Heart and Vessels最新文献

{"title":"Elucidating physiologic influences of sleep-related breathing and architectural disruption in Takotsubo syndrome.","authors":"Sepideh Khazaie, Michael D Faulx, James F Bena, Shannon L Morrison, Alex Milinovich, Megan Sheehan, Lu Wang, Reena Mehra","doi":"10.1007/s00380-026-02733-9","DOIUrl":"https://doi.org/10.1007/s00380-026-02733-9","url":null,"abstract":"<p><strong>Background: </strong>Takotsubo syndrome (TS), an acute stress-induced cardiomyopathy driven by catecholamine excess, shares pathophysiological features with sleep disordered breathing (SDB), yet this relationship remains unexplored. We hypothesize that SDB and sleep disruption influences TS risk and severity.</p><p><strong>Methods: </strong>We leveraged data from the Cleveland Clinic sleep cohort (1999-2021) including patients with proven TS and matched controls (1:5 ratio by age, sex, body mass index (BMI), and study year). Logistic regression models were used to assess odds of TS associated with SDB biomarkers, i.e., apnea-hypopnea index (AHI; evaluated at thresholds ≥ 5, ≥15, and ≥ 30), hypoxia (percentage of sleep time with SaO₂ <90%) and the arousal index, while adjusting for age, sex, BMI, comorbidities (hypertension, diabetes, and hyperlipidemia), and overall cardiovascular medication use. Spearman correlations were used to examine relationships between sleep measures and left ventricular ejection fraction (LVEF) in TS patients.</p><p><strong>Results: </strong>S cases (n = 84; mean age 64.1 ± 11.4 years, 86.9% female, BMI 30.9 ± 7.7 kg/m²) had higher comorbidity (e.g., 45.2% vs. 10.1% coronary artery disease, p < 0.001) and lower PAP use (17.9% vs. 43.0%, p < 0.001) compared to matched controls (n = 414). Mild OSA (AHI 5-<15) was associated with reduced odds of TS in unadjusted models (OR = 0.49, 95% CI 0.25-0.94, p = 0.032) and remained significant after adjustment for age, sex, BMI, comorbidities, and overall cardiovascular medication use (OR = 0.48, 95% CI 0.24-0.96, p = 0.037). In the subgroup analysis of patients with pre-TS sleep studies (n = 36), a stronger association was observed for overall OSA (AHI ≥ 5) (OR = 0.34, 95% CI 0.13-0.91, p = 0.031). Arousal index correlated with lower LVEF in pre-TS cases (rho = - 0.40, p = 0.024). Moderate/severe OSA and hypoxia showed no significant association with TS.</p><p><strong>Conclusions: </strong>Mild OSA may be protective in TS, possibly via hypoxic preconditioning, while sleep fragmentation is associated with greater cardiac dysfunction. This first study of SDB in TS highlights a novel sleep-cardiac interplay, warranting further investigation.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520052","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":"Clinical significance of geriatric nutritional risk index in risk stratification of acute myocarditis.","authors":"Yoshiki Kawai, Taishi Yonetsu, Takashi Hiruma, Yoshitaka Isotani, Yumiko Hosoya, Yasuhiro Maejima, Takeshi Yamamoto, Shun Kohsaka, Morimasa Takayama","doi":"10.1007/s00380-026-02735-7","DOIUrl":"https://doi.org/10.1007/s00380-026-02735-7","url":null,"abstract":"<p><p>The clinical course of acute myocarditis varies widely, making accurate prognostication difficult. Nutritional assessment aids risk stratification in various cardiovascular diseases; however, its role in myocarditis remains unclear. This study examined the association between Geriatric Nutritional Risk Index (GNRI)-defined nutritional risk, and prognosis in acute myocarditis. We analyzed admission data on patients with acute myocarditis hospitalized via emergency medical services from the multicenter Tokyo CCU Network Database between January 2017 and December 2022. Nutritional risk was assessed using the GNRI (≥ 98 normal nutrition; 92 to < 98 low; 82 to < 92 moderate; ≤82 severe). The primary outcome was in-hospital death, and secondary outcomes included hospital length of stay (LOS) and cardiovascular care unit LOS. Multivariable Cox regression assessed the association between GNRI-defined nutritional risk and outcomes, adjusting for patient characteristics. Among 402 patients, the median age was 43 years [27-66], and 24.9% presented with shock. GNRI categories were as follows: normal nutrition 41.5%, low 20.6%, moderate 22.9%, and severe 14.9%. Compared with the normal-nutrition group, the severe-risk group had a higher hazard of in-hospital death (adjusted hazard ratio (aHR) = 12.2; 95% CI 2.64-56; P = 0.0025). Each one-point decrease in GNRI was associated with higher in-hospital mortality after multivariable adjustment (aHR = 1.06; 95% CI 1.03-1.09; P < 0.001). The trend remained similar in models adjusted for inflammation. GNRI-defined nutritional risk was associated with poorer prognosis, and may provide additional prognostic information in patients with acute myocarditis.