Journal of cardiology最新文献

Heart transplantation (HTx) in Japan has significantly progressed since the Organ Transplant Law was enacted in 1997. Despite improvements in surgical techniques, immunosuppressive therapy, and postoperative care, Japan still faces major challenges. These include a persistently low rate of organ donation, long waiting times, and high mortality among patients on the transplant waiting list, as about 25% of registered patients died before receiving a heart transplant, while only 39% successfully received one. HTx remains the definitive treatment for selected patients with end-stage heart failure who have already received maximally optimized guideline-directed medical therapy and, in many cases, mechanical circulatory support (MCS) such as left ventricular assist devices, offering superior long-term survival and quality of life compared with these advanced therapies. Data from the International Society for Heart and Lung Transplantation and Japanese studies consistently show that HTx recipients experience improved physical function, emotional well-being, and social reintegration. This review summarizes the current status of HTx in Japan, including its history, institutional framework, clinical outcomes, and allocation challenges. It also discusses next generation HTx such as new allocation systems, integrating HTx with MCS, expanding donor availability with donation after circulatory death with innovations in ex-vivo heart perfusion and the potential of xenotransplantation, and liquid biopsy. By addressing systemic limitations and adopting new technologies, Japan can improve access to HTx and outcomes for patients with advanced heart failure.

Background: In treatment of pulmonary arterial hypertension (PAH), the prostacyclin (PGI₂) pathway is targeted by oral selexipag and parenteral PGI₂ analogs. Although guidelines recommend therapeutic strategies based on disease severity and etiology, there are limited data on real-world use of selexipag and parenteral PGI₂ analogs in Japan. This study aimed to characterize the use of these drugs in treatment of PAH in Japan, with a focus on differences related to patient characteristics and PAH etiology.

Methods: Patients with PAH registered in the Japan PH Registry (JAPHR) from November 2016 to March 2023 were evaluated. Patients who met the inclusion criteria were further stratified by PAH etiologies, drug used, severity of disease, treatment strategies, time from diagnosis to drug initiation, and pulmonary hemodynamics.

Results: A total of 235 patients were treated with selexipag and 121 patients with parenteral PGI₂. Selexipag and parenteral PGI₂ analogs were most frequently used for idiopathic PAH (IPAH) or heritable PAH (HPAH), at 56.2 % (132/235) and 82.6 % (100/121), respectively. Selexipag was also used more frequently than parenteral PGI₂ analogs for PAH associated with connective tissue disease and congenital heart disease. Most patients received triple therapy, with 76.2 % (179/235) and 59.5 % (72/121) receiving selexipag and parenteral PGI₂ analogs, respectively. Regarding New York Heart Association functional class (NYHA-FC), selexipag was primarily administered to Class II-III patients and parenteral PGI₂ analogs to Class III patients. Both mean pulmonary artery pressure and pulmonary vascular resistance values were lower in the selexipag group than in the parenteral PGI₂ group.

Conclusion: Parenteral PGI₂ analogs tend to be used mainly in patients with severe IPAH/HPAH, while selexipag is used in patients with a broader range of etiologies around NYHA-FC II-III. Choice of selexipag and parenteral PGI₂ analogs for treatment of PAH is influenced by disease severity and etiology.

Background: Real-world attainment of contemporary guidelines-recommended, stringent low-density lipoprotein cholesterol (LDL-C) targets for secondary prevention of cardiovascular events in patients with coronary artery disease (CAD) remains inadequate. This study aimed to assess LDL-C control in patients within a regional ischemic heart disease (IHD) referral system after the 2022-2023 guideline updates and examine its association with long-term cardiovascular outcomes.

Methods: We retrospectively analyzed annual serum LDL-C levels and achievement of guideline-recommended serum LDL-C target level (<70 mg/dL) of 1334 patients with CAD [acute coronary syndrome (ACS) or chronic coronary syndrome (CCS)] enrolled in a regional IHD referral system and followed up at Shizuoka City Shizuoka Hospital (2021-2024). The primary endpoint was the annual serum LDL-C level trend; secondary endpoints were major adverse cardiovascular events (MACE: cardiovascular death, nonfatal myocardial infarction, and coronary revascularization) and their associations with serum LDL-C levels.

Results: The mean serum LDL-C level declined from 80.2 ± 22.0 mg/dL in 2021 to 71.8 ± 20.7 mg/dL in 2024, with improved target attainment (29.8 % vs. 46.3 %; p < 0.001 for both). MACE occurred in 14.2 % of patients (mean follow-up period, 6.1 years), with its incidence in patients who achieved the target level significantly lower than in those who did not (6.8 % vs. 18.6 %, p < 0.001). Patients with ACS and CCS had similar benefits. In multivariate Cox regression analysis, target level attainment was independently associated with a reduced MACE risk (hazard ratio 0.326; 95 % CI 0.21-0.52; p < 0.001).

Conclusions: In a real-world cohort of patients with CAD managed under a structured IHD referral system, serum LDL-C levels progressively decreased over time, and patients who achieved stricter LDL-C control experienced a significantly lower incidence of major cardiovascular events.

Background: Patients with chronic kidney disease (CKD) have an elevated risk of adverse cardiovascular events. However, the impact of different stages of CKD on the prognosis of patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI) remains uncertain.

Methods: This multicenter registry included 902 patients with AF undergoing PCI. Patients were divided into 3 groups based on renal function: normal [estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73m²], early CKD (30 ≤ eGFR <60 mL/min/1.73m²), and advanced CKD (eGFR <30 mL/min/1.73m² or patients on hemodialysis). The primary endpoint was net adverse clinical events (NACE) within 1 year after PCI, a composite of all-cause death, myocardial infarction (MI), ischemic stroke, and major bleeding (Bleeding Academic Research Consortium type 3 or 5) events.

Results: Of the 902 patients, 338 (37.5 %), 438 (48.5 %), and 126 (14.0 %) were grouped as normal, early CKD, and advanced CKD. Within the one-year follow-up period, 142 (15.7 %) patients experienced NACE after PCI. The progression of CKD was associated with increased NACE rates, mainly driven by an increased risk of all-cause death. There were no significant differences in the rates of MI, ischemic stroke, and major bleeding events among the three groups.

Conclusions: Advanced CKD was significantly associated with a higher incidence of NACE compared with early CKD or normal renal function in patients with AF after PCI.