BACKGROUND: Heart failure (HF) is associated with poor clinical outcomes and is classified into Stages A-D. Estimated plasma volume (ePV) is a marker of plasma volume expansion. Prognostic markers applicable across all H...BACKGROUND: Heart failure (HF) is associated with poor clinical outcomes and is classified into Stages A-D. Estimated plasma volume (ePV) is a marker of plasma volume expansion. Prognostic markers applicable across all HF stages may enable the early identification of patients at high risk of adverse clinical outcomes. This study evaluated the impact of ePV on clinical outcomes in patients with Stage A-D HF. METHODS AND RESULTS: ePV was measured using the PRIME Plus analyzer in 494 patients with HF (Stage A, n=78; Stage B, n=274; Stage C/D, n=142) admitted to our hospital in 2022. Over a median follow-up of 3 years, 95 HF-related events, defined as HF rehospitalization and deaths, and 43 all-cause deaths occurred. Kaplan-Meier analysis demonstrated that patients in the highest ePV tertile had the greatest risk of HF-related events and all-cause deaths. Multivariable Cox proportional hazards regression analysis identified ePV as an independent predictor of HF-related events (hazard ratio [HR] 1.48; 95% confidence interval [CI] 1.26-1.73; P<0.0001) and all-cause deaths (HR 1.35; 95% CI 1.06-1.73; P=0.0158). The addition of ePV to established cardiovascular risk factors significantly improved the C-statistic (0.7009 vs. 0.7415; P=0.0260), net reclassification index, and integrated discrimination index. CONCLUSIONS: This study demonstrates that ePV is a feasible prognostic marker for HF-related events and all-cause deaths in patients with Stage A-D HF.
BACKGROUND: The interventricular septum contributes 30-60% of right ventricular (RV) output. However, few studies have assessed the prognostic value of RV septal strain in pulmonary embolism (PE). We hypothesized that RV...BACKGROUND: The interventricular septum contributes 30-60% of right ventricular (RV) output. However, few studies have assessed the prognostic value of RV septal strain in pulmonary embolism (PE). We hypothesized that RV septal strain would predict 30-day mortality in patients with intermediate-risk PE. METHODS AND RESULTS: This retrospective cohort study analyzed consecutive patients with intermediate-risk PE admitted to the Penn State Health Milton S. Hershey Medical Center between 2010 and 2018. The primary outcome was 30-day all-cause mortality. RV septal strain was measured within the RV endocardium and was defined as the mean of basal, mid, and apical septal longitudinal strain. Among 251 patients, 31 (12.4%) died within 30 days of PE diagnosis. RV strain analysis was feasible in 230 (91.6%) patients. RV septal strain was significantly lower in those who died and was independently associated with 30-day mortality (P<0.001). Receiver operating characteristic curve analysis indicated 14.4% as the optimal RV septal strain cut-off value (area under the curve 0.816). Kaplan-Meier curves demonstrated that 30-day mortality risk was higher among patients with low (≤14.4%) than high (>14.4%) RV septal strain (hazard ratio 9.29; P<0.001). CONCLUSIONS: RV septal strain is a feasible and reproducible parameter with strong prognostic value in patients with intermediate-risk PE. These findings highlight the central role of the interventricular septum in RV function and risk stratification.
