BACKGROUND: Left ventricular (LV) dyssynchrony worsens with heart failure (HF) progression. However, the early identification of LV dyssynchrony is challenging, and its prognostic value remains unclear. We aimed to evalu...BACKGROUND: Left ventricular (LV) dyssynchrony worsens with heart failure (HF) progression. However, the early identification of LV dyssynchrony is challenging, and its prognostic value remains unclear. We aimed to evaluate the prognostic value of LV dyssynchrony based on bandwidth (time width within which 95% of the LV myocardium begins to contract), assessed using Heart Risk View (HRV) analysis of myocardial perfusion scintigraphy data. METHODS AND RESULTS: This was a post hoc analysis of a prospective, non-randomized, single-center cohort study conducted between January 2019 and December 2023. This study included 584 patients (mean age 72.2±13.0 years; 425 [72.8%] males; non-ischemic 29.8%; LV ejection fraction [LVEF] 46.4±15.0%) who were admitted for HF and had LV dyssynchrony evaluated using HRV-based analysis. The composite endpoint was all-cause mortality and HF rehospitalization. Univariate and multivariate logistic regression showed LV dyssynchrony as a significant predictor of HF prognosis (bandwidth threshold 28.0°). Multiple regression analysis identified QRS width, LVEF, and ischemic cardiomyopathy as significant determinants of bandwidth. Prognosis was poorer in high-bandwidth groups defined by the median (21.0°) or threshold bandwidth (28.0°). Combined with B-type natriuretic peptide, bandwidth improved prognostic utility. Bandwidth showed a moderate correlation with QRS width and strong correlations with end-systolic volume and LVEF. CONCLUSIONS: HRV-derived bandwidth is a non-invasive and safe method providing automatic, objective, and reproducible measurements. It is useful for predicting HF prognosis.
BACKGROUND: Although percutaneous coronary intervention (PCI) has become safer due to advances in devices and procedural standardization, in-hospital outcomes may still vary depending on the involvement of certified inte...BACKGROUND: Although percutaneous coronary intervention (PCI) has become safer due to advances in devices and procedural standardization, in-hospital outcomes may still vary depending on the involvement of certified interventional cardiologists (ICs). This study evaluated the association between board-certified IC involvement and in-hospital outcomes following PCI using a nationwide Japanese registry. METHODS AND RESULTS: We analyzed PCI cases between 2020 and 2023, classifying them according to the involvement (defined as acting as a primary operator or supervising assistant) of board-certified members of the Japanese Association of Cardiovascular Intervention and Therapeutics (BMCVIT). Among 842,335 PCI cases analyzed, 579,459 (68.8%) were performed with BMCVIT involvement. The frequency of BMCVIT involvement was higher for the treatment of patients with prior revascularization and complex lesions, but lower for patients admitted with acute coronary syndrome (ACS) or hemodynamic instability. After adjusting for baseline characteristics, BMCVIT involvement remained independently associated with lower in-hospital mortality (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.86-0.92; P<0.001), composite in-hospital complications (OR 0.94; 95% CI 0.91-0.97, P<0.001), and access site bleeding (OR 0.88; 95% CI 0.80-0.97, P=0.012). Subgroup analyses revealed consistent mortality benefits across age, sex, dialysis status, lesion complexity, and institutional PCI volume, with stronger protection in patients without ACS or cardiogenic shock. CONCLUSIONS: BMCVIT involvement in PCI was independently associated with lower in-hospital mortality and complications, underscoring the quality gains of IC participation.
BACKGROUND: Little is known about the recently emerging entity, heart failure with supranormal ejection fraction (HFsnEF). METHODS AND RESULTS: Subanalysis of a nationwide, prospective, observational registry that includ...BACKGROUND: Little is known about the recently emerging entity, heart failure with supranormal ejection fraction (HFsnEF). METHODS AND RESULTS: Subanalysis of a nationwide, prospective, observational registry that included compensated ambulatory patients with chronic HF and left ventricular ejection fraction (LVEF) >40%. Among the 4,387 patients (mean age 77 years, 43% female), 1,423 had HFsnEF. They were older, more often female, had lower natriuretic peptide levels, and exhibited smaller LV. The prescription rate of guideline-directed medical therapy was lower. CONCLUSIONS: HFsnEF is a common and distinct phenotype characterized by a unique profile and treatment.
