Physical frailty is a prognostic determinant in heart failure (HF) patients, but its association with the modes of death remains unclear. We investigated the associations between walking status and modes of death in patients with HF with preserved ejection fraction (HFpEF) and those with non-HFpEF.
Methods
We analyzed 2009 patients with acute HF enrolled in two Japanese HF registries. We compared post-discharge causes of death in HFpEF and non-HFpEF patients, classified into three walking status groups: robust, impaired walking (IW), and disability groups.
Results
HF was the predominant cause of death in non-HFpEF patients across all walking categories, whereas HF deaths in HFpEF patients increased with worsening walking status, accounting for 35 % of deaths among those with disability. In robust HFpEF patients, non-cardiovascular (CV) deaths, particularly from cancer, were as frequent as HF deaths. The risk of CV death was higher in the IW group [hazard ratio (HR): 1.639; 95 % confidence interval (CI): 1.050–2.559] and the disability group (HR: 2.678; 95 % CI: 1.382–5.189) among non-HFpEF patients, while the risk of non-CV death was higher only in the disability group (HR: 2.495; 95 % CI: 1.206–5.159). HFpEF patients with IW and those with disability had higher risks of both CV death (IW group, HR: 2.369; 95 % CI: 1.486–3.776; disability group, HR: 5.768; 95 % CI: 3.051–10.900) and non-CV death (IW group, HR: 2.444; 95 % CI: 1.468–4.068; disability group, HR: 2.732; 95 % CI: 1.246–5.989).
Conclusion
Poor walking status at discharge was associated with higher risks of both CV and non-CV deaths, irrespective of HF type. HF was the predominant cause of mortality overall, whereas non-CV death, especially cancer death, was more common in robust HFpEF patients. These results highlight the clinical importance of walking status assessment in HF management.
{"title":"Associations between modes of death and physical impairment in patients with heart failure with preserved or reduced ejection fraction","authors":"Tomoyuki Hamada MD, PhD , Toru Kubo MD, PhD, FJCC , Kensuke Takabayashi MD, PhD , Kazuya Kawai MD, PhD, FJCC , Yoko Nakaoka MD , Toshikazu Yabe MD, PhD , Takashi Furuno MD, PhD , Eisuke Yamada MD , Ryoko Fujita MD, PhD , Tetsuhisa Kitamura MD, PhD , Ryuji Nohara MD, PhD, FJCC , Hiroaki Kitaoka MD, PhD, FJCC","doi":"10.1016/j.jjcc.2025.10.013","DOIUrl":"10.1016/j.jjcc.2025.10.013","url":null,"abstract":"<div><h3>Background</h3><div>Physical frailty is a prognostic determinant in heart failure (HF) patients, but its association with the modes of death remains unclear. We investigated the associations between walking status and modes of death in patients with HF with preserved ejection fraction (HFpEF) and those with non-HFpEF.</div></div><div><h3>Methods</h3><div>We analyzed 2009 patients with acute HF enrolled in two Japanese HF registries. We compared post-discharge causes of death in HFpEF and non-HFpEF patients, classified into three walking status groups: robust, impaired walking (IW), and disability groups.</div></div><div><h3>Results</h3><div>HF was the predominant cause of death in non-HFpEF patients across all walking categories, whereas HF deaths in HFpEF patients increased with worsening walking status, accounting for 35 % of deaths among those with disability. In robust HFpEF patients, non-cardiovascular (CV) deaths, particularly from cancer, were as frequent as HF deaths. The risk of CV death was higher in the IW group [hazard ratio (HR): 1.639; 95 % confidence interval (CI): 1.050<strong>–</strong>2.559] and the disability group (HR: 2.678; 95 % CI: 1.382–5.189) among non-HFpEF patients, while the risk of non-CV death was higher only in the disability group (HR: 2.495; 95 % CI: 1.206–5.159). HFpEF patients with IW and those with disability had higher risks of both CV death (IW group, HR: 2.369; 95 % CI: 1.486–3.776; disability group, HR: 5.768; 95 % CI: 3.051–10.900) and non-CV death (IW group, HR: 2.444; 95 % CI: 1.468–4.068; disability group, HR: 2.732; 95 % CI: 1.246–5.989).</div></div><div><h3>Conclusion</h3><div>Poor walking status at discharge was associated with higher risks of both CV and non-CV deaths, irrespective of HF type. HF was the predominant cause of mortality overall, whereas non-CV death, especially cancer death, was more common in robust HFpEF patients. These results highlight the clinical importance of walking status assessment in HF management.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Pages 266-274"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145476799","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 cardiothoracic ratio (CTR), derived from chest X-ray, is an established metric for quantifying cardiac size and has prognostic value in acquired heart disease. However, its association with echocardiographic parameters and clinical outcomes in heart failure with preserved ejection fraction (HFpEF) remains inadequately characterized.
