Heart and Vessels最新文献

{"title":"Comparative effectiveness of sodium zirconium cyclosilicate versus calcium polystyrene sulfonate for patients with heart failure.","authors":"Hiroki Shimada, Kayoko Mizuno, Koji Kawakami","doi":"10.1007/s00380-025-02609-4","DOIUrl":"https://doi.org/10.1007/s00380-025-02609-4","url":null,"abstract":"<p><p>Patients with heart failure (HF) are at increased risk of hyperkalemia, and implementing appropriate potassium-lowering therapy is essential for optimizing outcomes. Sodium zirconium cyclosilicate (SZC) is a selective potassium binder that effectively reduces serum potassium levels; however, its impact on mortality and cardiovascular outcomes in HF remains unclear. This study compared the effects of SZC and calcium polystyrene sulfonate (CPS) on a composite of all-cause death and major adverse cardiovascular event (MACE)-related hospitalization, along with individual MACE components and continuation rates of HF medications. We conducted a retrospective cohort study using data from the JMDC hospital database, including adult patients with HF who initiated SZC or CPS between April 2020 and September 2023 and continued treatment for at least 30 days. Propensity score-based inverse probability of treatment weighting (IPTW) and multivariable Cox models were used to control for confounding. A total of 12,918 patients were included (11,139 CPS; 1779 SZC), with a median follow-up of 147 and 138 days, respectively. After IPTW adjustment, baseline characteristics were balanced, except for the prescription year. The primary composite outcome (all-cause death or MACE hospitalization) occurred in 148 patients in the SZC group and 839 in the CPS group (Hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.94-1.43). In a post hoc analysis, the composite of all-cause death and HF hospitalization occurred in 143 vs. 793 patients (HR 1.21, 95% CI 0.98-1.50). SZC use was associated with a higher HR for HF hospitalization (103 vs. 524 events, HR 1.36, 95% CI 1.06-1.75) and a lower HR for stroke hospitalization (6 vs. 80 events, HR 0.33, 95% CI 0.12-0.91). Mineralocorticoid receptor antagonists (MRA) continuation was more frequent in the SZC group [70.1% vs. 59.0%, weighted odds ratio, 1.39 (95% CI 1.11-1.75)]. These findings suggest that although SZC may not improve survival or overall cardiovascular outcomes, it may help maintain essential HF therapies such as MRA.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endothelial dysfunction in plaque rupture and plaque erosion.","authors":"Yuki Ishii, Motoki Kure, Hiroshi Kawasumi, Yuki Numaziri, Yuka Tanizaki, Yosuke Takei, Hiromoto Sone, Kazuma Tashiro, Tokutada Sato, Hiroshi Suzuki, Hiroyoshi Mori","doi":"10.1007/s00380-025-02604-9","DOIUrl":"https://doi.org/10.1007/s00380-025-02604-9","url":null,"abstract":"<p><p>Vascular endothelial function plays an important role in the pathophysiology of acute coronary syndrome (ACS). Plaque erosion (PE) and plaque rupture (PR) are the two major mechanisms of ACS; however, how the vascular endothelial function differs between these etiologies is not well understood. Flow-mediated dilation (FMD) is a method used to evaluate the endothelial function. We aimed to assess endothelial function using FMD in patients with PE and PR. ACS patients (N = 160) who underwent primary percutaneous coronary intervention (PCI) with optical frequency domain imaging (OFDI) and FMD assessment were retrospectively enrolled. Culprit plaques were categorized as PE or PR based on OFDI. Based on the median value of FMD (4.1%) in our data, patients were classified into high-FMD (> 4.1%) and low-FMD (≤ 4.1%) groups. Based on the plaque type and FMD values, the patients were divided into PR-HighFMD (N = 48), PR-LowFMD (N = 47), PE-HighFMD (N = 33), and PE-LowFMD (N = 32) groups, and then the clinical characteristics were compared. Major adverse cardiac events (MACE) were defined as cardiovascular death, nonfatal myocardial infarction, stroke, ischemia-driven revascularization, hospitalization for angina or heart failure. FMD was similarly impaired in the PE and PR groups (4.2% vs. 4.1%, P = 0.85). Most clinical characteristics did not differ between the groups. The PR-High_FMD group showed the highest MACE-free survival, followed by the PE-Low_FMD (HR = 2.62, CI = 0.58-11.7, P = 0.21), PE-High_FMD (HR = 3.18, CI = 0.76-13.3, P = 0.11), and PR-Low_FMD (HR = 5.44, CI = 1.55-19.1, P = 0.008) groups. FMD is likely to have a prognostic impact on patients with ACS, which might vary depending on the culprit lesion.