Heart failure (HF) patients who exhibit improvement in systolic function following atrial fibrillation (AF) ablation may experience better outcomes than those who do not. However, the prognostic significance of such improvement compared to originally preserved systolic function remains unclear.
Methods
Among 1538 patients undergoing AF ablation, those meeting HF criteria were included. Patients with systolic dysfunction (n = 272) and those with a high likelihood of HF with preserved ejection fraction (HFA-PEFF score ≥ 5; pEF group, n = 293) were analyzed. The former were further subdivided based on post-procedural left ventricular ejection fraction (LVEF) into improved EF (imp-EF, LVEF ≥50 %) and non-improved EF (non-imp-EF, LVEF <50 %) groups. The primary endpoint was a composite of all-cause mortality and HF hospitalization, comparing the imp-EF and pEF groups.
Results
Among 272 patients with systolic dysfunction, 127 were categorized as imp-EF. After propensity-score matching (101 per group), the imp-EF group had comparable risk of the primary endpoint as the pEF group [HR 0.40 (0.13–1.16), p = 0.09] and similar atrial tachyarrhythmia (ATA) recurrence rates [HR 0.70 (0.37–1.30), p = 0.26] over a median follow-up of 41 (24–71) months. ATA recurrence after the last procedure was associated with adverse events in the imp-EF group, whereas E-wave velocity was the only predictor in the pEF group in univariate analysis.
Conclusions
Patients in both the imp-EF and pEF groups demonstrated comparable prognoses.
{"title":"Prognostic comparison of improved versus preserved left ventricular systolic function following atrial fibrillation ablation in heart failure patients","authors":"Miwa Kanai MD, PhD , Kyoichiro Yazaki MD, PhD , Koichiro Ejima MD, PhD , Shohei Kataoka MD, PhD , Shun Hasegawa MD , Satoshi Higuchi MD, PhD , Daigo Yagishita MD, PhD , Morio Shoda MD, PhD , Junichi Yamaguchi MD, PhD, FJCC","doi":"10.1016/j.jjcc.2025.11.005","DOIUrl":"10.1016/j.jjcc.2025.11.005","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) patients who exhibit improvement in systolic function following atrial fibrillation (AF) ablation may experience better outcomes than those who do not. However, the prognostic significance of such improvement compared to originally preserved systolic function remains unclear.</div></div><div><h3>Methods</h3><div>Among 1538 patients undergoing AF ablation, those meeting HF criteria were included. Patients with systolic dysfunction (<em>n</em> = 272) and those with a high likelihood of HF with preserved ejection fraction (HFA-PEFF score ≥ 5; pEF group, <em>n</em> = 293) were analyzed. The former were further subdivided based on post-procedural left ventricular ejection fraction (LVEF) into improved EF (imp-EF, LVEF ≥50 %) and non-improved EF (non-imp-EF, LVEF <50 %) groups. The primary endpoint was a composite of all-cause mortality and HF hospitalization, comparing the imp-EF and pEF groups.</div></div><div><h3>Results</h3><div>Among 272 patients with systolic dysfunction, 127 were categorized as imp-EF. After propensity-score matching (101 per group), the imp-EF group had comparable risk of the primary endpoint as the pEF group [HR 0.40 (0.13–1.16), <em>p</em> = 0.09] and similar atrial tachyarrhythmia (ATA) recurrence rates [HR 0.70 (0.37–1.30), <em>p</em> = 0.26] over a median follow-up of 41 (24–71) months. ATA recurrence after the last procedure was associated with adverse events in the imp-EF group, whereas <em>E</em>-wave velocity was the only predictor in the pEF group in univariate analysis.</div></div><div><h3>Conclusions</h3><div>Patients in both the imp-EF and pEF groups demonstrated comparable prognoses.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Pages 282-289"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145581963","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}
Chronic kidney disease (CKD) strongly affects prognosis in patients with heart failure (HF). However, the difference in the implementation of guideline-directed medical therapy (GDMT) during HF-related hospitalization between patients with and without CKD and its association with worsening heart failure (WHF) events remain unclear.
Methods
A post-hoc analysis was conducted using data from a retrospective, multicenter, observational registry of patients hospitalized for HF with a left ventricular ejection fraction (LVEF) of <50 %. The primary endpoint was a composite of outpatient WHF, HF-related hospitalization, and all-cause mortality.
