Heart and Vessels最新文献

A convolutional neural network (CNN)-enhanced electrocardiogram (ECG) has been reported for detecting mitral regurgitation (MR). This tool may be particularly useful for identifying candidates for echocardiography in patients with chronic atrial fibrillation (AF) to detect atrial functional MR early. The data from a single-center, prospective cohort study (Shinken Database 2010-2017, n = 19,170) were combined with an ECG database. Initially, a CNN model was developed to detect MR (Grade ≥ 3) across the entire cohort using fivefold cross-validation. The model was refined using sublabels, including primary MR, MR with chronic AF and left atrial dilatation, and MR with left ventricular remodeling, to create an integrated neural network (INN) model. We then analyzed the relationship between MR diagnosed by the INN and the MR prevalence in chronic AF patients. In the CNN model, the AUCs of the ROC curve and PR curve in 0.836 (SD: 0.022) and 0.196 (SD: 0.036), which numerically increased to 0.848 (SD: 0.014) and 0.198 (SD: 0.031) in the INN model. The Grad-CAM analysis revealed that the CNN algorithm appears to highlight nonspecific ECG features, such as P-waves in the leads V1 to V2 (or f-wave in the lead V1) and R-wave amplitude or ST-T changes in precordial leads, which may explain the high false-positive rate in the model. When applying the model to CAF patients, although the sensitivity was around 0.9 at the threshold determined by the ROC curve, PPR and F1 score was relatively low. These metrics slightly improved when adjusting the threshold to that corresponding to a sensitivity of 0.8 and further improved by restricting the target population to those with BNP ≥ 100 pg/mL. The INN model improved MR detection performance compared to the initial CNN model, but the overall PPR remained suboptimal. High false-positive rates remained an issue, even in high-prevalence populations such as CAF patients or those with elevated BNP values.

We introduce a technique for treating chronic limb-threatening ischemia with superficial femoral artery flush occlusion, facilitating intravascular treatment when conventional anterograde puncture is challenging. This retrospective study reviewed 37 patients who underwent vascular sheath fenestration assisted anterograde puncture to complete endovascular treatment for chronic limb-threatening ischemia from December 2022 to December 2023. All patients had superficial femoral artery flush occlusion, meeting chronic limb-threatening ischemia diagnostic criteria. Evaluations included intraoperative radiation dose, technical success rate, patency rate, limb retention rate, and postoperative complications from surgery to a 12-month follow-up. The mean age of the patients was 70 ± 10 years, with an age range of 46 to 90 years. A significant proportion of the cases presented with severe chronic limb-threatening ischemia, with 78.4% classified as Rutherford ≥ 5, 51.3% as WiFi ≥ 3, and 97.3% as Global Limb Anatomic Staging System III. In all surgical procedures, a plain old balloon angioplasty was utilized for anterograde dilation. Subsequently, based on angiographic findings, treatment involved either drug-coated balloon dilation combined with stent implantation or drug-coated balloon dilation alone. Successful revascularization was achieved in all cases, resulting in marked clinical and hemodynamic improvements, as evidenced by the mean ankle-brachial index increasing from 0.49 preoperatively to 0.86 postoperatively. The 12-month follow-up outcomes were as follows: limb salvage rate of 94.6%, primary patency rate of 83.8%, assisted primary patency rate of 91.9%, and secondary patency rate of 94.6%. The incidence of postoperative complications was 8.1%. The average duration of hospital stay was 8.43 ± 2.72 days. The vascular sheath fenestration assisted anterograde puncture technique demonstrates favorable surgical outcomes and merits consideration as a viable treatment option for chronic limb-threatening ischemia patients with superficial femoral artery occlusion.

Because heart failure (HF) with preserved ejection fraction (HFpEF) is mainly a disease of elderly, there are a few reports focusing young patients. This study aims to elucidate characteristics of comparatively young HFpEF patients. We divided HFpEF patients in PURSUIT-HFpEF registry into younger HFpEF group (age ≤ 65 years) and older HFpEF group and compared the all-cause mortality and HF readmission (HFR) between the two groups and identified discharge factors correlated with HFR among younger HFpEF patients. The younger HFpEF group comprised 51 patients (4.1%). In this group, body mass index and smoking were significantly higher, while hypertension was significantly lower compared to older HFpEF group. Kaplan-Meier analysis indicated no significant difference in HFR between the groups, although all-cause mortality was significantly lower in younger HFpEF group (p < 0.001). Multivariable Cox proportional hazards analysis indicated that angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) were inversely correlated with HFR, whereas mineralocorticoid receptor antagonists (MRA) were positively correlated with HFR in younger HFpEF patients (p = 0.004 and p = 0.007, respectively). In conclusion, younger HFpEF is rare (approximately 4%), with obesity and smoking being significant modifiable factors. HFR was similar between younger and older HFpEF patients. Administration of ACEI/ARB and unnecessity of MRA at discharge may be associated with reducing HFR in younger HFpEF patients.

