{"title":"Response to “Contemporary clinical implication of catheter ablation for atrial fibrillation in Japan”","authors":"Hiroki Sato MD, MSc, PhD , Naohiko Takahashi MD, PhD, FJCC","doi":"10.1016/j.jjcc.2025.11.010","DOIUrl":"10.1016/j.jjcc.2025.11.010","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 2","pages":"Pages 201-202"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633969","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 : 2026-02-01Epub Date: 2025-10-24DOI: 10.1016/j.jjcc.2025.10.005
Hirofumi Tomita MD, PhD, FJCC , Ken Okumura MD, PhD
In Japan, the CHADS2 score has long been recommended as a Class I indication for risk stratification in patients with nonvalvular atrial fibrillation. However, the recent Japanese Circulation Society guidelines have proposed the HELT-E2S2 score as a Class IIa recommendation, which is a novel risk stratification system developed using the pooled data from five registries in Japan. In Europe, the CHA2DS2-VASc score has been adopted as a Class I recommendation over the past decade. However, the 2024 European Society of Cardiology guidelines have newly recommended the CHA2DS2-VA score as a Class I indication, excluding the sex category from the original CHA2DS2-VASc score. This review will first present the background and rationale for the development of the HELT-E2S2 score, followed by a summary of the current status of its clinical validation and the remaining challenges that need to be addressed. In addition, a focused discussion will be provided on the comparison between the recently highlighted CHA2DS2-VA score and the widely used CHA2DS2-VASc score, emphasizing their similarities, differences, and potential implications for risk stratification.
{"title":"Current risk stratification schemes for preventing ischemic stroke in patients with nonvalvular atrial fibrillation: HELT-E2S2 and CHA2DS2-VA scores","authors":"Hirofumi Tomita MD, PhD, FJCC , Ken Okumura MD, PhD","doi":"10.1016/j.jjcc.2025.10.005","DOIUrl":"10.1016/j.jjcc.2025.10.005","url":null,"abstract":"<div><div>In Japan, the CHADS<sub>2</sub> score has long been recommended as a Class I indication for risk stratification in patients with nonvalvular atrial fibrillation. However, the recent Japanese Circulation Society guidelines have proposed the HELT-E<sub>2</sub>S<sub>2</sub> score as a Class IIa recommendation, which is a novel risk stratification system developed using the pooled data from five registries in Japan. In Europe, the CHA<sub>2</sub>DS<sub>2</sub>-VASc score has been adopted as a Class I recommendation over the past decade. However, the 2024 European Society of Cardiology guidelines have newly recommended the CHA<sub>2</sub>DS<sub>2</sub>-VA score as a Class I indication, excluding the sex category from the original CHA<sub>2</sub>DS<sub>2</sub>-VASc score. This review will first present the background and rationale for the development of the HELT-E<sub>2</sub>S<sub>2</sub> score, followed by a summary of the current status of its clinical validation and the remaining challenges that need to be addressed. In addition, a focused discussion will be provided on the comparison between the recently highlighted CHA<sub>2</sub>DS<sub>2</sub>-VA score and the widely used CHA<sub>2</sub>DS<sub>2</sub>-VASc score, emphasizing their similarities, differences, and potential implications for risk stratification.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 2","pages":"Pages 136-143"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370308","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}
Transcatheter angioplasty is an essential interventional procedure for congenital heart disease. However, in Japan, the lack of large high-pressure balloons and vascular stents limits treatment options. This study analyzes data from the Japanese Society of Congenital Interventional Cardiology registry (JCIC-R) to evaluate outcomes under these constraints and assess the need for device development.
Methods
This study analyzed transcatheter balloon angioplasty cases recorded in the JCIC-R from 2016 to 2018. Patients were categorized into two groups according to the technique used: single-balloon (SB) and double-balloon (DB). Baseline characteristics, procedural details, effectiveness, and adverse events were compared. Effectiveness was assessed by pressure gradient and minimal lumen diameter (MLD) if recorded. A subgroup analysis focused on SB vs. DB techniques for large pulmonary artery stenosis with limited balloon availability. Propensity score matching was used to adjust for confounders.
