Cardiovascular disease (CVD) is the world's major concern affecting the heart, blood arteries, and the blood that flows through and between them, making it a significant obstacle to contemporary healthcare practices. Approximately one in three individuals has a CVD, and many of them have several, overlapping diseases that might eventually result in catastrophic events such as a heart attack or stroke. The previous century opened the door for progress of life-saving drugs and treatment modalities. Recent developments in nanomaterials provide novel approaches for the treatment of CVD. Due to their unique properties, which include increased target specificity, sensitivity, and both active and passive targeting of cardiac tissues, the use of nanoparticles as carriers has received a lot of attention in the field of cardiology. Drug delivery using heart-targeted nanocarriers is a safe, efficient method of treating heart-related conditions such as hypertension, atherosclerosis, and myocardial infarction. Here, we highlight significant clinical opportunities in the quickly emerging field of CVD nanomedicine. This review concentrates on the use of nanoparticle-based therapeutics in CVD and provides a key take away regarding the use of metal, lipid, and polymer-based nanoparticle in CVD treatment. In this review, we emphasize recent advances in the use of nanomedicine to treat CVD and the therapeutic potential of drug delivery via nanoparticles in clinical prospects.
{"title":"Nanoparticle-driven drug delivery system for cardiovascular treatment","authors":"Raj Patel MBBS , Dhruvi Patel PhD , Unnati Dani PhD , Ketan Kuperkar PhD","doi":"10.1016/j.jjcc.2025.06.004","DOIUrl":"10.1016/j.jjcc.2025.06.004","url":null,"abstract":"<div><div>Cardiovascular disease (CVD) is the world's major concern affecting the heart, blood arteries, and the blood that flows through and between them, making it a significant obstacle to contemporary healthcare practices. Approximately one in three individuals has a CVD, and many of them have several, overlapping diseases that might eventually result in catastrophic events such as a heart attack or stroke. The previous century opened the door for progress of life-saving drugs and treatment modalities. Recent developments in nanomaterials provide novel approaches for the treatment of CVD. Due to their unique properties, which include increased target specificity, sensitivity, and both active and passive targeting of cardiac tissues, the use of nanoparticles as carriers has received a lot of attention in the field of cardiology. Drug delivery using heart-targeted nanocarriers is a safe, efficient method of treating heart-related conditions such as hypertension, atherosclerosis, and myocardial infarction. Here, we highlight significant clinical opportunities in the quickly emerging field of CVD nanomedicine. This review concentrates on the use of nanoparticle-based therapeutics in CVD and provides a key take away regarding the use of metal, lipid, and polymer-based nanoparticle in CVD treatment. In this review, we emphasize recent advances in the use of nanomedicine to treat CVD and the therapeutic potential of drug delivery via nanoparticles in clinical prospects.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Pages 23-37"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The ring finger protein 213 (RNF213) gene, identified in 2011 as a susceptibility gene for moyamoya disease (MMD), has since been recognized as a key factor in a broader spectrum of vascular disorders. The p.R4810K mutation in RNF213 is particularly common among Japanese MMD patients, although a smaller percentage of healthy individuals also carry the mutation, indicating that environmental factors, alongside genetic predisposition, likely influence disease onset. RNF213, a large E3 ubiquitin ligase, plays essential roles in vascular homeostasis, immune response, and endoplasmic reticulum stress reaction. Its mutation disrupts normal angiogenesis, contributing to abnormal vascular remodeling in conditions such as pulmonary hypertension and coronary artery disease. This review examines the multifaceted role of RNF213 and its p.R4810K mutation in the pathogenesis of MMD and other vascular conditions, collectively referred to as RNF213-associated vascular diseases.
While research has begun to clarify the mutation's effects on angiogenesis and the involved pathways, the roles of RNF213 and its mutation in vascular integrity remain unclear. This comprehensive overview underscores the complex interaction between genetic and environmental factors in RNF213-related vascular diseases and calls for further research to elucidate these mechanisms and develop targeted therapeutic interventions.
