Journal of cardiology最新文献_第2页

Antiarrhythmic potential of SGLT2 inhibitors: Mechanistic insights and clinical evidence SGLT2抑制剂的抗心律失常潜力：机制见解和临床证据。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-02-01 DOI: 10.1016/j.jjcc.2025.09.018

Shinya Fujiki MD, PhD

Sodium-glucose cotransporter 2 (SGLT2) inhibitors were originally developed to treat type 2 diabetes by promoting glycosuria through inhibition of renal glucose reabsorption. However, their clinical utility has expanded rapidly following the demonstration of consistent cardiovascular and renal benefits in large-scale randomized controlled trials. These trials have shown that SGLT2 inhibitors significantly reduce adverse cardiovascular outcomes—including sudden cardiac death—in patients with diabetes, heart failure, or chronic kidney disease, irrespective of glycemic control. As clinical experience has accumulated, several unanticipated hypotheses have emerged—one of which is that SGLT2 inhibitors may exert antiarrhythmic effects. This review summarizes the current evidence for antiarrhythmic effects of SGLT2 inhibitors, from both mechanistic and clinical perspectives. Experimental studies suggest that these agents modulate arrhythmogenic substrates via multiple pathways: inhibition of sodium–hydrogen exchanger 1, suppression of the late sodium current, modulation of potassium currents, attenuation of sympathetic tone, hemodynamic improvement, and enhanced myocardial energy efficiency through increased ketone body utilization. These cellular and systemic changes may attenuate arrhythmogenic remodeling and reduce the risk of both atrial and ventricular arrhythmias. Clinically, post-hoc analyses and meta-analyses of major SGLT2 inhibitor trials have reported reductions in the incidence of atrial fibrillation/flutter and ventricular arrhythmias, although findings have been somewhat heterogeneous. A small number of prospective studies using implantable cardioverter defibrillators have also provided high-resolution evidence supporting this effect. While definitive large-scale trials with arrhythmia-specific endpoints are still lacking, the potential antiarrhythmic benefits of SGLT2 inhibitors represent a promising area for further research and may help explain their ability to reduce sudden cardiac death across a range of cardiovascular conditions.

钠-葡萄糖共转运蛋白2 （SGLT2）抑制剂最初被开发用于治疗2型糖尿病，通过抑制肾脏葡萄糖重吸收促进糖尿。然而，在大规模随机对照试验中显示出一致的心血管和肾脏益处后，它们的临床应用迅速扩大。这些试验表明，无论血糖控制情况如何，SGLT2抑制剂均可显著降低糖尿病、心力衰竭或慢性肾脏疾病患者的心血管不良结局，包括心源性猝死。随着临床经验的积累，出现了一些意想不到的假设，其中之一是SGLT2抑制剂可能具有抗心律失常的作用。本文从机制和临床两方面综述了SGLT2抑制剂抗心律失常作用的现有证据。实验研究表明，这些药物通过多种途径调节致心律失常底物：抑制钠氢交换1，抑制晚期钠电流，调节钾电流，减弱交感神经张力，改善血流动力学，并通过增加酮体利用率提高心肌能量效率。这些细胞和全身的改变可以减轻致心律失常重构，降低心房和室性心律失常的风险。临床上，主要SGLT2抑制剂试验的事后分析和荟萃分析报告了房颤/扑动和室性心律失常发生率的降低，尽管结果有些不一致。少数使用植入式心律转复除颤器的前瞻性研究也提供了支持这种效果的高分辨率证据。虽然目前仍缺乏具有心律失常特异性终点的明确的大规模试验，但SGLT2抑制剂的潜在抗心律失常益处代表了一个有希望进一步研究的领域，并可能有助于解释它们在一系列心血管疾病中减少心源性猝死的能力。

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引用次数: 0

Precision cardiology: Integrating gene therapy, genome editing, and single-cell genomics 精准心脏病学：整合基因治疗、基因组编辑和单细胞基因组学。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-02-01 DOI: 10.1016/j.jjcc.2025.09.009