Despite advances in the treatment of cardiogenic shock (CS), the 30-day mortality rate remains high. While some biomarkers predict outcomes in CS, none have been identified for prognostic prediction in IMPELLA patients. Patients with IMPELLA support due to CS were prospectively enrolled in the Japanese Registry for Percutaneous Ventricular Assist Devices. Patients enrolled between February 2020 and December 2022 were included in the study cohort. We investigated the effects of albumin levels before IMPELLA insertion. The primary endpoint was all-cause mortality within 30 days following IMPELLA initiation. A total of 3,683 patients diagnosed with CS (median age, 69 years; 77.3% male) were included in our analysis. Acute coronary syndromes were present in 1,920 (52.1%) of the patients, whereas out-of-hospital cardiac arrest had occurred in 856 of the patients (23.2%). Before IMPELLA insertion, 1,727 (46.9%) of the patients received venoarterial extracorporeal membrane oxygenation. ROC curve showed that a cut-off albumin level of 3.5 g/dL predicted the 30-day survival rate with a sensitivity of 0.613 and a specificity of 0.507. Patients with albumin levels of ≥ 3.5 g/dL had a significantly higher 30-day survival rate (67% vs. 57%; hazard ratio = 0.736; 95% confidence interval: 0.6785-0.7894; p < 0.01). Lower baseline serum albumin levels were associated with worse outcomes in patients with CS receiving IMPELLA support.

Angioplasty using ultra-high-pressure (UHP) balloons may successfully treat stenotic lesions refractory to high-pressure dilation. The use of UHP balloons in patients with congenital heart disease is mostly for dilation of the pulmonary artery, and there have been few reports on the effectiveness and safety of balloons for other sites. We retrospectively evaluated the efficacy and safety of the ultra-high-pressure balloon angioplasty (UHP-BA) for stenotic lesions in patients with congenital heart disease between January 2020 and December 2022 at Okayama University Hospital. A total of 78 UHP-BAs were performed in 44 patients, with a median age of 6.6 years and a median weight of 17.6 kg. The balloon types used in the UHP-BAs were Yoroi^® and Conquest^®. UHP-BA performed 39 procedures for the pulmonary artery (PA), 24 for fenestration, 8 for SVC, 4 for shunt, and three for others. The lesion-specific acute procedural success rates for PA, Fontan fenestration, SVC, and shunt were 77%, 75%, 88%, and 75%, respectively. A complication of UHP-BA occurred in 3.8% (3/78). Two of the three patients had pulmonary hemorrhage, and the remaining patients had pulmonary artery embolization due to the migration of a thrombus. There were no fatal complications. Balloon dilation with UHP balloons was safe and effective not only for pulmonary artery stenotic lesions but also for SVC, Fontan fenestration, shunt, and other dilation sites in patients with congenital heart disease.