{"title":"RNF213 and cardiovascular disease: A review of histopathological, genetic perspectives, and potential molecular mechanisms","authors":"Toshinaru Kawakami MD , Masamichi Ito MD, PhD , Takayuki Isagawa PhD , Takahiro Kuchimaru PhD , Norihiko Takeda MD, PhD","doi":"10.1016/j.jjcc.2025.06.001","DOIUrl":"10.1016/j.jjcc.2025.06.001","url":null,"abstract":"<div><div>The ring finger protein 213 (<em>RNF213</em>) gene, identified in 2011 as a susceptibility gene for moyamoya disease (MMD), has since been recognized as a key factor in a broader spectrum of vascular disorders. The p.R4810K mutation in <em>RNF213</em> is particularly common among Japanese MMD patients, although a smaller percentage of healthy individuals also carry the mutation, indicating that environmental factors, alongside genetic predisposition, likely influence disease onset. RNF213, a large E3 ubiquitin ligase, plays essential roles in vascular homeostasis, immune response, and endoplasmic reticulum stress reaction. Its mutation disrupts normal angiogenesis, contributing to abnormal vascular remodeling in conditions such as pulmonary hypertension and coronary artery disease. This review examines the multifaceted role of RNF213 and its p.R4810K mutation in the pathogenesis of MMD and other vascular conditions, collectively referred to as RNF213-associated vascular diseases.</div><div>While research has begun to clarify the mutation's effects on angiogenesis and the involved pathways, the roles of RNF213 and its mutation in vascular integrity remain unclear. This comprehensive overview underscores the complex interaction between genetic and environmental factors in RNF213-related vascular diseases and calls for further research to elucidate these mechanisms and develop targeted therapeutic interventions.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Pages 17-22"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jjcc.2025.08.006
Kanae Hasegawa MD, PhD , William G. Stevenson MD
Radiofrequency catheter ablation (RFCA) is a common treatment option for ventricular arrhythmias (VA). Risks of RFA for VA include emboli and bleeding complications. In contrast to atrial fibrillation ablation procedures, for which anticoagulation therapy is relatively well standardized, peri-procedural antithrombotic therapy practices for RFCA of VA vary among laboratories and remains an area of investigation. This summary focuses on the current evidence-based antithrombotic therapies of RFCA for VA, with a particular emphasis on two recent major studies.
{"title":"Antithrombotic management in catheter ablation for ventricular arrhythmias - Mini review","authors":"Kanae Hasegawa MD, PhD , William G. Stevenson MD","doi":"10.1016/j.jjcc.2025.08.006","DOIUrl":"10.1016/j.jjcc.2025.08.006","url":null,"abstract":"<div><div>Radiofrequency catheter ablation (RFCA) is a common treatment option for ventricular arrhythmias (VA). Risks of RFA for VA include emboli and bleeding complications. In contrast to atrial fibrillation ablation procedures, for which anticoagulation therapy is relatively well standardized, peri-procedural antithrombotic therapy practices for RFCA of VA vary among laboratories and remains an area of investigation. This summary focuses on the current evidence-based antithrombotic therapies of RFCA for VA, with a particular emphasis on two recent major studies.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Pages 61-63"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Implantable cardioverter defibrillator (ICD) implantation is an established treatment that reduces the risk of sudden cardiac death; however, patients with ICD have been shown to be anxious. This study aimed to identify the characteristics of anxiety about returning to work after ICD implantation and to explore reemployment support.
Methods
Data from 56,002 patients who worked before admission to the cardiology department were analyzed using the Inpatient Clinico-Occupational Database of the Rosai Hospital Group (2011−2022). The patients were further categorized into two groups depending on whether ICD surgery was performed during hospitalization. Among patients who had undergone ICD surgery, multivariable logistic regression models were used to estimate the relationships between the prehospitalization occupational data, clinical data, and anxiety about returning to work.
Results
The ICD group had a higher rate of anxiety about returning to work than the non-ICD group (26.2 % vs. 16.1 %; p < 0.001). In the ICD group, younger age at discharge, female sex, self-employed, and longer working hours per day were independently associated with anxiety about returning to work. Among patients experiencing anxiety about returning to work, compared with the non-ICD group, the ICD group had a lower rate of anxiety about workplace understanding (17.9 % vs. 35.0 %; p = 0.008); but a higher rate of anxiety about workplace life (37.5 % vs. 18.3 %; p < 0.001).
