Journal of cardiology最新文献_第8页

Impact of stricter lipid control on cardiovascular outcomes in a regional hospital-clinic referral system. 更严格的脂质控制对地区医院转诊系统心血管结果的影响。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-01-06 DOI: 10.1016/j.jjcc.2025.12.017

Hirofumi Sugiyama, Teruno Saito, Norio Yamamoto, Mariko Kitajima, Kojiro Mochiduki, Koji Tanaka, Eriko Kojima, Takuya Nakagawa, Eri Ishikawa, Yoshinori Tokumasu, Shigetaka Kageyama, Koichiro Murata, Ryuzo Nawada, Tomoya Onodera

Background: Real-world attainment of contemporary guidelines-recommended, stringent low-density lipoprotein cholesterol (LDL-C) targets for secondary prevention of cardiovascular events in patients with coronary artery disease (CAD) remains inadequate. This study aimed to assess LDL-C control in patients within a regional ischemic heart disease (IHD) referral system after the 2022-2023 guideline updates and examine its association with long-term cardiovascular outcomes.

Methods: We retrospectively analyzed annual serum LDL-C levels and achievement of guideline-recommended serum LDL-C target level (<70 mg/dL) of 1334 patients with CAD [acute coronary syndrome (ACS) or chronic coronary syndrome (CCS)] enrolled in a regional IHD referral system and followed up at Shizuoka City Shizuoka Hospital (2021-2024). The primary endpoint was the annual serum LDL-C level trend; secondary endpoints were major adverse cardiovascular events (MACE: cardiovascular death, nonfatal myocardial infarction, and coronary revascularization) and their associations with serum LDL-C levels.

Results: The mean serum LDL-C level declined from 80.2 ± 22.0 mg/dL in 2021 to 71.8 ± 20.7 mg/dL in 2024, with improved target attainment (29.8 % vs. 46.3 %; p < 0.001 for both). MACE occurred in 14.2 % of patients (mean follow-up period, 6.1 years), with its incidence in patients who achieved the target level significantly lower than in those who did not (6.8 % vs. 18.6 %, p < 0.001). Patients with ACS and CCS had similar benefits. In multivariate Cox regression analysis, target level attainment was independently associated with a reduced MACE risk (hazard ratio 0.326; 95 % CI 0.21-0.52; p < 0.001).

Conclusions: In a real-world cohort of patients with CAD managed under a structured IHD referral system, serum LDL-C levels progressively decreased over time, and patients who achieved stricter LDL-C control experienced a significantly lower incidence of major cardiovascular events.

背景：当前指南推荐的严格的低密度脂蛋白胆固醇（LDL-C）指标在冠状动脉疾病（CAD）患者心血管事件二级预防中的实际实现仍然不足。本研究旨在评估在2022-2023年指南更新后，区域缺血性心脏病（IHD）转诊系统中患者的LDL-C控制情况，并检查其与长期心血管预后的关系。方法：我们回顾性分析了年度血清LDL-C水平和指南推荐的血清LDL-C目标水平的实现情况(结果：平均血清LDL-C水平从2021年的80.2 ± 22.0 mg/dL下降到2024年的71.8 ± 20.7 mg/dL，目标实现情况有所改善(29.8 %对46.3 %；p 结论：在结构化IHD转诊系统下管理的CAD患者的现实世界队列中，血清LDL-C水平随着时间的推移逐渐降低，并且实现更严格LDL-C控制的患者显着降低了主要心血管事件的发生率。

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引用次数: 0

Author's reply to the Letter to the Editor regarding "Characteristics of histologically proven fulminant myocarditis managed with venoarterial extracorporeal membrane oxygenation: A post-hoc analysis of a Japanese nationwide study". 作者给编辑的关于“经组织学证实的经静脉动脉体外膜氧合治疗暴发性心肌炎的特点：一项日本全国性研究的事后分析”的回复。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-01-06 DOI: 10.1016/j.jjcc.2025.12.020

