Journal of cardiology最新文献

{"title":"Usefulness of exercise stress echocardiography for predicting cardiovascular events and atrial fibrillation in hypertrophic cardiomyopathy.","authors":"Tomohiro Yoshii, Masashi Amano, Kenji Moriuchi, Shoko Nakagawa, Hitomi Nishimura, Yurie Tamai, Ayaka Mizumoto, Aiko Koda, Yutaka Demura, Yoshito Jo, Yuki Irie, Takahiro Sakamoto, Makoto Amaki, Hideaki Kanzaki, Teruo Noguchi, Kunihiro Nishimura, Takeshi Kitai, Chisato Izumi","doi":"10.1016/j.jjcc.2024.08.010","DOIUrl":"10.1016/j.jjcc.2024.08.010","url":null,"abstract":"<p><strong>Background: </strong>In hypertrophic cardiomyopathy (HCM), the determinants of exercise tolerance and the usefulness of exercise stress echocardiography (ESE) for predicting hard endpoints have not been fully investigated. We aimed to assess the key parameters of ESE for exercise tolerance and the factors predictive of cardiovascular events and new-onset atrial fibrillation (AF) in patients with HCM.</p><p><strong>Methods: </strong>Seventy-four consecutive patients with HCM who underwent ESE and with an ejection fraction ≥50 % were enrolled. The primary endpoint was a composite of cardiovascular death, heart failure hospitalization, ventricular fibrillation or tachycardia, and ventricular assist device implantation. The secondary endpoint was new-onset AF.</p><p><strong>Results: </strong>The primary endpoint occurred in 13 patients. The left and right ventricular functions during exercise were responsible for decreased exercise tolerance. Peak exercise e' and tricuspid annular plane systolic excursion (TAPSE) significantly predicted increased primary outcome risk (hazard ratio 1.35, 95 % confidence interval 1.10-1.76, p = 0.003; hazard ratio 1.19, 95 % confidence interval 1.07-1.32, p = 0.002, respectively), and the results were consistent even after adjustment by maximum workload. These ESE parameters improved the prognostic model containing estimated glomerular filtration rate (eGFR) and left atrial (LA) volume index. In AF-naive patients (n = 58), LA volume, peak exercise LA reservoir strain, and left ventricular outflow tract (LVOT) pressure gradient predicted new-onset AF.</p><p><strong>Conclusions: </strong>In patients with HCM, ESE parameters related to left and right ventricular function were responsible for low exercise tolerance. Furthermore, e' and TAPSE at peak workload could be useful for predicting cardiovascular events in addition to eGFR and LA volume index. LVOT pressure gradient and LA function during exercise predicted new-onset AF.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined assessment of fractional flow reserve, resting full-cycle ratio, and resting ratio of distal coronary to aortic pressure for clinical outcomes.","authors":"Tatsuro Yamazaki, Yuichi Saito, Shunsuke Nakamura, Yuya Tanabe, Hideki Kitahara, Yoshio Kobayashi","doi":"10.1016/j.jjcc.2024.08.009","DOIUrl":"10.1016/j.jjcc.2024.08.009","url":null,"abstract":"<p><strong>Background: </strong>Fractional flow reserve (FFR) and non-hyperemic indices are invasive standards for evaluating functional significance of coronary stenosis. However, data are limited about outcomes in vessels with concordant and discordant physiological results, particularly with a ratio of distal coronary to aortic pressure (Pd/Pa) at rest.</p><p><strong>Methods: </strong>This was a single-center, retrospective, observational study. Coronary physiological indices including FFR, resting full-cycle ratio (RFR), and resting Pd/Pa were invasively evaluated in vessels with intermediate coronary artery stenosis. FFR ≤0.80, RFR ≤0.89, and resting Pd/Pa ≤0.92 were considered physiologically positive. Vessels were divided into three groups according to the results of FFR, RFR, and resting Pd/Pa: concordant positive (all positive for FFR, RFR, and resting Pd/Pa), concordant negative (all negative for FFR, RFR, and resting Pd/Pa), and discordant groups. The primary endpoint was target vessel failure (TVF) defined as a composite of cardiac death and target vessel myocardial infarction and unplanned revascularization.