Conclusions
The ICD group had a higher rate of anxiety about returning to work. This study suggests that interventions for anxiety about returning to work, especially regarding life in the workplace, are important for working populations with ICDs.
背景：植入式心律转复除颤器（ICD）植入术是一种降低心源性猝死风险的成熟治疗方法；然而，ICD患者表现出焦虑。本研究旨在了解ICD植入后重返工作岗位的焦虑特征，并探讨再就业支持。方法：使用罗赛医院集团住院临床职业数据库（2011-2022）对56002例入院前在心内科工作的患者数据进行分析。根据住院期间是否进行ICD手术，将患者进一步分为两组。在接受ICD手术的患者中，使用多变量logistic回归模型来估计住院前职业数据、临床数据和重返工作焦虑之间的关系。结果：ICD组对重返工作的焦虑率高于非ICD组(26.2 % vs. 16.1 %；p 结论：ICD组对重返工作岗位的焦虑率更高。这项研究表明，对重返工作岗位的焦虑进行干预，特别是对工作场所的生活，对患有icd的工作人群很重要。
{"title":"Characteristics of anxiety about returning to work after implantable cardioverter defibrillator implantation in Japan","authors":"Yasunobu Yamagishi MD, PhD , Taichi Watabe MD, PhD , Daiki Nakahara MD , Kazunari Taniguchi MD , Yasushi Oginosawa MD, PhD , Masaharu Kataoka MD, PhD, FJCC","doi":"10.1016/j.jjcc.2025.05.019","DOIUrl":"10.1016/j.jjcc.2025.05.019","url":null,"abstract":"<div><h3>Background</h3><div>Implantable cardioverter defibrillator (ICD) implantation is an established treatment that reduces the risk of sudden cardiac death; however, patients with ICD have been shown to be anxious. This study aimed to identify the characteristics of anxiety about returning to work after ICD implantation and to explore reemployment support.</div></div><div><h3>Methods</h3><div>Data from 56,002 patients who worked before admission to the cardiology department were analyzed using the Inpatient Clinico-Occupational Database of the Rosai Hospital Group (2011−2022). The patients were further categorized into two groups depending on whether ICD surgery was performed during hospitalization. Among patients who had undergone ICD surgery, multivariable logistic regression models were used to estimate the relationships between the prehospitalization occupational data, clinical data, and anxiety about returning to work.</div></div><div><h3>Results</h3><div>The ICD group had a higher rate of anxiety about returning to work than the non-ICD group (26.2 % vs. 16.1 %; <em>p</em> < 0.001). In the ICD group, younger age at discharge, female sex, self-employed, and longer working hours per day were independently associated with anxiety about returning to work. Among patients experiencing anxiety about returning to work, compared with the non-ICD group, the ICD group had a lower rate of anxiety about workplace understanding (17.9 % vs. 35.0 %; <em>p</em> = 0.008); but a higher rate of anxiety about workplace life (37.5 % vs. 18.3 %; <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>The ICD group had a higher rate of anxiety about returning to work. This study suggests that interventions for anxiety about returning to work, especially regarding life in the workplace, are important for working populations with ICDs.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Pages 102-107"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jjcc.2025.05.012
Yuka Otaki MD, PhD
Although perfusion imaging is effective for evaluating relative myocardial blood flow (MBF) distribution, it has a well-known limitation in single photon emission computed tomography (SPECT): it often underestimates ischemia, particularly in patients with three-vessel coronary artery disease or left main trunk disease. In such cases, global reductions in MBF may not create significant perfusion defects, complicating the accurate detection of ischemia. In contrast, positron emission tomography (PET) has long offered absolute MBF quantification through dynamic imaging, allowing for a more precise assessment of coronary artery disease and microvascular dysfunction. By integrating absolute MBF quantification with perfusion imaging, PET has significantly improved diagnostic accuracy in ischemia evaluation.
Relative to PET, traditional SPECT has struggled to achieve comparable MBF quantification due to its lower sensitivity and spatial resolution. However, recent advancements in semiconductor-based detector technology have enabled SPECT to approximate PET's quantification accuracy. Emerging studies indicate that modern SPECT systems can now deliver absolute MBF values with enhanced reliability, opening new possibilities for clinical application.
