Korean Circulation Journal最新文献

Greenhouse gas emissions drive climate change, which in turn threatens human health through various pathways, including cardiovascular disease, respiratory illness, and infectious disease. Despite the healthcare sector accounting for 4.4% of global carbon emissions, carbon footprint analysis within the field remains limited. This perspective addresses the importance of carbon footprint assessment in healthcare, particularly in cardiovascular medicine, and illustrates the use of randomized controlled trial (RCT) data for carbon footprint comparison. Unlike other sectors, healthcare carbon footprint analysis must consider not only the emissions generated directly by medical interventions but also those produced during the subsequent clinical course and follow-up. Data routinely collected during RCT follow-up periods can be used to estimate total emissions associated with different treatment strategies. In the cardiovascular field, where procedures themselves are carbon-intensive and where serious clinical events frequently occur during long-term follow-up, such analyses are particularly relevant. For instance, based on RCT data comparing fractional flow reserve (FFR) and intravascular ultrasonography for intermediate coronary artery stenosis, we estimated that the FFR group had a lower carbon footprint during the 2-year follow-up period. Extending the analysis with a long-term simulation model over 30 years similarly revealed that the cumulative carbon emissions remained lower in the FFR group. Comparing the carbon footprint between treatment strategies using RCT data can provide meaningful insights to guide environmentally responsible healthcare decisions. Building more accurate carbon footprint databases specific to healthcare interventions and fostering greater awareness among healthcare professionals will be essential to advance this effort.

Background and objectives: Daily activity has a distinct hierarchy of movement behaviors. The association between 24-hour movement behaviors and cardiac conduction disease (CCD) remains unclear. We aimed to investigate the association between accelerometer-measured 24-hour movement behaviors and CCD risk.

Methods: A total of 92,436 UK Biobank participants who wore wrist accelerometers for 7 consecutive days were included, with a median follow-up of 6.1 years. Multivariable Cox proportional hazards models were used to investigate the associations between 24-hour movement behaviors (sleep, sedentary behavior, light-intensity physical activity [LIPA], and moderate-to-vigorous intensity physical activity [MVPA]) and the risk of CCD. Compositional data analysis was performed to estimate the effects of reallocating time among 24-hour movement behaviors.

Results: Among the 92,436 participants (median age 58 years; interquartile range, 50-63; 54% female), 1,442 developed incident CCD (2.58 per 1,000 person-years) during the follow-up. Greater sedentary behavior was associated with an increased risk of CCD (hazard ration [HR], 1.05; 95% confidence interval [CI], 1.02-1.08), whereas higher MVPA was associated with a lower risk (HR, 0.83; 95% CI, 0.75-0.92). Sleep duration and LIPA were not significantly associated with CCD risk. Reallocating 30 min/day to MVPA from other movement behaviors was associated with a 4% lower risk of CCD (HR, 0.96; 95% CI, 0.93-0.98). Conversely, reallocating 30 minutes/day to sedentary behavior was associated with a 3% increased risk (HR, 1.03; 95% CI, 1.01-1.05). Similar patterns were observed for specific CCD outcomes, including second- or third-degree atrioventricular block and pacemaker implantation.

Conclusions: Higher volumes of MVPA were associated with a lower risk of CCD, whereas increased sedentary behavior was associated with higher risk, highlighting the importance of preventive activity patterns.

Heart failure (HF) registries were established to bridge the gap between explanatory randomized clinical trials and daily clinical practice. Early hospital-based initiatives, such as ADHERE (2001) and the EuroHeart Failure Survey I (2000-2001), were followed by nationwide quality registries (e.g. SwedeHF, GWTG-HF) and global programmes (INTER-CHF, G-CHF), all together enrolling millions of patients across the acute-to-chronic HF spectrum. Registry-based analyses have provided insights into HF epidemiology, phenotypes, risk factors, prognosis, real-world therapy implementation, and have been hypotheses-generating for repurposing already existing treatments. Registries address questions that are unlikely to be answered in randomized trials, such as therapy effectiveness in underrepresented subgroups and settings that would be ethically challenging to study in a randomized setting (e.g., therapy withdrawal). Registry-based randomized controlled trials utilize the registry infrastructure for trial conduct and offer the opportunity to pragmatically test interventions at substantially lower costs than conventional randomized trials. Registries are a crucial part of a learning healthcare system, and will likely become increasingly relevant as methodological advances, including electronic record linkage, harmonized data standards, and modern causal inference techniques, enhance their validity. In this review, we provide a global overview of HF registries' evolution, scientific yield, and future potential.

Antiplatelet therapy is crucial for patients after percutaneous coronary intervention (PCI), but there is limited high-quality evidence guiding the best strategy for those with bifurcation lesions. The antiplatelet strategy for bifurcation PCI requires balancing the patient's overall thrombotic and bleeding risks. Bifurcation lesions present a complex, high-thrombotic-risk milieu because the procedure often causes plaque disruption and forms an inevitable gap in the sealing of the stent, compounded by turbulent blood flow that promotes thrombosis. Factors like stent malapposition, underexpansion, and low/oscillatory shear stress also contribute to increased local thrombotic risk, making the optimal antiplatelet therapy for bifurcation PCI difficult to define. Previous observational registry data broadly suggested a prolonged duration of dual antiplatelet therapy (DAPT) may be safer than a shorter duration of DAPT in reducing major adverse clinical outcomes. However, the reliability of these findings is limited by the inherent flaws of registry data, including the retrospective study design, lack of clinical event adjudication, and lack of specific protocol of PCI or DAPT strategy. Moreover, specific lesions factors such as complex PCI and left main bifurcation lesions or patient factors such as the presence of high bleeding risk or clopidogrel resistance necessitate special consideration, which leads to a individualized DAPT strategy beyond registry generalizations. The future of care points toward precision medicine, necessitating dedicated, prospective randomized controlled trials with standardized procedures to establish clear, evidence-based recommendations.

Myocardial stiffness is a key determinant of cardiac function. So far, its assessment required invasive methods such as pressure-volume loop measurements or mechanical testing of tissue biopsies, which are both not suited for daily clinical use. However, recent advances in echocardiography offer promising non-invasive alternatives. Initial clinical studies in different pathologies are encouraging and indicate a huge potential of these new ultrasound-based techniques for evaluating myocardial stiffness. In this review, we explain the concept of myocardial stiffness, explore the most promising ultrasound techniques currently available for its evaluation, and discuss key insights from recent clinical research in the field.