Heart and Vessels最新文献

Aortic stenosis (AS) is the most prevalent valvular disease in developed nations. Transcatheter Aortic Valve Replacement (TAVR) offers a minimally invasive alternative to Surgical Aortic Valve Replacement (SAVR), particularly for high-risk patients. However, TAVR adoption and outcomes in Japan remain understudied due to limited national database analyses and differences in patient demographics compared to major international trials. We conducted a retrospective cohort study of aortic valve replacement (AVR) procedures from 2014 to 2021 using the National Healthcare Reimbursement database. In total, 103,076 cases were analyzed, with 33,881 undergoing TAVR and 31,337 undergoing SAVR for aortic stenosis. TAVR patients were older (median age 85 vs. 76 years, p < 0.0001) and more often female (66.7% vs. 51.4%, p < 0.0001). TAVR was associated with lower in-hospital mortality (0.88% vs. 2.4%, p < 0.0001), shorter hospital stays (14 vs. 24 days, p < 0.0001), but significantly higher medical costs (¥5,303,722 vs. ¥3,945,622, p < 0.0001). Among patients younger than 75 years, no significant difference in mortality was observed. In this nationwide administrative database, TAVR was associated with lower in-hospital mortality and shorter hospital stays compared to SAVR, though at a higher cost. While patient backgrounds and clinical risks could not be fully adjusted due to data limitations, the observed differences in in-hospital outcomes between TAVR and SAVR reflect real-world practice patterns. These findings should be interpreted as descriptive, not causal. The absence of a mortality difference in patients under 75 years highlights the need for further evaluation of TAVR's long-term effectiveness and cost-efficiency in younger populations.

Reduced exercise capacity is a hallmark of heart failure with preserved ejection fraction (HFpEF), and this limitation is particularly pronounced in older patients with coexisting type 2 diabetes mellitus (T2DM), a high-risk population characterized by poor prognosis. Although previous studies have demonstrated that exercise training (ET) can improve exercise capacity in patients with HFpEF, its efficacy in older patients with coexisting HFpEF and T2DM remains unclear. Therefore, we evaluated the effects of ET on peak oxygen uptake (peakVO₂) and 6-min walk distance (6MWD) in older patients with HFpEF and investigated whether these effects differ based on T2DM status. A total of 99 stable outpatients with HFpEF aged 65 to 80 years were enrolled. Participants were classified into four groups based on T2DM and ET status: T2DM-ET (n = 25), non-T2DM-ET (n = 24), T2DM-usual-care (UC; n = 26), and non-T2DM-UC (n = 24). PeakVO₂ and hemodynamic responses during exercise were assessed using cardiopulmonary exercise testing and impedance cardiography. Additionally, walking distance, cadence, step length, and metabolic cost were assessed during the 6-min walk test. The interaction between T2DM and ET on changes in these parameters was analyzed using multivariable-adjusted linear regression. ET significantly improved peakVO₂ after 5 months; however, the magnitude of improvement was attenuated in the T2DM group (0.5 mL/kg/min) compared with that in the non-T2DM group (1.9 mL/kg/min; p < 0.001). This difference was primarily attributable to a blunted increase in arteriovenous oxygen difference, which increased by only 0.2 mL/100 mL in the T2DM group vs. 0.4 mL/100 mL in the non-T2DM group (p < 0.001). In contrast, improvements in 6MWD were similar between the groups (29 vs. 31 m; p = 0.651). Step length remained unchanged, whereas cadence increased in the T2DM and non-T2DM groups (11 vs. 8 steps/min, respectively), accompanied by a reduction in metabolic cost (- 0.06 vs. - 0.04 mL/kg/m), indicating enhanced walking efficiency regardless of T2DM status. Although T2DM attenuated improvements in peakVO₂, the walking efficiency and functional capacity improved with ET regardless of T2DM status. These findings highlight the potential value of ET in older patients with HFpEF, irrespective of T2DM status. This trial was registered with the University Hospital Medical Information Network, Japan (registration number: UMIN000045474; registration date: September 13th, 2021).

Objective: This study aimed to explore the short-term predictive value of the estimated glucose disposal rate (eGDR) for rehospitalization or death in elderly patients with acute decompensated heart failure (ADHF).

Methods: 117 elderly patients with ADHF admitted to our hospital from January 2020 to January 2022 were recruited and divided into control (80 cases) and event (37 cases) groups based on whether they were rehospitalized or died within 90 days following discharge. Basic information, clinical characteristics, and laboratory test results of them were collected, and the eGDR was calculated. Multivariate logistic regression analysis identified the independent factors associated with the short-term prognosis, and receiver operating characteristic (ROC) curves assessed the predictive value of eGDR.

