Allogeneic hematopoietic stem cell transplantation (allo-HSCT) and chimeric antigen receptor T-cell (CAR-T) therapy often lead to severe sarcopenia and cachexia during treatment, making it difficult to maintain exercise tolerance. Consequently, "cancer rehabilitation" programs have been implemented to sustain and improve physical activity and motor function. Hematologic malignancies often involve the use of cardiotoxic drugs. Moreover, graft-vs.-host disease associated with allo-HSCT and the cytokine release syndrome in CAR-T therapy elevate the risk of cardiovascular complications. Thus, establishing "cardio-oncology rehabilitation" (CORE) is essential to support cancer patients and survivors. CORE is expected to enhance quality of life, improve cardiopulmonary function, reduce cancer and cardiac events recurrence, and prolong survival. Our institution conducts cardiopulmonary exercise testing before HSCT and CAR-T therapy, with exercise prescriptions based on heart rate at the anaerobic threshold and guidance on resistance exercises. This report discusses current trends in CORE for patients undergoing HSCT and CAR-T therapy, along with future challenges.
{"title":"Role of Cardio-Oncology Rehabilitation in Hematopoietic Stem Cell Transplantation and Chimeric Antigen Receptor T-Cell (CAR-T) Therapy.","authors":"Shohei Moriyama, Moe Kondo, Ryuichi Awamura, Michinari Hieda, Mitsuhiro Fukata","doi":"10.1253/circrep.CR-24-0161","DOIUrl":"10.1253/circrep.CR-24-0161","url":null,"abstract":"<p><p>Allogeneic hematopoietic stem cell transplantation (allo-HSCT) and chimeric antigen receptor T-cell (CAR-T) therapy often lead to severe sarcopenia and cachexia during treatment, making it difficult to maintain exercise tolerance. Consequently, \"cancer rehabilitation\" programs have been implemented to sustain and improve physical activity and motor function. Hematologic malignancies often involve the use of cardiotoxic drugs. Moreover, graft-vs.-host disease associated with allo-HSCT and the cytokine release syndrome in CAR-T therapy elevate the risk of cardiovascular complications. Thus, establishing \"cardio-oncology rehabilitation\" (CORE) is essential to support cancer patients and survivors. CORE is expected to enhance quality of life, improve cardiopulmonary function, reduce cancer and cardiac events recurrence, and prolong survival. Our institution conducts cardiopulmonary exercise testing before HSCT and CAR-T therapy, with exercise prescriptions based on heart rate at the anaerobic threshold and guidance on resistance exercises. This report discusses current trends in CORE for patients undergoing HSCT and CAR-T therapy, along with future challenges.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 2","pages":"59-65"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Heart failure (HF) hospitalization is increasing in Japan's aging population. Current guidelines recommend daily biometric monitoring for patients with HF to facilitate early clinical intervention. However, promoting patient self-management remains insufficient. Therefore, we assessed the usefulness of the LAVITA telemonitoring system, which automatically obtains and stores the biometric data of patients with HF via wireless devices.
Methods and results: This prospective, single-arm, multicenter cohort study enrolled patients with HF. Patients were introduced to the LAVITA telemonitoring system and trained to measure body weight, blood pressure, pulse rate, oxygen saturation (SpO2), physical activity with activity trackers (AT), and electronic patient-reported outcomes (ePRO). The primary outcome was the measurement rate of each cetology at 9-12 weeks post-discharge. The secondary outcomes included the subgroup analyses by age, sex, and left ventricular function. Thirty patients continued to use the system at home. The measurement rates of patient data were as follows: body weight 92.4% (interquartile range [IQR] 83.3-97.8%); blood pressure 95.6% (IQR 84.8-98.5%); pulse rate 96.5% (IQR 86.5-98.8%); SpO2 93.1% (IQR 76.6-97.9%); AT 88.4% (IQR 31.3-98.5%); and ePRO 76.9% (IQR 26.4-95.9%). The subgroup analysis did not significantly differ.
Conclusions: The LAVITA telemonitoring system had high measurement rates for the biometric data of patients with HF, including elderly patients. Hence, it can possibly improve patient self-management and facilitate early clinical intervention.
