Circulation reports最新文献

Background: The clinical differences between intra-aortic balloon pumping (IABP) and a microaxial flow pump (Impella) for left ventricular (LV) unloading in patients with fulminant myocarditis (FM) supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) remain unclear.

Methods and results: In this single-center, retrospective cohort study, we analyzed 27 consecutive patients with lymphocytic FM who received VA-ECMO support. Patients were stratified by the LV unloading device that was used: IABP (n=15); or Impella (n=12). The primary endpoint was a composite of all-cause mortality or implantation of an extracorporeal ventricular assist device (exVAD) within 30 days of VA-ECMO initiation. Temporal changes in laboratory and hemodynamic parameters during the first 7 days of support were also assessed. Baseline characteristics, including LV ejection fraction (IABP 16% vs. Impella 18%; P=0.814) and QRS duration (139 vs. 105 ms; P=0.805), were comparable between groups. Nine patients met the primary endpoint (mortality [n=7]; exVAD implantation [n=2]). Kaplan-Meier analysis revealed a significantly lower incidence of the primary endpoint in the Impella group (log-rank P=0.018). The Impella group also showed a significantly greater improvement in cardiac power output (group×time interaction, P=0.040). Hemolysis, elevated total bilirubin, and increased serum creatinine were more pronounced in the Impella group.

Conclusions: In patients with FM requiring VA-ECMO, LV unloading with Impella was associated with improved short-term clinical outcomes compared with IABP.

Background: Drug-coated balloon (DCB) is a novel treatment option for percutaneous coronary intervention (PCI). The presence of heart failure (HF) in patients with coronary artery disease (CAD) is associated with a poor prognosis. However, the clinical significance of DCB-based PCI in CAD patients with HF is unknown.

Methods and results: This was a retrospective analysis of a cohort study from a prospective, single center registry from 2015 to 2024. We enrolled 258 CAD patients with chronic HF who underwent PCI with DCB or in combination with a drug-eluting stent (DES). Propensity score matching analysis was performed between the DCB-based PCI and DES-only PCI groups. The primary endpoint of this study was all-cause mortality. Baseline clinical characteristics were comparable between the groups. The total DES number and length were significantly reduced in patients with DCB-based PCI than in those with DES-only PCI. Kaplan-Meier analysis revealed that the DCB-based PCI group had a significantly lower rate of all-cause mortality compared with the DES-only group (log-rank test, P=0.04).

Conclusions: In CAD patients with chronic HF, DCB-based PCI was associated with a lower risk of mortality compared with DES-only PCI.

Background: The prognosis of acute myocarditis (AM) is difficult to predict due to its variable presentation. We investigated the prognosticators of AM patients requiring hospitalization.

Methods and results: We conducted a multicenter observational study including 80 hospitalized AM patients. The primary endpoint was a composite of all-cause death, heart transplantation, and implantation of ventricular assist devices during the index hospitalization. Thirteen (16%) patients reached the endpoint. Longer QRS duration at admission independently predicted adverse outcomes, with an optimal cut-off of 130 ms.

Conclusions: Prolonged QRS duration at admission might predict in-hospital prognosis in AM patients regardless of whether or not it was fulminant.

Background: Drug-coated balloon (DCB) angioplasty has shown short-term feasibility for large-vessel coronary artery disease (CAD; ≥3 mm); however, long-term outcomes remain unclear. This study aimed to evaluate the 5-year cardiovascular outcomes of DCB angioplasty vs. drug-eluting stents (DES) for de novo large-vessel CAD.

Methods and results: This single-center retrospective study analyzed patients undergoing percutaneous coronary intervention (PCI) with either DCB (SeQuent Please) or DES (Xience Alpine) between January 2016 and December 2018. The primary outcomes were cardiovascular events (CVE), defined as a composite of cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR). Secondary outcomes included minimal lumen diameter (MLD), diameter stenosis (DS), and late lumen loss (LLL), assessed at the index PCI and at the 1-year angiographic follow up. Overall, 114 patients (122 lesions) in the DCB group and 269 patients (293 lesions) in the DES group were analyzed, with similar median follow-up durations (1,678 vs. 1,825 days; P=0.687). At 5 years, TLR and CVE rates were comparable between the DCB and DES groups (7.9% vs. 4.5%, P=0.239; and 11.4% vs. 10.4%, P=0.773, respectively). No significant differences in MLD, DS, or LLL were observed between the groups at the 1-year follow up.