Teruo Noguchi, Kenichiro Sawada, Soshiro Ogata, Koshiro Kanaoka

引用次数: 0

Prognostic impact of chronic kidney disease in patients with atrial fibrillation after percutaneous coronary intervention. 经皮冠状动脉介入治疗后慢性肾病对房颤患者预后的影响

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-01-06 DOI: 10.1016/j.jjcc.2025.12.018

Hiroaki Yaginuma, Hideki Kitahara, Sakuramaru Suzuki, Yuji Ohno, Junya Harada, Kenichi Fukushima, Tatsuhiko Asano, Naoki Ishio, Raita Uchiyama, Hirofumi Miyahara, Shinichi Okino, Masanori Sano, Nehiro Kuriyama, Masashi Yamamoto, Naoya Sakamoto, Junji Kanda, Yoshio Kobayashi

Background: Patients with chronic kidney disease (CKD) have an elevated risk of adverse cardiovascular events. However, the impact of different stages of CKD on the prognosis of patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI) remains uncertain.

Methods: This multicenter registry included 902 patients with AF undergoing PCI. Patients were divided into 3 groups based on renal function: normal [estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73m²], early CKD (30 ≤ eGFR <60 mL/min/1.73m²), and advanced CKD (eGFR <30 mL/min/1.73m² or patients on hemodialysis). The primary endpoint was net adverse clinical events (NACE) within 1 year after PCI, a composite of all-cause death, myocardial infarction (MI), ischemic stroke, and major bleeding (Bleeding Academic Research Consortium type 3 or 5) events.

Results: Of the 902 patients, 338 (37.5 %), 438 (48.5 %), and 126 (14.0 %) were grouped as normal, early CKD, and advanced CKD. Within the one-year follow-up period, 142 (15.7 %) patients experienced NACE after PCI. The progression of CKD was associated with increased NACE rates, mainly driven by an increased risk of all-cause death. There were no significant differences in the rates of MI, ischemic stroke, and major bleeding events among the three groups.

Conclusions: Advanced CKD was significantly associated with a higher incidence of NACE compared with early CKD or normal renal function in patients with AF after PCI.

背景：慢性肾脏疾病（CKD）患者发生不良心血管事件的风险增高。然而，不同CKD分期对房颤（AF）患者经皮冠状动脉介入治疗（PCI）后预后的影响尚不明确。方法：该多中心登记包括902例接受PCI治疗的房颤患者。根据肾功能将患者分为3组：正常[估计肾小球滤过率（eGFR） ≥ 60 mL/min/1.73m2]，早期CKD（30 ≤ eGFR 2）和晚期CKD （eGFR 2或血液透析患者）。主要终点是PCI术后1 年内的净不良临床事件（NACE），包括全因死亡、心肌梗死（MI）、缺血性卒中和大出血（出血学术研究联盟3型或5型）事件。结果：902例患者中，338例（37.5% %）、438例（48.5% %）和126例（14.0% %）分为正常、早期和晚期CKD。1年随访期间，142例（15.7 %）患者PCI术后出现NACE。CKD的进展与NACE发生率的增加有关，主要是由全因死亡风险的增加引起的。三组间心肌梗死、缺血性卒中和大出血事件发生率无显著差异。结论：与早期CKD或肾功能正常的房颤PCI术后患者相比，晚期CKD与NACE的发生率显著相关。

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引用次数: 0

The role of POCUS in diagnosing acute heart failure in the emergency department: A meta-analysis POCUS在急诊科诊断急性心力衰竭中的作用：一项meta分析。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-01-01 Epub Date: 2025-06-22 DOI: 10.1016/j.jjcc.2025.06.012

Apurva Popat MD , Sweta Yadav MD , Gauri Pethe MD , Ateeq Rehman MD , Param Sharma MD , Shereif Rezkalla MD

The role of point-of-care ultrasound (POCUS) in diagnosing acute heart failure is not fully established. We evaluated the diagnostic accuracy of cardiac, lung, and inferior vena cava (IVC) POCUS, individually and combined, in the emergency department (ED).