Results
Of the 442 patients, 246 had CKD (56 %). These patients were older and had a higher prevalence of HF. At admission, the GDMT score was higher in patients with CKD than in those without CKD [3 (interquartile range, 1–5) vs. 1 (0–4)]; at discharge, the GDMT score was lower in patients with CKD [5 (3–7) vs. 6 (4.5–8)]. Optimized GDMT implementation at discharge, defined as a GDMT score of ≥6, was independently associated with improved prognosis in both groups.
Conclusions
In-hospital GDMT implementation was less optimized in patients with CKD compared with those without. Nevertheless, optimized GDMT implementation at discharge was associated with a lower incidence of adverse events, regardless of CKD status, among patients hospitalized with HF.
{"title":"Chronic kidney disease and contemporary guideline-directed medical therapy during hospitalization in patients with heart failure: Insights from PRE-UPFRONT-HF","authors":"Yudai Fujimoto MD , Takeshi Kitai MD, PhD , Yu Horiuchi MD, PhD , Toru Kondo MD, PhD , Ryosuke Murai MD , Ryuichi Matsukawa MD, PhD, FJCC , Takuro Abe MD , Kentaro Jujo MD, PhD, FJCC , Ayane Kanai MD , Yuya Matsue MD, PhD","doi":"10.1016/j.jjcc.2025.08.007","DOIUrl":"10.1016/j.jjcc.2025.08.007","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease (CKD) strongly affects prognosis in patients with heart failure (HF). However, the difference in the implementation of guideline-directed medical therapy (GDMT) during HF-related hospitalization between patients with and without CKD and its association with worsening heart failure (WHF) events remain unclear.</div></div><div><h3>Methods</h3><div>A post-hoc analysis was conducted using data from a retrospective, multicenter, observational registry of patients hospitalized for HF with a left ventricular ejection fraction (LVEF) of <50 %. The primary endpoint was a composite of outpatient WHF, HF-related hospitalization, and all-cause mortality.</div></div><div><h3>Results</h3><div>Of the 442 patients, 246 had CKD (56 %). These patients were older and had a higher prevalence of HF. At admission, the GDMT score was higher in patients with CKD than in those without CKD [3 (interquartile range, 1–5) vs. 1 (0–4)]; at discharge, the GDMT score was lower in patients with CKD [5 (3–7) vs. 6 (4.5–8)]. Optimized GDMT implementation at discharge, defined as a GDMT score of ≥6, was independently associated with improved prognosis in both groups.</div></div><div><h3>Conclusions</h3><div>In-hospital GDMT implementation was less optimized in patients with CKD compared with those without. Nevertheless, optimized GDMT implementation at discharge was associated with a lower incidence of adverse events, regardless of CKD status, among patients hospitalized with HF.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Pages 238-245"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955631","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}
Sarcoidosis, a multisystem granulomatous disease, can affect any organ and has various clinical presentations. Patients with sarcoidosis with cardiac involvement have a poorer prognosis than those without cardiac involvement. The prognostic value of the clinical manifestations at the time of cardiac sarcoidosis (CS) diagnosis remains unknown.
Methods
This secondary analysis of the ILLUMINATE-CS study evaluated the clinical characteristics and prognoses of patients with CS. The primary endpoint was a composite of all-cause death, hospitalization for heart failure (HF), and documented fatal ventricular arrhythmia events.
Results
We analyzed the data of 502 patients (mean age, 61.5 years; male, 36.1 %) diagnosed with CS and classified them into four clinical phenotypes (subclinical, arrhythmia, congestive heart failure, and overlapping phenotypes) based on the clinical manifestations at CS diagnosis. Over a median follow-up period of 1045 days, 145 primary endpoints were observed. For the subclinical phenotype, the 10-year estimated primary endpoint event rate was 20.8 %, whereas the corresponding rates in other clinical phenotypes were significantly higher (log-rank test, p < 0.001 for all comparisons). The rate of fatal ventricular arrhythmia events was also significantly lower in the subclinical phenotype than in other clinical phenotypes (log-rank test, p = 0.011, 0.041, and 0.002, respectively). The event rate of hospitalization for HF was significantly higher in the congestive HF and overlapping phenotypes than in the subclinical and arrhythmia phenotypes (log-rank test, p < 0.001 for all comparisons).
Conclusions
The clinical phenotype of CS is a useful prognostic indicator. The characteristics of clinical events differed for each clinical phenotype. Tailored management strategies should be implemented for each clinical phenotype.