Tamura Y, Kondo N, Tsukada F
… +12 more, Tanaka M, Kono M, Hasegawa K, Muraoka N, Shigematsu K, Matsumoto R, Ogihara Y, Ikeda N, Shoji M, Kumamaru H, Miyata H, Miyata T
BACKGROUND: This study prospectively collected and analyzed real-world clinical outcomes of cancer patients with venous thromboembolism (VTE) receiving rivaroxaban in Japan. METHODS AND RESULTS: From August 2018 to Decem...BACKGROUND: This study prospectively collected and analyzed real-world clinical outcomes of cancer patients with venous thromboembolism (VTE) receiving rivaroxaban in Japan. METHODS AND RESULTS: From August 2018 to December 2021, cancer patients with VTE treated with rivaroxaban or warfarin were enrolled at 27 Japanese institutions. A total of 322 patients treated with rivaroxaban were analyzed. The VTE recurrence/worsening-free survival rate by Kaplan-Meier estimate was 98.0% and neither VTE-related nor cardiovascular deaths occurred during 24-week rivaroxaban treatment. CONCLUSIONS: VTE recurrence/worsening occurred in only a small percentage of Japanese cancer-VTE patients treated with rivaroxaban.
BACKGROUND: Predicting the origin of premature ventricular contractions (PVCs) is challenging when a transition zone (TZ) appears in leads V3 and V4. The aim of this study was to develop a deep-learning model to predict...BACKGROUND: Predicting the origin of premature ventricular contractions (PVCs) is challenging when a transition zone (TZ) appears in leads V3 and V4. The aim of this study was to develop a deep-learning model to predict PVC origins and identify electrocardiographic (ECG) features that contribute to the model's decisions. METHODS AND RESULTS: ECG data from 314 patients with PVCs showing an inferior axis and TZ in leads V3 or V4 who underwent catheter ablation were analyzed. A convolutional neural network (CNN) was trained to predict an origin in the right or left ventricular outflow tract. Patients were divided into 3 cohorts for training, validation, and holdout (3 : 1 : 1 ratio). The CNN model was trained using paired data consisting of PVC and intrinsic QRS (iQRS). Five datasets per patient were used for training and validation; performance was evaluated using a single holdout dataset per patient. The CNN model achieved 92.1% accuracy, an F1 score of 0.91, and an area under the receiver operating characteristic curve of 0.96 on the holdout. Our model demonstrated superior diagnostic performance compared with conventional ECG indices. Gradient-weighted class activation mapping revealed that model attention was primarily focused on leads V3-V4 in iQRS, but was more diffusely distributed in PVC, notably the inferior limb leads and leads V2-V3. CONCLUSIONS: The CNN-based prediction of PVC origin demonstrated clinical utility.
Chatani R, Kinosada M, Kaneda K
… +11 more, Yamashita Y, Harata H, Fujita M, Nishiura N, Mushiake K, Ono S, Tasaka H, Maruo T, Kadota K, Chin M, Kubo S
BACKGROUND: In patients with atrial fibrillation-related ischemic stroke despite oral anticoagulation (AFIDA), left atrial appendage closure (LAAC) may be an additional strategy to prevent further stroke events. METHODS...BACKGROUND: In patients with atrial fibrillation-related ischemic stroke despite oral anticoagulation (AFIDA), left atrial appendage closure (LAAC) may be an additional strategy to prevent further stroke events. METHODS AND RESULTS: AFIDA was defined as ischemic stroke occurring despite ≥3 weeks of oral anticoagulation (OAC). We evaluated patients with AFIDA treated either with OAC alone (n=141; further divided into aggressive OAC [n=73] and conventional OAC [n=68] subgroups) or with additional LAAC (+LAAC; n=95; further divided into continued OAC [n=44] and discontinued OAC within 1 year after LAAC [n=51] subgroups). Patients in the +LAAC group were younger, had higher HAS-BLED scores, and lower HELT-ESscores. Three-year cumulative incidence rates of ischemic stroke and major bleeding were comparable between the OAC alone and +LAAC groups (15.2% vs. 14.5% [log-rank P=0.75] and 23.4% vs. 5.3% [log-rank P=0.38], respectively), whereas those of fatal or disabling stroke and fatal bleeding were lower in the +LAAC than OAC alone group (3.4% vs. 14.7% [log-rank P=0.06] and 0% vs. 6.0% [log-rank P=0.03], respectively). Results of propensity score-matched and subgroup analyses were largely consistent with those of the main analysis. Notably, fatal bleeding occurred only in patients switched to aggressive OAC. CONCLUSIONS: LAAC may potentially prevent fatal or disabling stroke and fatal bleeding in patients with AFIDA. These hypothesis-generating findings support the need for randomized controlled trials.
BACKGROUND: Non-home discharge (NHD) after endovascular therapy (EVT) for chronic limb-threatening ischemia (CLTI) signals frailty and higher healthcare costs. METHODS AND RESULTS: The nationwide J-EVT Registry (2021-202...BACKGROUND: Non-home discharge (NHD) after endovascular therapy (EVT) for chronic limb-threatening ischemia (CLTI) signals frailty and higher healthcare costs. METHODS AND RESULTS: The nationwide J-EVT Registry (2021-2023) captured data for 31,025 patients with CLTI who underwent EVT. NHD, defined as transfer to chronic-care hospitals, occurred in 12.9%. Independent predictors of NHD were age ≥70 years, non-ambulatory status, and perioperative complications. CONCLUSIONS: Because 1 in 8 Japanese CLTI patients required NHD after EVT, risk stratification and minimizing procedural invasiveness are essential to improve home-discharge rates.