</p><p><strong>Results: </strong>Of 987 vessels included, 311 (31.5 %), 263 (26.6 %), and 413 (41.9 %) were in the concordant positive, discordant, and concordant negative groups. During a median follow-up period of 417 (208-756) days, TVF occurred more frequently in the concordant positive group, followed by the discordant and concordant negative groups (7.7 % vs. 4.6 % vs. 2.4 %, p = 0.004). TVF increasingly accrued during long-term follow-up, while discordant results of RFR and resting Pd/Pa did not result in worse outcomes compared with negative RFR and resting Pd/Pa.</p><p><strong>Conclusion: </strong>The combined assessment of FFR with RFR and resting Pd/Pa stratified TVF risks in vessels with intermediate coronary stenosis.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early vs. late transcatheter aortic valve replacement in acute heart failure hospitalizations: A comparative nationwide analysis.","authors":"Anas Hashem, Amani Khalouf, Mohamed Salah Mohamed, Saryia Adra, Deya Alkhatib, Mahmoud Ismayl, Anthony Kashou, Devesh Rai, Jeremiah P Depta, Samian Sulaiman, Andrew M Goldsweig, Sudarshan Balla","doi":"10.1016/j.jjcc.2024.08.007","DOIUrl":"10.1016/j.jjcc.2024.08.007","url":null,"abstract":"<p><strong>Background: </strong>Severe aortic stenosis (AS) is the most common valvular disease in the USA. Patients undergoing urgent or emergent transcatheter aortic valve replacement (TAVR) have worse clinical outcomes than those undergoing non-urgent procedures. No studies have examined the impact of procedural TAVR timing on outcomes in AS complicated by acute heart failure (AHF).</p><p><strong>Aims: </strong>We aimed to evaluate differences in in-hospital mortality and clinical outcomes between early (<48 h) vs. late (≥48 h) TAVR in patients hospitalized with AHF using a real-world US database.</p><p><strong>Methods: </strong>We queried the National Inpatient Sample database to identify hospitalizations with a diagnosis of AHF, aortic valve disease, and a TAVR procedure (2015-2020). The associations between TAVR timing and clinical outcomes were examined using logistic regression model.</p><p><strong>Results: </strong>A total of 25,290 weighted AHF hospitalizations were identified, of which 6855 patients (27.1 %) underwent early TAVR, and 18,435 (72.9 %) late TAVR. Late TAVR patients had higher in-hospital mortality rate (2.2 % vs. 2.8 %, p < 0.01) on unadjusted analysis but no significant difference following adjustment for demographic, clinical, and hospital characteristics [aOR 1.00 (0.82-1.23)]. Late TAVR was associated with higher odds of cardiac arrest (aOR 1.50, 95 % CI: 1.18-1.90) and use of mechanical circulatory support (aOR 2.05, 95 % CI: 1.68-2.51). Late TAVR was associated with longer hospital stay (11 days vs. 4 days, p < 0.01) and higher costs ($72,851 vs. $53,209, p < 0.01).</p><p><strong>Conclusion: </strong>Early TAVR was conducted in approximately 25 % of the AS patients admitted with AHF, showing improved in-hospital outcomes before adjustment, with no significant differences observed after adjustment.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A risk model of mortality rate in dialysis patients following transcatheter aortic valve replacement.","authors":"Kizuku Yamashita, Koichi Maeda, Kyongsun Pak, Kazuo Shimamura, Ai Kawamura, Isamu Mizote, Masaki Taira, Daisuke Yoshioka, Shigeru Miyagawa","doi":"10.1016/j.jjcc.2024.07.009","DOIUrl":"10.1016/j.jjcc.2024.07.009","url":null,"abstract":"<p><strong>Background: </strong>Dialysis patients undergoing transcatheter aortic valve replacement (TAVR) generally have poor prognosis compared with non-dialysis patients. Furthermore, there are few reliable risk models in this clinical setting. Therefore, we aimed to establish a risk model in dialysis patients undergoing TAVR that would be informative for their prognosis and the decision-making process of TAVR.</p><p><strong>Methods: </strong>A total 118 dialysis patients (full cohort) with severe aortic stenosis underwent TAVR in our institute between 2012 and 2022. The patients of the full cohort were randomly assigned to two groups in a 2:1 ratio to form derivation and validation cohorts. Risk factors contributing to deaths were analyzed from the preoperative variables and a risk model was established from Cox proportional hazard model.