BACKGROUND: Effective imaging is lacking for intravascular lesions in pulmonary vascular diseases. Optical coherence tomography (OCT) offers micron-level resolution, enabling improved diagnosis and treatment guidance. Th...BACKGROUND: Effective imaging is lacking for intravascular lesions in pulmonary vascular diseases. Optical coherence tomography (OCT) offers micron-level resolution, enabling improved diagnosis and treatment guidance. This study aimed to evaluate pulmonary arterial lesions using OCT. METHODS AND RESULTS: This retrospective study reviewed consecutive patients with pulmonary arterial lesions undergoing OCT at The First Affiliated Hospital of Guangzhou Medical University between August 2022 and November 2024. Patients with chronic thromboembolic pulmonary disease, Takayasu arteritis, Behçet's disease, or fibrosing mediastinitis were included in the study. Arterial lesions assessed included fresh, subacute, and chronic thrombus, vascular dissection, and other OCT findings. Seventy-two patients (median age 57.5 years [interquartile range 48.0-66.0 years]; 39 [54.17%] males) were included in the study. The OCT features were as follows: fresh thrombus showed irregular regions with marked signal attenuation; subacute thrombus appeared as intraluminal clumps surrounding the catheter; chronic thrombus presented as multichambered mesh-like structures; Takayasu arteritis and Behçet's disease exhibited bead-like eccentric intimal thickening with vacuole-like changes; fibrosing mediastinitis showed an irregular lumen with high attenuation behind the wall; and vascular dissection presented as dark areas with occasional lumen communication and a streak-like longitudinal appearance. CONCLUSIONS: OCT yields high-resolution imaging for detailed assessment of pulmonary vascular diseases and holds promise for clinical application.
Matsunaga-Lee Y, Egami Y, Abe M
… +26 more, Nohara H, Kawanami S, Yasumoto K, Okamoto N, Yano M, Nishino M, Masuda M, Sunaga A, Tanaka N, Watanabe T, Minamiguchi H, Oka T, Minamisaka T, Kanda T, Okada M, Kawasaki M, Matsuda Y, Tanaka K, Makino N, Kida H, Hikoso S, Dohi T, Inoue K, Sotomi Y, Sakata Y, OCVC-SUPPRESS-AF Investigators
BACKGROUND: Incomplete low-voltage area (LVA) ablation may confound evaluation of its true efficacy in persistent atrial fibrillation (AF). This post hoc subanalysis of the multicenter randomized SUPPRESS-AF trial assess...BACKGROUND: Incomplete low-voltage area (LVA) ablation may confound evaluation of its true efficacy in persistent atrial fibrillation (AF). This post hoc subanalysis of the multicenter randomized SUPPRESS-AF trial assessed the impact of complete LVA ablation. METHODS AND RESULTS: Patients with persistent AF and a left atrial (LA) LVA ≥5 cmafter pulmonary vein isolation were randomized to LVA ablation or no additional ablation. The primary endpoint was freedom from AF or atrial tachycardia recurrence, assessed by 24-h Holter and twice-daily electrocardiogram recordings. Outcomes were compared among 3 groups: no LVA ablation; complete LVA ablation; and incomplete LVA ablation. Among 341 patients, 170 underwent LVA ablation, including 37 with incomplete. LVA size was significantly larger in the incomplete than complete ablation group (22.0 vs. 12.2 cm; P<0.001). Incomplete LVA ablation was not associated with increased arrhythmia recurrence. Arrhythmia-free survival did not differ significantly between the complete and no LVA ablation groups (hazard ratio [HR] 0.80; 95% confidence interval [CI] 0.56-1.13), including after propensity score matching (HR 0.76; 95% CI 0.51-1.15). However, a trend towards greater benefit of complete LVA ablation was observed with increasing LA diameter (P=0.099). CONCLUSIONS: Leaving LVA ablation incomplete to avoid complications appears reasonable. Although complete LVA ablation showed no overall superiority, LA enlargement may represent a clinically relevant factor for patient stratification.
