Heart and Vessels最新文献

The relationship between post-ablation excessive supraventricular ectopic activity (ESVEA), a new marker for new-onset atrial fibrillation (AF), and late AF recurrence is uncertain. We enrolled 469 patients with AF who underwent initial radiofrequency catheter ablation and 24-h Holter monitoring the day after. Early AF recurrence (n = 57; 12%) and ESVEA (n = 242; 52%) were noted. During a median follow-up of 25 months, 152 (32%) patients experienced late AF recurrence. Patients with early AF recurrence or ESVEA were significantly more likely to experience late recurrence (p = 0.02). Even without AF, ESVEA was associated with late recurrence following AF ablation.

Acute myocardial infarction-associated cardiogenic shock (AMICS) remains a condition with high mortality. Some patients require mechanical circulatory support (MCS) as their condition deteriorates. Sex-specific differences in risk factors and outcomes of cardiovascular disease have previously been described but are inconclusive regarding the use of MCS in AMICS. We aimed to investigate these with a focus on long-term outcomes. Health claim data from AOK - Die Gesundheitskasse (local health care funds) for patients hospitalized with AMICS between January 1, 2014, and December 31, 2015, was descriptively analyzed. Then, a Cox proportional hazards model was used to adjust for confounders. We analyzed 10,023 patients, of which 477 (4.8%) were treated with veno-arterial extra-corporeal membrane oxygenation (V-A ECMO). In-hospital mortality was high, but similar between treatments (V-A ECMO 59.1%, no V-A ECMO 56.6%). Women had a higher median age (78.9 years, IQR 13.8 vs. 71.8 years, IQR 17.9; p < 0.001), a different cardiovascular risk profile and in the conservatively treated patients underwent revascularization less often (69.2% vs. 77.1%; p < 0.001) than men did. In a multivariate analysis, female sex was not associated with lower survival (HR 1.03, CI 0.98-1.09; p = 0.233). V-A ECMO, however, was associated with lower survival in both sexes. We observed a low overall survival in follow-up after three years (no V-A ECMO: men 28.9% vs. women 21.7%, V-A ECMO: men 18.2% vs. women 17.0%). In conclusion, women with AMICS presented with a different risk profile, especially a higher age, and underwent guideline-recommended therapies such as revascularization less often than men. Female sex, however, was not associated with lower survival in a multivariate analysis. In-hospital mortality was high, regardless of treatment, and V-A ECMO was associated with lower survival in follow-up.

Ballistocardiogram (BCG) captures minute vibrations generated by heart movements. These vibrations are converted into heart rate variability (HRV) indices, allowing their unobtrusive monitoring over extended periods, while reducing the burden on patients or subjects. In this study, to evaluate the agreement between the HRV indices, we compared the HRV indices estimated from the BCG device with those obtained from the gold standard electrocardiogram (ECG). Twenty-five healthy volunteers (mean age: 40.6 ± 12.8 years; 14 males and 11 females) rested in the supine position on a bed with a BCG device placed under a pillow while ECG electrodes were attached. BCG and ECG measurements were simultaneously recorded for 20 min. Five min of time-series data for the JJ and RR intervals obtained from BCG and ECG were converted into HRV indices. These indices included the time-domain measures (mean inter-beat intervals [IBIs], standard deviation of normal-to-normal intervals [SDNN], root mean square of successive differences [RMSSD], and percent of difference between adjacent normal RR intervals greater than 50 ms [pNN50]) and frequency-domain measures (normalized low-frequency [LF], high-frequency power [HF], and LF/HF ratio). Of the 25 individuals, data of 22 (mean age: 38.9 ± 12.3 years; 13 males and 9 females) were used to assess the agreement between the two methods, excluding 3 (1 male and 2 females) with frequent premature ventricular contractions observed on ECG. Correlations between measurements were examined using scatter plots and Pearson's product-moment correlation coefficients; in contrast, differences between measurements were evaluated using paired t-tests. The Bland-Altman analysis was used to assess the agreement. For the mean IBIs, the correlation coefficient was 0.999 (p < 0.001), and the limits of agreement ranged from - 8.35 to 11.70, with no evidence of fixed bias (p = 0.139) or proportional bias (p = 0.402), indicating excellent agreement. In contrast, the correlation coefficients for SDNN, RMSSD, and pNN50 were 0.931 (p < 0.001), 0.923 (p < 0.001), and 0.964 (p < 0.001), respectively, showing high correlations. However, a fixed bias was observed in RMSSD (p = 0.007) and pNN50 (p = 0.010), and a proportional bias in SDNN (p = 0.002). The correlation coefficients for LF, HF, and LF/HF ratio were approximately 0.7, indicating lower agreement owing to observed fixed and proportional biases. These results indicate that, while the degree of agreement varies among HRV indices, the JJ intervals measured from BCG can be used as a suitable alternative to the RR intervals from ECG.

