Heart and Vessels最新文献

{"title":"The obesity paradox in super-elderly patients with heart failure: a retrospective cohort study.","authors":"Takahiro Tachibana, Yoshiaki Kubota, Takuya Nishino, Katsuhito Kato, Yoshiki Iwade, Daisuke Hayashi, Yukihiro Watanabe, Hideki Miyachi, Shuhei Tara, Kuniya Asai","doi":"10.1007/s00380-025-02597-5","DOIUrl":"https://doi.org/10.1007/s00380-025-02597-5","url":null,"abstract":"<p><p>Obesity is an independent risk factor for heart failure (HF) onset; however, weight loss is an independent poor prognostic factor in patients with HF. According to the obesity paradox, higher body weight is associated with better prognosis in these patients. This retrospective cohort study investigated the obesity paradox in super-elderly, understudied patients (aged ≥ 85 years) with HF and examined its impact on all-cause mortality. We included patients hospitalized for HF between April 2015 and March 2023. Participants were divided into four age groups: Groups A (< 65 years), B (65-74 years), C (75-84 years, elderly), and D (≥ 85 years, super-elderly). The primary endpoint was the 1-year all-cause mortality rate after discharge. The secondary endpoints included cardiac and non-cardiac death rates and all-cause mortality rates stratified by left ventricular ejection fraction (LVEF). Overall, 3,811 individuals (mean age: 74.3 years, 60.4% men) were included. A trend toward higher all-cause mortality rates associated with underweight (body mass index [BMI] < 18.5 kg/m²) was observed in all age groups. Patients with obesity (BMI ≥ 25.0 kg/m²) had significantly better survival than other patients. Underweight was associated with a higher cardiac death rate compared with the other weight categories (P = 0.014, 0.039, and 0.022 for groups B, C, and D, respectively). In the analysis stratified by LVEF, underweight was significantly associated with a higher cardiac death rate in patients with HF with preserved LVEF compared with the other weight categories (P < 0.001). The obesity paradox in the super-elderly population was confirmed. It is important to consider BMI in HF management and prognosis.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075196","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 discharge destination and medium-term mortality in patients with chronic limb-threatening ischemia after endovascular therapy: results of the DENEB study.","authors":"Naoki Yoshioka, Takahiro Tokuda, Akiko Tanaka, Shunsuke Kojima, Kohei Yamaguchi, Takashi Yanagiuchi, Kenji Ogata, Tatsuro Takei, Yasuhiro Morita, Tatsuya Nakama, Itsuro Morishima","doi":"10.1007/s00380-025-02599-3","DOIUrl":"https://doi.org/10.1007/s00380-025-02599-3","url":null,"abstract":"<p><p>Owing to the aging population, patients are increasingly undergoing endovascular therapy (EVT) for chronic limb-threatening ischemia (CLTI). CLTI onset causes patients to become increasingly frail and less able to perform daily activities, preventing their discharge home. However, the association of discharge destination with clinical backgrounds and outcomes in these patients has not been fully evaluated. In this study, data from 606 patients with CLTI who underwent EVT between March 2021 and December 2023 and survived to discharge were obtained from a multicenter registry (mean age, 74.5 years; 61.4% men). Non-home discharge was defined as transfer to another hospital or nursing home. Logistic regression analysis was used to identify independent predictors of non-home discharge. Mortality rates within two years of discharge were compared between the home and non-home discharge groups. Of the 606 patients, 108 underwent non-home discharge. Multivariate analysis identified mild frailty (odds ratio [OR] 2.32, 95% confidence interval [CI] 1.34-4.02, p = 0.003), advanced frailty (OR 3.50, 95% CI 1.95-6.28, p < 0.001), a Hemoglobin level < 11 g/dL (OR 1.87, 95% CI 1.15-3.02, p = 0.011), and a Wound, Ischemia, and Foot Infection grade 4 (OR 7.27, 95% CI 2.16-24.46, p = 0.001) as significant predictors of non-home discharge. During the two-year follow-up period, 161 patients died. Cumulative all-cause mortality was significantly higher in the non-home discharge group than in the home discharge group (58.6% vs. 33.7%; log-rank p < 0.001). The findings of this study reveal that non-home discharge occurred in one-sixth of patients with CLTI undergoing EVT, and was linked to a more severe clinical status and worse prognosis than home discharge.