Results
There were 4,902 procedures in 2,766 patients (2016–2018) who underwent balloon angioplasty. Most (93.6 %) had SB, while 6.4 % had DB. DB was used in larger patients (22.4 kg vs 9.0 kg, p < 0.001) and larger lesions (39.4 % vs. 6.4 %, p < 0.001), with pulmonary arteries as the main target (66.2 %). Angioplasty balloons were the most used device (83.4 % of procedures); however, suboptimal balloon selection, including under-pressurized or under-sized, occurred in 7.9 % of cases. Serious adverse events were rare (1.3 %) with no significant difference between groups. In pulmonary arteries with pre-procedural MLD >6 mm, DB group showed a larger pre-procedural MLD (8.2 mm vs 7.3 mm, p = 0.003) and more severe stenosis (30 mmHg vs 17 mmHg, p = 0.011), requiring longer procedures (132 vs 108 minutes, p = 0.002). Despite differences, effective balloon dilation remained limited (23 % vs 29 %, p = 0.5).
Conclusion
Balloon angioplasty is widely used and relatively safe for congenital heart disease in Japan, but its effectiveness for larger lesions may improve with better access to high-pressure balloons and stents.
{"title":"Balloon angioplasty for congenital heart disease in Japan - Comprehensive analysis from the Japanese Society of Congenital Interventional Cardiology Registry","authors":"Atsuko Kato MD, PhD , Hisateru Tachimori PhD , Ryo Inuzuka MD, PhD , Sung-Hae Kim MD , Hikoro Matsui MD, PhD , Takanari Fujii MD, PhD , Hiroaki Kise MD, PhD , Kazuto Fujimoto MD, PhD , Hiraku Kumamaru MD , Tohru Kobayashi MD, PhD , Hideshi Tomita MD, PhD, FJCC","doi":"10.1016/j.jjcc.2025.06.009","DOIUrl":"10.1016/j.jjcc.2025.06.009","url":null,"abstract":"<div><h3>Background</h3><div><span>Transcatheter angioplasty<span> is an essential interventional procedure for congenital heart disease. However, in Japan, the lack of large high-pressure balloons and </span></span>vascular stents<span> limits treatment options. This study analyzes data from the Japanese Society of Congenital Interventional Cardiology registry (JCIC-R) to evaluate outcomes under these constraints and assess the need for device development.</span></div></div><div><h3>Methods</h3><div><span>This study analyzed transcatheter balloon angioplasty<span><span> cases recorded in the JCIC-R from 2016 to 2018. Patients were categorized into two groups according to the technique used: single-balloon (SB) and double-balloon (DB). Baseline characteristics, procedural details, effectiveness, and adverse events were compared. Effectiveness was assessed by pressure gradient and minimal lumen diameter (MLD) if recorded. A subgroup analysis focused on SB vs. DB techniques for large pulmonary artery </span>stenosis with limited balloon availability. </span></span>Propensity score matching was used to adjust for confounders.</div></div><div><h3>Results</h3><div>There were 4,902 procedures in 2,766 patients (2016–2018) who underwent balloon angioplasty. Most (93.6 %) had SB, while 6.4 % had DB. DB was used in larger patients (22.4 kg vs 9.0 kg, <em>p</em> < 0.001) and larger lesions (39.4 % vs. 6.4 %, <em>p</em> < 0.001), with pulmonary arteries as the main target (66.2 %). Angioplasty balloons were the most used device (83.4 % of procedures); however, suboptimal balloon selection, including under-pressurized or under-sized, occurred in 7.9 % of cases. Serious adverse events were rare (1.3 %) with no significant difference between groups. In pulmonary arteries with pre-procedural MLD >6 mm, DB group showed a larger pre-procedural MLD (8.2 mm vs 7.3 mm, <em>p</em> = 0.003) and more severe stenosis (30 mmHg vs 17 mmHg, <em>p</em> = 0.011), requiring longer procedures (132 vs 108 minutes, <em>p</em><span> = 0.002). Despite differences, effective balloon dilation remained limited (23 % vs 29 %, </span><em>p</em> = 0.5).</div></div><div><h3>Conclusion</h3><div>Balloon angioplasty is widely used and relatively safe for congenital heart disease in Japan, but its effectiveness for larger lesions may improve with better access to high-pressure balloons and stents.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 2","pages":"Pages 153-160"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340165","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}
Superior vena cava isolation (SVCI) has been proposed as a treatment for non-pulmonary vein triggers of atrial fibrillation (AF). Recently, high-power short-duration ablation has emerged as a potential strategy for SVCI, although the optimal settings remain undetermined, particularly in the lateral region. Specifically, the QDOT MICRO™ (Biosense Webster, Irvine, CA, USA) system enables very high-power, short-duration (vHPSD, 90 W for 4 s) ablation, achieving a shallower tissue depth than conventional methods. In this study, we aimed to compare the effectiveness of vHPSD with a conventional strategy (20 W, ablation index of 240) using the Thermocool SmartTouch® Surround Flow (Biosense Webster) system in patients with AF.
