Heart and Vessels最新文献

Abdominal visceral adipose tissue (AVAT) is associated with the incidence of cardiovascular events (CVEs). We retrospectively evaluated the association between AVAT and the incidence of CVEs in 602 patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Patients were divided into four groups according to the quartiles of AVAT areas using computed tomography. The incidence of CVEs (cardiovascular death, ACS recurrence and stroke) during the follow-up period (median 49.5 months) was evaluated. Cox analysis adjusting for cardiovascular risk factors revealed that the AVAT quartile classification exhibited a significant association with the incidence of CVEs. The risk in quartile 3 (moderate AVAT areas, ≥ 106.0 to < 142.6 cm²) was significantly lower than in quartiles 1 (low AVAT areas, < 71.0cm²; P < 0.01; hazard ratio [HR], 5.06), 2 (mild AVAT areas, ≥ 71.0 to < 106.0 cm²; P < 0.01; HR, 4.25) and 4 (severe AVAT areas, ≥ 142.6 cm²; P < 0.01; HR, 4.52). Polynomial analyses revealed that quadratic model was the most appropriate to illustrate the relationship between AVAT area and the hazard ratios for CVEs (corrected Akaike's information criterion, 49.2; R², 0.47). The AVAT area and the incidence of CVEs exhibited a U-shaped relationship in patients with ACS undergoing PCI independent of conventional cardiovascular risk factors. The risk of CVEs was the lowest in patients with moderate AVAT areas. Evaluating AVAT may provide additional information for the assessment of long-term prognosis in patients with ACS.

Coronary embolism (CE) is an uncommon cause of acute myocardial infarction (AMI), representing around 3% of cases. Left atrial strain (LAS) has emerged as a promising tool for assessing atrial function, however its prognosis role in CE remains unsettled. We retrospectively analyzed 100 consecutive patients with CE that was diagnosed based on criteria encompassing clinical, angiographic and diagnostic imaging findings. We evaluated in-hospital and long-term outcomes. Among the 100 patients, 28 experienced adverse in-hospital events. In the univariate analysis, lower estimated glomerular filtration rate, peak troponin I, lower LAS reservoir, atrial fibrillation (AF), right ventricular dysfunction (RVD), mitral regurgitation and reduced left ventricular ejection fraction were associated with in-hospital events. Multivariate analysis confirmed reduced LAS reservoir (OR 0.88, 95%CI 0.81-0.95; p = 0.03), AF (OR 15, 95%CI 1.4-168; p = 0.02), and RVD (OR 18, 95% CI 1.2-275; p = 0.04) as independent predictors of adverse in-hospital outcomes. After a median follow-up of 26 months, 21 patients (23%) experienced adverse long-term events. In the univariate analysis chronic kidney disease, STEMI presentation, RVD and lower LAS reservoir were associated with worse long-term outcomes. In multivariate analysis, reduced LAS reservoir (HR 0.9 (95%CI 0.84-0.98; p = 0.02)) remained a significant predictor of long-term adverse outcomes. On the log-rank test using the discriminatory cutoff value of LASr < 17.5%, LASr was associated with higher risk of long-term outcomes (p < 0.001). Reduced LAS is associated with worse in-hospital and long-term outcomes in patients with CE. These findings highlight the potential role of LAS as a valuable prognostic tool in CE.

