Korean Circulation Journal最新文献

Large sized valve of a self-expandable nature has been suggested as the next generation transcatheter pulmonary valve to implant for various type of native right ventricular outflow tract (RVOT) lesions. Tissue engineered Pulsta valve including decellularization, alpha-galactosidase treatment provide longer valve durability and knitted woven nitinol wire stent provide low risk of stent fracture at the dynamic RVOT. Compact tubular design of Pulsta valve also offer easy valve loading to delivery system and good trackability to valve landing area. From the worldwide experience over 750 cases by February 2025, adaptability of Pulsta valve for various RVOT has proven. Pulsta valve has been implanted for various type of main pulmonary artery (PA) including pyramidal, reverse pyramidal shape and for branch PA stenosis including stent in the branch PA. In case of extremely large native RVOT anatomy, Pulsta valve can be implanted in both branch PA respectively. For the stenotic RVOT or failed bioprosthetic valve, Pulsta valve can also be implanted with or without pre-stenting. Recapturability using delivery system itself if less than one third of valve were flared outside of sheath and capability of whole delivery system retrieval using hooking system are another merit for safe procedure. Though the experience of Pulsta valve for various RVOT diseases is newly accumulated in many centers every day, we still have to learn more about Pulsta valve applicability for various RVOT diseases and long-term outcomes after Pulsta valve implantation.

Background and objectives: Endothelin-1 (ET-1) is a potent vasoconstrictor and multifunctional neuroendocrine hormone that is closely associated with the pathophysiology of heart failure (HF). Currently, the evidence about the predictive value of big ET-1 in HF remains insufficient. This study aims to investigate the prognostic importance of big ET-1 in HF.

Methods: We examined the incidence of cardiovascular death in a single-center retrospective cohort of HF (de novo, worsening, or chronic included).

Results: The 4,368 hospitalized HF patients were enrolled. During the median follow-up of 875 (365-1,400) days, 851 (19.5%) patients had primary outcome events. Big ET-1 was independently associated with cardiovascular death as a continuous variable (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.06-1.21; p<0.001) and by tertiles (HR, 1.35; 95% CI, 1.06-1.72; p=0.017 for tertile 2 and HR, 1.70; 95% CI, 1.32-2.19; p<0.001 for tertile 3). This pattern of risk was maintained after further adjustment for NT-proBNP (HR, 1.11; 95% CI, 1.03-1.19; p=0.006 for continuous variable, HR, 1.30; 95% CI, 1.02-1.67; p=0.035 for tertile 2, and HR, 1.69; 95% CI, 1.23-2.05; p=0.034 for tertile 3). Net reclassification index (NRI) and integrated discrimination improvement (IDI) analysis showed that big ET-1 provided additional predictive power in combination with NT-proBNP (NRI, 0.11; 95% CI, 0.04-0.17; p=0.012 and IDI, 0.012; 95% CI, 0.003-0.017; p<0.001).

Conclusions: Elevated big ET-1 was independently associated with cardiovascular death in patients with HF. Big ET-1 may be a promising indicator of HF prognosis. In combination with NT-proBNP, big ET-1 may provide incremental predictive information.

Background and objectives: We aim to investigate whether disruption of the skin defense in the form of cutaneous wounds may increase the incidence rate (IR) of infective endocarditis (IE) in the general population.

Methods: We performed a retrospective population-based study using Taiwan's National Health Insurance Database from 2013 to 2022. Self-controlled case series (SCCS) was used to investigate the time-sequential association between cutaneous wounds and IE. Adult patients with both cutaneous wounds (exposure) and IE (outcome) in the database were included in the study. Conditional Poisson regression was used to calculate the adjusted IR ratios (aIRRs) of IE during the 4 weeks following wounds to that of the baseline period within the same individuals.

Results: We enrolled 3,241 eligible patients for SCCS analysis. The risks of IE were elevated in the second week (aIRR, 2.16; 95% confidence interval [CI], 1.07-4.35; p value=0.032) after a treated traumatic wound. The risks of IE were elevated in the first (aIRR, 1.56; 95% CI, 1.17-2.09; p value=0.002) and second (aIRR, 1.58; 95% CI, 1.19-2.10; p value=0.002) after a treated non-traumatic wound.

Conclusions: Both traumatic and non-traumatic cutaneous wounds are associated with an increased risk of IE within the first 2 weeks after treatments among the general population in Taiwan. Clinicians should be vigilant for symptoms or signs associated with IE in these patients to avoid delays in diagnosis and treatment.

Background and objectives: The development of atherosclerotic cardiovascular disease (ASCVD) in middle-aged working groups can be a major contributor to disability-adjusted life years. However, information regarding the current trends in influenza vaccination within this demographic group remains scarce. Thus, we aimed to investigate the recent 11-year trends in influenza vaccination and related factors among these populations in Korea.

Methods: Of 42,879 individuals aged 40-64 years enrolled in the Korea National Health and Nutrition Examination Survey between 2010 and 2021, 35,323 were included. We investigated the yearly trend of influenza vaccination rate according to ASCVD risk and factors associated with being unvaccinated in the elevated ASCVD risk group (ASCVD risk score: ≥7.5%).

Results: Among the 35,323 participants, 20,392 (57.7%) were classified into the elevated ASCVD risk group. Over the 11 years, the vaccination rate was significantly higher in the elevated ASCVD risk group than in the low ASCVD risk group (33.8% vs. 25.3%, p<0.001). Factors associated with the unvaccinated status in the elevated ASCVD risk group included younger age (<50 years; adjusted odds ratio, 1.61; 95% confidence interval, 1.31-1.98), male sex (1.43; 1.16-1.76), current smoker status (1.41; 1.13-1.76), residence in an urban area (1.19; 1.01-1.41), and having higher education (1.3; 1.04-1.64).

Conclusions: One in 3 middle-aged working adults with an elevated risk of ASCVD received the influenza vaccination. Although the influenza vaccination rate was higher in participants with an elevated ASCVD risk than in those with low ASCVD risk, the vaccination rate was relatively unsatisfactory.

Background and objectives: Diastolic hyperemia-free ratio (DFR), an alternative to fractional flow reserve (FFR) for the assessment of intermediate coronary artery stenosis, helps reduce patients' time, and inconvenience. However, the validation data for DFR and FFR are lacking. We aimed to evaluate the diagnostic accuracy of DFR and FFR and to assess the effective decision making for revascularization using their values.

Methods: Patients subjected to an invasive physiological study for intermediate coronary artery stenosis at a single center in South Korea between August 2022 and January 2024 were prospectively recruited. We evaluated the correlation between DFR and FFR measurements and the diagnostic accuracy of DFR ≤0.89 to predict FFR ≤ 0.80. We also compared the correlation for each coronary artery.

Results: A total of 324 intermediate coronary stenotic lesions from 300 patients were evaluated using DFR and FFR values simultaneously. There was a strong linear relationship between DFR and FFR (r = 0.80; 95% confidence interval [CI], 0.76-0.84; p < 0.001). The diagnostic accuracy of the DFR was 92.0% in predicting FFR ≤0.80. When compared separately for each coronary artery, all vessels showed a strong linear relationship with no statistical differences between any of the vessels (p=0.641). There was also a strong linear relationship between DFR and distal coronary pressure/aorta pressure (r=0.93; 95% CI, 0.91-0.94; p<0.001).

Conclusions: There was a strong correlation between DFR and FFR and a high diagnostic accuracy rate of DFR compared to FFR. Good diagnostic performance of DFR was also observed in each coronary artery.

Trial registration: ClinicalTrials.gov Identifier: NCT05421169.