Circulation Journal最新文献

Cancer is widely recognized as one of the major risk factors for thrombosis, and cancer-associated thrombosis (CAT) is a concept that also encompasses arterial and venous thromboembolism. The risk factors for CAT of clinical concern are assumed to be a complex combination of patient-related factors, the cancer itself, factors related to anticancer therapy, tissue factors expressed on cancer cell membranes, and cytokines released by cancer cells to increase inflammation and coagulation at remote sites. In addition, some anticancer agents are known to damage vascular endothelial cells and cause thrombus formation; early diagnosis and treatment of CAT is recommended because CAT is a significant risk factor for poor prognosis in cancer patients.

Background: Previous randomized clinical trials did not support a benefit of screening for occult cancer after diagnosis of venous thromboembolism (VTE), although screening may be of potential benefit for selected high-risk patients.

Methods and results: The COMMAND VTE Registry-2 enrolled consecutive patients with acute symptomatic VTE between 2015 and 2020 from 31 centers across Japan. The 3,706 patients in the registry without known active cancer at the time of VTE diagnosis were divided into 2 groups: those with (n=250) and without (n=3,456) newly diagnosed cancer during the follow-up period. The cumulative incidence of newly diagnosed cancer was 1.5% at 30 days, 3.7% at 1 year, and 7.0% at 3 years. The multivariable Cox proportional hazard model demonstrated that older age (hazard ratio [HR] 1.02 per 1 year increase; 95% confidence interval [CI] 1.01-1.03; P<0.001), a history of cancer (HR 3.57; 95% CI 2.73-4.64; P<0.001), autoimmune disorders (HR 1.48; 95% CI 1.06-2.02; P=0.02), a history of major bleeding (HR 1.64; 95% CI 1.04-2.48; P=0.04), and the absence of transient provoking risk factors for VTE (HR 1.44; 95% CI 1.08-1.92; P=0.01) were independently associated with newly diagnosed cancer.

Conclusions: The incidence of newly diagnosed cancer after VTE diagnosis was 3.7% at 1 year, and several independent risk factors for newly diagnosed cancer after VTE diagnosis were identified.

Background: Venous thromboembolism (VTE) is a serious complication following spine surgery for metastatic tumors. This study used the US Nationwide Readmissions Database to identify predictors of VTE and its associations with outcomes.

Methods and results: Data between 2016 and 2020 were retrospectively reviewed. Patients aged ≥18 years undergoing non-emergency surgery for spinal metastasis were included in the analysis. Multivariable regression analysis was used to assess associations of VTE with in-hospital outcomes and 30- and 90-day readmissions, as well as demographic and clinical factors associated with VTE occurrence during the index admission. In all, 2,706 patients were included in the analysis (mean age 63.6 years; 1,435 [53%] male). Of all patients, 126 (4.7%) developed VTE during the index admission. After adjustment, VTE was significantly associated with an increased risk of in-hospital mortality (adjusted odds ratio [aOR] 5.34; 95% confidence interval [CI] 2.38-11.96) and 30-day readmission (aOR 2.06; 95% CI 1.33-3.19). Delays from admission to surgery (aOR 1.88; 95% CI 1.27-2.79) and a Charlson Comorbidity Index score ≥4 (aOR 3.11; 95% CI 1.60-6.04) were independently associated with an increased risk of VTE.

Conclusions: In patients undergoing surgery for spinal metastasis, postoperative VTE is associated with higher in-hospital mortality and 30-day readmission risks. A Charlson Comorbidity Index score ≥4 and delayed surgery are independently associated with greater risk of VTE.

Background: This study prospectively collected and analyzed real-world clinical outcomes of cancer patients with venous thromboembolism (VTE) receiving rivaroxaban in Japan.

Methods and results: From August 2018 to December 2021, cancer patients with VTE treated with rivaroxaban or warfarin were enrolled at 27 Japanese institutions. A total of 322 patients treated with rivaroxaban were analyzed. The VTE recurrence/worsening-free survival rate by Kaplan-Meier estimate was 98.0% and neither VTE-related nor cardiovascular deaths occurred during 24-week rivaroxaban treatment.

Conclusions: VTE recurrence/worsening occurred in only a small percentage of Japanese cancer-VTE patients treated with rivaroxaban.

Background: Decreased exercise tolerance after pulmonary resection for lung cancer is strongly associated with a poor prognosis, but its determinants remain underexplored. We investigated the mechanisms of postoperative effort intolerance in lung cancer using combined exercise-stress echocardiography and cardiopulmonary exercise testing (ESE-CPET).

Methods and results: We prospectively analyzed 38 patients with suspected non-small cell lung cancer who underwent pulmonary resection. Preoperative and 6-month postoperative evaluations included resting echocardiography, ESE-CPET, and pulmonary function tests. Pulmonary vascular function was assessed using the mean pulmonary artery pressure/cardiac output (MPAP/CO) slope (n=38). Postoperative peak oxygen consumption (V̇O₂) significantly decreased (19.4 vs. 17.3 mL/min/kg, P<0.001). Multiple regression analysis identified left atrial reservoir strain (B 0.797 [95% confidence interval: 0.138-1.456], P=0.019) and number of resected segments (-5.448 [-10.99 to -0.047], P=0.048) as independent predictors of postoperative change in peak V̇O₂. Subgroup analysis showed greater changes in systolic pulmonary artery pressure during exercise (∆SPAP) and steeper postoperative MPAP/CO slopes in patients with ≥3 resected segments vs. <3 (P<0.001 and P=0.052 for time-group interaction). A preoperative MPAP/CO slope >2.0 predicted larger increases in peak SPAP following ≥3-segment resection (P=0.006), signifying increased pulmonary vascular stress.

Conclusions: ESE-CPET demonstrated that extensive pulmonary resection adversely affects postoperative exercise tolerance and pulmonary vascular function, leading to greater ∆SPAP and steeper MPAP/CO slopes.