International heart journal最新文献

Esaxerenone, a non-steroidal mineralocorticoid receptor (MR) blocker, exhibits high selectivity for MR. While clinically used as an anti-hypertensive drug, its impact on cardiac remodeling remains poorly understood. This study investigated the effect of esaxerenone on pressure overload-induced cardiac hypertrophy in mice.Eight-week-old C57BL/6 mice underwent either transverse aortic constriction (TAC) or sham surgery. Animals were divided into 2 groups: 0.003% (3.0 mg/kg) Esaxerenone-fed (EX) and normal-fed (CNT) groups (n = 64, Sham/CNT = 12, Sham/EX = 13, TAC/CNT = 18, TAC/EX = 21). Cardiac gene expressions were analyzed using quantitative real-time PCR.Food intake and body weight variations showed no significant differences between CNT and EX groups during the 2-week experimental period. The mortality rate from 24 hours after TAC surgery to the end of the experiment was 30.8% in the CNT group, however, all mice survived following TAC surgery in EX group. CNT group showed a remarkable increase in heart weight/tibial length ratio 2 weeks after TAC compared with the Sham group. The EX group demonstrated a significant decrease in HW/TL following TAC surgery (-23.4%, P = 0.041). Masson's trichrome staining revealed that the TAC/CNT group had a significantly higher proportion of fibrotic area than the Sham/CNT group. However, the TAC/EX group had a slightly lower proportion of fibrotic area than the TAC/CNT group. In cardiac gene expression analysis, ANP and Collagen 3a1 were upregulated in the TAC group but were significantly reduced following treatment with esaxerenone.Esaxerenone attenuates cardiac hypertrophy and hypertrophy-related gene expression, resulting in improved survival in a pressure overload model in mice.

This case report presents a novel approach for ventricular tachycardia (VT) ablation in a patient with cardiac sarcoidosis, utilizing the Map Merge function of the CARTO 3 system to integrate mapping data from multiple ablation sessions. A 62-year-old male with recurrent VT underwent initial endocardial ablation, where voltage mapping revealed no low-voltage areas (LVA) in the endocardium, though pace mapping matched clinical VT morphology. Fragmentation potentials were noted in the coronary vein, indicating a probable epicardial substrate. Ablation successfully suppressed VT, but recurrence occurred within 4 days, prompting a second, epicardial approach. During this session, voltage mapping identified broad LVAs with late potentials in the epicardium, aligning with prior endocardial sites. The Map Merge function enabled superimposing maps from both sessions, confirming spatial consistency between endocardial and epicardial LVAs and enhancing the precision of ablation targeting. Post-ablation, no VT recurrence was observed.This case underscores the clinical value of Map Merge, which improves procedural accuracy by integrating data across temporally distinct sessions, especially in VT cases involving epicardial substrates. By enabling comprehensive mapping without repeated epicardial mapping, Map Merge facilitates efficient identification and alignment of LVAs and abnormal potentials. This approach may improve outcomes in VT ablation by ensuring precise targeting, particularly in cases requiring endo-epicardial intervention.

Although state-of-the-art therapy for left main disease (LMD) has been demonstrated to improve overall cardiovascular outcomes, it remains unclear whether differences in strategy and outcomes for Japanese and non-Japanese patients can be observed in a contemporary treatment.In this international multicenter registry, we analyzed 314 patients who received state-of-the-art management for LMD, including physiology-guided revascularization, coronary interventions using the latest drug-eluting stents aided by intracoronary imaging, or surgical procedures employing internal thoracic artery grafts, in conjunction with guideline-directed medical therapy. The patient cohort was divided into Japanese (n = 122) and non-Japanese (n = 192) groups. The primary endpoint was major adverse cardiovascular events (MACE), defined as death, non-fatal myocardial infarction, and ischemia-driven target lesion revascularization. Propensity score matching was utilized to account for baseline clinical variables.Baseline and lesion characteristics differed among groups, demonstrating higher frequency of diabetes and chronic kidney disease, higher SYNTAX score, and more severe stenosis in the Japanese cohort, resulting in a higher rate of revascularization performed (P < 0.05 for all). Percutaneous coronary intervention was significantly more frequently selected as the revascularization option (P < 0.001). While there were no significant differences in MACE between the 2 groups before adjustment, following adjustment, the Japanese cohort demonstrated significantly lower MACE at 4 years (6.3% versus 16.7%; HR: 0.37; 95%CI: 0.14-0.97; P = 0.042). Multivariate analysis further confirmed an independent association between Japanese patients and a reduced 4-year MACE risk (HR: 0.37; 95%CI: 0.14-0.96; P = 0.040).In a contemporary study with state-of-the-art therapy for LMD, patients who underwent treatment in Japan demonstrated better cardiovascular outcomes.

