Circulation reports最新文献

Background: Malnutrition worsens outcomes in heart failure (HF). Although nutritional therapy is important, evidence for enhanced nutritional care (ENC) combined with exercise therapy (ET) is limited.

Methods and results: This systematic review and meta-analysis evaluated ENC, alone or with ET, in HF. Randomized controlled trials (RCTs) published to March 31, 2023, were identified through comprehensive searches. Meta-analyses used a random-effects model with risk ratios (RRs) or mean differences (MDs) and 95% confidence intervals (CIs). Twenty-five RCTs were included: 20 assessed ENC alone and 5 assessed ENC+ET. ENC alone did not reduce all-cause mortality but was associated with fewer post hoc-defined cardiovascular events (RR 0.64; 95% CI 0.48-0.85), driven largely by 1 study and considered exploratory. ENC+ET improved 6-min walk distance (MD 39.85 m; 95% CI 13.05-66.65) and handgrip strength.

Conclusions: ENC may reduce cardiovascular events and improve physical function in HF, particularly with ET, but evidence is preliminary and large-scale trials are warranted.

Background: Although pulse rate variability (PRV) is considered a potential surrogate marker for heart rate variability in the assessment of autonomic function, it is not clear whether PRV-derived parameters predict mortality risk in the general population.

Methods and results: Between 2009 and 2018, a total of 5,943 Japanese individuals, aged 30-79 years, were recruited for a prospective study and followed until the end of 2022. The pulse wave was examined over a 5-min period using a fingertip photoplethysmography sensor to determine the resting heart rate (RHR) and the time and frequency domains of PRV. A Cox proportional hazard model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) of PRV-derived parameters for all-cause mortality using the penalized cubic splines method. During 12.4 years of follow up, 437 deaths were recorded. The HR for mortality, adjusted for sex, age, and community, for the lowest quartiles of the standard deviation of the normal-to-normal intervals (SDNN) increased 1.51 times (95% CI 1.15-1.98) vs. the third quartile. Although mortality risk was attenuated after adjustment for several confounders and RHR, PRV-derived parameters of autonomic function showed significant non-linearity of association with mortality risk in the spline analysis.

Conclusions: Low values of PRV-derived autonomic parameters were associated with an increased risk of all-cause mortality in the general Japanese population.

Background: This study aimed to evaluate the effects of protein and amino acid supplementation on physical performance in patients with chronic heart failure (CHF).

Methods and results: Studies from PubMed, the Cochrane Library, CINAHL, Web of Science, and PEDro published up to August 2024 were identified using a comprehensive strategy with no limitations on publication date or language. The primary outcome was physical performance, assessed using the 6-min walk distance (6MWD) test. This study included 15 randomized controlled trials involving a total of 744 patients. Control groups received either a placebo or usual care, including standard heart failure treatment. The meta-analysis demonstrated a significant improvement in 6MWD in the supplementation group compared with controls (mean difference 35.25 m; 95% confidence interval 15.93-54.58; I²=38%). Subgroup analysis showed no significant difference between supplementation alone and supplementation combined with exercise, suggesting independent effects. Patients aged ≥65 years showed similar benefits.

Conclusions: Our meta-analysis indicated that physical performance in patients with CHF was improved by using protein and amino acid supplementation, particularly in older adults or those unable to engage in adequate exercise therapy. However, the overall quality of the evidence was very low.

Background: The clinical implementation of secondary prevention implantable cardioverter-defibrillator (ICD) implantation in hemodialysis (HD) patients in Japan remains poorly characterized. We sought to characterize practice patterns and factors associated with secondary prevention ICD implantation in HD patients surviving cardiac arrest due to ventricular arrhythmias.