Undernutrition has been identified as a poor prognostic factor in heart failure with preserved ejection fraction (HFpEF). This study aimed to evaluate the impact of changes in nutritional status from discharge to one year post-discharge on the prognosis of patients with HFpEF. Initially, 547 HFpEF cases were classified into a normal nutrition group (NN) (n = 130) and an undernutrition group (UN) (n = 417), according to Controlling Nutritional Status (CONUT) scores at discharge. These groups were further subdivided according to CONUT scores one year post-discharge into NN (G1, n = 88) and UN (G2, n = 42), and NN (G3, n = 147) and UN (G4, n = 270), respectively. The primary end point was defined as a composite of all-cause mortality or heart failure readmission after the visit one year post-discharge. Normal nutrition was defined as a CONUT score of 0 or 1, and undernutrition as a CONUT score of ≥ 2. We compared the incidence rates of the primary end point between G1 and G2, and G3 and G4, and identified predictors for abnormalization or normalization of CONUT score one year post-discharge, as well as covarying factors with change in CONUT. In a multivariable Cox proportional hazards model, abnormalization of CONUT score was associated with an increased risk of the primary end point (adjusted HR [hazard ratio]: 2.87, 95% CI [confidence interval]: 1.32-6.22, p = 0.008), while normalization of CONUT was associated with a reduced risk (adjusted HR: 0.40, 95% CI: 0.23-0.67, p < 0.001). In a multivariate logistic regression analysis of patients with normal nutrition at discharge, the Euro Qol 5 Dimension score was identified as an independent predictor for abnormalization of CONUT score one year post-discharge (OR: 0.06, 95% CI: 0.01-0.43, p = 0.023). Among patients with undernutrition at discharge, prior heart failure hospitalization was the independent predictor for normalization of CONUT score (OR: 0.36, 95% CI: 0.20-0.66, p < 0.001). In a multivariate linear regression analysis, independent covariates associated with changes in CONUT included hemoglobin (β = - 0.297, p < 0.001), C-reactive protein (β = 0.349, p < 0.001), and log NT-proBNP (β = 0.142, p < 0.001). Post-discharge abnormalization or normalization of CONUT scores has prognostic impact on patients with HFpEF. Changes in CONUT may independently correlate with changes in hematopoiesis, inflammation, and fluid retention.