{"title":"Prognostic value of the clinical phenotype in patients with cardiac sarcoidosis: SARCO phenotype","authors":"Daisuke Miyahara MD , Keisuke Kida MD, PhD, FJCC , Takeru Nabeta MD, PhD , Kenji Yoshioka MD, PhD , Yoshihisa Naruse MD, PhD , Tatsunori Taniguchi MD, PhD , Hidekazu Tanaka MD, PhD, FJCC , Ryota Morimoto MD, PhD , Yuichi Baba MD, PhD , Takeshi Kitai MD, PhD , Yuya Matsue MD, PhD , Yoshihiro J. Akashi MD, PhD, FJCC","doi":"10.1016/j.jjcc.2025.10.009","DOIUrl":"10.1016/j.jjcc.2025.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Sarcoidosis, a multisystem granulomatous disease, can affect any organ and has various clinical presentations. Patients with sarcoidosis with cardiac involvement have a poorer prognosis than those without cardiac involvement. The prognostic value of the clinical manifestations at the time of cardiac sarcoidosis (CS) diagnosis remains unknown.</div></div><div><h3>Methods</h3><div>This secondary analysis of the ILLUMINATE-CS study evaluated the clinical characteristics and prognoses of patients with CS. The primary endpoint was a composite of all-cause death, hospitalization for heart failure (HF), and documented fatal ventricular arrhythmia events.</div></div><div><h3>Results</h3><div>We analyzed the data of 502 patients (mean age, 61.5 years; male, 36.1 %) diagnosed with CS and classified them into four clinical phenotypes (subclinical, arrhythmia, congestive heart failure, and overlapping phenotypes) based on the clinical manifestations at CS diagnosis. Over a median follow-up period of 1045 days, 145 primary endpoints were observed. For the subclinical phenotype, the 10-year estimated primary endpoint event rate was 20.8 %, whereas the corresponding rates in other clinical phenotypes were significantly higher (log-rank test, <em>p</em> < 0.001 for all comparisons). The rate of fatal ventricular arrhythmia events was also significantly lower in the subclinical phenotype than in other clinical phenotypes (log-rank test, <em>p</em> = 0.011, 0.041, and 0.002, respectively). The event rate of hospitalization for HF was significantly higher in the congestive HF and overlapping phenotypes than in the subclinical and arrhythmia phenotypes (log-rank test, <em>p</em> < 0.001 for all comparisons).</div></div><div><h3>Conclusions</h3><div>The clinical phenotype of CS is a useful prognostic indicator. The characteristics of clinical events differed for each clinical phenotype. Tailored management strategies should be implemented for each clinical phenotype.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Pages 230-237"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145431606","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 : 2026-03-01Epub Date: 2025-08-05DOI: 10.1016/j.jjcc.2025.07.011
Muhammad Khubaib Iftikhar MBBS, Muhammad Hamza MBBS, Mirza Muhammad Ali Baig MBBS, Saad Sajjad Khan MBBS
{"title":"Unraveling the vascular fallout of TMAO in CKD: Time to look beyond GATA4?","authors":"Muhammad Khubaib Iftikhar MBBS, Muhammad Hamza MBBS, Mirza Muhammad Ali Baig MBBS, Saad Sajjad Khan MBBS","doi":"10.1016/j.jjcc.2025.07.011","DOIUrl":"10.1016/j.jjcc.2025.07.011","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Pages 295-296"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789260","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 : 2026-03-01Epub Date: 2025-09-05DOI: 10.1016/j.jjcc.2025.08.016
Sefa Erdi Ömür MD, Çağrı Zorlu MD
{"title":"Approach to contrast agent-induced acute kidney injury after elective percutaneous coronary intervention in patients with diabetes","authors":"Sefa Erdi Ömür MD, Çağrı Zorlu MD","doi":"10.1016/j.jjcc.2025.08.016","DOIUrl":"10.1016/j.jjcc.2025.08.016","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Page 303"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015465","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}
Cognitive dysfunction is prevalent in patients with heart failure (HF) and predicts poor prognosis. The Six-Item Screener is a brief tool that requires no materials and can be administered easily in a variety of care settings. We evaluated whether this tool detects cognitive dysfunction and predicts all-cause mortality in older HF patients, in comparison with the Mini-Cog.
Methods
We conducted a post-hoc analysis of consecutive patients aged ≥65 years from the multicenter FRAGILE-HF cohort. Cognitive dysfunction at discharge was defined as Six-Item Screener ≤4 and Mini-Cog ≤2. Agreement was quantified using Cohen's kappa. Associations with all-cause mortality were examined with multivariable Cox proportional hazards models. Prognostic capabilities were assessed by the area under the receiver operating characteristic curve (AUC) and compared using the DeLong test.
