Circulation reports最新文献

Background: Sustainability of the 24/7 acute coronary syndrome response system is at risk due to the Work Style Reform for physicians.

Methods and results: A survey of 93 facilities in Chugoku-Shikoku region found that 30% of facilities expected acute coronary syndrome services to be restricted due to the Work Style Reform. Approximately 35% had implemented task shifting, which reduced physicians' workload by 30% and improved team care.

Conclusions: Task shifting improved the working environment. However, various barriers to implementation were also identified. Further investigation is needed to achieve a balance between the Work Style Reform and sustainability of the acute coronary syndrome response system.

Background: Data on the impact of valve position on clinical outcomes in patients with atrial fibrillation (AF) and bioprosthetic valves (BPVs) are limited.

Methods and results: The BPV-AF Registry was a multicenter, prospective, observational study involving 894 patients with BPVs and AF. In this post-hoc substudy, patients were classified according to BPV position: aortic (n=588; 65.8%), mitral (n=195; 21.8%), or both (n=111; 12.4%). The primary outcome was a composite of stroke/systemic embolism, major bleeding, heart failure requiring hospitalization, all-cause death, or BPV reoperation. During a mean follow up of 15.3±4.0 months, the primary outcome occurred in 90 (15.3%) patients (12.7/100 patient-years) in the aortic group, 25 (12.8%; 10.2/100 patient-years) in the mitral group, and 16 (14.4%; 11.8/100 patient-years) in the both-valves group (log-rank P=0.621). The unadjusted and adjusted risks were not significant for the mitral and both-valves groups relative to the aortic group (unadjusted hazard ratio [95% confidence interval] 0.80 [0.52-1.25] and 0.92 [0.54-1.57]; adjusted hazard ratio 0.89 [0.51-1.54] and 1.10 [0.58-2.09], respectively). There was no significant difference in the incidence of stroke/systemic embolism or major bleeding among the 3 groups (log-rank P=0.651 and 0.156, respectively).

Conclusions: In patients with BPVs and AF, the risk for the composite outcome was comparable regardless of the BPV position.

Background: Clinical impact of inframalleolar (IM) angioplasty in patients with chronic limb-threatening ischemia (CLTI) is still controversial.

Methods and results: This single-center, retrospective study included 168 patients with CLTI and tissue loss who underwent angioplasty for IM lesions. Angiographic follow up was performed at reintervention between April 2010 and December 2020. The outcome measure was the incidence of angiographic deterioration characterized by severe restenosis or occlusion of mildly stenotic lesions, occlusion of severely stenotic lesions, or extension of the occlusion length at reintervention. Angiographic deterioration was observed in 47.7% of patients, with the majority attributed to occlusion in severely stenotic lesions. Multivariate analysis revealed that a distal reference vessel diameter ≤1.0 mm in the initial angioplasty (hazard ratio 1.91 [95% confidence interval 1.20-3.04]; P=0.006) was significantly associated with angiographic deterioration of IM lesions at reintervention.

Conclusions: Angiographic deterioration occurred in approximately half of the patients with CLTI who underwent IM angioplasty and reintervention.

Approximately 7,000 ambulatory (outpatient) heart groups (AHG) with 125,000 patients who are physically active on a regular basis have been established in Germany since the mid-1960s. Following phase II cardiac rehabilitation (CR), patients in an AHG aim to meet their set CR goals in groups of up to 20 participants under the instruction of a competent exercise therapist, and with regular attendance by a physician. Physical activity is the dominant aspect; psychosocial and educative elements are integrated to stabilize secondary cardiovascular prevention. Patients are legally entitled by German rehabilitation law to participate in AHGs. According to current studies, only 13-40% of all patients attend an AHG after phase II CR. In 2019, special AHGs for patients with high cardiovascular risk (chronic heart failure) were established. In the future, special emphasis needs to be placed on the recruitment of more patients into AHGs, particularly for the known under-represented groups (i.e., women, older patients, patients with low socioeconomic status). Furthermore, AHGs have to be established for patients with special needs (e.g., adults with congenital heart diseases). To date, the efficiency of AHG participation has still not been sufficiently investigated. A case-control study analyzing the long-term results of AHG participation reported an improvement in physical performance, as well as a reduction in cardiovascular morbidity (54%) and medical costs (approximately 47%). More superior investigations in this field are needed.

