Korean Circulation Journal最新文献

Background and objectives: Rotational atherectomy (RA) is a technique used to ablate calcified plaques. There is speculation that operators' experience with RA could play a role in the outcomes.

Methods: From December 2015 to April 2020, patients with calcified coronary lesions requiring percutaneous coronary intervention (PCI) with RA were enrolled in a prospective, multicenter, observational registry. The patients were divided into two groups based on the number of RAs performed by their operator in the past. A propensity score matching was done for a sensitivity analysis. The primary outcome was a composite of cardiac death, myocardial infarction, and target vessel revascularization at 1 year.

Results: A total of 497 patients were enrolled in the study. The calculated cutoff number of RA-PCI between the two groups was 82 cases. The more experienced group underwent PCI with less fluoroscopy time (less experienced vs. more experienced, 38.8 vs. 30.0 minutes, p<0.001), and more frequent intravascular imaging (54.6% vs. 69.0%, p=0.012). The primary outcome did not differ significantly between the groups (5.2% vs. 7.3%, hazard ratio, 1.46; 95% confidence interval [CI], 0.57-3.74; p=0.433). No significant difference in the incidence of complications was observed between the groups (5.5% vs. 7.0%, odds ratio, 1.38; 95% CI, 0.57-3.04; p=0.526). Similar results were observed in the propensity-score matched population.

Conclusions: In PCI using RA for calcified lesions, the composite outcome of cardiac death, myocardial infarction, and target vessel revascularization at 1 year was not significantly different according to RA experience among operators.

Background and objectives: The 2022 revised pulmonary hypertension guidelines emphasize risk stratification to enhance outcomes, necessitating investigation into adherence. This study aimed to examine the treatment patterns of patients in the Pulmonary Arterial Hypertension (PAH) Platform for deep Phenotyping in Korean Subjects (PHOENIKS) study cohort.

Methods: A total of 321 patients from the PHOENIKS cohort were included, consisting of 101 patients in phase 1 (2018-2020) and 220 in phase 2 (2021-2023). A total of 275 patients with either idiopathic PAH or associated PAH were included in the final analysis. Risk assessment was conducted utilizing an online calculator that integrates multiple validated risk stratification models. Adherence to the revised guidelines was evaluated, and survival outcomes were analyzed over the study period.

Results: The cohort consisted primarily of middle-aged and female patients (mean age 51.96±15 years, 71% female). A total of 53% had idiopathic PAH and 47% had associated PAH. Intermediate-risk patients comprised 62% of the cohort during the initial diagnosis. The proportion of low-risk patients increased from 34% to 64% throughout the follow-up period. Adherence to the revised guidelines slightly improved during the study period, though only 26% of patients demonstrated compliance. The one-year survival rate was 96%, whereas the 3-year survival rate was 87%.

Conclusions: The current Korean PAH treatment strategy must be improved to align with the revised guidelines and optimize patient outcomes. Further efforts are needed to change health insurance coverage criteria to enhance guideline adherence.

Large sized valve of a self-expandable nature has been suggested as the next generation transcatheter pulmonary valve to implant for various type of native right ventricular outflow tract (RVOT) lesions. Tissue engineered Pulsta valve including decellularization, alpha-galactosidase treatment provide longer valve durability and knitted woven nitinol wire stent provide low risk of stent fracture at the dynamic RVOT. Compact tubular design of Pulsta valve also offer easy valve loading to delivery system and good trackability to valve landing area. From the worldwide experience over 750 cases by February 2025, adaptability of Pulsta valve for various RVOT has proven. Pulsta valve has been implanted for various type of main pulmonary artery (PA) including pyramidal, reverse pyramidal shape and for branch PA stenosis including stent in the branch PA. In case of extremely large native RVOT anatomy, Pulsta valve can be implanted in both branch PA respectively. For the stenotic RVOT or failed bioprosthetic valve, Pulsta valve can also be implanted with or without pre-stenting. Recapturability using delivery system itself if less than one third of valve were flared outside of sheath and capability of whole delivery system retrieval using hooking system are another merit for safe procedure. Though the experience of Pulsta valve for various RVOT diseases is newly accumulated in many centers every day, we still have to learn more about Pulsta valve applicability for various RVOT diseases and long-term outcomes after Pulsta valve implantation.

Background and objectives: Endothelin-1 (ET-1) is a potent vasoconstrictor and multifunctional neuroendocrine hormone that is closely associated with the pathophysiology of heart failure (HF). Currently, the evidence about the predictive value of big ET-1 in HF remains insufficient. This study aims to investigate the prognostic importance of big ET-1 in HF.