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069435","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":"Prognostic significance of right ventricular-pulmonary artery coupling assessed by TAPSE/PASP ratio in patients with HFmrEF.","authors":"Manami Ono, Yurika Fukunaga, Atsushi Suzuki, Shota Shirotani, Asaka Mikami, Arisa Nokubo, Makoto Kishihara, Toshiharu Koike, Eiji Shibahashi, Yoshiaki Minami, Ayano Yoshida, Noriko Kikuchi, Hidetoshi Hattori, Tsuyoshi Shiga, Masao Daimon, Kyomi Ashihara, Junichi Yamaguchi","doi":"10.1007/s00380-025-02600-z","DOIUrl":"https://doi.org/10.1007/s00380-025-02600-z","url":null,"abstract":"<p><p>Right ventricular-pulmonary artery (RV-PA) coupling is an indicator of the degree to which the right ventricle can adapt to afterload. The ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) (TAPSE/PASP ratio) has been proposed as a non-invasive measure of RV-PA coupling. RV-PA coupling is a key prognostic predictor of heart failure (HF); however, HF with mildly reduced left ventricular ejection fraction (HFmrEF) is difficult to predict. This study aimed to determine the prognostic significance of the TAPSE/PASP ratio in HFmrEF. This retrospective cohort study selected eligible patients from two previous cohorts of patients who were hospitalized for HF and discharged with HFmrEF diagnosed by echocardiography: one cohort from August 2015 to September 2019 and one from April 2020 and March 2023. The primary indicator was the TAPSE/PASP ratio, and the primary endpoint was a composite of all-cause mortality and HF rehospitalization. Patients were categorized into two groups based on the median TAPSE/PASP ratio, and the high and low TAPSE/PASP ratio groups were compared. Multivariate analysis was performed using the Cox proportional hazards model. This study included 391 patients (median age, 72 [60-80] years; 70% male). The median TAPSE/PASP ratio used as a cut-off was 0.54 mm/mmHg. The low TAPSE/PASP group was older (median age, 75 [67-82] vs. 68 [56-77] years, p < 0.001), had fewer men (65% vs. 76%, p = 0.019), and had higher B-type natriuretic peptide levels (267 [135-629] vs. 161 [54-394] pg/mL, p = 0.005) than the high TAPSE/PASP group. A significantly greater proportion of the low TAPSE/PASP group had atrial fibrillation (49% vs. 32%, p < 0.001) and renal dysfunction (estimated glomerular filtration rate, 46 [26-66] vs. 58 [32-76] mL/min/1.73 m², p = 0.003) compared with the high TAPSE/PASP group. The low TAPSE/PASP group showed significantly higher rates of all-cause mortality and HF rehospitalization than the high TAPSE/PASP group (log-rank p < 0.001). Multivariate analysis confirmed that a TAPSE/PASP ratio < 0.54 mm/mmHg was an independent predictor of the primary endpoint (hazard ratio, 2.242; 95% confidence interval, 1.492-3.370; p < 0.001). At the one-year post-discharge follow-up, patients in the low TAPSE/PASP group were more likely to have inadequate recovery of RV-PA coupling than those in the high TAPSE/PASP group. The TAPSE/PASP ratio is a useful non-invasive prognostic indicator in patients with HFmrEF. This ratio may contribute to early risk stratification and treatment decision-making.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033170","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":"Sex disparities in mental distress, selfcare ability, and quality of life in patients with chronic heart failure.","authors":"Hiroyuki Sawatari, Mayumi Niitani","doi":"10.1007/s00380-025-02527-5","DOIUrl":"10.1007/s00380-025-02527-5","url":null,"abstract":"<p><p>Previous studies have reported that the clinical features of chronic heart failure (CHF), such as symptoms, prognosis, mental distress, and quality of life (QOL), differ between men and women. However, no studies have shown sex disparities in distress, which has been assessed by multiple indicators in patients with CHF. This study evaluated sex disparities in physical and mental distress among patients with CHF. This prospective multicenter cross-sectional study included outpatients with CHF. Clinical