Circulation reports最新文献

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.

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.