Despite PET's superior quantification capability, its availability remains confined to specialized facilities, limiting its broader clinical use. In this context, the implementation of SPECT to quantify MBF presents a promising avenue for expanding access to more accurate ischemia assessment. Enhancing the diagnostic precision of SPECT could improve patient stratification and treatment planning, particularly in environments where PET is not readily available.
This review summarizes recent advancements in MBF quantification using SPECT, discusses its clinical implications, and explores the prospects for its integration into routine cardiovascular imaging.
{"title":"Beyond perfusion imaging: the growing clinical role of myocardial blood flow quantification by SPECT","authors":"Yuka Otaki MD, PhD","doi":"10.1016/j.jjcc.2025.05.012","DOIUrl":"10.1016/j.jjcc.2025.05.012","url":null,"abstract":"<div><div>Although perfusion imaging is effective for evaluating relative myocardial blood flow (MBF) distribution, it has a well-known limitation in single photon emission computed tomography (SPECT): it often underestimates ischemia, particularly in patients with three-vessel coronary artery disease or left main trunk disease. In such cases, global reductions in MBF may not create significant perfusion defects, complicating the accurate detection of ischemia. In contrast, positron emission tomography (PET) has long offered absolute MBF quantification through dynamic imaging, allowing for a more precise assessment of coronary artery disease and microvascular dysfunction. By integrating absolute MBF quantification with perfusion imaging, PET has significantly improved diagnostic accuracy in ischemia evaluation.</div><div>Relative to PET, traditional SPECT has struggled to achieve comparable MBF quantification due to its lower sensitivity and spatial resolution. However, recent advancements in semiconductor-based detector technology have enabled SPECT to approximate PET's quantification accuracy. Emerging studies indicate that modern SPECT systems can now deliver absolute MBF values with enhanced reliability, opening new possibilities for clinical application.</div><div>Despite PET's superior quantification capability, its availability remains confined to specialized facilities, limiting its broader clinical use. In this context, the implementation of SPECT to quantify MBF presents a promising avenue for expanding access to more accurate ischemia assessment. Enhancing the diagnostic precision of SPECT could improve patient stratification and treatment planning, particularly in environments where PET is not readily available.</div><div>This review summarizes recent advancements in MBF quantification using SPECT, discusses its clinical implications, and explores the prospects for its integration into routine cardiovascular imaging.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Pages 1-9"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jjcc.2025.11.004
Zhiyuan Ma MD, PhD
{"title":"Author's reply: Impact of congestive heart failure on early fluid administration and mortality in patients with sepsis","authors":"Zhiyuan Ma MD, PhD","doi":"10.1016/j.jjcc.2025.11.004","DOIUrl":"10.1016/j.jjcc.2025.11.004","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Pages 111-112"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Frailty has increasingly been recognized as an important factor influencing the prognosis of older patients with heart failure (HF). While previous studies have primarily focused on physical frailty, the need for comprehensive frailty assessments, including assessments of cognitive and social aspects, has been emphasized for effective HF management. Although the importance of multidimensional frailty assessment has been highlighted in the past, specific indicators for defining multidimensional frailty and its relationship with prognosis have not been clearly established to date. The FRAGILE-HF cohort study is a multicenter prospective cohort study that investigates the prevalence, overlap, and prognostic impact of multidimensional frailty in older patients with HF. The primary objective of this project was to address issues related to multidimensional frailty in older patients with HF. Additionally, this study provides extensive foundational data not only on frailty but also on sarcopenia and cachexia, which are commonly observed in older patients with HF. This review summarizes the current understanding of physical and non-physical frailty, sarcopenia, and cachexia in patients with HF, with a focus on insights from the FRAGILE-HF registry.