Methods
We retrospectively analyzed 100 consecutive patients with recurrent AF post-initial pulmonary vein isolation who underwent SVCI using either the vHPSD or 20 W strategy at our institution between January 2016 and October 2024. Outcome measures included SVCI procedure time, number of application points, the incidence of gaps in each segment, and associated complications.
Results
There were 40 participants in the vHPSD group and 60 in the 20 W group. The vHPSD group showed significantly shorter SVCI procedure time than the 20 W group (11 ± 5.5 vs. 16 ± 9.6 min, p < 0.01) and required fewer application points (21 ± 7.6 vs. 29 ± 12, p < 0.01). The incidence of gaps in the lateral segments was significantly lower in the vHPSD group (13 % vs. 38 %, p < 0.01). Only one complication (aspiration pneumonia) occurred in the 20 W group.
Conclusions
This study suggests that SVCI using vHPSD appears effective, offering potential advantages in reducing procedure time and improving efficiency.
{"title":"Very high-power short-duration ablation for superior vena cava isolation in patients with recurrent atrial fibrillation","authors":"Naoki Aizawa MD , Kaoru Tanno MD, PhD, FJCC , Takahiro Furuya MD, PhD , Tomoyuki Ishinaga MD , Keita Shibata MD, PhD , Chisato Sato MD, PhD , Tenjin Nishikura MD, PhD , Naoko Ikeda MD, PhD , Kohei Wakabayashi MD, PhD, FJCC , Takaaki Matsuyama MD, PhD","doi":"10.1016/j.jjcc.2025.06.015","DOIUrl":"10.1016/j.jjcc.2025.06.015","url":null,"abstract":"<div><h3>Background</h3><div>Superior vena cava<span> isolation (SVCI) has been proposed as a treatment for non-pulmonary vein triggers of atrial fibrillation (AF). Recently, high-power short-duration ablation has emerged as a potential strategy for SVCI, although the optimal settings remain undetermined, particularly in the lateral region. Specifically, the QDOT MICRO™ (Biosense Webster, Irvine, CA, USA) system enables very high-power, short-duration (vHPSD, 90 W for 4 s) ablation, achieving a shallower tissue depth than conventional methods. In this study, we aimed to compare the effectiveness of vHPSD with a conventional strategy (20 W, ablation index of 240) using the Thermocool SmartTouch® Surround Flow (Biosense Webster) system in patients with AF.</span></div></div><div><h3>Methods</h3><div>We retrospectively analyzed 100 consecutive patients with recurrent AF post-initial pulmonary vein isolation who underwent SVCI using either the vHPSD or 20 W strategy at our institution between January 2016 and October 2024. Outcome measures included SVCI procedure time, number of application points, the incidence of gaps in each segment, and associated complications.</div></div><div><h3>Results</h3><div>There were 40 participants in the vHPSD group and 60 in the 20 W group. The vHPSD group showed significantly shorter SVCI procedure time than the 20 W group (11 ± 5.5 vs. 16 ± 9.6 min, <em>p</em> < 0.01) and required fewer application points (21 ± 7.6 vs. 29 ± 12, <em>p</em> < 0.01). The incidence of gaps in the lateral segments was significantly lower in the vHPSD group (13 % vs. 38 %, <em>p</em> < 0.01). Only one complication (aspiration pneumonia) occurred in the 20 W group.</div></div><div><h3>Conclusions</h3><div>This study suggests that SVCI using vHPSD appears effective, offering potential advantages in reducing procedure time and improving efficiency.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 2","pages":"Pages 174-179"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528136","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 dynamics and prognostic value of diuretic metrics in response to initial intravenous (IV) diuretic therapy in patients with acute heart failure (AHF) remain unclear. We assessed the association between urinary sodium concentration, diuretic response (DR) following IV furosemide administration, and their prognostic implications in patients with AHF.