Results: The event group had significantly higher rates of comorbid diabetes (DM), hypertension, Class IV heart failure, and cardiogenic shock, as well as a larger waist circumference, higher peak troponin I during hospitalization, greater glycated hemoglobin (HbA1c) and fasting blood glucose (FBG), and lower eGDR values compared to the control group (P < 0.05). Multivariate logistic regression showed that comorbid hypertension, DM, Class IV cardiac function, cardiogenic shock, FBG, HbA1c, and eGDR were independent factors associated with poor short-term prognosis in elderly patients with ADHF (P < 0.05). ROC curve analysis showed that the area under the curve for eGDR in predicting poor short-term prognosis was 0.84 (P = 0.04), with an optimal cutoff value of 5.31, a sensitivity of 83.8%, and a specificity of 70.1%. Patients with eGDR < 5.31 had a significantly higher incidence of rehospitalization or death within 90 days compared to those with higher eGDR (52.0% vs. 16.5%, P < 0.001).

Conclusion: eGDR is an independent predictor of poor short-term prognosis in elderly patients with ADHF: a low eGDR was associated with a higher risk of rehospitalization and death within 90 days.

Background: Anthracyclines are known to exhibit dose-dependent cardiotoxicity, leading to cancer therapy-related cardiac dysfunction (CTRCD). The significance of routine global longitudinal strain (GLS) measurements remains uncertain in patients at low or moderate risk for cardiotoxicity. This study aimed to investigate the appropriateness of the contemporary CTRCD surveillance strategy in this population.

Methods: We prospectively enrolled women with breast cancer undergoing anthracycline-based chemotherapy at Keio University Hospital from April 2018 to November 2023. Cardiotoxicity risk was assessed using the Heart Failure Association-International Cardio-Oncology Society (HFA-ICOS) tool. GLS was measured by echocardiography at baseline (T0), completion of anthracyclines (T1), and 6 months (T2) and 12 months (T3) after initiating chemotherapy. CTRCD was defined as a > 15% relative decline in GLS from baseline. Repeated GLS measurements were analyzed using linear mixed models with post-hoc Tukey testing.

Results: Fifty-eight patients (mean age 53.8 ± 9.3 years) were included, with 53 (91.3%) classified as low or moderate risk. GLS significantly declined at T2 and returned toward baseline at T3. GLS-based CTRCD was observed in 4 (6.9%), 14 (24.1%), and 4 (6.9%) patients at T1, T2, and T3, respectively. The majority of CTRCD cases showed spontaneous recovery by T3. Persistent CTRCD at T3 was limited to a small number of patients and was significantly associated with higher high-sensitivity cardiac troponin T levels at T1 (area under curve = 0.836; 95% CI, 0.674-0.997), with a Youden index-derived cutoff of 0.016 ng/mL by receiver operating characteristic analysis.

Conclusions: In breast cancer patients with low to moderate cardiotoxicity risk, early GLS decline following anthracycline exposure was mostly transient. These findings support current surveillance recommendations and suggest a potential role for troponin in identifying patients at risk for persistent dysfunction.

This study aimed to evaluate the clinical utility of a novel mitral valve repair technique, the Referring to the Anterior, Fixing on the Frontal (RAFF) method, which improves anatomical precision and enhances the reproducibility of loop-type artificial chordae ("neochordae") reconstruction. This retrospective study included 67 individuals who underwent isolated, elective mitral valve repair with neochordae between 2019 and 2024. Participants were divided into the RAFF (n = 36) and non-RAFF (n = 31) groups. In the RAFF technique, chordal length is determined by referencing the anterior leaflet chordae from the ipsilateral papillary muscle, with loop sets anchored to the frontal head of the papillary muscle. Leaflet resection was not performed in any case. Baseline demographics and lesion characteristics were similar between groups. The RAFF group demonstrated significantly less residual mitral regurgitation at the conclusion of surgery (p = 0.014). Use of the RAFF method was significantly associated with suppression of postoperative leaflet billowing and a lower recurrence rate of moderate or greater mitral regurgitation during follow-up. Frontal fixation of posterior leaflet neochordae, a defining feature of the technique, resulted in a significant increase in coaptation length without inducing systolic anterior motion or elevating transvalvular gradients. The method also significantly reduced aortic cross-clamp time without compromising hemodynamic performance. The RAFF technique offers a standardized and anatomically guided approach to neochordae reconstruction. It minimizes inter-surgeon variability and anatomical inconsistencies, and promotes durable mitral competence by optimizing leaflet coaptation without incurring adverse events.

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.