Circulation reports最新文献

Background: This study evaluated the impact of Rheocarna® (Kaneka Medix, Osaka, Japan) after endovascular treatment (EVT) in patients with chronic limb-threatening ischemia (CLTI).

Methods and results: We retrospectively analyzed consecutive data from 913 patients who underwent EVT for infrainguinal lesions between March 2021 and December 2023 at 8 centers in Japan. Patients were categorized into 2 groups based on whether they received Rheocarna: EVT alone and EVT combined with Rheocarna. Propensity score matching (PSM) was used to adjust for differences in patient and lesion characteristics. The primary outcome was the 1-year wound healing rate. Secondary outcomes included wound healing time, major amputation rate, and reintervention at 1 year. After PSM, 88 matched pairs were identified, with no significant differences in baseline characteristics between the 2 groups. Among patients with severe disease small artery disease (SAD2), the combination of EVT and Rheocarna significantly improved the wound healing rate vs. EVT alone (66.6% vs. 26.0%, respectively; P=0.01) No significant differences were observed between the 2 groups for the other endpoints.

Conclusions: Among patients with CLTI and SAD2, EVT combined with Rheocarna significantly improved the wound healing rate at 1 year, although there were no significant differences in terms of wound healing time, major amputation rate, and reintervention at 1 year. These findings suggest that patients with CLTI and SAD2 may be suitable candidates for Rheocarna treatment following EVT.

Background: To contribute to the treatment and management of venous thromboembolism (VTE) patients with cancer, we used data from the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination database to clarify the impact of chemotherapy on 30-day all-cause in-hospital mortality. Annual changes in oral anticoagulant use were also evaluated.

Methods and results: We identified 106,404 VTE patients who were hospitalized for the management of VTE between 2012 and 2021. The primary outcome was all-cause in-hospital mortality within 30 days after admission for VTE. After adjusting for covariates using propensity score (PS) matching, outcomes were compared between patients with and without chemotherapy. In the PS-matched cohort, subgroup analyses estimated the association between specific anticancer agents or hormone therapy and 30-day all-cause mortality. Mortality was significantly lower in the group with than without chemotherapy group (odds ratio 0.46; P<0.001). However, the analysis revealed no significant association between any anticancer agent or therapy and 30-day mortality. Warfarin use decreased markedly from 100% in 2012 to 7% in 2021, whereas the use of oral direct Factor Xa inhibitors increased significantly (P for trend <0.001).

Conclusions: In this study, 30-day mortality was lower in the group with than without chemotherapy group. Among VTE patients with cancer, direct Factor Xa inhibitors appear to be preferred over warfarin due to bleeding risk.

Background: The significance of routine electrocardiogram (ECG)-based cardiovascular disease (CVD) screening, particularly whether routine ECGs contribute to primary prevention or early detection of CVD, remains controversial worldwide.

Methods and results: A literature review was conducted to compare and contrast policies across countries. In Western countries, regular ECG screening is not recommended due to uncertain clinical efficacy; however, recent Japanese studies have supported routine periodic ECGs. Furthermore, analysis of national statistical indicators compiled by the Ministry of Health, Labour and Welfare in Japan, broken down by prefecture, suggested that regions with higher rates of regular ECG screening have higher rates of new outpatient visits for CVD and lower cerebrovascular mortality rates.

Conclusions: Routine ECG screening for CVD in adults has the potential to contribute to early detection, optimization of treatment interventions, and improvement of CVD prognosis.

Background: This study investigated the effects of pre- and post-hospitalization exercise habits on readmission among older (age ≥65 years) heart failure (HF) patients.

Methods and results: The study included 98 older patients who were admitted to Odawara Municipal Hospital because of HF (mean [±SD] age 80.6±7.8 years; 41.8% female). Patients were categorized into 4 groups based on pre- and post-hospitalization exercise habits: persistent non-exercisers; exercise dropouts; new exercisers; and persistent exercisers. Exercise was defined as engaging in ≥30 min of moderate or vigorous exercise at least once a week. The primary outcome was all-cause readmission during the 1-year follow-up period. Twenty (20.4%), 25 (25.5%), 39 (39.8%), and 14 (14.3%) patients were classified as persistent non-exercisers, exercise dropouts, persistent exercisers, and new exercisers, respectively. Of the 98 patients in the study, 46 (46.9%) were readmitted during the 1-year follow-up period. In Cox proportional hazards analyses, newly exercising (hazard ratio [HR] 0.14; 95% confidence interval [CI] 0.03-0.53; P=0.004) and persistent exercising (HR 0.23; 95% CI, 0.09-0.57; P=0.001) remained independent prognostic factors for reduced rates of readmission, even after adjusting for confounding factors.