The impact of mid-range (mr) ejection fraction (EF) on long-term clinical outcomes has been reported in patients with heart failure but remains unclear in patients with ST-segment elevation myocardial infarction (STEMI). The purpose of this study was to compare the long-term clinical outcomes among STEMI patients with preserved EF (pEF), mrEF, and reduced EF (rEF), and to evaluate the significance of mrEF as a prognostic factor for patients with STEMI. We included 705 patients with STEMI and divided them into rEF group (n = 155), mrEF group (n = 155), and pEF group (n = 395) according to the pre-discharge EF. The primary endpoint was the major adverse cardiovascular events (MACE), which were defined as the composite of all-cause death, re-admission for heart failure, and non-fatal myocardial infarction (MI). The median follow-up duration was 906 days (Q1:349.5-Q3:1479). The Kaplan-Meier curves showed that MACE and re-admission for heart failure were more frequently observed in the rEF group, followed by the mrEF group, and least in the pEF group (p < 0.001). The multivariate Cox hazard analysis revealed that mrEF as well as rEF were significantly associated with MACE after controlling for confounding factors [rEF: hazard ratio (HR) 2.333, 95% confidence interval (CI) 1.350-4.034, p = 0.002, mrEF:HR1.852, 95%CI 1.139-3.010, p = 0.013]. Mid-range EF as well as rEF was significantly associated with MACE and re-admission for heart failure in patients with STEMI. Our results suggest that mrEF is an important prognostic factor in patients with STEMI.

Purpose: To evaluate the peri-procedural and 6-month outcomes of the Jetstream rotational atherectomy system in treating severely calcified femoropopliteal lesions in a Japanese population under postmarketing surveillance (PMS).

Materials and methods: This prospective observational PMS included 154 patients (161 procedures) treated at 20 Japanese centers between September 2022 and March 2023. Eligible lesions were ≥ 70% stenosed and severely calcified. Procedural success was defined as no bailout stenting or bypass. Lesion success required ≤ 30% residual stenosis, no Grade C or higher dissection, no perforation requiring treatment, and no significant flow reduction. Six-month follow-up included duplex ultrasound, Ankle-Brachial Index, and Rutherford category assessment.

Results: Patients had a mean age of 74.3 years; 74.7% had diabetes while 44.8% were currently on dialysis. Most lesions were in the superficial femoral artery with a mean length of 80.0 mm. Lesions were severely calcified (99.4%), and 33.3% of patients had chronic limb threatening ischemia at baseline. Procedural and lesion success rates were 98.8% and 96.6%, respectively. Distal embolization occurred in 5.8% of procedures. At 6 months, primary patency was 87.5%, freedom from TLR was 98.8%, and 87.1% of patients showed hemodynamic improvement without reintervention. All-cause mortality was 7.8% at 6-months post procedure.

Conclusion: The Jetstream atherectomy system demonstrated high procedural and lesion success with acceptable complication rates in complex, calcified femoropopliteal lesions. These findings support its use in combination with drug-coated balloons in real-world Japanese clinical practice.

Level of evidence: Level 3a, Nonrandomized postmarket surveillance.

Accurate assessment of pulmonary congestion is essential for managing heart failure but remains challenging using conventional clinical methods. The Remote Dielectric Sensing (ReDS) system provides a non-invasive, objective measurement of lung fluid content. However, its high cost raises the question of whether clinicians can estimate congestion with similar accuracy without referencing such a technology. In this prospective study, 26 hospitalized patients with cardiovascular disease underwent ReDS measurement. A total of 112 ReDS value estimations were obtained from junior and senior clinicians, who were blinded to the actual values and estimated lung fluid content using routine clinical data. Estimation accuracy was evaluated using correlation analysis, Bland-Altman plots, and subgroup comparisons based on ReDS severity and clinician experience. Estimated and measured ReDS values showed a moderate correlation (R = 0.70, p < 0.001). However, more than 50% of estimations exhibited discrepancies of ≥  ± 3%, particularly in cases of mild congestion. Underestimation occurred in over 60% of cases and was more pronounced among senior clinicians. A regression formula incorporating estimated ReDS and B-type natriuretic peptide improved prediction accuracy (R = 0.78, p < 0.001). Clinicians frequently underestimate pulmonary congestion, especially when it is mild. This may lead to suboptimal diuretic management. The ReDS system can serve as a valuable adjunct to conventional assessment, particularly in less overt cases, and may enhance both diagnostic precision and therapeutic decision-making.

Background: Drug-coated balloons (DCBs) are increasingly being used to treat superficial femoral artery (SFA) lesions during endovascular therapy (EVT). However, the evaluation of paclitaxel distribution following DCB treatment remains challenging. This study aimed to develop a novel criterion to systematically semi-quantitatively grade the degree of paclitaxel distribution using nonobstructive general angioscopy and analyze the clinical factors affecting this criterion.

