Korean Circulation Journal最新文献

Background and objectives: The prognostic implication of coexisting hypertension in patients with hypertrophic cardiomyopathy (HCM) is poorly defined. This study aimed to evaluate the association between left ventricular global longitudinal strain (LV-GLS) and adverse cardiovascular (CV) events in patients with HCM and coexisting hypertension.

Methods: We analyzed consecutive patients with HCM from 2 tertiary HCM referral centers. The primary outcome was CV events, defined as a composite of CV death, heart failure, and stroke. All LV-GLS measurements were conducted in a core laboratory.

Results: Of 1,139 patients with HCM, 522 (45.8%) had hypertension. Patients with hypertension were older, had more CV comorbidities, and showed a lower LV-GLS (13.7% vs. 14.4%, p=0.001). During a median 6.6-year follow-up, 155 CV events occurred, with a significantly higher crude incidence in patients with hypertension than in those without (p=0.005). Lower LV-GLS was independently associated with a higher risk of CV events in patients with hypertension (per 1% decrease in LV-GLS, adjusted hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.01-1.13; p=0.013). When stratified by four groups based on hypertension and LV-GLS, CV events most frequently occurred in patients with both hypertension and a lower LV-GLS (<13.1%), with a significantly higher risk compared to those without hypertension and a higher LV-GLS (≥13.1%) (adjusted HR, 1.60; 95% CI, 1.01-2.54; p=0.044).

Conclusions: Patients with HCM and coexisting hypertension were older, had more prevalent CV comorbidities, and exhibited a lower LV-GLS compared to those without hypertension. LV-GLS provides important prognostic information in patients with both HCM and hypertension.

Background and objectives: Stent implantation for coronary ostial lesions is challenging. This study evaluated the feasibility, safety, and immediate procedural results of the Osfit™, innovatively designed sirolimus drug-eluting stent delivery system for the treatment of coronary ostial lesions.

Methods: The Osfit™ has a 5 mm long extended balloon proximal to the stent (bare balloon without mounted stent). When inflated at 1.5 atm, only bare balloon inflated and acts like a stopper. We evaluated the technical feasibility in 49 patients with a coronary ostial lesion (defined as stenosis within 3 mm from the origin of the vessel) who had received the Osfit™. Intravascular ultrasound (IVUS) analysis was done in 11 patients who consented to IVUS examination, and the depth from the proximal edge of the stent to the ostial plane (DSO) was measured.

Results: In all 49 lesions, stents were successfully implanted in one single angiographic view without obvious stent protrusion or definite angiographic missing of the ostium. The proportions of aorto-ostial, and bifurcation lesions were 28.6% and 71.4%, respectively. The DSO was 0.2±0.69 mm, and the proximal stent edges were located within 1 mm of the ostial edge in all patients. No adverse events like death, myocardial infarction, target lesion revascularization, target vessel revascularization or stent thrombosis were reported during the in-hospital period or within 30 days.

Conclusions: The implantation of the Osfit™ for coronary ostial lesions appears to be an accurate and safe procedure that may reduce multiple angiographic projections and advanced skills.

Background and objectives: Patients with dilated cardiomyopathy (DCM) tend to be accompanied by biventricular impairment. We hypothesized that the combination of the aortic pulsatility index (API) and pulmonary artery pulsatility index (PAPI) could refine risk stratification in DCM.

Methods: We studied 120 consecutive patients with advanced DCM who underwent right heart catheterization (RHC). The primary outcome was all-cause mortality within 1 year after RHC. We used the receiver operating characteristic curve to determine the optimal cut-off of API and PAPI to predict outcomes.

Results: The optimal cut-offs of API (1.02) and PAPI (2.16) were used to classify patients into four groups. There were significant differences in left ventricular ejection fraction (LVEF) and tricuspid annular plane systolic excursion (TAPSE) among the four groups (both p<0.05). When delineating API by LVEF above or below the median (28%), the cumulative rate of survival in patients with API <1.02 was lower than that of those with API ≥1.02 in both higher and lower LVEF groups (both p<0.05). Similar trends were observed when delineating PAPI using TAPSE higher or lower than the cut-off (17 mm) (both p<0.05). The cumulative rate of survival in the API <1.02 and PAPI <2.16 group was lower than that in the API ≥1.02 and/or PAPI ≥2.16 (all p<0.05).