Methods
The diuretic resistance measured by sodium excretion and urine output (DIURESIS)-AHF study was a prospective, multicenter, observational study that assessed spot urinary sodium concentrations at 0/1/2 h, total urine output, and urinary sodium excretion achieved within the first 6 h following initial IV furosemide administration. The DR was measured using the urine output or sodium excretion per 40 mg of IV furosemide.
Results
Ninety-six patients with AHF (mean age, 78 years; men, 56 %) were included. Urine sodium concentrations at 1/2 h showed high inter- and intra-patient variabilities. A lower DR based on 6-h sodium excretion was independently associated with a higher incidence of composite outcome, even after adjusting for known risk factors (/10-mmol increase; hazard ratio: 0.96, 95 % confidence interval: 0.93–0.99, p = 0.011); the DR measured by urine output was not.
Conclusions
Urine sodium concentrations at 1/2 h after initial IV furosemide showed great inter- and intra-patient variabilities, and lower DR using 6-h sodium excretion after IV furosemide was associated with a poor prognosis in patients with AHF.
{"title":"Diuretic resistance measured by sodium excretion and urine output in acute heart failure: The DIURESIS-AHF study","authors":"Yudai Fujimoto MD , Takeshi Kitai MD, PhD , Takahito Nasu MD, PhD , Shingo Matsumoto MD, PhD , Yoshihisa Naruse MD, PhD , Hirofumi Hioki MD, PhD , Masato Shimizu MD, PhD, FJCC , Taishi Yonetsu MD, PhD , Yu Horiuchi MD, PhD , Yuya Matsue MD, PhD","doi":"10.1016/j.jjcc.2025.06.018","DOIUrl":"10.1016/j.jjcc.2025.06.018","url":null,"abstract":"<div><h3>Background</h3><div><span><span>The dynamics and prognostic value of diuretic metrics in response to initial intravenous (IV) </span>diuretic therapy<span> in patients with acute heart failure (AHF) remain unclear. We assessed the association between </span></span>urinary<span><span> sodium concentration, diuretic response (DR) following IV </span>furosemide administration, and their prognostic implications in patients with AHF.</span></div></div><div><h3>Methods</h3><div><span>The diuretic resistance measured by sodium excretion and urine output (DIURESIS)-AHF study was a prospective, multicenter, observational study that assessed spot urinary sodium concentrations at 0/1/2 h, total urine output, and urinary sodium excretion achieved within the first 6 h following initial IV </span>furosemide administration. The DR was measured using the urine output or sodium excretion per 40 mg of IV furosemide.</div></div><div><h3>Results</h3><div>Ninety-six patients with AHF (mean age, 78 years; men, 56 %) were included. Urine sodium concentrations at 1/2 h showed high inter- and intra-patient variabilities. A lower DR based on 6-h sodium excretion was independently associated with a higher incidence of composite outcome, even after adjusting for known risk factors (/10-mmol increase; hazard ratio: 0.96, 95 % confidence interval: 0.93–0.99, <em>p</em> = 0.011); the DR measured by urine output was not.</div></div><div><h3>Conclusions</h3><div>Urine sodium concentrations at 1/2 h after initial IV furosemide showed great inter- and intra-patient variabilities, and lower DR using 6-h sodium excretion after IV furosemide was associated with a poor prognosis in patients with AHF.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 2","pages":"Pages 167-173"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564814","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 : 2026-02-01Epub Date: 2025-09-04DOI: 10.1016/j.jjcc.2025.08.018
Jeong-Eun Yi MD, PhD , Jung Sun Cho MD, PhD
Heart failure with preserved ejection fraction (HFpEF) accounts for more than half of all HF cases and its incidence and prevalence continue to increase, with a substantial burden of morbidity and mortality. Despite advances in our understanding of heterogeneous pathophysiology underlying HFpEF, the diagnosis, risk assessment, and management of this disease entity remain challenging in everyday practice. Artificial intelligence (AI) algorithm can handle large amounts of complex data and machine learning (ML), a subfield of AI, allows for the identification of relevant patterns by learning from big data. Considering the vast datasets generated from patients with HFpEF over the course of their illness, the application of AI and ML algorithms in HFpEF has the potential to improve patient care through enhancing early and precise diagnosis, personalized treatment based on phenotypes, and efficient monitoring. In this review, we provide an overview of the use of AI and ML in patients with HFpEF, focusing on diagnosis, phenotyping, risk stratification and prognosis, and management. Additionally, we discuss the limitations in the clinical adaptability of AI and suggest the future research directions for developing novel and feasible AI-based HFpEF model.