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of convolutional neural network-enhanced electrocardiogram to diagnose and predict mitral regurgitation in patients with chronic atrial fibrillation.","authors":"Mayu Sakuma, Shinya Suzuki, Naomi Hirota, Jun Motogi, Takuya Umemoto, Hiroshi Nakai, Wataru Matsuzawa, Tsuneo Takayanagi, Akira Hyodo, Keiichi Satoh, Takuto Arita, Naoharu Yagi, Mikio Kishi, Hiroaki Semba, Hiroto Kano, Shunsuke Matsuno, Yuko Kato, Takayuki Otsuka, Junji Yajima, Yasuchika Takeishi, Tokuhisa Uejima, Yuji Oikawa, Takeshi Yamashita","doi":"10.1007/s00380-025-02546-2","DOIUrl":"10.1007/s00380-025-02546-2","url":null,"abstract":"<p><p>A convolutional neural network (CNN)-enhanced electrocardiogram (ECG) has been reported for detecting mitral regurgitation (MR). This tool may be particularly useful for identifying candidates for echocardiography in patients with chronic atrial fibrillation (AF) to detect atrial functional MR early. The data from a single-center, prospective cohort study (Shinken Database 2010-2017, n = 19,170) were combined with an ECG database. Initially, a CNN model was developed to detect MR (Grade ≥ 3) across the entire cohort using fivefold cross-validation. The model was refined using sublabels, including primary MR, MR with chronic AF and left atrial dilatation, and MR with left ventricular remodeling, to create an integrated neural network (INN) model. We then analyzed the relationship between MR diagnosed by the INN and the MR prevalence in chronic AF patients. In the CNN model, the AUCs of the ROC curve and PR curve in 0.836 (SD: 0.022) and 0.196 (SD: 0.036), which numerically increased to 0.848 (SD: 0.014) and 0.198 (SD: 0.031) in the INN model. The Grad-CAM analysis revealed that the CNN algorithm appears to highlight nonspecific ECG features, such as P-waves in the leads V1 to V2 (or f-wave in the lead V1) and R-wave amplitude or ST-T changes in precordial leads, which may explain the high false-positive rate in the model. When applying the model to CAF patients, although the sensitivity was around 0.9 at the threshold determined by the ROC curve, PPR and F1 score was relatively low. These metrics slightly improved when adjusting the threshold to that corresponding to a sensitivity of 0.8 and further improved by restricting the target population to those with BNP ≥ 100 pg/mL. The INN model improved MR detection performance compared to the initial CNN model, but the overall PPR remained suboptimal. High false-positive rates remained an issue, even in high-prevalence populations such as CAF patients or those with elevated BNP values.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"883-894"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new technique of anterograde puncture for chronic limb-threatening ischemia with superficial femoral artery flush occlusion: vascular sheath fenestration.","authors":"Zhaopeng He, Boyu Wang, Haoyong Meng, Lei Zhang, Qingfu Zhang","doi":"10.1007/s00380-025-02534-6","DOIUrl":"10.1007/s00380-025-02534-6","url":null,"abstract":"<p><p>We introduce a technique for treating chronic limb-threatening ischemia with superficial femoral artery flush occlusion, facilitating intravascular treatment when conventional anterograde puncture is challenging. This retrospective study reviewed 37 patients who underwent vascular sheath fenestration assisted anterograde puncture to complete endovascular treatment for chronic limb-threatening ischemia from December 2022 to December 2023. All patients had superficial femoral artery flush occlusion, meeting chronic limb-threatening ischemia diagnostic criteria. Evaluations included intraoperative radiation dose, technical success rate, patency rate, limb retention rate, and postoperative complications from surgery to a 12-month follow-up. The mean age of the patients was 70 ± 10 years, with an age range of 46 to 90 years. A significant proportion of the cases presented with severe chronic limb-threatening ischemia, with 78.4% classified as Rutherford ≥ 5, 51.3% as WiFi ≥ 3, and 97.3% as Global Limb Anatomic Staging System III. In all surgical procedures, a plain old balloon angioplasty was utilized for anterograde dilation. Subsequently, based on angiographic findings, treatment involved either drug-coated balloon dilation combined with stent implantation or drug-coated balloon dilation alone. Successful revascularization was achieved in all cases, resulting in marked clinical and hemodynamic improvements, as evidenced by the mean ankle-brachial index increasing from 0.49 preoperatively to 0.86 postoperatively. The 12-month follow-up outcomes were as follows: limb salvage rate of 94.6%, primary patency rate of 83.8%, assisted primary patency rate of 91.9%, and secondary patency rate of 94.6%. The incidence of postoperative complications was 8.1%. The average duration of hospital stay was 8.43 ± 2.72 days. The vascular sheath fenestration assisted anterograde puncture technique demonstrates favorable surgical outcomes and merits consideration as a viable treatment option for chronic limb-threatening ischemia patients with superficial femoral artery occlusion.