Circulation Journal最新文献

Background: HeartMate 3 (HM3), a magnetically levitated centrifugal-flow pump, has demonstrated superior hemocompatibility and reduced adverse events compared to HeartMate II (HMII), an axial-flow pump, in global studies. However, because long-term comparative data in Japanese patients remain scarce, in the present study we evaluated the 5-year outcomes of HM3 support by comparing them with those of HMII at 2 leading left ventricular assist device (LVAD) centers in Japan.

Methods and results: We retrospectively analyzed 364 patients who underwent primary LVAD implantation (HM3: n=168; HMII: n=196) between 2010 and 2023. The primary endpoint included survival to transplant, recovery, or continued LVAD support free from stroke or pump replacement. At 5 years, freedom from the composite endpoint was higher in the HM3 group (75% vs. 52%; hazard ratio [HR] 0.52; P=0.001), although overall survival was comparable (90% vs. 85%; P=0.44). The HM3 group experienced significantly fewer strokes (HR 0.40; P=0.0008), bleeding events (HR 0.22; P<0.0001), and pump thrombosis (HR 0.09; P=0.003). Rates of rehospitalization, driveline infections, and late right heart failure did not differ between the groups.

Conclusions: HM3 support significantly improved long-term event-free outcomes compared to HMII, despite comparable overall survival, supporting the use of HM3 as durable mechanical circulatory support devices in Japan.

Background: Timely initiation of temporary mechanical circulatory support (tMCS), with appropriate escalation and de-escalation strategies, is critical in managing cardiogenic shock (CS). However, how tMCS utilization and outcomes differ by CS etiology remains unclear.

Methods and results: Using data from the Japan Registry for Percutaneous Ventricular Assist Device (J-PVAD), we evaluated the differences in tMCS use and outcomes among 3,678 Impella-supported patients with acute myocardial infarction-related CS (AMI-CS, n=2,418 (65.7%)), de novo heart failure-related CS (de novo HF-CS, n=758 (20.6%)), and acute-on-chronic HF-related CS (acute-on-chronic HF-CS, n=502 (13.7%)). The median shock-to-support time was significantly shorter in AMI-CS (123 min) than in de novo HF-CS (186 min) and acute-on-chronic HF-CS (205 min; P<0.001 for each). De novo HF-CS patients were more likely to receive multiple tMCS (64.2%) devices compared with AMI-CS (51.4%; P<0.001) and acute-on-chronic HF-CS (55.2%; P=0.001). Compared with de novo HF-CS, the adjusted odds ratio (OR) for in-hospital death was higher in AMI-CS (OR 1.34, 95% confidence interval (CI) 1.08-1.66; P=0.008) and acute-on-chronic HF-CS (OR 1.67, 95% CI 1.25-2.22; P<0.001).

Conclusions: tMCS timing and utilization differed by CS type. De novo HF-CS was associated with the lowest in-hospital mortality rate.

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: Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death in patients with heart failure, but the value of ICD therapy after left ventricular ejection fraction (LVEF) recovery is uncertain.

Methods and results: We retrospectively studied 118 patients undergoing primary prevention ICD therapy (2013-2022). Of them, 40 (34%) improved to LVEF >35% (impEF). Over 4.4 years, appropriate ICD therapy occurred significantly less in the impEF group vs. the persistently low LVEF group (P=0.008), but 4 impEF patients still required antitachycardia pacing therapy. No patient with LVEF ≥40% received such therapy.

Conclusions: LVEF recovery reduces but does not eliminate ventricular arrhythmia risk, supporting individualized ICD management.

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: 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: Although percutaneous coronary intervention (PCI) has become safer due to advances in devices and procedural standardization, in-hospital outcomes may still vary depending on the involvement of certified interventional cardiologists (ICs). This study evaluated the association between board-certified IC involvement and in-hospital outcomes following PCI using a nationwide Japanese registry.

Methods and results: We analyzed PCI cases between 2020 and 2023, classifying them according to the involvement (defined as acting as a primary operator or supervising assistant) of board-certified members of the Japanese Association of Cardiovascular Intervention and Therapeutics (BMCVIT). Among 842,335 PCI cases analyzed, 579,459 (68.8%) were performed with BMCVIT involvement. The frequency of BMCVIT involvement was higher for the treatment of patients with prior revascularization and complex lesions, but lower for patients admitted with acute coronary syndrome (ACS) or hemodynamic instability. After adjusting for baseline characteristics, BMCVIT involvement remained independently associated with lower in-hospital mortality (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.86-0.92; P<0.001), composite in-hospital complications (OR 0.94; 95% CI 0.91-0.97, P<0.001), and access site bleeding (OR 0.88; 95% CI 0.80-0.97, P=0.012). Subgroup analyses revealed consistent mortality benefits across age, sex, dialysis status, lesion complexity, and institutional PCI volume, with stronger protection in patients without ACS or cardiogenic shock.

Conclusions: BMCVIT involvement in PCI was independently associated with lower in-hospital mortality and complications, underscoring the quality gains of IC participation.