Korean Circulation Journal最新文献

Background and objectives: Tetralogy of Fallot (TOF) patients require pulmonary valve replacement (PVR) after total correction to prevent the late complications associated with pulmonary valve dysfunction. This study aimed to evaluate factors affecting the durability of bio-prosthetic pulmonary valves, with an emphasis on the angle of implantation as well as age, size or materials of prosthetic valve.

Methods: Of the 50 consecutive patients with TOF who underwent redo-PVR due to prosthetic valvular failure (PVF) between January 2001 and May 2020, 36 had good images for measuring implantation angle on computed tomography, magnetic resonance imaging, or angiography. We defined the angle of implantation as the angle between an imaginary axial line from the center of the prosthetic valve and an imaginary parallel line from the point where the line meets the anterior wall of main pulmonary artery on sagittal planes.

Results: The median age at total repair of TOF was 13.4 months (interquartile range [IQR], 8.4-22.3 months) and the median age at initial PVR was 10.1 years (IQR, 8.4-12.2 years). The mean interval from initial PVR to redo-PVR was 10.1±3.6 years and follow-up duration was 15.6±2.5 years after initial PVR. The implantation angle (<30° or ≥45°) was significantly related with early (<10 years after PVR) PVF.

Conclusions: The risk for early PVF was relatively lower when the implantation angle was between 30° and 45°. We should be careful to implant a prosthetic valve with an adequate angle to maintain a laminar flow in the pulmonary position for better durability.

Background and objectives: Rapid reduction of low-density lipoprotein cholesterol (LDL-C) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) is critical but challenging. This study evaluated the efficacy and safety of early triple lipid-lowering therapy with evolocumab, a moderate-intensity statin, and ezetimibe in statin-naïve ACS patients.

Methods: The C-STAR trial (Effect of Early Initiation of Evolocumab on Lipid Profile Changes in Patients with ACS Undergoing PCI) was a single-center, randomized, open-label trial conducted from December 2022 to January 2025. A total of 108 statin-naïve ACS patients undergoing PCI were randomized to evolocumab (140 mg) plus rosuvastatin 5 mg and ezetimibe 10 mg (n=54) or rosuvastatin 5 mg and ezetimibe 10 mg alone (n=54). The primary endpoint was LDL-C level at 2 weeks; cognitive safety was assessed using the Everyday Cognition (ECog) tool.

Results: Baseline LDL-C levels were similar between the 2 groups. At 2 weeks, LDL-C levels were lower in the evolocumab group compared to the non-evolocumab group (31±16 mg/dL vs. 63±17 mg/dL; p<0.001), with a greater percentage reduction (-77.5% vs. -53.3%, p<0.001). Target achievement rates were also higher in the evolocumab group (84.6% vs. 26.9%, p<0.001). Comparable cognitive functions were observed using ECog questionnaire (23.9±3.4 vs. 24.5±5.5; p=0.493).

Conclusions: Early initiation of evolocumab in combination therapy achieved greater LDL-C reduction and target achievement in ACS patients undergoing PCI.

Trial registration: ClinicalTrials.gov Identifier:NCT05661552.

Background and objectives: Left ventricular reverse remodeling (LVRR) following aortic valve surgery has been associated with improved outcomes in chronic aortic regurgitation (AR), yet its definition remains controversial. This study evaluated the prognostic impact of LVRR using the degree of left ventricular mass index (LVMi) reduction.

Methods: We retrospectively analyzed patients undergoing surgery for severe AR at Asan Medical Center between January 2006 and December 2020. LVRR was determined by the degree of LVMi regression at 1 year postoperatively. Patients were categorized into greater (n=315) or lesser (n=248) regression groups based on time-dependent receiver operating characteristic curve analysis. The primary endpoint was a composite of all-cause mortality and rehospitalization due to heart failure (HF).

Results: Over a median follow-up of 7.58 years, 29 patients (9.2%) in the greater regression group and 51 (20.6%) in the lesser regression group experienced the primary endpoint. Multivariate Cox regression analysis revealed that the greater regression group had a lower risk of mortality or HF rehospitalization (hazard ratio, 0.44; 95% confidence interval, 0.27-0.72). Further analyses identified hypertension as the only clinical predictor of reduced LVRR, while smaller left atrial diameter, larger baseline LVMi, and higher left ventricular ejection fraction were independent echocardiographic predictors of greater LVRR.