{"title":"Usefulness of the LAVITA Telemonitoring System in Patients With Heart Failure - A Feasibility Study.","authors":"Masahiro Noguchi, Akihiro Nomura, Yasuaki Takeji, Masaya Shimojima, Shohei Yoshida, Teppei Kitano, Keisuke Ohtani, Hayato Tada, Shinichiro Takashima, Kenji Sakata, Masayuki Takamura, Soichiro Usui","doi":"10.1253/circrep.CR-24-0099","DOIUrl":"10.1253/circrep.CR-24-0099","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) hospitalization is increasing in Japan's aging population. Current guidelines recommend daily biometric monitoring for patients with HF to facilitate early clinical intervention. However, promoting patient self-management remains insufficient. Therefore, we assessed the usefulness of the LAVITA telemonitoring system, which automatically obtains and stores the biometric data of patients with HF via wireless devices.</p><p><strong>Methods and results: </strong>This prospective, single-arm, multicenter cohort study enrolled patients with HF. Patients were introduced to the LAVITA telemonitoring system and trained to measure body weight, blood pressure, pulse rate, oxygen saturation (SpO<sub>2</sub>), physical activity with activity trackers (AT), and electronic patient-reported outcomes (ePRO). The primary outcome was the measurement rate of each cetology at 9-12 weeks post-discharge. The secondary outcomes included the subgroup analyses by age, sex, and left ventricular function. Thirty patients continued to use the system at home. The measurement rates of patient data were as follows: body weight 92.4% (interquartile range [IQR] 83.3-97.8%); blood pressure 95.6% (IQR 84.8-98.5%); pulse rate 96.5% (IQR 86.5-98.8%); SpO<sub>2</sub> 93.1% (IQR 76.6-97.9%); AT 88.4% (IQR 31.3-98.5%); and ePRO 76.9% (IQR 26.4-95.9%). The subgroup analysis did not significantly differ.</p><p><strong>Conclusions: </strong>The LAVITA telemonitoring system had high measurement rates for the biometric data of patients with HF, including elderly patients. Hence, it can possibly improve patient self-management and facilitate early clinical intervention.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 2","pages":"106-112"},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-25eCollection Date: 2025-02-10DOI: 10.1253/circrep.CR-24-0107
Haruka Matsuura, Tsukasa Kamakura, Koji Miyamoto, Kengo Kusano
{"title":"Utility of the Tissue Proximity Indication Feature in Predicting Reconnection of Pulmonary Vein Isolation During Pulsed-Field Ablation.","authors":"Haruka Matsuura, Tsukasa Kamakura, Koji Miyamoto, Kengo Kusano","doi":"10.1253/circrep.CR-24-0107","DOIUrl":"10.1253/circrep.CR-24-0107","url":null,"abstract":"","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 2","pages":"144-145"},"PeriodicalIF":0.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Predictors of the clinical characteristics of pregnant women at risk of peripartum cardiomyopathy (PPCM) remain unclear.
Methods and results: We enrolled 450 cases of high-risk pregnancy with any risk factor from among ≥35 years of age, hypertensive disorders of pregnancy (HDP), multiple gestation, or other systemic or obstetric complications except for a history of cardiac disease. All the women underwent echocardiography and plasma B-type natriuretic peptide (BNP) measurement during the second/third trimester and the early/late postpartum period. Logistic regression analyses identified clinical factors associated with left ventricular (LV) dysfunction. The incidence of PPCM was 0.89%, which was higher than in previous reports. Early diastolic mitral annular velocity (e') was significantly negatively associated with the occurrence of PPCM, and the BNP level showed a significant positive association with the occurrence of PPCM. The percentages of cases of e' <7 cm/s, and BNP level ≥100 pg/mL were 25.3%, and 20.4%, respectively. Multivariate regression analysis revealed that HDP was independently associated with e'. A negative correlation between e' and BNP level was observed in HDP.
Conclusions: High-risk pregnancy was associated with an increased incidence of PPCM. Measurement of BNP levels and echocardiographic assessment of LV diastolic function during pregnancy may be useful in predicting PPCM.
