Circulation Journal最新文献

Background: Ischemic heart disease remains the leading cause of death worldwide, and although early coronary revascularization is essential, it can paradoxically induce additional myocardial damage known as ischemia-reperfusion (I/R) injury, driven in part by excessive generation of reactive oxygen species (ROS). This study evaluated the cardioprotective potential of resorcimoline (RML), a newly developed free radical scavenger, in mitigating ROS-mediated myocardial injury in a preclinical setting.

Methods and results: ROS production was induced in primary cardiomyocytes through hypoxia, angiotensin II, or hydrogen peroxide treatment. The antioxidant effects of RML were assessed by cytosolic and mitochondrial ROS assays. Cell viability and cytotoxicity were evaluated by metabolic activity and lactate dehydrogenase release assays. In vivo, myocardial I/R injury was induced in rats by transient coronary artery ligation followed by reperfusion. RML significantly reduced intracellular and mitochondrial ROS levels and improved cardiomyocyte viability in vitro. Consistently, in vivo DHE staining demonstrated that RML suppressed myocardial ROS accumulation, decreased infarct size, lowered serum troponin I, reduced apoptosis, and preserved left ventricular function, whereas these protective effects were not observed without reperfusion.

Conclusions: RML exerts cardioprotective effects by scavenging ROS and mitigating downstream oxidative damage in both in vitro and in vivo models of myocardial I/R injury, suggesting promise as a therapeutic agent against reperfusion-induced myocardial injury.

Background: Whether the components of sarcopenia provide sex-specific prognostic information in heart failure (HF) remains uncertain.

Methods and results: We enrolled 604 patients with HF (259 women; median age, 73 years) undergoing dual-energy X-ray absorptiometry. During 2.18-year follow-up, 124 deaths occurred. All sarcopenia components as continuous variables were associated with death in the overall cohort. Asian Working Group for Sarcopenia (AWGS2019) cutoffs for weak handgrip strength, prolonged fivetimes sittostand time (FTSS), or low Short Physical Performance Battery (SPPB) score showed the strongest association, whereas low appendicular skeletal muscle mass index (ASMI) did not predict death. No significant sex interactions were observed for ASMI, gait speed, FTSS, or SPPB, and only handgrip strength showed a borderline interaction trend (P=0.058), with a stronger association for death in women. Despite a nonsignificant interaction (P=0.284), the AWGS2019 criteria predicted death in men (adjusted HR, 2.23; 95% confidence interval (CI), 1.21-4.09, P=0.013) but not in women (aHR, 1.28; 95% CI, 0.70-2.34, P=0.423). Exploratory analyses showed that optimized, HF-specific ASMI thresholds improved prognostic performance.

Conclusions: Performancebased sarcopenia components can provide valuable mortality risk stratification in HF irrespective of sex. Although sex interactions were limited, population-derived muscle mass thresholds showed reduced prognostic performance in women, indicating that refining disease-specific or sex-adapted thresholds may enhance risk stratification in HF.

Background: Because monocyte chemoattractant protein-1 (MCP-1) and high-sensitivity C-reactive protein (hs-CRP) are crucial biomarkers in the early stages of atherosclerosis, we examined the association of their serum levels with all-cause and cause-specific deaths in a healthy population.

Methods and results: Between 2004 and 2007, 568 participants (64% women, mean age 64.4 years) underwent health check-ups from which their serum MCP-1 and hs-CRP levels were categorized as high or low based on the median values of each biomarker. We analyzed all-cause deaths using Kaplan-Meier curves and used a multivariable Cox regression model to calculate hazard ratios for all-cause, cardiovascular disease (CVD), and cancer deaths both individually and in combination. During a median follow-up of 17.9 years, 140 deaths occurred: 43 from CVD and stroke, and 33 from cancer. The cumulative all-cause mortality rate was higher in participants with both high serum MCP-1 and hs-CRP levels than in those with lower levels. The adjusted hazard ratios for combined high serum MCP-1 and hs-CRP levels vs. low levels were 1.86 (95% confidence interval (CI): 1.09-3.17) for all-cause, 3.24 (95% CI: 1.07-9.82) for CVD and stroke, and 3.28 (95% CI: 1.06-10.18) for cancer deaths.

Conclusions: Combined serum MCP-1 and hs-CRP levels could predict all-cause and cause-specific mortality rates in the general population.

Background: Although Achilles tendon thickening (ATT) is associated with poor prognosis after percutaneous coronary intervention (PCI), its impact may differ between acute coronary syndrome (ACS) and chronic coronary syndrome (CCS).

Methods and results: We retrospectively analyzed 1,362 patients after PCI. ATT was present in 228 patients (16.7%) and associated with more 3-year major adverse cardiovascular events (MACE) (P<0.001). The association was pronounced in ACS patients (P=0.001), whereas in CCS patients, ATT showed a non-significant trend toward a higher incidence of MACE (P=0.066).

Conclusions: ATT may be a simple, non-invasive marker for risk stratification after PCI, particularly in ACS patients.