Conclusions: We found that continuing or starting exercise after hospital discharge is associated with lower rates of readmission among HF patients. Regular post-discharge assessments of exercise habits are essential for older HF patients.

Background: In-stent occlusions in femoropopliteal lesions (FP-ISOs) remain a significant clinical issue. Excimer laser atherectomy (ELA) can ablate tissue, including thrombi, and may therefore be effective in FP-ISOs, which frequently contain both thrombi and neointimal hyperplasia. Angioscopy can directly visualize the stent lumen, making it useful for distinguishing thrombi from neointimal hyperplasia. Here, we investigated whether angioscopy-guided ELA was useful for FP-ISOs.

Methods and results: We studied 10 consecutive patients with FP-ISO who underwent endovascular therapy (EVT) with ELA between August 2020 and May 2023. Based on preprocedural angioscopy, patients were divided into 2 groups (n=5 in each): M (thrombi <70% of lesion length) and S (thrombi ≥70%). Outcomes, including Thrombolysis in Myocardial Infarction (TIMI) flow grade and major adverse events (MAE; restenosis, amputation, and death) were compared. There were no significant differences between the 2 groups in TIMI grade 3 flow just after EVT or in the ankle-brachial pressure index 1 month after EVT. Clinical outcomes after ELA were similar between the M and S groups (6-month patency: 60% vs. 80%, respectively [P=0.49]; MAE rate: 40% vs. 60%, respectively [P=0.53]). Five patients receiving direct oral anticoagulants (DOACs) had no events.

Conclusions: ELA effectively vaporized thrombi in FP-ISOs, achieving comparable outcomes regardless of thrombus burden. Angioscopy-guided ELA, particularly combined with DOAC therapy, may represent a useful strategy for managing FP-ISOs.

Background: The left atrial volume index (LAVi) is a sensitive surrogate marker for left ventricular diastolic dysfunction (LVDD) and is associated with poor outcomes. Although LVDD is associated with coronary microvascular dysfunction (CMD), the prognostic significance of coexisting elevated LAVi and CMD remains unclear. This study aimed to assess the significance of coexisting elevated LAVi and CMD.

Methods and results: We studied 330 patients who underwent intracoronary physiological assessment for suspected ischemia with non-obstructive coronary artery disease. Among these patients, 75 had LVDD, and 107 had coronary flow reserve (CFR) <2.5. Patients were classified into 4 groups: Group 1, normal LAVi and CFR; Group 2, elevated LAVi only; Group 3, impaired CFR only; and Group 4, abnormal LAVi and CFR. The primary endpoints were major adverse cardiovascular events (MACE), including cardiovascular death, acute coronary syndrome, and heart failure requiring hospitalization. During a median follow-up of 759 days, 16 (4.8%) patients experienced 18 events. Event-free survival was significantly lower in Group 4 than in the other groups (P<0.01).

Conclusions: The coexistence of elevated LAVi and impaired CFR is associated with a significantly higher risk of MACE. The combination of LAVi and CFR may improve risk stratification in patients without epicardial coronary stenosis.

Background: The increasing prevalence of heart failure (HF) in aging populations challenges healthcare systems, especially in rural and insular regions of super-aged societies. This study examines hospitalization incidence rates (IRs) and the association between physician experience and HF prognosis in an insular super-aged cohort.

Methods and results: We conducted a retrospective population-based observational study including patients first hospitalized for HF between 2015 and 2019. Among 218 patients, 30 in-hospital deaths were excluded and 188 patients were followed up. We estimated hospitalization and readmission IRs and analyzed the association between physician experience and HF prognosis. Additionally, we conducted a landmark analysis 90 days post-discharge for readmissions. The first hospitalization IR for HF was 135/100,000 person-years (112 men, 157 women), and both rates increased with age. The median age was 86 years; 33% were ≥90 years, and 58% were female. Landmark analysis showed that 90-day all-cause mortality was significantly higher in patients with readmission than in those without (P=0.02). The multivariate Cox model confirmed a significant association between 90-day readmissions and all-cause mortality. The physician experience was not significantly associated with HF prognosis.

Conclusions: This study highlighted the hospitalization IR for HF in a super-aged society and the high risk of all-cause mortality associated with 90-day readmissions. No significant association was identified between physician experience and HF prognosis.