Conclusions: Greater 1-year postoperative LVMi regression was associated with improved outcomes in chronic AR, particularly by reducing HF-related hospitalizations. While hypertension negatively affected remodeling, favorable baseline echocardiographic profiles, including higher LVMi, preserved left ventricular ejection fraction, and a smaller left atrium, were connected to more significant postoperative LVRR.

Background and objectives: The optimal sedation strategy for cryoablation in atrial fibrillation (AF) remains uncertain. We aimed to compare the safety and efficacy outcomes between deep sedation (DS) and general anesthesia (GA) in patients undergoing cryoablation.

Methods: We analyzed 2,068 patients from the Korean Heart Rhythm Society Cryoablation Registry who underwent cryoablation for AF between 2018 and 2022. Patients were grouped based on anesthesia method: DS (n=1,390) and GA (n=678). Propensity score matching (1:1) was performed to adjust for baseline differences. The primary outcomes included any recurrence of atrial tachyarrhythmias (ATs) after a 3 month blanking period and procedure-related major complications.

Results: The study included 2,068 patients (average age: 61.7±9.7 years; 76.3% male; 57.9% with persistent AF). In the matched cohort, AT recurrence rates were comparable between DS and GA groups (47.1% [n=220] vs. 53.1% [n=225]; p=0.99) during a mean follow-up of 1.2 years. The incidence of major complications was also similar between groups both before (2.8% [n=39] vs. 2.4% [n=16]; p=0.66) and after matching (2.3% [n=15] vs. 2.1% [n=14]; p=1.00). Subgroup analysis based on body mass index (≥30 vs. <30) revealed no significant differences in efficacy and safety outcomes between the DS and GA groups.

Conclusions: DS provides a comparable safety and efficacy profile to GA for cryoablation in patients with AF. These findings support the use of DS as a feasible and practical alternative to GA in routine clinical practice.

Over the past 4 decades, significant advances in pediatric cardiology in Korea have led to marked improvements in the prognosis of patients with complex congenital heart diseases, including single ventricle physiology. The number of patients reaching adulthood has steadily increased. In particular, there is a growing need for clinical practice guidelines that reflect the latest medical trends for the long-term management of Fontan circulation patients. Accordingly, a Korean Fontan cohort was established in 2019, and a guideline development committee was formed in 2023 to publish the first Korean clinical practice guidelines for Fontan patients. Nineteen working committee members discussed and reviewed the methodology and content with expert consultation, incorporating both international guidelines and Korean-specific data. Through multiple rounds of review and discussion between authors and editors, the content was finalized, including evaluations of clinical guidelines from the United States, Europe, and Australia. The guidelines also incorporate survey data from members of the Korean Pediatric Cardiology Society and results from meta-analyses, and propose outpatient follow-up schedules tailored to the Korean clinical context. The finalized guidelines underwent rigorous review by leading national experts to enhance their completeness and applicability.

Background and objectives: Adolescents with congenital heart disease (CHD) are at increased cardiovascular risk, exacerbated by high-fat meals (HFMs) and sedentary behavior. While exercise is recommended to mitigate this risk, adherence can be challenging. Virtual reality (VR) exergaming has emerged as a potentially motivating alternative. This study examined whether a single session of VR exergaming could attenuate vascular and metabolic impairment induced by an HFM and prolonged sitting in adolescents with CHD.

Methods: In a randomized crossover design, 10 adolescents with CHD (mean age, 12.6±3.3 years) completed 2 trials after an HFM with 4 hours of sitting: (1) 30 minutes of VR cycling, and (2) uninterrupted sitting. Vascular and metabolic markers were assessed at baseline and 4 hours, including flow-mediated dilation (FMD), augmentation index (AIx), carotid-femoral pulse wave velocity, blood pressure (BP), glucose, lipids, and triglyceride-glucose index (TyG).

Results: FMD was preserved in the VR trial and decreased in the sitting trial, with a significant interaction (p=0.008). Systolic BP showed a significant interaction (p=0.022), with reductions observed only after VR exercise. AIx was significantly lower in the VR trial compared with sitting (p=0.002), but no interaction was observed. The postprandial increase in TyG index was attenuated in the VR trial (interaction p=0.040).

Conclusions: A single session of VR exergaming attenuated vascular and metabolic impairment induced by an HFM and prolonged sitting in adolescents with CHD. These findings suggest that VR exergaming may serve as an alternative to traditional exercise for vascular health in CHD.