Methods
This analysis was performed using the PURSUIT-HFpEF registry, a prospective multicenter observational study for HFpEF. Among 1238 patients registered, 1195 with CTR data at discharge were included. Patients were categorized into three groups: CTR <50 % (N = 199), 50–59 % (N = 631), and ≥60 % (N = 365). Associations of CTR with echocardiographic indices and clinical outcomes were evaluated.
Results
The median CTR at discharge was 56 % (interquartile range: 51–61 %). Increased CTR was associated with impaired hemodynamics on Doppler echocardiography but not with the left ventricular (LV) end-diastolic or end-systolic volume indices. Conversely, CTR demonstrated moderate correlations with the left atrial volume index (r = 0.39), indexed right ventricular diameter (r = 0.28), inferior vena cava end-expiratory diameter (r = 0.30), and LV mass index (r = 0.18) (all p < 0.001). During a 36-month follow-up, 687 patients experienced the composite of death or rehospitalization for heart failure. Event rates increased with the CTR category (<50 %: 44.2 % vs. 50–59 %: 57.2 % vs. ≥60 %: 65.2 %; log-rank p < 0.001). Compared with CTR <50 %, CTR ≥60 % independently predicted the composite endpoint (hazard ratio, 1.47; 95 % confidence interval, 1.09–1.98; p = 0.011) after multivariable adjustment.
Conclusions
In patients with HFpEF, increased CTR reflected hemodynamic compromise, along with enlargement of the left atrium and right-sided chambers without LV cavity dilatation. CTR ≥60 % independently predicted adverse clinical outcomes, supporting its value for risk stratification in this population.
背景：心胸比值（CTR），来源于胸部x线，是一种确定的量化心脏大小的指标，在获得性心脏病中具有预后价值。然而，它与保留射血分数（HFpEF）心力衰竭的超声心动图参数和临床结果的关系仍然没有充分的表征。方法：本分析是通过对HFpEF进行前瞻性多中心观察登记的PURSUIT-HFpEF Registry进行的。在登记的1238例患者中，纳入了1195例出院时CTR数据。患者分为三组：CTR结果：出院时中位CTR为56 %（四分位数范围：51-61 %）。在多普勒超声心动图上，CTR升高与血流动力学受损有关，但与左室舒张末期或收缩末期容积指数无关。相反,CTR了温和的相关性与左心室容积指数(r = 0.39),索引右心室直径(0.28 r = ),呼气末下腔静脉直径(0.30 r = ),和LV质量指数(r = 0.18)(所有p 结论:患者HFpEF,增加点击率反映血流动力学妥协,左心房增大和右侧室没有LV腔扩张。CTR≥60 %独立预测不良临床结果，支持其在该人群中的风险分层价值。
{"title":"Cardiothoracic ratio as a prognostic marker in heart failure with preserved ejection fraction","authors":"Masato Okada MD , Koichi Inoue MD, PhD , Toshinari Onishi MD , Nobuaki Tanaka MD , Katsuomi Iwakura MD, PhD , Masahiro Seo MD , Takaharu Hayashi MD, PhD , Masamichi Yano MD, PhD , Akito Nakagawa MD, PhD , Yusuke Nakagawa MD, PhD , Shunsuke Tamaki MD, PhD, FJCC , Yoshio Yasumura MD, PhD, FJCC , Takahisa Yamada MD, PhD, FJCC , Shungo Hikoso MD, PhD, FJCC , Daisuke Sakamoto MD , Katsuki Okada MD, PhD , Daisaku Nakatani MD, PhD , Yohei Sotomi MD, PhD , Yasushi Sakata MD, PhD, FJCC , OCVC-Heart Failure Investigators","doi":"10.1016/j.jjcc.2025.09.008","DOIUrl":"10.1016/j.jjcc.2025.09.008","url":null,"abstract":"<div><h3>Background</h3><div>The cardiothoracic ratio (CTR), derived from chest X-ray, is an established metric for quantifying cardiac size and has prognostic value in acquired heart disease. However, its association with echocardiographic parameters and clinical outcomes in heart failure with preserved ejection fraction (HFpEF) remains inadequately characterized.