characteristics such as age, sex, and echocardiography findings were extracted from the medical records. Anxiety/depression, selfcare ability, and QOL were assessed using the Hospital Anxiety and Depression Scale (HADS), the European Heart Failure Selfcare Behavior Scale (EHFScBS), and Short Form-12 (SF-12), respectively. The mean age of the participants was 69.7 ± 11.9 years, and 28.3% of the 251 patients were female. The mean left ventricular ejection fraction (LVEF) was 52.0 ± 13.9%, and LVEF was higher in women. The most common underlying disease was ischemic heart disease (38.3%). Multivariate analysis showed that women had significantly higher levels of anxiety/depression, lower mental component summary scores, and reduced physical functioning in terms of QOL, whereas selfcare ability did not differ between women and men. The findings of this study suggest that women have significantly more anxiety/depression and worse physical and mental QOL than men. Thus, more attention should be paid to psychological disorders, including QOL, during CHF management, especially in women.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"805-813"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565969","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":"Influence and molecular mechanism of cinnamaldehyde against ventricular arrhythmia via the TAK1-p38MAPK-NLRP3 pathway.","authors":"Guoping Ma, Mian Li, Wanyue Yang, Hai Wang, Xue Tian, Yajuan Yin, Yida Tang, Wenjie Liang","doi":"10.1007/s00380-025-02529-3","DOIUrl":"10.1007/s00380-025-02529-3","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Based on the transforming growth factor β-activated kinase 1 (TAK1)-p38 mitogen-activated protein kinase (p38MAPK)-nucleotide-binding oligo-like receptor protein 3 (NLRP3) signalling pathway, the protective effect and mechanism of isoproterennaline (ISO)-induced cinnamaldehyde on inflammatory injury in ventricular rats were investigated. Fifty male SPF SD rats were randomly assigned to the normal group, model group, propranolol group, cinnamaldehyde low-dose group or cinnamaldehyde high-dose group. The ventricular arrhythmia model was constructed using the \"6 + 1\" ISO injection method. The rats in the propranolol group were given propranolol 15 mg·(kg d)&lt;sup&gt;-1&lt;/sup&gt;, those in the low and high-dose groups were given cinnamaldehyde 20 mg·(kg d)&lt;sup&gt;-1&lt;/sup&gt; and 50 mg·(kg d)&lt;sup&gt;-1&lt;/sup&gt;, respectively, and those in the control and model groups received an equal volume of 0.9% NaCl solution. Changes in the serum troponin (cTnI), creatine kinase isoenzyme (CK-MB), and interleukin-1β (IL-1β) levels in SD rats were determined by ELISA. HE staining was used to observe the tissue morphology of heart disease. The mRNA expression of IL-1β and NLRP3 was determined by RT‒PCR. Mitochondrial damage was observed by transmission electron microscopy. The expression of reactive oxygen species (ROS) was detected by immunofluorescence. Western blot or immunohistochemical detection of the protein expression of IL-1β, NLRP3, TAK1, phospho-TAK1 (p-TAK1), p38MAPK, phospho-p38MAPK (p-p38MAPK), nuclear factor-κB (NF-κB),and phospho-NF-κB (p-NF-κB) was also performed. Data analysis was performed using SPSS 25.0 software. In the control SD rats, there were no obvious ventricular arrhythmias on ECG, the cardiac tissue and mitochondria were basically normal, the serum IL-1β level was low, and the expression of myocardial IL-1β, NLRP3, ROS, p-TAK1, p-p38MAPK and p-NF-κB was weak. Compared with the control group, the model group of SD rats had significant increases in ventricular arrhythmia and arrhythmia scores according to ECG (P &lt; 0.01). Myocardial histopathological injury, cardiac weight index (HWI) and increases in serum cTnI and CK-MB levels were detected (P &lt; 0.01). Additionally, mitochondrial damage in myocardial tissue, increased ROS fluorescence intensity, and elevated expression of myocardial p-TAK1, p-p38MAPK and p-NF-κB were detected(P &lt; 0.01). The protein and mRNA expression of inflammation-related factors NLRP3 and IL-1β were increased (P &lt; 0.01 or P &lt; 0.05). Compared with those in the model group, the arrhythmia scores were decreased in the three treatment groups (P &lt; 0.01 or