While vitamin K antagonist (VKA) has traditionally been the preferred treatment for left ventricle (LV) thrombus, the comparative efficacy and safety of direct oral anticoagulants (DOACs) with VKA in this setting remain unelucidated.
Methods
A comprehensive literature search of PubMed and Google Scholar was conducted through May 7, 2025, to identify randomized controlled trials (RCTs) comparing DOACs with VKA in patients with LV thrombus. The primary endpoint was complete resolution of LV thrombus. Secondary endpoints included stroke, systemic embolism, the composite of both stroke and systemic embolism, major bleeding, and all-cause mortality. Both pairwise and network meta-analyses were performed using a random-effects model to synthesize the effect estimates.
Results
Eight RCTs comprising a total of 576 patients were included. Collectively, 88.9 % of the patients treated with DOACs and 81.7 % of those receiving VKA experienced LV thrombus resolution, with a synthesized risk ratio (RR) of 1.01 [95 % confidence interval (CI), 0.94 to 1.07]. No significant differences were observed between the two groups for stroke (RR, 0.75; 95 % CI, 0.25 to 2.19), systemic embolism (RR, 0.21; 95 % CI, 0.01 to 4.58), the composite of stroke and systemic embolism (RR, 0.64; 95 % CI, 0.17 to 2.32), major bleeding (RR, 0.43; 95 % CI, 0.16 to 1.19), or all-cause mortality (RR, 0.92; 95 % CI, 0.36 to 2.31). A network meta-analysis showed no statistically significant differences across the anticoagulants in any clinical endpoint.
Conclusion
DOACs showed comparable efficacy and safety to VKA in managing LV thrombus, supporting their potential role as a viable alternative anticoagulation strategy.
{"title":"Efficacy and safety of direct oral anticoagulants versus vitamin K antagonist in patients with left ventricular thrombus: A meta-analysis of randomized controlled trials","authors":"Tadashi Asanuma , Yuriko Hiruma (MD) , Atsuyuki Watanabe (MD) , Tomonari M. Shimoda (MD) , Masao Iwagami (MD, PhD) , Kaveh Hosseini (MD) , Leandro Slipczuk (MD, PhD) , Jose Wiley (MD, MPH) , Alexandros Briasoulis (MD, PhD) , Hisato Takagi (MD, PhD) , Tadao Aikawa (MD, PhD) , Toshiki Kuno (MD, PhD)","doi":"10.1016/j.jjcc.2025.09.012","DOIUrl":"10.1016/j.jjcc.2025.09.012","url":null,"abstract":"<div><h3>Background</h3><div>While vitamin K antagonist (VKA) has traditionally been the preferred treatment for left ventricle (LV) thrombus, the comparative efficacy and safety of direct oral anticoagulants (DOACs) with VKA in this setting remain unelucidated.</div></div><div><h3>Methods</h3><div>A comprehensive literature search of PubMed and Google Scholar was conducted through May 7, 2025, to identify randomized controlled trials (RCTs) comparing DOACs with VKA in patients with LV thrombus. The primary endpoint was complete resolution of LV thrombus. Secondary endpoints included stroke, systemic embolism, the composite of both stroke and systemic embolism, major bleeding, and all-cause mortality. Both pairwise and network meta-analyses were performed using a random-effects model to synthesize the effect estimates.</div></div><div><h3>Results</h3><div>Eight RCTs comprising a total of 576 patients were included. Collectively, 88.9 % of the patients treated with DOACs and 81.7 % of those receiving VKA experienced LV thrombus resolution, with a synthesized risk ratio (RR) of 1.01 [95 % confidence interval (CI), 0.94 to 1.07]. No significant differences were observed between the two groups for stroke (RR, 0.75; 95 % CI, 0.25 to 2.19), systemic embolism (RR, 0.21; 95 % CI, 0.01 to 4.58), the composite of stroke and systemic embolism (RR, 0.64; 95 % CI, 0.17 to 2.32), major bleeding (RR, 0.43; 95 % CI, 0.16 to 1.19), or all-cause mortality (RR, 0.92; 95 % CI, 0.36 to 2.31). A network meta-analysis showed no statistically significant differences across the anticoagulants in any clinical endpoint.</div></div><div><h3>Conclusion</h3><div>DOACs showed comparable efficacy and safety to VKA in managing LV thrombus, supporting their potential role as a viable alternative anticoagulation strategy.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 6","pages":"Pages 618-621"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124700","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}
Guidelines recommend biomarker-based screening for pre-heart failure (pre-HF) among at-risk populations. Although the asymptomatic nature of pre-HF necessitates proactive screening, real-world implementation remains understudied. This retrospective study analyzed data from a regional pre-HF screening initiative, integrated into annual health screenings, to evaluate: (1) the prevalence of elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, (2) associated echocardiographic findings, and (3) adherence across the screening-to-consultation pathway.
