Journal of cardiology最新文献

ST-segment elevation myocardial infarction remains a leading cause of mortality. Despite the success of primary percutaneous coronary intervention (PCI), outcomes have plateaued, largely due to reperfusion injury and subsequent microvascular obstruction. This review examines the evolving landscape of microbubble-enhanced ultrasound therapy (aka sonothrombolysis/ sonoperfusion), which is a novel strategy aimed at mitigating reperfusion injury and improving myocardial salvage. We summarize the fundamental mechanisms and critically appraise the clinical trial evidence, from early feasibility studies to pivotal randomized controlled trials. The clinical application of this therapy has progressed significantly. While early trials without microbubbles or with suboptimal ultrasound parameters yielded neutral or even negative results, recent studies have demonstrated clear benefits. A critical determinant of success has emerged: the timing of the intervention. Compelling evidence from recent randomized trials indicates that therapy initiated before PCI significantly improves myocardial salvage and reduces infarct size. In contrast, post-PCI application alone appears to offer limited therapeutic benefit once significant microvascular injury is established. Microbubble-enhanced ultrasound therapy, particularly when administered pre-PCI, represents a promising adjunctive treatment to address the persistent challenge of reperfusion injury. Its potential for pre-hospital application could make it a crucial bridging strategy, capable of initiating myocardial salvage at the earliest possible moment. Further research should focus on technological refinement and validating its efficacy in a pre-hospital setting.

Cardiac regenerative medicine is an emerging field that aims to revolutionize the treatment of heart disease through innovative therapies and technologies. This review highlights the key advancements in human induced pluripotent stem cell (hiPSC) therapy that are paving the way for novel approaches to repair and regenerate damaged cardiac tissue. Substantial progress has been made over the past decade, laying a strong foundation for future developments. However, to fully realize the potential of hiPSC-based therapies, it is crucial to address challenges related to safety, scalability, and ethical considerations. As the field evolves, cardiac regenerative medicine promises to transform cardiovascular care by providing more effective, personalized, and sustainable treatments, ultimately improving patient outcomes and quality of life. This review offers a comprehensive overview of the current state and prospects of regenerative therapies for heart disease, emphasizing the opportunities and challenges in this rapidly advancing field.

Background: Our previous multivariable analysis of hypertensive participants in Hiratsuka City identified younger age, grade I hypertension, absence of prior hypertension at the previous specific health check-up (SHC), and willingness to improve lifestyle as key determinants of achieving target blood pressure (BP). Building on these findings, we further characterized participants who achieved BP control without antihypertensive medications to identify responders for lifestyle guidance using decision-tree analysis.

Methods: The study included 5428 residents age 40-74 years with hypertension (BP ≥140/90 mmHg) but untreated at SHCs conducted from May 2016 to March 2023. Of these, 2468 participants started antihypertensive medications by their next SHC. Descriptive analysis and decision-tree analysis stratified by antihypertensive medication use were used to identify factors associated with achieving BP <140/90 mmHg and to assess their relative importance.

Results: Among participants without antihypertensive medications, 55.9% achieved BP <140/90 mmHg. Decision-tree analysis revealed that no history of hypertension at the previous SHC and lower BP grade were the primary predictors of success. Notably, a reduction in γ-glutamyl transpeptidase (γ-GTP) was the next most influential factor in the non-medication group. For individuals who initiated antihypertensive therapy, younger age was associated with higher achievement rates.

Conclusion: A greater reduction in γ-GTP was associated with achieving BP <140/90 mmHg without antihypertensive medication, among individuals who newly developed Grade I hypertension, suggesting that effective lifestyle modification, reflected by improvements in metabolic markers, may play a pivotal role in BP control in this population.

Heart transplantation (HTx) in Japan has significantly progressed since the Organ Transplant Law was enacted in 1997. Despite improvements in surgical techniques, immunosuppressive therapy, and postoperative care, Japan still faces major challenges. These include a persistently low rate of organ donation, long waiting times, and high mortality among patients on the transplant waiting list, as about 25% of registered patients died before receiving a heart transplant, while only 39% successfully received one. HTx remains the definitive treatment for selected patients with end-stage heart failure who have already received maximally optimized guideline-directed medical therapy and, in many cases, mechanical circulatory support (MCS) such as left ventricular assist devices, offering superior long-term survival and quality of life compared with these advanced therapies. Data from the International Society for Heart and Lung Transplantation and Japanese studies consistently show that HTx recipients experience improved physical function, emotional well-being, and social reintegration. This review summarizes the current status of HTx in Japan, including its history, institutional framework, clinical outcomes, and allocation challenges. It also discusses next generation HTx such as new allocation systems, integrating HTx with MCS, expanding donor availability with donation after circulatory death with innovations in ex-vivo heart perfusion and the potential of xenotransplantation, and liquid biopsy. By addressing systemic limitations and adopting new technologies, Japan can improve access to HTx and outcomes for patients with advanced heart failure.

Background: In treatment of pulmonary arterial hypertension (PAH), the prostacyclin (PGI₂) pathway is targeted by oral selexipag and parenteral PGI₂ analogs. Although guidelines recommend therapeutic strategies based on disease severity and etiology, there are limited data on real-world use of selexipag and parenteral PGI₂ analogs in Japan. This study aimed to characterize the use of these drugs in treatment of PAH in Japan, with a focus on differences related to patient characteristics and PAH etiology.

Methods: Patients with PAH registered in the Japan PH Registry (JAPHR) from November 2016 to March 2023 were evaluated. Patients who met the inclusion criteria were further stratified by PAH etiologies, drug used, severity of disease, treatment strategies, time from diagnosis to drug initiation, and pulmonary hemodynamics.

Results: A total of 235 patients were treated with selexipag and 121 patients with parenteral PGI₂. Selexipag and parenteral PGI₂ analogs were most frequently used for idiopathic PAH (IPAH) or heritable PAH (HPAH), at 56.2 % (132/235) and 82.6 % (100/121), respectively. Selexipag was also used more frequently than parenteral PGI₂ analogs for PAH associated with connective tissue disease and congenital heart disease. Most patients received triple therapy, with 76.2 % (179/235) and 59.5 % (72/121) receiving selexipag and parenteral PGI₂ analogs, respectively. Regarding New York Heart Association functional class (NYHA-FC), selexipag was primarily administered to Class II-III patients and parenteral PGI₂ analogs to Class III patients. Both mean pulmonary artery pressure and pulmonary vascular resistance values were lower in the selexipag group than in the parenteral PGI₂ group.

Conclusion: Parenteral PGI₂ analogs tend to be used mainly in patients with severe IPAH/HPAH, while selexipag is used in patients with a broader range of etiologies around NYHA-FC II-III. Choice of selexipag and parenteral PGI₂ analogs for treatment of PAH is influenced by disease severity and etiology.