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}
Pub Date : 2026-01-01DOI: 10.1016/j.jjcc.2025.08.001
Kazutaka Ueda MD, PhD
Vascular inflammation plays a pivotal role in the development and progression of cardiovascular pathology. Understanding the mechanisms underlying vascular inflammation is therefore essential for the prevention and treatment of cardiovascular diseases. In recent years, perivascular adipose tissue (PVAT), which surrounds arteries ranging from the aorta to the coronary and peripheral arteries, has emerged as a key player in vascular pathophysiology. Notably, recent clinical trials have demonstrated that antidiabetic agents such as glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors exert cardiovascular benefits beyond glycemic control. Basic and translational studies suggest that these agents may modulate both the quantity and functional phenotype of coronary PVAT, further highlighting its relevance as a therapeutic target. In this review, we summarize the current understanding of the role of PVAT in vascular inflammation and remodeling and discuss its potential as a novel target for the prevention and treatment of cardiovascular diseases.
{"title":"Perivascular adipose tissue in cardiovascular disease: From mechanisms to therapeutic targets","authors":"Kazutaka Ueda MD, PhD","doi":"10.1016/j.jjcc.2025.08.001","DOIUrl":"10.1016/j.jjcc.2025.08.001","url":null,"abstract":"<div><div>Vascular inflammation plays a pivotal role in the development and progression of cardiovascular pathology. Understanding the mechanisms underlying vascular inflammation is therefore essential for the prevention and treatment of cardiovascular diseases. In recent years, perivascular adipose tissue (PVAT), which surrounds arteries ranging from the aorta to the coronary and peripheral arteries, has emerged as a key player in vascular pathophysiology. Notably, recent clinical trials have demonstrated that antidiabetic agents such as glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors exert cardiovascular benefits beyond glycemic control. Basic and translational studies suggest that these agents may modulate both the quantity and functional phenotype of coronary PVAT, further highlighting its relevance as a therapeutic target. In this review, we summarize the current understanding of the role of PVAT in vascular inflammation and remodeling and discuss its potential as a novel target for the prevention and treatment of cardiovascular diseases.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Pages 64-68"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821547","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.2025.10.004
Kevin Chung MD , Ramzi Ibrahim MD , Mahmoud Abdelnabi MBBCh, MS , Hoang Nhat Pham, MD , Eiad Habib MBBS , Mohamed Allam MD , Hossam Elbenawi MD , Nima Baba Ali MD , Juan Farina MD , Balaji Tamarappoo MD, PhD , Justin Z. Lee MD , Chadi Ayoub MBBS, PhD , Kwan Lee MD , D. Eric Steidley MD , Dan Sorajja MD , Julie Rosenthal MD , Talal Hilal MD , Reza Arsanjani MD
Background
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive disease associated with high morbidity and mortality. Tafamidis is the only US Food and Drug Administration-approved disease-modifying therapy. Sodium-glucose cotransporter-2 inhibitors (SGLT2-Is) have shown promise in heart failure and may offer additive benefit when combined with tafamidis, although this remains unclear.
Methods
Using the TriNetX global research network, we identified adults with ATTR-CM treated with tafamidis between 2019 and 2022. Patients were stratified by concomitant use of SGLT2-Is (empagliflozin, dapagliflozin, or canagliflozin). Primary outcome was all-cause mortality; secondary outcomes included all-cause hospitalizations, acute myocardial infarction (AMI), stroke, heart failure hospitalizations, arrhythmias, and end-stage renal disease at 1- and 3-year follow-up.
Results
After matching, 409 patients remained in each cohort. Combination therapy with SGLT2-Is and tafamidis was associated with significantly lower all-cause hospitalizations (1-year: OR 0.67, p = 0.005; 3-year: OR 0.67, p = 0.006) and AMI (1-year: OR 0.44, p = 0.001; 3-year: OR 0.56, p = 0.004). No significant mortality reduction was observed at either time point. No significant differences were observed for any of the other secondary outcomes.
Conclusions
In patients with ATTR-CM treated with tafamidis, adjunctive SGLT2-I use was associated with lower rates of hospitalization and AMI, without a significant mortality benefit. These findings support further prospective evaluation of combination therapy.