Left ventricular hypertrophy (LVH), with the accompanying decrease in diastolic function, can originate from an augmented cardiac load caused by arterial stiffness (AS). The Cardio-Ankle Vascular Index (CAVI) is widely used as a good evaluation index for AS in Japan. We therefore conducted a longitudinal study aiming to determine the involvement of AS in changes in cardiac geometry using ultrasonography and CAVI.Between 2015 and 2020, 131 patients for whom echocardiography and CAVI measurements were performed at intervals of 401 ± 185 days were investigated to identify factors contributing to changes in cardiac geometry.Multivariate analysis showed that the value of change in the CAVI had an independent effect on the value of change in the left ventricular mass index (B = 4.023, β = 0.180, P = 0.046), which represents cardiac geometry, and on the value of change in relative wall thickness (RWT) (B = 0.021, β = 0.211, P = 0.010).This observational study suggested that improvements in CAVI, an indicator of cardiac afterload, may contribute to better cardiac remodeling, particularly in cases of concentric remodeling and concentric hypertrophy.

Very late stent thrombosis (VLST) is a rare but critical complication of stent placement. In this report, we present 2 VLST cases diagnosed with neoatherosclerosis by detecting cholesterol crystals (CCs) via the filter paper rinse method. In terms of differentiating between neoatherosclerosis and stent thrombosis. There was no visible thrombus observed on thrombus aspiration. Examination of the blood sample obtained from the thrombus aspiration using the filter paper rinse method showed the presence of CCs under polarized light microscopy, thus, diagnosing VLST caused by neoatherosclerosis. Diagnosis of neoatherosclerosis would provide a rationale for intensive lipid-lowering therapy.

Myocardial ischemia and hypoxia are the main causes of heart failure, and cardiomyocyte apoptosis induced by mitochondrial injury is the basis of adverse heart remodeling and heart failure. Upstream stimulatory factor 2 (USF2), a transcription factor involved in multiple cellular processes, was recently shown to play an active role in mitochondrial function and energy homeostasis. However, its involvement in cardiovascular disease has not been previously reported. In this study, we demonstrated that under hypoxic conditions, USF2 protein expression can be degraded via the ubiquitin-proteasome pathway in cardiomyocytes. The deletion of USF2 results in mitochondrial dysfunction and exacerbates mitochondrial damage, ultimately promoting apoptosis. Mechanistically, we demonstrated that USF2 deficiency induces apoptosis in cells by modulating the AMPK/mTOR signaling pathway. In conclusion, this study provides new insights into the protective role of USF2 in hypoxic cardiomyocyte injury and indicates that USF2 could be a potential therapeutic target for myocardial hypoxia.