{"title":"Impact of High-Risk Pregnancy on Peripartum Left Ventricular Function.","authors":"Yasuyo Komoriya, Kazuo Komamura, Hiroshi Miyake, Hisashi Umeda, Koichi Kobayashi, Ryoji Ishiki, Hidenori Oguchi, Toyoaki Murohara, Mitsunori Iwase","doi":"10.1253/circrep.CR-24-0154","DOIUrl":"10.1253/circrep.CR-24-0154","url":null,"abstract":"<p><strong>Background: </strong>Predictors of the clinical characteristics of pregnant women at risk of peripartum cardiomyopathy (PPCM) remain unclear.</p><p><strong>Methods and results: </strong>We enrolled 450 cases of high-risk pregnancy with any risk factor from among ≥35 years of age, hypertensive disorders of pregnancy (HDP), multiple gestation, or other systemic or obstetric complications except for a history of cardiac disease. All the women underwent echocardiography and plasma B-type natriuretic peptide (BNP) measurement during the second/third trimester and the early/late postpartum period. Logistic regression analyses identified clinical factors associated with left ventricular (LV) dysfunction. The incidence of PPCM was 0.89%, which was higher than in previous reports. Early diastolic mitral annular velocity (e') was significantly negatively associated with the occurrence of PPCM, and the BNP level showed a significant positive association with the occurrence of PPCM. The percentages of cases of e' <7 cm/s, and BNP level ≥100 pg/mL were 25.3%, and 20.4%, respectively. Multivariate regression analysis revealed that HDP was independently associated with e'. A negative correlation between e' and BNP level was observed in HDP.</p><p><strong>Conclusions: </strong>High-risk pregnancy was associated with an increased incidence of PPCM. Measurement of BNP levels and echocardiographic assessment of LV diastolic function during pregnancy may be useful in predicting PPCM.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 2","pages":"122-130"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-22eCollection Date: 2025-02-10DOI: 10.1253/circrep.CR-24-0150
Daiki Hirayama, Susumu Manabe, Norihisa Yuge
Background: Although cardiac auscultation plays an essential role in detecting valvular heart diseases, false-positive rates due to innocent heart murmurs remain a concern because accelerated transaortic valve blood flow can be a major contributor to systolic heart murmurs. In this study we investigated the effect of transaortic valve flow velocity on the development of systolic heart murmurs.
Methods and results: Cardiac auscultation was performed in 571 patients referred for echocardiography and systolic heart murmur was detected in 103 (18.0%). Maximum transaortic valve flow velocity was higher in patients with murmurs than in those without (2.02 vs. 1.34 m/s, P<0.001; area under the receiver operating characteristic curve, 0.82). A cutoff maximum transaortic flow velocity of 1.7 m/s predicted systolic heart murmurs (sensitivity, 65%; specificity, 88%). The incidence of heart murmur was associated with higher maximum transaortic valve flow velocity (<1.7 m/s, 7.3%; 1.7-2.5 m/s, 50.0%; >2.5 m/s, 73.5%). Multivariate analysis revealed the maximum transaortic valve flow velocity as an independent predictor of systolic heart murmurs (hazard ratio, 9.18; 95% confidence interval, 5.35-15.75; P<0.001).
Conclusions: Accelerated transaortic valve flow velocity is an important determinant of systolic heart murmurs. Systolic heart murmurs can be heard before the transaortic valve flow velocity reaches the clinically significant aortic stenosis criterion, which can constitute a considerable number of innocent heart murmurs.