背景：转甲状腺素淀粉样心肌病（atr - cm）是一种高发病率和死亡率的进行性疾病。Tafamidis是美国食品和药物管理局批准的唯一一种治疗疾病的药物。钠-葡萄糖共转运蛋白-2抑制剂（SGLT2-Is）在心力衰竭中显示出希望，并可能与他法非底斯联合使用时提供附加益处，尽管这一点尚不清楚。方法：利用TriNetX全球研究网络，我们确定了2019年至2022年期间接受他法米地治疗的atr - cm成人。患者通过同时使用SGLT2-Is（恩格列净、达格列净或卡格列净）进行分层。主要结局是全因死亡率；在1年和3年的随访中，次要结局包括全因住院、急性心肌梗死（AMI）、中风、心力衰竭住院、心律失常和终末期肾病。结果：配对后，每个队列中仍有409例患者。SGLT2-Is和他法非底斯联合治疗与全因住院率（1年：OR 0.67, p = 0.005；3年：OR 0.67, p = 0.006）和AMI（1年：OR 0.44, p = 0.001；3年：OR 0.56, p = 0.004）显著降低相关。在两个时间点均未观察到明显的死亡率降低。其他次要结果均无显著差异。结论：在接受他法非地治疗的atr - cm患者中，辅助使用SGLT2-I与较低的住院率和AMI相关，但没有显著的死亡率获益。这些发现支持对联合治疗进行进一步的前瞻性评价。
{"title":"Combination therapy with SGLT2-inhibitors and tafamidis in transthyretin cardiomyopathy","authors":"Kevin Chung MD , Ramzi Ibrahim MD , Mahmoud Abdelnabi MBBCh, MS , Hoang Nhat Pham, MD , Eiad Habib MBBS , Mohamed Allam MD , Hossam Elbenawi MD , Nima Baba Ali MD , Juan Farina MD , Balaji Tamarappoo MD, PhD , Justin Z. Lee MD , Chadi Ayoub MBBS, PhD , Kwan Lee MD , D. Eric Steidley MD , Dan Sorajja MD , Julie Rosenthal MD , Talal Hilal MD , Reza Arsanjani MD","doi":"10.1016/j.jjcc.2025.10.004","DOIUrl":"10.1016/j.jjcc.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive disease associated with high morbidity and mortality. Tafamidis is the only US Food and Drug Administration-approved disease-modifying therapy. Sodium-glucose cotransporter-2 inhibitors (SGLT2-Is) have shown promise in heart failure and may offer additive benefit when combined with tafamidis, although this remains unclear.</div></div><div><h3>Methods</h3><div>Using the TriNetX global research network, we identified adults with ATTR-CM treated with tafamidis between 2019 and 2022. Patients were stratified by concomitant use of SGLT2-Is (empagliflozin, dapagliflozin, or canagliflozin). Primary outcome was all-cause mortality; secondary outcomes included all-cause hospitalizations, acute myocardial infarction (AMI), stroke, heart failure hospitalizations, arrhythmias, and end-stage renal disease at 1- and 3-year follow-up.</div></div><div><h3>Results</h3><div>After matching, 409 patients remained in each cohort. Combination therapy with SGLT2-Is and tafamidis was associated with significantly lower all-cause hospitalizations (1-year: OR 0.67, <em>p</em> = 0.005; 3-year: OR 0.67, <em>p</em> = 0.006) and AMI (1-year: OR 0.44, <em>p</em> = 0.001; 3-year: OR 0.56, <em>p</em> = 0.004). No significant mortality reduction was observed at either time point. No significant differences were observed for any of the other secondary outcomes.</div></div><div><h3>Conclusions</h3><div>In patients with ATTR-CM treated with tafamidis, adjunctive SGLT2-I use was associated with lower rates of hospitalization and AMI, without a significant mortality benefit. These findings support further prospective evaluation of combination therapy.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Pages 108-110"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313016","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}
Heart failure with preserved ejection fraction (HFpEF), previously referred to as diastolic heart failure, accounts for more than half of heart failure hospitalizations in patients over 65 years of age. Although the prevalence of heart failure with reduced ejection fraction has declined, HFpEF is increasingly prevalent in Japan and worldwide. Traditionally, HFpEF was primarily thought to be caused by diastolic dysfunction, characterized by impaired left ventricular (LV) relaxation and increased LV stiffness.