{"title":"Artificial intelligence in HFpEF: Diagnosis, prognosis, and management strategies","authors":"Jeong-Eun Yi MD, PhD , Jung Sun Cho MD, PhD","doi":"10.1016/j.jjcc.2025.08.018","DOIUrl":"10.1016/j.jjcc.2025.08.018","url":null,"abstract":"<div><div>Heart failure with preserved ejection fraction (HFpEF) accounts for more than half of all HF cases and its incidence and prevalence continue to increase, with a substantial burden of morbidity and mortality. Despite advances in our understanding of heterogeneous pathophysiology underlying HFpEF, the diagnosis, risk assessment, and management of this disease entity remain challenging in everyday practice. Artificial intelligence (AI) algorithm can handle large amounts of complex data and machine learning (ML), a subfield of AI, allows for the identification of relevant patterns by learning from big data. Considering the vast datasets generated from patients with HFpEF over the course of their illness, the application of AI and ML algorithms in HFpEF has the potential to improve patient care through enhancing early and precise diagnosis, personalized treatment based on phenotypes, and efficient monitoring. In this review, we provide an overview of the use of AI and ML in patients with HFpEF, focusing on diagnosis, phenotyping, risk stratification and prognosis, and management. Additionally, we discuss the limitations in the clinical adaptability of AI and suggest the future research directions for developing novel and feasible AI-based HFpEF model.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"87 2","pages":"Pages 113-120"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008283","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: Patients with coronary artery disease who lack any standard modifiable cardiovascular risk factors (SMuRFs; hypertension, diabetes mellitus, dyslipidemia, and smoking) have attracted much attention in recent years due to their unexpectedly poor clinical outcomes. This study aimed to perform optical coherence tomography (OCT)-based evaluation of the characteristics and morphology of coronary culprit lesions of patients with acute myocardial infarction (AMI) but without any SMuRFs, in a prospective multicenter registry.
Methods: Patients with AMI diagnosed within 24 h of symptom onset who underwent OCT-guided emergency percutaneous coronary intervention were enrolled. The primary endpoint of the study was to characterize the coronary artery lesions of patients without any SMuRFs.
Results: A total of 640 AMI patients were enrolled. Of these, 58 (9%) had no SMuRFs and were in poor clinical condition at presentation, including acute heart failure or cardiogenic shock. OCT found no difference in the morphology of the culprit lesions in terms of presence or absence of SMuRFs. Rates of lipid plaque lesions and plaque calcification >180 degrees were lower in patients without SMuRFs. The risk of cardiovascular events at 12 months was higher in patients without SMuRFs than with SMuRFs (adjusted hazard ratio 2.28, 95% confidence interval 1.13-4.23, p = 0.02).
Conclusions: OCT evaluation revealed less lipid plaque and severe calcification in patients without SMuRFs than in those with SMuRFs. This finding indicates that the poor prognosis in the patient group without SMuRFs is due to the poor state of these patients at the time of onset rather than to the morphology of coronary artery lesions.
