Circulation reports最新文献

Background: Because snowfall may affect the acute outcomes of severe cardiovascular diseases by prolonging emergency medical service (EMS) response times, we investigated the association between snowfall and EMS response times for out-of-hospital cardiac arrests (OHCAs) in the regions of Japan.

Methods and results: We used the Utstein database, a nationwide population-based registry that collects data on all OHCA patients in Japan, during winter from 2009 to 2019. A prefecture-specific logistic regression model was applied to estimate odds ratios (ORs) of prolongation of EMS response time (≥7 min), which was associated with poorer neurological outcomes, on days with moderate/heavy snowfall compared to no-snowfall days. A random-effects meta-analysis model was applied to obtain pooled ORs in both overall and subgroup analyses ("heavy snowfall prefectures" and "non-heavy snowfall prefectures"). Among 94,428 bystander-witnessed cardiogenic OHCA patients, the ORs of prolonged EMS response time were 1.05 (95% confidence interval (CI): 0.96, 1.14) on moderate snowfall days and 1.22 (95% CI: 1.07, 1.40) on heavy snowfall days, compared to no-snowfall days. Subgroup analysis revealed no statistical difference between heavy snowfall prefectures and non-heavy snowfall prefectures, although ORs were higher for heavy snowfall prefectures.

Conclusions: Snowfall prolongs EMS response time to cardiogenic OHCA in both areas with heavy snowfall and those with less snowfall, which may also impact survival and neurological outcomes.

Background: The Japanese Resuscitation Council's 2020 Guidelines recommend transmitting a prehospital 12-lead electrocardiogram (PH-ECG) for adult patients suspected of having ST-elevation myocardial infarction (STEMI). Nationwide, the primary methods of ECG transmission are either prefecture-specific emergency transport systems or cloud-based services. However, prefectural systems often lack convenience, while cloud-based services are associated with substantial implementation costs.

Methods and results: A smartphone application (JOIN^®), which enables ambulance information-sharing with receiving hospital physicians, has been widely adopted across Japan. Leveraging its photo function to transmit ECGs, we initiated prehospital ECG transmission from ambulances without incurring additional costs. Over the past year, the system has been utilized in approximately 20 cases at our hospital. Analysis of transport times by shift period (weekday daytime vs. non-shift hours [weekday nighttime and weekends/holidays]) revealed no significant difference during daytime shifts. However, during non-shift hours, the ECG transmission group demonstrated a tendency for shorter door-to-catheterization laboratory time (25±5.0 vs. 51±18 min).

Conclusions: Obtaining a 12-lead ECG prior to hospital arrival reduces waiting times for catheter-based treatment. When ambulances and receiving hospitals are connected via a smartphone application, the photo function can facilitate prehospital ECG transmission without additional implementation costs. This approach may represent a novel strategy to improve outcomes for STEMI patients.

Background: This nationwide survey investigated new heart failure drug prescriptions by Japanese pediatric cardiologists.

Methods and results: Among 97 responding institutions, 357 patients received sodium-glucose cotransporter-2 inhibitors (SGLT-2i; n=189), angiotensin receptor-neprilysin inhibitors (ARNI; n=89), selective hyperpolarization-activated cyclic nucleotide-gated channel (HCN) blockers (n=76), or soluble guanylate cyclase (sGC) stimulators (n=3). SGLT-2i were predominantly prescribed in post-Fontan patients (45%), with one-third being children under 18 years. ARNI were commonly used for biventricular congenital heart disease (CHD) and cardiomyopathy (47% and 29%), with 40% under 18 years.

Conclusions: Pediatric-specific clinical trials and appropriate usage guidelines are urgently needed.

Background: Acute coronary syndrome (ACS) is the critical situation caused by decreased blood flow of the coronary arteries. The most recent clinical guideline compiled by the Japanese Circulation Society (JCS) recommends lowering low-density lipoprotein cholesterol (LDL-C) to <70 mg/dL in patients with ACS, because of the lack of clinical evidence. It has been shown that there are substantial numbers of patients with familial hypercholesterolemia (FH) among ACS patients. On this basis, we intend assembling a multicenter registry to establish the evidence for lowering LDL-C <55 mg/dL while also clarifying the proportion of FH patients among Japanese ACS patients using a prespecified clinical pathway.

