Circulation reports最新文献

Background: Although the COVID-19 pandemic altered hospitalization trends for acute cardiovascular diseases (CVD) in Japan, the effects of a concomitant COVID-19 diagnosis on mortality in this high-risk population remains unclear. We investigated the association between COVID-19 infection and 30-day mortality among patients hospitalized for acute CVD using a nationwide database.

Methods and results: This retrospective cohort study used data from the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC) database from January 2020 to March 2022. We included patients hospitalized for acute myocardial infarction, acute heart failure, aortic rupture, or venous thromboembolism. We compared patients with and without COVID-19, with 30-day mortality as the primary outcome. We used 1 : 1 propensity score matching to balance baseline patient and hospital characteristics. Of 395,671 eligible patients in the JROAD-DPC database, 41,794 (10.6%) had a concomitant COVID-19 diagnosis. In the matched cohort of 41,794 pairs, the risk of 30-day mortality was significantly higher patients for patients with than without COVID-19 (6.6% vs. 5.8%; odds ratio 1.14; 95% confidence interval 1.08-1.21; P<0.001). This increased risk was consistent across all major diagnostic subgroups (P for interaction >0.3).

Conclusions: In this large nationwide study of patients hospitalized for acute CVD in Japan, concomitant COVID-19 infection was associated with a significant increase in 30-day mortality. These findings suggest that COVID-19 infection is associated with increased mortality in this vulnerable patient population.

Background: Cancer therapy-related cardiac dysfunction (CTRCD) is a recognized complication of breast cancer treatment. Although early detection using cardiac biomarkers such as cardiac troponin I (cTnI) is recommended, the impact of CTRCD on cancer prognosis remains unclear.

Methods and results: We conducted a prospective observational study of 273 patients with breast cancer treated with anthracycline-based chemotherapy and/or human epidermal growth factor receptor 2 (HER2)-targeted therapy at Fukushima Medical University between January 2016 and July 2022. Serial measurements of cTnI, B-type natriuretic peptide (BNP), and echocardiographic parameters were performed at baseline and at 3, 6, 12, and 24 months. CTRCD was defined based on declines in left ventricular ejection fraction (LVEF) and categorized as mild, moderate, or severe. CTRCD occurred in 40 (14.7%) patients. Even mild CTRCD was associated with greater reductions in LVEF at 12 months in patients with elevated cTnI, although recovery was observed by 24 months. Kaplan-Meier analysis revealed significantly shorter progression-free survival in the CTRCD group. In multivariable analysis, CTRCD was an independent predictor of cancer progression (hazard ratio 2.50; 95% confidence interval 1.17-5.36; P=0.018).

Conclusions: CTRCD following cardiotoxic chemotherapy was associated with reduced progression-free survival in patients with breast cancer. These findings underscore the importance of early CTRCD detection not only for cardiac protection but also as a prognostic indicator in cancer management.

Background: The impact of emergency surgery for acute type A aortic dissection (ATAAD) on renal function in patients with autosomal dominant polycystic kidney disease (ADPKD) remains unclear.

Methods and results: The renal function of 4 patients with ADPKD undergoing emergency ATAAD surgery remained unchanged up to 30 days postoperatively. During follow-up of 2 patients, 1 progressed from Stage 4 chronic kidney disease (CKD) preoperatively to Stage 5 at 3 years postoperatively, while the other progressed from Stage 3b CKD preoperatively to Stage 4 at 5 years postoperatively.

Conclusions: Emergency surgery for ATAAD had no effect on renal function.

Background: Several studies have reported that age influences the severity of hospitalization-associated disability (HAD) after cardiac surgery. However, age-specific differences in the incidence and characteristics of HAD remain unclear. Therefore, this study aimed to clarify the incidence and characteristics of HAD according to age group.

Methods and results: This prospective, multicenter observational study included 604 patients who underwent elective cardiac surgery at 12 acute-care hospitals. HAD was defined as a decrease of ≥5 points in the Barthel Index score from the preoperative assessment to the discharge assessment. The HAD incidence rate was 6.8% for patients aged 65-74 years, 14.5% for patients aged 75-89 years, and 10.4% overall. The characteristics varied by age group. In the 65-74 age group, the incidence of HAD was influenced by a higher prevalence of comorbidities, level of prehospital nursing care, preoperative left ventricular ejection fraction, intubation time, and physical function. In the 75-89 age group, HAD incidence was associated with Kihon Checklist score, level of nursing care, the use of rehabilitation services, preoperative physical function, and intubation time.

Conclusions: The incidence of HAD in post-cardiac surgery patients was 10.4%, increasing with age. Factors affecting the incidence of HAD differed by age group.

