Heart and Vessels最新文献

Cardiovascular diseases are strongly associated with poor lifestyle habits. Adopting healthier lifestyle habits is essential for reducing the risks associated with cardiovascular diseases. However, low health literacy (HL) may compromise assessing, using, and understanding health information, making modification of health behavior less likely. This study aimed to clarify the relationship between HL and changes in health behavior in inpatients undergoing cardiac rehabilitation. This was a multicenter cohort study of patients undergoing phase I cardiac rehabilitation. We used the 14-item Health Literacy Scale (HLS-14) to assess HL and the transtheoretical model (TTM) to assess changes in health behavior. Behavioral changes during hospitalization were defined using the stages of the TTM. A total of 428 patients who underwent cardiac rehabilitation (mean age: 73.0 years; males: 71.5%) were included. Evaluation of the behavioral changes exhibited by the participants revealed that the pre-contemplation stage (83.2%) was common at the beginning of rehabilitation, whereas contemplation (50.7%) and preparation (38.1%) stages were common at discharge. Of the 428 participants, 83.6% exhibited behavioral changes during hospitalization. Multivariate analysis revealed that HLS-14 score was a significant explanatory variable associated with changes in health behavior (odds ratio: 1.04; 95% confidence interval: 1.00-1.07). The spline curves modeling the relationship between HLS-14 score and changes in health behavior showed a positive correlation in the low HL group. HL is significantly correlated with changes in health behavior, especially in individuals with a low HL level.

Dual antiplatelet therapy is the standard therapy for the secondary prevention of acute and chronic coronary syndromes in patients undergoing percutaneous coronary intervention (PCI). The introduction of more potent antiplatelet agents and understanding of prognostic implications associated with bleeding have led to a substantial evolution in antiplatelet treatment regimens over the past decades. Several investigations have been conducted to better stratify patients undergoing PCI according to their ischemic and bleeding risks and to optimize antithrombotic regimens accordingly. One of the available strategies involves using platelet aggregation tests to determine the most suitable antiplatelet agent to combine with aspirin. Our aim was to evaluate the role of platelet function tests (PFT) in clinical practice in choosing dual antiplatelet therapy for patients undergoing PCI: in this study, we compared the impact on ischemic and hemorrhagic cardiovascular events in a 5 year follow-up between patients treated according to standard guidelines and those treated with a platelet function test guided approach. This study included 490 patients with acute or chronic coronary syndrome who underwent percutaneous angioplasty between 2013 and 2016 and were subsequently treated with dual antiplatelet therapy. Patients whose treatment strategy was based on PFT were 68.4% (n = 335), while others received standard therapy. The primary endpoint of the study was to assess the incidence of net adverse clinical events (NACE), defined as a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding, according to the BARC scale. Follow-up was conducted 5 years after angioplasty by telephone contact or by consulting patients' medical records. Heart failure and stable angina were considered as secondary endpoints. From the univariate analysis, the incidence of NACE was significantly lower in patients who received tailored therapy (33.7% vs. 43.9% in the non-tailored group, p = 0.02). In addition, results showed that total length of implanted stents and left main coronary disease were independent risk factors for net adverse clinical events (NACE). Similarly, an initial diagnosis of N-STEMI or unstable angina was associated with an increased risk of adverse events during follow-up. In patients undergoing PCI, a tailored antithrombotic approach guided by PFT appears safe and effective, may represent a feasible strategy in contemporary practice and should be considered in case of high bleeding risk.

We appreciate the comments from Arshad et al. regarding our study on long-term outcomes of alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) in Japan. Addressing concerns about sex-related differences, our analyses revealed no significant differences between men and women in overall mortality (log-rank P = 0.759) or major cardiovascular events (heart failure admission, P = 0.521; pacemaker/implantable cardioverter-defibrillator implantation, P = 0.234; sustained ventricular tachycardia/ventricular fibrillation, P = 0.615; new-onset atrial fibrillation, P = 0.894). The 12% reintervention rate is consistent with reported rates from high-volume centers over 10 years (10-15%), suggesting appropriate patient selection. Primary risk factors for reintervention were thicker interventricular septum and residual mitral regurgitation, as previously reported. Sustained efficacy of ASA is supported by 75% of patients maintaining NYHA class I at 10-year follow-up. These findings, while acknowledging potential differences between Japanese and Western populations, reinforce the long-term safety and effectiveness of ASA for HOCM in Japan.

