Circulation Journal最新文献

Background: Anthracycline-induced cardiotoxicity (AIC) poses significant challenges due to its severe adverse effects, limiting the use of anthracycline drugs (ATC). Early detection and intervention are pivotal, yet current diagnostic methods lack sensitivity.

Methods and results: In a prospective animal study, 20 rabbits were administered adriamycin weekly and underwent cardiac magnetic resonance (CMR) scanning every 2 weeks. Ventricular function and myocardial metabolite content were assessed. Using a linear mixed model, we determined the earliest CMR-sensitive time and diagnostic thresholds for AIC detection via proton magnetic resonance spectroscopy (¹H-MRS). Results showed that Lipid1 increased significantly earlier at week 6 compared to the decreased left ventricular ejection fraction (LVEF) at week 8 (P<0.05). ROC analysis revealed that a Lipid1 cutoff value of 2.60 had the best diagnostic accuracy for AIC at week 6, with an area under the curve of 0.745, specificity of 0.71, and sensitivity of 0.80 (95% CI: 0.575-0.916). Lipid1 also demonstrated a moderately negative correlation with LVEF (r=-0.418, P<0.01).

Conclusions: ¹H-MRS-detected Lipid1 increased at week 6 after anthracycline injection, offering earlier diagnosis of AIC compared to conventional LVEF biomarkers.

Background: The Japanese version of the high bleeding risk (J-HBR) criteria was proposed to identify Japanese patients at HBR after percutaneous coronary intervention. However, the diagnostic ability of the J-HBR in patients with lower extremity peripheral arterial disease (LEAD) remains unclear.

Methods and results: This multicenter registry included 818 LEAD patients undergoing endovascular treatment (EVT). Based on J-HBR major (1 point) and minor (0.5 points) criteria, patients were grouped into LEAD with (≥2.0 points) and without (1.0-1.5 points) additional J-HBR. LEAD itself is a major criterion. The primary endpoint was major bleeding events and major adverse cardiovascular and limb events (MACLE), a composite of cardiovascular death, myocardial infarction, ischemic stroke, acute limb ischemia, and major amputation. Of the 818 patients in the study, 683 (83.5%) had LEAD with additional J-HBR. During the median follow-up period of 729 days, the risk of major bleeding events did not differ significantly between the 2 groups, although the risk of MACLE was higher in the LEAD with than without additional J-HBR group (12.4% vs. 5.9%; P=0.03). The probability of major bleeding and MACLE increased progressively with an increase in the number of J-HBR major and minor criteria.

Conclusions: Among patients with LEAD undergoing EVT, the J-HBR criteria successfully stratified ischemic and bleeding risks. This risk-predicting model may be useful in patients with LEAD.

Background: Adequate endothelization after drug-eluting stent (DES) implantation is essential to reduce thrombotic risk. Adequate strut coverage (ASC) is defined as ≥40 μm on optical coherence tomography, but its functional significance remains uncertain. Coronary angioscopy can assess neointimal function by detecting thrombus and plaque color. This study evaluated functionally adequate endothelization and contributing factors after DES implantation.

Methods and results: Post hoc analyses of the COLLABORATION 1 and 2 studies were performed using serial optical coherence tomography and coronary angioscopy 1 and 12 months after DES implantation. Four DES types were examined: durable polymer everolimus-eluting stent (DP-EES); sirolimus-eluting stent (SES); polymer-free biolimus-coated stent (PF-BCS); and dual-therapy sirolimus-eluting stent (DTS). PF-BCS and DTS were classified as "ingenious" DES, and DP-EES and SES were classified as "fundamental." The correlation between the percentage of struts with ≥40 μm coverage (%ASC) and functional neointima (i.e., no thrombus and white plaque) was assessed. Among 150 patients (177 lesions), thrombus and yellow plaque were inversely correlated with %ASC at 12 months. Cut-off values of %ASC were 67% for thrombus prevention and 90% for plaque stabilization. Multivariable analysis identified the use of ingenious DES, prasugrel therapy, and hypertension as independent predictors of chronic adequate endothelization.

Conclusions: Functional protection against thrombus requires %ASC ≥67%, and plaque stabilization requires ≥90%. The use of ingenious DESs and prasugrel contributes to improved chronic adequate endothelization.

Background: Acute right heart failure (RHF) is life threatening in patients with pulmonary hypertension (PH). This study investigated the efficacy and safety of inhaled nitric oxide (iNO; INOflo^®for inhalation 800 ppm), a rapid pulmonary vasodilator, in patients with acute severe RHF due to PH.

Methods and results: In this Phase 2 randomized controlled trial, 30 patients with acute severe RHF due to PH (pulmonary arterial hypertension or chronic thromboembolic PH) were randomized 1 : 1 to either an iNO or control group (which did not receive iNO). The primary endpoint was the change in pulmonary vascular resistance (PVR) from baseline to 30 min after either iNO initiation or patient registration and assignment (control group), which differed significantly between the iNO and control groups (mean [±SD] -2.41±2.47 vs. 0.8±1.03 Wood units, respectively; between group difference -3.21 [95% confidence interval -4.633, -1.785] Wood units). Serum B-type natriuretic peptide (BNP) levels and inferior vena cava diameter (secondary endpoints) decreased significantly in the iNO group over the 7-day study period. No serious adverse events, including methemoglobinemia, were observed.

Conclusions: iNO significantly reduced PVR in patients with acute severe RHF due to PH, without serious adverse events. Serum BNP levels and inferior vena cava diameter improved in the iNO group. These findings suggest that iNO is a promising acute treatment option for RHF due to PH.

Over the past decade, there have been significant advances in pharmacotherapy for cardiovascular diseases and related health conditions. In particular, numerous large-scale clinical trials have been conducted internationally, and remarkable progress has been made in several disease-modifying medications for diabetes, chronic kidney disease, and heart failure. These research trends have driven dynamic changes in treatment guidelines and clinical practice. At the same time, this era has given rise to the concept of cardiovascular-kidney-metabolic (CKM) syndrome, which represents a transformative shift in understanding the complex pathophysiology and therapeutics of relevant health conditions. Positioning this framework as part of a unified disease continuum could promote early intervention, multidisciplinary care, and more effective prevention and treatment strategies. Although challenges remain in validating the CKM syndrome framework and implementing the care model in Japan, this concept may provide a unique clinical tool for addressing the globally increasing burden of cardiovascular, kidney, and metabolic health issues. This review discusses the current understanding of CKM syndrome and introduces the author's research contributions related to CKM network medicine.