P &lt; 0.05). Cardiac histopathological morphology was significantly improved, and HWI and myocardial injury-related indicators were decreased(P &lt; 0.01 or P &lt; 0.05). Damaged mitochondria were significantly improved, and the expression of ROS, p-TAK1, p-p38MAPK, and p-NF-κB were decreased. The expression of inflammation-related factors in serum and myocardial tissue was decreased (P &lt; 0.0","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"846-861"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718797","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":"Evaluation of intrarenal vein flow patterns during routine echocardiography.","authors":"Tomoo Nagai, Hitomi Horinouchi, Tabata Hirotsugu, Yuji Ikari","doi":"10.1007/s00380-025-02523-9","DOIUrl":"10.1007/s00380-025-02523-9","url":null,"abstract":"<p><strong>Objective: </strong>Intrarenal vein flow (IRVF) abnormalities can predict cardiovascular events including heart failure. This study aimed to evaluate the utility of short IRVF scans during routine comprehensive transthoracic echocardiography (TTE) examinations in a standard TTE laboratory.</p><p><strong>Methods: </strong>We screened consecutive patients who underwent elective TTE at our Ultrasound Imaging Laboratory between March 2018 and July 2019 and prospectively enrolled those who completed a 5 min IRVF scan during the 30 min TTE procedure.</p><p><strong>Results: </strong>Among the 2101 screened patients, 1326 were included in the study cohort (age: 73 ± 13 years, 756 men). IRVF abnormalities were detected in 13 (1.0%) patients. Twenty-one cardiac events were observed (1.6%, 21/1326): one myocardial infarction and 20 heart failures. Cumulative survival probability plots were generated using the Kaplan-Meier method within 6 months after the TTE index day and assessed using the log-rank test. The plots revealed significantly worse prognoses in patients with elevated right arterial pressure (RAP) and abnormal IRVF, when compared to normal RAP or normal IEVF (p < 0.0001 and p < 0.0001, respectively). In a receiver operating curve analysis to predict the occurrence of cardiovascular events, E/e' had moderate predictive potential (area under the curve: 0.795, p < 0.0001), and the combination of E/e' and IRVF abnormality had better predictive potential than did E/e' alone (p = 0.043).</p><p><strong>Conclusion: </strong>Although rarely observed on TTE, IRVF abnormalities improve the ability of E/e' to detect cardiac events, especially heart failure. Further large-scale prospective studies are required to confirm our findings.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"837-845"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189144","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":"Clinical impacts of malnutrition based on the GLIM criteria using the MNA-SF for nutritional screening in patients with acute heart failure.","authors":"Yusuke Uemura, Rei Shibata, Yuta Ozaki, Shogo Yamaguchi, Takashi Okajima, Takayuki Mitsuda, Kenji Takemoto, Shinji Ishikawa, Toyoaki Murohara, Masato Watarai","doi":"10.1007/s00380-025-02524-8","DOIUrl":"10.1007/s00380-025-02524-8","url":null,"abstract":"<p><p>The Global Leadership Initiative on Malnutrition (GLIM) suggested a two-step framework for the assessment of malnutrition based on screening and diagnosis. Malnutrition, as defined by the GLIM criteria, and the risk of malnutrition determined through nutritional screening are associated with adverse outcomes in patients with heart failure (HF). This study investigated the prognostic impact of malnutrition, as defined by the GLIM criteria, compared with the risk of malnutrition determined by the Mini Nutritional Assessment-Short Form (MNA-SF) screening tool among patients hospitalized for acute HF. A total of 446 patients with acute HF who underwent nutritional screening using the MNA-SF and were diagnosed with malnutrition based on the GLIM criteria were include in this study. The primary outcome was the incidence of all-cause death or HF-related readmission after discharge. Patients diagnosed with malnutrition based on both indices had a higher incidence of adverse events within one year post-discharge than patients diagnosed without malnutrition. However, a landmark analysis of