Analysis of LV pressure-volume (PV) loop is an invasive method that allows for the simultaneous and detailed evaluation of intrinsic LV systolic and diastolic function, as well as effective arterial elastance (Ea). LV systolic function is assessed by end-systolic elastance, derived from end-systolic PV relations, while diastolic stiffness is evaluated by LV stiffness constant (β), determined from the slope of the end-diastolic pressure-volume relation. Ea, representing LV afterload, is calculated as end-systolic pressure divided by stroke volume. Furthermore, PV loop analysis provides insights into LV mechanics through measurements of stroke work, PV area, and ventricular-arterial coupling. These parameters enable clinicians to more precisely characterize the mechanical properties of the LV than conventional echocardiography or imaging modalities.
In HFpEF, where accurate assessments of LV function and hemodynamics is essential, understanding PV loop data provides valuable insight into the pathophysiology of HFpEF. PV loop analysis has the potential to facilitate in-depth assessment and monitoring of treatment strategies. In this review, we introduce LV PV loop analysis in our patients with HFpEF and explore its correlation with PV loop parameters obtained from the other imaging modalities, such as echocardiography and cardiac magnetic resonance imaging. By highlighting the clinical relevance of PV loop analysis, we aim to advance therapeutic decision-making and promote a personalized approach in this heterogenous HFpEF population.
{"title":"Pressure-volume loop analysis in heart failure with preserved ejection fraction: Implications for cardiac mechanics, diagnosis, and treatment strategy","authors":"Naoki Fujimoto MD, PhD, FJCC, Taku Omori MD, PhD, Keishi Moriwaki MD, PhD, Shiro Nakamori MD, PhD, FJCC, Kaoru Dohi MD, PhD, FJCC","doi":"10.1016/j.jjcc.2025.08.011","DOIUrl":"10.1016/j.jjcc.2025.08.011","url":null,"abstract":"<div><div>Heart failure with preserved ejection fraction (HFpEF), previously referred to as diastolic heart failure, accounts for more than half of heart failure hospitalizations in patients over 65 years of age. Although the prevalence of heart failure with reduced ejection fraction has declined, HFpEF is increasingly prevalent in Japan and worldwide. Traditionally, HFpEF was primarily thought to be caused by diastolic dysfunction, characterized by impaired left ventricular (LV) relaxation and increased LV stiffness.</div><div>Analysis of LV pressure-volume (PV) loop is an invasive method that allows for the simultaneous and detailed evaluation of intrinsic LV systolic and diastolic function, as well as effective arterial elastance (Ea). LV systolic function is assessed by end-systolic elastance, derived from end-systolic PV relations, while diastolic stiffness is evaluated by LV stiffness constant (β), determined from the slope of the end-diastolic pressure-volume relation. Ea, representing LV afterload, is calculated as end-systolic pressure divided by stroke volume. Furthermore, PV loop analysis provides insights into LV mechanics through measurements of stroke work, PV area, and ventricular-arterial coupling. These parameters enable clinicians to more precisely characterize the mechanical properties of the LV than conventional echocardiography or imaging modalities.</div><div>In HFpEF, where accurate assessments of LV function and hemodynamics is essential, understanding PV loop data provides valuable insight into the pathophysiology of HFpEF. PV loop analysis has the potential to facilitate in-depth assessment and monitoring of treatment strategies. In this review, we introduce LV PV loop analysis in our patients with HFpEF and explore its correlation with PV loop parameters obtained from the other imaging modalities, such as echocardiography and cardiac magnetic resonance imaging. By highlighting the clinical relevance of PV loop analysis, we aim to advance therapeutic decision-making and promote a personalized approach in this heterogenous HFpEF population.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Pages 69-76"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955673","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 cardiopulmonary system is not only a pump-respirator network but also a sophisticated sensor-effector circuit. Recent findings have highlighted how mechanical and inflammatory stress in the heart and lungs is transmitted via afferent nerves—including vagal, glossopharyngeal, and spinal fibers—to the brainstem and higher autonomic centers. These afferent signals trigger adaptive or maladaptive efferent responses via the sympathetic nervous system, which in turn modulate immune cell dynamics in the bone marrow and peripheral organs. This review discusses the cardiopulmonary afferent-efferent axis, focusing on three major components: (1) the molecular and functional basis of afferent pathways linking the heart and lungs to the brain; (2) the impact of these inputs on central autonomic regulation; (3) the downstream effects of sympathetic outflow on hematopoietic stem cells, leading to myeloid skewing, epigenetic memory, and inflammatory macrophage expansion. Finally, we explore how this axis contributes to cardiovascular disease progression and multimorbidity, and how recent studies—especially those on innate immune memory—open new therapeutic avenues targeting neuro-immune crosstalk.