{"title":"Clinical outcomes and optical coherence tomography findings in myocardial infarction patients without standard modifiable risk factors: Insights from the TACTICS registry.","authors":"Hideki Wada, Tomotaka Dohi, Manabu Ogita, Satoru Suwa, Nobuaki Kobayashi, Masamichi Takano, Seita Kondo, Tomoyo Sugiyama, Tsunekazu Kakuta, Kohei Wakabayashi, Hiroyoshi Mori, Shigeki Kimura, Satoru Mitomo, Sunao Nakamura, Takumi Higuma, Junichi Yamaguchi, Taishi Yonetsu, Makoto Natsumeda, Yuji Ikari, Jun Yamashita, Takuya Mizukami, Myong Hwa Yamamoto, Toshiro Shinke","doi":"10.1016/j.jjcc.2026.01.010","DOIUrl":"https://doi.org/10.1016/j.jjcc.2026.01.010","url":null,"abstract":"<p><strong>Background: </strong>Patients with coronary artery disease who lack any standard modifiable cardiovascular risk factors (SMuRFs; hypertension, diabetes mellitus, dyslipidemia, and smoking) have attracted much attention in recent years due to their unexpectedly poor clinical outcomes. This study aimed to perform optical coherence tomography (OCT)-based evaluation of the characteristics and morphology of coronary culprit lesions of patients with acute myocardial infarction (AMI) but without any SMuRFs, in a prospective multicenter registry.</p><p><strong>Methods: </strong>Patients with AMI diagnosed within 24 h of symptom onset who underwent OCT-guided emergency percutaneous coronary intervention were enrolled. The primary endpoint of the study was to characterize the coronary artery lesions of patients without any SMuRFs.</p><p><strong>Results: </strong>A total of 640 AMI patients were enrolled. Of these, 58 (9%) had no SMuRFs and were in poor clinical condition at presentation, including acute heart failure or cardiogenic shock. OCT found no difference in the morphology of the culprit lesions in terms of presence or absence of SMuRFs. Rates of lipid plaque lesions and plaque calcification >180 degrees were lower in patients without SMuRFs. The risk of cardiovascular events at 12 months was higher in patients without SMuRFs than with SMuRFs (adjusted hazard ratio 2.28, 95% confidence interval 1.13-4.23, p = 0.02).</p><p><strong>Conclusions: </strong>OCT evaluation revealed less lipid plaque and severe calcification in patients without SMuRFs than in those with SMuRFs. This finding indicates that the poor prognosis in the patient group without SMuRFs is due to the poor state of these patients at the time of onset rather than to the morphology of coronary artery lesions.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119088","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: Immediate administration of beta-blockers is recommended for acute myocardial infarction (AMI). However, the benefit of beta-blockers according to left ventricular ejection fraction (LVEF), especially for preserved LVEF, remains uncertain. This study aimed to examine the efficacy and safety of beta-blockers for patients with mildly reduced or preserved LVEF after AMI.
Methods: We reviewed randomized controlled trials (RCTs) comparing standard therapy with versus without beta-blockers for patients with AMI with LVEF ≥40%. The primary outcome was a composite of all-cause death, myocardial infarction, and hospitalization for heart failure. The safety outcome was hospitalization for a composite of bradycardia, atrioventricular block, and pacemaker implantation. A pairwise meta-analysis was performed to evaluate hazard ratios (HRs) with 95% confidence intervals (CIs) using a random-effect model.
Results: A total of 19,826 participants from four RCTs (9892 received beta-blocker therapy and 9934 received non-beta-blocker therapy) were included. The primary outcome (HR, 0.93; 95% CI, 0.82-1.04) and the safety outcome (HR, 1.06; 95% CI, 0.83-1.34) were comparable between the two groups. Beta-blockers were also not associated with significant different risks of other outcomes, including each component of the primary outcome and stroke.
Conclusions: In patients with AMI with preserved LVEF, beta-blocker therapy was not significantly associated with lower cardiovascular outcomes or higher bradyarrhythmic events compared to non-beta-blocker therapy. Further trials are warranted to clarify the role and necessity of beta-blockers.
{"title":"Beta-blocker therapy for acute myocardial infarction with preserved ejection fraction: A meta-analysis from randomized controlled trials.","authors":"Yuriko Hiruma, Atsuyuki Watanabe, Tadao Aikawa, Masao Iwagami, Kaveh Hosseini, Leandro Slipczuk, Toshiki Kuno","doi":"10.1016/j.jjcc.2026.01.007","DOIUrl":"https://doi.org/10.1016/j.jjcc.2026.01.007","url":null,"abstract":"<p><strong>Background: </strong>Immediate administration of beta-blockers is recommended for acute myocardial infarction (AMI). However, the benefit of beta-blockers according to left ventricular ejection fraction (LVEF), especially for preserved LVEF, remains uncertain. This study aimed to examine the efficacy and safety of beta-blockers for patients with mildly reduced or preserved LVEF after AMI.</p><p><strong>Methods: </strong>We reviewed randomized controlled trials (RCTs) comparing standard therapy with versus without beta-blockers for patients with AMI with LVEF ≥40%. The primary outcome was a composite of all-cause death, myocardial infarction, and hospitalization for heart failure. The safety outcome was hospitalization for a composite of bradycardia, atrioventricular block, and pacemaker implantation. A pairwise meta-analysis was performed to evaluate hazard ratios (HRs) with 95% confidence intervals (CIs) using a random-effect model.</p><p><strong>Results: </strong>A total of 19,826 participants from four RCTs (9892 received beta-blocker therapy and 9934 received non-beta-blocker therapy) were included. The primary outcome (HR, 0.93; 95% CI, 0.82-1.04) and the safety outcome (HR, 1.06; 95% CI, 0.83-1.34) were comparable between the two groups. Beta-blockers were also not associated with significant different risks of other outcomes, including each component of the primary outcome and stroke.</p><p><strong>Conclusions: </strong>In patients with AMI with preserved LVEF, beta-blocker therapy was not significantly associated with lower cardiovascular outcomes or higher bradyarrhythmic events compared to non-beta-blocker therapy. Further trials are warranted to clarify the role and necessity of beta-blockers.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119112","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: Antihypertensive medications are essential for preventing cardiovascular events and have traditionally been taken in the morning. However, recent studies have suggested that taking the medication at bedtime may be more effective in reducing cardiovascular risk. This study aimed to examine the association between dosing time and cardiovascular outcomes.
