Korean Circulation Journal最新文献

Background and objectives: Ticagrelor monotherapy after short-term dual-antiplatelet therapy (DAPT) has not been established in chronic kidney disease (CKD) patients. This study evaluated the effects of ticagrelor monotherapy after 3-month of DAPT on renal function in acute coronary syndrome patients.

Methods: From the TICO trial, the primary outcome was a composite of net adverse clinical events (NACEs), defined as a composite of major bleeding and major adverse cardiovascular and cerebrovascular events (MACCEs). The secondary outcomes were thrombolysis in myocardial infarction (TIMI) major or minor bleeding and MACCE.

Results: Among patients without CKD (n=2,436), ticagrelor monotherapy after 3 months of DAPT had a lower rate of NACE (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.21-0.78; p=0.007) and TIMI bleeding (HR, 0.86; 95% CI, 0.19-0.81; p=0.011) than those of ticagrelor-based 12-month DAPT. Among CKD patients receiving ticagrelor monotherapy, lower risk of NACE (HR, 0.45; 95% CI, 0.20-1.02; p=0.055) and bleeding (HR, 0.20; 95% CI, 0.06-0.68; p=0.009) were observed. Otherwise, ticagrelor monotherapy was not significantly associated with an increased MACCE risk in those without CKD (HR, 0.62; 95% CI, 0.30-1.27; p=0.192) or with CKD (HR, 0.55; 95% CI, 0.21-1.48; p=0.237), versus 12-month DAPT.

Conclusions: Regardless of renal function, ticagrelor monotherapy after 3 months of DAPT resulted in a reduced risk of not only NACE but also major or minor bleeding at 1 year compared with ticagrelor-based 12-month DAPT. Irrespective of renal function status, however, the MACCE risk was not significantly different between the two strategies.

Background and objectives: MicroRNAs (miRNAs) are small, non-coding RNAs that control gene expression patterns by inducing the degradation of messenger RNAs (mRNAs). Furthermore, miRNAs are known to play an important role in the pathogenesis of atrial fibrillation (AF). AF is typically diagnosed using an electrocardiogram. However, this study investigated whether specific miRNAs could be involved in alleviating AF by regulating aquaporin 4 (AQP4).

Methods: HL-1 cells were transfected with either miRNA negative control (NC) or miR-140-5p, followed by incubation with or without tachypacing (TP) condition. We investigated the protein expression of calcium-handling and inflammation-related proteins in control, control + miR-NC, control + miR-140-5p, TP, and TP + miR-140-5p groups by Western blotting. Also, the relative mRNA expression of AQP4 was determined through real-time polymerase chain reaction.

Results: Compared to the control, miR-140-3p was increased in the TP-induced AF group. Additionally, AQP4 protein expression and mRNA level were increased in the AF group along with inflammation-related proteins toll-like receptor 4, nucleotide-binding domain-like receptor protein 3, ERK, AKT, and interleukin-1β. The increase in such proteins was mitigated through miR-140-5p treatment. In accordance with these results, calcium-handling protein markers CaMKII, phospholamban, and ryanodine receptor 2 gene were also increased in the AF group and alleviated with miR-140-5p treatment.

Conclusions: miR-140-5p is engaged in suppressing the expression of AQP4 in TP-induced AF HL-1 cells. In doing so, miR-140-5p reduced the risk of AF by suppressing inflammation and phosphorylation of Ca-handling proteins.

The Korea Acute Myocardial Infarction Registry (KAMIR) was established in 2005 to address the paucity of large-scale, real-world evidence on acute myocardial infarction (AMI) in East Asia. Over the last 2 decades, KAMIR has enrolled more than 86,000 patients across multiple centers in Korea, enabling comprehensive analyses of epidemiology, risk profiles, risk stratification, acute interventional management, and medical therapies. The registry has documented temporal shifts from ST-segment elevation myocardial infarction to non-ST-segment elevation myocardial infarction, progressive population aging, and distinctive metabolic risk profiles characterized by a high prevalence of diabetes and low levels of high-density lipoprotein cholesterol. KAMIR has also supported the development and validation of prognostic tools, including the KAMIR risk score and artificial intelligence-driven models. Widespread adoption of primary percutaneous coronary intervention, advanced stent technologies, intravascular imaging, and tailored antithrombotic strategies have improved procedural success rates and reduced mortality. Long-term medical therapy findings underscore the importance of intensive lipid-lowering, optimized renin-angiotensin system blockade, and individualized antiplatelet regimens, with emerging evidence supporting sodium-glucose cotransporter 2 inhibitors. KAMIR evidence has informed national guidelines and holds strong potential to guide future East Asian consensus guidelines, highlighting the value of region-specific data in shaping global cardiovascular practice. Ongoing integration of precision medicine approaches, digital health tools, and multinational collaboration is expected to further advance AMI care in East Asia.