Methods
This study included individuals aged 40–74 years who received pre-HF screening in Furano City, Japan, from October 2023 to March 2024. During the study period, NT-proBNP testing was incorporated into an existing annual health screening program. Participants with elevated NT-proBNP levels (≥125 pg/mL) were referred for cardiology consultation and echocardiography.
Results
Among 1585 screening attendees (mean age, 54.5 years; females, 57.0 %), 1579 (99.6 %) underwent NT-proBNP testing. Elevated levels were found in 118 (7.5 %) individuals. These individuals were older, female, and had a higher blood pressure. Of these 118 individuals, only 55 (46.6 %) attended the follow-up cardiology consultation. Among those evaluated with echocardiography, 22 (40.0 %) had abnormal findings (increased left atrial volume index and left ventricular end-diastolic volume index being the most common).
Conclusions
Integrating NT-proBNP testing into a public health screening program achieved near-perfect testing adherence. The program identified 7.5 % of the general middle-aged population as having pre-HF with predominantly benign echocardiographic changes, highlighting important prevention opportunities. However, a critical drop-off in adherence to specialist consultation highlights a major implementation gap. Optimizing the post-screening pathway is essential to maximize the potential benefits of population-wide pre-HF screening.
{"title":"Biomarker-based pre-heart failure screening in a middle-aged rural population","authors":"Yuichiro Mori MD, MPH , Shunsuke Natori MD, PhD , Toshio Arai MD, PhD , Fujio Kakuya MD, PhD , Shingo Fukuma MD, PhD","doi":"10.1016/j.jjcc.2025.08.019","DOIUrl":"10.1016/j.jjcc.2025.08.019","url":null,"abstract":"<div><h3>Background</h3><div>Guidelines recommend biomarker-based screening for pre-heart failure (pre-HF) among at-risk populations. Although the asymptomatic nature of pre-HF necessitates proactive screening, real-world implementation remains understudied. This retrospective study analyzed data from a regional pre-HF screening initiative, integrated into annual health screenings, to evaluate: (1) the prevalence of elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, (2) associated echocardiographic findings, and (3) adherence across the screening-to-consultation pathway.</div></div><div><h3>Methods</h3><div>This study included individuals aged 40–74 years who received pre-HF screening in Furano City, Japan, from October 2023 to March 2024. During the study period, NT-proBNP testing was incorporated into an existing annual health screening program. Participants with elevated NT-proBNP levels (≥125 pg/mL) were referred for cardiology consultation and echocardiography.</div></div><div><h3>Results</h3><div>Among 1585 screening attendees (mean age, 54.5 years; females, 57.0 %), 1579 (99.6 %) underwent NT-proBNP testing. Elevated levels were found in 118 (7.5 %) individuals. These individuals were older, female, and had a higher blood pressure. Of these 118 individuals, only 55 (46.6 %) attended the follow-up cardiology consultation. Among those evaluated with echocardiography, 22 (40.0 %) had abnormal findings (increased left atrial volume index and left ventricular end-diastolic volume index being the most common).</div></div><div><h3>Conclusions</h3><div>Integrating NT-proBNP testing into a public health screening program achieved near-perfect testing adherence. The program identified 7.5 % of the general middle-aged population as having pre-HF with predominantly benign echocardiographic changes, highlighting important prevention opportunities. However, a critical drop-off in adherence to specialist consultation highlights a major implementation gap. Optimizing the post-screening pathway is essential to maximize the potential benefits of population-wide pre-HF screening.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 6","pages":"Pages 568-575"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008246","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}
Anemia and renal failure, common comorbidities in patients with heart failure (HF), are associated with increased mortality. Hypoxia-inducible factor prolyl hydroxylase inhibitors, such as daprodustat, treat renal anemia by stimulating erythropoiesis and enhancing iron availability. However, its efficacy in treating HF with renal anemia remains to be determined.