We systematically searched PubMed, Embase, Web of Science, and Google Scholar for English-language studies published from inception to November 2024. Statistical analyses were conducted using STATA 16, and study quality was assessed with the QUADAS-2 tool.

Fifteen studies involving 2751 dyspneic patients in the ED were included. Lung ultrasound demonstrated sensitivities of 72 % for B-lines ≥10, 79 % for bilateral B-pattern in two or more zones, and 100 % for pleural effusion, with specificities of 86 %, 82 %, and 75 %, respectively. Cardiac ultrasound revealed sensitivities of 70 % for the E/A ratio, 100 % for the E/e′ ratio, and 63–82 % for varying left ventricular ejection fraction (LVEF) thresholds (<40 %, <45 %, <50 %), with specificities ranging from 76 % to 88 %.

Plethoric IVC demonstrated a sensitivity of 100 % and a specificity of 25 %. The IVC collapsibility index (IVC-CI) <20 % and <50 % yielded sensitivities of 43 % and 83 % and specificities of 90 % and 81 %, respectively. Multiorgan ultrasound combining lung and cardiac findings achieved overall sensitivity of 78 % and specificity of 96 %. Combining bilateral B-pattern in two or more zones, MAPSE, E/A, and E/e′ yielded 96 % sensitivity and 93 % specificity. The combination of LVEF and B-lines demonstrated 61 % sensitivity and 96 % specificity, while LVEF and bilateral B-pattern in two or more zones showed 70 % sensitivity and 93 % specificity. LVEF and pleural effusion showed a sensitivity of 91 % and a specificity of 99 %. Adding IVC to the combined lung and cardiac approach resulted in a specificity of 99 % but reduced sensitivity to 54 %. Conclusively, the lung, cardiac, and IVC ultrasounds, individually or combined, demonstrated consistently high specificity and moderately high sensitivity.

即时超声（POCUS）在诊断急性心力衰竭中的作用尚未完全确定。我们评估了在急诊科（ED）单独和联合诊断心脏、肺和下腔静脉（IVC） POCUS的准确性。我们系统地检索了PubMed， Embase， Web of Science和b谷歌Scholar，检索了从成立到2024年11月发表的英语研究。使用STATA 16进行统计分析，并使用QUADAS-2工具评估研究质量。纳入了15项研究，涉及2751例急诊科呼吸困难患者。肺超声对b线≥10的敏感性为72 %，对双侧b线≥10的敏感性为79 %，对胸膜积液的敏感性为100 %，特异性分别为86 %、82 %和75 %。心脏超声显示对E/A比的敏感性为70 %，对E/ E '比的敏感性为100 %，对左室射血分数（LVEF）阈值的敏感性为63-82 % (

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引用次数: 0

Nanoparticle-driven drug delivery system for cardiovascular treatment 用于心血管治疗的纳米颗粒驱动给药系统。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-01-01 Epub Date: 2025-06-13 DOI: 10.1016/j.jjcc.2025.06.004

Raj Patel MBBS , Dhruvi Patel PhD , Unnati Dani PhD , Ketan Kuperkar PhD

Cardiovascular disease (CVD) is the world's major concern affecting the heart, blood arteries, and the blood that flows through and between them, making it a significant obstacle to contemporary healthcare practices. Approximately one in three individuals has a CVD, and many of them have several, overlapping diseases that might eventually result in catastrophic events such as a heart attack or stroke. The previous century opened the door for progress of life-saving drugs and treatment modalities. Recent developments in nanomaterials provide novel approaches for the treatment of CVD. Due to their unique properties, which include increased target specificity, sensitivity, and both active and passive targeting of cardiac tissues, the use of nanoparticles as carriers has received a lot of attention in the field of cardiology. Drug delivery using heart-targeted nanocarriers is a safe, efficient method of treating heart-related conditions such as hypertension, atherosclerosis, and myocardial infarction. Here, we highlight significant clinical opportunities in the quickly emerging field of CVD nanomedicine. This review concentrates on the use of nanoparticle-based therapeutics in CVD and provides a key take away regarding the use of metal, lipid, and polymer-based nanoparticle in CVD treatment. In this review, we emphasize recent advances in the use of nanomedicine to treat CVD and the therapeutic potential of drug delivery via nanoparticles in clinical prospects.

