Korean Circulation Journal最新文献

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is the most prevalent chronic liver disease globally and a key driver of cardiometabolic morbidity. Beyond hepatic manifestations, MASLD significantly elevates the risk of cardiovascular disease (CVD)-including myocardial infarction, ischemic stroke, heart failure, and cardiovascular mortality-through overlapping mechanisms such as visceral adiposity, insulin resistance, inflammation, oxidative stress, and dyslipidemia. Epidemiologic data demonstrate a consistent and independent association between MASLD and adverse cardiovascular outcomes. Subclinical changes in vascular structure and function precedes overt events, underscoring the need for early detection and proactive risk stratification. While glucagon-like-peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors offer dual hepatic and cardiovascular benefits, recent trials have revealed nuances in efficacy across patient populations, particularly in heart failure with preserved ejection fraction and cirrhotic cohorts. Non-invasive diagnostics-including elastography, magnetic resonance elastography, magnetic resonance imaging-derived proton density fat fraction, and machine learning-based tools-are enhancing the precision of MASLD staging and risk assessment. However, implementation remains variable, and cost-effectiveness in CVD screening is underexplored. This review synthesizes current knowledge on the MASLD-CVD interface, critically appraises existing evidence, and identifies gaps in mechanistic understanding, diagnostics, and therapeutics. We advocate for an integrated, multidisciplinary framework combining hepatology and cardiology expertise to optimize patient care in this evolving disease landscape.

Background and objectives: The association between food insecurity and cardiovascular health (CVH) in Korean adults remains unclear. This study aimed to investigate the association between food insecurity and CVH in Korean adults.

Methods: This study included 14,034 adults aged ≥19 years in the Korea National Health and Nutrition Examination Survey 2019-2021. CVH was defined using the American Heart Association's Life's Simple 7 framework, including smoking status, physical activity, diet, body mass index, total cholesterol, blood pressure, and fasting glucose. Participants were categorized into the food secure or food insecure group based on their survey scores. Multivariate logistic regression analysis was performed to calculate the association between food insecurity and poor CVH.

Results: Among the participants, 4.0% belonged to the food insecure group and 96.0% belonged to the food secure group, and 15.3%, 61.4%, and 23.3% of the participants had ideal, intermediate, and poor CVH, respectively. In the multivariate analysis, the odds ratio (95% confidence interval) for poor CVH was 1.32 (1.06-1.64) in food insecure group compared to food secure group. The odds for poor CVH increased as food security status aggravated (p for trend <0.05). Moreover, food insecure group had higher odds of poor status in the following CVH components: smoking and blood pressure.

Conclusions: Food insecurity is associated with poor CVH in Korean adults. Specifically, it is associated with current smoking and high blood pressure. Improving food insecurity may help prevent poor CVH in Korea.

Background and objectives: The optimal grafting strategy for ischemic cardiomyopathy (ICMP) remains uncertain despite the growing heart failure population undergoing coronary artery bypass grafting (CABG). This study sought to explore the outcomes of CABG in ICMP patients according to the number of inflow sources.

Methods: A total of 447 patients with an ejection fraction (EF) of ≤35% who underwent isolated CABG from 2009 to 2020 were analyzed. Patients were categorized into either a single inflow source group (single group, n=203), in which unilateral in situ internal thoracic artery (ITA) served as the sole inflow, or a multiple inflow source group (multiple group, n=244), utilizing additional inflow sources from the aorta or contralateral ITA. The primary outcome was all-cause mortality, analyzed after adjustment using the inverse-probability-of-treatment-weighting method.

Results: There were no differences in the early outcomes between 2 groups. After adjustment, the single group exhibited significantly worse survival compared to the multiple group during a median follow-up of 5.3-years (adjusted hazard ratio, 1.88; 95% confidence interval, 1.26-2.80; p=0.001), particularly in the subgroup of patients without a recent myocardial infarction within 1 month (p=0.005) and those with an EF of ≥25% (p=0.007). At the last follow-up echocardiography (>6 months), the multiple group showed a significantly higher postoperative EF (p=0.009) and a smaller left ventricular end-systolic dimension (p=0.027) compared to the single group, which had not shown significant differences preoperatively.

Conclusions: In ICMP patients, CABG using multiple inflow sources was associated with improved outcomes, particularly in those without recent or profound myocardial injury.