Azuma N, Yokoyama H, Isobe M
… +18 more, Sakata Y, Kushimoto S, Morimura N, Hasegawa T, Tsujita K, Saiki Y, Motomura N, Morino Y, Hikoso S, Okada K, Ogino H, Miyamoto S, Kamiya H, Sase K, Ohtsu H, Morikage N, Komori K, Ueda Y
BACKGROUND: The use of information and communication technology (ICT) as a strategy to improve the quality of emergency medical care is gaining attention. A survey was conducted to investigate the extent to which ICT is...BACKGROUND: The use of information and communication technology (ICT) as a strategy to improve the quality of emergency medical care is gaining attention. A survey was conducted to investigate the extent to which ICT is being used in cardiovascular emergencies. METHODS AND RESULTS: A web-based questionnaire survey targeting cardiovascular surgery, cardiology, and emergency medicine departments at 320 facilities was conducted. The survey questions focused primarily on the presence and effectiveness of image sharing between hospitals and information sharing with emergency technicians using ICT, challenges in the use of ICT, and barriers hindering ICT adoption. The adoption rates of ICT for image sharing in cardiovascular surgery and electrocardiogram transmission in cardiology were 24% and 28%, respectively. ICT implementation was evaluated as being highly useful not only for reducing time to treatment but also for improving collaboration between medical professionals both within and outside the hospital. In emergency medicine, ICT collaboration with emergency technicians was implemented at 38% of hospitals, with image sharing at the emergency scene being prevalent. In cardiovascular surgery, 29% of facilities reported that the number of non-urgent transfers decreased or decreased significantly due to ICT implementation. CONCLUSIONS: Although ICT utilization remains at 20-25%, expectations for its widespread adoption are extremely high. Conversely, concerns about the costs and differences in ICT platforms are common, and there is a desire to adopt compatible systems.
BACKGROUND: Atrial fibrillation (AF) is associated with disrupted right ventricular-pulmonary artery (RV-PA) coupling. Pulsed-field ablation (PFA) is less likely to induce an increase in pulmonary arterial pressure; howe...BACKGROUND: Atrial fibrillation (AF) is associated with disrupted right ventricular-pulmonary artery (RV-PA) coupling. Pulsed-field ablation (PFA) is less likely to induce an increase in pulmonary arterial pressure; however, changes in RV-PA coupling following AF ablation using PFA remain unclear. METHODS AND RESULTS: We retrospectively analyzed consecutive patients who underwent AF ablation using PFA. RV-PA coupling was assessed using the echocardiographic tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio before and 3 months after ablation. In all, 103 patients were included in this study: 46 with paroxysmal AF (PAF) and 57 with persistent AF (PeAF), with 41 PeAF patients maintaining sinus rhythm (SR) at 3 months. The TAPSE/PASP ratio improved significantly after AF ablation using PFA in the overall cohort (mean [±SD] 0.794±0.313 vs. 0.906±0.294; P=0.009) and in PeAF patients (0.740±0.343 vs. 0.887±0.282, P=0.01); however, no significant change was observed in PAF patients (P=0.26). PASP did not increase after ablation in any group. Among PeAF patients maintaining SR at 3 months, baseline mean heart rate during AF showed a weak association with changes in the TAPSE/PASP ratio. CONCLUSIONS: AF ablation using PFA was associated with an improvement in RV-PA coupling without an increase in pulmonary arterial pressure, particularly in patients with PeAF in whom SR was maintained at 3 months.
BACKGROUND: Mac-2 binding protein glycosylation isomer (M2BPGi) is a validated biomarker for liver fibrosis in chronic liver disease. We investigated the clinical significance of serum M2BPGi concentrations in patients w...BACKGROUND: Mac-2 binding protein glycosylation isomer (M2BPGi) is a validated biomarker for liver fibrosis in chronic liver disease. We investigated the clinical significance of serum M2BPGi concentrations in patients with Fontan circulation. METHODS AND RESULTS: We prospectively measured serum M2BPGi concentrations in 426 consecutive Fontan patients (mean [±SD] age 23±10 years) and analyzed their associations with patients' pathophysiology, including Fontan-associated liver disease (FALD), as well as all-cause unplanned hospitalization (UPH) and mortality. M2BPGi concentrations were associated with a wide range of Fontan-related pathophysiological features, including characteristic Fontan hemodynamics, total bile acid concentrations, FALD indices such as hepatic fibrosis markers and ultrasonographic image abnormalities, and impaired renal function. Among these variables, older age at Fontan operation, hypoxemia, C-reactive protein, total bile acid levels, and indices of hepatic fibrosis were independently associated with higher M2BPGi concentrations (P<0.05-0.001). During follow-up after the M2BPGi evaluation, 68 patients experienced UPH and 14 patients died. Elevated M2BPGi concentrations were associated with a higher risk of UPH and all-cause mortality (P<0.0001 for both), independent of elevated B-type natriuretic peptide levels. CONCLUSIONS: Serum M2BPGi concentrations reflect both FALD pathophysiology and hemodynamic burden, serving as a strong prognostic biomarker. M2BPGi can be a valuable tool for risk stratification in patients with Fontan failure, including those with FALD.
