Circulation reports最新文献

Background: Decline or inadequate recovery of activities of daily living (ADL) during hospitalization is crucial for clinical prognosis. In this study we investigated the relationship between cardiac rehabilitation (CR) and ADL recovery in patients with cardiovascular disease (CVD), with the aim of exploring associations that may contribute to the development of rehabilitation interventions.

Methods and results: This study analyzed consecutive patients hospitalized with CVD. ADL was assessed using the Barthel index (BI) at the commencement of rehabilitation and discharge. As the outcome measure for ADL, relative functional gain: BI effectiveness, calculated as (discharge BI - initial BI) / (100 - initial BI), was adopted in order to compensate ceiling effect of BI. BI effectiveness ≥0.5 defined the ADL recovery group, while <0.5 defined the ADL non-recovery group. Of the 2,938 patients screened, 1,582 (median age 79 years, male 59%) were included after exclusions. The ADL recovery group consisted of 1,162 patients, the ADL non-recovery group, 420 patients. Between-group comparisons and multivariate regression analysis identified age and initial BI as highly significant ADL recovery determinants. Recursive partitioning analysis showed CR volumes of ≥75 min/day for patients ≥75 years and ≥45 min/day for those <75 years with lower initial BI were associated with ADL recovery. These CR volumes also reduced the institutionalization odds ratios (OR=0.42 and OR=0.34, P<0.001) compared to CR volumes <45 min/day.

Conclusions: CR volume was associated with ADL recovery, especially for older patients with low baseline function at admission. Optimizing CR volume based on patient background and condition may contribute to enhance ADL recovery and improved clinical prognosis.

Background: There is a substantial risk of slow flow during percutaneous coronary intervention (PCI) for the culprit lesion in acute myocardial infarction (AMI), which can lead to adverse outcomes. We hypothesized that single-step long balloon inflation during stent deployment was associated with a more favorable final Thrombolysis in Myocardial Infarction (TIMI) flow grade. This retrospective study aimed to compare both the final TIMI flow grade and the delta TIMI flow grade in intravascular ultrasound (IVUS)-guided PCI for AMI between patients with long balloon inflation and those with conventional inflation.

Methods and results: Long inflation was defined as single-step inflation ≥60 s at stent deployment. The primary endpoints were achievement of the final TIMI flow grade 3 and the delta TIMI flow grade, defined as the difference between the initial and final grades. We analyzed 336 AMI patients with attenuation plaque on IVUS, dividing them into a long inflation group (n=50) and a conventional inflation group (n=286). Despite a significantly higher TIMI thrombus grade in the long inflation group (P<0.001), the rate of the final TIMI 3 flow was similar (90% vs. 88.5%; P=1.00). However, the delta TIMI flow grade was significantly greater in the long inflation group (P=0.028).

Conclusions: Single-step long balloon inflation may be a simple and feasible method to achieve optimal final TIMI flow in IVUS-guided PCI for AMI.

Background: Malnutrition is a significant prognostic factor in chronic heart failure (CHF), particularly among older adults. The geriatric nutritional risk index (GNRI) is a screening tool for assessing malnutrition in this population. Although low GNRI is associated with increased deaths of patients with HF, the prognostic impact of longitudinal GNRI changes in malnourished patients remains unclear.

Methods and results: This post-hoc analysis of the KUNIUMI registry chronic cohort, a prospective observational study of patients with pre-HF/HF, assessed GNRI at baseline and 1-year follow-up. The annual GNRI change (∆GNRI) was calculated, and its association with all-cause death in malnourished patients was analyzed. The primary outcome was all-cause death, with a 2-year follow-up after the initial 1-year assessment. Among 1,242 patients (mean age: 74.4±10.9 years), 19.8% had low GNRI (<92). All-cause death was significantly higher in patients with low GNRI than in those with high GNRI (30.1% vs. 7.1%; P<0.001). In patients with low GNRI, multivariable Cox regression showed a significant association between ∆GNRI and death (hazard ratio: 0.94; 95% confidence interval: 0.91-0.96; P<0.001). Multiple linear regression indicated that nutritional counseling positively influenced ∆GNRI, but HF severity was not significantly associated.

