Takase B, Ikeda T, Shimizu W
… +27 more, Abe H, Aiba T, Chinushi M, Koba S, Kusano K, Niwano S, Takahashi N, Takatsuki S, Tanno K, Watanabe E, Yoshioka K, Amino M, Fujino T, Iwasaki YK, Kohno R, Kinoshita T, Kurita Y, Masaki N, Murata H, Shinohara T, Yada H, Yodogawa K, Kimura T, Kurita T, Nogami A, Sumitomo N, Japanese Circulation Society and Japanese Heart Rhythm Society Joint Working Group
BACKGROUND: Patients with bradyarrhythmia requiring pacemaker implantation often report disrupted sleep, which could be related to bradyarrhythmia, apprehension of having heart disease and undiagnosed sleep disorders, re...BACKGROUND: Patients with bradyarrhythmia requiring pacemaker implantation often report disrupted sleep, which could be related to bradyarrhythmia, apprehension of having heart disease and undiagnosed sleep disorders, resulting in impaired quality of life (QOL). We aimed to assess the prevalence of poor subjective sleep quality in patients with bradyarrhythmia requiring pacemaker implantation and its effect on sleep quality. METHODS AND RESULTS: Patients undergoing permanent pacemaker implantation for bradyarrhythmia were evaluated for subjective sleep quality and health-related QOL using the Pittsburgh Sleep Quality Index (PSQI) and Short Form-8 (SF-8) before and after pacemaker implantation. Poor subjective sleep quality was defined as PSQI score ≥6. Of 89 enrolled patients, 54 (60.7%) reported poor subjective sleep quality. A greater PSQI score indicative of poor sleep quality was likely to be observed in patients who had greater left ventricular ejection fraction and were treated with calcium-channel blockers, as well as in patients with more frequent sleep disturbance-related complaints/symptoms. After pacemaker implantation, the PSQI score improved significantly (from a median score of 6.0 to 5.0; P=0.015) proportional to an improvement in the mental component summary score. CONCLUSIONS: Poor subjective sleep quality is common among patients with bradyarrhythmia, contributing to impaired QOL. Pacemaker implantation may have a favorable effect on subjective sleep quality, and QOL for such patients.
BACKGROUND: Hospitalization for heart failure (HF) is associated with poor outcomes, yet the temporal patterns of laboratory biomarkers surrounding such events remain inadequately described. This study aimed to character...BACKGROUND: Hospitalization for heart failure (HF) is associated with poor outcomes, yet the temporal patterns of laboratory biomarkers surrounding such events remain inadequately described. This study aimed to characterize trajectories of routinely measured biomarkers before and after HF hospitalization. METHODS AND RESULTS: We retrospectively analyzed patients hospitalized for acute HF at Nagoya University Hospital between January 2018 and December 2023. In the main cohort, outpatient levels of B-type natriuretic peptide (BNP), creatinine, hemoglobin, hematocrit, uric acid, sodium, and potassium were evaluated for 1 year following discharge. A second cohort included patients with ≥2 hospitalizations, assessing biomarker trends 1 year before and after the second admission. The main cohort included 709 patients (7,299 laboratory visits). Of them, 191 patients with rehospitalization comprised the second cohort (3,318 visits). In the main cohort, BNP, creatinine, uric acid, hemoglobin, and hematocrit declined for 60 days post-discharge, followed by increases. In the second cohort, BNP, creatinine, and uric acid levels began to rise 60 days before rehospitalization (e.g., BNP increased by 185.2 pg/mL per 30 days, 95% confidence interval: 138.1 to 232.3, P<0.001), while hemoglobin, hematocrit, and sodium declined. CONCLUSIONS: Biomarkers exhibited distinct patterns before and after HF hospitalization. A BNP increase of approximately 200 pg/mL per 30 days within 60 days prior to admission may represent a practical, non-invasive marker to guide early intervention.
BACKGROUND: Cardiac computed tomography (CCT) not only evaluates coronary artery disease but also characterizes myocardial features through late iodine enhancement (LIE). This study evaluated the clinical characteristics...BACKGROUND: Cardiac computed tomography (CCT) not only evaluates coronary artery disease but also characterizes myocardial features through late iodine enhancement (LIE). This study evaluated the clinical characteristics and prognostic significance of incidentally detected non-ischemic LIE patterns in patients undergoing CCT for coronary artery evaluation. METHODS AND RESULTS: We retrospectively analyzed 465 patients who underwent CCT between January 2020 and December 2021. The primary outcome was all-cause death, and the secondary outcome was cardiovascular events, defined as cardiac death and unplanned cardiovascular hospitalization. Cox hazard analysis was performed to identify parameters significantly associated with the outcomes. After excluding patients with non-ischemic cardiomyopathy diagnosed before and after undergoing CCT, coronary stenosis and previous revascularization, 57 patients had non-ischemic LIE and 408 showed no LIE. Compared with patients without LIE, non-ischemic LIE was significantly associated with increased high-sensitivity cardiac troponin T and B-type natriuretic peptide levels, left ventricular (LV) diastolic diameter, LV thickness, and impaired LV ejection fraction. The cumulative incidence of cardiovascular events was significantly higher in patients with non-ischemic LIE than in those without LIE (log-rank P=0.024). In the Cox multivariable analysis, non-ischemic LIE was associated with cardiovascular events (hazard ratio 7.01; 95% confidence interval 1.09-42.2; P=0.041). CONCLUSIONS: CCT may provide prognostic significance through the assessment of myocardial properties.
