Heart and Vessels最新文献

Chronic kidney disease (CKD) is associated with increased platelet reactivity following stent implantation. However, the effect of sex on platelet reactivity remains unclear and requires further investigation. We evaluated the impact of high platelet reactivity (HPR) and sex on 5-year outcomes in patients with CKD undergoing percutaneous coronary intervention (PCI) using drug-eluting stents (DES). From the Platelet Function and Genotype-Related Long-Term Prognosis in Drug-Eluting Stent-Treated Patients With Coronary Artery Disease Consortium, 2126 patients with CKD were included. Patients were categorized into HPR (n = 939) and non-HPR (n = 1187) groups based on P2Y₁₂ reaction unit values and further subdivided by sex. The primary endpoint was the 5-year incidence of patient-oriented composite outcomes (POCO), comprising all-cause mortality, myocardial infarction, stent thrombosis, or stroke. The secondary outcomes included individual POCO components and major bleeding events. In the HPR group, no significant sex differences were observed in 5-year outcomes. However, in the non-HPR group, female patients had significantly lower rates of POCO (adjusted hazard ratio [aHR]: 0.552; P = 0.002) and all-cause mortality (aHR: 0.373; P < 0.001) than male patients. No significant differences in outcomes were observed between the HPR and non-HPR groups for either sex. The incidence of major bleeding did not differ by sex in either HPR (P = 0.586) or non-HPR group (P = 0.325). In patients with CKD undergoing PCI with DES, long-term outcomes did not differ by sex in the HPR group, whereas female patients in the non-HPR group had better survival than male patients.

Atrial fibrillation (AF) is a prevalent comorbidity among patients undergoing transcatheter aortic valve implantation (TAVI); however, its prognostic implications remain uncertain. This study aimed to elucidate the impact of preprocedural AF on clinical outcomes following TAVI in patients with aortic stenosis (AS). We conducted a single-center, retrospective cohort study comprising 297 consecutive AS patients who underwent TAVI (mean age 83 ± 4 years; 69% female). Pre-existing AF was identified in 89 (30%) patients. Patients were stratified into two groups based on the presence or absence of AF, and propensity score matching (PSM) was employed, resulting in 68 matched pairs. The study endpoint was the incidence of net adverse clinical events (NACE) and all-cause mortality. NACE was defined as a composite of all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke, systemic thromboembolism, valve thrombosis, and major bleeding events. These clinical outcomes were analyzed according to the presence and subtype of pre-existing AF and further stratified across body mass index (BMI) categories. To further assess the combined impact of AF and BMI, patients were additionally categorized into four groups according to the presence or absence of AF and low BMI (< 18.5 kg/m²), and multivariable Cox regression analysis was performed across these groups. The median duration of follow-up was 2.3 [1.0-3.7] years. While baseline characteristics, including age and gender, were comparable between groups, patients with pre-existing AF exhibited a higher prevalence of prior heart failure hospitalizations and reduced renal function. There were no statistically significant differences in the incidence of NACE and all-cause mortality between the AF and non-AF groups, both before and after PSM. However, among patients with AF, those with a low BMI < 18.5 kg/m² experienced a significantly higher rate of adverse clinical events compared to those with normal or high BMI. This was supported by multivariable analysis. Although preprocedural AF was not independently associated with adverse clinical outcomes following TAVI, the coexistence of AF and low BMI was linked to significantly worse prognosis. These findings suggest a potential synergistic effect warranting further investigation and individualized risk stratification.

As Japan becomes an aging society, the number of patients with heart failure (HF) is increasing. The European Society of Cardiology guidelines recommend noninvasive ICT monitoring from the perspective of self-care and team medical care; however, evidence regarding the effectiveness of remote monitoring in Japan is limited. This study assessed the usefulness of OMRON Connect with the Health Data Monitoring System, which provides simultaneous sharing of biomonitoring data of patients with HF using wireless devices. A prospective, single-arm, multicenter observational study for 84 days was performed, including 30 patients with HF (age 72 ± 5.6 years, male, n = 19). They were introduced to the measurement of body weight (BW), blood pressure (BP), electrocardiogram (ECG) recording, and patient-reported symptoms on a smartphone application (PRS on App) using OMRON Connect. The primary outcome was adherence to this system, and the secondary outcome included factors that influence adherence. The adherence measurements were as follows: BW, 97.0% (interquartile range [IQR] 92.3-100%); BP, 88.7% (IQR, 79.8-95.8%); and ECG, 88.7% (IQR, 64.9-94.1%). No patients dropped out during the 84-day period. No significant relationship was found between adherence and the following parameters: age, sex, prior HF admission, left ventricular ejection fraction, New York Heart Association class, serum brain natriuretic peptide level, renal function, cognitive impairment, and living alone or with family. However, the continuation rate of PRS on App gradually decreased to 53%. One of the patients was admitted for HF exacerbation, and this system could clearly detect BW increase before admission. In addition, fatal arrhythmias, such as a short run of premature ventricular contractions or advanced atrioventricular block, could be detected in ECG. The use of OMRON Connect for noninvasive ICT monitoring in patients with HF demonstrates good adherence in checking BP, BW change, and ECG changes. This method proves to be feasible for patient self-management and facilitates appropriate clinical intervention.