years one to three post-discharge found that the incidence of the primary outcome was comparable between patients diagnosed with malnutrition and those that here not. Furthermore, although malnutrition as defined by the GLIM criteria was found to be an independent predictor of the 1 year incidence of all-cause death or rehospitalization for HF even after adjusting for other prognostic indicators (hazard ratio, 1.593; 95% confidence interval, 1.056-2.403; P = 0.026), the risk of malnutrition based on the MNA-SF was not. In conclusion, a diagnosis of malnutrition based on the GLIM criteria provides better prognostic stratification in the first year post-discharge in patients with acute HF as compared with nutritional screening based only on the MNA-SF.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"789-796"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189136","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 use of beta-blockers for heart failure with reduced ejection fraction in the era of SGLT2 inhibitors - are we still afraid to up-titrate?","authors":"Fran Rode, Nikola Pavlović, Ana Jordan, Marija Radić, Ante Lisičić, Sanda Sokol Tomić, Jelena Kursar, Šime Manola, Ivana Jurin","doi":"10.1007/s00380-025-02525-7","DOIUrl":"10.1007/s00380-025-02525-7","url":null,"abstract":"<p><p>Beta-blockers are one of the four major pillars of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). The therapy has presented the best effects when up-titrated to evidence-based target doses. Despite their proven benefits, physicians have traditionally shown reluctance to up-titrate beta-blockers because of their negative inotropic and chronotropic effects. The effects of newly introduced sodium-glucose cotransporter 2 inhibitors (SGLT2I) in treating HFrEF might open more room for adequate beta-blockers up-titration. The goal of this study was to evaluate the up-titration practice, and impact of target doses of beta-blockers in patients with HFrEF receiving SGLT2I. This is a prospective cohort study involving patients with HFrEF receiving SGLT2I therapy. Baseline use and dosing to the evidence-based targets were examined. We compared the groups of patients receiving maximally titrated beta-blockers versus incompletely titrated. Primary outcome was composite of (1) rehospitalization or revisit to emergency unit due to the heart failure; (2) all-cause death and major adverse cardiac events (MACE). Secondary outcomes were heart rate at rest, left ventricular ejection fraction, NT-proBNP, and NYHA status at 6 and 12 months of follow-up. Study endpoints were documented via telephone interviews, regular outpatient follow-up, or by electronic hospital records. This study included a total of 458 patients with median follow-up time of 365 (186-502) days. A total of 122 (26.6%) patients had beta-blockers maximally up-titrated. The results show that adherence to maximal target doses of β-blocker therapy significantly reduces hazard of death or MACE comparing to not using maximal doses of β-blocker (factor 0.43). Hazard reduction was not statistically significant for composite of rehospitalization or revisit to emergency unit due to HF. Maximal doses of beta-blockers did not result in a significant decrease in resting heart rate. Our real-world data have highlighted the prevalence of incomplete titration of beta-blockers. Although it has been shown that evidence-based target dosing of beta-blockers reduces death and MACE, there is still room for improvement with up-titrating beta-blockers in eligible patients.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"797-804"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398877","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":"Impact of lactate levels on admission in STEMI patients with cardiogenic shock treated with IMPELLA.","authors":"Kazuyuki Yahagi, Yuki Gonda, Daiki Yoshiura, Yu Horiuchi, Masahiko Asami, Masanori Taniwaki, Kota Komiyama, Hitomi Yuzawa, Jun Tanaka, Jiro Aoki, Kengo Tanabe","doi":"10.1007/s00380-025-02516-8","DOIUrl":"10.1007/s00380-025-02516-8","url":null,"abstract":"<p><p>The concomitant use of IMPELLA and veno-arterial extracorporeal membrane oxygenation (V-A ECMO) (ECPELLA) has been increasingly used to treat severe cardiogenic shock. However, the