</div></div><div><h3>Methods</h3><div>This analysis was performed using the PURSUIT-HFpEF registry, a prospective multicenter observational study for HFpEF. Among 1238 patients registered, 1195 with CTR data at discharge were included. Patients were categorized into three groups: CTR <50 % (<em>N</em> = 199), 50–59 % (<em>N</em> = 631), and ≥60 % (<em>N</em> = 365). Associations of CTR with echocardiographic indices and clinical outcomes were evaluated.</div></div><div><h3>Results</h3><div>The median CTR at discharge was 56 % (interquartile range: 51–61 %). Increased CTR was associated with impaired hemodynamics on Doppler echocardiography but not with the left ventricular (LV) end-diastolic or end-systolic volume indices. Conversely, CTR demonstrated moderate correlations with the left atrial volume index (<em>r</em> = 0.39), indexed right ventricular diameter (<em>r</em> = 0.28), inferior vena cava end-expiratory diameter (<em>r</em> = 0.30), and LV mass index (<em>r</em> = 0.18) (all <em>p</em> < 0.001). During a 36-month follow-up, 687 patients experienced the composite of death or rehospitalization for heart failure. Event rates increased with the CTR category (<50 %: 44.2 % vs. 50–59 %: 57.2 % vs. ≥60 %: 65.2 %; log-rank <em>p</em> < 0.001). Compared with CTR <50 %, CTR ≥60 % independently predicted the composite endpoint (hazard ratio, 1.47; 95 % confidence interval, 1.09–1.98; <em>p</em> = 0.011) after multivariable adjustment.</div></div><div><h3>Conclusions</h3><div>In patients with HFpEF, increased CTR reflected hemodynamic compromise, along with enlargement of the left atrium and right-sided chambers without LV cavity dilatation. CTR ≥60 % independently predicted adverse clinical outcomes, supporting its value for risk stratification in this population.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Pages 246-256"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075322","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}
An enlarged v-wave amplitude and a large v-wave in the pulmonary artery wedge pressure (PAWP) suggest impaired left atrial (LA) reservoir function. This study investigated the clinical importance of enlargement of v-wave amplitude in patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM).
Methods and results
We retrospectively analysed patients with ATTRwt-CM (n = 204) and hypertrophic cardiomyopathy (HCM) (n = 78). The v-wave amplitude of PAWP was higher in the ATTRwt-CM group than in the HCM group (5.6 ± 4.73 mm Hg vs. 3.0 ± 2.50 mm Hg; p < 0.001). We also assessed prognostic impact of v-waves in patients with ATTRwt-CM. Large v-waves were defined as amplitude ≥10 mm Hg. We assigned the patients to groups with (n = 48) and without (n = 156) large v-wave. LA peak longitudinal strain (LS) and LS rate (LSR) were significantly decreased in the group with large v-waves. Large v-waves were also a determinant of all-cause death (log-rank, p = 0.033) and rehospitalization for heart failure (HF) events (log-rank, p = 0.001). The four forced inclusion models significantly associated a large v-wave with increased HF rehospitalization risk in multivariable Cox analysis.