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520081","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":"Clinical characteristics and outcomes of the anomalous aortic origin of a coronary artery: a nationwide pediatric survey in Japan.","authors":"Koki Kiyomatsu, Masaki Nii, Naomi Nakagawa, Kentaro Ikeda, Tomomi Ueda, Keiichi Hirono, Hiroyuki Suzuki, Ayako Kuraoka, Kenichi Kurosaki, Yozo Teramachi, Kenji Suda","doi":"10.1007/s00380-026-02722-y","DOIUrl":"https://doi.org/10.1007/s00380-026-02722-y","url":null,"abstract":"<p><p>An anomalous aortic origin of a coronary artery (AAO-CA) is one of the leading causes of sudden cardiac death in children. This study aimed to characterize the clinical features and outcomes of AAO-CA diagnosed between 2000 and 2019 using data from a nationwide survey in Japan. We identified 106 pediatric patients with AAO-CA (71 AAO-right CA and 35 AAO-left CA cases) from 32 participating institutions, with a median age of 9.1 (4.9-13.3) years at the time of diagnosis. At diagnosis, more than half (59%) of the patients were asymptomatic; AAO-CA was mainly detected during cardiac screening (52%) or Kawasaki disease management (48%), and the remaining patients (41%) presented with cardiac events (n = 24), chest pain (n = 15), or other manifestations (n = 4). Multivariable logistic regression analysis identified older age at diagnosis, AAO-left CA, and intra-mural coronary course as predictors of symptoms. Soon after established diagnosis [median of 2.0 (0.9-5.2) months], 7 asymptomatic and 32 symptomatic patients underwent surgical intervention, based on symptoms, anatomy, or positive myocardial stress test results. All patients (including one who presented with cardiopulmonary arrest and later underwent heart transplantation), survived to the age of 12.2 (7.4-16.2) years without further cardiac events. In conclusion, more than half of the patients with AAO-CA were diagnosed without symptoms with specific clinical features in Japan. Patients who underwent timely surgical intervention achieved excellent outcomes, highlighting the need for practical guidelines for the management of asymptomatic patients.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520035","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":"Author's Reply to \"Microvascular angina beyond risk markers: the need for endotype-specific validation\".","authors":"Satoru Suzuki, Kenichi Tsujita","doi":"10.1007/s00380-026-02732-w","DOIUrl":"https://doi.org/10.1007/s00380-026-02732-w","url":null,"abstract":"<p><p>We thank Birgün et al. for their thoughtful comments regarding our recent study on microvascular angina (MVA). In this reply, we address concerns regarding the selection of control group, medication-related confounding, and the heterogeneity of MVA endotypes. We acknowledge the limitations inherent to our retrospective case-control design while emphasizing that the observed associations between mildly elevated HbA1c, low high-density lipoprotein cholesterol, low hemoglobin levels, and MVA remained significant. We hope that these findings will stimulate further prospective investigations into the pathophysiology and clinical characteristics of MVA.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520115","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":"Clinical characteristics and outcomes of isolated severe functional tricuspid regurgitation in a real-world setting.","authors":"Mina Tsukuda, Hidekazu Tanaka, Yoshiro Kubota, Tomohiro Matsuura, Jun-Ichi Noiri, Tomoyuki Nagano, Haruna Yokota, Chihiro Fujii, Hiroshi Tsunamoto, Mariko Takeuchi, Masayuki Kintsu, Eriko Hisamatsu, Terunobu Fukuda, Hiromasa Otake","doi":"10.1007/s00380-026-02734-8","DOIUrl":"10.1007/s00380-026-02734-8","url":null,"abstract":"<p><p>Functional tricuspid regurgitation (FTR) is increasingly prevalent in aging populations with heart failure (HF) and has been associated with adverse outcomes. However, the clinical characteristics and prognosis of patients with isolated severe FTR remain poorly defined. We retrospectively reviewed 108,513 consecutive transthoracic echocardiographic examinations performed between June 2013 and March 2025. Isolated severe FTR was defined as severe FTR without significant left-sided valvular disease and preserved left ventricular ejection fraction (LVEF ≥ 50%). The primary endpoint was all-cause mortality, and the