Patients with Fontan circulation (Fontan) have a higher venous pressure (VP) and lower cardiac index (CI) than those with biventricular circulation (BiV). Although the cost to increase VP per unit CI (ΔVP/ΔCI) during exercise is expected to be higher in Fontan than in BiV, to our knowledge, no previous study has specifically tested ΔVP/ΔCI as the main variable.We included 9 patients with Fontan and 10 with postoperative BiV in this pilot study and assessed their hemodynamics via an ergometer-based exercise test. CI was continuously measured using impedance cardiography.The median age and quartile range values in patients with Fontan (15.0 [13.6, 16.7] years) were significantly higher than those in patients with BiV (12.9 [11.3, 14.3] years, P = 0.028). The ΔVP/ΔCI values were significantly higher in the Fontan group than in the BiV group at 25 W (4.5 [4.3, 6.0] versus 1.1 [0.9, 2.6] mmHg/ (L/minute/m²), respectively; P = 0.0008) and peak exercise (3.6 [33, 4.5] versus 1.1 [0.9, 1.5] mmHg/ (L/minute/m²), respectively; P = 0.0002) irrespective of age. The areas under the curve values of the 2 receiver operating curves (at 25 W and peak exercise time points) were 0.961 and 0.967, respectively. Patients with Fontan exhibited the 3 highest ΔVP/ΔCI values at peak exercise had an elevated New York Heart Association functional class (IIm-III) and hemodynamic concerns.Patients with Fontan displayed a higher cost to increase VP per unit CI. ΔVP/ΔCI may be a potential circulatory or prognostic marker for these patients and its value should be validated via larger prospective studies.

Serum N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and brain-type natriuretic peptide (BNP) levels are rarely evaluated simultaneously in patients requiring intensive care.A total of 4,724 patients were screened, and 1,755 patients with BNP levels < 100 pg/mL were analyzed. Patients were divided into two groups, according to the median value of the NT-proBNP/BNP ratio (low-NT-proBNP/BNP group [Group L] versus high-NT-proBNP/BNP group [Group H]). A multivariate logistic regression model showed that the C-reactive protein levels (per 1-mg/dL increase) and serum creatinine levels (per 1-mg/dL increase) were independently associated with a high NT-proBNP/BNP ratio (odds ratio: 1.251, 95% confidence interval [95% CI]: 1.172-1.335 and odds ratio: 1.941, 95% CI: 1.468-2.567, respectively). The Kaplan-Meier curve analysis showed that the prognosis was significantly poorer in Group H than in Group L. Moreover, a multivariate Cox regression model revealed that a high NT-proBNP/BNP ratio was an independent predictor of 365-day mortality (hazard ratio: 1.468, 95% CI: 1.027-2.067). The same significant trend in prognostic impact was observed in the low-creatinine (< 0.83 mg/dL, n = 883), high-creatinine (≥ 0.83 ng/dL, n = 872), and high- C-reactive protein (≥ 0.16 mg/dL, n = 842) cohorts.A high NT-proBNP/BNP ratio was associated with a non-cardiac condition. Consequently, it was independently associated with adverse outcomes in patients requiring intensive care, even in those with a low BNP value on admission.

Continuous intravenous epoprostenol or treprostinil therapy is essential for the treatment of severe pulmonary arterial hypertension (PAH). However, it has several side effects, including thyroid gland dysfunction. This study aimed to estimate the prevalence rate of thyroid gland dysfunction.We enrolled 52 patients (9 males, 43 females) who were diagnosed with PAH at Gunma University Hospital. Treatment was selected according to disease severity. The characteristics of patients with thyroid gland dysfunction were also assessed. The mean age was 54 ± 21 years. Before PAH treatment initiation, right heart catheterization showed abnormal results (mean pulmonary arterial pressure: 43.4 ± 17.5 mmHg, cardiac index: 2.45 ± 0.97 L/minute/m², and pulmonary vascular resistance: 10.5 ± 8.0 Wood units). Regarding the initial treatment, 30 patients received oral epoprostenol, and 18 received continuous intravenous treprostinil. The overall prevalence rate of thyroid gland dysfunction was 15.4%, with a significantly higher rate in patients initiated with continuous intravenous epoprostenol therapy than in those receiving only oral agents (2.9% versus 38.9%, P = 0.0007).Patients receiving continuous intravenous epoprostenol therapy had a high prevalence rate of thyroid gland dysfunction. Thus, severe PAH should be treated with an understanding that thyroid gland dysfunction is an important side effect in patients with PAH.