Methods
This pilot, multicenter, open-label, randomized controlled trial was conducted in five hospitals in Japan. Patients with HF, anemia (hemoglobin, 7.5–11 g/dL), and renal impairment (estimated glomerular filtration rate, <60 mL/min/1.73 m2) not requiring hemodialysis were randomized 1:1 to receive daprodustat or standard of care. The primary endpoint was the hemoglobin level at 16 weeks. The secondary endpoints included blood transfusion rates, alleviation of HF symptoms, changes in N-terminal pro-B-type natriuretic peptide and iron-related biomarkers, and cardiac structural and functional changes.
Results
Twenty-one patients were randomized between March 2022 and November 2023. At 16 weeks, the mean hemoglobin level was significantly higher in the daprodustat group (12.1 ± 0.73 g/dL) than in the standard of care group (10.3 ± 0.97 g/dL, p < 0.001). Serum iron, ferritin, hepcidin, and transferrin saturation levels were significantly lower, whereas N-terminal pro-B-type natriuretic peptide levels were significantly higher in the daprodustat treatment group. Kansas City Cardiomyopathy Questionnaire Total Symptom Score improvement (44.4 % vs. 55.6 %, p = 0.99) and structural and functional cardiac parameters showed no significant differences.
Conclusions
Daprodustat effectively increases hemoglobin levels and modifies iron metabolism by decreasing hepcidin levels and increasing iron utilization in patients with HF and renal anemia.
{"title":"Daprodustat for patients with heart failure and renal anemia: A pilot multicenter, open-label, randomized controlled study","authors":"Yu Suresvar Singh MD , Yuya Matsue MD, PhD , Takashi Iso MD, PhD , Yudai Fujimoto MD , Naotake Yanagisawa PhD , Jun Shitara MD, PhD , Satoru Suwa MD , Shota Miyakuni MD, PhD , Akira Mizukami MD , Yuki Saito MD, PhD, FJCC , Yasuo Okumura MD, PhD, FJCC , Kiyoshi Takasu MD, PhD , Takashi Tokano MD, PhD , Masaru Hiki MD, PhD , Kikuo Isoda MD, PhD, FJCC , Tadashi Miyazaki MD, PhD , Katsumi Miyauchi MD, PhD, FJCC , Tohru Minamino MD, PhD, FJCC","doi":"10.1016/j.jjcc.2025.09.011","DOIUrl":"10.1016/j.jjcc.2025.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Anemia and renal failure, common comorbidities in patients with heart failure (HF), are associated with increased mortality. Hypoxia-inducible factor prolyl hydroxylase inhibitors, such as daprodustat, treat renal anemia by stimulating erythropoiesis and enhancing iron availability. However, its efficacy in treating HF with renal anemia remains to be determined.</div></div><div><h3>Methods</h3><div>This pilot, multicenter, open-label, randomized controlled trial was conducted in five hospitals in Japan. Patients with HF, anemia (hemoglobin, 7.5–11 g/dL), and renal impairment (estimated glomerular filtration rate, <60 mL/min/1.73 m<sup>2</sup>) not requiring hemodialysis were randomized 1:1 to receive daprodustat or standard of care. The primary endpoint was the hemoglobin level at 16 weeks. The secondary endpoints included blood transfusion rates, alleviation of HF symptoms, changes in N-terminal pro-B-type natriuretic peptide and iron-related biomarkers, and cardiac structural and functional changes.</div></div><div><h3>Results</h3><div>Twenty-one patients were randomized between March 2022 and November 2023. At 16 weeks, the mean hemoglobin level was significantly higher in the daprodustat group (12.1 ± 0.73 g/dL) than in the standard of care group (10.3 ± 0.97 g/dL, <em>p</em> < 0.001). Serum iron, ferritin, hepcidin, and transferrin saturation levels were significantly lower, whereas N-terminal pro-B-type natriuretic peptide levels were significantly higher in the daprodustat treatment group. Kansas City Cardiomyopathy Questionnaire Total Symptom Score improvement (44.4 % vs. 55.6 %, <em>p</em> = 0.99) and structural and functional cardiac parameters showed no significant differences.</div></div><div><h3>Conclusions</h3><div>Daprodustat effectively increases hemoglobin levels and modifies iron metabolism by decreasing hepcidin levels and increasing iron utilization in patients with HF and renal anemia.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 6","pages":"Pages 592-598"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102747","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 : 2025-12-01DOI: 10.1016/j.jjcc.2025.09.015
Kazuya Tateishi MD , Yuichi Saito MD , Yuki Shiko PhD , Kohei Takahashi MS , Hideki Kitahara MD , Yoshio Kobayashi MD, PhD, FJCC , Naohiro Yonemoto MPH, PhD , Tetsuya Matoba MD, PhD , Yoshio Tahara MD, PhD , Japanese Circulation Society Resuscitation Science Study (JCS-ReSS) Group
Background
Patients with out-of-hospital cardiac arrest (OHCA) during the night tend to have worse outcomes than those with OHCA during the day. One possible explanation for poorer outcomes in patients with night-time onset is the lower quality of bystander cardiopulmonary resuscitation (CPR), although the exact cause has not been fully clarified. This study evaluated the differences between day and night-time-OHCA onset on neurologically favourable survival for patients with and without bystander CPR.