BACKGROUND: Artificial intelligence-enhanced electrocardiography (AI-ECG) for detecting atrial fibrillation (AF) using sinus rhythm ECGs has shown promise. However, even when AI-ECG results are positive, ECG confirmation...BACKGROUND: Artificial intelligence-enhanced electrocardiography (AI-ECG) for detecting atrial fibrillation (AF) using sinus rhythm ECGs has shown promise. However, even when AI-ECG results are positive, ECG confirmation of AF may not always be obtained immediately. Repeat testing may be required, particularly in patients with a dilated left atrium, who may warrant more intensive monitoring. We aimed to investigate whether newly detected AF was frequent in patients with both high risk on AI-ECG evaluation and dilated left atrium. METHODS AND RESULTS: We used a convolutional neural network-based ECG algorithm to predict AF using data (2010-2022) from the Shinken database (n=12,595 patients without a prior AF event). The 3-year incidence of newly detected AF was compared across 3 left atrial diameter (LAD) categories: <35, 35-39, and ≥40 mm (small, middle, and large, respectively). Patients were stratified by the AI-ECG-generated diagnostic probability of AF (AIECG-AF-DP). The incidence of newly detected AF increased according to LAD category among patients with high (≥0.8) vs. low (<0.8) AIECG-AF-DP: 3.2 vs. 0.5%/year for small; 6.1 vs. 0.6%/year for middle, and 11.6 vs. 1.5%/year for large, respectively (all P<0.001). Although the area under the receiver operating characteristic curve was similar across LAD categories of <35, 35-39, and ≥40 mm (0.770, 0.753, and 0.784, respectively), the area under the precision-recall curve differed markedly (0.083, 0.114, and 0.236, respectively). CONCLUSIONS: Newly detected AF was particularly frequent in patients with both high AIECG-AF-DP and large LAD, suggesting repeated AF screening may be warranted in this population.
Saito S, Temma T, Nagai T
… +20 more, Nakao M, Yokota I, Tada A, Koya T, Ishizaka S, Mizuguchi Y, George F, Kato Y, Takahashi Y, Imagawa S, Motoi K, Tokuda Y, Matsumoto J, Takahashi M, Okamoto H, Machida M, Saito T, Shimizu T, Anzai T, ELMSTAT-HF Investigators
BACKGROUND: Prolonged QRS is an established marker of adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, the prognostic significance of modest QRS prolongation (120-149 ms; m...BACKGROUND: Prolonged QRS is an established marker of adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, the prognostic significance of modest QRS prolongation (120-149 ms; mid-range QRS) remains unclear, especially in patients without cardiac implantable electronic devices (CIEDs). This study assessed the natural prognosis associated with mid-range QRS compared with narrow QRS (<120 ms) in a recent Asian cohort of patients with HFrEF. METHODS AND RESULTS: We analyzed patients with HFrEF from the Epidemiological Multicenter Study for Tailored Treatment in Heart Failure (ELMSTAT-HF; January 2020-October 2023). QRS was measured from 12-lead electrocardiograms. Patients with wide QRS (≥150 ms) or CIEDs were excluded. The primary outcome was a composite of all-cause mortality and heart failure hospitalizations. Multivariable Cox models adjusted for the MAGGIC risk score and log-transformed N-terminal pro B-type natriuretic peptide were used. Among 415 patients, 328 had narrow QRS and 87 had mid-range QRS. Over a median follow-up of 547 days, the primary outcome occurred more frequently in the mid-range QRS group (34.5% vs. 12.5%; P<0.001). Mid-range QRS remained independently associated with adverse outcomes (hazard ratio 3.12; 95% confidence interval 1.91-5.11), consistent across non-left bundle branch block (LBBB) and LBBB subgroups. CONCLUSIONS: Mid-range QRS is an independent predictor of adverse outcomes in HFrEF, even in the absence of LBBB.