心血管疾病（CVD）是影响心脏、血动脉以及流经它们之间的血液的世界主要问题，使其成为当代医疗保健实践的重大障碍。大约三分之一的人患有心血管疾病，其中许多人患有几种重叠的疾病，最终可能导致心脏病发作或中风等灾难性事件。上个世纪为拯救生命的药物和治疗方式的进步打开了大门。纳米材料的最新发展为心血管疾病的治疗提供了新的途径。由于其独特的特性，包括增加的靶标特异性、敏感性，以及对心脏组织的主动和被动靶向，纳米颗粒作为载体的使用在心脏病学领域受到了广泛的关注。使用靶向心脏的纳米载体给药是一种安全、有效的治疗心脏相关疾病的方法，如高血压、动脉粥样硬化和心肌梗死。在这里，我们强调了快速发展的心血管疾病纳米医学领域的重要临床机会。本文综述了纳米颗粒在心血管疾病治疗中的应用，并提供了关于金属、脂质和聚合物纳米颗粒在心血管疾病治疗中的应用的关键结论。在这篇综述中，我们强调了纳米药物在治疗心血管疾病方面的最新进展，以及通过纳米颗粒给药的临床前景。

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引用次数: 0

RNF213 and cardiovascular disease: A review of histopathological, genetic perspectives, and potential molecular mechanisms RNF213与心血管疾病：组织病理学、遗传学和潜在分子机制综述

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-01-01 Epub Date: 2025-06-10 DOI: 10.1016/j.jjcc.2025.06.001

Toshinaru Kawakami MD , Masamichi Ito MD, PhD , Takayuki Isagawa PhD , Takahiro Kuchimaru PhD , Norihiko Takeda MD, PhD

The ring finger protein 213 (RNF213) gene, identified in 2011 as a susceptibility gene for moyamoya disease (MMD), has since been recognized as a key factor in a broader spectrum of vascular disorders. The p.R4810K mutation in RNF213 is particularly common among Japanese MMD patients, although a smaller percentage of healthy individuals also carry the mutation, indicating that environmental factors, alongside genetic predisposition, likely influence disease onset. RNF213, a large E3 ubiquitin ligase, plays essential roles in vascular homeostasis, immune response, and endoplasmic reticulum stress reaction. Its mutation disrupts normal angiogenesis, contributing to abnormal vascular remodeling in conditions such as pulmonary hypertension and coronary artery disease. This review examines the multifaceted role of RNF213 and its p.R4810K mutation in the pathogenesis of MMD and other vascular conditions, collectively referred to as RNF213-associated vascular diseases.

While research has begun to clarify the mutation's effects on angiogenesis and the involved pathways, the roles of RNF213 and its mutation in vascular integrity remain unclear. This comprehensive overview underscores the complex interaction between genetic and environmental factors in RNF213-related vascular diseases and calls for further research to elucidate these mechanisms and develop targeted therapeutic interventions.

2011年，无名指蛋白213 （RNF213）基因被确定为烟雾病（MMD）的易感基因，此后被认为是更广泛的血管疾病的关键因素。RNF213中的p.R4810K突变在日本烟雾病患者中尤为常见，尽管一小部分健康人也携带该突变，这表明环境因素和遗传易感性可能影响疾病的发病。RNF213是一种大型E3泛素连接酶，在血管稳态、免疫反应和内质网应激反应中起重要作用。它的突变破坏了正常的血管生成，导致肺动脉高压和冠状动脉疾病等疾病的异常血管重塑。本文综述了RNF213及其p.R4810K突变在烟雾病和其他血管疾病发病机制中的多方面作用，这些疾病统称为RNF213相关血管疾病。虽然研究已经开始阐明突变对血管生成的影响及其相关途径，但RNF213及其突变在血管完整性中的作用仍不清楚。这一综合综述强调了遗传和环境因素在rnf213相关血管疾病中的复杂相互作用，并呼吁进一步研究阐明这些机制并制定有针对性的治疗干预措施。

