Circulation Journal最新文献

Background: The usefulness of non-sustained ventricular tachycardia (NSVT) in predicting sudden cardiac death is not clear. The Heart Failure Indication and Sudden Cardiac Death Prevention Trial Japan (HINODE) investigated the effectiveness of implantable cardioverter defibrillator (ICD) treatment for primary prevention in Japanese patients. This subanalysis examined associations between NSVT and clinical outcomes.

Methods and results: Patients with ICD/cardiac resynchronization therapy defibrillator (CRT-D) for primary prevention (n=164) were divided into NSVT (n=25) and no NSVT (n=139) groups. NSVT was defined as ventricular tachycardia of <30 s duration regardless of pulse rate. The median follow-up period was 19 months, mean patient age was 67 years, and 21% of patients were female. There were no significant differences between the 2 groups in the frequency ischemic cardiomyopathy, mean left ventricular ejection fraction, or (in Kaplan-Meier analysis) in all-cause mortality (log-rank P=0.613), ventricular arrhythmia (VA; log-rank P=0.282), or the composite endpoint of all-cause death and VA events (log-rank P=0.352). Cox proportional hazards analysis indicated that NSVT was not a prognostic factor.

Conclusions: Prognosis was similar between the NSVT and no NSVT groups. NSVT, although recommended in guidelines for risk stratification, was not associated with appropriate ICD therapy in patients with ICD/CRT-D for primary prevention. The utility of NSVT in guiding ICD indication may depend on its definition and the characteristics of the studied population, and requires further investigation.

Background: Metabolic derangements are associated with incident and recurrent atrial fibrillation (AF), in addition to the development of metabolic dysfunction-associated fatty liver disease (MAFLD). A recent study reported MAFLD was associated with significantly increased arrhythmia recurrence rates following AF ablation in Western patients. However, in Asian patients with a higher prevalence of non-obese MAFLD, it is not clear whether MAFLD affects recurrence after AF ablation regardless of obesity. This study investigated the impact of MAFLD on AF recurrence in Japanese patients.

Methods and results: We enrolled 872 patients who underwent AF ablation and assessed the relationship between MAFLD and AF recurrence. The prevalence of MAFLD was significantly higher in the group with than without AF recurrence. Although the liver/spleen ratio was significantly lower among patients with than without AF recurrence, the liver fibrosis score did not differ significantly between the 2 groups. Multivariate Cox proportional hazards regression analysis identified MAFLD, but not body mass index, as a factor independently associated with AF recurrence (adjusted hazard ratio 2.62; 95% confidence interval 1.44-4.80; P=0.002). We found a significant interaction between MAFLD and homeostasis model assessment of insulin resistance (HOMA-IR; P for interaction=0.034).

Conclusions: MAFLD is an independent risk factor for recurrence after AF ablation in Japanese patients regardless of obesity, and its effects are likely heterogeneous, with a greater impact in the presence of insulin resistance.

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized, non-atherosclerotic cause of acute coronary syndrome (ACS), predominantly affecting younger women without traditional cardiovascular risk factors. SCAD results from an intramural hematoma or intimal tear that compresses the coronary lumen, leading to myocardial ischemia. Diagnosis is critical, as management differs fundamentally from atherosclerotic ACS. Conservative therapy is preferred for hemodynamically stable patients due to high rates of spontaneous vessel healing; revascularization is reserved for ongoing ischemia, hemodynamic instability or left main/multivessel involvement. Long-term management focuses on reducing recurrence risk through β-blocker therapy, strict blood pressure control, and individualized cardiac rehabilitation. Although outcomes are generally favorable, recurrence occurs in up to 20% of patients. Ongoing research is needed to refine antiplatelet strategies, identify genetic and vascular risk factors, and optimize preventive care.

Background: Cardiac computed tomography (CCT) not only evaluates coronary artery disease but also characterizes myocardial features through late iodine enhancement (LIE). This study evaluated the clinical characteristics and prognostic significance of incidentally detected non-ischemic LIE patterns in patients undergoing CCT for coronary artery evaluation.

Methods and results: We retrospectively analyzed 465 patients who underwent CCT between January 2020 and December 2021. The primary outcome was all-cause death, and the secondary outcome was cardiovascular events, defined as cardiac death and unplanned cardiovascular hospitalization. Cox hazard analysis was performed to identify parameters significantly associated with the outcomes. After excluding patients with non-ischemic cardiomyopathy diagnosed before and after undergoing CCT, coronary stenosis and previous revascularization, 57 patients had non-ischemic LIE and 408 showed no LIE. Compared with patients without LIE, non-ischemic LIE was significantly associated with increased high-sensitivity cardiac troponin T and B-type natriuretic peptide levels, left ventricular (LV) diastolic diameter, LV thickness, and impaired LV ejection fraction. The cumulative incidence of cardiovascular events was significantly higher in patients with non-ischemic LIE than in those without LIE (log-rank P=0.024). In the Cox multivariable analysis, non-ischemic LIE was associated with cardiovascular events (hazard ratio 7.01; 95% confidence interval 1.09-42.2; P=0.041).

Conclusions: CCT may provide prognostic significance through the assessment of myocardial properties.

Background: The effect of residual pulmonary hypertension (PH) on clinical outcomes in patients with secondary mitral regurgitation (MR) after transcatheter edge-to-edge repair (TEER) remains unexplored.

Methods and results: We analyzed 62 patients with secondary MR who underwent TEER. In 32 (51.6%) patients with residual PH after TEER, adverse clinical events were observed more frequently compared with those without residual PH. Multivariate analysis confirmed residual PH as an independent predictor of all-cause death or hospitalization for heart failure.

Conclusions: In patients with secondary MR, residual PH after TEER is an independent predictor of adverse clinical outcomes.