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized, non-atherosclerotic cause of acute coronary syndrome (ACS), predominantly affecting younger women without traditional cardiovascular risk facto...Spontaneous coronary artery dissection (SCAD) is an increasingly recognized, non-atherosclerotic cause of acute coronary syndrome (ACS), predominantly affecting younger women without traditional cardiovascular risk factors. SCAD results from an intramural hematoma or intimal tear that compresses the coronary lumen, leading to myocardial ischemia. Diagnosis is critical, as management differs fundamentally from atherosclerotic ACS. Conservative therapy is preferred for hemodynamically stable patients due to high rates of spontaneous vessel healing; revascularization is reserved for ongoing ischemia, hemodynamic instability or left main/multivessel involvement. Long-term management focuses on reducing recurrence risk through β-blocker therapy, strict blood pressure control, and individualized cardiac rehabilitation. Although outcomes are generally favorable, recurrence occurs in up to 20% of patients. Ongoing research is needed to refine antiplatelet strategies, identify genetic and vascular risk factors, and optimize preventive care.
BACKGROUND: The effect of residual pulmonary hypertension (PH) on clinical outcomes in patients with secondary mitral regurgitation (MR) after transcatheter edge-to-edge repair (TEER) remains unexplored. METHODS AND RESU...BACKGROUND: The effect of residual pulmonary hypertension (PH) on clinical outcomes in patients with secondary mitral regurgitation (MR) after transcatheter edge-to-edge repair (TEER) remains unexplored. METHODS AND RESULTS: We analyzed 62 patients with secondary MR who underwent TEER. In 32 (51.6%) patients with residual PH after TEER, adverse clinical events were observed more frequently compared with those without residual PH. Multivariate analysis confirmed residual PH as an independent predictor of all-cause death or hospitalization for heart failure. CONCLUSIONS: In patients with secondary MR, residual PH after TEER is an independent predictor of adverse clinical outcomes.
Taguchi T, Yoshioka D, Tonai K
… +19 more, Fukushima S, Yanagino Y, Kitahata N, Akazawa Y, Saito S, Kawamura T, Kawamura A, Yajima S, Misumi Y, Kainuma S, Kawamoto N, Suzuki K, Tadokoro N, Kakuta T, Watanabe T, Mochizuki H, Sakata Y, Tsukamoto Y, Miyagawa S
BACKGROUND: HeartMate 3 (HM3), a magnetically levitated centrifugal-flow pump, has demonstrated superior hemocompatibility and reduced adverse events compared to HeartMate II (HMII), an axial-flow pump, in global studies...BACKGROUND: HeartMate 3 (HM3), a magnetically levitated centrifugal-flow pump, has demonstrated superior hemocompatibility and reduced adverse events compared to HeartMate II (HMII), an axial-flow pump, in global studies. However, because long-term comparative data in Japanese patients remain scarce, in the present study we evaluated the 5-year outcomes of HM3 support by comparing them with those of HMII at 2 leading left ventricular assist device (LVAD) centers in Japan. METHODS AND RESULTS: We retrospectively analyzed 364 patients who underwent primary LVAD implantation (HM3: n=168; HMII: n=196) between 2010 and 2023. The primary endpoint included survival to transplant, recovery, or continued LVAD support free from stroke or pump replacement. At 5 years, freedom from the composite endpoint was higher in the HM3 group (75% vs. 52%; hazard ratio [HR] 0.52; P=0.001), although overall survival was comparable (90% vs. 85%; P=0.44). The HM3 group experienced significantly fewer strokes (HR 0.40; P=0.0008), bleeding events (HR 0.22; P<0.0001), and pump thrombosis (HR 0.09; P=0.003). Rates of rehospitalization, driveline infections, and late right heart failure did not differ between the groups. CONCLUSIONS: HM3 support significantly improved long-term event-free outcomes compared to HMII, despite comparable overall survival, supporting the use of HM3 as durable mechanical circulatory support devices in Japan.