Tomohiro Nishino MD, PhD, Koh Ono MD, PhD

Gene therapy is poised to revolutionize cardiovascular medicine by targeting the molecular roots of disease. This review examines the evolution of gene therapy, highlighting its past progress and future potential with emerging technologies. We first assess foundational gene addition and silencing strategies, noting clinical progress for monogenic cardiomyopathies alongside significant setbacks in multifactorial heart failure, driven mainly by the central challenge of vector delivery. We then discuss the evolution of delivery platforms, from engineered adeno-associated virus capsids to targeted lipid nanoparticles, which are designed to enhance cardiac specificity and safety. Concurrently, the gene editing revolution—progressing from the foundational Clustered Regularly Interspaced Short Palindromic Repeats-Cas9 system to high-fidelity base and prime editors—is enabling the direct correction of pathogenic mutations with increasing precision. Catalyzing these therapeutic platforms is the recent explosion in single-cell genomics, which provides an unprecedented resolution of cardiac pathology, revealing novel cell-specific targets previously obscured by bulk analysis. We conclude that the synergistic convergence of these pillars—genomics-driven discovery, precision genome editing, and targeted delivery—is creating a new paradigm of precision cardiology, moving the field from chronic management towards durable, curative interventions.

基因疗法瞄准疾病的分子根源，准备彻底改变心血管医学。本文回顾了基因治疗的发展，强调了其过去的进展和未来的潜力与新兴技术。我们首先评估了基础基因添加和沉默策略，注意到单基因心肌病的临床进展以及多因素心力衰竭的重大挫折，主要是由载体递送的核心挑战驱动的。然后，我们讨论了递送平台的演变，从工程腺相关病毒衣壳到靶向脂质纳米颗粒，旨在提高心脏的特异性和安全性。与此同时，基因编辑革命——从基础的Clustered Regularly Interspaced Short Palindromic Repeats-Cas9系统发展到高保真的碱基和引物编辑器——正在以越来越高的精度直接纠正致病性突变。催化这些治疗平台的是最近单细胞基因组学的爆炸式发展，它提供了前所未有的心脏病理学分辨率，揭示了以前被批量分析所掩盖的新的细胞特异性靶点。我们的结论是，这些支柱——基因组学驱动的发现、精确的基因组编辑和靶向递送——的协同融合正在创造一个精确心脏病学的新范例，将该领域从慢性管理转向持久的、治愈性的干预。

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引用次数: 0

Early-phase heart rate in patients with out-of-hospital cardiac arrest who received extracorporeal cardiopulmonary resuscitation: A retrospective multicenter study in Japan 院外心脏骤停患者接受体外心肺复苏的早期心率：日本的一项回顾性多中心研究

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-02-01 DOI: 10.1016/j.jjcc.2025.06.016

Takuya Taira MD , Akihiko Inoue MD , Shinichi Ijuin MD , Takeshi Nishimura MD , Taiki Moriyama MD , Masahide Omoda MD , Toru Hifumi MD , Tetsuya Sakamoto MD , Yasuhiro Kuroda MD , Satoshi Ishihara MD , the SAVE-J II study group

Background

The association between heart rate (HR) and clinical outcomes in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) remains unclear. The current study aimed to investigate the association between HR in the early phase and in-hospital mortality and unfavorable neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA) who received ECPR.

Methods

We performed a secondary analysis of the SAVE-J II study, retrospective multicenter study involving patients aged ≥18 years who experienced OHCA and received ECPR between 2013 and 2018 in Japan. Adult patients with OHCA of presumed cardiac etiology who were admitted to the intensive care unit were included in the analysis. Early-phase HR was defined as the patients' HR within 3 days after intensive care unit admission. We examined the association between early-phase maximum HR and outcomes. The primary outcome was in-hospital mortality, and the secondary outcome was an unfavorable neurological outcome (cerebral performance category scores of 3–5 at discharge). The logistic regression models were fitted with a generalized estimating equation to account for patient clustering within a hospital.

Results

In total, 643 patients met our inclusion criteria. The in-hospital mortality rate was 49.0 % (n = 315), and the proportion of patients with unfavorable neurological outcomes was 73.4 % (n = 472). The median early-phase maximum HR was 97 beats per minute. According to the generalized estimating equation analysis, early-phase maximum HR was significantly associated with in-hospital mortality [odds ratio (OR): 1.08, 95 % confidence interval (CI): 1.03–1.13, p < 0.001] and an unfavorable neurological outcome (OR: 1.04, 95 % CI: 1.00–1.09, p = 0.044).