Methods
A cohort of 118,822 patients with witnessed OHCA and prehospital return of spontaneous circulation was obtained from a nationwide OHCA registry database in Japan. The primary endpoint was neurologically favourable survival at 1 month. We also investigated the impact of night-time bystander CPR presence or absence as a sub-analysis.
Results
The neurologically favourable survival rate was significantly lower for patients with night-time than those with daytime OHCA onset (30.7 % vs. 31.8 %, p < 0.001). The multivariable analysis determined night-time OHCA onset was a significant negative factor associated with neurologically favourable survival at 1-month [odds ratio (OR) 0.95; 95 % confidence interval (CI) 0.92–0.98, p = 0.002]. This negative effect of night-time onset compared to daytime was more pronounced for patients with bystander CPR from a citizen (OR 0.91; 95 % CI 0.87–0.95, p < 0.001). In contrast, this negative effect was attenuated in patients without bystander CPR (OR 1.00; 95 % CI 0.95–1.04, p = 0.836).
Conclusion
These results suggest that the insufficient quality of bystander CPR may be one of the causes for the negative impact of night-time OHCA compared to daytime on patients.
背景：夜间院外心脏骤停（OHCA）患者的预后往往比白天OHCA患者差。夜间起病患者预后较差的一个可能解释是旁观者心肺复苏（CPR）的质量较低，尽管确切的原因尚未完全澄清。本研究评估了白天和夜间ohca发作对有和没有旁观者心肺复苏术患者的神经学有利生存的差异。方法：从日本全国OHCA登记数据库中获得118,822例OHCA和院前自发循环恢复的患者。主要终点是1 个月的神经系统有利生存期。我们还调查了夜间旁观者CPR存在或不存在的影响，作为一项亚分析。结果：夜间OHCA患者的神经系统有利生存率明显低于白天OHCA患者（30.7% % vs. 31.8% %,p ）。结论：这些结果提示，旁观者心肺复苏术质量不足可能是夜间OHCA对患者产生负面影响的原因之一。
{"title":"Effect of night-time onset on neurologically favourable survival between patients with and without bystander cardiopulmonary resuscitation","authors":"Kazuya Tateishi MD , Yuichi Saito MD , Yuki Shiko PhD , Kohei Takahashi MS , Hideki Kitahara MD , Yoshio Kobayashi MD, PhD, FJCC , Naohiro Yonemoto MPH, PhD , Tetsuya Matoba MD, PhD , Yoshio Tahara MD, PhD , Japanese Circulation Society Resuscitation Science Study (JCS-ReSS) Group","doi":"10.1016/j.jjcc.2025.09.015","DOIUrl":"10.1016/j.jjcc.2025.09.015","url":null,"abstract":"<div><h3>Background</h3><div>Patients with out-of-hospital cardiac arrest (OHCA) during the night tend to have worse outcomes than those with OHCA during the day. One possible explanation for poorer outcomes in patients with night-time onset is the lower quality of bystander cardiopulmonary resuscitation (CPR), although the exact cause has not been fully clarified. This study evaluated the differences between day and night-time-OHCA onset on neurologically favourable survival for patients with and without bystander CPR.</div></div><div><h3>Methods</h3><div>A cohort of 118,822 patients with witnessed OHCA and prehospital return of spontaneous circulation was obtained from a nationwide OHCA registry database in Japan. The primary endpoint was neurologically favourable survival at 1 month. We also investigated the impact of night-time bystander CPR presence or absence as a sub-analysis.</div></div><div><h3>Results</h3><div>The neurologically favourable survival rate was significantly lower for patients with night-time than those with daytime OHCA onset (30.7 % vs. 31.8 %, <em>p</em> < 0.001). The multivariable analysis determined night-time OHCA onset was a significant negative factor associated with neurologically favourable survival at 1-month [odds ratio (OR) 0.95; 95 % confidence interval (CI) 0.92–0.98, <em>p</em> = 0.002]. This negative effect of night-time onset compared to daytime was more pronounced for patients with bystander CPR from a citizen (OR 0.91; 95 % CI 0.87–0.95, <em>p</em> < 0.001). In contrast, this negative effect was attenuated in patients without bystander CPR (OR 1.00; 95 % CI 0.95–1.04, <em>p</em> = 0.836).</div></div><div><h3>Conclusion</h3><div>These results suggest that the insufficient quality of bystander CPR may be one of the causes for the negative impact of night-time OHCA compared to daytime on patients.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 6","pages":"Pages 586-591"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124741","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 : 2025-12-01DOI: 10.1016/j.jjcc.2025.06.011
Xinglong Zhong MD , Zehua Li PhD , Hailin Liu MD , Liangzhao Huang MD , Fan Yang PhD , Hong Wang PhD