{"title":"Impact of Transaortic Valve Flow Velocity on the Development of Systolic Heart Murmurs.","authors":"Daiki Hirayama, Susumu Manabe, Norihisa Yuge","doi":"10.1253/circrep.CR-24-0150","DOIUrl":"10.1253/circrep.CR-24-0150","url":null,"abstract":"<p><strong>Background: </strong>Although cardiac auscultation plays an essential role in detecting valvular heart diseases, false-positive rates due to innocent heart murmurs remain a concern because accelerated transaortic valve blood flow can be a major contributor to systolic heart murmurs. In this study we investigated the effect of transaortic valve flow velocity on the development of systolic heart murmurs.</p><p><strong>Methods and results: </strong>Cardiac auscultation was performed in 571 patients referred for echocardiography and systolic heart murmur was detected in 103 (18.0%). Maximum transaortic valve flow velocity was higher in patients with murmurs than in those without (2.02 vs. 1.34 m/s, P<0.001; area under the receiver operating characteristic curve, 0.82). A cutoff maximum transaortic flow velocity of 1.7 m/s predicted systolic heart murmurs (sensitivity, 65%; specificity, 88%). The incidence of heart murmur was associated with higher maximum transaortic valve flow velocity (<1.7 m/s, 7.3%; 1.7-2.5 m/s, 50.0%; >2.5 m/s, 73.5%). Multivariate analysis revealed the maximum transaortic valve flow velocity as an independent predictor of systolic heart murmurs (hazard ratio, 9.18; 95% confidence interval, 5.35-15.75; P<0.001).</p><p><strong>Conclusions: </strong>Accelerated transaortic valve flow velocity is an important determinant of systolic heart murmurs. Systolic heart murmurs can be heard before the transaortic valve flow velocity reaches the clinically significant aortic stenosis criterion, which can constitute a considerable number of innocent heart murmurs.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 2","pages":"139-142"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Constipation commonly coexists with heart failure (HF) and can increase blood pressure because of straining during defecation and accompanying mental stress. Daikenchuto, a Japanese herbal medicine to ameliorate gastrointestinal motility, may be effective as a complement to laxatives in improving outcomes in patients with HF and constipation.
Methods and results: We used the Diagnosis Procedure Combination database to identify patients aged ≥65 years who were admitted for HF, had constipation, and were discharged alive between April 2016 and March 2022. We divided the 115,544 eligible patients into 2 groups according to the prescription of Daikenchuto in addition to laxatives at discharge and compared the incidence of 1-year HF readmission using 1 : 4 propensity score matching. Daikenchuto was prescribed at discharge in 3,315 (2.9%) patients. In the unmatched cohort, patients treated with Daikenchuto were more often male and had a higher prevalence of malignancy than those treated without Daikenchuto. In the 1 : 4 propensity score-matched cohort (3,311 and 13,243 patients with and without Daikenchuto, respectively), no significant difference was noted in 1-year HF readmission between the groups (22.2% vs. 21.9%; hazard ratio=1.02, 95% confidence interval=0.94-1.11). This result was consistent across clinically relevant subgroups except for renal disease.
Conclusions: Complementary use of Daikenchuto in combination with laxatives was not associated with a lower incidence of HF readmission in patients with HF and constipation.
{"title":"Association Between Complementary Use of Daikenchuto (a Japanese Herbal Medicine) and Readmission in Older Patients With Heart Failure and Constipation.","authors":"Toshiaki Isogai, Kojiro Morita, Akira Okada, Nobuaki Michihata, Hiroki Matsui, Atsushi Miyawaki, Hideo Yasunaga","doi":"10.1253/circrep.CR-24-0114","DOIUrl":"10.1253/circrep.CR-24-0114","url":null,"abstract":"<p><strong>Background: </strong>Constipation commonly coexists with heart failure (HF) and can increase blood pressure because of straining during defecation and accompanying mental stress. Daikenchuto, a Japanese herbal medicine to ameliorate gastrointestinal motility, may be effective as a complement to laxatives in improving outcomes in patients with HF and constipation.</p><p><strong>Methods and results: </strong>We used the Diagnosis Procedure Combination database to identify patients aged ≥65 years who were admitted for HF, had constipation, and were discharged alive between April 2016 and March 2022. We divided the 115,544 eligible patients into 2 groups according to the prescription of Daikenchuto in addition to laxatives at discharge and compared the incidence of 1-year HF readmission using 1 : 4 propensity score matching. Daikenchuto was prescribed at discharge in 3,315 (2.9%) patients. In the unmatched cohort, patients treated with Daikenchuto were more often male and had a higher prevalence of malignancy than those treated without Daikenchuto. In the 1 : 4 propensity score-matched cohort (3,311 and 13,243 patients with and without Daikenchuto, respectively), no significant difference was noted in 1-year HF readmission between the groups (22.2% vs. 21.9%; hazard ratio=1.02, 95% confidence interval=0.94-1.11). This result was consistent across clinically relevant subgroups except for renal disease.</p><p><strong>Conclusions: </strong>Complementary use of Daikenchuto in combination with laxatives was not associated with a lower incidence of HF readmission in patients with HF and constipation.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 2","pages":"86-96"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21eCollection Date: 2025-02-10DOI: 10.1253/circrep.CR-24-0152
Robin Willixhofer, Nikita Ermolaev, Christina Kronberger, Mahshid Eslami, Johannes Vilsmeier, René Rettl, Christian Nitsche, Andreas Kammerlander, Jutta Bergler-Klein, Johannes Kastner, David Niederseer, Roza Badr Eslam
Background: This study assessed the prognostic value of submaximal cardiopulmonary exercise testing (CPET) in cardiac amyloidosis and explored CPET as an alternative to the 6-min walk test (6MWT).