{"title":"Current findings and challenges on frailty, sarcopenia, and cachexia in older patients with heart failure: insights from the FRAGILE-HF study","authors":"Shota Uchida PT, PhD , Kentaro Kamiya PT, PhD, FJCC , Masashi Yamashita PT, PhD , Takumi Noda PT, PhD , Nobuyuki Kagiyama MD, PhD , Yuya Matsue MD, PhD","doi":"10.1016/j.jjcc.2025.05.013","DOIUrl":"10.1016/j.jjcc.2025.05.013","url":null,"abstract":"<div><div>Frailty has increasingly been recognized as an important factor influencing the prognosis of older patients with heart failure (HF). While previous studies have primarily focused on physical frailty, the need for comprehensive frailty assessments, including assessments of cognitive and social aspects, has been emphasized for effective HF management. Although the importance of multidimensional frailty assessment has been highlighted in the past, specific indicators for defining multidimensional frailty and its relationship with prognosis have not been clearly established to date. The FRAGILE-HF cohort study is a multicenter prospective cohort study that investigates the prevalence, overlap, and prognostic impact of multidimensional frailty in older patients with HF. The primary objective of this project was to address issues related to multidimensional frailty in older patients with HF. Additionally, this study provides extensive foundational data not only on frailty but also on sarcopenia and cachexia, which are commonly observed in older patients with HF. This review summarizes the current understanding of physical and non-physical frailty, sarcopenia, and cachexia in patients with HF, with a focus on insights from the FRAGILE-HF registry.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Pages 10-16"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study evaluated the safety of sacubitril/valsartan for up to 52 weeks in Japanese patients with chronic heart failure (CHF) in real-world settings.
Methods
This was an uncontrolled, multicenter, observational study conducted at 120 sites in Japan. Adult patients on standard of care for CHF and newly initiated on sacubitril/valsartan were included. The primary outcome was the exposure-adjusted incidence rate (EAIR: patients/100 patient-years) of adverse drug reactions (ADRs) and adverse events of interest (related to hypotension, hyperkalemia, renal impairment, and dehydration). The impact of patient risk factors on ADRs and clinical outcomes (EAIR of the composite endpoint [cardiovascular (CV) death or first hospitalization due to heart failure], and its components) were also assessed.
Results
Overall, 682 patients (median age: 78.0 years, male: 61.4 %, age 75 years: 61.9 %) were assessed. Sacubitril/valsartan was typically initiated at 50 mg twice daily and up-titrated to 100 mg or 200 mg sequentially at 2- to 4-week intervals. Dose adjustments were made in 57.2 % of patients. EAIRs of ADRs related to hypotension, hyperkalemia, renal impairment, and dehydration were 7.776, 0.606, 0.913, and 0.151, respectively. The incidence of ADRs was 9.7 %, with hypotension (4.7 %) and decreased blood pressure (1.8 %) being the most common ADRs. Patients with systolic blood pressure (SBP) of ≤120 mmHg at sacubitril/valsartan initiation had a higher risk of ADRs than those in other SBP groups. EAIRs for composite endpoints, CV death, and first hospitalization for heart failure were 9.404, 2.269, and 8.150, respectively.
Conclusions
This study did not show notable differences from the known safety profile of sacubitril/valsartan, and no new safety concerns were identified in Japanese patients with CHF. The EAIR of the composite endpoint of CV death or first hospitalization due to heart failure was lower than that in patients enrolled in clinical studies at the time of approval.
{"title":"Real-world safety of sacubitril/valsartan in Japanese patients with chronic heart failure: A post-marketing surveillance study","authors":"Jiro Arita PhD , Tomomi Ohishi , Takayoshi Sasajima MS , Daisuke Yarimizu PhD , Katsuya Onishi MD, PhD","doi":"10.1016/j.jjcc.2025.05.020","DOIUrl":"10.1016/j.jjcc.2025.05.020","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluated the safety of sacubitril/valsartan for up to 52 weeks in Japanese patients with chronic heart failure (CHF) in real-world settings.</div></div><div><h3>Methods</h3><div>This was an uncontrolled, multicenter, observational study conducted at 120 sites in Japan. Adult patients on standard of care for CHF and newly initiated on sacubitril/valsartan were included. The primary outcome was the exposure-adjusted incidence rate (EAIR: patients/100 patient-years) of adverse drug reactions (ADRs) and adverse events of interest (related to hypotension, hyperkalemia, renal impairment, and dehydration). The impact of patient risk factors on ADRs and clinical outcomes (EAIR of the composite endpoint [cardiovascular (CV) death or first hospitalization due to heart failure], and its components) were also assessed.