relationship between severity of heart failure on admission and prognosis based on differences in the mechanical circulatory support (MCS) is not fully understood. This study evaluated the association between lactate levels on admission and clinical outcomes based on differences in MCS. We identified 852 patients (median age 71 years; 78% male) with cardiogenic shock due to ST-elevation myocardial infarction (STEMI) from the Japanese Registry for Percutaneous Ventricular Assist Devices. The primary endpoint was the in-hospital mortality rate. Additionally, patients were classified into three groups based on lactate levels according to the SCAI SHOCK classification for the assessment of in-hospital mortality: group 1 (lactate level < 2 mmol/L), group 2 (lactate level 2-8 mmol/L), and group 3 (lactate level ≥ 8 mmol/L). The in-hospital mortality rate was 41.8%. The rate of V-A ECMO combined with IMPELLA use was 37.6%. The in-hospital mortality rates of the IMPELLA alone and ECPELLA group were 30.1% and 61.3%, respectively. The median lactate level was significantly higher in non-survivors than in survivors (5.7 mmol/L vs. 3.5 mmol/L, p < 0.0001). The in-hospital mortality rate with IMPELLA alone was significantly higher in group 3 compared to groups 1 and 2; however, there was no difference in in-hospital mortality with ECPELLA among the three groups. A lactate cut-off value of 6.9 mmol/L showed the best discrimination for in-hospital mortality. Patients classified as the SCAI SHOCK stage E have a higher mortality rate with IMPELLA support alone. Further research is needed to optimize management strategies for this high-risk group.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"759-767"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052292","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":"Sensitive detection of atherosclerotic coronary artery disease by a novel index of pressure-area relationship of the brachial artery.","authors":"Chikage Oshita, Takuya Nishikawa, Kazunori Uemura, Yuko Uchimura, Hiroki Teragawa","doi":"10.1007/s00380-025-02528-4","DOIUrl":"10.1007/s00380-025-02528-4","url":null,"abstract":"<p><p>Cross-sectional area (eA) and volumetric elastic modulus (V_E) of the brachial artery estimated by an oscillometric device have been introduced to evaluate the degree of severity of atherosclerosis. However, there were concerns over the clinical efficacy of eA and V_E. In this study, we searched for a novel device-based index that effectively evaluates atherosclerosis, and compared its efficacy in detecting coronary artery disease (CAD) with conventional indexes comprising eA, V_E, carotid maximum intima-media thickness (IMT), cardio-ankle vascular index (CAVI), and flow-mediated dilation (FMD). The Health Chronos TM-2772 device approximates the arterial pressure-area relation to a logarithmic function. We hypothesized that the asymptotic pressure (P_a) of the logarithmic function that reflects the shift of the relation on the pressure axis may be effective in evaluating atherosclerosis. The diagnostic abilities of eA, V_E, P_a, IMT, CAVI, and FMD to detect CAD were analyzed in 60 patients who were classified into CAD (n = 30) and non-CAD (n = 30) groups based on coronary angiographic findings. In CAD group, P_a and FMD were significantly lower, and max-IMT was significantly higher than the respective indices in non-CAD group. eA, V_E, and CAVI showed no significant differences between the two groups. Receiver operating curve (ROC) analysis of the indices for diagnosing the presence of CAD indicated that only P_a [area under the ROC curve (AUC) = 0.706, p < 0.01] and max-IMT (AUC = 0.752, p < 0.01) had acceptable diagnostic ability. The optimal cutoff values were 15.3 mmHg for P_a (sensitivity 77%, specificity 67%) and 1.6 mm for max-IMT (sensitivity 71%, specificity 71%). In conclusion, P_a may be a sensitive and effective index for evaluating the severity of atherosclerosis. Verification of the efficacy and usefulness of P_a is warranted in further prospective multicenter studies and registries.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"768-777"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440752","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}