Circulation reports最新文献

Background: Inflammation in epicardial adipose tissue (EAT) has been hypothesized to influence heart structure and function, thereby contributing to aortic valve (AV) disease. However, it remains unclear how the biological state of EAT is related to AV hemodynamics.

Methods and results: We studied 50 patients with AV calcification who underwent elective cardiac surgery (cardiac valve surgery and/or coronary artery bypass graft). Echocardiographic data (AV area index [AVAI] and peak transvalvular AV velocity [PAVV]), were acquired before surgery. During cardiac surgery, 2 EAT samples were obtained for immunohistochemistry and the number of CD68- and CD11c-positive macrophages and osteocalcin-positive cells was counted in 6 random high-power fields (×400 magnification). PAVV, but not AVAI, was positively correlated with the number of CD11c-positive macrophages and osteocalcin-positive cells in EAT in patients with clinical AV stenosis (AS), defined as PAVV ≥2.5 m/s. On multivariate analysis adjusted for left ventricular function, the number of osteocalcin-positive cells in EAT was independently correlated with increased PAVV (β=0.42; P=0.013) and the presence of clinical AS (odds ratio per 1-unit increase 1.14; P=0.011), whereas there was no correlation between increased PAVV or the presence of clinical AS and the number of CD68- and CD11c-positive macrophages in EAT.

Conclusions: The biological activities of EAT, which are characterized mainly by osteogenic activity, are associated with AV hemodynamics and may contribute to AS progression.

Background: Chronic heart failure (CHF) affects millions worldwide, posing a significant burden on healthcare resources. For patients with HF with reduced ejection fraction (HFrEF) following a worsening event, vericiguat is a promising new treatment. In this study we evaluated the budgetary impact on Japan's health system with the introduction of vericiguat as an add-on to standard of care (SoC) for chronic HFrEF after a worsening event.

Methods and results: An economic model was developed comparing SoC to a scenario in which vericiguat is introduced as an add-on therapy over a 5-year time horizon. A literature review, medical claims data and clinical trial data were used to derive inputs. Total healthcare costs after introducing vericiguat were estimated to increase <1% over 5 years compared to the SoC scenario showing a cumulated budget impact of US$41,027,304. Increases were driven by drug and medical costs, but were partially offset by decreasing costs for hospitalizations, terminal care, and urgent HF visits. In the sensitivity analyses, the hospitalization rate had the largest effect on the overall budget impact.

Conclusions: This analysis highlighted the minimal budgetary impact of vericiguat and its potential to reduce hospitalizations in Japan. Although drug and monitoring costs increased, reductions in acute care expenses helped offset these costs. Further research is needed on long-term cost-effectiveness and real-world outcomes.

Background: Sex differences exist in atherosclerotic cardiovascular disease, partly due to the anti-atherosclerotic properties of estrogens in women. While polyvascular disease (PolyVD) exhibits worse outcomes, it is unknown whether women have an impact on cardiovascular outcomes of PolyVD.

Methods and results: We analyzed 678 coronary artery disease patients receiving PCI. PolyVD was defined as the concomitance of ischemic stroke and/or lower extremity arterial disease (LEAD). The occurrence of 3-year major adverse cardiovascular events (MACE; i.e., all-cause death + non-fatal myocardial infarction + ischemic stroke + ischemic-driven non-culprit lesion revascularization + LEAD) was compared between men and women with and without PolyVD, respectively. Women accounted for 17.8% and 21.1% of patients with and without PolyVD, respectively (P=0.34). In patients without PolyVD, women presented marginally higher on-treatment low-density lipoprotein cholesterol (LDL-C) levels (101.5 vs. 93.0 mg/dL; P=0.05). However, women exhibited a lower 3-year MACE risk (adjusted hazard ratio [HR] 0.31; 95% confidence interval [CI] 0.11-0.88; P=0.02). In patients with PolyVD, women exhibited higher LDL-C levels (103.0 vs. 82.0 mg/dL; P=0.04). Furthermore, even after adjusting clinical demographics and risk factor control, the 3-year MACE risk did not differ between males and females (adjusted HR 0.67; 95% CI 0.29-1.57; P=0.36).

Conclusions: Women without PolyVD were less likely to experience 3-year MACE, whereas cardiovascular outcomes in women with PolyVD were similar to men with PolyVD. These findings suggest a need to intensify anti-atherosclerotic management in both men and women with PolyVD.

Intravenous magnesium is commonly used in clinical practice for treating Torsade de Pointes (TdP), although supporting evidence remains limited. This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension guidelines. Four online databases were searched for relevant studies published as of November 27, 2024, but only 4 observational studies met the inclusion criteria. TdP resolved in a substantial proportion of patients treated with intravenous magnesium (78.3% [N=36/46]), although most studies lacked a control group. No serious adverse events related to magnesium were reported (0% [N=0/46]). Despite several limitations that preclude firm conclusions, intravenous magnesium appears to be a relatively safe and effective treatment for TdP. However, TdP progressed to ventricular fibrillation (VF) in 21.7% (N=10/46) of patients, underscoring the need for readiness to perform immediate electrical defibrillation during treatment. Further high-quality studies are warranted to validate these findings.

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.