Conclusions: ∆GNRI is a significant prognostic indicator in malnourished patients with pre-HF/HF. Serial GNRI assessments may improve risk stratification and guide nutritional interventions.

Intravenous atropine is widely recommended as the first-line treatment for symptomatic bradycardia, but because the optimal initial dose remains uncertain, the aim of this scoping review was to examine the existing literature on the efficacy and safety of intravenous atropine at specific doses in adult patients with symptomatic bradycardia and to identify gaps in evidence. A systematic search of 4 databases (PubMed, CENTRAL, Web of Science, and Ichushi-Web) was conducted from inception to December 16, 2024. Studies were included if they reported administration of a specified dose of atropine in adult patients, regardless of study design. No randomized controlled trials directly comparing 0.5 mg vs. 1.0 mg were found. A total of 19 studies were included and categorized into groups based on initial atropine dose: low (<0.5 mg), moderate (0.5 mg ≤ dose <1.0 mg), high (≥1.0 mg), and those spanning multiple categories. No consistent relationship was found between atropine dose and clinical outcomes, such as heart rate response or adverse effects. None of the moderate-dose studies reported worsening bradycardia. Moderate-dose atropine could be safe, and the current practice of using 0.5 mg as an initial dose in Japan, where 0.5 mg/mL prefilled syringes are commercially available, appears clinically reasonable. However, in the absence of high-quality comparative data, future research should apply rigorous study designs to determine the optimal atropine dose in emergency care settings.

Background: The physician ordered advance code (PAC), a treatment code used in Japanese hospitals based on the physician orders for life sustaining treatment paradigm, plays a crucial role in guiding treatment decisions for patients with acute heart failure (AHF). However, data on the clinical characteristics, decision-making processes, and outcomes associated with PAC in Japanese patients are limited.

Methods and results: We retrospectively analyzed data from 1,203 AHF patients across multiple centers in Japan. Patients were categorized based on the presence or absence of PAC orders; clinical characteristics and mortality outcomes were compared between the 2 groups. Patients with PAC orders were significantly older, more often female, and had lower activities of daily living scores. Cognitive impairment was markedly more prevalent in the PAC than non-PAC group. PAC decisions were primarily communicated to family members rather than to patients themselves, with only 7.3% of patients directly informed. The median time from admission to final PAC order was 2 days, with 74.1% finalized within 5 days. PAC orders frequently permitted intravenous therapies, but limited resuscitative measures in only 15% of patients. In-hospital and 2-year mortality rates were substantially higher in the PAC than non-PAC group.

Conclusions: PAC designation reflected poor clinical status and was linked to significantly worse mortality outcome. Enhancing shared decision-making and aligning PAC with patient values are essential steps to optimize care for this vulnerable population.

Background: This study aimed to identify fall risk indicators associated with future falls among older patients with cardiovascular disease (CVD), based on a multidimensional assessment.

Methods and results: In this prospective cohort study, 129 patients aged ≥65 years with CVD were enrolled between 2021 and 2023. Participants were classified into fall and non-fall groups based on fall incidence during a 1-year follow up. We assessed physical frailty, systolic blood pressure, polypharmacy, and the Falls Efficacy Scale International (FES-I) to evaluate concern about falling. The overall 1-year fall incidence was 17.0% (22 falls), equating to 0.28 falls per person-year. Compared with the non-fall group, the fall group was older, had lower physical function and blood pressure, and higher FES-I scores. Multivariate logistic regression, adjusted with propensity scores, revealed that a FES-I score ≥28 was a significant predictor of falls (odds ratio [OR] 8.906, 95% confidence interval [CI] 2.556-13.031, P=0.001; adjusted OR 2.964, 95% CI 1.038-8.460, P=0.042). Receiver operating characteristic analysis identified a FES-I cut-off of 28, with an area under the curve of 0.684 (95% CI 0.527-0.840, P=0.017).

Conclusions: The 1-year fall incidence among older patients with CVD was comparable with rates in community-dwelling older adults. Higher concern about falling, as measured using FES-I, was significantly associated with future falls.

