Korean Circulation Journal最新文献

Background and objectives: We aimed to evaluate the efficacy and safety of coronavirus disease 2019 (COVID-19) vaccination in patients with heart failure (HF) using national databases.

Methods: We retrospectively analyzed the data from the Korean nationwide COVID-19 cohort, including patients with HF from February 2021 to June 2022. The study population was divided into the vaccinated (≥2 doses) and unvaccinated (≤1 dose) groups. Clinical outcomes assessed included hospitalization for HF, COVID-19-related events, and cardiovascular complications. Patients were matched by age, sex, and comorbidities, and were followed up for up to 15 months to assess vaccination-associated risks.

Results: We included 651,127 patients with HF (mean age 69.5 years; 50.2% male), of whom 112,693 (17.3%) were unvaccinated, and 538,434 (82.7%) were vaccinated. After propensity score matching, 73,559 patients in each group were compared. Over a median follow-up of 6 months, vaccination was associated with a significantly reduced risk of COVID-19 (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.22-0.33) and critical COVID-19 infection (HR, 0.47; 95% CI, 0.31-0.71). The vaccinated group also had a significantly lower risk of hospitalization for HF (HR, 0.53; 95% CI, 0.52-0.55) and all-cause mortality (HR, 0.18; 95% CI, 0.17-0.18) compared with the unvaccinated group. Additionally, vaccination was associated with a significantly lower risk of stroke, myocardial infarction, myocarditis/pericarditis, and venous thromboembolism compared with the unvaccinated patients (all, p<0.0001).

Conclusions: COVID-19 vaccination in patients with HF was associated with a reduced risk of hospitalization for HF, all-cause mortality, and other cardiovascular events.

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: 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: 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.

Background and objectives: Conflicting results have been reported regarding the efficacy of left ventricular-only pacing (LVP) synchronized with intrinsic right ventricular conduction (adaptive LVP) for cardiac resynchronization therapy (CRT) in Western heart failure (HF) populations. We compared adaptive LVP with conventional biventricular pacing (BVP) in Asian HF patients.

Methods: The K-adaptive CRT study, the largest adaptive CRT study to date in Asian HF patients, evaluated 368 HF patients who received CRT devices with an adaptive pacing algorithm between September 2013 and March 2020 from 25 tertiary hospitals in Korea. Patients were classified into 3 groups according to their pacing configuration: adaptive LVP (n=160), adaptive BVP (n=86), and conventional BVP groups (n=122). Primary outcome was the composite of all-cause death, HF hospitalization, and appropriate implantable cardioverter-defibrillator therapy.

Results: During the mean 3.7-year follow-up period, incidence of the primary outcome was significantly lower in the adaptive LVP group than the conventional BVP group (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.36-0.85; p=0.007), while outcomes in the adaptive and conventional BVP groups were comparable. Patients with higher LVP% (≥65%) showed a further reduction in relative risk of the primary outcome (HR, 0.41; 95% CI, 0.22-0.76; p=0.005). Adaptive LVP was consistently associated with a lower risk of clinical outcomes in various subgroup analyses, and was identified as an independent factor for favorable long-term outcomes.

Conclusions: The K-adaptive CRT study suggests that adaptive LVP is associated with better clinical outcomes than conventional BVP in Asian HF patients.