Conclusions: API and PAPI could add additional prognostic value to LVEF and TAPSE, respectively. The combination of API and PAPI could provide a comprehensive assessment of biventricular function and refine risk stratification.

Trial registration: ClinicalTrials.gov Identifier: NCT02664818.

Recently, usage of the term 'heart failure with preserved ejection fraction (HFpEF)' has predominated over the term 'diastolic heart failure (DHF).' The term 'preserved ejection fraction' represents only one aspect of DHF and does not provide insight into the hemodynamic mechanism of heart failure. In heart failure with reduced ejection fraction (HFrEF), depressed ejection fraction is the independent determinant of prognosis regardless of etiology. However, in HFpEF, because the prognosis is predominantly determined by etiologies of HFpEF, results of the drug on the prognosis in the clinical trial cannot be interpreted as it is. Therefore, studies on patients with HFpEF should be restricted to patients with diastolic dysfunction and, effects of drugs should be focused on symptom improvement not survival benefit. One reason for the prevalent use of HFpEF over DHF is the complexity in assessing diastolic function. Current official recommendations for the evaluation of diastolic function are too complex to be widely applied in the patient enrollment in large clinical trials as well as not easily applicable in our daily clinical practice. Therefore, there is a clinical need for a simple and practical way of assessing diastolic function.

Background and objectives: Several real-world studies have been done in patients with nonvalvular atrial fibrillation (NVAF); however, information on its safety profile in patients with renal impairment is limited. XARENAL, a real-world study, aimed to prospectively investigate the safety profile of rivaroxaban in patients with NVAF with renal impairment (creatinine clearance [CrCl], 15-49 mL/min).

Methods: XARENAL is an observational single-arm cohort study in renal impairment NVAF patients. Patients were followed up approximately every 3 months for 1 year or until 30 days following early discontinuation. The primary endpoint was major bleeding events. All adverse events, symptomatic thromboembolic events, treatment duration, and renal function change from baseline were the secondary endpoints.

Results: XARENAL included 888 patients from 29 study sites. Overall, 713 (80.3%) had moderate renal impairment (CrCl, 30-49 mL/min), and 175 (19.7%) had severe renal impairment (CrCl, 15-29 mL/min) with a mean estimated glomerular filtration rate (eGFR) of 45.2±13.0 mL/min/1.73 m². The mean risk scores were 3.3±1.4 and 1.7±0.9 for CHA₂DS₂-VASc score and HAS-BLED score, respectively. An incidence proportion of 5.6% (6.2 events per 100 patient-years) developed major bleeding; however, fatal bleeding occurred in 0.5% (0.5 events per 100 patient-years). The mean change in the eGFR was 2.22±26.47 mL/min/1.73 m² per year.

Conclusions: XARENAL observed no meaningful differences in major bleeding events from other previous findings as well as renal function changes in rivaroxaban-treated NVAF patients with renal impairment, which is considered to be acceptable in clinical practice.

Trial registration: ClinicalTrials.gov Identifier: NCT03746301.

Background and objectives: The timing of the reinstitution of warfarin after cesarean section (CS) delivery was not adequately addressed in the literature. This study aims to evaluate the risks of early versus late initiation of warfarin post-CS in patients with mechanical heart valves.

Methods: This randomized, open-label cohort study included 114 pregnant women with mechanical heart valves planned to be delivered by CS at or after 28 weeks of gestation. Patients were randomly divided into two groups: Day-2-group, where warfarin was started on day 2, and Day-5-group, where warfarin was started on day 5 after CS. Maternal postoperative bleeding complications, mechanical valve thrombosis, need for blood transfusion or reoperation, and maternal mortality were identified.

Results: Ten women (8.8%) had 11 bleeding complications, of whom 2 patients (20%) had intraperitoneal hemorrhage (none in Day-2-group and 2 in Day-5-group), 3 patients (30%) had subcutaneous hematoma (none in Day-2-group and 3 in Day-5-group), and 6 patients (60%) had sub-rectus hematoma (3 in Day-2-group and 3 in Day-5-group). No mechanical valve thrombosis, other thromboembolic events, or in-hospital maternal mortality were reported.

Conclusion: Despite the small number of events, the bleeding risk was lower in the group with early post-CS warfarin introduction than in the group with late warfarin introduction in patients with prosthetic heart valves.

Trial registration: ClinicalTrials.gov Identifier: NCT04855110.