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引用次数: 0

Antithrombotic management in catheter ablation for ventricular arrhythmias - Mini review 导管消融治疗室性心律失常的抗血栓管理。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-01-01 Epub Date: 2025-08-21 DOI: 10.1016/j.jjcc.2025.08.006

Kanae Hasegawa MD, PhD , William G. Stevenson MD

Radiofrequency catheter ablation (RFCA) is a common treatment option for ventricular arrhythmias (VA). Risks of RFA for VA include emboli and bleeding complications. In contrast to atrial fibrillation ablation procedures, for which anticoagulation therapy is relatively well standardized, peri-procedural antithrombotic therapy practices for RFCA of VA vary among laboratories and remains an area of investigation. This summary focuses on the current evidence-based antithrombotic therapies of RFCA for VA, with a particular emphasis on two recent major studies.

射频导管消融（RFCA）是室性心律失常（VA）的常见治疗选择。RFA治疗VA的风险包括栓塞和出血并发症。房颤消融手术的抗凝治疗相对标准化，与之相反，室性心律失常RFCA的术中抗凝治疗实践在各个实验室中各不相同，仍然是一个研究领域。本综述重点介绍了目前以证据为基础的RFCA治疗VA的抗血栓疗法，并特别强调了最近的两项主要研究。

引用次数: 0

Characteristics of anxiety about returning to work after implantable cardioverter defibrillator implantation in Japan 日本植入式心律转复除颤器植入术后重返工作岗位的焦虑特征。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-01-01 Epub Date: 2025-05-30 DOI: 10.1016/j.jjcc.2025.05.019

Yasunobu Yamagishi MD, PhD , Taichi Watabe MD, PhD , Daiki Nakahara MD , Kazunari Taniguchi MD , Yasushi Oginosawa MD, PhD , Masaharu Kataoka MD, PhD, FJCC

Background

Implantable cardioverter defibrillator (ICD) implantation is an established treatment that reduces the risk of sudden cardiac death; however, patients with ICD have been shown to be anxious. This study aimed to identify the characteristics of anxiety about returning to work after ICD implantation and to explore reemployment support.

Methods

Data from 56,002 patients who worked before admission to the cardiology department were analyzed using the Inpatient Clinico-Occupational Database of the Rosai Hospital Group (2011−2022). The patients were further categorized into two groups depending on whether ICD surgery was performed during hospitalization. Among patients who had undergone ICD surgery, multivariable logistic regression models were used to estimate the relationships between the prehospitalization occupational data, clinical data, and anxiety about returning to work.

Results

The ICD group had a higher rate of anxiety about returning to work than the non-ICD group (26.2 % vs. 16.1 %; p < 0.001). In the ICD group, younger age at discharge, female sex, self-employed, and longer working hours per day were independently associated with anxiety about returning to work. Among patients experiencing anxiety about returning to work, compared with the non-ICD group, the ICD group had a lower rate of anxiety about workplace understanding (17.9 % vs. 35.0 %; p = 0.008); but a higher rate of anxiety about workplace life (37.5 % vs. 18.3 %; p < 0.001).

Conclusions

The ICD group had a higher rate of anxiety about returning to work. This study suggests that interventions for anxiety about returning to work, especially regarding life in the workplace, are important for working populations with ICDs.