Conclusions
The v-wave amplitude of enlarged PAWP in ATTRwt-CM correlated with declining LA peak LS and LSR and higher risk of all-cause death and HF rehospitalization. Therefore, assessing PAWP waveforms might help to diagnose ATTRwt-CM, and predict LA dysfunction and a poor prognosis.
背景：肺动脉楔压（PAWP） v波振幅增大和大v波提示左房（LA）储层功能受损。本研究探讨野生型转甲状腺素淀粉样心肌病（ATTRwt-CM）患者v波振幅增大的临床意义。方法和结果：我们回顾性分析attrt - cm （n = 204）和肥厚性心肌病（n = 78）患者。ATTRwt-CM组paap v波振幅高于HCM组(5.6 ± 4.73 mmHg vs. 3.0 ± 2.50 mmHg； p 结论：ATTRwt-CM组paap v波振幅增大与LA峰LS和LSR下降、全因死亡和HF再住院风险升高相关。因此，评估PAWP波形可能有助于诊断attrt - cm，预测LA功能障碍和不良预后。
{"title":"The impact of large v-waves of pulmonary artery wedge pressure in patients with wild-type transthyretin amyloid cardiomyopathy","authors":"Masahiro Yamamoto MD, PhD , Yasuhiro Izumiya MD, PhD, FJCC , Seiji Takashio MD, PhD, FJCC , Kei Morikawa MD , Tetsuya Oguni MD , Naoto Kuyama MD, PhD , Fumi Oike MD, PhD , Masanobu Ishii MD, PhD , Hiroki Usuku MD, PhD, FJCC , Shinsuke Hanatani MD, PhD, FJCC , Yasushi Matsuzawa MD, PhD , Eiichiro Yamamoto MD, PhD, FJCC , Mitsuharu Ueda MD, PhD , Kenichi Tsujita MD, PhD, FJCC","doi":"10.1016/j.jjcc.2025.11.008","DOIUrl":"10.1016/j.jjcc.2025.11.008","url":null,"abstract":"<div><h3>Background</h3><div>An enlarged v-wave amplitude and a large v-wave in the pulmonary artery wedge pressure (PAWP) suggest impaired left atrial (LA) reservoir function. This study investigated the clinical importance of enlargement of v-wave amplitude in patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM).</div></div><div><h3>Methods and results</h3><div>We retrospectively analysed patients with ATTRwt-CM (<em>n</em> = 204) and hypertrophic cardiomyopathy (HCM) (<em>n</em> = 78). The v-wave amplitude of PAWP was higher in the ATTRwt-CM group than in the HCM group (5.6 ± 4.73 mm Hg vs. 3.0 ± 2.50 mm Hg; <em>p</em> < 0.001). We also assessed prognostic impact of v-waves in patients with ATTRwt-CM. Large v-waves were defined as amplitude ≥10 mm Hg. We assigned the patients to groups with (<em>n</em> = 48) and without (<em>n</em> = 156) large v-wave. LA peak longitudinal strain (LS) and LS rate (LSR) were significantly decreased in the group with large v-waves. Large v-waves were also a determinant of all-cause death (log-rank, <em>p</em> = 0.033) and rehospitalization for heart failure (HF) events (log-rank, <em>p</em> = 0.001). The four forced inclusion models significantly associated a large v-wave with increased HF rehospitalization risk in multivariable Cox analysis.</div></div><div><h3>Conclusions</h3><div>The v-wave amplitude of enlarged PAWP in ATTRwt-CM correlated with declining LA peak LS and LSR and higher risk of all-cause death and HF rehospitalization. Therefore, assessing PAWP waveforms might help to diagnose ATTRwt-CM, and predict LA dysfunction and a poor prognosis.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Pages 221-229"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648589","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}
{"title":"Critique on “Mitral regurgitation in atrial fibrillation: Is a simple repair enough to tackle a complex problem?”","authors":"Abeer Aijaz MBBS, Iffat Ambreen Magsi MBBS, Izhaan Zeeshan MBBS","doi":"10.1016/j.jjcc.2025.05.011","DOIUrl":"10.1016/j.jjcc.2025.05.011","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Page 292"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183574","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: 2025-12-24DOI: 10.1016/j.jjcc.2025.12.016
Heba M. El-Naggar MD, Alaa A. Abdel-Gaber MSc, Yehia T. Kishk MD, Tarek A.N. Ahmed MD, PhD