A high percentage of chronic kidney disease (CKD) patients suffer from vascular aging. It has been demonstrated that trimethylamine N-oxide (TMAO) is an important indicator of cardiovascular events in patients with CKD. However, there is no clear understanding of how TMAO contributes to vascular aging in CKD. According to our findings, TMAO induced vascular aging in aged rats under normal physiological conditions, and additionally exacerbated vascular aging in young rats with kidney failure. When young rats undergo a 5/6 nephrectomy to build a CKD model, TMAO could cause vascular aging, indicated by upregulated senescence markers including senescence-associated β-galactosidase, p16, p21, p53, vascular dysfunction, and remodeling. By contrast, a reduction in the levels of TMAO by antibiotic treatment attenuated the aging of the arteries in rats with CKD. Also, TMAO was shown to positively regulate senescence in both human umbilical vein endothelial cells (HUVECs) and human vascular smooth muscle cells. A further observation was that TMAO inhibited GATA4 degradation, which resulted in activating the nuclear factor κB signal thus stimulating senescence-associated secretory phenotype during aging. By contrast, silencing of GATA4 attenuated TMAO-induced senescence in HUVECs. As a result of our findings, we suggest that TMAO might be a potential therapeutic target for CKD-associated vascular aging. Blocking the GATA4 pathway may offer a therapeutic approach.
{"title":"Trimethylamine-N-oxide promotes vascular aging via inhibiting GATA4 degradation in chronic kidney disease rats","authors":"Xinglong Zhong MD , Zehua Li PhD , Hailin Liu MD , Liangzhao Huang MD , Fan Yang PhD , Hong Wang PhD","doi":"10.1016/j.jjcc.2025.06.011","DOIUrl":"10.1016/j.jjcc.2025.06.011","url":null,"abstract":"<div><div><span><span>A high percentage of chronic kidney disease<span> (CKD) patients suffer from vascular aging. It has been demonstrated that trimethylamine<span> N-oxide (TMAO) is an important indicator of cardiovascular events in patients with CKD. However, there is no clear understanding of how TMAO contributes to vascular aging in CKD. According to our findings, TMAO induced vascular aging in aged rats under normal physiological conditions, and additionally exacerbated vascular aging in young rats with kidney failure. When young rats undergo a 5/6 nephrectomy to build a CKD model, TMAO could cause vascular aging, indicated by upregulated senescence markers including senescence-associated β-galactosidase, </span></span></span>p16, </span>p21<span><span>, p53, vascular dysfunction, and remodeling. By contrast, a reduction in the levels of TMAO by antibiotic<span> treatment attenuated the aging of the arteries in rats with CKD. Also, TMAO was shown to positively regulate senescence in both human umbilical vein endothelial cells (HUVECs) and human </span></span>vascular smooth muscle cells<span>. A further observation was that TMAO inhibited GATA4<span> degradation, which resulted in activating the nuclear factor κB signal thus stimulating senescence-associated secretory phenotype during aging. By contrast, silencing of GATA4<span> attenuated TMAO-induced senescence in HUVECs. As a result of our findings, we suggest that TMAO might be a potential therapeutic target for CKD-associated vascular aging. Blocking the GATA4 pathway may offer a therapeutic approach.</span></span></span></span></div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 6","pages":"Pages 533-544"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484526","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}
Trace elements, including zinc, copper, and selenium may influence heart failure prognosis due to their roles in mitochondrial function. Previous studies have reported associations between individual trace element abnormalities—such as low serum zinc, high serum copper, and low selenium levels—and adverse clinical outcomes, including reduced exercise capacity in patients with heart failure. However, the impact of multiple trace element abnormalities remains poorly understood. This study aimed to explore the prevalence of these abnormalities, both individually and in combination, and evaluate the association between multiple abnormalities and outcomes in patients with acute heart failure.
