P=0.001), and higher LGE than HCM patients without apical aneurysms. Multivariate analysis demonstrated that torsion (OR: 21.23; 95% CI: 1.27 to 354.26; P=0.03) and LGE (OR: 1.17; 95% CI: 1.01 to 1.36; P=0.03) were independent parameters of apical aneurysm events in patients with HCM. When applying a cutoff value of 1.25° for torsion and LGE into a baseline model with clinical and conventional echocardiographic parameters, the new model showed a significant incremental value of torsion and LGE (P<0.001) in identifying apical aneurysm events in HCM patients. The C-statistic for this model increased from 0.65 to 0.90 when adding torsion and LGE. Conclusion: HCM patients with apical aneurysms have impaired rotational mechanics and more pronounced fibrosis. Torsion and LGE are independent markers of apical aneurysm events in patients with HCM and could provide incremental value to baseline models in identifying apical aneurysms.