Background: Atrial fibrillation (AF) after bioprosthetic valve (BPV) replacement is common in older patients with multiple comorbidities and is associated with a heightened risk of thromboembolism. Anticoagulation therapy is often indicated, but renal impairment and other comorbidities elevate bleeding risk, making clinical decisions complex. This study compared clinical outcomes between warfarin and direct oral anticoagulants (DOACs) in this high-risk population.

Methods and results: This subgroup analysis of the BPV-AF Registry included 612 patients treated with oral anticoagulants after BPV replacement, stratified by renal function: normal or mild impairment (creatinine clearance [CCr] ≥50 mL/min), mild-to-moderate impairment (30 mL/min ≤ CCr < 50 mL/min), and moderate-to-severe impairment (15 mL/min ≤ CCr < 30 mL/min). Baseline characteristics and outcomes were analyzed within each stratum. The composite outcome of stroke, systemic embolism, and cardiovascular events was numerically less frequent in the DOAC than warfarin group across all strata, although the differences were not statistically significant. Major bleeding also tended to be lower in the DOAC group.

Conclusions: In this study from a Japanese nationwide registry comparing outcomes of AF patients after BPV replacement with severe renal impairment between those treated with DOACs and those treated with warfarin, comparative conclusions between DOACs and warfarin cannot be drawn because of the small sample size. Nonetheless, both anticoagulants may be acceptable in clinical practice, highlighting the need for individualized decision-making based on patient risk.

Despite advances in the treatment of cardiogenic shock (CS), it remains associated with high mortality rates. To improve patient outcomes, management in a dedicated care center has been proposed. However, the definition of a dedicated CS center has not been systematically examined, and no consensus exists across major societies or guidelines. The aim of this scoping review was to identify key elements defining CS centers linked to better patient outcomes and guide future research. This review was conducted in accordance with the PRISMA extension for scoping reviews. The PubMed, Cochrane, and Web of Science electronic databases were systematically searched to identify studies published from inception to July 19, 2023. Twenty observational studies examining hospital characteristics and patient outcomes with CS were included. Higher volumes of CS patients, more board-certified cardiologists, percutaneous coronary intervention (PCI) availability 24/7, and the presence of cardiovascular intensive care units, left ventricular assist device (LVAD) centers, and hub-and-spoke systems were associated with better outcomes. Inconsistent associations were observed for the number of PCIs, extracorporeal membrane oxygenation, and percutaneous microaxial ventricular assist device procedures, and LVAD case volume and the availability of cardiac surgical support were not associated with improved outcomes. This scoping review identified candidate elements of CS centers linked to better outcomes, providing a foundation for developing an optimal CS care system.

Background: Heart failure (HF) is an increasing public health concern in Japan, largely related to the aging population. This protocol describes the rationale, objectives, and methods of the Hokuriku-plus Heart Failure Registry (HpHFR), designed to establish a comprehensive clinical and digital database to assess novel prognostic indicators in patients with HF.

Methods and results: HpHFR is a prospective, multicenter observational cohort study that has enrolled patients with acute or chronic HF from 5 Japanese centers. Eligible patients provided informed consent and underwent baseline clinical, laboratory, and biometric assessment, including digital phonocardiography and wearable device data. Follow-up assessment will be conducted at 4, 12, 26, and 52 weeks. Primary outcomes include all-cause death, HF-related hospitalization, and worsening HF. Secondary outcomes are the changes in clinical parameters over time. A digital substudy will investigate continuous biometric monitoring, and a genomic substudy explores the loss of chromosome Y as a prognostic biomarker.

Conclusions: In conclusion, this study protocol summarizes the development of a valuable prospective cohort resource. This registry will provide a unique dataset enabling multifaceted investigations to improve HF prediction and management by systematically integrating comprehensive clinical and laboratory data with biometric indicators derived from digital devices and genomic markers.

Background: Hospitalization-associated disability (HAD) is linked to poor post-discharge outcomes in older individuals with heart failure (HF). We investigated whether HAD could be predicted by physical activity measured using a wearable device.

Methods and results: We retrospectively analyzed data from 104 older individuals with HF whose physical activity was recorded for 3 consecutive days after initiating cardiac rehabilitation. Physical activity was categorized as sedentary behavior (≤1.5 metabolic equivalents [METs]), light-intensity physical activity (LPA; 1.6-2.9 METs), and moderate-to-vigorous physical activity (≥3.0 METs). HAD was observed in 31 (29.8%) individuals. LPA duration was significantly shorter in the HAD than non-HAD group (mean [±SD] 45.7±24.9 vs. 121.2±67.4 min/day; P<0.0001). In receiver operating characteristic curve analysis, the optimal LPA cut-off was 68 min/day, with 87.1% sensitivity and 80.8% specificity (area under the curve=0.888; P<0.0001).

Conclusions: Physical activity measured using a wearable device may be useful in predicting HAD in older individuals with HF.