Wearable technology, such as photoplethysmography (PPG), enables easily accessible individual health data with the potential for improved risk assessment. We hypothesized that the overnight stiffness index (OSI), derived from nocturnal finger PPG, could be used to assess cardiovascular risk and vascular ageing. Subjects with confirmed or suspected hypertension (n = 79, 56 males) underwent simultaneous ambulatory blood pressure monitoring (ABPM) and overnight sleep polygraphy with a continuous PPG registration. Overnight PPG-based pulse propagation time was used to calculate OSI. Associations between OSI and markers of cardiovascular risk, blood pressure, and indices of arterial stiffness, as indicators of vascular ageing, were assessed. Subjects were stratified into low and high OSI (according to median, 10.9 m/s). SCORE2/SCORE2-OP and Framingham risk scores were calculated. The high OSI group had higher SCORE2/SCORE2-OP (9.5 [5.5;12.5] vs 5.0 [4.0;6.5]), and OSI correlated with SCORE2/SCORE2-OP and Framingham risk score (r_s = 0.40 and r_s = 0.41; both P < 0.01). Indices of arterial stiffness were increased in the high OSI group including ABPM awake and asleep pulse pressures (59 ± 14 vs 50 ± 9 mmHg, P < 0.01, and 54 ± 14 vs 45 ± 7 mmHg, P < 0.001), and ambulatory arterial stiffness index (0.47 ± 0.12 vs 0.37 ± 0.11, P < 0.001), respectively. OSI correlated with 24-h and asleep pulse pressure also after adjusting for confounders. OSI was related to systolic ABPM (awake r = 0.42, asleep r = 0.55; both P < 0.001) and diastolic ABPM (asleep r = 0.36, P < 0.01). OSI, a novel PPG-based measure of nocturnal arterial stiffness, correlates with established cardiovascular risk scores and with blood pressure-derived indices of vascular ageing. This simple method may facilitate cardiovascular risk assessment using readily available medical and wearable consumer devices.

Anemia can worsen the prognosis of patients with acute cardiovascular (CV) disease; however, the effect of red blood cell (RBC) transfusion on mid-term outcomes in such patients requiring intensive care remains unclear. Therefore, this study investigated the association between RBC transfusions during hospitalization and subsequent CV events (all-cause mortality, non-fatal myocardial infarction or stroke, admission for acute heart failure [AHF], unstable angina, and other CV events) after hospital discharge in patients admitted to the cardiovascular intensive care unit (CICU). We retrospectively enrolled 517 patients with emergent admission to the CICU for suspected acute CV disease between January and December 2018. After excluding 41 patients who died or developed CV events during hospitalization, the remaining 476 patients (44.3% with acute coronary syndrome, 22.1% with heart failure, 6.7% with acute aortic dissection, 16.0% with other cardiac diseases, and 10.9% with non-cardiac diseases) were included in the analysis and divided into transfusion (n = 111) and non-transfusion (n = 365) groups based on RBC transfusion requirements during hospitalization. All patients were followed up for subsequent CV events over a period of 180 days after hospital discharge. Compared with the non-transfusion group, the transfusion group showed a higher incidence of chronic kidney disease (73.9% vs. 48.2%, p < 0.001), Acute Physiology and Chronic Health Evaluation II score (18.0 ± 7.2 vs. 13.9 ± 5.6, p < 0.001), frequency of use of invasive mechanical support devices (52.3% vs. 13.7%, p < 0.001), and surgery rate (35.1% vs. 3.3%, p < 0.001), as well as a lower nadir hemoglobin level (8.9 ± 2.3 g/dL vs. 11.7 ± 1.9 g/dL, p < 0.001). The cumulative incidence of CV events was higher in the transfusion group than in the non-transfusion group (32.9% vs. 9.1%, log-rank p < 0.001), with a similar trend observed even after propensity score matching (29.2% vs. 12.3%, log-rank p = 0.049). RBC transfusion remained independently associated with subsequent CV events after adjusting for age, sex, nadir hemoglobin level, bleeding complications, and CV risk factors (adjusted hazard ratio, 2.46; 95% confidence interval, 1.11-5.46; p = 0.027). These findings suggest that RBC transfusion during hospitalization is independently associated with subsequent CV events in patients admitted to the CICU, indicating the need for cautious evaluation of transfusion practices based on potential long-term adverse effects.

Autonomic nervous system (ANS) modulation increases the heart rate (HR) after catheter ablation (CA) for paroxysmal atrial fibrillation (PAF). However, its influence on exercise tolerance (ET) is poorly understood. This single-center retrospective cohort study enrolled patients who underwent CA for PAF. To analyze the effects of ANS modulation on ET, cardiopulmonary stress testing was performed before and 3 and 12 months after CA. The final analysis included 25 patients in the cryoballoon ablation (CBA) group and 24 in the radiofrequency CA (RFCA) group. HR increased at 3 and 12 months after CA compared with preoperative values (64.8 ± 8.6 vs. 77.7 ± 10.9, p < 0.001; 64.8 ± 8.6 vs. 74.8 ± 11.4, p < 0.001). ANS modulation was more frequent in the CBA group than in the RFCA group at 3 and 12 months after CA (64% vs. 21%, p < 0.01; 48% vs. 4%, p < 0.01). However, no significant difference in ET was observed before and after CA (anaerobic threshold 15.2 ± 2.8 vs. 15.7 ± 2.8, p = 0.46; 15.4 ± 3.0 vs. 16.3 ± 3.9, p = 0.38; peak VO2 23.5 ± 5.7 vs. 24.4 ± 5.2, p = 0.44; 23.0 ± 6.0 vs. 25.3 ± 7.7; p = 0.43) at both 3 and 12 months after CA. ANS modulation was more frequently observed in the CBA group than in the RFCA group. ET was not worsened by ANS modulation after CA.