secondary endpoint was cardiovascular death or HF hospitalization. Seventy-four patients met the criteria for isolated severe FTR. Patients were predominantly elderly (mean age: 80.9 ± 5.9 years), 54.0% were New York Heart Association functional class III or IV, 70.2% had HF stage C or D, and chronic kidney disease was present in 86.4% of patients. During a median follow-up of 3.1 years, 13 patients (17%) died, and 31 patients (41%) experienced cardiovascular death or HF hospitalization. Therapeutic intervention for TR was performed in only 14 patients (18.9%). Compared with previously reported cohorts of severe mitral regurgitation, aortic stenosis, and aortic regurgitation, patients with isolated severe FTR were older, more symptomatic, and had worse outcomes despite lower intervention rates. In conclusion, in real-world practice, isolated severe FTR predominantly affects elderly patients with advanced HF and multiple comorbidities and is associated with poor outcomes despite preserved LVEF. Relative to other severe valvular heart diseases, isolated severe FTR appears to represent an underrecognized and undertreated high-risk condition.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520125","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 1-month dual antiplatelet therapy after treatment with drug-coated balloon for femoropopliteal artery disease.","authors":"Kojiro Miki, Rin Hoshina, Takamasa Tanaka, Hirokazu Tanaka, Koji Yanaka, Nagataka Yoshihara, Ten Saita, Toshio Kimura, Akinori Sumiyoshi, Hiroto Tamaru, Takahiro Imanaka, Hirokuni Akahori, Daizo Kawasaki, Yoshiharu Nishibori, Masaharu Ishihara","doi":"10.1007/s00380-026-02730-y","DOIUrl":"10.1007/s00380-026-02730-y","url":null,"abstract":"<p><p>Established data describing the optimal duration of dual antiplatelet therapy (DAPT) after endovascular therapy (EVT) for patients with peripheral artery disease (PAD) are limited. This study is a prospective, multi-center single-arm study evaluating 1-month DAPT on clinical outcomes following EVT using drug-coated balloon (DCB) for patients with symptomatic femoropopliteal artery (FPA) disease. A total of 151 patients with de novo FPA lesions which planned DCB therapy were enrolled from seven centers. DAPT (aspirin 100 mg/day and clopidogrel 75 mg/day) was started prior to EVT and continued 1-month after EVT, and subsequent aspirin monotherapy was continued during follow-up period. The primary endpoint was 1-year primary patency, as assessed by duplex ultrasound. Secondary endpoints included re-occlusion, target lesions revascularization (TLR), major amputation, acute limb ischemia (ALI), and bleeding events at one year. Mean age was 74.6 ± 8.8 and critical limb ischemia were observed in 48 patients (31.8%). Mean lesion length was 14.1 ± 9.7 cm and chronic occluded lesions were 23.8%. The primary patency rate was 74.3% at 1-year (the median period: 12.9 months). The rate of freedom from re-occlusion, TLR, and major amputation was 84.0, 86.1, and 88.2% respectively. There were no incidence of ALI and life-threatening bleedings. One-month DAPT and subsequent aspirin monotherapy following EVT with DCB for FPA lesions might be an option in terms of the bleeding risk. Further investigations with large number of subjects are required to reveal the optimal antiplatelet therapy for PAD patients.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390770","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":"Microvascular angina beyond risk markers: the need for endotype-specific validation.","authors":"Abdülmelik Birgün, Abdullah Sarıhan, Macit Kalçık","doi":"10.1007/s00380-026-02731-x","DOIUrl":"10.1007/s00380-026-02731-x","url":null,"abstract":"<p><p>This letter discusses methodological limitations of a retrospective case-control study evaluating HbA1c, HDL-C, and hemoglobin levels in microvascular angina. Although the findings are clinically interesting, differences in control phenotyping, incomplete CFR assessment, medication confounding, and endotype heterogeneity limit causal interpretation. Prospective, mechanism-based validation is needed before these variables are accepted as therapeutic targets.