Circulation reports最新文献

Background: Type A acute aortic dissection (TAAAD) requires integrated care and often interfacility transfer. However, the association between transfer and outcome remains unclear.

Methods and results: We analyzed 328 patients with TAAAD who were admitted within 48 h of onset and were enrolled in the Tokyo Acute Aortic Super-Network Database between November 2010 and October 2011. Patients with intramural hematoma, cardiopulmonary arrest before arrival, or those who refused surgery were excluded. Directly admitted patients who underwent fewer operations were more often treated at lower-volume institutes and experienced higher rates of respiratory failure and renal ischemia, with a shorter time from symptom onset to admission, than transferred patients. The 30-day mortality rate was higher in directly admitted patients (n=182) than in transferred patients (n=146; 25.8% vs. 14.4%; P=0.016). Logistic regression analysis identified age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01-1.09; P=0.025), pre-arrival complications (OR 3.09; 95% CI 1.40-6.86; P=0.005), and surgery (OR 0.084; 95% CI 0.031-0.23; P<0.001) as independent predictors of 30-day mortality, while transfer status was not predictive (OR 0.836; 95% CI 0.345-2.02; P=0.69).

Conclusions: Interfacility patient transfer did not appear to affect early mortality in patients with TAAAD; however, large scale studies are warranted to confirm this finding.

Background: The HELT-E₂S₂ score is a new risk assessment tool for ischemic stroke in Japanese patients with atrial fibrillation (AF), so we investigated its association with clinical outcomes after catheter ablation (CA) for AF.

Methods and results: We analyzed 769 patients enrolled in the Shinshu Catheter Ablation (Shinshu-AB) Registry who underwent first-time CA for AF (median age, 70 years; 31.2% female; 40.8% persistent AF). AF recurrence after CA beyond the 3-month blanking period during the 1-year follow-up was evaluated in relation to the HELT-E₂S₂ score. Patients were categorized into 4 groups based on HELT-E₂S₂ score: 0 (group 1, n=155), 1 (group 2, n=287), 2 (group 3, n=216), and ≥3 (group 4, n=111). Overall, AF recurred in 170 patients (22.1%). Kaplan-Meier analysis showed that higher HELT-E₂S₂ scores were associated with increased risk of AF recurrence (log-rank P=0.003). After multivariable adjustment, the risk tended to increase across groups and was significant for group 4 compared with group 1 (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.03-4.00; P=0.041). When analyzed as a continuous variable, the HELT-E₂S₂ score was associated with AF recurrence after multivariable adjustment (HR, 1.26; 95% CI, 1.06-1.49; P=0.007).

Conclusions: Higher HELT-E₂S₂ scores were associated with an increased risk of AF recurrence after CA.

Background: Acute myocardial infarction (AMI) is a fatal cardiovascular disease with varying prognosis. Recent studies suggest a close relationship between cardiovascular disease and metabolic dysfunction-associated fatty liver disease (MAFLD), but because the prognostic value of MAFLD in patients with AMI remains unclear, we investigated the relationship between MAFLD and clinical outcomes in patients with AMI.

Methods and results: This retrospective study included 1,142 patients with AMI who underwent percutaneous coronary intervention (PCI) to the culprit lesion of AMI and were classified as MAFLD (n=231) and non-MAFLD (n=911). Hepatic steatosis was diagnosed by a liver-to-spleen attenuation (L/S) ratio <1 on computed tomography. The primary outcome was major adverse cardiovascular events (MACE), which were defined as a composite of all-cause death, non-fatal MI, and readmission for heart failure. Over a median follow-up of 609 days, MACE was less frequently observed in the MAFLD group than in the non-MAFLD group (P=0.015). However, the multivariate Cox hazard analysis showed that MAFLD was not associated with MACE (hazard ratio 0.80, 95% confidence interval 0.564-1.140, P=0.219) after controlling for confounding factors.

Conclusions: We could not show a significant association between MAFLD and MACE in patients with AMI, suggesting the absence of strong association between MAFLD and long-term clinical outcomes in these patients.

Background: The impact of the coronavirus disease 2019 (COVID-19) pandemic on the volume of endovascular therapy (EVT) procedures for symptomatic PAD in Japan has not been systematically studied.

Methods and results: We analyzed data from the nationwide EVT procedural registry in Japan (2012-2023). The volume for chronic limb-threatening ischemia (CLTI) remained stable during and after the pandemic, but the volume for intermittent claudication was lower than forecasted after 2020, and the decrease in volume lasted even after the COVID-19 pandemic.

Conclusions: The impact of the COVID-19 pandemic on EVT volumes differs based on limb severity.

Background: Coronary artery brightness (CAB) on echocardiography has been observed during the acute phase of Kawasaki disease (KD), but its clinical relevance remains unclear. This study aimed to quantify CAB and evaluate its clinical significance using unsupervised machine learning (ML).

Methods and results: Echocardiographic still images from 89 patients with acute-phase KD were analyzed. Pixel values of the coronary arteries (CAs) were extracted and standardized as Z-scores using brightness around the right coronary cusp as a reference. Mean and median pixel intensity (Z-scores) within the coronary artery region were calculated for each major CA branch. Based on these parameters, K-means clustering stratified patients into 2 clusters. Cluster 1 had significantly greater CA diameters and Z-scores in all 3 major coronary branches, with a higher proportion of patients with a maximum CA Z-score ≥2.5. In addition, levels of total bilirubin and pentraxin 3, both known predictors of intravenous immune globulin (IVIG) resistance, were significantly higher in Cluster 1.