Background: Point-of-care (POC) cardiac troponin testing, although less sensitive than high-sensitivity cardiac troponin assays, allows for rapid bedside evaluation. This study assessed the diagnostic performance of POC troponin tests for both ruling in and ruling out acute myocardial infarction (AMI) at the time of patient presentation.

Methods and results: In accordance with PRISMA-DTA guidelines, we conducted a systematic review and meta-analysis using PubMed, Web of Science, and the Cochrane Library from inception through June 17, 2023. We included all studies evaluating the diagnostic accuracy of POC troponin assays for identifying AMI among adult patients. Among the 551 studies initially screened, 6 met the eligibility criteria for inclusion. A meta-analysis of diagnostic accuracy based on these 6 observational datasets demonstrated pooled sensitivity and specificity values of 47% (95% confidence interval (CI) 45-49%) and 90% (95% CI 89-90%), respectively, for AMI detection. In a subgroup meta-analysis of non-ST-segment elevation MI using 4 observational datasets, the pooled sensitivity and specificity were 48% (95% CI 45-50%) and 89% (95% CI 89-90%), respectively.

Conclusions: These findings emphasize that the clinical application of POC troponin assays in AMI diagnosis must consider the test's robust specificity (≈90%) alongside its limited sensitivity (<50%).

Background: The Navitor valve shows excellent valve function and high deliverability. However, valve pop-up during valve implantation remains a concern.

Methods and results: We defined pop-up as an upward valve dislocation ≥3 mm after implantation. Pop-up occurred in 13 (19%) of 67 patients, with 2 (3.0%) patients requiring a second valve. The depth ratio between non- and left-coronary cusp side at the 80% release and aortic valve calcification score were identified as predictors of valve pop-up.

Conclusions: Pop-up of the Navitor valve occurred in 19% of patients. Inconsistent valve depth and severe leaflet calcification were predictors of valve pop-up.

Background: The optimal device for mechanical circulatory support (MCS) in patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) remains unknown. Therefore, in this study we aimed to analyze which MCS (intra-aortic balloon pumping (IABP) or IMPELLA) is associated with better outcomes in patients with AMI-related CS.

Methods and results: This systematic review and meta-analysis used a random-effects model to account for potential heterogeneity. Risk ratios (RRs) and 95% confidence intervals (CIs) were used for the dichotomous outcomes. The PubMed, Web of Science, and CENTRAL databases were searched up to April 30, 2023. The risk of bias was evaluated using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2) tool, and the certainty of evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Two randomized controlled trials were included in the meta-analysis. For the primary outcome of 30-day survival, IMPELLA probably improves the outcome by a small amount compared with IABP (RR0.94 [95% CI 0.5-1.53], 29 fewer per 1,000 [95% CI from 204 fewer to 258 more], low certainty of evidence).

Conclusions: We could not show a survival benefit of IMPELLA compared with IABP in patients with AMI complicated by CS. Further investigation is required to resolve this issue.

Background: Frailty is a crucial factor in the prognoses of patients who undergo transcatheter aortic valve implantation (TAVI); however, comprehensive assessments of this parameter are not frequently performed in this regard. This study evaluated the prognostic value of the Kihon Checklist (KCL), which covers physical, cognitive, and social domains, for patients receiving TAVI.

Methods and results: We retrospectively analyzed data from 986 patients who underwent elective TAVI between May 2017 and September 2022. Frailty was classified according to the KCL as non-frail (for scores of 0-3), pre-frail (4-7), or frail (≥8). The primary outcome measure was all-cause mortality following discharge. Kaplan-Meier, Cox regression, and classification and regression tree (CART) analyses were used. Of the overall patient cohort, 47.4% were classified as frail. Over a mean follow-up period of 968±578 days, 18.1% died. Frailty was significantly associated with higher mortality (adjusted hazard ratio 1.771; 95% confidence interval 1.096-2.862; P<0.02). Impaired socialization and physical function were also found to represent independent predictors of mortality. CART identified socialization as the primary node in the risk stratification.

Conclusions: Preoperative frailty, as defined by the KCL, was found to be independently associated with mortality after TAVI. Social and physical domains were also found to have strong prognostic relevance in this context.