It is unclear how pulmonary veins (PVs) maintain paroxysmal atrial fibrillation (AF). To clarify the PV's arrhythmogenic role, we examined PV activation sequences during paroxysmal AF. Left superior PV (LSPV) endocardial non-contact mapping was performed after a right PV isolation in 13 paroxysmal AF patients. Activation sequences within the LSPV before and during left-sided PVs ablation were analyzed, and those in complex fractionated atrial electrogram (CFAE) areas were compared with those in non-CFAE areas. CFAEs were observed in the LSPV's proximal half (area; 8.8 ± 3.2cm²) occupying 19.9 ± 6.0% of LSPV. The number of pivoting activations, wave breaks, and fusions over CFAE areas were significantly higher than those over non-CFE areas (25.5 ± 9.3 vs. 4.5 ± 4.8 times/s, p < 0.0001; 9.1 ± 5.3 vs. 1.4 ± 1.8 times/s, p < 0.0001; 13.0 ± 4.6 vs. 5.4 ± 4.4 times/s, p < 0.0001). The conduction velocities in CFAE areas were significantly slower than in non-CFAE areas (0.6 ± 0.2 vs. 1.7 ± 0.8 m/s, p < 0.001). After delivery of ablation lesions around the left-sided PVs (13.2 ± 7.4 applications), the PV activation became organized with a loss of CFAE areas, and the frequency of the LSPV's pivoting activation, wave break, and fusion significantly decreased compared to that pre-ablation (7.3 ± 10.9 vs. 30.0 ± 11.6 times/s, p < 0.001; 2.1 ± 5.3 vs. 10.5 ± 6.2 times/s, p < 0.002; 6.0 ± 6.6 vs. 18.4 ± 8.2 times/s, p < 0.001). Subsequently, AF terminated before the left-sided PV isolation in all patients. In conclusion, high-frequency random reentry associated with pivoting activation, wave break, and fusion within the LSPV, observed mostly over CFAE areas, maintained AF. Linear ablation lesions around the PV suppressed random reentry, resulting in the loss of CFAEs and AF termination.

In April 2020, the Japanese Circulation Society updated guidelines recommending shortened dual antiplatelet therapy (DAPT) for patients at Japanese Version of the High Bleeding Risk (J-HBR), but the impact remains unclear. We conducted a prospective multicenter registry (SAKURA PCI2 Antithrombotic Registry) starting June 2020 (n = 1136), enrolling patients who underwent percutaneous coronary intervention (PCI). Planned DAPT duration, defined as short if less than 3 months, was based on patient background post-PCI and physicians' discretion. Planned short DAPT was used in 55.2% of patients, with a similar incidence of J-HBR (68.3% vs. 66.6%, p = 0.55) and a shorter actual DAPT duration (97 vs. 229 days, p < 0.001) compared with Planned non-short DAPT. Primary endpoints, major adverse cardiovascular and cerebrovascular events (MACCE) including all-cause death, non-fatal myocardial infarction, stent thrombosis, and stroke, and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding (BARC-3/5), occurred similarly across groups (MACCE: 6.5% vs. 7.3%, p = 0.66; BARC-3/5: 3.7% vs. 2.2%, p = 0.14). Independent predictors of MACCE included age ≥ 75, Clinical Frailty Scale ≥ 4, and hemoglobin < 11. Age ≥ 75, severe chronic kidney disease, hemoglobin < 11, and platelets < 100,000 were linked to BARC-3/5. Among BARC 3/5 patients, 41.2% experienced bleeding after switching to single antiplatelet therapy. Planned short DAPT was implemented in 55.2% of patients, showing comparable thrombotic and bleeding outcomes to non-short DAPT.

Urgent revascularization should be performed to patients with acute limb ischemia (ALI) unless the ischemia is irreversible. In patients with severe ALI and multiple morbidities, surgical revascularization is not feasible; however, endovascular revascularization (EVR) may be an option. This study aimed to examine 1-year clinical outcomes of EVR in patients with ALI and determine prognostic factors. We retrospectively examined 90 EVR procedures performed in 81 patients with ALI between January 2018 and February 2024. The primary endpoint was 1-year amputation-free survival (AFS). Multivariable logistic regression was performed to identify predictors of 1-year AFS. Fifty-one procedures were performed for severe ALI (56.7%). Fifty-six patient were ambulatory at the time of procedures (62.2%). The 1-year AFS rate was 59.7%. Multivariable analysis revealed that hypertension (adjusted hazard ratio [aHR] 0.14; 95% confidence interval [CI], 0.05-0.47; P = 0.0007), presence of blood flow of both tibial arteries after EVR (aHR 0.19; 95% CI, 0.03-0.93; P = 0.04), and presence of arterial flow below the ankle after EVR (aHR 0.29; 95% CI, 0.09-0.84; P = 0.022) were independently associated with a higher AFS rate. Aortic plaque was independently associated with a lower AFS rate (aHR 3.98; 95% CI, 1.55-9.90; P = 0.048). EVR may be an acceptable treatment of ALI even in non-ambulatory patients and those with severe ALI. Achieving adequate blood flow of both tibial arteries and below the ankle by performing EVR may be important for improving patient outcomes.