Methods and results: Using the nationwide JROAD-DPC database (2012-2020), we analyzed cardiac arrest survivors with ventricular arrhythmias and no prior ICD. We assessed patient factors associated with ICD implantation and analyzed temporal trends in device selection, institutional and geographical variations in utilization patterns among HD patients. Among 17,653 cardiac arrest survivors, 530 of 1,931 HD patients (27%) received ICDs, significantly lower than 6,870 of 15,722 non-HD patients (44%; P<0.001). Multivariable analysis revealed that HD treatment was an independent negative predictor of ICD implantation (odds ratio 0.42, 95% confidence interval [CI] 0.37-0.47). Subcutaneous-ICD use among HD patients increased significantly from 13% to 32% during 2016-2019 (P<0.001 for trend). Among HD patients, ICD implantation rates were consistent across institutional characteristics and geographical regions.

Conclusions: This nationwide analysis revealed significantly lower secondary prevention ICD use in HD patients compared to non-HD patients, with consistent implementation patterns across Japan's healthcare system. These findings provide important baseline evidence for developing consensus regarding ICD therapy and underscore the need for future prospective studies to guide optimal ICD selection in this population.

Background: Cardiac rupture (CR), encompassing both free wall and ventricular septal ruptures, is a serious complication of ST-segment elevation myocardial infarction (STEMI). In this study, we aimed to investigate the incidence, characteristics, and clinical outcomes of CR in patients with STEMI.

Methods and results: The Japan Acute Myocardial Infarction Registry (JAMIR) is a multicenter prospective study. Of the 3,411 patients hospitalized with acute MI between 2015 and 2017, data from 2,626 patients with STEMI (612 women [23.3%]; median age, 68 years) were analyzed. CR occurred in 34 patients (1.3%), comprising free wall rupture in 25 cases (73.5%), ventricular septal rupture in 8 cases (23.5%), and both in 1 case (2.9%). Compared to those without CR, the cumulative incidence of the primary endpoints (cardiovascular death, non-fatal MI, or non-fatal stroke) at 1 year was significantly higher in the CR group (64.7% vs. 7.9%, log-rank P<0.001). Factors independently associated with CR included older age, anterior wall infarction, and prolonged onset-to-admission time. Notably, the incidence of CR increased with longer onset-to-admission times (0-3 h, 0.6%; 3-6 h, 1.7%; 6-12 h, 1.7%; ≥12 h, 3.6%; P for trend <0.001), but was not associated with door-to-device times (≤90 min, 0.7% vs. >90 min, 1.4%; P=0.156).

Conclusions: CR following STEMI is associated with delayed onset-to-admission time and poor clinical outcomes.

Background: Atrial functional mitral regurgitation (FMR) results from left atrial enlargement and dysfunction, typically observed in patients with atrial fibrillation (AF). Predictors of sinus rhythm maintenance after catheter ablation in atrial FMR patients are not well understood.

Methods and results: We retrospectively reviewed 1,410 consecutive patients who underwent initial catheter ablation for AF at Kobe University Hospital between January 2014 and December 2022. Of these patients, 56 (4%; mean [±SD] age 68±8 years; 68% male) had significant (moderate, n=48; severe, n=8) atrial FMR based on pre-ablation transesophageal echocardiography. At follow-up echocardiography, a reduction in the left atrial diameter (LAd) was observed in 30 patients, whereas improvement in mitral regurgitation (MR) was noted in 26. During a mean follow-up period of 835 days, AF recurred in 23 (41%) patients. Kaplan-Meier curves for AF recurrence did not differ based on LAd reductions or MR improvements alone. However, recurrence rates were significantly lower in patients who achieved both LAd reduction and MR improvement than in those who did not achieve both changes (P=0.0259). Multivariate analysis revealed that the combination of LAd reduction and MR improvement was the only significant predictor of a decrease in AF recurrence (hazard ratio 0.275; 95% confidence interval 0.091-0.826; P=0.021).

Conclusions: In AF patients with significant atrial FMR, achieving both LAd reduction and MR improvement after ablation is important to reduce the risk of AF recurrence.

Background: Left ventricular (LV) dysfunction after mitral valve (MV) repair for degenerative mitral regurgitation (DMR) is a poor prognostic factor. Preoperative LV end-systolic diameter (LVESD) and LV ejection fraction (LVEF) are used in guidelines as indices for LV dysfunction, with cut-off values of 60% for LVEF and 40 mm for LVESD. However, these factors have received little validation in Japanese patients.