BACKGROUND: Timely initiation of temporary mechanical circulatory support (tMCS), with appropriate escalation and de-escalation strategies, is critical in managing cardiogenic shock (CS). However, how tMCS utilization an...BACKGROUND: Timely initiation of temporary mechanical circulatory support (tMCS), with appropriate escalation and de-escalation strategies, is critical in managing cardiogenic shock (CS). However, how tMCS utilization and outcomes differ by CS etiology remains unclear. METHODS AND RESULTS: Using data from the Japan Registry for Percutaneous Ventricular Assist Device (J-PVAD), we evaluated the differences in tMCS use and outcomes among 3,678 Impella-supported patients with acute myocardial infarction-related CS (AMI-CS, n=2,418 (65.7%)), de novo heart failure-related CS (de novo HF-CS, n=758 (20.6%)), and acute-on-chronic HF-related CS (acute-on-chronic HF-CS, n=502 (13.7%)). The median shock-to-support time was significantly shorter in AMI-CS (123 min) than in de novo HF-CS (186 min) and acute-on-chronic HF-CS (205 min; P<0.001 for each). De novo HF-CS patients were more likely to receive multiple tMCS (64.2%) devices compared with AMI-CS (51.4%; P<0.001) and acute-on-chronic HF-CS (55.2%; P=0.001). Compared with de novo HF-CS, the adjusted odds ratio (OR) for in-hospital death was higher in AMI-CS (OR 1.34, 95% confidence interval (CI) 1.08-1.66; P=0.008) and acute-on-chronic HF-CS (OR 1.67, 95% CI 1.25-2.22; P<0.001). CONCLUSIONS: tMCS timing and utilization differed by CS type. De novo HF-CS was associated with the lowest in-hospital mortality rate.
Nakamura T, Ishibashi K, Ueda N
… +11 more, Oshima T, Oka S, Miyazaki Y, Wakamiya A, Nakajima K, Kamakura T, Wada M, Inoue Y, Miyamoto K, Aiba T, Kusano K
BACKGROUND: Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death in patients with heart failure, but the value of ICD therapy after left ventricular ejection fraction (LVEF) recovery is uncertain....BACKGROUND: Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death in patients with heart failure, but the value of ICD therapy after left ventricular ejection fraction (LVEF) recovery is uncertain. METHODS AND RESULTS: We retrospectively studied 118 patients undergoing primary prevention ICD therapy (2013-2022). Of them, 40 (34%) improved to LVEF >35% (impEF). Over 4.4 years, appropriate ICD therapy occurred significantly less in the impEF group vs. the persistently low LVEF group (P=0.008), but 4 impEF patients still required antitachycardia pacing therapy. No patient with LVEF ≥40% received such therapy. CONCLUSIONS: LVEF recovery reduces but does not eliminate ventricular arrhythmia risk, supporting individualized ICD management.
BACKGROUND: Sudden cardiac death (SCD) is the most devastating complication of hypertrophic cardiomyopathy (HCM). Validation of the Japanese Circulation Society (JCS)/Japanese Heart Failure Society (JHFS) guidelines for...BACKGROUND: Sudden cardiac death (SCD) is the most devastating complication of hypertrophic cardiomyopathy (HCM). Validation of the Japanese Circulation Society (JCS)/Japanese Heart Failure Society (JHFS) guidelines for SCD prevention needs to be undertaken in a large cohort of Japanese patients with HCM. METHODS AND RESULTS: In a subanalysis of the REVEAL-HCM registry comprising 3,611 patients, we enrolled 3,547 patients after excluding 64 patients with missing data required for calculating the HCM Risk-SCD score. The endpoint was a composite of SCD or an equivalent event. During a median 5.8-year follow-up period, SCD events occurred in 247 (7.0%) patients. The 5-year cumulative incidence of SCD events differed significantly between Class 2a and 2b recommendations (6.7% vs. 4.9%, respectively; P=0.006) and between Class 2b and 3 recommendations (4.9% vs. 1.7%, respectively; P<0.001). Excess risk of SCD was also significant for patients with Class 2a and 2b compared with Class 3 recommendations, with hazard ratios of 3.59 (95% confidence interval [CI] 2.40-5.37; P<0.001) and 2.09 (95% CI 1.47-2.97; P<0.001), respectively. The 2018 JCS/JHFS guidelines had an area under the curve of 0.75 (95% CI 0.71-0.80; P<0.001) for discriminating SCD events at 5 years. CONCLUSIONS: The 2018 JCS/JHFS guidelines showed good discriminatory performance for SCD risk stratification, particularly among patients with Class 2a recommendations for an implantable cardioverter defibrillator.