Conclusions

High HR in the early phase was associated with in-hospital mortality and unfavorable neurological outcomes in patients with OHCA who received ECPR.

背景：接受体外心肺复苏（ECPR）患者的心率（HR）与临床结果之间的关系尚不清楚。本研究旨在探讨院外心脏骤停（OHCA）患者接受ECPR后早期HR与院内死亡率和不良神经系统预后之间的关系。方法：我们对SAVE-J II研究进行了二次分析，这是一项回顾性多中心研究，涉及年龄≥18 岁的日本患者，他们在2013年至2018年期间经历了OHCA并接受了ECPR。假定心脏病因的成年OHCA患者被纳入重症监护病房的分析。早期HR定义为患者在重症监护室入院后3 天内的HR。我们检查了早期最大HR与预后之间的关系。主要结局是住院死亡率，次要结局是不利的神经系统结局（出院时脑功能分类评分为3-5）。逻辑回归模型与广义估计方程拟合，以解释医院内的患者聚类。结果：共有643例患者符合我们的纳入标准。住院死亡率为49.0 % (n = 315)，神经系统预后不良患者比例为73.4 % （n = 472）。早期最大HR中位数为每分钟97次。根据广义估计方程分析，早期最大HR与住院死亡率显著相关[优势比（OR）： 1.08, 95 %置信区间（CI）： 1.03-1.13， p ]结论：早期高HR与接受ECPR的OHCA患者的住院死亡率和不良神经预后相关。

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引用次数: 0

Proteome-wide Mendelian randomization and colocalization analyses identify novel protein targets for cardiac conduction disorders 蛋白质组范围的孟德尔随机化和共定位分析确定了心脏传导障碍的新蛋白靶点。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-02-01 DOI: 10.1016/j.jjcc.2025.07.005

Zheng-Qi Song MD , Yu-Peng Xu MD , Yi-Qi Chen MD , Han Zeng MD , Xiao-Shu Lin MD , Xin-Yu Lu MD , Yu-Tao MD , Si Shi MD , Yi-He Chen MD, PhD

Background

The occurrence and progression of cardiac conduction disorder (CCD) pose a significant threat to people's health. However, current pharmacological treatments for CCD are relatively limited, with few mechanistic studies and intervention strategies.

Methods

We derived protein quantitative trait loci from two comprehensive databases: UKBPPP and deCODE Health study. Genetic associations with CCD and its subsets were obtained from the FinnGen R11 database. Summary-data-based Mendelian randomization and colocalization analyses were conducted to identify potential protein targets. Phenome-wide association study (PheWAS), multivariable Mendelian randomization (MVMR), and multi-omic analyses were further performed to elucidate the underlying biological mechanisms of the identified protein targets.

Results

Genetically predicted CASP9 (OR: 2.65, 95 % CI: 1.65 to 4.26, p_FDR = 0.007) and ASPH (OR: 2.03, 95 % CI: 1.32 to 3.11, p_FDR = 0.024) were significantly associated with a higher risk of atrioventricular block, while genetically predicted SRA1 (OR: 0.54, 95 % CI: 0.39 to 0.75, p_FDR = 0.009) was markedly associated with a lower risk of atrioventricular block. Additionally, the protein CFHR5 (OR: 0.82, 95 % CI: 0.70 to 0.96, p_FDR = 0.157) was linked to a decreased incidence of left bundle branch block with suggestive significance. PheWAS and MVMR analyses suggested that hyperkalemia may serve as a potential mediating pathway between CASP9 and atrioventricular block. Multi-omics analysis revealed several methylation sites of CASP9 linked with atrioventricular block.

Conclusion

We identified several novel protein targets for CCD and uncovered their underlying biological processes.