</p><p><strong>Results: </strong>There were 69 deaths following TAVR derived from infectious disease (43.5 %), cardiovascular-related disease (11.6 %), cerebral stroke or hemorrhage (2.9 %), cancer (1.4 %), unknown origin (18.8 %), and others (21.7 %) during the observational period (811 ± 719 days). The cumulative overall survival rates using the Kaplan-Meier method at 1 year, 3 years, and 5 years in the full cohort were 82.8 %, 41.9 %, and 24.2 %, respectively. An optimal risk model composed of five contributors: peripheral vascular disease, serum albumin, left ventricular ejection fraction < 40 %, operative age, and hemoglobin level, was established. The estimated C index for the developed models were 0.748 (95 % CI: 0.672-0.824) in derivation cohort and 0.705 (95 % CI: 0.578-0.832) in validation cohort. The prediction model showed good calibration [intraclass correlation coefficient = 0.937 (95%CI: 0.806-0.981)] between actual and predicted survival.</p><p><strong>Conclusions: </strong>The risk model was a good indicator to estimate the prognosis in dialysis patients undergoing TAVR.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JCS/JSCVS/JCC/CVIT 2023 guideline focused update on indication and operation of PCPS/ECMO/IMPELLA","authors":"Takashi Nishimura,&nbsp;Yasutaka Hirata,&nbsp;Takayuki Ise,&nbsp;Hiroyuki Iwano,&nbsp;Hironori Izutani,&nbsp;Koichiro Kinugawa,&nbsp;Takeshi Kitai,&nbsp;Takayuki Ohno,&nbsp;Tomohito Ohtani,&nbsp;Takahiro Okumura,&nbsp;Minoru Ono,&nbsp;Kazuhiro Satomi,&nbsp;Akira Shiose,&nbsp;Koichi Toda,&nbsp;Yasumasa Tsukamoto,&nbsp;Osamu Yamaguchi,&nbsp;Takeo Fujino,&nbsp;Toru Hashimoto,&nbsp;Haruhiko Higashi,&nbsp;Akihiro Higashino,&nbsp;Yoshiki Sawa","doi":"10.1016/j.jjcc.2024.04.006","DOIUrl":"10.1016/j.jjcc.2024.04.006","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"84 3","pages":"Pages 208-238"},"PeriodicalIF":2.5,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0914508724000790/pdfft?md5=78dca824b6f3826f6b58981518fe5e1d&pid=1-s2.0-S0914508724000790-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BP classification using the 2017 ACC/AHA BP guidelines with risk of cardiovascular events in older individuals","authors":"Yuta Suzuki PhD ,&nbsp;Hidehiro Kaneko MD ,&nbsp;Akira Okada MD ,&nbsp;Katsuhito Fujiu MD ,&nbsp;Norifumi Takeda MD, FJCC ,&nbsp;Hiroyuki Morita MD, FJCC ,&nbsp;Yuichiro Yano MD ,&nbsp;Akira Nishiyama MD ,&nbsp;Koichi Node MD, FJCC ,&nbsp;Hideo Yasunaga MD ,&nbsp;Issei Komuro MD, FJCC","doi":"10.1016/j.jjcc.2024.07.005","DOIUrl":"10.1016/j.jjcc.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><div>The association between stage 1 hypertension and the risk of cardiovascular disease (CVD) has not been established in older adults. Furthermore, little is known about whether lowering blood pressure (BP) is beneficial in older adults with stage 1 hypertension.</div></div><div><h3>Methods</h3><div>This cohort study analyzed nationwide data collected from the Japanese DeSC database, including 476,654 individuals aged ≥60 years. Individuals were categorized into four groups according to the 2017 ACC/AHA BP guidelines: normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension. The primary outcome was a composite CVD event, including myocardial infarction, angina pectoris, stroke, and heart failure.</div></div><div><h3>Results</h3><div>During a mean follow-up of 3.1 years, 53,946 composite CVD events were recorded. Hazard ratios of stage 1 hypertension for composite CVD events, myocardial infarction, angina pectoris, stroke, and heart failure were 1.10 (95 % CI, 1.07–1.13), 1.16 (95 % CI, 1.03–1.31), 1.06 (95 % CI, 1.01–1.10), 1.13 (95 % CI, 1.08–1.18), and 1.13 (95 % CI, 1.09–1.16), respectively. Individuals with a ≥5 mmHg decrease in systolic BP over one year had a lower risk of stroke among individuals with stage 1 hypertension. The positive association between stage 1 hypertension and composite CVD events was attenuated in individuals aged ≥75 years.</div></div><div><h3>Conclusions</h3><div>Stage 1 hypertension is associated with a higher risk of developing CVD events among older adults. The 2017 ACC/AHA BP guidelines could be applied to older populations; however, the applicability of these guidelines to older adults aged ≥75 years requires further investigations.