{"title":"Authors' Reply to “Predictive value of speckle tracking echocardiography for left ventricular thrombus formation”","authors":"Heba M. El-Naggar MD, Alaa A. Abdel-Gaber MSc, Yehia T. Kishk MD, Tarek A.N. Ahmed MD, PhD","doi":"10.1016/j.jjcc.2025.12.016","DOIUrl":"10.1016/j.jjcc.2025.12.016","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Page 302"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145843758","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: 2025-10-09DOI: 10.1016/j.jjcc.2025.10.001
Juan Gao MD , Hong-Shuai Cao MD , Le Han MD , Xiao-Qin Luo MD , Li-Yue Xu MD , Ying Zhou MD , Zhe-Xun Lian MD , Jing-Yi Ren MD
Background
Insomnia, as one of the most prevalent sleep disorders, is frequently linked to heart failure (HF). However, the precise relationship and potential risk of HF events associated with insomnia and subtypes of symptoms necessitate further investigation. This meta-analysis aims to provide a comprehensive and current evaluation of the associations between insomnia symptoms and HF risk, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early-morning awakening, and non-restorative sleep (NRS).
Methods
A comprehensive literature search was conducted in PubMed, Web of Science, Embase, ProQuest and the Cochrane Library to identify prospective cohort studies from inception to October 31, 2024. Pooled hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated to assess the correlation between insomnia and the risk of HF. Funnel plots and Egger's tests were employed to assess publication bias.
Results
A total of 177,008 patients from seven eligible prospective cohort studies were included. The pooled minimally adjusted HR for HF was 1.26 (p = 0.001), indicating that insomnia was associated with an increased risk of HF. Among the individual insomnia symptoms, only DIS showed a positive association with the risk of HF (p = 0.005). DMS and NRS had no significant effect on the risk of HF (p > 0.05). In the subgroup analysis including age, sex, and body mass index, there were no significant differences between groups.
Conclusion
This meta-analysis confirms the link between insomnia and an increased risk of HF, particularly highlighting the importance of DIS as a potential predictor for HF.
背景：失眠是最常见的睡眠障碍之一，常与心力衰竭（HF）有关。然而，与失眠和症状亚型相关的心衰事件的确切关系和潜在风险需要进一步研究。本荟萃分析旨在全面评估失眠症状与HF风险之间的关系，包括入睡困难（DIS）、维持睡眠困难（DMS）、清晨醒来和非恢复性睡眠（NRS）。方法：在PubMed， Web of Science, Embase， ProQuest和Cochrane Library中进行全面的文献检索，以确定从成立到2024年10月31日的前瞻性队列研究。计算95 %置信区间（ci）的合并风险比（hr），以评估失眠与心衰风险之间的相关性。采用漏斗图和Egger检验评估发表偏倚。结果：共纳入了来自7项符合条件的前瞻性队列研究的177,008例患者。合并HF的最低校正HR为1.26 (p = 0.001)，表明失眠与HF的风险增加有关。在个体失眠症状中，只有DIS与HF风险呈正相关（p = 0.005）。DMS和NRS对HF发生风险无显著影响（p > 0.05）。在包括年龄、性别和身体质量指数在内的亚组分析中，各组之间没有显著差异。结论：该荟萃分析证实了失眠与HF风险增加之间的联系，特别强调了DIS作为HF潜在预测因子的重要性。
{"title":"Association between insomnia symptoms and risk of heart failure: A meta-analysis of prospective cohort studies","authors":"Juan Gao MD , Hong-Shuai Cao MD , Le Han MD , Xiao-Qin Luo MD , Li-Yue Xu MD , Ying Zhou MD , Zhe-Xun Lian MD , Jing-Yi Ren MD","doi":"10.1016/j.jjcc.2025.10.001","DOIUrl":"10.1016/j.jjcc.2025.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Insomnia, as one of the most prevalent sleep disorders, is frequently linked to heart failure (HF). However, the precise relationship and potential risk of HF events associated with insomnia and subtypes of symptoms necessitate further investigation. This meta-analysis aims to provide a comprehensive and current evaluation of the associations between insomnia symptoms and HF risk, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early-morning awakening, and non-restorative sleep (NRS).