背景：心传导障碍（CCD）的发生和发展严重威胁着人们的健康。然而，目前对CCD的药物治疗相对有限，缺乏机制研究和干预策略。方法：从UKBPPP和deCODE Health研究两个综合数据库中获得蛋白质数量性状位点。与CCD及其亚群的遗传关联从FinnGen R11数据库中获得。采用基于汇总数据的孟德尔随机化和共定位分析来确定潜在的蛋白质靶点。研究人员通过全现象关联研究（PheWAS）、多变量孟德尔随机化（MVMR）和多组学分析进一步阐明了所鉴定蛋白靶点的潜在生物学机制。结果:基因预测CASP9 (OR: 2.65, 95 % CI: 1.65至4.26,pFDR = 0.007)和沥青质(OR: 2.03, 95 % CI: 1.32至3.11,pFDR = 0.024)明显与房室传导阻滞的风险更高,而基因预测SRA1 (OR: 0.54, 95 % CI: 0.39至0.75,pFDR = 0.009)是显著降低房室传导阻滞的风险。此外，CFHR5蛋白（OR: 0.82, 95 % CI: 0.70至0.96,pFDR = 0.157）与左束支阻滞发生率降低有关，具有提示意义。PheWAS和MVMR分析提示高钾血症可能是CASP9和房室传导阻滞之间的潜在介导途径。多组学分析显示CASP9的几个甲基化位点与房室传导阻滞相关。结论：我们发现了几个新的CCD蛋白靶点，并揭示了它们潜在的生物学过程。

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引用次数: 0

Clinical and speckle tracking echocardiographic predictors of left ventricular thrombus following primary percutaneous coronary intervention for anterior ST-elevation myocardial infarction 经皮冠状动脉介入治疗st段抬高型心肌梗死后左室血栓的临床和斑点追踪超声心动图预测指标。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-02-01 DOI: 10.1016/j.jjcc.2025.07.007

Heba M. El-Naggar MD, Alaa A. Abdel-Gaber MSc, Yehia T. Kishk MD, Tarek A.N. Ahmed MD, PhD

Background

Left ventricular thrombus (LVT) remains a serious complication of acute ST-elevation myocardial infarction (STEMI), mandating timely detection and proper antithrombotic therapy. This study aimed to assess the incidence and possible clinical and echocardiographic predictors of LVT development.

Methods

This study prospectively included 300 patients with acute anterior STEMI who underwent primary percutaneous coronary intervention (PPCI). Serial echocardiographic examinations were performed at three time-points post-PPCI: in-hospital, 2-weeks, and 3-months to assess LVT development. LV global (GLS) and regional longitudinal strain (LS) and radial strain were determined. The occurrence of major adverse cardiovascular events (MACE) at three months post-PPCI was reported.

Results

The incidence of LVT development was 16.3 %, most of which (51 %) were detected early at the post-PPCI in-hospital echocardiography examination, whereas 22.4 % were detected at 2 weeks and 26.5 % after 3 months post-PPCI. Prior infarction, longer total ischemic time, no or partial ST-segment resolution, and high coronary thrombus grade were significant independent predictors of LVT development. On receiver operating characteristic analysis, baseline GLS ≥ -11.08 % [area under the curve (AUC) = 0.73, 95 % confidence interval (CI) = 0.65–0.81, p < 0.001] and apical LS ≥ -4.9 % (AUC = 0.75, 95 % CI = 0.69–0.82, p < 0.001) showed significant discrimination for LVT. Adjusted for other covariates, impaired baseline apical LS was the only echocardiographic independent predictor of later LVT development at 2 weeks and 3 months post-PPCI. MACE were significantly higher among patients who developed LVT. LVT resolution was achieved in 93.3 % after three months of anticoagulation.

Conclusion

Serial echocardiographic studies after acute anterior STEMI improved LVT detection. The occurrence of LVT within three months following PPCI was associated with impaired GLS and apical LS obtained after PPCI.

背景：左室血栓（LVT）仍然是急性st段抬高型心肌梗死（STEMI）的严重并发症，需要及时发现和适当的抗血栓治疗。本研究旨在评估LVT的发生率和可能的临床和超声心动图预测因素。方法：本研究前瞻性纳入300例经皮冠状动脉介入治疗（PPCI）的急性STEMI患者。在ppci后的三个时间点进行连续超声心动图检查：住院、2周和3个月，以评估LVT的发展。测量LV全局应变（GLS）、区域纵向应变（LS）和径向应变。报告了ppci后3个月主要不良心血管事件（MACE）的发生情况。结果：LVT发生的发生率为16.3 %，其中大部分（51 %）在ppci术后住院超声心动图检查中早期发现，而在ppci术后2 周和3 个月时发现的发生率分别为22.4 %和26.5 %。既往梗死、总缺血时间较长、st段不溶解或部分溶解、冠状动脉血栓等级高是LVT发展的重要独立预测因素。接受者操作特征分析,在基线gl ≥-11.08  %(曲线下的面积(AUC) = 0.73,95 %可信区间(CI) = 0.65 - -0.81,p 结论:连续超声心动图研究急性前STEMI后改进从而检测。PPCI后3个月内LVT的发生与PPCI后GLS和根尖LS受损有关。