BACKGROUND: The impact of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) on long-term clinical outcomes remains controversial. METHODS AND RESULTS: Of 14,927 consecutive patients wi...BACKGROUND: The impact of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) on long-term clinical outcomes remains controversial. METHODS AND RESULTS: Of 14,927 consecutive patients with their first coronary revascularization in the CREDO-Kyoto Registry Cohort-3, we extracted data for 1,483 undergoing CABG without prior atrial fibrillation (AF). POAF was defined as newly documented AF during hospitalization for CABG and was diagnosed in 337 (23%) patients during the index hospitalization. The remaining 1,146 patients were categorized as the non-POAF group. The median follow-up after discharge was 5.7 years. The cumulative 5-year incidence of all-cause death did not differ significantly between the POAF and non-POAF groups (15.9% vs. 13.0%, respectively; P=0.38), whereas the cumulative 5-year incidence of stroke, heart failure, and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding was significantly higher in the POAF group. There was no excess adjusted risk of the POAF group relative to the non-POAF group for all-cause death (hazard ratio 0.96; 95% confidence interval 0.70-1.31; P=0.81). The risk of the POAF group relative to the non-POAF group was numerically higher for stroke and heart failure, and significantly higher for BARC type 3 or 5 bleeding. CONCLUSIONS: The long-term risk of patients with POAF relative to those without was significantly higher for major bleeding and numerically higher for stroke and heart failure, with no difference for mortality.
Takaoka H, Kato K, Miyauchi H
… +10 more, Kajiyama T, Nishikawa Y, Yoshida K, Suzuki K, Aoki S, Yashima S, Kinoshita M, Sasaki H, Suzuki-Eguchi N, Kobayashi Y
BACKGROUND: Emerging evidence highlights the clinical significance of lipid variability in cardiovascular disease and adverse outcomes. This study investigated the relationship between lipid variability and incident peri...BACKGROUND: Emerging evidence highlights the clinical significance of lipid variability in cardiovascular disease and adverse outcomes. This study investigated the relationship between lipid variability and incident peripheral artery disease (PAD) risk. METHODS AND RESULTS: We identified 93,948 patients in the Chang Gung Research Database in Taiwan who had been diagnosed with hyperlipidemia between 2007 and 2013 and had annual lipid measurements over 4 consecutive years. Lipid levels, including total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides, as well as their visit-to-visit variability, were assessed over the 4-year period. Patients were followed until December 31, 2019 for incident PAD development. Over a mean 5.9-year follow-up, 2,735 patients (2.5%) developed PAD. Mean lipid levels were significantly associated with incident PAD. Of note, the average real variability (ARV) in HDL-C was independently associated with increased PAD risk (adjusted hazard ratio 1.13; 95% confidence interval 1.004-1.27 for highest vs. lowest quartile of HDL-C ARV; P for trend=0.002). Sensitivity analysis using variability independent of the mean as the HDL-C variability index confirmed this finding. Consistency was observed across all subgroup analyses. CONCLUSIONS: In this multi-institutional database analysis, visit-to-visit variability in HDL-C was significantly associated with the risk of incident PAD, independent of traditional risk factors for atherosclerosis, mean lipid levels, and the use of lipid-lowering therapy.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement in hemodialysis patients; however, contemporary outcomes and risk stratifications remain unreported. METHO...BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement in hemodialysis patients; however, contemporary outcomes and risk stratifications remain unreported. METHODS AND RESULTS: Using data from a multicenter database, this study included 2,888 patients who underwent TAVI between 2021 and 2024: 336 (11.6%) on hemodialysis and 2,552 (88.4%) not. The primary outcome was all-cause death after TAVI; the median follow-up was 527 days. Hemodialysis patients were younger, predominantly male, and had more comorbidities with higher surgical risk. Hemodialysis and non-hemodialysis patients had similar 30-day mortality (2.9% vs. 1.5%, respectively) and major procedural complications. Hemodialysis patients had 2- to 3-fold higher rates of all-cause death (14.4% vs. 6.5% at 1-year; 21.5% vs. 11.0% at 2 years), cardiovascular death, and the composite of all-cause death and heart failure hospitalization. After adjusting for confounders, hemodialysis had no significant effect on all-cause death and the composite endpoint. Body mass index, Clinical Frailty Scale, and albumin levels were associated with all-cause death in hemodialysis patients, allowing risk stratification into low-, intermediate-, and high-risk groups. CONCLUSIONS: In this study, hemodialysis patients were younger and had more comorbidities, but 30-day mortality and complications were similar to the non-hemodialysis group. Although hemodialysis patients had higher all-cause mortality, the worse outcomes in this group were attributed to comorbidities rather than the hemodialysis itself.