We aimed to examine the impact of coronary inflammation, coronary microvascular dysfunction (CMD), and coronary artery spasm (CAS) on cardiac remodeling and dysfunction in patients suspected of angina with non-obstructive coronary artery disease (ANOCA). This retrospective single-center study included consecutive patients who underwent coronary spasm provocation testing between July 2020 and January 2025 for suspected ANOCA without prior revascularization and coronary stenosis ≥ 75%. Those who underwent coronary angiography after September 2022 also underwent invasive coronary physiology studies to diagnose structural CMD. PCAT attenuation (PCATA), reflecting coronary inflammation, was measured from prior coronary CT angiography, while strain analyses were obtained from prior echocardiography. Regression models were established between echocardiographic parameters and each of PCATA, CMD, and CAS. 257 patients (mean age, 64.2 ± 12.2 years; male, 62.1%) were included in the analysis. Multivariable regression analyses including PCATA, CMD, and CAS demonstrated that higher PCATA was associated with higher left ventricular mass index (β = 0.25, p = 0.007), reduced left ventricular ejection fraction (β = -0.21, p = 0.01), and impaired right ventricular four-chamber strain (β = 0.21, p = 0.04). CMD was independently associated with higher left atrial volume index (β = 0.67, p = 0.002) and impaired left atrial contraction strain (β = 5.31, p = 0.009). CAS showed no correlation with these parameters. Our study demonstrated a significant association between PCATA and left ventricular remodeling and dysfunction independent of CMD. It also revealed a direct relationship between CMD and left atrial remodeling and dysfunction.

Advances in interventional cardiology have increased procedural complexity, raising concerns about radiation exposure-especially for women operators of reproductive age, who are subject to stricter dose limits. Standard dosimeters provide only delayed cumulative data, limiting timely risk assessment. Real-time personal dosimetry offers immediate feedback, but its clinical utility during catheter ablation (CA) remains underexplored. We retrospectively analyzed 82 CA procedures performed between January and May 2024. First operators wore real-time dosimeters positioned at the waist under lead aprons. Radiation exposure and procedural characteristics were recorded and analyzed. The median operator radiation dose per procedure was 2 [1, 3] µSv, while the median patient dose was 0.163 [0.082, 0.324] Gy. A procedure-related cardiac tamponade requiring pericardiocentesis resulted in the highest operator dose (50 µSv). Higher patient BMI (≥ 25 kg/m²) and longer fluoroscopy time were independently associated with increased operator exposure (OR: 1.238, P = 0.008; OR: 1.056, P = 0.022), though no linear correlation was observed between BMI and operator dose (r = 0.029, P = 0.797). Radiation exposure to operators during CA is generally low but may increase significantly in the event of complications or with higher-risk patient characteristics. Real-time dosimetry provides valuable immediate feedback and may be especially important for radiation-sensitive operators, supporting safer practice in the evolving field of interventional electrophysiology.

Transcatheter aortic valve implantation (TAVI) has become available for elderly patients with aortic stenosis (AS). However, no markers have been established to predict prognosis after TAVI. Cardiac damage caused by AS progresses sequentially in most cases through the left ventricle, left atrium, and right ventricle. However, cardiac damage does not always progress sequentially. This study examined whether the burden of cardiac damage assessed by echocardiography predicts prognosis in patients with severe AS who underwent TAVI. We assessed patient data from a multicenter TAVI registry involving seven hospitals in Japan. Among 1,850 patients with severe AS, patients with preserved LV ejection fraction were included. We performed echocardiography before TAVI in 1,285 patients. The primary endpoint was cardiovascular (CV) events including CV deaths and rehospitalizations for heart failure. During a median follow-up of 741 days, 76 CV events occurred. A multivariate Cox-proportional hazards analysis revealed that four echocardiographic parameters, including tricuspid regurgitation pressure gradient, E/e', left atrial volume index, and left ventricular mass index were associated with CV events. We created a scoring system using these four echocardiographic parameters. The echocardiography-directed aortic stenosis score (EDA score) was computed by assigning one point each for the presence of abnormal parameters. The receiver operating characteristic curve of EDA score for CV events showed an area under the curve value of 0.74, a cutoff value of 3 points, a sensitivity value of 75%, and a specificity value of 63%. Kaplan-Meier analysis showed that CV event rates were significantly higher in patients with high EDA scores compared with those having low scores. Hazard ratio was 14.3-fold for the 3-point group and 26.6-fold for the 4-point group when compared with the 0-point group of patients. EDA score may be a feasible indicator for risk stratification in patients with severe AS who underwent TAVI.

Although surface electrocardiography (ECG) provides important information about the localization of atrial flutter (Afl), in cases where the p wave is unclear, it may not provide enough information about the ablation strategy and the procedure time may be prolonged. This study aimed to investigate the potential utility of crista terminalis double split signals in the differentiation of right- versus left-sided Afl in patients undergoing ablation therapy. In this retrospective study, symptomatic patients with Afl diagnosed by surface ECG and in whom no thrombus was detected by transesophageal echocardiography were enrolled. The decapolar catheter was placed into the crista terminalis and coronary sinus. The two most distant split signals were recorded as 'maximum interdeflection time' (MIT) in crista terminalis. The right or left atrium was mapped with 3-D system. 3-D mapping identified 112 patients with right Afl and 32 patients with left Afl. The right atrium was found to be significantly increased in patients with right Afl, whereas the left atrial diameter (LAD) was found to be significantly increased in patients with left Afl. The number of patients with coronary sinus activation sequence from proximal to distal, coronary sinus proximal to distal interval time and MIT were significantly increased in patients with right Afl. When patients with MIT > 80 ms and coronary sinus activation sequence from proximal to distal were taken together, it was found that the distinction between right and left atrial flutter was perfectly distinguished. In conclusion, MIT may serve as a valuable adjunctive parameter for distinguishing right- from left-sided Afl prior to 3-D mapping.