{"title":"Cardiopulmonary neuro-immune reflex: From afferent stress signaling to peripheral myeloid memory","authors":"Junichi Sugita MD, PhD , Ziyu Chen MD , Naoto Setoguchi MD , Kohsaku Goto MD, PhD , Atsushi Kobayashi MD, PhD , Kunihiko Kani MD, PhD , Yiyi Yang MD , Jiaxin Ku MD , Kensuke Ueno PhD , Ryoko Uchida BS , Eriko Hasumi MD, PhD , Tsukasa Oshima MD, PhD , Yukiteru Nakayama MD, PhD , Katsuhito Fujiu MD, PhD","doi":"10.1016/j.jjcc.2025.08.013","DOIUrl":"10.1016/j.jjcc.2025.08.013","url":null,"abstract":"<div><div>The cardiopulmonary system is not only a pump-respirator network but also a sophisticated sensor-effector circuit. Recent findings have highlighted how mechanical and inflammatory stress in the heart and lungs is transmitted via afferent nerves—including vagal, glossopharyngeal, and spinal fibers—to the brainstem and higher autonomic centers. These afferent signals trigger adaptive or maladaptive efferent responses via the sympathetic nervous system, which in turn modulate immune cell dynamics in the bone marrow and peripheral organs. This review discusses the cardiopulmonary afferent-efferent axis, focusing on three major components: (1) the molecular and functional basis of afferent pathways linking the heart and lungs to the brain; (2) the impact of these inputs on central autonomic regulation; (3) the downstream effects of sympathetic outflow on hematopoietic stem cells, leading to myeloid skewing, epigenetic memory, and inflammatory macrophage expansion. Finally, we explore how this axis contributes to cardiovascular disease progression and multimorbidity, and how recent studies—especially those on innate immune memory—open new therapeutic avenues targeting neuro-immune crosstalk.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Pages 77-84"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955645","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.2025.08.010
Songsong Luo MD
{"title":"Impact of congestive heart failure on early fluid administration and mortality in patients with sepsis","authors":"Songsong Luo MD","doi":"10.1016/j.jjcc.2025.08.010","DOIUrl":"10.1016/j.jjcc.2025.08.010","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 1","pages":"Page 111"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955628","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 : 2025-12-28DOI: 10.1016/j.jjcc.2025.12.013
Mohamed Abuelazm, Mohamed Saad Rakab, Ibraheem Altamimi, Ahmed Mazen Amin, Hazem Rezq, Hosam I Taha, Mustafa Turkmani, Basel Abdelazeem, Farouk Mookadam
Background: Urinary sodium evaluation is promising to guide decongestion in acute decompensated heart failure (ADHF). We aim to assess the efficacy and safety of natriuresis-guided diuretic protocols for ADHF decongestion.
Methods: This was a systematic review and meta-analysis synthesizing evidence from randomized controlled trials and non-randomized studies obtained from PubMed, CENTRAL, Scopus, and WOS until August 2024. We report dichotomous outcomes using risk ratio and continuous outcomes using mean difference (MD), with a 95 % confidence interval (CI).