Methods: Randomized controlled trials were retrieved through a systematic literature review using PubMed and Embase. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause (or cardiovascular) death, myocardial infarction, stroke, and hospitalization for heart failure. Secondary outcomes included each component of the primary outcome. A random-effects model was applied to calculate the pooled hazard ratio (HR) for each outcome.
Results: Five randomized controlled trials with 46,477 participants (bedtime, 23,178; morning, 23,299) were included. The median follow-up period ranged from 1.1 to 6.3 years, and the mean or median age ranged from 55.6 to 88 years. We found no evidence that bedtime antihypertensives administration was associated with the risk of MACE [HR = 0.71; 95% confidence interval (CI), 0.43-1.16], all-cause death (HR = 0.76; 95% CI, 0.49-1.17), stroke (HR = 0.70; 95% CI, 0.39-1.23), myocardial infarction (HR = 0.88; 95% CI, 0.56-1.38), or hospitalization for heart failure (HR = 0.58; 95% CI, 0.26-1.33), compared to morning administration.
Conclusions: Administration of antihypertensives at bedtime was not significantly associated with a lower incidence of cardiovascular outcomes in comparison with administration in the morning.
{"title":"The effect of bedtime vs. morning antihypertensive treatment on cardiovascular events: A meta-analysis.","authors":"Yuriko Hiruma, Tomonari M Shimoda, Atsuyuki Watanabe, Masao Iwagami, Leandro Slipczuk, Alexandros Briasoulis, Tadao Aikawa, Toshiki Kuno","doi":"10.1016/j.jjcc.2026.01.008","DOIUrl":"https://doi.org/10.1016/j.jjcc.2026.01.008","url":null,"abstract":"<p><strong>Background: </strong>Antihypertensive medications are essential for preventing cardiovascular events and have traditionally been taken in the morning. However, recent studies have suggested that taking the medication at bedtime may be more effective in reducing cardiovascular risk. This study aimed to examine the association between dosing time and cardiovascular outcomes.</p><p><strong>Methods: </strong>Randomized controlled trials were retrieved through a systematic literature review using PubMed and Embase. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause (or cardiovascular) death, myocardial infarction, stroke, and hospitalization for heart failure. Secondary outcomes included each component of the primary outcome. A random-effects model was applied to calculate the pooled hazard ratio (HR) for each outcome.</p><p><strong>Results: </strong>Five randomized controlled trials with 46,477 participants (bedtime, 23,178; morning, 23,299) were included. The median follow-up period ranged from 1.1 to 6.3 years, and the mean or median age ranged from 55.6 to 88 years. We found no evidence that bedtime antihypertensives administration was associated with the risk of MACE [HR = 0.71; 95% confidence interval (CI), 0.43-1.16], all-cause death (HR = 0.76; 95% CI, 0.49-1.17), stroke (HR = 0.70; 95% CI, 0.39-1.23), myocardial infarction (HR = 0.88; 95% CI, 0.56-1.38), or hospitalization for heart failure (HR = 0.58; 95% CI, 0.26-1.33), compared to morning administration.</p><p><strong>Conclusions: </strong>Administration of antihypertensives at bedtime was not significantly associated with a lower incidence of cardiovascular outcomes in comparison with administration in the morning.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119131","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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