Method and results: This study included 18 patients (20 limbs) who underwent EVT for SFA lesions using DCBs. Angioscopic observation of the vessel surface was performed before and after DCB treatment. The amount of paclitaxel distribution was systematically graded using the novel surface observation by nonobstructive general angioscopy of wall drug-distribution (SNOW) grade. Clinical factors were statistically analyzed to determine their relationship with the SNOW grade. Paclitaxel particles were observed on vessel walls after DCB treatment in all patients. A significant relationship was found between the DCB diameter and reference vessel and lumen diameter, measured by intravascular ultrasound; specifically, a same DCB-to-vessel ratio was associated with greater drug distribution.

Conclusions: The SNOW grading system was successfully developed for systematic evaluation of paclitaxel distribution. Our findings suggest that appropriate DCB sizing is essential for adequate drug application, highlighting that an undersized DCB may provide insufficient coverage. Therefore, a careful DCB selection that balances optimal drug delivery with the imperative to avoid vessel injury is crucial.

This study aimed to clarify the contributions of dispersive electrode configuration, extracardiac impedance, and blood pool impedance to generator impedance (GI). Forty-five patients who underwent catheter ablation with Intellanav Stablepoint™ catheter were included. Four dispersive electrode positions were tested: the left hip, lower back, middle back, and upper back. For each dispersive electrode position, GI in the blood pool (BP-GI) and GI during contact with the myocardium of the left atrial anterior wall (Myo-GI) were measured at 46 kHz in standby mode. Body mass index (BMI) and hematocrit served as surrogates for extracardiac and blood pool impedance, respectively. The lowest BP-GI and Myo-GI were observed with the middle back dispersive electrode (BP-GI: 119 ± 13 Ω; Myo-GI: 123 ± 13 Ω), followed by the upper back (122 ± 13 Ω; 126 ± 13 Ω), lower back (126 ± 14 Ω; 129 ± 14 Ω), and the left hip dispersive electrode (153 ± 15 Ω; 156 ± 14 Ω). With the middle back dispersive electrode, BMI and hematocrit predicted BP-GI and Myo-GI with acceptable accuracy (adjusted R² = 0.78 and 0.55, respectively). The standardized beta coefficients of BMI and hematocrit were 0.38 and 0.70 for BP-GI and 0.37 and 0.54 for Myo-GI, respectively. The middle back dispersive electrode yielded the lowest GI. GI differences among the back positions were small. BMI and hematocrit accurately predicted GI under the optimal (middle back) dispersive electrode position, and the effect of hematocrit was greater than that of BMI.

Ultrasound-guided pacemaker puncture allows for visualization of vascular anatomy in real time, potentially reducing complications; however, detailed comparative studies with the traditional fluoroscopy-guided technique are lacking, particularly those incorporating objective imaging endpoints such as postoperative computed tomography (CT). In this study, we aimed to compare the procedural time and complications associated with fluoroscopy- and ultrasound-guided axillary and subclavian vein puncture techniques for pacemaker lead implantation. We conducted a retrospective analysis of 250 patients who underwent DDD pacemaker implantation for symptomatic bradycardia at Sakakibara Heart Institute between January 2021 and December 2023. The patients were categorized into two groups: fluoroscopy-guided (Group X, n = 147) and ultrasound-guided axillary or subclavian vein puncture (Group E, n = 103). The demographic data, number of punctures, and number of complications were analyzed. Among the 250 patients, postoperative chest CT scans were available for 75 to assess lead placement, focusing on intrathoracic lead insertion and distance from the lead to the outer edge of the clavicle. The mean age of the patients was 82 years, 46% were male, and the mean body mass index was 22 kg/m². The puncture time was significantly shorter in Group E than in Group X (5.6 ± 3.8 vs. 9.7 ± 10.3 min, p < 0.01). Patients in Group E had no puncture-related complications. Group X had more patients with the venous insertion point of the lead located within the thoracic cavity, as revealed by postoperative CT scans, than did Group E (8.0% vs. 0.6%, p < 0.01, respectively). Ultrasound-guided venous puncture reduced the puncture time, number of complications, and incidence of intrathoracic lead insertion. This technique may reduce lead stress and mitigate long-term lead-related complications.