Background and objectives: Quantitative flow ratio (QFR) is a method for estimating fractional flow reserve (FFR) without the use of an invasive pressure wire or hyperemic agent. However, the reasons for variation in QFR accuracy across studies and the factors associated with its accuracy remain unclear. The aim of this study was to investigate the diagnostic performance of QFR under different clinical and analysis conditions.

Methods: This multicenter trial prospectively enrolled patients undergoing coronary angiography with an indication for invasive FFR. The composite score for the QFR analysis factors was calculated based on the presence or absence of the angiographic factor, system factor, lesion factor, and subjective difficulty factor. The diagnostic performance of the QFR was assessed for each composite score using FFR ≤0.80 as the reference.

Results: A total of 285 vessels from 239 patients were analyzed. The median FFR and QFR values were 0.83 (interquartile range [IQR], 0.78-0.88) and 0.83 (IQR, 0.76-0.89), respectively. Using FFR ≤0.80 as a reference, QFR showed an overall diagnostic accuracy of 81.4%. Higher composite scores were associated with lower diagnostic performance of QFR in predicting FFR ≤0.80 (p-for-trend=0.010). The diagnostic accuracy of QFR ranged from 94.1% in vessels with low composite scores to 73.7% in those with high composite scores.

Conclusions: The diagnostic accuracy of QFR decreases with increasing lesion complexity, system factors, lower angiographic image quality, and analysis difficulty. These findings suggest that specific lesion, system, and imaging-related factors can significantly impact the reliability of QFR in clinical practice.

Trial registration: ClinicalTrials.gov Identifier: NCT06305572.

Background and objectives: We aimed to study temporal trends in cardiogenic shock (CS) complicating acute myocardial infarction (AMI) and assessed the predictors of shock development during hospitalization and of mortality.

Methods: Data were obtained from 2 Korean AMI Registries (KAMIRs), the KAMIR-National Institutes of Health (early) and KAMIR-V (late). Patients with CS were those with CS before admission (ba-CS) and those who developed CS during admission as a complication of AMI (da-CS). Temporal trends were examined as early (2011-2015) and late (2016-2020) periods.

Results: A total of 28,990 patients was included, of whom 3,179 (11.0%) had CS. The overall prevalence of CS decreased from 12.5% to 9.6% (p for trend <0.001). Among CS patients, 1,900 (59.8% of those with CS) had ba-CS and 1,279 developed da-CS. The prevalence of both ba- (7.1% to 6.1%, p<0.001) and da-CS (5.4% to 3.6%, p<0.001) decreased, while the use of percutaneous coronary intervention increased. Over the 10-year period, in-hospital mortality rates decreased in overall CS (from 27.3% to 22.9%; p=0.004) and ba-CS (from 25.1% to 17.0%; p<0.001), but not in da-CS (from 30.3% to 32.9%; p=0.335).

Conclusions: The decline in mortality rates of overall and ba-CS but not that of da-CS emphasizes the need for enhanced prevention strategies, early identification of development of CS after admission, and alternative therapeutic strategies for patients at high risk of CS in the acute stage of AMI.

Background and objectives: Even low-risk atrial fibrillation (AF) patients usually continue anticoagulant therapy for several months after the procedure. However, there is no solid evidence supporting this practice. The REDUCIBLE trial is designed to compare the outcomes of conventional 2- versus 1-month oral anticoagulant (OAC) therapy following successful catheter ablation (CA) in men with a CHA₂DS₂-VASc score of ≤1 and women with ≤2, where long-term OAC is not recommended.

Methods: In this pilot study, patients undergoing CA for drug-refractory paroxysmal AF were randomly divided into 2 groups. One group received OAC for 1 month, whereas the other received it for 2 months. The primary outcome was the incidence of stroke and systemic embolism within 1 year after ablation.

Results: A total of 220 patients were enrolled and randomly assigned to 2 groups. Baseline characteristics were similar between the groups. The AF recurrence-free survival (RFS) rate was similar (76.9% vs. 77.7%, p=0.98). During the blanking period, AF RFS was also similar (92.5% vs. 92.9%, p=0.98). No ischemic stroke or systemic embolism occurred in either group during 1-year follow-up. One patient in the 1-month group experienced a minor bleeding event when anticoagulants were not taken (7 months after ablation).

Conclusions: This study found that a single month of OAC post-ablation did not significantly elevate the risk of stroke or systemic embolism in low-risk patients. Nonetheless, a larger sample size would be necessary to achieve the statistical power for definitive conclusions. Future larger prospective clinical trials are needed to address this question comprehensively.

Trial registration: ClinicalTrials.gov Identifier: NCT03573037.