Methods: We examined the incidence of cardiovascular death in a single-center retrospective cohort of HF (de novo, worsening, or chronic included).

Results: The 4,368 hospitalized HF patients were enrolled. During the median follow-up of 875 (365-1,400) days, 851 (19.5%) patients had primary outcome events. Big ET-1 was independently associated with cardiovascular death as a continuous variable (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.06-1.21; p<0.001) and by tertiles (HR, 1.35; 95% CI, 1.06-1.72; p=0.017 for tertile 2 and HR, 1.70; 95% CI, 1.32-2.19; p<0.001 for tertile 3). This pattern of risk was maintained after further adjustment for NT-proBNP (HR, 1.11; 95% CI, 1.03-1.19; p=0.006 for continuous variable, HR, 1.30; 95% CI, 1.02-1.67; p=0.035 for tertile 2, and HR, 1.69; 95% CI, 1.23-2.05; p=0.034 for tertile 3). Net reclassification index (NRI) and integrated discrimination improvement (IDI) analysis showed that big ET-1 provided additional predictive power in combination with NT-proBNP (NRI, 0.11; 95% CI, 0.04-0.17; p=0.012 and IDI, 0.012; 95% CI, 0.003-0.017; p<0.001).

Conclusions: Elevated big ET-1 was independently associated with cardiovascular death in patients with HF. Big ET-1 may be a promising indicator of HF prognosis. In combination with NT-proBNP, big ET-1 may provide incremental predictive information.

Background and objectives: Substantial efforts have been made to categorize the diverse and broad population of individuals with primary hypertension into more defined, homogeneous subgroups according to their hormonal responses to biological stimuli, such as low-renin hypertension. This study aimed to explore the phenotype and prognosis of patients with untreated primary hypertension with high renin and aldosterone levels.

Methods: In this study, we explored hypertensive phenotypes related to renin and aldosterone levels in untreated patients with primary hypertension (n=747). Patients were stratified into 4 groups on the basis of plasma renin activity (≥1.0 ng/mL/hr or <1.0 ng/mL/hr) and the plasma aldosterone concentration (≥15 ng/dL or <15 ng/dL).: high renin and aldosterone (n=172), low renin and high aldosterone (n=70), high renin and low aldosterone (n=308), and low renin and aldosterone (n=196).

Results: Multinomial logistic regression analysis revealed that younger age (p<0.001), higher pulse rates (p=0.002), and greater nighttime systolic blood pressure (p=0.046) were independent predictors of high renin and aldosterone levels. Microalbuminuria (25.5%, p<0.001) and elevated uric acid levels (5.5±1.4 mg/dL, p=0.006) were also more prevalent in this group.

Conclusions: These findings highlight the importance of stratifying hypertensive phenotypes to enable personalized treatment for primary hypertensives with elevated renin and aldosterone levels.

Background and objectives: Distal radial access (DRA) has been recognized as an alternative to conventional radial access, with potential puncture sites at the anatomical snuffbox and on the dorsum of the hand. However, the optimal puncture site remains unknown. This study aims to evaluate the efficacy and safety of DRA at these two sites.

Methods: This analysis was performed using the KODRA (Korean Prospective Registry for Evaluating the Safety and Efficacy of Distal Radial Approach) registry. The primary efficacy endpoint was defined as successful puncture and completion of the coronary procedure without access-site crossover, while the primary safety endpoint was the DRA-related bleeding.

Results: A total of 4,977 and 4,644 patients were included in efficacy and safety analyses, respectively. DRA via the anatomical snuffbox improved the primary efficacy endpoint (odds ratio [OR], 2.358; 95% confidence interval [CI], 1.800-3.090; p<0.001), but did not differ from the dorsum of the hand approach in the primary safety endpoint (OR, 1.305; 95% CI, 0.792-2.150; p=0.296). The anatomical snuffbox approach was also associated with higher puncture success rates (OR, 2.244; 95% CI, 1.672-3.010; p<0.001), but with an increased rate of prolonged hemostasis >180 minutes (OR, 15.002; 95% CI, 7.708-29.197; p<0.001).

Conclusions: Compared to the dorsum of the hand approach, DRA via the anatomical snuffbox demonstrated higher procedural efficacy, but was associated with prolonged hemostasis, without an increase in DRA-related bleeding. Further research is needed to determine the optimal site for DRA.