BACKGROUND: Depression is common among patients with heart failure (HF) and worsens prognosis, but its metabolic heterogeneity remains unclear. METHODS AND RESULTS: Fifty HF patients completed the Patient Health Question...BACKGROUND: Depression is common among patients with heart failure (HF) and worsens prognosis, but its metabolic heterogeneity remains unclear. METHODS AND RESULTS: Fifty HF patients completed the Patient Health Questionnaire-9 (PHQ-9) and underwent metabolomic profiling of 163 metabolites. Depressed patients (PHQ-9 score ≥5; n=26) were stratified using k-means clustering. Spearman's correlation with false discovery rate (FDR) correction (FDR <0.05) and bootstrap-validated least absolute shrinkage and selection operator (LASSO) regression (1,000 iterations) were applied to identify robust predictors of PHQ-9 scores. Two subtypes emerged. Cluster 1 (n=19) was characterized by elevated HbA1c; in this cluster, glycerol was the only metabolite significantly correlated with PHQ-9 scores. Cluster 2 (n=7) exhibited a cardiorenal phenotype, with elevated B-type natriuretic peptide (BNP) levels and a reduced estimated glomerular filtration rate. In Cluster 2, PHQ-9 scores were significantly positively correlated with BNP and metabolites related to methyl-group metabolism, specifically N,N-dimethylglycine (DMG), betaine, and 1-methylhistidine/3-methylhistidine. Bootstrap-validated LASSO identified BNP and DMG as the most robust predictors of depression severity in this specific cluster. CONCLUSIONS: Depression in HF is metabolically heterogeneous. Cluster 1 is characterized by glycerol-linked lipid dysregulation. In contrast, Cluster 2 is associated with cardiac stress and alterations in methylation pathways, potentially linking metabolic dysfunction to neurotransmitter imbalances. These preliminary findings highlight the potential need for phenotype-specific therapeutic strategies to effectively manage depression in HF patients.
BACKGROUND: In patients with pulmonary arterial hypertension, death due to ventricular arrhythmias accounts for 8-26% of total deaths, so in this study we investigated whether mitochondrial Cauptake affects ventricular a...BACKGROUND: In patients with pulmonary arterial hypertension, death due to ventricular arrhythmias accounts for 8-26% of total deaths, so in this study we investigated whether mitochondrial Cauptake affects ventricular arrhythmias in right ventricular hypertrophy (RVH). METHODS AND RESULTS: A total of 70 rats were subcutaneously injected with monocrotaline (MCT-rats) or solvent; 8 mice underwent pulmonary artery banding (PAB) surgery. At 4 weeks after MCU injection or PAB surgery, trabeculae were dissected from the RVs. Levels of mitochondrial Ca, cytoplasmic Ca, and reactive oxygen species (ROS) were measured using fluorescence dyes. Mitochondrial calcium uniporter (MCU) expression was measured by Western blotting. Cawaves and arrhythmias were induced by electrical stimulation (24℃). Both MCT-rats and PAB-mice showed RVH. Ru360, an MCU inhibitor, improved arrhythmias in trabeculae from severe RVH, whereas it worsened them in trabeculae from milder RVH in MCT-rats. Depending on the degree of RVH, Ru360 decreased rhod-2 fluorescence in both MCT-rats and PAB-mice, and decreased Cawave velocity, the 2',7'-dichlorofluorescein fluorescence slope, and MitoSox Red fluorescence in the MCT-rats. MCU expression increased with the degree of RVH. CONCLUSIONS: Inhibition of mitochondrial Cauptake improved arrhythmias in severe RVH, but worsened them in milder RVH, due to differences in mitochondrial Cauptake, ROS production, and MCU expression.