Conclusions: Quantitative CAB analysis combined with unsupervised ML effectively stratified KD patients into subgroups with distinct coronary and biomarker profiles. This method may serve as a novel non-invasive tool to evaluate disease severity and predict IVIG resistance in acute-phase KD.

Background: Zinc deficiency is frequent in heart failure (HF) and may worsen prognosis.

Methods and results: We retrospectively analyzed 157 HF patients hospitalized between 2016 and 2019. Zn deficiency was defined as ≤60 µg/dL. Correlations between Zn and clinical indices were examined, and 1-year outcomes were evaluated. Zn deficiency correlated with anemia, malnutrition, and reduced muscle indices but not with dietary intake. Zn-deficient patients had higher rates of mortality/readmission (43% vs. 25%, P=0.027), especially in HF with preserved ejection fraction (HFpEF: 62% vs. 26%, P=0.01).

Conclusions: Zn deficiency predicted poor prognosis in HF, particularly HFpEF, and may serve as a simple biomarker for risk stratification.

Background: Complex aortic atheroma (CAA) is a high-risk source of ischemic stroke, yet predictors of recurrent vascular events in CAA-related stroke remain poorly defined. We evaluated the prognostic value of high-sensitivity C-reactive protein (hsCRP).

Methods and results: This single-center, prospective, observational registry enrolled consecutive patients with stroke within 1 week of onset. Transesophageal echocardiography (TEE) was not protocol-mandated but used at physician discretion, mainly for embolic-source evaluation. CAA was defined as any plaque ≥4 mm in thickness or a plaque with ulceration or mobile components on TEE. Patients were dichotomized by hsCRP at 3.0 mg/L. The primary outcome was 1-year major adverse cardiovascular events (MACE), including stroke, acute coronary syndrome, and vascular death. Among 1,214 patients, TEE was performed in 335; CAA was identified in 83 (24.8%). Seventy-six with hsCRP data were analyzed, with 1-year follow up obtained in 73 (96.1%). Over 1 year, 17 patients had at least 1 vascular event, yielding an event rate of 23.2%. The incidence of MACE was significantly higher in patients with hsCRP ≥3.0 mg/L than in those with hsCRP <3.0 mg/L (42.2% vs. 15.3%; log-rank P=0.010). In multivariable Cox analysis, hsCRP ≥3.0 mg/L independently predicted MACE (hazard ratio 4.68; 95% confidence interval 1.43-15.32).

Conclusions: Elevated hsCRP is independently associated with an increased risk of MACE in CAA-related stroke. hsCRP may aid risk stratification and underscores the role of systemic inflammation in this high-risk subgroup.

Background: The clinical implication of left atrial pressure (LAP) elevation during atrial fibrillation (AF) ablation remains uncertain.

Methods and results: We retrospectively analyzed 189 patients undergoing their first AF thermal ablation. LAP was measured via the transseptal sheath at insertion (initial) and withdrawal (final), showing a median intraprocedural elevation of 4 mmHg (interquartile range 1-6). Patients were dichotomized by the median intraprocedural change (high LAP increase: ≥4 mmHg, n=95; low LAP increase: <4 mmHg, n=94). The primary endpoint was heart failure (HF) hospitalization within 1 year, and the secondary endpoint included identifying predictors with a high LAP increase. Procedural characteristics were similar. Although initial LAP values were comparable between groups, patients with a high LAP increase exhibited higher right atrial pressure (RAP) and RAP/LAP ratio (0.9±0.3 vs. 0.7±0.2; P<0.001). The cumulative incidence of HF hospitalization was significantly higher in the high LAP increase group (8.5% [95% confidence interval (CI) 2.7-13.9] vs. 1.1% [95% CI 0-3.2]; P=0.020). On multivariate analysis, female sex, persistent AF, higher body mass index, higher initial RAP/LAP ratio, and structural heart disease were independent predictors of a high LAP increase.

Conclusions: Intraprocedural LAP elevation was associated with a higher risk of HF hospitalization within 1 year after the procedure. Monitoring LAP at both the start and end of ablation provides a feasible approach for post-procedural risk stratification.

Progress in intensive care for cardiovascular disease, including catheter-based therapies and mechanical circulatory support, has improved patient survival. Conversely, the numbers of patients with severe disease and older patients with multimorbidities have increased, resulting in complications during management in the intensive care unit (ICU). In addition to ICU-acquired weakness and delirium, postintensive care syndrome (PICS) has recently been recognized, defined as a prolonged impairment in physical, cognitive, and mental status. Physiotherapy is an important treatment option to prevent and ameliorate PICS. Recently, the goals of early-phase physiotherapy have shifted beyond short-term outcomes, such as reducing the length of ICU and hospital stays and recovery of physical function, to include long-term outcomes, such as return to social activity and reduced rehospitalization. Thus, appropriate physiotherapy management and intervention during the ICU are potentially crucial, because high-quality phase I cardiovascular rehabilitation leads to a seamless approach to the next phase of rehabilitation. This review summarizes current clinical issues, the implementation of assessment and treatment strategies in acute-phase physiotherapy, and future perspectives and challenges in cardiovascular intensive care.

Background: Functional tricuspid regurgitation (TR) develops in atrial fibrillation (AF), but its natural history after transcatheter aortic valve replacement (TAVR) remains unclear.

Methods and results: Of 981 patients from a single-center registry, AF/atrial flutter (AFL) was present in 169. Over 5 years, severe TR developed in 11.7% with AF/AFL vs. 0.8% without. AF/AFL independently predicted TR progression (sub-distribution hazard ratio 1.82, 95% confidence interval: 1.34-2.47).

Conclusions: AF/AFL significantly increases TR progression risk post-TAVR, highlighting the importance of surveillance and preventive strategies.