Results: We included four studies with 831 patients. Natriuresis-guided protocols significantly increased natriuresis after 24 h [MD: 86.71 mmol, 95 % CI (49.95, 123.46), p < 0.01], natriuresis after 48 h [MD: 137.57 mmol, 95 % CI (68.58, 206.56), p < 0.01], diuresis after 24 h [MD: 0.76 L, 95 % CI (0.48, 1.05), p < 0.01], diuresis after 48 h [MD: 1.11 L, 95 % CI (0.57, 1.65), p < 0.01], weight loss after 48 h [MD: -0.45, 95 % CI (-0.79, -0.10), p = 0.01], and significantly reduced the length of stay [MD: -0.93 day, 95 % CI (-1.45, -0.40), p < 0.01] compared with the standard of care. However, both groups had no difference in congestion score change (p = 0.12) and all-cause mortality/HF re-hospitalization (p = 0.8).
Conclusion: Natriuresis-guided decongestion in ADHF resulted in significantly increased natriuresis, diuresis, weight loss, and shorter length of hospitalization. However, this did not reflect significant clinical benefits, with no significant effect on mortality or HF re-hospitalization.
背景：尿钠评估有望指导急性失代偿性心力衰竭（ADHF）患者的去充血。我们的目的是评估钠导利尿方案对ADHF去充血的有效性和安全性。方法：这是一项系统评价和荟萃分析，综合了截至2024年8月从PubMed、CENTRAL、Scopus和WOS获得的随机对照试验和非随机研究的证据。我们使用风险比报告二分类结果，使用平均差异（MD）报告连续结果，置信区间（CI）为95% %。结果：我们纳入了4项研究，共831例患者。钠尿疗法显著增加ADHF患者24 h后的尿钠量[MD: 86.71 mmol, 95% % CI (49.95, 123.46)， p ]结论：钠尿疗法显著增加ADHF患者的尿钠量，利尿，体重减轻，住院时间缩短。然而，这并没有反映出显著的临床益处，对死亡率或心衰再住院没有显著影响。
{"title":"Natriuresis-guided decongestion in acute decompensated heart failure: A systematic review and meta-analysis.","authors":"Mohamed Abuelazm, Mohamed Saad Rakab, Ibraheem Altamimi, Ahmed Mazen Amin, Hazem Rezq, Hosam I Taha, Mustafa Turkmani, Basel Abdelazeem, Farouk Mookadam","doi":"10.1016/j.jjcc.2025.12.013","DOIUrl":"10.1016/j.jjcc.2025.12.013","url":null,"abstract":"<p><strong>Background: </strong>Urinary sodium evaluation is promising to guide decongestion in acute decompensated heart failure (ADHF). We aim to assess the efficacy and safety of natriuresis-guided diuretic protocols for ADHF decongestion.</p><p><strong>Methods: </strong>This was a systematic review and meta-analysis synthesizing evidence from randomized controlled trials and non-randomized studies obtained from PubMed, CENTRAL, Scopus, and WOS until August 2024. We report dichotomous outcomes using risk ratio and continuous outcomes using mean difference (MD), with a 95 % confidence interval (CI).</p><p><strong>Results: </strong>We included four studies with 831 patients. Natriuresis-guided protocols significantly increased natriuresis after 24 h [MD: 86.71 mmol, 95 % CI (49.95, 123.46), p < 0.01], natriuresis after 48 h [MD: 137.57 mmol, 95 % CI (68.58, 206.56), p < 0.01], diuresis after 24 h [MD: 0.76 L, 95 % CI (0.48, 1.05), p < 0.01], diuresis after 48 h [MD: 1.11 L, 95 % CI (0.57, 1.65), p < 0.01], weight loss after 48 h [MD: -0.45, 95 % CI (-0.79, -0.10), p = 0.01], and significantly reduced the length of stay [MD: -0.93 day, 95 % CI (-1.45, -0.40), p < 0.01] compared with the standard of care. However, both groups had no difference in congestion score change (p = 0.12) and all-cause mortality/HF re-hospitalization (p = 0.8).</p><p><strong>Conclusion: </strong>Natriuresis-guided decongestion in ADHF resulted in significantly increased natriuresis, diuresis, weight loss, and shorter length of hospitalization. However, this did not reflect significant clinical benefits, with no significant effect on mortality or HF re-hospitalization.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862897","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: Coronary microvascular dysfunction (CMD) after percutaneous coronary intervention (PCI) is associated with poor prognosis, including periprocedural myocardial infarction, and is often attributed to distal embolization of lipid-rich plaque components. However, whether preprocedural lipid quantification using near-infrared spectroscopy-intravascular ultrasonography (NIRS-IVUS) can predict CMD remains unclear.