In recent years, the adverse effects of prolonged sedentary behavior in daily life, so-called 'sitting too much', on health have been pointed out. Sedentary behavior is defined as 'all waking behavior in which the energy expenditure in a sitting, semi-recumbent, or recumbent position is 1.5 metabolic equivalents or less'. Even if a person engages in the level of physical activity recommended in the guidelines, sitting for too long at other times may increase the risk of developing various diseases and death. For patients with cardiovascular disease, a comprehensive cardiac rehabilitation program that systematically includes not only medical treatment but also exercise therapy, patient education, and disease management is extremely important. Also, differences in sedentary behavior during the acute and recovery phases are known to affect physical function and activities of daily living at the time of hospital discharge. Here, we discuss cardiac rehabilitation that addresses sedentary behavior and review the previous related research.

Background: Constipation often coexists with heart failure (HF) and can cause increased blood pressure variability, which may increase the risk of repeated HF admissions. However, large-scale contemporary data regarding the prognostic effect of constipation in patients with HF are lacking.

Methods and results: We retrospectively identified 556,792 patients admitted for HF for the first time and discharged alive in the fiscal years 2016-2021 using the Japanese Diagnosis Procedure Combination database. Constipation was defined as continued use of laxatives after discharge. We examined the association between constipation and 1-year HF readmission. The prevalence of constipation was 22.0% (n=122,670), which remained stable over the 6 years. Patients with constipation were older (82.7±10.1 vs. 79.3±12.8 years), more often female (53.5% vs. 48.0%), and received medications for HF more frequently at discharge compared with those without constipation. In the multivariable Cox proportional hazards model, constipation was significantly associated with a higher incidence of 1-year HF readmission (24.0% vs. 18.6%; adjusted hazard ratio [HR] 1.08; 95% confidence interval [CI] 1.06-1.10). This result was consistent with the result from the Fine-Gray model accounting for competing risk of death (subdistribution HR 1.08; 95% CI 1.06-1.09).

Conclusions: Constipation was associated with a higher risk of HF readmission after the first episode of HF hospitalization. Given the detrimental effect of constipation, further efforts are warranted to decrease constipation-related risk in patients with HF.

Ehime Prefecture has the highest heart failure mortality rate among men and women in Japan. Healthy life expectancy is low nationwide, which may be related to sarcopenia and frailty. Uwajima City contains a progresses aging of the population in the Ehime Prefecture. Therefore, preventing heart failure requires treatment and patient education not only for the underlying disease, but also for the complications associated with aging, such as sarcopenia and frailty. In 2020, we began working with the fitness club LocomoK.O to focus on prevention after the onset of disease and prevention before onset. We have commenced surveys of healthy older adults living in the community in Uwajima City, including the Short Physical Performance Battery, physical functions such as handgrip strength, and body composition assessment using in-body tests. The data showed that the rate of sarcopenia was extremely high, at 70% in patients with acute heart failure and 39% in the healthy older group, and that 24% of patients with acute heart failure had severe sarcopenia. Based on the collected data, we started health seminars in 2023 to educate citizens about the disease to prevent the onset and recurrence of heart disease, which is in line with the current situation in Uwajima City. We hope that our activities will help those struggling with local medical care.

Background: Non-invasive diagnosis of disease stage in Fabry cardiomyopathy with multimodality imaging is pivotal when deciding on the appropriate time to initiate enzyme replacement therapy. However, this approach has not been well established.

Methods and results: We enrolled 14 patients with Fabry disease. All patients were evaluated using echocardiography and contrast cardiac magnetic resonance (CMR), and were divided into either an early-stage group without left ventricular hypertrophy (LVH; wall thickness >12 mm) or late gadolinium enhancement (LGE; n=7; median age 37 years; 4 female), or an advanced-stage group with LVH and/or LGE (n=7; median age 66 years; 7 female). Strain data from echocardiography and T1 mapping on CMR were compared between the groups. In the advanced-stage group, all strain data were impaired. In the early-stage group, localized longitudinal strain in the basal posterolateral segment was already reduced but both localized and global circumferential strain remained preserved. On CMR analysis, global and localized native T1 shortening were observed in the early-stage group, but were pseudo-normalized in the advanced-stage group. In logistic regression analysis, localized circumferential strain had significant diagnostic value for differentiating between early- and advanced stage (P=0.037) and significantly improved the predictive power of the model containing localized native T1 in CMR.

Conclusions: A combination of localized native T1 in CMR and echocardiographic strain parameters could be useful for staging Fabry cardiomyopathy.