Circulation reports最新文献

Background: The optimal period for discontinuing tafamidis in wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) patients based on cost-effectiveness is unknown.

Methods and results: A retrospective analysis of 80 tafamidis-treated ATTRwt-CM patients was conducted. The median follow up was 26.4 months; 17 patients permanently discontinued tafamidis, and 12 patients died after a median of 1.0 month following tafamidis discontinuation. Discontinuation was mainly due to non-cardiovascular hospitalization; deaths were mostly non-cardiovascular and occurred early after discontinuation.

Conclusions: The period from tafamidis discontinuation to death was shorter in ATTRwt-CM patients hospitalized for non-cardiovascular diseases. Discussions of the right period for discontinuation are needed.

Background: Electrode catheter placement into the coronary sinus (CS) is critical for electrophysiologic studies. Although central venous approaches (e.g., internal jugular or subclavian) are well documented, peripheral venous approaches like the cubital vein are not. This study evaluated the feasibility and safety of CS catheter placement via the right cubital vein during atrial fibrillation (AF) ablation.

Methods and results: Of 1,363 consecutive patients who underwent first-time AF ablation at Sakurabashi Watanabe Advanced Healthcare Hospital between January 2019 and December 2021, 1,274 underwent at least 1 right cubital vein puncture attempt. The success rate, causes of failure, and complications were analyzed. CS catheters were successfully placed via the right cubital vein in 1,214 (95.3%) patients, whereas placements were unsuccessful in 60 (4.7%) patients. Although older patients were more likely to experience unsuccessful placements, there were no significant differences in other baseline characteristics between the 2 groups. Unsuccessful placements were attributed to failure in venipuncture or sheath insertion (n=49) and failure to advance the CS catheter through the vein (n=11). No major complications were reported.

Conclusions: CS catheter placement via the right cubital vein demonstrated high feasibility and safety, with a 95% success rate and minimal complications. This approach offers a practical and technically straightforward alternative for placing CS catheters, particularly in patients with adequate vein development.

Background: Electrical storm (ES) is defined as a condition in which ventricular tachycardia (VT) or ventricular fibrillation (VF) episodes requiring electrical shock or implantable cardioverter-defibrillator (ICD) shocks occur ≥3 times within 24 h. It is a life-threatening condition, and treatment options include antiarrhythmic drugs, sedation, circulatory support, and catheter ablation. Sedation is conventionally performed for repeated electrical shocks; however, evidence for its effectiveness in ES suppression remains limited. This scoping review aimed to assess whether the use of sedatives is beneficial for ES suppression.

Methods and results: This scoping review followed the PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. Three online databases were searched to identify studies published from the inception of each database until September 18, 2024. To date, no randomized or quasi-randomized controlled trials or observational analytical studies have met the inclusion criteria for the use of sedation in patients with ES.

Conclusions: This scoping review underscores the need for high-quality studies to enhance the level of evidence and bridge knowledge gaps, ultimately aiming to shift the care paradigm for patients with ES.

Background: We developed the SaFIS, a structured self-administered food intake survey for patients with cardiovascular diseases needing dietary improvements.

Methods and results: The SaFIS comprised questions on 31 items, including staple foods (7 items) and food ingredients (24 items), based on the foods recommended by the Japanese Atherosclerosis Society for the Prevention of Arteriosclerotic Disease. To evaluate reproducibility, SaFIS was administered twice with a 1-month interval using the intraclass correlation coefficient (ICC [1,1]). Validity was assessed by comparing energy and nutrient content from a weighed dietary record (WDR) with the first SaFIS survey using Bland-Altman plots. Reproducibility values were energy (ICC 0.90, 95% confidence interval: 0.80-0.95), protein (0.90, 0.80-0.95), fat (0.76, 0.54-0.88), saturated fatty acids (0.78, 0.58-0.89), monounsaturated fatty acids (0.76, 0.56-0.88), polyunsaturated fatty acids (0.82, 0.66-0.91), carbohydrates (0.89, 0.79-0.95), and dietary fiber (0.86, 0.71-0.93). Bland-Altman values indicated SaFIS-based energy, protein, carbohydrate, monounsaturated fatty acids, and dietary fiber were 67.2 kJ, 5.7 g, 3.9 g, 0.5 g, and 1.8 g greater than WDR-based values, respectively. SaFIS-based fat, saturated, and polyunsaturated fatty acid values were 0.7 g, 1.3 g, and 0.39 g less than WDR-based values, respectively.

Conclusions: SaFIS demonstrated high reproducibility and validity with clinical potential. Subsequent introduction to digital health from the usability perspective is planned.

Background: This study retrospectively evaluated the safety of resuscitation training during the Coronavirus Disease 2019 (COVID-19) pandemic under Japan Resuscitation Council (JRC) guidance.

Methods and results: From 2018 to 2024, all participating staff were monitored by the Infection Prevention and Control Center. Although learner numbers declined in 2020, training sessions increased, and numbers returned to prepandemic levels. The Resuscitation Quality Improvement program enabled flexible, contactless training, further boosting participation. Notably, no COVID-19 cases were linked to training sessions.

Conclusions: These findings demonstrate that resuscitation training can be conducted safely by adhering to JRC guidance, even during a public health crisis.

Background: Decline or inadequate recovery of activities of daily living (ADL) during hospitalization is crucial for clinical prognosis. In this study we investigated the relationship between cardiac rehabilitation (CR) and ADL recovery in patients with cardiovascular disease (CVD), with the aim of exploring associations that may contribute to the development of rehabilitation interventions.

