Journal of cardiology最新文献

Background: Coronary microvascular dysfunction (CMD) after percutaneous coronary intervention (PCI) is associated with poor prognosis, including periprocedural myocardial infarction, and is often attributed to distal embolization of lipid-rich plaque components. However, whether preprocedural lipid quantification using near-infrared spectroscopy-intravascular ultrasonography (NIRS-IVUS) can predict CMD remains unclear.

Methods: We retrospectively analyzed 147 coronary lesions in 121 patients with coronary artery disease (excluding ST-segment elevation myocardial infarction) who underwent NIRS-IVUS-guided PCI. CMD was defined as an angiography-based index of microcirculatory resistance (angio-IMR) ≥25. Two NIRS-derived lipid parameters were assessed: maximum lipid core burden index >4 mm (maxLCBI_4mm) and a novel index, lipid burden in the stent (LBS = stent diameter × length × LCBI), which was determined by the operator based on the planned stent diameter, planned stent length, and the LCBI within the planned stent implantation segment.

Results: CMD occurred in 36.7 % of lesions and was associated with significantly higher values of both indices (p < 0.01). A stepwise trend between lipid burden and microvascular dysfunction was also observed. Optimal cut-offs were identified as maxLCBI_4mm ≥ 579 and LBS ≥20,384. Both indices independently predicted CMD (odds ratios = 7.253 and 3.181), and CMD risk was highest in lesions exceeding both thresholds.

Conclusions: Higher pre-PCI maxLCBI_4mm and LBS values were independently associated with CMD development after PCI. Further studies are warranted to validate their clinical relevance in optimizing PCI strategies.

Background: Dementia and heart failure (HF) are two major epidemics that adversely influence each other, yet few studies have explored strategies to prevent cognitive decline in HF. The Reducing Cognitive impairment by management of Heart Failure as a Modifiable Risk Factor (Cog-HF) trial is a randomized controlled trial assessing whether a disease management program (DMP) compared to usual care can mitigate cognitive decline in HF patients with mild cognitive impairment (MCI). This report describes the baseline characteristics of patients enrolled in Cog-HF and their comparability to recent Japanese HF registries.

Methods: Patients with HF and MCI, defined as a Montreal Cognitive Assessment (MoCA) <26, were recruited for Cog-HF. Baseline characteristics of patients in Cog-HF were compared to those of the FRAGILE-HF, JROADHF, and CURE-HF cohorts.

Results: Among 176 participants (mean age 79 ± 6 years; 53 % men; body mass index 22.3 ± 3.4 kg/m²), prevalence of hypertension, atrial fibrillation, coronary artery disease, and chronic obstructive pulmonary disease was 68 %, 46 %, 25 %, and 7 %, respectively. Most patients had a preserved ejection fraction (HFpEF, 74 %), were in New York Heart Association class II (61 %), and exhibited lower rates of physical (50 %) and social frailty (35 %). The Cog-HF cohort had similarly high rates of background medical therapy (69 % angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitors, 51 % mineralocorticoid receptor antagonists, and 66 % beta blockers), with a higher rate of sodium glucose cotransporter 2 inhibitors (56 %) compared to those in recent registries.

Conclusions: Patients in Cog-HF were similar to those in recent HF registries and were receiving guideline-recommended HF treatment, supporting the external validity of future trial findings.

Background: Acute kidney injury (AKI) following percutaneous coronary intervention (PCI) is associated with poor outcomes. The National Cardiovascular Data Registry (NCDR) AKI prediction model includes a relatively high number of complex clinical variables. We propose a simplified bedside score including 5 pre-procedural variables from the NCDR model as an effective tool for AKI prediction after PCI.

Methods: The Mayo Clinic Rochester cardiac catheterization laboratory registry, which follows NCDR criteria, was analyzed between Q2 2022 and Q1 2023. Inclusion/exclusion criteria, definitions, and outcome data were based on the NCDR model. Logistic regression models were built to predict AKI, including a simplified integer score comprised of 5 pre-procedural variables: Cardiac arrest, Reduced glomerular filtration rate < 30 ml/min/1.73 m2, Anemia (Hb <10 mg/dl), Shock, and Heart failure history. Model calibration and discrimination were tested.

Results: We identified 840 patients with a mean age of 70 (IQR 61-79), of which 593 (70.6 %) were men. AKI developed in 107 (12.7 %) patients. There was no significant difference between the groups in gender, vascular access, PCI indication, or contrast volume used (median: 150; IQR: 110-200 ml in the non-AKI group and median: 170 IQR: 123-213 ml in the AKI group; p = 0.14). The CRASH score demonstrated a c-statistic of 0.77 (0.60-0.88) and calibration intercept of 0.31 (-0.07-0.69) and slope of 1.03 (0.66-1.39) in the validation data, similar to the NCDR score.