</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted in PubMed, Web of Science, Embase, ProQuest and the Cochrane Library to identify prospective cohort studies from inception to October 31, 2024. Pooled hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated to assess the correlation between insomnia and the risk of HF. Funnel plots and Egger's tests were employed to assess publication bias.</div></div><div><h3>Results</h3><div>A total of 177,008 patients from seven eligible prospective cohort studies were included. The pooled minimally adjusted HR for HF was 1.26 (<em>p</em> = 0.001), indicating that insomnia was associated with an increased risk of HF. Among the individual insomnia symptoms, only DIS showed a positive association with the risk of HF (<em>p</em> = 0.005). DMS and NRS had no significant effect on the risk of HF (<em>p</em> > 0.05). In the subgroup analysis including age, sex, and body mass index, there were no significant differences between groups.</div></div><div><h3>Conclusion</h3><div>This meta-analysis confirms the link between insomnia and an increased risk of HF, particularly highlighting the importance of DIS as a potential predictor for HF.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Pages 257-265"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258454","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: 2025-12-04DOI: 10.1016/j.jjcc.2025.11.018
Yanbing Jiang MM , Xiaohui Zhao MD
{"title":"Reply to: “Approach to contrast agent-induced acute kidney injury after elective percutaneous coronary intervention in patients with diabetes”","authors":"Yanbing Jiang MM , Xiaohui Zhao MD","doi":"10.1016/j.jjcc.2025.11.018","DOIUrl":"10.1016/j.jjcc.2025.11.018","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Pages 303-304"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696004","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}
Hypertrophic cardiomyopathy (HCM) is caused by mutations in sarcomere-related genes, with MYBPC3 being the most common. Documenting potential genotype-phenotype associations may allow for more personalized genetic counselling.
Methods and results
Observational case-control, cohort, and cross-sectional studies reporting genotype-phenotype associations and the occurrence of predefined events were selected from Cochrane and Medline databases. A random- effects meta-analysis was conducted. Twenty-four studies were included, with 3869 patients enrolled. The mean age at diagnosis of HCM associated with mutations in the MYBPC3 gene was 39.8 years (95 % CI 32.96 to 46.55), and the mean maximum left ventricular thickness was 20.4 mm (95 % CI 19.72 to 21.06). Proportion rates were 12.6 % (95 % CI 5.7 to 21.5 %) for septal reduction therapy, 20.4 % (95 % CI 11.9 to 30.2 %) for the development of heart failure New York Heart Association (NYHA) III/IV functional class, 16.1 % (95 % CI 10.3 to 22.6 %) for the occurrence of atrial fibrillation, and 26 % (95 % CI 17.0 to 36.1 %) for ventricular tachycardia. Cardioverter-defibrillators were implanted in 31.4 % (95 % CI 18.6 to 45.6 %) for secondary prevention, and sudden cardiac arrest occurred in 14.7 % (95 % CI 7.8 to 23.0 %) of patients. Cardiovascular death occurred in 8.6 % of patients over a median of 73 months of follow-up.
Conclusion
This is the largest meta-analysis of MYBPC3 HCM patients to date. We were able to obtain data on the proportion rates of events in this population, which allows to answer some questions about the clinical course of HCM disease associated with mutations in the MYBPC3 gene more clearly. We found not only a late disease onset and low mortality risk, but importantly, a non-negligible risk of developing severe heart failure throughout life.