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"875-882"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12464102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of comparatively young heart failure with preserved ejection fraction: PurSuit-HFpEF registry.","authors":"Masami Nishino, Yasuyuki Egami, Ayako Sugino, Noriyuki Kobayashi, Masaru Abe, Mizuki Ohsuga, Hiroaki Nohara, Shodai Kawanami, Kohei Ukita, Akito Kawamura, Koji Yasumoto, Naotaka Okamoto, Yasuharu Matsunaga-Lee, Masamichi Yano, Takahisa Yamada, Yoshio Yasumura, Masahiro Seo, Takaharu Hayashi, Akito Nakagawa, Yusuke Nakagawa, Shunsuke Tamaki, Katsuki Okada, Yohei Sotomi, Daisaku Nakatani, Shungo Hikoso, Yasushi Sakata","doi":"10.1007/s00380-025-02545-3","DOIUrl":"10.1007/s00380-025-02545-3","url":null,"abstract":"<p><p>Because heart failure (HF) with preserved ejection fraction (HFpEF) is mainly a disease of elderly, there are a few reports focusing young patients. This study aims to elucidate characteristics of comparatively young HFpEF patients. We divided HFpEF patients in PURSUIT-HFpEF registry into younger HFpEF group (age ≤ 65 years) and older HFpEF group and compared the all-cause mortality and HF readmission (HFR) between the two groups and identified discharge factors correlated with HFR among younger HFpEF patients. The younger HFpEF group comprised 51 patients (4.1%). In this group, body mass index and smoking were significantly higher, while hypertension was significantly lower compared to older HFpEF group. Kaplan-Meier analysis indicated no significant difference in HFR between the groups, although all-cause mortality was significantly lower in younger HFpEF group (p < 0.001). Multivariable Cox proportional hazards analysis indicated that angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) were inversely correlated with HFR, whereas mineralocorticoid receptor antagonists (MRA) were positively correlated with HFR in younger HFpEF patients (p = 0.004 and p = 0.007, respectively). In conclusion, younger HFpEF is rare (approximately 4%), with obesity and smoking being significant modifiable factors. HFR was similar between younger and older HFpEF patients. Administration of ACEI/ARB and unnecessity of MRA at discharge may be associated with reducing HFR in younger HFpEF patients.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"863-873"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of serum albumin levels before IMPELLA insertion on mortality risk in patients with cardiogenic shock.","authors":"Toru Miyoshi, Takashi Nishimura, Haruhiko Higashi, Hironori Izutani, Osamu Yamaguchi","doi":"10.1007/s00380-025-02539-1","DOIUrl":"10.1007/s00380-025-02539-1","url":null,"abstract":"<p><p>Despite advances in the treatment of cardiogenic shock (CS), the 30-day mortality rate remains high. While some biomarkers predict outcomes in CS, none have been identified for prognostic prediction in IMPELLA patients. Patients with IMPELLA support due to CS were prospectively enrolled in the Japanese Registry for Percutaneous Ventricular Assist Devices. Patients enrolled between February 2020 and December 2022 were included in the study cohort. We investigated the effects of albumin levels before IMPELLA insertion. The primary endpoint was all-cause mortality within 30 days following IMPELLA initiation. A total of 3,683 patients diagnosed with CS (median age, 69 years; 77.3% male) were included in our analysis. Acute coronary syndromes were present in 1,920 (52.1%) of the patients, whereas out-of-hospital cardiac arrest had occurred in 856 of the patients (23.2%). Before IMPELLA insertion, 1,727 (46.9%) of the patients received venoarterial extracorporeal membrane oxygenation. ROC curve showed that a cut-off albumin level of 3.5 g/dL predicted the 30-day survival rate with a sensitivity of 0.613 and a specificity of 0.507. Patients with albumin levels of ≥ 3.5 g/dL had a significantly higher 30-day survival rate (67% vs. 57%; hazard ratio = 0.736; 95% confidence interval: 0.6785-0.7894; p < 0.01). Lower baseline serum albumin levels were associated with worse outcomes in patients with CS receiving IMPELLA support.