Methods and results: This study analyzed consecutive patients hospitalized with CVD. ADL was assessed using the Barthel index (BI) at the commencement of rehabilitation and discharge. As the outcome measure for ADL, relative functional gain: BI effectiveness, calculated as (discharge BI - initial BI) / (100 - initial BI), was adopted in order to compensate ceiling effect of BI. BI effectiveness ≥0.5 defined the ADL recovery group, while <0.5 defined the ADL non-recovery group. Of the 2,938 patients screened, 1,582 (median age 79 years, male 59%) were included after exclusions. The ADL recovery group consisted of 1,162 patients, the ADL non-recovery group, 420 patients. Between-group comparisons and multivariate regression analysis identified age and initial BI as highly significant ADL recovery determinants. Recursive partitioning analysis showed CR volumes of ≥75 min/day for patients ≥75 years and ≥45 min/day for those <75 years with lower initial BI were associated with ADL recovery. These CR volumes also reduced the institutionalization odds ratios (OR=0.42 and OR=0.34, P<0.001) compared to CR volumes <45 min/day.

Conclusions: CR volume was associated with ADL recovery, especially for older patients with low baseline function at admission. Optimizing CR volume based on patient background and condition may contribute to enhance ADL recovery and improved clinical prognosis.

Background: There is a substantial risk of slow flow during percutaneous coronary intervention (PCI) for the culprit lesion in acute myocardial infarction (AMI), which can lead to adverse outcomes. We hypothesized that single-step long balloon inflation during stent deployment was associated with a more favorable final Thrombolysis in Myocardial Infarction (TIMI) flow grade. This retrospective study aimed to compare both the final TIMI flow grade and the delta TIMI flow grade in intravascular ultrasound (IVUS)-guided PCI for AMI between patients with long balloon inflation and those with conventional inflation.

Methods and results: Long inflation was defined as single-step inflation ≥60 s at stent deployment. The primary endpoints were achievement of the final TIMI flow grade 3 and the delta TIMI flow grade, defined as the difference between the initial and final grades. We analyzed 336 AMI patients with attenuation plaque on IVUS, dividing them into a long inflation group (n=50) and a conventional inflation group (n=286). Despite a significantly higher TIMI thrombus grade in the long inflation group (P<0.001), the rate of the final TIMI 3 flow was similar (90% vs. 88.5%; P=1.00). However, the delta TIMI flow grade was significantly greater in the long inflation group (P=0.028).

Conclusions: Single-step long balloon inflation may be a simple and feasible method to achieve optimal final TIMI flow in IVUS-guided PCI for AMI.

Background: Malnutrition is a significant prognostic factor in chronic heart failure (CHF), particularly among older adults. The geriatric nutritional risk index (GNRI) is a screening tool for assessing malnutrition in this population. Although low GNRI is associated with increased deaths of patients with HF, the prognostic impact of longitudinal GNRI changes in malnourished patients remains unclear.

Methods and results: This post-hoc analysis of the KUNIUMI registry chronic cohort, a prospective observational study of patients with pre-HF/HF, assessed GNRI at baseline and 1-year follow-up. The annual GNRI change (∆GNRI) was calculated, and its association with all-cause death in malnourished patients was analyzed. The primary outcome was all-cause death, with a 2-year follow-up after the initial 1-year assessment. Among 1,242 patients (mean age: 74.4±10.9 years), 19.8% had low GNRI (<92). All-cause death was significantly higher in patients with low GNRI than in those with high GNRI (30.1% vs. 7.1%; P<0.001). In patients with low GNRI, multivariable Cox regression showed a significant association between ∆GNRI and death (hazard ratio: 0.94; 95% confidence interval: 0.91-0.96; P<0.001). Multiple linear regression indicated that nutritional counseling positively influenced ∆GNRI, but HF severity was not significantly associated.

Conclusions: ∆GNRI is a significant prognostic indicator in malnourished patients with pre-HF/HF. Serial GNRI assessments may improve risk stratification and guide nutritional interventions.

Intravenous atropine is widely recommended as the first-line treatment for symptomatic bradycardia, but because the optimal initial dose remains uncertain, the aim of this scoping review was to examine the existing literature on the efficacy and safety of intravenous atropine at specific doses in adult patients with symptomatic bradycardia and to identify gaps in evidence. A systematic search of 4 databases (PubMed, CENTRAL, Web of Science, and Ichushi-Web) was conducted from inception to December 16, 2024. Studies were included if they reported administration of a specified dose of atropine in adult patients, regardless of study design. No randomized controlled trials directly comparing 0.5 mg vs. 1.0 mg were found. A total of 19 studies were included and categorized into groups based on initial atropine dose: low (<0.5 mg), moderate (0.5 mg ≤ dose <1.0 mg), high (≥1.0 mg), and those spanning multiple categories. No consistent relationship was found between atropine dose and clinical outcomes, such as heart rate response or adverse effects. None of the moderate-dose studies reported worsening bradycardia. Moderate-dose atropine could be safe, and the current practice of using 0.5 mg as an initial dose in Japan, where 0.5 mg/mL prefilled syringes are commercially available, appears clinically reasonable. However, in the absence of high-quality comparative data, future research should apply rigorous study designs to determine the optimal atropine dose in emergency care settings.