Circulation Journal最新文献

Background: Patients with infective endocarditis (IE) on maintenance hemodialysis (HD) have poor outcomes, but contemporary data remain limited.

Methods and results: We conducted a retrospective analysis using a nationwide Japanese administrative database and identified 12,158 patients hospitalized with IE between 2018 and 2021, including 806 (6.6%) on maintenance HD. The inhospital mortality rate was significantly higher in HD patients (30.0% vs. 13.5%, P<0.05).

Conclusions: Maintenance HD patients with IE had worse outcomes, underscoring the need for early recognition and tailored management in this highrisk group.

Background: Left ventricular (LV) dyssynchrony worsens with heart failure (HF) progression. However, the early identification of LV dyssynchrony is challenging, and its prognostic value remains unclear. We aimed to evaluate the prognostic value of LV dyssynchrony based on bandwidth (time width within which 95% of the LV myocardium begins to contract), assessed using Heart Risk View (HRV) analysis of myocardial perfusion scintigraphy data.

Methods and results: This was a post hoc analysis of a prospective, non-randomized, single-center cohort study conducted between January 2019 and December 2023. This study included 584 patients (mean age 72.2±13.0 years; 425 [72.8%] males; non-ischemic 29.8%; LV ejection fraction [LVEF] 46.4±15.0%) who were admitted for HF and had LV dyssynchrony evaluated using HRV-based analysis. The composite endpoint was all-cause mortality and HF rehospitalization. Univariate and multivariate logistic regression showed LV dyssynchrony as a significant predictor of HF prognosis (bandwidth threshold 28.0°). Multiple regression analysis identified QRS width, LVEF, and ischemic cardiomyopathy as significant determinants of bandwidth. Prognosis was poorer in high-bandwidth groups defined by the median (21.0°) or threshold bandwidth (28.0°). Combined with B-type natriuretic peptide, bandwidth improved prognostic utility. Bandwidth showed a moderate correlation with QRS width and strong correlations with end-systolic volume and LVEF.

Conclusions: HRV-derived bandwidth is a non-invasive and safe method providing automatic, objective, and reproducible measurements. It is useful for predicting HF prognosis.

Background: Sudden cardiac death (SCD) is the most devastating complication of hypertrophic cardiomyopathy (HCM). Validation of the Japanese Circulation Society (JCS)/Japanese Heart Failure Society (JHFS) guidelines for SCD prevention needs to be undertaken in a large cohort of Japanese patients with HCM.

Methods and results: In a subanalysis of the REVEAL-HCM registry comprising 3,611 patients, we enrolled 3,547 patients after excluding 64 patients with missing data required for calculating the HCM Risk-SCD score. The endpoint was a composite of SCD or an equivalent event. During a median 5.8-year follow-up period, SCD events occurred in 247 (7.0%) patients. The 5-year cumulative incidence of SCD events differed significantly between Class 2a and 2b recommendations (6.7% vs. 4.9%, respectively; P=0.006) and between Class 2b and 3 recommendations (4.9% vs. 1.7%, respectively; P<0.001). Excess risk of SCD was also significant for patients with Class 2a and 2b compared with Class 3 recommendations, with hazard ratios of 3.59 (95% confidence interval [CI] 2.40-5.37; P<0.001) and 2.09 (95% CI 1.47-2.97; P<0.001), respectively. The 2018 JCS/JHFS guidelines had an area under the curve of 0.75 (95% CI 0.71-0.80; P<0.001) for discriminating SCD events at 5 years.

Conclusions: The 2018 JCS/JHFS guidelines showed good discriminatory performance for SCD risk stratification, particularly among patients with Class 2a recommendations for an implantable cardioverter defibrillator.

Background: Passive leg lifting (PLL) may serve as a simple alternative to simulate exercise stress.

Methods and results: We evaluated 33 patients with PH who underwent PLL-RHC and exercise right heart catheterization (RHC); 25 patients were classified as having PLL-induced PH (LIPH), demonstrating significant increases in mean pulmonary arterial pressure (mPAP) and mPAP-cardiac output slopes. Strong correlations were observed between PLL-RHC and exercise RHC measurements.

Conclusions: PLL-RHC may represent a simple method for detecting EIPH.

Background: Cardiovascular autonomic neuropathy (CAN) is a major complication of type 2 diabetes mellitus (T2DM), but the roles of arterial stiffness and right atrial (RA) function in CAN remain unclear.

Methods and results: In 120 patients with T2DM, we assessed short-term heart rate variability (CVR-R), cardio-ankle vascular index (CAVI), and two-dimensional speckle-tracking echocardiography (2DSTE). CAN was defined as CVR-R <2%. Multivariable analysis showed that higher CAVI and lower RA function composite scores were independently associated with CAN.

Conclusions: Both increased arterial stiffness and impaired RA function characterized CAN, indicating a key cardiovascular interaction. Combined CAVI and RA strain assessment may aid early detection.

Background: In repaired tetralogy of Fallot (TOF) and related diseases, reoperation for pulmonary regurgitation (PR) may be delayed unless marked right ventricular (RV) enlargement is present.

Methods and results: 32 patients with significant PR post-repair underwent catheterization and 4D flow MRI for reoperation evaluation. The Non-severe RV Dilation group (n=20) did not meet the surgical volume criteria, whereas the Severe RV Dilation group (n=12) did. The Non-severe RV Dilation group had higher biventricular filling pressures. The RV-Energy loss index in both groups was high.

Conclusions: Diastolic dysfunction could serve as a therapeutic target in PR patients with heterogeneous etiologies.