背景：植入式心律转复除颤器（ICD）植入术是一种降低心源性猝死风险的成熟治疗方法；然而，ICD患者表现出焦虑。本研究旨在了解ICD植入后重返工作岗位的焦虑特征，并探讨再就业支持。方法：使用罗赛医院集团住院临床职业数据库（2011-2022）对56002例入院前在心内科工作的患者数据进行分析。根据住院期间是否进行ICD手术，将患者进一步分为两组。在接受ICD手术的患者中，使用多变量logistic回归模型来估计住院前职业数据、临床数据和重返工作焦虑之间的关系。结果：ICD组对重返工作的焦虑率高于非ICD组(26.2 % vs. 16.1 %；p 结论：ICD组对重返工作岗位的焦虑率更高。这项研究表明，对重返工作岗位的焦虑进行干预，特别是对工作场所的生活，对患有icd的工作人群很重要。

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引用次数: 0

Beyond perfusion imaging: the growing clinical role of myocardial blood flow quantification by SPECT 超越灌注成像：SPECT心肌血流定量的临床作用日益增强。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-01-01 Epub Date: 2025-05-28 DOI: 10.1016/j.jjcc.2025.05.012

Yuka Otaki MD, PhD

Although perfusion imaging is effective for evaluating relative myocardial blood flow (MBF) distribution, it has a well-known limitation in single photon emission computed tomography (SPECT): it often underestimates ischemia, particularly in patients with three-vessel coronary artery disease or left main trunk disease. In such cases, global reductions in MBF may not create significant perfusion defects, complicating the accurate detection of ischemia. In contrast, positron emission tomography (PET) has long offered absolute MBF quantification through dynamic imaging, allowing for a more precise assessment of coronary artery disease and microvascular dysfunction. By integrating absolute MBF quantification with perfusion imaging, PET has significantly improved diagnostic accuracy in ischemia evaluation.

Relative to PET, traditional SPECT has struggled to achieve comparable MBF quantification due to its lower sensitivity and spatial resolution. However, recent advancements in semiconductor-based detector technology have enabled SPECT to approximate PET's quantification accuracy. Emerging studies indicate that modern SPECT systems can now deliver absolute MBF values with enhanced reliability, opening new possibilities for clinical application.

Despite PET's superior quantification capability, its availability remains confined to specialized facilities, limiting its broader clinical use. In this context, the implementation of SPECT to quantify MBF presents a promising avenue for expanding access to more accurate ischemia assessment. Enhancing the diagnostic precision of SPECT could improve patient stratification and treatment planning, particularly in environments where PET is not readily available.

This review summarizes recent advancements in MBF quantification using SPECT, discusses its clinical implications, and explores the prospects for its integration into routine cardiovascular imaging.

虽然灌注成像对评估相对心肌血流量（MBF）分布是有效的，但它在单光子发射计算机断层扫描（SPECT）中有一个众所周知的局限性：它经常低估缺血，特别是在三支冠状动脉疾病或左主干疾病患者中。在这种情况下，MBF的整体减少可能不会造成明显的灌注缺陷，使缺血的准确检测复杂化。相比之下，正电子发射断层扫描（PET）长期以来通过动态成像提供绝对的MBF量化，允许更精确地评估冠状动脉疾病和微血管功能障碍。PET通过将绝对MBF定量与灌注成像相结合，显著提高了缺血评估的诊断准确性。相对于PET，传统的SPECT由于其较低的灵敏度和空间分辨率而难以实现可比的MBF定量。然而，最近基于半导体的探测器技术的进步使SPECT能够接近PET的定量精度。新兴研究表明，现代SPECT系统现在可以提供绝对的MBF值，可靠性更高，为临床应用开辟了新的可能性。尽管PET具有优越的定量能力，但它的可用性仍然局限于专门的设施，限制了其更广泛的临床应用。在这种情况下，SPECT量化MBF的实施为扩大获得更准确的缺血评估提供了一条有希望的途径。提高SPECT的诊断精度可以改善患者分层和治疗计划，特别是在PET不容易获得的环境中。本文综述了SPECT量化MBF的最新进展，讨论了其临床意义，并探讨了将其纳入常规心血管成像的前景。

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引用次数: 0

Author's reply: Impact of congestive heart failure on early fluid administration and mortality in patients with sepsis 作者回复：充血性心力衰竭对败血症患者早期输液和死亡率的影响。

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology

Pub Date : 2026-01-01 Epub Date: 2025-11-16 DOI: 10.1016/j.jjcc.2025.11.004

Zhiyuan Ma MD, PhD

引用次数: 0