Results
Of 1332 enrolled patients, 1316 were included in the analysis (median age 81 years; 56.8 % male). The prevalence of cognitive dysfunction was 42.9 % by the Six-Item Screener and 38.5 % by the Mini-Cog, showing moderate agreement (kappa = 0.55). Cognitive dysfunction defined by the Six-Item Screener [hazard ratio (HR), 1.30; 95 % confidence interval (CI), 1.02–1.65; p = 0.034] and by the Mini-Cog (HR, 1.44; 95 % CI, 1.13–1.83; p = 0.003) was associated with higher all-cause mortality. AUCs were similar for the Six-Item Screener (0.553; 95 % CI, 0.515–0.592) and the Mini-Cog (0.556; 95 % CI, 0.519–0.594).
Conclusions
In older patients with HF, the Six-Item Screener identifies cognitive dysfunction and predicts mortality with prognostic performance comparable to the Mini-Cog.
{"title":"Six-item screener for cognitive and prognostic assessment in heart failure: A comparison with the mini-cog","authors":"Koji Matsuo PT, BSc , Kentaro Kamiya PT, PhD, FJCC , Daichi Maeda MD, PhD , Nobuaki Hamazaki PT, PhD , Shota Uchida PT, PhD , Masashi Yamashita PT, PhD , Masaaki Konishi MD, PhD , Takatoshi Kasai MD, PhD, FJCC , Hiroshi Saito PT, PhD , Yuki Ogasahara RN , Takeshi Kitai MD, PhD , Kentaro Iwata PT, PhD , Kentaro Jujo MD, PhD, FJCC , Hiroshi Wada MD, PhD, FJCC , Emi Maekawa MD, PhD , Shin-Ichi Momomura MD, PhD, FJCC , Nobuyuki Kagiyama MD, PhD , Yuya Matsue MD, PhD","doi":"10.1016/j.jjcc.2025.11.009","DOIUrl":"10.1016/j.jjcc.2025.11.009","url":null,"abstract":"<div><h3>Background</h3><div>Cognitive dysfunction is prevalent in patients with heart failure (HF) and predicts poor prognosis. The Six-Item Screener is a brief tool that requires no materials and can be administered easily in a variety of care settings. We evaluated whether this tool detects cognitive dysfunction and predicts all-cause mortality in older HF patients, in comparison with the Mini-Cog.</div></div><div><h3>Methods</h3><div>We conducted a post-hoc analysis of consecutive patients aged ≥65 years from the multicenter FRAGILE-HF cohort. Cognitive dysfunction at discharge was defined as Six-Item Screener ≤4 and Mini-Cog ≤2. Agreement was quantified using Cohen's kappa. Associations with all-cause mortality were examined with multivariable Cox proportional hazards models. Prognostic capabilities were assessed by the area under the receiver operating characteristic curve (AUC) and compared using the DeLong test.</div></div><div><h3>Results</h3><div>Of 1332 enrolled patients, 1316 were included in the analysis (median age 81 years; 56.8 % male). The prevalence of cognitive dysfunction was 42.9 % by the Six-Item Screener and 38.5 % by the Mini-Cog, showing moderate agreement (kappa = 0.55). Cognitive dysfunction defined by the Six-Item Screener [hazard ratio (HR), 1.30; 95 % confidence interval (CI), 1.02–1.65; <em>p</em> = 0.034] and by the Mini-Cog (HR, 1.44; 95 % CI, 1.13–1.83; <em>p</em> = 0.003) was associated with higher all-cause mortality. AUCs were similar for the Six-Item Screener (0.553; 95 % CI, 0.515–0.592) and the Mini-Cog (0.556; 95 % CI, 0.519–0.594).</div></div><div><h3>Conclusions</h3><div>In older patients with HF, the Six-Item Screener identifies cognitive dysfunction and predicts mortality with prognostic performance comparable to the Mini-Cog.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Pages 275-281"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648587","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 : 2026-03-01Epub Date: 2025-09-20DOI: 10.1016/j.jjcc.2025.09.013
Muhammad Mohid Haroon MBBS
{"title":"Residual tricuspid regurgitation after edge-to-edge repair versus annuloplasty: Implications for device selection","authors":"Muhammad Mohid Haroon MBBS","doi":"10.1016/j.jjcc.2025.09.013","DOIUrl":"10.1016/j.jjcc.2025.09.013","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Page 305"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124673","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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