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"84 6","pages":"Pages 394-403"},"PeriodicalIF":2.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term clinical outcomes following percutaneous coronary intervention in patients aged 90 years and older","authors":"Kotaro Tokuda MD ,&nbsp;Akihito Tanaka MD, PhD ,&nbsp;Yusuke Uemura MD, PhD ,&nbsp;Naoki Shibata MD, PhD ,&nbsp;Makoto Iwama MD, PhD ,&nbsp;Teruhiro Sakaguchi MD, PhD ,&nbsp;Ruka Yoshida MD ,&nbsp;Yosuke Negishi MD ,&nbsp;Hiroshi Tashiro MD ,&nbsp;Miho Tanaka MD, PhD ,&nbsp;Yosuke Tatami MD, PhD ,&nbsp;Shogo Yamaguchi MD ,&nbsp;Naoki Yoshioka MD, PhD ,&nbsp;Norio Umemoto MD ,&nbsp;Taiki Ohashi MD ,&nbsp;Yasunobu Takada MD, PhD ,&nbsp;Hiroshi Asano MD, PhD ,&nbsp;Yukihiko Yoshida MD, PhD ,&nbsp;Toshikazu Tanaka MD ,&nbsp;Toshiyuki Noda MD, PhD, FJCC ,&nbsp;Toyoaki Murohara MD, PhD, FJCC","doi":"10.1016/j.jjcc.2024.07.004","DOIUrl":"10.1016/j.jjcc.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><div>In an aging society, percutaneous coronary intervention (PCI) for super-elderly patients is commonly performed in clinical practice. However, data are scarce regarding the clinical features and outcomes of this population.</div></div><div><h3>Methods</h3><div>This multicenter observational study enrolled patients aged over 90 years who underwent PCI across 10 hospitals between 2011 and 2020. The study included patients presenting with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). The occurrence of all-cause and cardiac deaths during hospitalization and after discharge was investigated.</div></div><div><h3>Results</h3><div>In total, 402 patients (91.9 ± 2.0 years, 48.3 % male) participated in the study, of whom 77.9 % presented with ACS. The rate of in-hospital death was significantly higher in patients with ACS compared to patients with CCS (15.3 % vs. 2.2 %, <em>p</em> &lt; 0.001). The estimated cumulative incidence rates of all-cause death were 24.3 %, 39.5 %, and 60.4 % at 1, 3, and 5 years, respectively. No significant difference was observed in the occurrence of all-cause death between patients with ACS and CCS. Regarding causes of death after discharge, non-cardiac deaths accounted for just over half of the cases.</div></div><div><h3>Conclusion</h3><div>This study highlights the clinical features and long-term clinical course of patients aged over 90 years who underwent PCI in a real-world setting. Patients presenting with ACS exhibited a higher rate of in-hospital mortality compared to those with CCS. Following discharge, both ACS and CCS patients experienced comparable and substantial increases in the incidence rates of both cardiac and non-cardiac mortality over time, and a more holistic management approach is warranted.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"84 6","pages":"Pages 388-393"},"PeriodicalIF":2.5,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of cardiac allograft vasculopathy using splenic switch-off on myocardial PET.","authors":"Atsushi Yamamoto, Michinobu Nagao, Michiru Nomoto, Akihiro Inoue, Risa Imakado, Risako Nakao, Yuka Matsuo, Akiko Sakai, Hidetoshi Hattori, Noriko Kikuchi, Shinichi Nunoda, Koichiro Kaneko, Mitsuru Momose, Shuji Sakai, Junichi Yamaguchi","doi":"10.1016/j.jjcc.2024.06.010","DOIUrl":"10.1016/j.jjcc.2024.06.010","url":null,"abstract":"<p><strong>Background: </strong>Heart transplantation (HTx) is a definitive therapy for refractory heart failure. Cardiac allograft vasculopathy (CAV), characterized by diffuse arteriopathy involving the epicardial coronary arteries and microvasculature, is the major cause of death for patients with HTx. ¹³N-ammonia positron emission tomography (NH₃-PET) can offer diagnostic and prognostic utility for CAV. The splenic switch-off (SSO) detected in NH3-PET is a hemodynamic indicator of favorable response to adenosine. We hypothesized that both CAV and SSO reflected a pathology that progresses in parallel with systemic vascular endothelial dysfunction. Therefore, we quantitatively evaluated splenic adenosine reactivity measured using NH3-PET as an index of endothelial function, and examined its predictability for CAV.