</div></div><div><h3>Results</h3><div>Overall, 682 patients (median age: 78.0 years, male: 61.4 %, age 75 years: 61.9 %) were assessed. Sacubitril/valsartan was typically initiated at 50 mg twice daily and up-titrated to 100 mg or 200 mg sequentially at 2- to 4-week intervals. Dose adjustments were made in 57.2 % of patients. EAIRs of ADRs related to hypotension, hyperkalemia, renal impairment, and dehydration were 7.776, 0.606, 0.913, and 0.151, respectively. The incidence of ADRs was 9.7 %, with hypotension (4.7 %) and decreased blood pressure (1.8 %) being the most common ADRs. Patients with systolic blood pressure (SBP) of ≤120 mmHg at sacubitril/valsartan initiation had a higher risk of ADRs than those in other SBP groups. EAIRs for composite endpoints, CV death, and first hospitalization for heart failure were 9.404, 2.269, and 8.150, respectively.</div></div><div><h3>Conclusions</h3><div>This study did not show notable differences from the known safety profile of sacubitril/valsartan, and no new safety concerns were identified in Japanese patients with CHF. The EAIR of the composite endpoint of CV death or first hospitalization due to heart failure was lower than that in patients enrolled in clinical studies at the time of approval.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Pages 92-101"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The prevalence of calcific mitral stenosis (MS), which is associated with mitral annular calcification (MAC), has been increasing, particularly in aging populations such as in Japan. Severe MAC interferes with the normal diastolic relaxation of the mitral annulus, and calcification can extend onto the mitral leaflets with reduced leaflet mobility, causing MS. As MAC frequently coexists with aortic stenosis, aortic stenosis is a strong risk factor for calcific MS among patients with MAC. The advent and expansion of transcatheter aortic valve implantation revealed attendant challenges of calcific MS. The diagnosis and severity assessment of calcific MS differ from rheumatic MS. Further, the combination of aortic and mitral stenoses complicates the hemodynamic assessment. Calcific MS is frequently observed in elderly patients with multiple comorbidities; therefore the prognosis of calcific MS is influenced by these comorbidities as well as the patient's general condition. Surgical mitral valve replacement is considered an optimal treatment for MS. However, severe MAC poses significant challenges for surgeons, often requiring debridement, decalcification, and annular reconstruction, which lead to an increased surgical risk. Because perioperative mortality can be high in these patients undergoing high-risk cardiac surgery, medical therapy is preferred, and less invasive surgical procedures or catheter interventions are considered. This review integrates the latest insights into the pathophysiology, diagnosis, prognosis, and treatment options of calcific MS, highlighting its clinical challenges.
{"title":"Clinical challenges in calcific mitral stenosis from diagnosis to management","authors":"Nahoko Kato MD, PhD , Hiroyuki Watanabe MD, PhD, FJCC , Patricia A. Pellikka MD , Mayra Guerrero MD","doi":"10.1016/j.jjcc.2025.06.014","DOIUrl":"10.1016/j.jjcc.2025.06.014","url":null,"abstract":"<div><div>The prevalence of calcific mitral stenosis (MS), which is associated with mitral annular calcification (MAC), has been increasing, particularly in aging populations such as in Japan. Severe MAC interferes with the normal diastolic relaxation of the mitral annulus, and calcification can extend onto the mitral leaflets with reduced leaflet mobility, causing MS. As MAC frequently coexists with aortic stenosis, aortic stenosis is a strong risk factor for calcific MS among patients with MAC. The advent and expansion of transcatheter aortic valve implantation revealed attendant challenges of calcific MS. The diagnosis and severity assessment of calcific MS differ from rheumatic MS. Further, the combination of aortic and mitral stenoses complicates the hemodynamic assessment. Calcific MS is frequently observed in elderly patients with multiple comorbidities; therefore the prognosis of calcific MS is influenced by these comorbidities as well as the patient's general condition. Surgical mitral valve replacement is considered an optimal treatment for MS. However, severe MAC poses significant challenges for surgeons, often requiring debridement, decalcification, and annular reconstruction, which lead to an increased surgical risk. Because perioperative mortality can be high in these patients undergoing high-risk cardiac surgery, medical therapy is preferred, and less invasive surgical procedures or catheter interventions are considered. This review integrates the latest insights into the pathophysiology, diagnosis, prognosis, and treatment options of calcific MS, highlighting its clinical challenges.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Pages 51-60"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent studies showed that clinical parameters other than cardiac function, such as physical function, cognitive function, mental status, social status, and quality of life, were associated with heart failure (HF) prognosis. These parameters have not been extensively investigated in large Japanese cohorts. Furthermore, novel biomarkers to predict prognosis or treatment responses are required to provide individualized medicine. To address these issues, we developed the Japanese Registry Of Acute Decompensated Heart Failure (JROADHF-NEXT).