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引用次数: 0

Evaluating the intersectionality of race and gender and its impact on heart transplant equity, listing outcomes, and allocation policy 评估种族和性别的交叉性及其对心脏移植公平性的影响，列出结果和分配政策。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-02-01 DOI: 10.1016/j.jjcc.2025.06.007

Ahad Firoz MD , Huaqing Zhao PhD , Xiaoning Lu MS , Eman Hamad MD

Background

Although there are existing studies on the role of race- and gender-based disparities as one-dimensional elements in heart transplantation (HTx), few reports have examined the intersection of such identities. Our study investigates the intersectionality of race and gender, and its impact on HTx waitlist outcomes.

Methods

Data from adult patients listed for orthotopic HTx between 2010 and 2023 were analyzed using the United Network for Organ Sharing database. Inclusion criteria included “White” and “Black” races. Exclusion criteria included missing data in race or gender, a previous history of HTx, or concurrent listing for other transplants. Four groups were created using a combination of race and gender. Waitlist outcomes of interest include transplantation and death using competing-risk models.

Results

In total, 37,796 patients were included in this analysis, of which 55.1 % were White-male (M), 17.4 % White-female (F), 18.6 % Black-M, and 8.9 % Black-F. Relative to White-M, Black-M (HR = 0.86, p < 0.001) and Black-F (HR = 0.82, p < 0.001) had decreased odds of transplantation. In the survival models, both female groups had a decreased mortality risk compared to White-M (White-F: HR = 0.56, p = 0.001; Black-F: HR = 0.61, p = 0.008) and Black-M (White-F: HR = 0.60, p = 0.005; Black-F: HR = 0.64, p = 0.025). Following the 2018 policy changes, with reference to White-F, Black-M (0.94, p = 0.189) had comparable odds of HTx while Black-F (HR = 0.91, p = 0.618) had a similar pattern of survival.

Conclusion

Disparities on the HTx waiting list continue to exist. Black patients had decreased odds of transplantation compared to White groups. Additionally, females had superior overall survival on the waitlist. Although outcomes appear to have improved marginally for some vulnerable groups in the new allocation system, further work is required to achieve equity on the heart transplant waiting list.

背景：虽然已有关于种族和性别差异作为心脏移植（HTx）的一维因素的研究，但很少有报道检查了这些身份的交集。我们的研究调查了种族和性别的交叉性，及其对HTx候补名单结果的影响。方法：使用美国器官共享网络数据库对2010年至2023年成人原位HTx患者的数据进行分析。入选标准包括“白人”和“黑人”种族。排除标准包括种族或性别数据缺失、既往HTx病史或其他移植同时上市。根据种族和性别组合创建了四组。候选结果包括使用竞争风险模型的移植和死亡。结果：共纳入37796例患者，其中55.1% %为白人男性(M)， 17.4% %为白人女性(F)， 18.6% %为黑人-M， 8.9 %为黑人-F。相对于White-M， Black-M （HR = 0.86,p ）结论：HTx候诊名单上的差异仍然存在。与白人患者相比，黑人患者移植的几率降低。此外，女性在等待名单上的总体存活率更高。虽然在新的分配制度下，一些弱势群体的结果似乎有所改善，但在心脏移植等待名单上实现公平还需要进一步的工作。

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引用次数: 0

Degree of mitral regurgitation in children with ventricular septal defect after surgical closure: A comparative study with and without mitral valve repair - A retrospective research 小儿室间隔缺损手术关闭后二尖瓣返流程度：有二尖瓣修复和没有二尖瓣修复的比较研究-回顾性研究。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-02-01 DOI: 10.1016/j.jjcc.2025.07.006

Wenfeng Li MM , Mengjie Zhou MM , Taoyue Yao MM , Jinqiao Liu MD , Xicheng Deng MD