Methods and results: The Hokuriku-plus ACS registry is a prospective, observational, multicenter cohort study, enrolling consecutive ACS patients from 14 participating hospitals in Hokuriku region of Japan from October 2025 to September 2027. A total of 1,000 patients will be enrolled followed over 1 year. The primary endpoint is the proportion of patients who attain LDL-C <55 mg/dL at 4 weeks. This study has been registered at the Japan Registry of Clinical Trials (jRCT1040250123).

Conclusions: We will disseminate the final results at international conferences and in a peer-reviewed journal.

Background: Clinical trial results suggest inclisiran lowers low-density lipoprotein-cholesterol (LDL-C), but long-term real-world data in Japanese coronary artery disease (CAD) patients are limited.

Methods and results: We retrospectively studied 40 CAD patients treated with inclisiran and followed for 12 months, assessing LDL-C levels at baseline and every 3 months; endpoints were within-patient LDL-C change, MACE (exploratory), and safety. Mean LDL-C fell by 59%, 56%, and 57% at 3, 6, and 12 months, respectively (all P<0.05). Adverse reactions comprised 1 case of MACE and 1 of injection-site reaction over the 12 months.

Conclusions: In this single-center cohort, inclisiran was associated with sustained LDL-C reductions and acceptable tolerability over 1 year.

Background: Microvascular spasm (MVS), a phenotype of microvascular dysfunction in patients with angina with non-obstructive coronary arteries (ANOCA), involves transient microvascular constriction. The angiography-derived index of microcirculatory resistance (A-IMR) is a less invasive method for assessing microcirculatory resistance. We aimed to evaluate MVS characteristics using A-IMR.

Methods and results: We retrospectively studied ANOCA patients who underwent acetylcholine spasm provocation tests (SPT). Patients were classified into no-spasm, epicardial spasm (ECS), or MVS groups. A-IMR was measured before and after SPT. Of 109 patients, 21 (19.3%) had MVS. The MVS group had more women (76.2% vs. 42.0%; P=0.01) than the other 2 groups combined. While pre-SPT A-IMR values were similar, post-SPT A-IMR after nitroglycerin was significantly higher in the MVS group than the no-spasm group, especially in the left anterior descending (LAD) artery (44.60 vs. 33.54; P=0.007). ∆A-IMR (post- minus pre-SPT) was significantly greater in the MVS group for both the LAD (9.89 vs. -9.26; P=0.001) and right coronary artery (RCA; 3.22 vs. -6.83; P=0.001). Multivariable analysis showed ∆A-IMR in the LAD and RCA were independently associated with MVS.

Conclusions: Serial A-IMR assessment during SPT reveals sustained nitrate-resistant microvascular constriction in patients with MVS, which may confound standard post-SPT physiological assessments such as coronary flow reserve or IMR. These findings underscore the need for careful interpretation of physiological data in the presence of MVS.

Background: The effectiveness of multiple arterial grafting (MAG) for hemodialysis (HD) patients is unclear.

Methods and results: We retrospectively analyzed 149 HD patients who underwent either MAG (n=97) or single arterial grafting (SAG) (n=52). After adjusting for preoperative characteristics using inverse probability of treatment weighting, the adjusted estimated 5-year rates of freedom from all-cause death and cardiac death in the MAG vs. SAG groups were 54.8% vs. 60.4% (P=0.779) and 83.5% vs. 87.4% (P=0.869), respectively.

Conclusions: MAG did not improve the midterm outcomes for HD patients compared to SAG.

Background: There are limited numbers of studies of the relationship between maximum tongue pressure (MTP) and respiratory muscle strength in older patients with acute heart failure (AHF).