Methods and results: In this single-center prospective observational study, 160 patients with cardiac amyloidosis (87% male; mean age 78±7 years) were evaluated. A total of 145 performed maximum symptom limited CPET. The V̇E/V̇CO2 slope was 39±8, submaximal power output (SPO) was 24.75±11.50 W, and V̇O2 at anaerobic threshold (AT) was 8.13±2.29 mL/min/kg. During follow up, 34 (21.25%) patients died, and another 34 (21.25%) experienced heart failure (HF)-related hospitalization, with 15 (9.38%) patients experiencing both events. Univariate analysis showed that V̇E/V̇CO2 slope (hazard ratio [HR] 0.89; 95% confidence interval [CI] 0.86-0.93; P<0.001) and SPO (HR 0.91; 95% CI 0.87-0.96; P<0.001) were predictors of mortality. In multivariate analysis, V̇E/V̇CO2 slope remained a significant predictor (HR 0.92; 95% CI 0.88-0.97; P<0.001) for both all-cause mortality and HF-related hospitalization independently. A SPO cut-off of <28 W predicted a worse outcome for both measures independently. Moderate correlations for V̇E/V̇CO2 slope (-0.56 [CI -0.67, -0.42]) and SPO (0.55 [CI 0.42, 0.67]) with 6MWT distance have been found.
Conclusions: These findings highlight CPET parameters, particularly V̇E/V̇CO2 slope and SPO with a cut-off <28 W, as predictors of survival and HF-related hospitalization in cardiac amyloidosis.
{"title":"Prognostic Value of Submaximal Cardiopulmonary Exercise Testing in Patients With Cardiac Amyloidosis.","authors":"Robin Willixhofer, Nikita Ermolaev, Christina Kronberger, Mahshid Eslami, Johannes Vilsmeier, René Rettl, Christian Nitsche, Andreas Kammerlander, Jutta Bergler-Klein, Johannes Kastner, David Niederseer, Roza Badr Eslam","doi":"10.1253/circrep.CR-24-0152","DOIUrl":"10.1253/circrep.CR-24-0152","url":null,"abstract":"<p><strong>Background: </strong>This study assessed the prognostic value of submaximal cardiopulmonary exercise testing (CPET) in cardiac amyloidosis and explored CPET as an alternative to the 6-min walk test (6MWT).</p><p><strong>Methods and results: </strong>In this single-center prospective observational study, 160 patients with cardiac amyloidosis (87% male; mean age 78±7 years) were evaluated. A total of 145 performed maximum symptom limited CPET. The V̇E/V̇CO<sub>2</sub> slope was 39±8, submaximal power output (SPO) was 24.75±11.50 W, and V̇O<sub>2</sub> at anaerobic threshold (AT) was 8.13±2.29 mL/min/kg. During follow up, 34 (21.25%) patients died, and another 34 (21.25%) experienced heart failure (HF)-related hospitalization, with 15 (9.38%) patients experiencing both events. Univariate analysis showed that V̇E/V̇CO<sub>2</sub> slope (hazard ratio [HR] 0.89; 95% confidence interval [CI] 0.86-0.93; P<0.001) and SPO (HR 0.91; 95% CI 0.87-0.96; P<0.001) were predictors of mortality. In multivariate analysis, V̇E/V̇CO<sub>2</sub> slope remained a significant predictor (HR 0.92; 95% CI 0.88-0.97; P<0.001) for both all-cause mortality and HF-related hospitalization independently. A SPO cut-off of <28 W predicted a worse outcome for both measures independently. Moderate correlations for V̇E/V̇CO<sub>2</sub> slope (-0.56 [CI -0.67, -0.42]) and SPO (0.55 [CI 0.42, 0.67]) with 6MWT distance have been found.</p><p><strong>Conclusions: </strong>These findings highlight CPET parameters, particularly V̇E/V̇CO<sub>2</sub> slope and SPO with a cut-off <28 W, as predictors of survival and HF-related hospitalization in cardiac amyloidosis.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 2","pages":"76-85"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-11eCollection Date: 2025-02-10DOI: 10.1253/circrep.CR-24-0140
Ken-Ichi Hiasa, Miki Imura, Susumu Hirose
Background: Prevention of death from in-hospital pulmonary thromboembolism (PE) is crucial, but research exploring the risk factors for this event remains limited.