BACKGROUND: This study investigated whether small dense low-density lipoprotein cholesterol (sdLDL-C) can predict long-term coronary artery disease (CAD) events in patients with stable CAD without metabolic dyslipidemia....BACKGROUND: This study investigated whether small dense low-density lipoprotein cholesterol (sdLDL-C) can predict long-term coronary artery disease (CAD) events in patients with stable CAD without metabolic dyslipidemia. METHODS AND RESULTS: Directly measured sdLDL-C was evaluated in 396 male and 144 female patients with stable CAD who had high-density lipoprotein cholesterol (HDL-C) ≥40 mg/dL and triglyceride <150 mg/dL. CAD events, which were defined as sudden cardiac death, acute coronary syndrome onset, and/or a need for coronary revascularization, were monitored for 12 years. First-time CAD events were observed in 110 men and 44 women. Kaplan-Meier event-free survival curves showed that patients with sdLDL-C ≥32.5 mg/dL (top quartile) had an increased risk of CAD events (log-rank P=0.009). The multivariate-adjusted hazard ratio (HR) in the top sdLDL-C quartile was 1.632 (95% confidence interval 1.159-2.297) and remained significant in 354 patients treated with statins (HR 1.582; P=0.041), whereas the risk in the top quartiles of LDL-C, non-HDL-C, apolipoprotein B, and triglyceride was not significantly higher relative to lower quartiles. Receiver operating characteristic curve analyses indicated that risk increased at cut-off values of sdLDL-C ≥32.2 mg/dL (HR 1.566; P=0.011) and sdLDL-C/LDL-C ratio ≥0.316 (HR 1.569; P=0.018). CONCLUSIONS: Although sdLDL is a feature of metabolic dyslipidemia, high sdLDL-C can predict long-term recurrence of CAD events even in patients without metabolic dyslipidemia.
BACKGROUND: Abdominal aortic aneurysm (AAA) is a severe aortic disease with limited pharmacological treatment to prevent its progression. Whether early prevention of aortic lesions inhibits later formation of AAAs remain...BACKGROUND: Abdominal aortic aneurysm (AAA) is a severe aortic disease with limited pharmacological treatment to prevent its progression. Whether early prevention of aortic lesions inhibits later formation of AAAs remains unclear. Therefore, this study aimed to investigate whether early intervention could prevent aortic lesion progression and AAA formation, and to explore the underlying molecular mechanisms. METHODS AND RESULTS: Genome-wide RNA sequencing of aortas from saline-treated mice and mice treated with angiotensin (Ang: 1,000 ng/kg/min) II via subcutaneously implanted mini-osmotic pumps for 14 or 28 days showed that nuclear factor (NF)-κB signaling contributes to the phenotypic switch and inflammation, and identified Nfkb1 as a potential key gene in vascular smooth muscle cells (VSMCs) for AAA development. Andrographolide (an NF-κB1 inhibitor) was administered via intraperitoneal injection at a dose of 20 mg/kg/day to pre-treat vascular lesions before AAA formation, and transcriptomic and functional studies were performed to explore the underlying mechanisms. In AngII-treated mice, andrographolide significantly attenuated vascular lesions at the early stage (day 14) and reduced AAA formation at later stages of the disease (day 28). Andrographolide also reduced aortic macrophage infiltration, decreased neutrophil recruitment, and suppressed cytokines. Although detailed mechanistic analyses focused on VSMCs due to their structural predominance in early lesions, chromatin immunoprecipitation (ChIP) further demonstrated that NF-κB1 regulates its direct target Krüppel-like factor 4 to induce VSMC dedifferentiation and tumor necrosis factor (TNF)-α to drive inflammation, indicating that NF-κB1 exacerbates inflammation via TNF-α signaling. CONCLUSIONS: Our results demonstrate a previously unrecognized role of vascular lesions in AAA development and progression. Andrographolide pretreatment may be a novel therapeutic approach for AAA.