Methods
We analyzed patients with acute heart failure admitted to the Nagoya University Hospital between January 2012 and May 2024. Zinc, copper, and selenium levels were measured upon admission.
Results
Among the 147 patients, 39 % had zinc deficiency, 52 % had copper excess, and 61 % had selenium deficiency. At least one trace element abnormality was observed in 84 % of patients, and two or three abnormalities were observed in 51 % of patients. Patients with multiple abnormalities had lower albumin levels, higher C-reactive protein levels, and lower hemoglobin levels than those without multiple abnormalities. Over a median follow-up of 196 days, all-cause death was more frequently observed in patients with two or three abnormalities than those with zero or one abnormality (adjusted hazard ratio, 3.78, 95 % confidence interval, 1.23–11.6).
Conclusions
Multiple trace element abnormalities are common in patients with acute heart failure and are associated with poor clinical outcomes. These findings suggest correcting trace element abnormalities may be a potential target in heart failure management.
{"title":"Association of trace element abnormalities and adverse outcomes in patients with acute heart failure","authors":"Shin Nagai MD, Toru Kondo MD, PhD, Ryota Morimoto MD, PhD, Hiroaki Hiraiwa MD, PhD, Chiaki Mizuno MD, Asuka Nozaki MD, Shotaro Komeyama MD, Kiyota Kondo MD, Ryota Ito MD, Shingo Kazama MD, PhD, Toyoaki Murohara MD, PhD","doi":"10.1016/j.jjcc.2025.07.009","DOIUrl":"10.1016/j.jjcc.2025.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Trace elements, including zinc, copper, and selenium may influence heart failure prognosis due to their roles in mitochondrial function. Previous studies have reported associations between individual trace element abnormalities—such as low serum zinc, high serum copper, and low selenium levels—and adverse clinical outcomes, including reduced exercise capacity in patients with heart failure. However, the impact of multiple trace element abnormalities remains poorly understood. This study aimed to explore the prevalence of these abnormalities, both individually and in combination, and evaluate the association between multiple abnormalities and outcomes in patients with acute heart failure.</div></div><div><h3>Methods</h3><div>We analyzed patients with acute heart failure admitted to the Nagoya University Hospital between January 2012 and May 2024. Zinc, copper, and selenium levels were measured upon admission.</div></div><div><h3>Results</h3><div>Among the 147 patients, 39 % had zinc deficiency, 52 % had copper excess, and 61 % had selenium deficiency. At least one trace element abnormality was observed in 84 % of patients, and two or three abnormalities were observed in 51 % of patients. Patients with multiple abnormalities had lower albumin levels, higher C-reactive protein levels, and lower hemoglobin levels than those without multiple abnormalities. Over a median follow-up of 196 days, all-cause death was more frequently observed in patients with two or three abnormalities than those with zero or one abnormality (adjusted hazard ratio, 3.78, 95 % confidence interval, 1.23–11.6).</div></div><div><h3>Conclusions</h3><div>Multiple trace element abnormalities are common in patients with acute heart failure and are associated with poor clinical outcomes. These findings suggest correcting trace element abnormalities may be a potential target in heart failure management.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 6","pages":"Pages 545-551"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731130","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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