Methods and results: We evaluated preoperative echocardiographic data in 322 Japanese patients who underwent MV repair for DMR to identify factors associated with postoperative LV dysfunction. Postoperative LV dysfunction was observed in 31 (10%) patients, who had greater LVESD (39±6 mm vs. 33±5 mm; P<0.001) and lower LVEF (62±5% vs. 67±5%; P<0.001) preoperatively, compared with the non-LV dysfunction group. The optimal threshold of preoperative LVESD and LVEF for predicting postoperative LV dysfunction in receiver operating characteristic curve analysis was 36 mm (AUC=0.819; P<0.001) and 61% (AUC=0.706; P<0.001), respectively. Kaplan-Meier analysis showed a significantly lower rate of avoided adverse cardiac events in the LV dysfunction group (P<0.001).

Conclusions: The criteria for LVESD in MV repair in patients with DMR should be lower than the values indicated by the guidelines. Adoption of these revised criteria may improve prognosis after surgery in Japanese patients.

Background: Reliable assessment of pitting edema remains a challenge, especially in remote care, because it is inherently subjective. We developed a video-based deep learning (DL) model to objectively classify the severity of pitting edema.

Methods and results: A total of 247 videos from 34 consecutive hemodialysis patients were analyzed. A convolutional neural-network (EfficientNetB0) was trained using pre and postpressing pretibial images graded on a 0-4 scale. The model achieved 81.5% accuracy, 81.2% sensitivity, and 81.9% specificity in distinguishing grades 3-4 edema from grades 0-1. For extreme cases (grade 0 vs. 4), accuracy improved to 85.8%.

Conclusions: This pilot study demonstrated feasibility of video-based DL for edema detection. Larger, more diverse datasets and clinical validation are needed for generalization.

Background: Transient high-glucose exposure induces Erk2 phosphorylation and cell proliferation in human coronary artery endothelial cells (HCAEC), but the upstream mechanisms remain unclear.

Methods and results: HCAEC were exposed to 183 mg/dL L-glucose or D-glucose for 1 h followed by 23 h in a glucose-free medium. Transient high D-glucose decreased miR-138 levels, increased Giα2 protein levels, inactivated Rap1, and activated Ras, leading to Erk2 activation.

Conclusions: Transient high D-glucose exposure activates Erk2 via the miRNA-138/Giα2/Rap1/Ras signaling axis, suggesting a potential therapeutic target for atherosclerosis.

Background: Spontaneous coronary artery dissection (SCAD) causes acute myocardial infarction (AMI). Clinical characteristics of SCAD patients remain insufficiently understood.

Methods and results: We analyzed AMI patients aged ≤60 years using the nationwide Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination database (2012.04.01-2022.03.31). SCAD was defined by International Classification of Diseases, 10th revision code I24.8 and the presence of keyword 'coronary artery dissection'. The primary outcome was in-hospital all-cause mortality. Among 96,304 eligible patients, 330 (0.34%) had SCAD. SCAD patients were younger (P<0.001), more often female (P<0.001), and had fewer atherogenic risk factors. They less frequently received aspirin (P<0.001), angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (P<0.001), statins (P<0.001), and percutaneous coronary intervention (PCI; P<0.001). After propensity score matching, in-hospital all-cause mortality did not differ between SCAD and non-SCAD patients (1.0% vs. 2.9%; P=0.142). The subgroup analysis revealed that the use of aspirin was associated with a lower adjusted in-hospital all-cause mortality (P=0.002), whereas primary PCI (P=0.223), β-blocker (P=0.646), and statin (P=0.608) were not. Of note, older SCAD patients were more likely to exhibit inferior MI (P=0.036 for trend) with shorter duration of hospitalization (P=0.025 for trend).

Conclusions: Short-term outcomes in SCAD patients are comparable with those of atherosclerotic AMI. While aspirin lowered in-hospital mortality, PCI, β-blocker, and statin did not. Our findings suggest the need for physicians to select appropriate therapeutic management in SCAD patients to achieve better outcomes.