Conclusions: With careful lesion selection and preparation, DCB angioplasty could serve as a feasible treatment option for de novo large-vessel CAD in clinical practice.

Background: Day-to-day home blood pressure variability (BPV) is associated with cardiovascular risk and influenced by environmental conditions. However, it is unclear whether short-term increases in day-to-day BPV can be predicted from personal sensor data. In this study, our aim is to develop and validate a machine-learning prediction model for short-term increases in day-to-day BPV using personal sensor data on behavioral and environmental exposure.

Methods and results: We will conduct a 30-day monitoring study in community-dwelling adults. Participants will measure home BP twice daily, while a portable sensor and an activity tracker record environmental conditions and physical activity. The primary outcome is an episode of increased systolic day-to-day BPV, defined as a rolling 5-day coefficient of variation ≥11.0%. Candidate predictors will be derived from the preceding 5-day exposure window. We will construct window-level data, allocate participants to training and test sets, and train machine-learning models with participant-level cross-validation. We will evaluate performance using the area under the receiver operating characteristic curve, calibration, Brier score, and decision-curve analysis, and interpret the XGBoost model with Shapley additive explanations to quantify the predictor contributions.

Conclusions: This protocol outlines a framework for predicting short-term increases in day-to-day BPV from personally experienced environmental exposure and behaviors, supporting future personalized interventions targeting modifiable environmental and behavioral factors.

Background: Postoperative declines in activities of daily living (ADL) are concerning in older adults undergoing cardiovascular surgeries. Sarcopenia represents a determinant of such adverse outcomes. We examined whether preoperative sarcopenia and its components predicted postoperative ADL decline in older patients who underwent elective cardiovascular surgeries.

Methods and results: This retrospective cohort study included 589 patients aged ≥65 years who underwent elective coronary artery bypass grafting, heart valve surgery, or thoracic aortic surgery. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. ADLs were assessed using the Barthel Index, with in-hospital ADL decline being defined as a ≥10-point reduction. Thirty-three (5.6%) patients had sarcopenia preoperatively. ADL decline was significantly higher in the patients with sarcopenia compared with those without (15.2% vs. 5.0%; P=0.014). Multivariable logistic regression analyses demonstrated that sarcopenia was independently associated with ADL decline (odds ratio 3.094; 95% confidence interval 1.067-8.968; P=0.038). Each sarcopenia component - low muscle mass, low muscle strength, and slow gait speed - was also independently associated with ADL decline (all P<0.050). Age-adjusted receiver operating characteristic analyses showed that sarcopenia demonstrated moderate discrimination for predicting postoperative ADL decline, with an area under the curve of 0.707.

Conclusions: Preoperative sarcopenia and its individual components independently predicted in-hospital ADL decline following cardiovascular surgery. Preoperative assessments may help identify high-risk patients.

Background: Because snowfall may affect the acute outcomes of severe cardiovascular diseases by prolonging emergency medical service (EMS) response times, we investigated the association between snowfall and EMS response times for out-of-hospital cardiac arrests (OHCAs) in the regions of Japan.

Methods and results: We used the Utstein database, a nationwide population-based registry that collects data on all OHCA patients in Japan, during winter from 2009 to 2019. A prefecture-specific logistic regression model was applied to estimate odds ratios (ORs) of prolongation of EMS response time (≥7 min), which was associated with poorer neurological outcomes, on days with moderate/heavy snowfall compared to no-snowfall days. A random-effects meta-analysis model was applied to obtain pooled ORs in both overall and subgroup analyses ("heavy snowfall prefectures" and "non-heavy snowfall prefectures"). Among 94,428 bystander-witnessed cardiogenic OHCA patients, the ORs of prolonged EMS response time were 1.05 (95% confidence interval (CI): 0.96, 1.14) on moderate snowfall days and 1.22 (95% CI: 1.07, 1.40) on heavy snowfall days, compared to no-snowfall days. Subgroup analysis revealed no statistical difference between heavy snowfall prefectures and non-heavy snowfall prefectures, although ORs were higher for heavy snowfall prefectures.