Bepridil are often administered after catheter ablation (CA) in patients with persistent atrial fibrillation (AF); however, it is unclear for how long it should be continued. We administered hybrid therapy consisting of CA and bepridil to 130 patients with persistent AF and left atrial (LA) enlargement (volume index > 48 ml/m²). After 2 months of hybrid therapy, bepridil discontinuation was attempted. All patients underwent echocardiography 6 months after CA. We investigated the relationship between the duration of bepridil administration and the recurrence of AF after bepridil discontinuation. After excluding patients who were unable to maintain sinus rhythm during bepridil administration (n = 18), and those who disagreed to bepridil discontinuation (n = 17), 95 patients were divided into the short-term continuation (bepridil discontinued for < 6 months [median 3 months] after CA [n = 63]), and long-term continuation (bepridil discontinued for > 6 months [median 11.4 months] after CA [n = 32]) groups. During the mean follow-up period of 28 ± 15 months, the groups showed a similar incidence of recurrent AF after bepridil discontinuation. In the long-term continuation group, 13 patients had recurrence, with 8 (62%) cases occurring within 4 months after discontinuation. A multivariate Cox regression analysis revealed that left atrial (LA) reverse remodeling (> 15% decrease in LA volume index at 6 months) was an independent predictor of recurrent AF after CA (p < 0.01). Long-term bepridil administration after CA did not affect the recurrence of AF after discontinuation. The assessment of LA reverse remodeling may be useful for decision-making regarding the discontinuation of antiarrhythmic drugs after CA.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated significant cardiovascular benefits, including reductions in hospitalizations and mortality among patients with heart failure (HF). However, the mechanisms underlying these benefits, particularly their effects on autonomic nervous system activity, remain incompletely understood. This single-center, prospective observational study included 11 patients with chronic HF who were newly initiated on SGLT2 inhibitors. Sympathetic nerve activity was assessed using 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy, while parasympathetic activity was evaluated via heart rate recovery during cardiopulmonary exercise testing (CPET) conducted at baseline and three months post-treatment initiation. Echocardiographic and laboratory parameters were also analyzed. After three months of treatment, no significant changes were observed in MIBG-derived heart-to-mediastinum (H/M) ratios, washout rates, or heart rate recovery following exercise. Echocardiographic assessment revealed significant improvements in cardiac function. Laboratory findings demonstrated reductions in uric acid and HbA1c levels, improved liver function, and increased erythropoietin levels, while NT-proBNP exhibited a non-significant downward trend. Notably, free carnitine levels decreased significantly, possibly indicating enhanced energy metabolism within the failing myocardium. In patients with chronic HF, SGLT2 inhibitors had no significant effect on autonomic nervous system activity within the first three months of treatment. However, significant improvements in cardiac function and metabolic parameters were observed, supporting their cardioprotective role.

Duchenne muscular dystrophy (DMD) is a progressive myopathy caused by a mutation in the dystrophin gene. Cardiac disease is currently the leading cause of death in patients with DMD; thus, early diagnosis and management of cardiomyopathy are essential. Intra-voxel incoherent motion (IVIM) analysis provides quantitative values from diffusion-weighted imaging (DWI) and may serve as a novel index for evaluating myocardial properties in DMD. We conducted IVIM analysis in patients with DMD and compared their results with those of healthy volunteers to confirm that IVIM analysis can detect myocardial damage more effectively than conventional imaging methods. Patients with DMD who underwent cardiac magnetic resonance IVIM were enrolled. D and F values were measured using DWI of the left ventricle. Six healthy volunteers served as the control group. Twelve male patients with DMD were enrolled (median age, 14 years). Creatinine kinase levels were elevated, brain natriuretic peptide values remained within the normal range, and troponin T levels were only mildly elevated. The D value in patients with DMD was significantly higher than that in healthy volunteers, indicating increased diffusion in the myocardium (2.59 vs. 1.85, p = 0.0057); however, the F value was comparable between the two groups (0.62 vs. 0.61, p = 0.60). The D and F values from IVIM analysis provided a more detailed reflection of myocardial properties. Myocardial diffusion in patients with DMD was elevated compared with that in healthy volunteers.

Our purpose was to determine the outcome of pregnancy and delivery in patients with coronary artery lesions and myocardial involvement caused by Kawasaki disease after half a century after the first report of this disease. We investigated 67 deliveries in 39 patients with coronary artery lesions caused by Kawasaki disease in our institution between 1991 and 2022. The age at delivery ranged from 18 to 42 years, with a median of 31 years. Twenty-four patients (62%) had stenotic lesions, including 11 with coronary arterial bypass grafting. Low-dose aspirin was given to 26 patients (67%). The deliveries were vaginal in 29 patients (74%), albeit that 16 required assistance by forceps or vacuum extraction under epidural anesthesia. Caesarean sections were performed in 10 patients (26%), 5 (13%) for cardiac disease. There were two patients with worsening ventricular tachycardia and two patients with ST-T depression on Holter monitoring during pregnancy. Three patients experienced an increase in isolated ventricular premature contractions during pregnancy. No severe maternal cardiac events occurred in any patients. There were four preterm babies less than 35 weeks of gestation (6%). The results of the pregnancy and delivery in patients without myocardial ischemia and involvement were favorable, even if they had stenotic lesions. Ventricular tachycardia can worsen during pregnancy in patients with myocardial involvement, and myocardial ischemia may also occur in patients with coronary artery occlusions. Their evaluation during pregnancy by Holter-electrocardiograms is helpful in deciding the management of the pregnancy and mode of delivery.