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390469","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":"Predictive ability of microvascular resistance reserve for periprocedural myocardial injury in patients with stable coronary artery disease undergoing percutaneous coronary intervention.","authors":"Mikio Shigehara, Hiroki Ikenaga, Yuki Yoshitomi, Hiroshi Kobatake, Atsushi Kuraishi, Ayano Osawa, Takayuki Nakano, Yuichi Morita, Tasuku Higashihara, Noriaki Watanabe, Yoshiharu Sada, Yukiko Nakano","doi":"10.1007/s00380-025-02646-z","DOIUrl":"10.1007/s00380-025-02646-z","url":null,"abstract":"<p><p>Periprocedural myocardial injury (PMI) has shown an association with worse prognosis after percutaneous coronary intervention (PCI). The microvascular resistance reserve (MRR) has been introduced as an index to evaluate microvascular vasodilatory capacity, independent of epicardial disease. Given the unclear association between MRR and PMI, this study aimed to determine the relationship between PMI and coronary microvascular dysfunction, including index of microcirculatory resistance (IMR) and MRR. This study identified 68 patients with stable angina pectoris who underwent PCI after measurements of coronary circulatory physiological indices at Hiroshima University Hospital between October 2017 and October 2024. PMI was assessed by a post-PCI high-sensitivity troponin T level > 5 times the 99th percentile of the normal upper limit (> 0.07 ng/mL). In total, 57 patients were enrolled, of which 18 (31.6%) had elevation of troponin T > 0.07 ng/mL after PCI and were classified into the PMI group. Significantly worse measurements of IMR (33.7 [24.0–43.8] vs. 26.0 [15.9–33.0], p = 0.029) and MRR (2.95 [2.28–4.00] vs. 4.29 [3.01–5.74], p = 0.009) were documented in the PMI group. After multivariable logistic regression analyses, both MRR (OR 0.464; 95% CI 0.234–0.919; p = 0.028) and IMR (OR 1.060; 95% CI 1.000–1.1830; p = 0.041) were identified as predictive factors of PMI. Both MRR and IMR before PCI were independent predictors of PMI.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"451-460"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145855643","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":"Response to letter to the editor regarding \"HELT-E₂S₂ score is a promising marker for predicting left atrial appendage dysfunction in patients with ischemic stroke\".","authors":"Naoto Hashimoto, Tetsu Watanabe, Atsushi Iizuka, Tomoki Kobayashi, Shunsuke Edamura, Takayuki Sugai, Masahiro Wanezaki, Harutoshi Tamura, Satoshi Nishiyama, Masafumi Watanabe","doi":"10.1007/s00380-025-02591-x","DOIUrl":"10.1007/s00380-025-02591-x","url":null,"abstract":"","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"510-511"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759969","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 impact of diabetes on clinical outcomes in patients with pseudonormal left ventricular diastolic filling pattern and preserved ejection fraction.","authors":"Seongjin Park, Dong-Gil Kim, Jiwon Kim, Gi Rim Kim, Woo Jae Jeong, Heejin Jeong, Hyun Cho, Kyu-Yong Ko, Sung Eun Kim, Hyeon Jeong Oh, Ji-Won Hwang, Joon-Hyung Doh, Sung Uk Kwon, June Namgung, Min Sun Kim, Sung Woo Cho","doi":"10.1007/s00380-025-02647-y","DOIUrl":"10.1007/s00380-025-02647-y","url":null,"abstract":"<p><p>Type 2 diabetes mellitus (DM) is a risk factor for the development of heart failure (HF) and associated with a poor prognosis. However, the impact of DM on clinical outcomes in patients with left ventricular diastolic dysfunction (LVDD) and HF with preserved ejection fraction (EF), which is the phenotype of diabetic cardiomyopathy, remains uncertain. This study aimed to investigate the impact of DM on cardiac functional changes and prognosis in patients with pseudonormal LV diastolic filling pattern (LVDFP) and preserved EF. A total of 413 patients with pseudonormal LVDFP and preserved EF who underwent follow-up echocardiography were enrolled between 2011 and 2020. The primary outcome was major adverse cardiac events (MACE) including all-cause death, non-fatal myocardial infarction, cardiac hospitalization, or stroke. Among the study population, 125 patients (30.3%) had DM. During the follow-up period (median 3.8 years [interquartile range: 2.1 to 5.6 years]), the follow-up EF comparing baseline EF was more significantly decreased in DM patients (67.3 ± 6.3 to 64.8 ± 7.5; p = 0.001) compared with non-DM patients (67.8 ± 5.8 to 66.8 ± 6.9; p = 0.03). Furthermore, compared with the non-DM patients, the DM patients significantly increased the risk of MACE (26.2% vs. 54.7%; adjusted hazard ratio, 1.68; 95% confidence interval, 1.11-2.54; p = 0.015). In patients with pseudonormal LVDFP and preserved EF, the DM was associated with the risk of worse clinical outcomes compared with the non-DM.</p>","PeriodicalId":12940,"journal":{"name":"Heart and Vessels","volume":" ","pages":"486-494"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018334","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}