In cases of ventricular septal defect (VSD) accompanied by mitral regurgitation (MR), there is a lack of clear guidelines regarding the necessity of concomitant mitral valve repair (MVR) during VSD surgical closure. This study aimed to evaluate the degree of MR in children with VSD after surgical closure, comparing outcomes with and without MVR, to assess the necessity of simultaneous MVR. Between January 2010 and January 2023, pediatric patients with VSD and moderate or severe MR who underwent surgical treatment at Hunan Children's Hospital were enrolled. They were categorized into two groups: Group I (VSD repair only) and Group II (VSD repair with MVR). Clinical and surgical data were collected and analyzed. Follow-up commenced from the date of surgery. The primary endpoint was defined as the resolution of MR to a trivial or none level. Survival curves were plotted using the Kaplan-Meier method, and patient outcomes were monitored to determine the necessity of MVR. In pediatric patients with VSD accompanied by MR, MR often resolves with VSD closure alone in the absence of structural MV defects. However, simultaneous MVR offers significant advantages for patients exhibiting overt mitral valve prolapse, cleft, and mitral annular dilatation.

在室间隔缺损（VSD）合并二尖瓣返流（MR）的病例中，关于在室间隔缺损手术关闭期间合并二尖瓣修复（MVR）的必要性缺乏明确的指南。本研究旨在评估儿童VSD手术关闭后的MR程度，比较MVR和不MVR的结果，以评估同时MVR的必要性。2010年1月至2023年1月，在湖南儿童医院接受手术治疗的VSD和中度或重度MR患儿被纳入研究对象。他们被分为两组：I组（仅VSD修复）和II组（MVR修复VSD）。收集并分析临床及手术资料。随访自手术之日起开始。主要终点定义为MR的分辨率为微不足道或无水平。使用Kaplan-Meier法绘制生存曲线，并监测患者预后以确定MVR的必要性。在室间隔缺损伴有MR的儿童患者中，MR通常在没有结构性MV缺陷的情况下仅通过室间隔缺损闭合来解决。然而，同时MVR对于表现出明显二尖瓣脱垂、二尖瓣裂和二尖瓣环扩张的患者具有显著的优势。

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引用次数: 0

Current risk stratification schemes for preventing ischemic stroke in patients with nonvalvular atrial fibrillation: HELT-E2S2 and CHA2DS2-VA scores 目前预防非瓣膜性房颤患者缺血性卒中的风险分层方案：HELT-E2S2和CHA2DS2-VA评分

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-02-01 DOI: 10.1016/j.jjcc.2025.10.005

Hirofumi Tomita MD, PhD, FJCC , Ken Okumura MD, PhD

In Japan, the CHADS₂ score has long been recommended as a Class I indication for risk stratification in patients with nonvalvular atrial fibrillation. However, the recent Japanese Circulation Society guidelines have proposed the HELT-E₂S₂ score as a Class IIa recommendation, which is a novel risk stratification system developed using the pooled data from five registries in Japan. In Europe, the CHA₂DS₂-VASc score has been adopted as a Class I recommendation over the past decade. However, the 2024 European Society of Cardiology guidelines have newly recommended the CHA₂DS₂-VA score as a Class I indication, excluding the sex category from the original CHA₂DS₂-VASc score. This review will first present the background and rationale for the development of the HELT-E₂S₂ score, followed by a summary of the current status of its clinical validation and the remaining challenges that need to be addressed. In addition, a focused discussion will be provided on the comparison between the recently highlighted CHA₂DS₂-VA score and the widely used CHA₂DS₂-VASc score, emphasizing their similarities, differences, and potential implications for risk stratification.