Methods
JROADHF-NEXT is a prospective, multicenter, nationwide registry of patients hospitalized for acute decompensated HF. A total of 4016 patients were enrolled from 87 centers and blood and urine samples were collected from 3203 of these patients. The study protocol using the JROADHF-NEXT database was approved by all Kyushu University, International University of Health and Welfare and participating hospitals.
Results
The mean age was 72.9 ± 14.0 years and 61.4 % were male. Cardiomyopathy was the most common etiology (24.4 %). Volume overload and arrhythmia accounted for 26.3 % and 17.4 % of precipitating causes. The median follow-up period was 2.0 (1.6–2.2) years and 2-year follow-up completion rate was 88.5 % (n = 3554). The incidence rates for cardiovascular death and rehospitalization for HF were 5.2 and 16.7 per 100 person-years, respectively.
Conclusions
The JROADHF-NEXT is a large-scale HF registry comprising extensive clinical variables with a biobank. This registry is anticipated to provide valuable insights and serve as a significant source of evidence for future research and clinical practice.
{"title":"Clinical characteristics and outcomes of hospitalized patients with heart failure from the Japanese prospective registry","authors":"Nobuyuki Enzan MD, PhD , Takeshi Tohyama MD, PhD , Tatsuya Watanabe , Takuya Nagata MD, PhD , Eri Noda MD , Yoshitomo Tsutsui MD , Masataka Ikeda MD, PhD , Takafumi Sakamoto MD, PhD , Shouji Matsushima MD, PhD , Yuya Matsue MD, PhD , Takeshi Kitai MD, PhD , Tatsunori Taniguchi MD, PhD , Keisuke Kida MD, PhD, FJCC , Takahiro Okumura MD, PhD, FJCC , Takuya Kishi MD, PhD, FJCC , Tomomi Ide MD, PhD , Hiroyuki Tsutsui MD, PhD, FJCC","doi":"10.1016/j.jjcc.2025.05.015","DOIUrl":"10.1016/j.jjcc.2025.05.015","url":null,"abstract":"<div><h3>Background</h3><div>Recent studies showed that clinical parameters other than cardiac function, such as physical function, cognitive function, mental status, social status, and quality of life, were associated with heart failure (HF) prognosis. These parameters have not been extensively investigated in large Japanese cohorts. Furthermore, novel biomarkers to predict prognosis or treatment responses are required to provide individualized medicine. To address these issues, we developed the Japanese Registry Of Acute Decompensated Heart Failure (JROADHF-NEXT).</div></div><div><h3>Methods</h3><div>JROADHF-NEXT is a prospective, multicenter, nationwide registry of patients hospitalized for acute decompensated HF. A total of 4016 patients were enrolled from 87 centers and blood and urine samples were collected from 3203 of these patients. The study protocol using the JROADHF-NEXT database was approved by all Kyushu University, International University of Health and Welfare and participating hospitals.</div></div><div><h3>Results</h3><div>The mean age was 72.9 ± 14.0 years and 61.4 % were male. Cardiomyopathy was the most common etiology (24.4 %). Volume overload and arrhythmia accounted for 26.3 % and 17.4 % of precipitating causes. The median follow-up period was 2.0 (1.6–2.2) years and 2-year follow-up completion rate was 88.5 % (<em>n</em> = 3554). The incidence rates for cardiovascular death and rehospitalization for HF were 5.2 and 16.7 per 100 person-years, respectively.</div></div><div><h3>Conclusions</h3><div>The JROADHF-NEXT is a large-scale HF registry comprising extensive clinical variables with a biobank. This registry is anticipated to provide valuable insights and serve as a significant source of evidence for future research and clinical practice.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Pages 85-91"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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