Conclusions: Snowfall prolongs EMS response time to cardiogenic OHCA in both areas with heavy snowfall and those with less snowfall, which may also impact survival and neurological outcomes.

Background: Postoperative atrial fibrillation (POAF) after cardiac surgery requires prompt intervention. We compared landiolol with verapamil for POAF treatment.

Methods and results: This randomized trial enrolled 179 patients; 45 developed POAF. Landiolol achieved higher sinus rhythm conversion at 8 h (73.3% vs 16.7%; P=0.0016), but not at 12 h. No differences were observed in recurrence, adverse events, or intensive care unit stay.

Conclusions: Landiolol facilitates earlier rhythm conversion without clear short-term clinical benefit.

Background: The clinical impact of left QRS axis deviation (LAD) during new-onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) remains unclear.

Methods and results: This single-center retrospective study analyzed 254 patients who developed new-onset LBBB during hospitalization after TAVR. Clinical and echocardiographic outcomes were compared between patients with LBBB and LAD (LBBB_LAD) and those with LBBB and a normal QRS axis (LBBB_NA). 96 patients (38%) had LBBB_LAD, defined as a QRS axis <-30°. A more leftward preprocedural QRS axis independently predicted LBBB_LAD (odds ratio 1.20 per 10° decrement; 95% confidence interval (CI) 1.09-1.33; P<0.01). At 3 years, there were no significant differences between groups in all-cause death (28% vs. 19%; P=0.14), cardiovascular death (6% vs. 5%; P=0.73), or heart failure rehospitalization (18% vs. 10%; P=0.07). However, LBBB_LAD was associated with a higher incidence of permanent pacemaker implantation (PPI) for atrioventricular conduction disorder (16% vs. 6%; P=0.02) and remained an independent predictor of PPI (Cox hazard ratio 2.46; 95% CI 1.06-5.73; P=0.04). Echocardiographic measures, including left ventricular ejection fraction, chamber size, and mitral regurgitation severity showed no significant longitudinal differences between groups.

Conclusions: Compared to post-TAVR LBBB_NA, post-TAVR LBBB_LAD is associated with an increased need for PPI, but not with adverse mortality or heart failure outcomes at 3-year follow-up. Closer and extended rhythm monitoring may be warranted in this subgroup.

Background: Data on the clinical outcomes and hemodynamic performance of the smallest commercially available bioprostheses (19 mm) in Japan for aortic valve replacement (AVR) remain limited.

Methods and results: We analyzed the data of 187 adults (median age, 76 [interquartile range (IQR): 73-80] years; 165 women [88%]; median follow-up, 65 [IQR: 32-95] months) with symptomatic aortic valve stenosis, regurgitation, and valve deterioration who underwent surgical AVR between January 2015 and July 2024 with the Avalus (n=7), Magna (n=77), Epic (n=26), Inspiris (n=58), or Mosaic (n=27) bioprosthesis because of having small aortic annuli. The primary and secondary endpoints were all-cause death and major adverse cardiac events, respectively. Moderate-to-severe prosthesis-patient mismatch occurred in 53 patients (28%). The overall survival rates (95% confidence interval [CI]) at 1, 3, and 5 years after valve replacement were 93.0% (88.3-95.9%), 87.0% (81.0-91.2%), and 85.7% (79.5-90.1%), respectively. The rates of freedom from major adverse cardiac and cerebrovascular events (95% CI) at 1, 3, and 5 years were 96.2% (92.1-98.2%), 90.2(84.5-93.9%), and 88.7(82.5-92.7%), respectively. Four patients required re-intervention (3, re-AVR and 1, medication). No significant differences were observed in either outcomes or hemodynamics among the different aortic bioprostheses.

Conclusions: Surgical replacement with 19-mm third-generation aortic valve bioprostheses for small aortic annuli is feasible with favorable early and mid-term hemodynamics.