Circulation Journal最新文献

Background: Harmony^TMtranscatheter pulmonary valve implantation (TPVI) was developed to treat pulmonary regurgitation (PR) in patients with an enlarged native right ventricular outflow tract. Favorable outcomes have been reported in cohorts from the USA, but data from other regions are limited.

Methods and results: This prospective single-center study included 55 Japanese adults who underwent Harmony^TMTPVI between March 2023 and September 2024. Echocardiography and cardiac magnetic resonance imaging were performed at baseline and at 3 months. The median age was 45 years (interquartile range [IQR]: 29-54 years) and the median body mass index (BMI) was 20 kg/m²(IQR: 18-24). Procedural success was achieved in all patients. The PR fraction improved from 46% to 2.3% (P<0.01). Right ventricular end-diastolic and end-systolic volume indices decreased from 156 to 108 mL/m²and from 84 to 69 mL/m², respectively (P<0.01). Stroke volume increased from 59 to 64 mL, and cardiac index from 2.4 to 2.6 L/min/m²(P<0.05). During a median follow-up of 17 months, all patients remained free from reintervention.

Conclusions: In Japanese patients characterized by older age and lower BMI, Harmony^TMTPVI achieved high procedural success and rapid right ventricular reverse remodeling, indicating it is a safe and effective treatment option.

Background: The EARNEST-PVI trial showed that left atrial ablation in addition to pulmonary vein isolation (PVI) reduced atrial fibrillation (AF) recurrence after catheter ablation for persistent AF; however, the efficacy of left atrial additional ablation in patients with diabetes mellitus (DM) is not well known. The aim of this study was to evaluate the efficacy of left atrial additional ablation after PVI in patients with and without DM.

Methods and results: This study, a subanalysis of the EARNEST-PVI trial, a multicenter, prospective, randomized, controlled trial, analyzed 493 consecutive patients undergoing initial radiofrequency catheter ablation for persistent AF. Patients were randomized to PVI alone (PVI-alone group) or PVI plus linear and/or complex fractionated atrial electrogram ablation (PVI-plus group). The primary outcome was defined as AF recurrence during the 12-month follow-up period after ablation. A total of 84 (17%) patients had DM. The primary outcome occurred in 120 (24%) patients. In patients without DM, freedom from AF recurrence was significantly higher in the PVI-plus group than in the PVI-alone group (80.0% vs. 71.1%, P=0.034). In contrast, in patients with DM, freedom from AF recurrence was similar between the PVI-plus and PVI-alone groups (75.4% vs. 72.9%, P=0.696).

Conclusions: The efficacy of left atrial additional ablation after PVI in reducing AF recurrence following catheter ablation for persistent AF was diminished in patients with DM.

Background: Severe right ventricular (RV) dilatation and exercise intolerance are considered indications for pulmonary valve replacement in surgically repaired tetralogy of Fallot (rTOF).

Methods and results: Cardiopulmonary exercise testing (CPET) and cardiac magnetic resonance (CMR) were performed in rTOF patients with pulmonary insufficiency (PI). Oxygen pulse (OP), calculated as oxygen consumption (V̇O₂)/heart rate, was used as a surrogate of stroke volume (SV). Correlations between CPET and CMR measures were investigated. In all, 37 patients (mean [±SD] age 17±5 years; 14 males) were examined. Peak V̇O₂/kg was approximately 70% of predicted value. The pulmonary regurgitant fraction (PRF) was 28.3±13.4%. Body surface area (BSA)-indexed RV end-diastolic volume (RVEDVi) and RVSV (RVSVi) were 127±28 and 65±16 mL/m², respectively. RV and left ventricular (LV) ejection fractions were 50.3±7.8% and 59.1±6.1%, respectively. A strong positive correlation was noted between RV end-diastolic volume and RVSV (P<0.0001), RVSV and LVSV (P<0.0001), and RVEDVi and peak OP/BSA (P=0.0004). Larger RVEDVi was correlated with better exercise performance, whereas smaller RVEDVi was correlated with worse exercise performance. RVEDVi was larger in male than female rTOF patients despite comparable PRF, RVSVi, LVEDVi, and BSA-indexed LVSV.

Conclusions: A smaller RV was associated with worse exercise performance, indicating exercise intolerance is independent of RV dilatation in young rTOF with PI and represents a unique pathological entity responsible for reduced exercise performance.

Background: The benefits of adding aspirin to warfarin and warfarin treatment intensity for Japanese patients with mechanical valve replacement (MeVR) are unclear.

Methods and results: This multicenter non-randomized observational study recruited 158 Japanese patients who underwent MeVR in 11 university hospitals in Kyushu and Okinawa; 74 patients were allocated to the warfarin (W) group and 84 were allocated to the warfarin plus aspirin (W+A) group. Patients were followed for a mean (±SD) of 5.0±1.9 years. The primary and secondary endpoints were mainly atherosclerotic/thrombotic and bleeding events, respectively. There was no difference in the incidence of the primary endpoint between the W and W+A groups (14% vs. 22%, respectively; P=0.13). Univariate analysis revealed a higher incidence of the secondary endpoint in the W+A than W group (35% vs. 22%; P=0.032), but the difference was not significant in multivariate analysis. For the entire cohort, the postoperative mean international normalized ratio of prothrombin time (PT-INR) was relatively low (2.1±0.3). There were no differences in the incidence of events between PT-INR <2.0 and 2.0-3.0 (primary endpoint: 21% vs. 16%, respectively [P=0.41]; secondary endpoints: 33% vs. 26%, respectively [P=0.19]).

Conclusions: Adding aspirin to warfarin treatment was not superior to warfarin alone, and relatively weak warfarin treatment (PT-INR <2.0) was not necessarily associated with an increased number of events (vs. PT-INR 2.0-3.0) in Japanese patients who underwent MeVR.

Background: This study aimed to identify the most influential factors affecting severe respiratory failure requiring respiratory assist devices (RADs), including mechanical ventilation and non-invasive positive pressure ventilation, in patients with uncomplicated acute Stanford Type B aortic dissection (TBAD).

Methods and results: Ninety-seven patients were retrospectively analyzed and categorized into RAD (n=15) and non-RAD (n=82) groups. The mean (±SD) time to RAD initiation was 2.1±1.2 days, with a PaO₂to fraction of inspired oxygen (FiO₂) ratio of 116±53 at initiation. Compared with the non-RAD group, patients in the RAD group were younger (56.8±13.6 vs. 70.2±12.1 years; P<0.001), had higher body mass index (27.2±7.0 vs. 23.4±3.9 kg/m²; P=0.003), more frequently had a completely patent false lumen (47% vs. 11%; P<0.001), and showed significantly higher white blood cell (WBC) counts the day after admission (12,580±2,899 vs. 9,589±2,917/μL; P<0.001). Multivariable logistic regression identified a WBC count ≥11,100/μL on the day after admission as an independent predictor of RAD requirement (odds ratio 6.17; 95% confidence interval 1.71-25.74; P=0.007). Structural equation modeling further supported the central role of an elevated WBC count (regression coefficient=0.184; P<0.05).

Conclusions: An elevated WBC count appears to be the most influential factor associated with respiratory failure requiring RAD in patients with uncomplicated acute TBAD.