Methods: We retrospectively analyzed 147 coronary lesions in 121 patients with coronary artery disease (excluding ST-segment elevation myocardial infarction) who underwent NIRS-IVUS-guided PCI. CMD was defined as an angiography-based index of microcirculatory resistance (angio-IMR) ≥25. Two NIRS-derived lipid parameters were assessed: maximum lipid core burden index >4 mm (maxLCBI4mm) and a novel index, lipid burden in the stent (LBS = stent diameter × length × LCBI), which was determined by the operator based on the planned stent diameter, planned stent length, and the LCBI within the planned stent implantation segment.
Results: CMD occurred in 36.7 % of lesions and was associated with significantly higher values of both indices (p < 0.01). A stepwise trend between lipid burden and microvascular dysfunction was also observed. Optimal cut-offs were identified as maxLCBI4mm ≥ 579 and LBS ≥20,384. Both indices independently predicted CMD (odds ratios = 7.253 and 3.181), and CMD risk was highest in lesions exceeding both thresholds.
Conclusions: Higher pre-PCI maxLCBI4mm and LBS values were independently associated with CMD development after PCI. Further studies are warranted to validate their clinical relevance in optimizing PCI strategies.
{"title":"Physiological impact of lipid-rich plaque on coronary microvascular dysfunction: Evaluation using near-infrared spectroscopy intravascular ultrasound and angiography-derived index of microcirculatory resistance after percutaneous coronary intervention.","authors":"Nobuhiro Yamada, Masafumi Ueno, Kyohei Onishi, Kazuyoshi Kakehi, Kosuke Fujita, Takayuki Kawamura, Koichiro Matsumura, Gaku Nakazawa","doi":"10.1016/j.jjcc.2025.12.014","DOIUrl":"10.1016/j.jjcc.2025.12.014","url":null,"abstract":"<p><strong>Background: </strong>Coronary microvascular dysfunction (CMD) after percutaneous coronary intervention (PCI) is associated with poor prognosis, including periprocedural myocardial infarction, and is often attributed to distal embolization of lipid-rich plaque components. However, whether preprocedural lipid quantification using near-infrared spectroscopy-intravascular ultrasonography (NIRS-IVUS) can predict CMD remains unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed 147 coronary lesions in 121 patients with coronary artery disease (excluding ST-segment elevation myocardial infarction) who underwent NIRS-IVUS-guided PCI. CMD was defined as an angiography-based index of microcirculatory resistance (angio-IMR) ≥25. Two NIRS-derived lipid parameters were assessed: maximum lipid core burden index >4 mm (maxLCBI<sub>4mm</sub>) and a novel index, lipid burden in the stent (LBS = stent diameter × length × LCBI), which was determined by the operator based on the planned stent diameter, planned stent length, and the LCBI within the planned stent implantation segment.</p><p><strong>Results: </strong>CMD occurred in 36.7 % of lesions and was associated with significantly higher values of both indices (p < 0.01). A stepwise trend between lipid burden and microvascular dysfunction was also observed. Optimal cut-offs were identified as maxLCBI<sub>4mm</sub> ≥ 579 and LBS ≥20,384. Both indices independently predicted CMD (odds ratios = 7.253 and 3.181), and CMD risk was highest in lesions exceeding both thresholds.</p><p><strong>Conclusions: </strong>Higher pre-PCI maxLCBI<sub>4mm</sub> and LBS values were independently associated with CMD development after PCI. Further studies are warranted to validate their clinical relevance in optimizing PCI strategies.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145843769","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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