在日本，CHADS2评分长期以来被推荐为非瓣膜性房颤患者风险分层的一级指征。然而，最近的日本循环学会指南提出HELT-E2S2评分为IIa级推荐，这是一种新的风险分层系统，使用了日本五个注册中心的汇总数据。在欧洲，CHA2DS2-VASc评分在过去十年中被采纳为一级推荐。然而，2024年欧洲心脏病学会指南新推荐CHA2DS2-VA评分作为I类指征，从原始CHA2DS2-VASc评分中排除性别类别。本文将首先介绍HELT-E2S2评分的开发背景和基本原理，然后总结其临床验证的现状和需要解决的挑战。此外，将重点讨论最近备受关注的CHA2DS2-VA评分与广泛使用的CHA2DS2-VASc评分之间的比较，强调它们的异同，以及对风险分层的潜在影响。

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引用次数: 0

Response to “Contemporary clinical implication of catheter ablation for atrial fibrillation in Japan” 对“导管消融治疗心房颤动在日本的当代临床意义”的回应。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-02-01 DOI: 10.1016/j.jjcc.2025.11.010

Hiroki Sato MD, MSc, PhD , Naohiko Takahashi MD, PhD, FJCC

引用次数: 0

Very high-power short-duration ablation for superior vena cava isolation in patients with recurrent atrial fibrillation 高功率短时间消融术治疗复发性房颤患者的上腔静脉隔离。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-02-01 DOI: 10.1016/j.jjcc.2025.06.015

Naoki Aizawa MD , Kaoru Tanno MD, PhD, FJCC , Takahiro Furuya MD, PhD , Tomoyuki Ishinaga MD , Keita Shibata MD, PhD , Chisato Sato MD, PhD , Tenjin Nishikura MD, PhD , Naoko Ikeda MD, PhD , Kohei Wakabayashi MD, PhD, FJCC , Takaaki Matsuyama MD, PhD

Background

Superior vena cava isolation (SVCI) has been proposed as a treatment for non-pulmonary vein triggers of atrial fibrillation (AF). Recently, high-power short-duration ablation has emerged as a potential strategy for SVCI, although the optimal settings remain undetermined, particularly in the lateral region. Specifically, the QDOT MICRO™ (Biosense Webster, Irvine, CA, USA) system enables very high-power, short-duration (vHPSD, 90 W for 4 s) ablation, achieving a shallower tissue depth than conventional methods. In this study, we aimed to compare the effectiveness of vHPSD with a conventional strategy (20 W, ablation index of 240) using the Thermocool SmartTouch® Surround Flow (Biosense Webster) system in patients with AF.

Methods

We retrospectively analyzed 100 consecutive patients with recurrent AF post-initial pulmonary vein isolation who underwent SVCI using either the vHPSD or 20 W strategy at our institution between January 2016 and October 2024. Outcome measures included SVCI procedure time, number of application points, the incidence of gaps in each segment, and associated complications.

Results

There were 40 participants in the vHPSD group and 60 in the 20 W group. The vHPSD group showed significantly shorter SVCI procedure time than the 20 W group (11 ± 5.5 vs. 16 ± 9.6 min, p < 0.01) and required fewer application points (21 ± 7.6 vs. 29 ± 12, p < 0.01). The incidence of gaps in the lateral segments was significantly lower in the vHPSD group (13 % vs. 38 %, p < 0.01). Only one complication (aspiration pneumonia) occurred in the 20 W group.

Conclusions

This study suggests that SVCI using vHPSD appears effective, offering potential advantages in reducing procedure time and improving efficiency.

背景：上腔静脉隔离（SVCI）已被提议作为非肺静脉诱发心房颤动（AF）的治疗方法。最近，高功率短时间消融已成为SVCI的潜在治疗策略，尽管最佳设置仍未确定，特别是在外侧区域。具体来说，QDOT MICRO™（Biosense Webster, Irvine， CA， USA）系统可以实现非常高的功率，短时间（vHPSD, 90 W, 4 s）消融，实现比传统方法更浅的组织深度。在这项研究中，我们旨在比较vHPSD与使用Thermocool SmartTouch®Surround Flow （Biosense Webster）系统治疗房颤患者的传统策略（20 W，消融指数240）的有效性。方法：我们回顾性分析了2016年1月至2024年10月在我们机构连续100例首次肺静脉隔离后使用vHPSD或20 W策略进行SVCI的复发性房颤患者。结果测量包括SVCI手术时间、应用点数量、各节段间隙发生率和相关并发症。结果：vHPSD组40例， W组20例。vHPSD组SVCI手术时间明显短于20 W组（11 ± 5.5 vs. 16 ± 9.6 min, p ）。结论：本研究提示使用vHPSD进行SVCI是有效的，在减少手术时间和提高效率方面具有潜在的优势。

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