We investigated the prognostic value of cardiac myosin-binding protein C (cMyC), a novel cardiospecific marker, both independently and in combination with N-terminal pro-B-type natriuretic peptide (NT-proBNP), for predicting 6-month all-cause mortality in patients without acute coronary syndrome (ACS) treated at medical (nonsurgical) cardiac intensive care units (CICUs). Admission levels of cMyC, high-sensitivity cardiac troponin T (hs-cTnT), and NT-proBNP were measured in 1032 consecutive patients (mean age; 70 years) without ACS hospitalized acutely in medical CICUs for the treatment of cardiovascular disease. Serum cMyC was closely correlated with hs-cTnT and moderately with NT-proBNP (r = 0.92 and r = 0.49, respectively, p < 0.0001). During the 6-month follow-up period after admission, there were 109 (10.6%) all-cause deaths, including 72 cardiovascular deaths. Both cMyC and NT-proBNP were independent predictors of 6-month all-cause mortality (all p < 0.05). Combining cMyC and NT-proBNP with a baseline model of established risk factors improved patient classification and discrimination beyond any single biomarker (all p < 0.05) or the baseline model alone (both p < 0.0001). Moreover, patients were divided into nine groups using cMyC and NT-proBNP tertiles, and the adjusted hazard ratio (95% confidence interval) for 6-month all-cause mortality in patients with both biomarkers in the highest vs. lowest tertile was 9.67 (2.65-35.2). When cMyC was replaced with hs-cTnT, similar results were observed for hs-cTnT. In addition, the C-indices for addition of cMyC or hs-cTnT to the baseline model were similar (0.798 vs. 0.800, p = 0.94). In conclusion, similar to hs-cTnT, cMyC at admission may be a potent, independent predictor of 6-month all-cause mortality in patients without ACS treated at medical CICUs, and their prognostic abilities may be comparable. Combining cMyC or hs-cTnT with NT-proBNP may substantially improve early risk stratification of this population.

Aerobic exercise habits have shown promising potential in reducing inflammation. Several studies have suggested that a higher albumin-globulin ratio (AGR), a key indicator of the immune-inflammatory response, could potentially suppress the progression of atherosclerosis. In this study, we investigated the relationship between aerobic exercise and atherosclerotic cardiovascular disease (ASCVD) predictors, specifically, AGR and cellular immune-inflammatory markers. We conducted a cross-sectional study involving 8381 participants (average age, 46.7 ± 13.0 years; 59% men) with no history of ASCVD registered at the Health Planning Center, Nihon University Hospital between 2019 and 2020. We defined aerobic exercise habits as 30 min of sweating at least twice a week for over a year, per the guideline for conducting specific health examinations according to Japan's Ministry of Health, Labour and Welfare. Participants who engaged in habitual aerobic exercise (n = 2159) had a significantly higher AGR than those who did not (n = 6220) [1.70 (1.55/1.86) vs. 1.67 (1.53/1.84), P < 0.0001]. Cellular immune-inflammatory markers, including neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and systemic immune-inflammation index (neutrophil/lymphocyte × platelet count), were significantly lower in participants who engaged in habitual aerobic exercise than in those who did not (all P < 0.0001). Furthermore, lower cellular immune-inflammatory markers were associated with a higher AGR. Causal mediation analysis revealed that cellular immune-inflammatory markers partially mediated the association between aerobic exercise and AGR. In conclusion, aerobic exercise habits may be associated with a higher AGR and lower cellular immune-inflammatory markers. Moreover, the lower immune-inflammatory response related to aerobic exercise may partially mediate the higher AGR. These associations may explain the attenuating effects of aerobic exercise on the risk of ASCVD.