Mitral regurgitation is a prevalent cardiac valvular disease, and its incidence is increasing with the aging population. While surgical intervention has traditionally been the standard treatment for this disease, in Japan, mitral transcatheter edge-to-edge repair (M-TEER) has emerged as a less invasive alternative since 2018. M-TEER demonstrates promising outcomes in reducing postoperative complications and shortening hospital stays. However, scarce data on cardiac rehabilitation (CR) following M-TEER is available. Therefore, in this study, we aimed to investigate the characteristics of CR progress during hospitalization and in-hospital outcomes following M-TEER. This single-center, retrospective cohort study involved 244 patients who underwent M-TEER at the Sakakibara Heart Institute between April 2018 and March 2023. Data on progress in CR and in-hospital outcomes, including hospitalization-associated disability (HAD), rate of return to home, and hospitalization that extended beyond 30 days after M-TEER, were collected. After excluding patients who met the exclusion criteria-including conversion to surgical mitral valve replacement or the absence of CR during hospitalization-233 patients were included in the analysis. The patients' median age was 81 years, with 48.5% being female. In 43% of cases, the hospitalizations were unplanned. Ambulation was initiated at a median of 1 day after M-TEER, with 88.4% of patients being able to commence ambulation as early as 2 days after M-TEER. However, only 19.3% engaged in aerobic exercise using equipment in the CR room. The median length of stay following M-TEER was 6 days, with 4.7% of hospitalizations resulting in a stay of 30 days or more. Ultimately, 90.6% of patients were discharged home, with an incidence of HAD of 9.9%. Compared to the planned hospitalization group, the unplanned hospitalization group had a significantly lower rate of early postoperative ambulation (planned hospitalization group: 97.7% vs. unplanned hospitalization group: 76.2%, p < 0.01), a higher proportion of patients with hospital stays exceeding 30 days (0% vs. 10.9%, p < 0.01), a lower rate of home discharge (98.5% vs. 80.2%, p < 0.01), and an increased incidence of HAD (0.8% vs. 22.2%, p < 0.01). M-TEER provides a minimally invasive treatment option for mitral regurgitation with favorable early rehabilitation and in-hospital outcomes, particularly in planned hospitalization. However, for unplanned hospitalizations, inpatient outcomes were poor.

Implementing advance care planning (ACP) is recommended in clinical guidelines. However, in pulmonary hypertension, patients' preference toward ACP remains unclear. We aimed to elucidate the preference of patients with pulmonary hypertension for ACP conversations and the association of ACP with important patient factors underlying treatment decision-making. We conducted a cross-sectional questionnaire-based study, assessing patients' preferred and actual participation in ACP conversations, as well as important patient factors underlying their treatment decision-making (including prognosis; patient values; physician recommendation; and symptom, financial, family, and social burdens). Univariate logistic regression analysis was conducted to identify patients with positive attitudes toward ACP conversations. Of 133 patients with pulmonary hypertension (median age, 60 years; mean pulmonary arterial pressure, 23 mmHg; female, 71.4%), 78.2% recognized the importance of ACP conversations. Regarding the patients' perception of appropriate ACP timing, 37.8% chose after repeated hospitalizations for worsening pulmonary hypertension and 22.4% chose during readmission for worsening pulmonary hypertension. Among these, 40.8% engaged in ACP conversations. A positive attitude toward ACP conversations was associated with marital status (married), having children, better oxygenation, and patients' preference toward physician recommendations in pulmonary hypertension treatment decision-making, but not with age, pulmonary hypertension etiology, or other patient preferences in treatment decision-making. Most patients with pulmonary hypertension preferred ACP conversations. A positive attitude toward ACP was associated with patients' preference toward physicians' recommendations in pulmonary hypertension treatment decision-making. Further research is required to establish an appropriate ACP approach that aligns with patient preference and physician recommendations for this patient population.