Conclusions: A simplified integer score using 5 pre-procedural variables was an effective tool for risk prediction of post-PCI AKI, with performance similar to the more complex NCDR model.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common hepatic disorder that significantly increases cardiovascular risk. However, no established screening method exists for detecting subclinical coronary artery disease (CAD) in this high-risk population. The cardio-ankle vascular index (CAVI), a blood pressure-independent measure of arterial stiffness, may offer a non-invasive tool for early detection of coronary atherosclerosis.

Methods: We retrospectively analyzed 295 patients with MASLD who underwent both CAVI measurement and coronary computed tomography angiography at a single center. Significant CAD was defined as ≥50 % luminal stenosis. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic performance. Multivariable logistic regression was performed to identify independent associations between elevated CAVI and CAD. The incremental predictive value of CAVI was assessed using net reclassification improvement (NRI).

Results: Of the 295 patients, 110 (37.3 %) had significant CAD. Patients with CAD had significantly higher CAVI values (9.0 vs. 8.7, p = 0.007). The area under the ROC curve for CAVI predicting CAD was 0.614. A CAVI cut-off of 8.6 provided a sensitivity of 66.4 % and a specificity of 56.8 %. CAVI ≥8.0 was independently associated with CAD (OR 3.44, 95 % CI: 1.06-11.2, p = 0.040). Adding CAVI to a conventional risk model improved risk reclassification (NRI 0.4236, p < 0.001), although the C-statistic change was not significant (from 0.724 to 0.725, p = 0.835).

Conclusions: CAVI is independently associated with significant coronary stenosis in MASLD patients and may serve as a non-invasive screening tool to enhance cardiovascular risk stratification. Its moderate diagnostic accuracy suggests utility as a component of a multifactorial risk assessment strategy.

Background: Cardiomyopathies and idiopathic ventricular fibrillation have traditionally been studied as distinct entities; however, emerging evidence suggests that arrhythmias may represent an early manifestation of cardiomyopathy. The clinical utility of genetic testing in these conditions requires comprehensive evaluation.

Methods: We retrospectively analyzed 51 consecutive patients with idiopathic cardiomyopathies and/or idiopathic ventricular fibrillation who were admitted between 2020 and 2024. Genetic testing was performed using either whole-exome sequencing or targeted gene panels. Clinical characteristics, myocardial biopsy findings, and outcomes-including arrhythmia recurrence following catheter ablation-were assessed in relation to the presence of pathogenic or likely pathogenic (P/LP) genetic variants.

Results: P/LP variants were identified in 24 % of patients. Those harboring P/LP variants had a higher prevalence of family history (58 % vs. 21 %, p = 0.012). No significant difference in myocardial interstitial fibrosis was observed between P/LP carriers and non-carriers. Patients with P/LP variants exhibited significantly earlier clinical manifestations, including diagnosis, heart failure onset, and arrhythmic events (all p < 0.05). However, P/LP variant status did not significantly affect recurrence rates after catheter ablation for atrial or ventricular tachyarrhythmias. All P/LP variant carriers were diagnosed before age 60 years.

Conclusions: P/LP genetic variants are associated with earlier disease onset; however, they do not appear to influence the severity of myocardial fibrosis or the recurrence of arrhythmias following catheter ablation. Genetic testing is recommended for younger patients presenting with cardiomyopathy, although further investigation is warranted to clarify its impact on therapeutic responses.

Objective: To investigate whether differences in carotid plaque size between the ipsilateral and contralateral sides of the stroke site influence the detection of atrial fibrillation (AF) after cryptogenic stroke (CS).

Methods: We analyzed data from the prospective, multicenter LOOK Study, which enrolled patients with CS diagnosed and monitored using an implantable cardiac monitor (ICM). The study included patients with unilateral anterior circulation cerebral infarction, divided by whether AF was detected within 6 months of ICM implantation. Carotid plaque size was compared between the ipsilateral and contralateral sides of the stroke site.

Results: Ninety-seven patients (32 women; median age 70 years; median NIHSS 3) were included; 21 developed AF. Among patients without detected AF, carotid plaques ≥1.4 mm were significantly more frequent on the ipsilateral side compared to the contralateral side (27/76 vs. 18/76, p = 0.022). Conversely, patients with detected AF showed no significant difference in plaque size between ipsilateral and contralateral to the stroke site (1.5 mm vs. 1.7 mm, p = 0.754). For patients with an ipsilateral plaque ≥1.4 mm, an ipsilateral-to-contralateral plaque size ratio of ≥1.2 demonstrated a specificity of 75 % and sensitivity of 63 % for predicting no detected AF (area under the curve = 0.727, 95 % CI 0.543-0.911, p = 0.025).

Conclusion: This study demonstrated that carotid plaque distribution patterns differ significantly between CS patients with and without detected AF. An ipsilateral carotid plaque ≥1.4 mm and a size ratio ≥ 1.2 may predict no detected AF, potentially indicating an embolic source other than AF.

Background: The comparative safety and efficacy of Watchman FLX (Boston Scientific, Marlborough, MA, USA) and Amplatzer Amulet (Abbott, Abbott Park, IL, USA) devices for left atrial appendage occlusion (LAAO) remain unclear.