Background: Lower extremity artery disease (LEAD) is a common disease associated with a higher risk of amputation and death. The Geriatric Nutritional Risk Index (GNRI) is a useful marker for assessing nutritional status; however, its relationship with outcomes in patients with LEAD following endovascular therapy (EVT) remains unclear.

Methods and results: This study included 127 patients who underwent initial EVT between April 2010 and December 2022. Patients were divided into 2 groups based on a GNRI score of 92. The primary endpoint was all-cause mortality; the secondary endpoint was major amputation after EVT. The median follow-up period was 47.5 months (interquartile range 34.0-61.8 months). All-cause mortality and major amputation were significantly higher in the group with a GNRI score <92 (log-rank P<0.01). GNRI was independently associated with all-cause mortality after EVT (hazard ratio 0.95 per 1-unit increase in GNRI; 95% confidence interval 0.92-0.97; P<0.01). In addition, in the claudication group, all-cause mortality and major amputation were significantly higher in the group with a GNRI score <92 (log-rank P=0.01 and P=0.02, respectively).

Conclusions: All-cause mortality and major amputation after EVT were significantly higher in the patients with a GNRI score <92 overall, as well as in the claudication group. These findings highlight the importance of addressing nutritional status in the early stages of LEAD to improve clinical outcomes.

Background: Heart failure (HF) is increasing in Japan's rapidly aging population, yet use of implantable cardioverter defibrillators and cardiac resynchronization therapy remains lower than in Western countries. Using data from HINODE, which prospectively evaluated Japanese patients with cardiac devices, we developed interpretable machine learning (ML) models to improve risk stratification and identify key predictors of adverse outcomes.

Methods and results: Among 354 HINODE participants, 332 with adequate data were analyzed. Predictive models (XGBoost; 5-fold cross-validation) targeted HF hospitalization and all-cause mortality. Missingness was handled with multiple imputation; calibration was assessed by calibration plots and Hosmer-Lemeshow tests. Model discrimination was strong (area under the curve 0.83 and 0.85 for HF events and mortality). Shapley additive explanations (SHAP) highlighted QRS duration, QT interval, left ventricular (LV) volumes, and selected medications as major contributors. Using top SHAP features, K-means (k=2) identified low-risk (n=236) and high-risk (n=86) clusters. The high-risk cluster had larger LV volumes, wider QRS, and higher event rates. Kaplan-Meier curves showed significant differences between clusters for HF events (15.7% vs. 47.7%, log-rank P<0.001) and mortality (8.1% vs. 20.9%; hazard ratio 2.58, 95% confidence interval 1.45-4.60). Performance was temporally stable across enrollment periods.

Conclusions: Interpretable ML provided accurate risk prediction and phenotype-based stratification in Japanese HF patients with cardiac devices, supporting personalized management.

Background: The usefulness of the sinus of Valsalva wall thickness for diagnosing concomitant amyloid cardiomyopathy is not evaluated in patient with aortic stenosis (AS).

Methods and results: We investigated 70 consecutive patients with moderate to severe AS who underwent ^{99 m}Tc-pyrophosphate (PYP) scintigraphy at Kumamoto University Hospital between 2012 and 2020. The patients were divided into 2 groups based on ^{99 m}Tc-PYP scintigraphy positivity (n=15) or negativity (n=55). The sinus of Valsalva wall thickness and relative apical longitudinal strain (LS) index (RapLSI, apical LS / [basal LS + mid LS]) were significantly associated with ^{99 m}Tc-PYP scintigraphy positivity when adjusted for severe AS (odds ratio [OR] 3.76; 95% confidence interval [CI] 1.36-10.38; P<0.05; and OR 20.7; 95% CI 2.00-215.44; P<0.05, respectively). Receiver-operating characteristic curve analysis showed that the sinus of Valsalva wall thickness had an area under the curve of 0.77 (95% CI 0.63-0.90; P<0.01) for ^{99 m}Tc-PYP scintigraphy positivity and that the best cut-off value was 1.75 mm (sensitivity 87%, specificity 55%). The ^{99 m}Tc-PYP scintigraphy positivity rate in patients with a sinus of Valsalva wall thickness ≥1.75 mm and RapLSI ≥1.0 was 66.7% and the negativity rate in those with a sinus of Valsalva wall thickness <1.75 mm and RapLSI <1.0 was 96.2%.

Conclusions: The sinus of Valsalva wall thickness was useful for predicting ^{99 m}Tc-PYP scintigraphy positivity in patients with AS.