Patients with heart failure (HF) are at increased risk of hyperkalemia, and implementing appropriate potassium-lowering therapy is essential for optimizing outcomes. Sodium zirconium cyclosilicate (SZC) is a selective potassium binder that effectively reduces serum potassium levels; however, its impact on mortality and cardiovascular outcomes in HF remains unclear. This study compared the effects of SZC and calcium polystyrene sulfonate (CPS) on a composite of all-cause death and major adverse cardiovascular event (MACE)-related hospitalization, along with individual MACE components and continuation rates of HF medications. We conducted a retrospective cohort study using data from the JMDC hospital database, including adult patients with HF who initiated SZC or CPS between April 2020 and September 2023 and continued treatment for at least 30 days. Propensity score-based inverse probability of treatment weighting (IPTW) and multivariable Cox models were used to control for confounding. A total of 12,918 patients were included (11,139 CPS; 1779 SZC), with a median follow-up of 147 and 138 days, respectively. After IPTW adjustment, baseline characteristics were balanced, except for the prescription year. The primary composite outcome (all-cause death or MACE hospitalization) occurred in 148 patients in the SZC group and 839 in the CPS group (Hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.94-1.43). In a post hoc analysis, the composite of all-cause death and HF hospitalization occurred in 143 vs. 793 patients (HR 1.21, 95% CI 0.98-1.50). SZC use was associated with a higher HR for HF hospitalization (103 vs. 524 events, HR 1.36, 95% CI 1.06-1.75) and a lower HR for stroke hospitalization (6 vs. 80 events, HR 0.33, 95% CI 0.12-0.91). Mineralocorticoid receptor antagonists (MRA) continuation was more frequent in the SZC group [70.1% vs. 59.0%, weighted odds ratio, 1.39 (95% CI 1.11-1.75)]. These findings suggest that although SZC may not improve survival or overall cardiovascular outcomes, it may help maintain essential HF therapies such as MRA.

Vascular endothelial function plays an important role in the pathophysiology of acute coronary syndrome (ACS). Plaque erosion (PE) and plaque rupture (PR) are the two major mechanisms of ACS; however, how the vascular endothelial function differs between these etiologies is not well understood. Flow-mediated dilation (FMD) is a method used to evaluate the endothelial function. We aimed to assess endothelial function using FMD in patients with PE and PR. ACS patients (N = 160) who underwent primary percutaneous coronary intervention (PCI) with optical frequency domain imaging (OFDI) and FMD assessment were retrospectively enrolled. Culprit plaques were categorized as PE or PR based on OFDI. Based on the median value of FMD (4.1%) in our data, patients were classified into high-FMD (> 4.1%) and low-FMD (≤ 4.1%) groups. Based on the plaque type and FMD values, the patients were divided into PR-HighFMD (N = 48), PR-LowFMD (N = 47), PE-HighFMD (N = 33), and PE-LowFMD (N = 32) groups, and then the clinical characteristics were compared. Major adverse cardiac events (MACE) were defined as cardiovascular death, nonfatal myocardial infarction, stroke, ischemia-driven revascularization, hospitalization for angina or heart failure. FMD was similarly impaired in the PE and PR groups (4.2% vs. 4.1%, P = 0.85). Most clinical characteristics did not differ between the groups. The PR-High_FMD group showed the highest MACE-free survival, followed by the PE-Low_FMD (HR = 2.62, CI = 0.58-11.7, P = 0.21), PE-High_FMD (HR = 3.18, CI = 0.76-13.3, P = 0.11), and PR-Low_FMD (HR = 5.44, CI = 1.55-19.1, P = 0.008) groups. FMD is likely to have a prognostic impact on patients with ACS, which might vary depending on the culprit lesion.