背景：肥厚性心肌病（HCM）是由肌瘤相关基因突变引起的，其中MYBPC3最为常见。记录潜在的基因型-表型关联可能允许更个性化的遗传咨询。方法和结果：从Cochrane和Medline数据库中选择报告基因型-表型关联和预定事件发生的观察性病例对照、队列和横断面研究。进行随机效应荟萃分析。共纳入24项研究，3869例患者。诊断与MYBPC3基因突变相关的HCM的平均年龄为39.8 岁（95 % CI 32.96 ~ 46.55），平均最大左心室厚度为20.4 mm（95 % CI 19.72 ~ 21.06）。比例率12.6 %(95 % CI 5.7到21.5 %)间隔减少药物治疗20.4 %(95 % CI 11.9到30.2 %)心力衰竭发展的纽约心脏协会(NYHA) III / IV功能类,16.1 %(95 % CI 10.3到22.6 %)心房颤动的发生,和26 %(95 % CI 17.0到36.1 %)室性心动过速。31.4% %（95% % CI 18.6 ~ 45.6% %）的患者植入了心律转复除颤器用于二级预防，14.7% %（95% % CI 7.8 ~ 23.0% %）的患者发生了心脏骤停。在中位73 个月的随访期间，8.6 %的患者发生心血管死亡。结论：这是迄今为止对MYBPC3型HCM患者进行的规模最大的荟萃分析。我们能够获得该人群中事件比例率的数据，这可以更清楚地回答与MYBPC3基因突变相关的HCM疾病临床病程的一些问题。我们不仅发现疾病发病晚，死亡率低，而且重要的是，在整个生命中发生严重心力衰竭的风险不可忽视。
{"title":"Genotype-phenotype associations in sarcomeric hypertrophic cardiomyopathy associated with mutations in the MYBPC3 gene: Systematic review and meta-analysis","authors":"Beatriz Nogueira-Garcia MD , Daniela Pinheiro MD , Catarina Gregório MD , Daniel Caldeira PhD , Fausto J. Pinto PhD , Dulce Brito PhD","doi":"10.1016/j.jjcc.2025.12.007","DOIUrl":"10.1016/j.jjcc.2025.12.007","url":null,"abstract":"<div><h3>Background</h3><div>Hypertrophic cardiomyopathy (HCM) is caused by mutations in sarcomere-related genes, with <em>MYBPC3</em> being the most common. Documenting potential genotype-phenotype associations may allow for more personalized genetic counselling.</div></div><div><h3>Methods and results</h3><div>Observational case-control, cohort, and cross-sectional studies reporting genotype-phenotype associations and the occurrence of predefined events were selected from Cochrane and Medline databases. A random- effects meta-analysis was conducted. Twenty-four studies were included, with 3869 patients enrolled. The mean age at diagnosis of HCM associated with mutations in the <em>MYBPC3</em> gene was 39.8 years (95 % CI 32.96 to 46.55), and the mean maximum left ventricular thickness was 20.4 mm (95 % CI 19.72 to 21.06). Proportion rates were 12.6 % (95 % CI 5.7 to 21.5 %) for septal reduction therapy, 20.4 % (95 % CI 11.9 to 30.2 %) for the development of heart failure New York Heart Association (NYHA) III/IV functional class, 16.1 % (95 % CI 10.3 to 22.6 %) for the occurrence of atrial fibrillation, and 26 % (95 % CI 17.0 to 36.1 %) for ventricular tachycardia. Cardioverter-defibrillators were implanted in 31.4 % (95 % CI 18.6 to 45.6 %) for secondary prevention, and sudden cardiac arrest occurred in 14.7 % (95 % CI 7.8 to 23.0 %) of patients. Cardiovascular death occurred in 8.6 % of patients over a median of 73 months of follow-up.</div></div><div><h3>Conclusion</h3><div>This is the largest meta-analysis of <em>MYBPC3</em> HCM patients to date. We were able to obtain data on the proportion rates of events in this population, which allows to answer some questions about the clinical course of HCM disease associated with mutations in the <em>MYBPC3</em> gene more clearly. We found not only a late disease onset and low mortality risk, but importantly, a non-negligible risk of developing severe heart failure throughout life.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 3","pages":"Pages 205-211"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774876","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}
Background: Stroke is a devastating complication after transcatheter aortic valve implantation (TAVI), however contemporary data on its incidence and predictors remain limited.