Objective: To compare Watchman FLX and Amplatzer Amulet devices for LAAO.

Methods: We systematically searched PubMed, Embase, and Cochrane Library for studies comparing Watchman FLX versus Amulet in patients with atrial fibrillation (AF) undergoing percutaneous LAAO. We applied a random-effects model to pool risk ratios (RR) with corresponding 95 % confidence intervals (CI) for binary endpoints.

Results: We included five studies comprising 1316 patients with AF undergoing LAAO for high bleeding risk. A total of 629 (47.8 %) patients underwent LAAO with Watchman FLX. Amulet was associated with lower rates of stroke or transient ischemic attack (TIA) (RR 2.31; 95 % CI 1.02-5.25; p = 0.04; I² = 0 %), but no differences were observed in terms of peridevice leak (RR 1.57; 95 % CI 0.86-2.89; p = 0.14; I² = 0 %) between Watchman and Amulet devices. Additionally, no differences were found in terms of device-related thrombus (RR 2.01; 95 % CI 0.87-4.68; p = 0.10; I² = 0 %), or pericardial effusion (RR 1.00; 95 % CI 0.17-5.96; p = 1.00; I² = 59.7 %) between both groups.

Conclusion: This meta-analysis indicates a lower risk of stroke or TIA with Amulet compared to Watchman FLX.

Background: While fractional flow reserve (FFR) is the gold standard for assessing coronary stenosis, non-hyperemic pressure ratios (NHPRs) such as the resting full-cycle ratio (RFR) are used as less invasive alternatives. However, NHPR-guided percutaneous coronary intervention (PCI) has been reported to be associated with poorer outcomes. We hypothesized that the difference between RFR and FFR (RFR-FFR) carries important clinical information.

Methods: This retrospective study included 460 patients with chronic coronary syndrome who underwent FFR-guided elective PCI following functional assessment of the left anterior descending artery (LAD) with both RFR and FFR. Patients were stratified into tertiles based on their RFR-FFR value. The primary endpoint was all-cause death.

Results: Patients in the lowest RFR-FFR tertile presented with a higher-risk clinical profile including older age, female sex, and greater comorbidity burden such as elevated N-terminal pro-B-type natriuretic peptide and lower renal function, and evidence of microvascular dysfunction such as lower coronary flow reserve and microvascular resistance reserve. During a median follow-up of 5.2 years, lower RFR-FFR patients showed higher rate of all-cause death. Multivariable analysis identified age and baseline heart rate as independent predictors of a low RFR-FFR value. Crucially, a multivariable Cox regression analysis revealed that a low RFR-FFR value was an independent predictor of all-cause death.

Conclusions: A lower RFR-FFR value is a marker of increased comorbidities and microvascular dysfunction, correlating with poorer long-term clinical outcomes. This pre-PCI novel metric holds potential utility for risk stratification and personalizing treatment strategies in patients with chronic coronary artery disease undergoing LAD PCI.

Background: Avoiding potentially inappropriate medications (PIMs) that can worsen heart failure (HF) is a clinical priority. Yet, the prevalence and determinants of PIM use in this population are not well characterized. The Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination (JROAD-DPC) database is a nationwide claims-based registry that captures detailed information on hospitalizations for cardiovascular disease across Japan, providing a unique opportunity to examine prescribing patterns in real-world practice.

Methods: We analyzed JROAD-DPC data on hospitalizations for HF among patients aged ≥ 60 years between 2012 and 2020, in a study supported by the Japan Agency for Medical Research and Development. The temporal trend in the utilization of HF-exacerbating PIMs listed in the American Geriatrics Society Beers Criteria®, non-steroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, non-dihydropyridine calcium-channel blockers (CCBs), cilostazol, and thiazolidinediones, was assessed using Cochran-Armitage trend tests. Factors associated with PIM use were evaluated using multivariate mixed-effects Poisson regression models, with hospitals treated as random intercepts.

Results: A total of 1,232,368 HF hospitalizations were analyzed. The overall prevalence of PIM use declined over time: NSAIDs and COX-2 inhibitors decreased from 15.7 % in 2012 to 9.2 % in 2020, and non-dihydropyridine CCBs from 14.5 % to 9.7 %. Despite this decline, these medications continued to be prescribed for a substantial proportion of patients. Utilization patterns differed by patient characteristics; notably, women were more likely than men to receive NSAIDs, COX-2 inhibitors, and non-dihydropyridine CCBs.

Conclusions: Although the use of HF-exacerbating PIMs has decreased over time, NSAIDs, COX-2 inhibitors, and non-dihydropyridine CCBs remain commonly prescribed. Given their potential to worsen HF outcomes, raising clinical awareness of PIMs and addressing patient-specific prescribing patterns are essential steps toward safer pharmacological management in older adults with HF. Findings from JROAD-DPC highlight the ongoing need for strategies to further minimize PIM-related risks.