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"905-912"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between red blood cell transfusion and subsequent cardiovascular events in patients admitted to the cardiovascular intensive care unit: a single-center retrospective study.","authors":"Shin Sakai, Shuhei Tara, Eiichiro Oka, Junsuke Shibuya, Reiko Shiomura, Junya Matsuda, Jun Nakata, Hideki Miyachi, Takeshi Yamamoto, Kuniya Asai","doi":"10.1007/s00380-025-02541-7","DOIUrl":"10.1007/s00380-025-02541-7","url":null,"abstract":"<p><p>Anemia can worsen the prognosis of patients with acute cardiovascular (CV) disease; however, the effect of red blood cell (RBC) transfusion on mid-term outcomes in such patients requiring intensive care remains unclear. Therefore, this study investigated the association between RBC transfusions during hospitalization and subsequent CV events (all-cause mortality, non-fatal myocardial infarction or stroke, admission for acute heart failure [AHF], unstable angina, and other CV events) after hospital discharge in patients admitted to the cardiovascular intensive care unit (CICU). We retrospectively enrolled 517 patients with emergent admission to the CICU for suspected acute CV disease between January and December 2018. After excluding 41 patients who died or developed CV events during hospitalization, the remaining 476 patients (44.3% with acute coronary syndrome, 22.1% with heart failure, 6.7% with acute aortic dissection, 16.0% with other cardiac diseases, and 10.9% with non-cardiac diseases) were included in the analysis and divided into transfusion (n = 111) and non-transfusion (n = 365) groups based on RBC transfusion requirements during hospitalization. All patients were followed up for subsequent CV events over a period of 180 days after hospital discharge. Compared with the non-transfusion group, the transfusion group showed a higher incidence of chronic kidney disease (73.9% vs. 48.2%, p < 0.001), Acute Physiology and Chronic Health Evaluation II score (18.0 ± 7.2 vs. 13.9 ± 5.6, p < 0.001), frequency of use of invasive mechanical support devices (52.3% vs. 13.7%, p < 0.001), and surgery rate (35.1% vs. 3.3%, p < 0.001), as well as a lower nadir hemoglobin level (8.9 ± 2.3 g/dL vs. 11.7 ± 1.9 g/dL, p < 0.001). The cumulative incidence of CV events was higher in the transfusion group than in the non-transfusion group (32.9% vs. 9.1%, log-rank p < 0.001), with a similar trend observed even after propensity score matching (29.2% vs. 12.3%, log-rank p = 0.049). RBC transfusion remained independently associated with subsequent CV events after adjusting for age, sex, nadir hemoglobin level, bleeding complications, and CV risk factors (adjusted hazard ratio, 2.46; 95% confidence interval, 1.11-5.46; p = 0.027). These findings suggest that RBC transfusion during hospitalization is independently associated with subsequent CV events in patients admitted to the CICU, indicating the need for cautious evaluation of transfusion practices based on potential long-term adverse effects.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"913-924"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overnight stiffness index from finger photoplethysmography in relation to markers of cardiovascular risk and vascular ageing.","authors":"Henrik Hellqvist, Hermine Rietz, Ludger Grote, Jan Hedner, Dirk Sommermeyer, Thomas Kahan, Jonas Spaak","doi":"10.1007/s00380-025-02537-3","DOIUrl":"10.1007/s00380-025-02537-3","url":null,"abstract":"<p><p>Wearable technology, such as photoplethysmography (PPG), enables easily accessible individual health data with the potential for improved risk assessment. We hypothesized that the overnight stiffness index (OSI), derived from nocturnal finger PPG, could be used to assess cardiovascular risk and vascular ageing. Subjects with confirmed or suspected hypertension (n = 79, 56 males) underwent simultaneous ambulatory blood pressure monitoring (ABPM) and overnight sleep polygraphy with a continuous PPG registration. Overnight PPG-based pulse propagation time was used to calculate OSI. Associations between OSI and markers of cardiovascular risk, blood pressure, and indices of arterial stiffness, as indicators of vascular ageing, were assessed. Subjects were stratified into low and high OSI (according to median, 10.9 m/s). SCORE2/SCORE2-OP and Framingham risk scores were calculated. The high OSI group had higher SCORE2/SCORE2-OP (9.5 [5.5;12.5] vs 5.0 [4.0;6.5]), and OSI correlated with SCORE2/SCORE2-OP and Framingham risk score (r_s = 0.40 and r_s = 0.41; both P < 0.01). Indices of arterial stiffness were increased in the high OSI group including ABPM awake and asleep pulse pressures (59 ± 14 vs 50 ± 9 mmHg, P < 0.01, and 54 ± 14 vs 45 ± 7 mmHg, P < 0.001), and ambulatory arterial stiffness index (0.47 ± 0.12 vs 0.37 ± 0.11, P < 0.001), respectively. OSI correlated with 24-h and asleep pulse pressure also after adjusting for confounders. OSI was related to systolic ABPM (awake r = 0.42, asleep r = 0.55; both P < 0.001) and diastolic ABPM (asleep r = 0.36, P < 0.01). OSI, a novel PPG-based measure of nocturnal arterial stiffness, correlates with established cardiovascular risk scores and with blood pressure-derived indices of vascular ageing. This simple method may facilitate cardiovascular risk assessment using readily available medical and wearable consumer devices.