Methods and results: We analyzed 4774 consecutive patients undergoing TAVI between April 2010 and June 2024 in the prospective multicenter LAPLACE-TAVI registry. Patients with valve-in-valve procedures, investigational devices, or missing data were excluded. The primary endpoint was symptomatic stroke within 30 days after TAVI. Patients were stratified into 2 groups: Stroke (n = 68) and non-Stroke groups (n = 4706). Baseline characteristics, TAVI procedural data, and clinical outcomes were compared. Multivariate logistic regression was performed to identify predictors of periprocedural stroke. Thirty-day symptomatic stroke occurred in 1.4% of study patients. Stroke patients more frequently had previous stroke, peripheral artery disease (PAD), frailty, and higher Society of Thoracic Surgeons (STS) scores. Nearly 90% of stroke events occurred within 5 days after TAVI. Use of self-expanding (SE) valves was more common in the Stroke group (47% vs. 32%). On multivariate analysis, PAD [odds ratio (OR): 1.70, 95% confidence interval (CI): 1.10-2.63], higher STS score (OR: 1.03, 95%CI: 1.00-1.05), and SE valve use (OR: 1.71, 95%CI: 1.16-2.53) were independent predictors.
Conclusions: In this large multicenter registry, the 30-day incidence of symptomatic stroke after TAVI was 1.4%. PAD, higher STS score, and SE valve use were independent predictors. Careful patient selection and procedural planning are warranted.
{"title":"Incidence and predictors for symptomatic stroke within 30 days after transcatheter aortic valve implantation: insights from the LAPLACE-TAVI registry.","authors":"Hiroaki Yokoyama, Ken Yamazaki, Shun Shikanai, Misato Hamadate, Michiko Tsushima, Noritomo Narita, Maiko Senoo, Hiroaki Ichikawa, Shuji Shibutani, Kenji Hanada, Yoshiaki Saito, Kenyu Murata, Yuki Imamura, Ryosuke Higuchi, Kenichi Hagiya, Itaru Takamisawa, Mamoru Nanasato, Nobuo Iguchi, Morimasa Takayama, Jun Shimizu, Harutoshi Tamura, Shinichiro Doi, Shinya Okazaki, Masaki Ishiyama, Motoki Fukutomi, Shuichiro Takanashi, Mike Saji, Masahito Minakawa, Hirofumi Tomita","doi":"10.1016/j.jjcc.2026.02.007","DOIUrl":"10.1016/j.jjcc.2026.02.007","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a devastating complication after transcatheter aortic valve implantation (TAVI), however contemporary data on its incidence and predictors remain limited.</p><p><strong>Methods and results: </strong>We analyzed 4774 consecutive patients undergoing TAVI between April 2010 and June 2024 in the prospective multicenter LAPLACE-TAVI registry. Patients with valve-in-valve procedures, investigational devices, or missing data were excluded. The primary endpoint was symptomatic stroke within 30 days after TAVI. Patients were stratified into 2 groups: Stroke (n = 68) and non-Stroke groups (n = 4706). Baseline characteristics, TAVI procedural data, and clinical outcomes were compared. Multivariate logistic regression was performed to identify predictors of periprocedural stroke. Thirty-day symptomatic stroke occurred in 1.4% of study patients. Stroke patients more frequently had previous stroke, peripheral artery disease (PAD), frailty, and higher Society of Thoracic Surgeons (STS) scores. Nearly 90% of stroke events occurred within 5 days after TAVI. Use of self-expanding (SE) valves was more common in the Stroke group (47% vs. 32%). On multivariate analysis, PAD [odds ratio (OR): 1.70, 95% confidence interval (CI): 1.10-2.63], higher STS score (OR: 1.03, 95%CI: 1.00-1.05), and SE valve use (OR: 1.71, 95%CI: 1.16-2.53) were independent predictors.</p><p><strong>Conclusions: </strong>In this large multicenter registry, the 30-day incidence of symptomatic stroke after TAVI was 1.4%. PAD, higher STS score, and SE valve use were independent predictors. Careful patient selection and procedural planning are warranted.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147306282","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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