Korean Circulation Journal最新文献

Background and objectives: As long-term survival after the Fontan operation has improved, exercise capacity has become a crucial determinant of prognosis. Various exercise rehabilitation programs involving different populations and protocols have been developed to improve these outcomes. This systematic review and meta-analysis compared the effects of exercise rehabilitation in patients with Fontan circulation according to age group and exercise method.

Methods: We searched the PubMed, Embase, and Cochrane Library databases for articles on exercise rehabilitation programs for patients who had undergone the Fontan procedure up to November 2023. After selection and eligibility assessment, 20 studies (5 randomized controlled trials [RCTs], 2 randomized trials, and 13 cohort studies) were included in the meta-analysis of peak oxygen consumption (VO₂) and minute ventilation equivalents for carbon dioxide production (VE/VCO₂ slope).

Results: Peak VO₂ was significantly better in groups with exercise training than in the control groups in 5 RCTs (standardized mean difference [SMD], 0.48; p=0.0017); it showed a notable increase in 20 studies before and after exercise training (SMD, 0.44; p=0.001). VE/VCO₂ showed no significant changes in the RCTs (SMD, 0.22; p=0.68) or before and after exercise training (SMD, -0.11; p=0.25). Subgroup analyses revealed significant improvements in peak VO₂ for aerobic exercise (SMD, 0.32; p=0.0136) and in groups that included children (SMD, 0.49; p=0.0013 in "children and adults" and SMD, 0.49; p=0.047 in "children" group).

Conclusions: Exercise training is effective for improving exercise capacity in patients after the Fontan procedure, particularly when initiated at a young age and implemented as an aerobic exercise.

Background and objectives: Ticagrelor monotherapy after short-term dual-antiplatelet therapy (DAPT) has not been established in chronic kidney disease (CKD) patients. This study evaluated the effects of ticagrelor monotherapy after 3-month of DAPT on renal function in acute coronary syndrome patients.

Methods: From the TICO trial, the primary outcome was a composite of net adverse clinical events (NACEs), defined as a composite of major bleeding and major adverse cardiovascular and cerebrovascular events (MACCEs). The secondary outcomes were thrombolysis in myocardial infarction (TIMI) major or minor bleeding and MACCE.

Results: Among patients without CKD (n=2,436), ticagrelor monotherapy after 3 months of DAPT had a lower rate of NACE (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.21-0.78; p=0.007) and TIMI bleeding (HR, 0.86; 95% CI, 0.19-0.81; p=0.011) than those of ticagrelor-based 12-month DAPT. Among CKD patients receiving ticagrelor monotherapy, lower risk of NACE (HR, 0.45; 95% CI, 0.20-1.02; p=0.055) and bleeding (HR, 0.20; 95% CI, 0.06-0.68; p=0.009) were observed. Otherwise, ticagrelor monotherapy was not significantly associated with an increased MACCE risk in those without CKD (HR, 0.62; 95% CI, 0.30-1.27; p=0.192) or with CKD (HR, 0.55; 95% CI, 0.21-1.48; p=0.237), versus 12-month DAPT.

Conclusions: Regardless of renal function, ticagrelor monotherapy after 3 months of DAPT resulted in a reduced risk of not only NACE but also major or minor bleeding at 1 year compared with ticagrelor-based 12-month DAPT. Irrespective of renal function status, however, the MACCE risk was not significantly different between the two strategies.

Background and objectives: MicroRNAs (miRNAs) are small, non-coding RNAs that control gene expression patterns by inducing the degradation of messenger RNAs (mRNAs). Furthermore, miRNAs are known to play an important role in the pathogenesis of atrial fibrillation (AF). AF is typically diagnosed using an electrocardiogram. However, this study investigated whether specific miRNAs could be involved in alleviating AF by regulating aquaporin 4 (AQP4).

Methods: HL-1 cells were transfected with either miRNA negative control (NC) or miR-140-5p, followed by incubation with or without tachypacing (TP) condition. We investigated the protein expression of calcium-handling and inflammation-related proteins in control, control + miR-NC, control + miR-140-5p, TP, and TP + miR-140-5p groups by Western blotting. Also, the relative mRNA expression of AQP4 was determined through real-time polymerase chain reaction.