Background: To provide evidence from randomized controlled trials (RCTs) for large-vessel vasculitis (LVV), including Takayasu arteritis (TAK) and giant cell arteritis (GCA), to inform the forthcoming 2026 Japanese Circulation Society (JCS) clinical practice guideline.

Methods and results: We drafted 4 and 7 clinical questions for TAK and GCA, respectively. A systematic review (SR) of RCTs was conducted using PubMed, CENTRAL, EMBASE, and the Japan Medical Abstracts Society through March 2024. Assessed with the GRADE approach, the certainty of evidence was very low for the most critical outcomes, low for some outcomes, and moderate for only 1 outcome. Evidence for TAK was limited. Tocilizumab (TCZ) resulted in a numerically lower relapse rate vs. placebo (risk ratio (RR) 0.73, 95% confidence interval (CI) 0.39-1.37) and was similar to adalimumab. No clear difference between mycophenolate mofetil (MMF) and methotrexate (MTX), or between abatacept (ABA) and placebo was observed. In GCA, TCZ reduced relapse (RR 0.29, 95% CI 0.09-0.98) and increased remission (RR 3.56, 95% CI 2.29-5.54) over placebo at 52 weeks. Tumor necrosis factor inhibitor, ABA, and MTX showed no benefit in cranial GCA. Serious adverse events were comparable between treatment groups. Geographic variation and differences in entry criteria were noted.

Conclusions: This SR was comprehensive synthesis of evidence from RCTs for LVV therapies to support the 2026 JCS guideline.

Background: Because a disease-modifying therapy is now available, bone scintigraphy plays a crucial role in diagnosing transthyretin cardiac amyloidosis (ATTR-CM).

Methods and results: We retrospectively analyzed 24 patients with ATTR-CM to determine the amyloid accumulation volume (AAV: mean standardized uptake value×volume) of the left ventricular wall. AAV showed a significant decrease (591.1±426.0 vs. 213.8±201.9, P<0.0001) after tafamidis treatment, and correlated with troponin T (R=0.49, P=0.022).

Conclusions: AAV provided a precise quantitative evaluation of the amyloid burden in ATTR-CM.

Background: Although early right ventricular failure (eRVF) following durable left ventricular assist device (dLVAD) implantation is associated with a poor prognosis, reliable predictive parameters have not yet been established. In this study we evaluated the predictive value of right ventricular (RV) to pulmonary artery (PA) uncoupling, measured by the ratio of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP), in patients undergoing dLVAD implantation.

Methods and results: We conducted a single-center retrospective study of adult patients who underwent dLVAD implantation between January 2008 and December 2024. eRVF was defined as receiving short- or long-term right-sided circulatory support, or continuous inotropic support for more than 14 days within 30 days after dLVAD implantation. Preoperative echocardiographic variables, including the TAPSE/PASP ratio and right-sided heart catheter parameters, were analyzed using univariate and multivariate logistic regression models to identify eRVF predictors. We analyzed data for 111 patients who underwent dLVAD implantation and 46.8% developed eRVF postoperatively. The TAPSE/PASP ratio was an independent predictor of eRVF, even after adjustments for other echocardiographic variables (odds ratio [OR], 0.05; 95% confidence interval [CI], 0.004-0.67, P=0.024) and right-sided heart catheter variables (OR, 0.04; 95% CI, 0.002-0.69, P=0.027).

Conclusions: Preoperative RV-PA uncoupling, assessed using the TAPSE/PASP ratio, may predict eRVF following dLVAD implantation. This parameter is clinically accessible and valuable for preoperative risk stratification and may facilitate improved perioperative management.

Background: Chest symptoms, such as angina and palpitation, are common complaints in patients with cardiovascular diseases, but few studies have addressed how cardiac afferent information is processed through the brain.

Methods and results: We recruited 10 patients (mean age 74.7±1.9 years; 9 men) with cardiac pacemaker implantation. The patients underwent brain H₂¹⁵O positron emission tomography (PET) followed by blood sampling during right ventricular pacing of sham (1.5 V) and stimulation (7.5-8 V) conditions with a 10min interval. A voxel-wise analysis of the brain PET images identified the anterior cingulate cortex (ACC), posterior cingulate cortex, prefrontal cortex, thalamus, amygdala and midbrain as regions of increased regional cerebral blood flow (rCBF) under stimulation compared to sham conditions at a family-wise error-corrected cluster-extent threshold of P<0.05 with an underlying voxel level of P<0.001. The stimulation conditions increased rCBF in the ACC (59.8±4.4 vs. 49.2±3.5 mL/100 g/min, P<0.001) and plasma noradrenaline levels (332.3±139.0 vs. 312.0±139.8 pg/mL, P=0.004) compared to the sham stimulation. A linear mixed-effects model showed a significant positive correlation between the changes in rCBF in the ACC and those in plasma noradrenaline levels (P<0.001).

Conclusions: Cardiac electrical stimulation increased both rCBF in the ACC and plasma noradrenaline levels, and the changes were correlated. The ACC may be the brain center that transfers cardiac afferent information into autonomic arousal during cardiac pacing.