Jeong JC, Park JI, Choi KU
… +13 more, Nam JH, Lee CH, Son JW, Park JS, Lee JH, Hur SH, Yun KH, Kim HS, Kim JH, Ahn Y, Jeong MH, Kim U, KAMIR-V Registry Investigators
BACKGROUND: Beta-blocker therapy remains a cornerstone in the management of acute myocardial infarction (AMI) with reduced left ventricular ejection fraction (LVEF). However, evidence comparing clinical outcomes among di...BACKGROUND: Beta-blocker therapy remains a cornerstone in the management of acute myocardial infarction (AMI) with reduced left ventricular ejection fraction (LVEF). However, evidence comparing clinical outcomes among different β-blocker types is limited. This study compared the 3-year cardiovascular outcomes between bisoprolol and carvedilol in patients with AMI and reduced LVEF who underwent percutaneous coronary intervention (PCI). METHODS AND RESULTS: Data were derived from the Korean Acute Myocardial Infarction Registry V (KAMIR-V), a prospective nationwide multicenter registry. Among 16,521 enrolled patients, those who did not undergo PCI, had non-reduced or unknown LVEF, were not prescribed β-blockers, or received other β-blocker types were excluded. In all, 1,062 patients were classified according to the β-blocker prescribed at discharge (bisoprolol, n=386; carvedilol, n=676). The primary endpoint was the 3-year patient-oriented composite endpoint (POCE) of all-cause death, any myocardial infarction, or any revascularization. During a median follow-up of 1,076 days (interquartile range 732-1,109 days), POCE occurred in 18.9% of the bisoprolol group and 16.3% of the carvedilol group (hazard ratio [HR] 0.79; 95% confidence interval [CI] 0.54-1.17; P=0.237). After propensity score matching, results were consistent (HR 0.88; 95% CI 0.62-1.24; P=0.470). CONCLUSIONS: Among patients with AMI and reduced LVEF undergoing PCI, bisoprolol and carvedilol showed comparable 3-year cardiovascular outcomes. Both agents appear to be suitable options for secondary prevention in this high-risk population.
Makimoto H, Okatani T, Sato M
… +17 more, Sawano S, Kodera S, Harada K, Anno K, Kabutoya T, Kamioka M, Watanabe T, Watanabe H, Komori T, Yokota A, Imai Y, Ogata Y, Kohro T, Takeda N, Matoba T, Nagai R, Kario K
BACKGROUND: Single-lead electrocardiograms (ECGs) contain subtle markers of left ventricular (LV) dysfunction. We hypothesized that a synthesized frontal-plane vector would improve single-lead detection of reduced LV eje...BACKGROUND: Single-lead electrocardiograms (ECGs) contain subtle markers of left ventricular (LV) dysfunction. We hypothesized that a synthesized frontal-plane vector would improve single-lead detection of reduced LV ejection fraction (LVEF) compared with standard limb leads. METHODS AND RESULTS: This diagnostic study used paired 12-lead ECGs (10 s, 500 Hz) and echocardiograms obtained within 30 days from three Japanese hospital cohorts (one development and two external validation cohorts). For each beat, a derived lead, X, was synthesized from limb leads I and II as X(θ) = cosθ · I + sinθ · II, with θ scanned from 0° to 360°. A deep neural network generated beat-level predictions aggregated per recording to detect LVEF <50%. AUROC was the primary metric; accuracy, F1 score, sensitivity, and specificity were secondary metrics. Two performance peaks emerged near 30° and 210° (AUROC ≈0.857). Across repeated modeling from 180° to 270°, the 210° lead consistently ranked among the best single-lead models, matching or slightly exceeding aVR, although the 12-lead model remained superior. In external cohorts, the 210° lead achieved mean (±SD) AUROC 0.863±0.031, comparable to 12-lead and aVR (0.872±0.024 and 0.852±0.032; P>0.05). CONCLUSIONS: An aVR-adjacent frontal vector near 210° enables single-lead detection of LV dysfunction that approaches 12-lead performance and exceeds other individual leads. Requiring only standard limb electrodes, this strategy could facilitate screening; further validation and mechanistic studies are warranted.