Circulation Journal最新文献

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.

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: 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.

Background: Predicting the origin of premature ventricular contractions (PVCs) is challenging when a transition zone (TZ) appears in leads V3 and V4. The aim of this study was to develop a deep-learning model to predict PVC origins and identify electrocardiographic (ECG) features that contribute to the model's decisions.

Methods and results: ECG data from 314 patients with PVCs showing an inferior axis and TZ in leads V3 or V4 who underwent catheter ablation were analyzed. A convolutional neural network (CNN) was trained to predict an origin in the right or left ventricular outflow tract. Patients were divided into 3 cohorts for training, validation, and holdout (3 : 1 : 1 ratio). The CNN model was trained using paired data consisting of PVC and intrinsic QRS (iQRS). Five datasets per patient were used for training and validation; performance was evaluated using a single holdout dataset per patient. The CNN model achieved 92.1% accuracy, an F1 score of 0.91, and an area under the receiver operating characteristic curve of 0.96 on the holdout. Our model demonstrated superior diagnostic performance compared with conventional ECG indices. Gradient-weighted class activation mapping revealed that model attention was primarily focused on leads V3-V4 in iQRS, but was more diffusely distributed in PVC, notably the inferior limb leads and leads V2-V3.

Conclusions: The CNN-based prediction of PVC origin demonstrated clinical utility.

Background: Abdominal aortic aneurysm (AAA) is a vascular disease strongly associated with immune dysregulation and metabolic disturbances. Although lactate metabolism and its associated process, lactylation, have been implicated in various diseases, their specific role in AAA pathogenesis remains poorly understood.

Methods and results: In this study, we used a multi-faceted approach, integrating single-cell and bulk RNA data analyses, with the objective of elucidating the interrelationship between lactylation and immune response in AAA patients. The result revealed significant heterogeneity in lactylation levels across different immune cell types. Cells with higher lactylation activity exhibited markedly elevated immune response scores. Differential expression and correlation analyses identified 65 lactylation-associated genes, which were further evaluated in the bulk RNA sequencing data to assess their relationship with the immune microenvironment in patients with AAA. Using 113 combinations of machine-learning algorithms, we identified 8 lactylation-related hub genes. The immune infiltration analysis demonstrated that these genes were linked to a multitude of immune cells. The animal experiments corroborated that Tnfsf8, Hist1 h2ag, Cd79b, Cd69, and Bank1 were upregulated in the AAA group, while Rpl36a and Rps29 were downregulated in the AAA group.

Conclusions: This study highlighted a potentially critical link between lactylation and immune dysregulation in AAA, thereby advancing our comprehension of the function of lactylation in AAA.

Background: This study reports on a single center's experience over 10 years with the frozen elephant trunk (FET) technique and a Japanese prosthesis. FET outcomes were compared among groups according to aortic etiology, acute aortic dissection (AAD), chronic aortic dissection (CAD), and thoracic aortic aneurysm (TAA).

Methods and results: Between September 2014 and December 2023, 435 patients underwent total arch replacement using the FET technique for AAD, CAD, and TAA. The overall in-hospital mortality rate was 5.1% (13 patients with AAD, 3 with CAD, and 6 with TAA). Perioperative neurological deficits occurred in 5.8% of patients overall (13 patients with AAD, 2 with CAD, and 10 with TAA), and spinal cord injury occurred in 1.1% of patients overall (1 with AAD, 0 with CAD, and 4 with TAA). The respective overall 5- and 7-year survival rates were 88.8% and 83.8% for AAD, 69.2% and 67.4% for TAA, and 83.6% and 83.6% for CAD. The respective 5- and 7-year rates of freedom from distal thoracic aortic reintervention were 78.8% and 71.7% among AAD patients, and 93.7% and 93.7% among TAA patients, and 73.2% at 5 years among CAD patients.

Conclusions: The FET technique using a Japanese prosthesis for thoracic aortic disease has acceptable perioperative and long-term outcomes. Close follow-up is required after FET implantation, especially after repair of AAD and CAD.

Background: Predicting the bleeding risk during anticoagulation therapy is a key clinical challenge in patients with venous thromboembolism (VTE). However, there is no established prediction score for major bleeding (MB) in patients with VTE treated with direct oral anticoagulants (DOACs).

Methods and results: Using the COMMAND VTE Registry-2, which enrolled 5,197 patients with acute symptomatic VTE between 2015 and 2020 among 31 centers in Japan, we investigated the risk factors for MB beyond 7 days and within 180 days in patients who received DOACs. A prediction score was developed in the derivation cohort (n=1,618), and prediction performance was evaluated in the validation cohort (n=809). Multivariate logistic regression analysis in the derivation cohort identified factors associated with MB. Based on β coefficients for each factor, the prediction score assigned 2 points to active cancer, history of MB, and thrombocytopenia, and 1 point to creatinine >1.2 mg/dL and anemia, summing them. The C statistic of the prediction score was 0.74 (95% confidence interval [CI] 0.68-0.80) in the derivation cohort and 0.74 (95% CI 0.67-0.81) in the validation cohort (P=0.98). When a cut-off value of 3 was used for the risk score, the sensitivity and specificity were 56.1% and 79.2%, respectively.

Conclusions: The prediction score developed for MB during DOAC therapy (COMMAND-BLEED score) could be clinically useful for decision-making regarding anticoagulation strategies with DOACs.