Background and objectives: Comprehensive data on sex-based differences in the management and outcomes of patients with and without ischemic cardiomyopathy (ICMP) presenting with cardiogenic shock (CS) remain limited. This study aimed to investigate whether clinical management and outcomes differ by sex among CS patients, stratified by underlying etiology.

Methods: We analyzed 1,247 CS patients from the RESCUE registry, a multicenter observational cohort, stratified by sex and CS etiology: ICMP (females: 276, males: 730) and non-ICMP (females: 111, males: 130). Primary outcomes included in-hospital and 12-month mortality. Multivariable Cox proportional hazards models and propensity-score matching were used to adjust for confounding factors.

Results: Among ICMP patients, females were less likely to undergo coronary angiography (p=0.001), although rates of successful revascularization were similar between sexes (p=0.982). In-hospital 30-day mortality did not differ significantly between females and males in either the ICMP cohort (37.1% vs. 29.5%; adjusted hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.63-1.39; p=0.737) or the non-ICMP cohort (28.3% vs. 25.6%; adjusted HR, 1.23; 95% CI, 0.68-2.22; p=0.493). At 12 months, mortality risk remained comparable between sexes in both ICMP (46.4% vs. 37.1%; adjusted HR, 0.82; 95% CI, 0.57-1.17; p=0.274) and non-ICMP groups (40.1% vs. 41.3%; adjusted HR, 0.91; 95% CI, 0.56-1.45; p=0.685). These findings were consistent after propensity-score matching.

Conclusions: There was no significant difference in management, 12-month or in-hospital mortality between females and males, irrespective of the etiology of CS.

Trial registration: ClinicalTrials.gov Identifier: NCT02985008.

Background and objectives: Cardiovascular disease is a leading cause of mortality globally and in South Korea. The American Heart Association (AHA) developed Life's Essential 8 (LE8) to evaluate cardiovascular health (CVH) through 8 metrics. However, LE8 has not been studied in the Korean population. This study aims to assess CVH in Korean adults using LE8 metrics and Korea National Health and Nutrition Examination Survey (KNHANES) data.

Methods: This cross-sectional study analyzed 35,117 adults from KNHANES (2014-2021). CVH scores were calculated across 8 metrics (diet, physical activity [PA], nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure) and classified as high (80-100), moderate (50-79), or low (0-49). Demographic, socioeconomic, and clinical characteristics were compared across categories.

Results: Among 35,117 participants (weighted population: 30,544,496; 51.6% women), the mean CVH score was 63.1±0.1, with women scoring higher than men (66.9 vs. 59.1; p<0.001). Only 12.3% achieved high CVH, while 17.7% were classified as low. Diet and PA had the lowest scores, while sleep and blood glucose scored highest. Women demonstrated higher scores than men except in PA. Low CVH was associated with older age (≥65 years: 19.5% low vs. 4.4% in 19-39 years), lower socioeconomic status (68.2% low vs. 31.8% high education), and chronic diseases (e.g., hypertension, diabetes).

Conclusions: This first application of AHA's LE8 metrics to Korean adults revealed suboptimal CVH with significant disparities by age, gender, socioeconomic status, and chronic diseases, emphasizing the need for targeted interventions.

Background and objectives: The effect of pulmonary vasodilator therapy on patients with Fontan circulation remains unclear. This study aims to assess its impact on exercise capacity and hemodynamic parameters in this population.

Methods: We searched PubMed, Embase, and the Cochrane Library for relevant studies up to November 2023. Pooled outcomes were used to evaluate the efficacy of pulmonary vasodilators in Fontan patients.

Results: A total of 18 studies with 667 patients were included. Exercise capacity was assessed in 14 studies (526 patients). Pulmonary vasodilator therapy improved oxygen consumption anaerobic threshold (VO₂AT; MD, 1.12 mL/min/kg; 95% CI, 0.35 to 1.89; p=0.004) and Ve/VCO₂ slope (MD, -1.14; 95% CI, -1.97 to -0.31; p=0.007) during exercise. No significant differences were found among drug classes regarding peak oxygen consumption, Ve/VCO₂, or VO₂AT. Invasive hemodynamics were evaluated in 6 studies (126 patients). Pulmonary vasodilators significantly reduced mean pulmonary arterial pressure (MD, -2.28 mmHg; p=0.02), pulmonary vascular resistance (MD, -0.91 WU*m²; p=0.01), and improved pulmonary flow (MD, 0.46 L/min/m²; p=0.02).

Conclusions: Pulmonary vasodilator therapy appears beneficial for exercise capacity and pulmonary hemodynamics in Fontan patients. More randomized controlled trials are needed to confirm these findings.