Methods and results: Patients aged ≥65 years hospitalized with AHF were analyzed. MTP, maximal inspiratory mouth pressure (PI_max), and maximal expiratory mouth pressure (PE_max), which serve as indicators of swallowing, inspiratory, and expiratory muscle strength, respectively, were measured. The prevalence of sarcopenic dysphagia and respiratory sarcopenia was also assessed. The effect of respiratory muscle strength on MTP was evaluated using linear regression models, with MTP at the commencement of rehabilitation (baseline) or hospital discharge as the dependent variable and respiratory muscle strength measured at the baseline as the independent variable across four models. A total of 168 patients (median age: 85 years) were included in the final analysis. Sarcopenic dysphagia was observed in 16.7% of patients at baseline and 11.3% at hospital discharge (P=0.067). The prevalence of respiratory sarcopenia significantly increased from 59.7% at baseline to 70.7% at hospital discharge (P=0.018). MTP at hospital discharge was significantly associated with PI_max at baseline (β=0.335); MTP at baseline was significantly associated with PI_max at baseline (β=0.309).

Conclusions: PI_max was independently associated with MTP in older patients with AHF and may indicate a need for more intensive physical therapy interventions.

Background: The rising global older population increases the incidence of atrial fibrillation (AF), a major cause of stroke and heart failure, necessitating access to effective treatment. Catheter ablation (CA) has evolved into a primary treatment option, driven by significant advancements in device innovation, but is not available in all facilities.

Methods and results: According to public data from Japan (the Vital Statistics survey of Japanese events in 2022, the Japanese government Survey of Household Economy, the Survey on the Impact of the Diagnosis Procedure Combination System, and publicly available data from the Japan Heart Rhythm Society), a severe regional disparity exists in access to CA due to the uneven distribution of arrhythmia specialists. Ablation procedures per 10,000 population across the 47 prefectures averaged 6.67 (95% CI: 6.19-7.12), with a range of 3.02-9.24. This access gap is the "paradox of technological innovation", associated with inequitable treatment outcomes, higher AF-related hospitalization, and poorer quality of life in underserved prefectures. Structural threats, including a shrinking cardiologist workforce and new work constraints (Restrictions under the Work Style Reform-related Laws by the Japanese Government), risk worsening this disparity. Addressing this requires a paradigm shift toward equitable dissemination of CA.

Conclusions: The future of arrhythmia care rests not only on pursuing cutting-edge technology but also on formulating evidence-based, policy-oriented action plans to fulfill the professional and societal responsibility of eliminating treatment inequity.

Background: Acute decompensated heart failure (ADHF) causes multi-organ damage associated with congestion, hypoperfusion, or both. However, its impact on pancreatic exocrine function (PEF), which can be associated with impaired digestion and absorption and contribute to malnutrition, remains unclear. Thus, in this proof-of-concept study, we investigated whether hospitalized patients with ADHF have impaired PEF.

Methods and results: Patients admitted to the cardiac intensive care unit were enrolled. Following initial stabilization, the N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) test, which is the only clinically available PEF test in Japan, was performed. Data from 51 patients (age 73.3±9.8 years; 80.4% men; body mass index 23.9±5.0 kg/m²) were assessed. Patients hospitalized for ADHF (n=33) exhibited significantly lower levels of urinary PABA excretion rate (i.e., pancreatic function diagnostic [PFD] value) than in those hospitalized for other cardiovascular conditions (52.4±20.1% vs. 66.4±17.3%; P=0.022). Simple regression analyses revealed that decreased PFD values were associated with advanced age, increased hemoglobin A1c level, impaired kidney function, low urinary volume in the BT-PABA test, and ADHF-related hospitalization. Multiple regression analysis revealed that only reduced estimated glomerular filtration rate (coefficient 0.319; P=0.031) and ADHF-related hospitalization (coefficient -0.326; P=0.027) were associated with poor PFD values.

Conclusions: PEF was impaired in hospitalized patients with ADHF. Our findings could inform further hypotheses regarding how improved PEF in hospitalized patients with ADHF affects their nutritional status.