Methods and results: This retrospective analysis evaluated PE data among hospitalized patients, focusing on the diseases present on admission to hospital with the highest number of patients with in-hospital PE events, using the Medical Data Vision database (January 2017-December 2021). Endpoints included the incidence rate of in-hospital PE, patient characteristics, and PE prophylactic procedures. Overall, 4,684,659 patients (in-hospital PE cohort, n=5,007; non-PE cohort, n=4,679,952) were eligible: heart failure (n=208; n=87,160), femoral fracture (n=478; n=139,049), pneumonia (n=309; n=222,257), stroke (n=351; n=248,805), and cancer (n=934; n=764,413). The incidence rate of in-hospital PE in the overall population was 20.6/1,000 person-years: heart failure (34.6), femoral fracture (35.3), pneumonia (21.4), stroke (15.9), and cancer (25.6). History of venous thromboembolism (VTE) was a risk factor for in-hospital PE in >50% of patients in all subgroups. Prophylactic PE procedures were implemented in 33.8% of the overall population: femoral fracture (79.5%), cancer (49.7%), stroke (24.2%), heart failure (12.7%), and pneumonia (6.2%).
Conclusions: The incidence of in-hospital PE was not high overall but was higher in patients with a history of VTE and those with hospitalization due to heart failure or femoral fracture. Risk assessment for in-hospital PE, including medical history and diagnosis at admission, is preferred in hospitalized patients.
{"title":"In-Hospital Pulmonary Thromboembolism Development by Disease at Admission - A Nationwide, Retrospective, Observational Study Using Japanese Claims Data.","authors":"Ken-Ichi Hiasa, Miki Imura, Susumu Hirose","doi":"10.1253/circrep.CR-24-0140","DOIUrl":"10.1253/circrep.CR-24-0140","url":null,"abstract":"<p><strong>Background: </strong>Prevention of death from in-hospital pulmonary thromboembolism (PE) is crucial, but research exploring the risk factors for this event remains limited.</p><p><strong>Methods and results: </strong>This retrospective analysis evaluated PE data among hospitalized patients, focusing on the diseases present on admission to hospital with the highest number of patients with in-hospital PE events, using the Medical Data Vision database (January 2017-December 2021). Endpoints included the incidence rate of in-hospital PE, patient characteristics, and PE prophylactic procedures. Overall, 4,684,659 patients (in-hospital PE cohort, n=5,007; non-PE cohort, n=4,679,952) were eligible: heart failure (n=208; n=87,160), femoral fracture (n=478; n=139,049), pneumonia (n=309; n=222,257), stroke (n=351; n=248,805), and cancer (n=934; n=764,413). The incidence rate of in-hospital PE in the overall population was 20.6/1,000 person-years: heart failure (34.6), femoral fracture (35.3), pneumonia (21.4), stroke (15.9), and cancer (25.6). History of venous thromboembolism (VTE) was a risk factor for in-hospital PE in >50% of patients in all subgroups. Prophylactic PE procedures were implemented in 33.8% of the overall population: femoral fracture (79.5%), cancer (49.7%), stroke (24.2%), heart failure (12.7%), and pneumonia (6.2%).</p><p><strong>Conclusions: </strong>The incidence of in-hospital PE was not high overall but was higher in patients with a history of VTE and those with hospitalization due to heart failure or femoral fracture. Risk assessment for in-hospital PE, including medical history and diagnosis at admission, is preferred in hospitalized patients.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 2","pages":"66-75"},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Intensive lipid-lowering therapy (ILLT) is crucial for preventing secondary acute coronary syndrome (ACS). However, achieving target low-density lipoprotein cholesterol (LDL-C) levels remains challenging in clinical practice.