Results: Compared to the control, miR-140-3p was increased in the TP-induced AF group. Additionally, AQP4 protein expression and mRNA level were increased in the AF group along with inflammation-related proteins toll-like receptor 4, nucleotide-binding domain-like receptor protein 3, ERK, AKT, and interleukin-1β. The increase in such proteins was mitigated through miR-140-5p treatment. In accordance with these results, calcium-handling protein markers CaMKII, phospholamban, and ryanodine receptor 2 gene were also increased in the AF group and alleviated with miR-140-5p treatment.

Conclusions: miR-140-5p is engaged in suppressing the expression of AQP4 in TP-induced AF HL-1 cells. In doing so, miR-140-5p reduced the risk of AF by suppressing inflammation and phosphorylation of Ca-handling proteins.

The Korea Acute Myocardial Infarction Registry (KAMIR) was established in 2005 to address the paucity of large-scale, real-world evidence on acute myocardial infarction (AMI) in East Asia. Over the last 2 decades, KAMIR has enrolled more than 86,000 patients across multiple centers in Korea, enabling comprehensive analyses of epidemiology, risk profiles, risk stratification, acute interventional management, and medical therapies. The registry has documented temporal shifts from ST-segment elevation myocardial infarction to non-ST-segment elevation myocardial infarction, progressive population aging, and distinctive metabolic risk profiles characterized by a high prevalence of diabetes and low levels of high-density lipoprotein cholesterol. KAMIR has also supported the development and validation of prognostic tools, including the KAMIR risk score and artificial intelligence-driven models. Widespread adoption of primary percutaneous coronary intervention, advanced stent technologies, intravascular imaging, and tailored antithrombotic strategies have improved procedural success rates and reduced mortality. Long-term medical therapy findings underscore the importance of intensive lipid-lowering, optimized renin-angiotensin system blockade, and individualized antiplatelet regimens, with emerging evidence supporting sodium-glucose cotransporter 2 inhibitors. KAMIR evidence has informed national guidelines and holds strong potential to guide future East Asian consensus guidelines, highlighting the value of region-specific data in shaping global cardiovascular practice. Ongoing integration of precision medicine approaches, digital health tools, and multinational collaboration is expected to further advance AMI care in East Asia.

Background and objectives: Comprehensive data on sex-based differences in the management and outcomes of patients with and without ischemic cardiomyopathy (ICMP) presenting with cardiogenic shock (CS) remain limited. This study aimed to investigate whether clinical management and outcomes differ by sex among CS patients, stratified by underlying etiology.

Methods: We analyzed 1,247 CS patients from the RESCUE registry, a multicenter observational cohort, stratified by sex and CS etiology: ICMP (females: 276, males: 730) and non-ICMP (females: 111, males: 130). Primary outcomes included in-hospital and 12-month mortality. Multivariable Cox proportional hazards models and propensity-score matching were used to adjust for confounding factors.

Results: Among ICMP patients, females were less likely to undergo coronary angiography (p=0.001), although rates of successful revascularization were similar between sexes (p=0.982). In-hospital 30-day mortality did not differ significantly between females and males in either the ICMP cohort (37.1% vs. 29.5%; adjusted hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.63-1.39; p=0.737) or the non-ICMP cohort (28.3% vs. 25.6%; adjusted HR, 1.23; 95% CI, 0.68-2.22; p=0.493). At 12 months, mortality risk remained comparable between sexes in both ICMP (46.4% vs. 37.1%; adjusted HR, 0.82; 95% CI, 0.57-1.17; p=0.274) and non-ICMP groups (40.1% vs. 41.3%; adjusted HR, 0.91; 95% CI, 0.56-1.45; p=0.685). These findings were consistent after propensity-score matching.

Conclusions: There was no significant difference in management, 12-month or in-hospital mortality between females and males, irrespective of the etiology of CS.

Trial registration: ClinicalTrials.gov Identifier: NCT02985008.