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"895-904"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12464147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of ultra-high-pressure balloon angioplasty for congenital heart disease in single-center experience.","authors":"Maiko Kondo, Yoshihiko Kurita, Yosuke Fukushima, Yusuke Shigemitsu, Kenta Hirai, Yuya Kawamoto, Mayuko Hara, Tomoyuki Kanazawa, Tatsuo Iwasaki, Yasuhiro Kotani, Shingo Kasahara, Hirokazu Tsukahara, Kenji Baba","doi":"10.1007/s00380-025-02547-1","DOIUrl":"10.1007/s00380-025-02547-1","url":null,"abstract":"<p><p>Angioplasty using ultra-high-pressure (UHP) balloons may successfully treat stenotic lesions refractory to high-pressure dilation. The use of UHP balloons in patients with congenital heart disease is mostly for dilation of the pulmonary artery, and there have been few reports on the effectiveness and safety of balloons for other sites. We retrospectively evaluated the efficacy and safety of the ultra-high-pressure balloon angioplasty (UHP-BA) for stenotic lesions in patients with congenital heart disease between January 2020 and December 2022 at Okayama University Hospital. A total of 78 UHP-BAs were performed in 44 patients, with a median age of 6.6 years and a median weight of 17.6 kg. The balloon types used in the UHP-BAs were Yoroi^® and Conquest^®. UHP-BA performed 39 procedures for the pulmonary artery (PA), 24 for fenestration, 8 for SVC, 4 for shunt, and three for others. The lesion-specific acute procedural success rates for PA, Fontan fenestration, SVC, and shunt were 77%, 75%, 88%, and 75%, respectively. A complication of UHP-BA occurred in 3.8% (3/78). Two of the three patients had pulmonary hemorrhage, and the remaining patients had pulmonary artery embolization due to the migration of a thrombus. There were no fatal complications. Balloon dilation with UHP balloons was safe and effective not only for pulmonary artery stenotic lesions but also for SVC, Fontan fenestration, shunt, and other dilation sites in patients with congenital heart disease.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"953-960"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12464099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between exercise tolerance and autonomic nervous system modulation after catheter ablation for paroxysmal atrial fibrillation.","authors":"Natsumi Toyoda, Tomotaka Yoshiyama, Shiho Wakasa, Shun Hirayama, Kohei Fukuda, Tomoya Yanagishita, Atsushi Shibata, Daiju Fukuda","doi":"10.1007/s00380-025-02543-5","DOIUrl":"10.1007/s00380-025-02543-5","url":null,"abstract":"<p><p>Autonomic nervous system (ANS) modulation increases the heart rate (HR) after catheter ablation (CA) for paroxysmal atrial fibrillation (PAF). However, its influence on exercise tolerance (ET) is poorly understood. This single-center retrospective cohort study enrolled patients who underwent CA for PAF. To analyze the effects of ANS modulation on ET, cardiopulmonary stress testing was performed before and 3 and 12 months after CA. The final analysis included 25 patients in the cryoballoon ablation (CBA) group and 24 in the radiofrequency CA (RFCA) group. HR increased at 3 and 12 months after CA compared with preoperative values (64.8 ± 8.6 vs. 77.7 ± 10.9, p < 0.001; 64.8 ± 8.6 vs. 74.8 ± 11.4, p < 0.001). ANS modulation was more frequent in the CBA group than in the RFCA group at 3 and 12 months after CA (64% vs. 21%, p < 0.01; 48% vs. 4%, p < 0.01). However, no significant difference in ET was observed before and after CA (anaerobic threshold 15.2 ± 2.8 vs. 15.7 ± 2.8, p = 0.46; 15.4 ± 3.0 vs. 16.3 ± 3.9, p = 0.38; peak VO2 23.5 ± 5.7 vs. 24.4 ± 5.2, p = 0.44; 23.0 ± 6.0 vs. 25.3 ± 7.7; p = 0.43) at both 3 and 12 months after CA. ANS modulation was more frequently observed in the CBA group than in the RFCA group. ET was not worsened by ANS modulation after CA.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"934-942"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}