Methods and results: This retrospective study included 534 patients with ACS who underwent primary percutaneous coronary intervention (PCI) between September 2016 and August 2022. The ILLT protocol, wherein ezetimibe and statins are prescribed, was introduced in September 2019. We compared the rate of achievement of the LDL-C target of <70 mg/dL at the first outpatient visit and the incidence of cardiovascular events during the 3-year observation period after PCI between the conventional therapy (n=226) and ILLT (n=308) groups. The ILLT group had a higher achievement rate than the conventional therapy group (71.8% vs. 48.7%; P=0.001). In the ILLT group, 17% of statin-naïve patients did not achieve the LDL-C target, and the cutoff value of LDL-C on admission for predicting non-achievement of this target was 146 mg/dL. Patients in the ILLT group showed a significantly lower incidence of cardiovascular events than those in the conventional therapy group (hazard ratio 0.57; 95% confidence interval 0.34-0.97).
Conclusions: Implementing the ILLT protocol using statins and ezetimibe helped achieve the target LDL-C level early in patients with ACS and may consequently improve prognosis. However, patients with LDL-C levels ≥146 mg/dL on admission may need more intensive treatment.
{"title":"Impact of an Intensive Lipid-Lowering Therapy Protocol on Achieving Target Low-Density Lipoprotein Cholesterol Levels in Patients With Acute Coronary Syndrome.","authors":"Kosuke Seiyama, Akihiro Oka, Toru Miyoshi, Yuya Sudo, Wataru Takagi, Satoko Ugawa, Tomoaki Okada, Kazumasa Nosaka, Masayuki Doi","doi":"10.1253/circrep.CR-24-0071","DOIUrl":"10.1253/circrep.CR-24-0071","url":null,"abstract":"<p><strong>Background: </strong>Intensive lipid-lowering therapy (ILLT) is crucial for preventing secondary acute coronary syndrome (ACS). However, achieving target low-density lipoprotein cholesterol (LDL-C) levels remains challenging in clinical practice.</p><p><strong>Methods and results: </strong>This retrospective study included 534 patients with ACS who underwent primary percutaneous coronary intervention (PCI) between September 2016 and August 2022. The ILLT protocol, wherein ezetimibe and statins are prescribed, was introduced in September 2019. We compared the rate of achievement of the LDL-C target of <70 mg/dL at the first outpatient visit and the incidence of cardiovascular events during the 3-year observation period after PCI between the conventional therapy (n=226) and ILLT (n=308) groups. The ILLT group had a higher achievement rate than the conventional therapy group (71.8% vs. 48.7%; P=0.001). In the ILLT group, 17% of statin-naïve patients did not achieve the LDL-C target, and the cutoff value of LDL-C on admission for predicting non-achievement of this target was 146 mg/dL. Patients in the ILLT group showed a significantly lower incidence of cardiovascular events than those in the conventional therapy group (hazard ratio 0.57; 95% confidence interval 0.34-0.97).</p><p><strong>Conclusions: </strong>Implementing the ILLT protocol using statins and ezetimibe helped achieve the target LDL-C level early in patients with ACS and may consequently improve prognosis. However, patients with LDL-C levels ≥146 mg/dL on admission may need more intensive treatment.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 2","pages":"131-138"},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11807690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}