</p><p><strong>Methods: </strong>Forty-eight patients who underwent NH₃-PET after HTx were analyzed. The spleen ratio was calculated as the mean standardized uptake value, measured by placing an ROI on the spleen, at stress divided by that at rest. SSO was defined by a cutoff determined using receiver operating characteristic (ROC) analysis for the spleen ratio. The endpoint was appearance or progression of CAV. Predictability of SSO was analyzed using Kaplan-Meier analysis.</p><p><strong>Results: </strong>The endpoint occurred in 9 patients during a mean follow-up of 45 ± 17 months. ROC curve analysis demonstrated a cutoff of 0.94 for spleen ratio. Patients without SSO displayed a significantly higher CAV rate than those with SSO (p = 0.022).</p><p><strong>Conclusions: </strong>SSO reflects the endothelial function of systemic blood vessels and was a predictor of CAV in patients with HTx.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of hyper-polypharmacy due to non-cardiovascular medications on long-term clinical outcomes following endovascular treatment for lower limb artery disease: A sub-analysis of the I-PAD Nagano registry","authors":"","doi":"10.1016/j.jjcc.2024.06.011","DOIUrl":"10.1016/j.jjcc.2024.06.011","url":null,"abstract":"<div><h3>Background</h3><div>Lower limb artery disease (LEAD) is accompanied by multiple comorbidities; however, the effect of hyperpolypharmacy on patients with LEAD has not been established. This study investigated the associations between hyperpolypharmacy, medication class, and adverse clinical outcomes in patients with LEAD.</div></div><div><h3>Methods</h3><div>This study used data from a prospective multicenter observational Japanese registry. A total of 366 patients who underwent endovascular treatment (EVT) for LEAD were enrolled in this study. The primary endpoints were major adverse cardiac events (MACE), including myocardial infarction, stroke, and all-cause death.</div></div><div><h3>Results</h3><div><span>Of 366 patients with LEAD, 12 with missing medication information were excluded. Of the 354 remaining patients, 166 had hyperpolypharmacy (≥10 medications, 46.9 %), 162 had polypharmacy (5–9 medications, 45.8 %), and 26 had nonpolypharmacy (&lt;5 medications, 7.3 %). Over a 4.7-year median follow-up period, patients in the hyperpolypharmacy group showed worse outcomes than those in the other two groups (log-rank test, </span><em>p</em><span> &lt; 0.001). Multivariate analysis revealed that the total number of medications was significantly associated with an increased risk of MACE (hazard ratio per medication increase 1.07, 95 % confidence interval 1.02–1.13 </span><em>p</em> = 0.012). Although an increased number of non-cardiovascular medications was associated with an elevated risk of MACE, the increase in cardiovascular medications was not statistically significant (log-rank test, <em>p</em> = 0.002 and 0.35, respectively).</div></div><div><h3>Conclusions</h3><div>Hyperpolypharmacy due to non-cardiovascular medications was significantly associated with adverse outcomes in patients with LEAD who underwent EVT, suggesting the importance of medication reviews, including non-cardiovascular medications.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"84 6","pages":"Pages 379-387"},"PeriodicalIF":2.5,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of change in hepato-renal function and cardiac rehabilitation on mortality in patients with heart failure","authors":"","doi":"10.1016/j.jjcc.2024.06.006","DOIUrl":"10.1016/j.jjcc.2024.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Patients with heart failure (HF) often suffer from hepato-renal dysfunction. The associations between hepato-renal function changes and mortality remain unclear. Further, the effect of cardiac rehabilitation (CR) on mortality and motor functions in patients with HF and hepato-renal dysfunction requires investigation.</div></div><div><h3>Methods</h3><div>We reviewed 2522 patients with HF (63.2 % male; median age: 74 years). The association between changes in hepato-renal function assessed by the Model for End-stage Liver Disease eXcluding INR (MELD-XI) score and mortality was examined. The association of CR participation with mortality and physical functions was investigated in patients with HF with decreased, unchanged, and increased MELD-XI scores.</div></div><div><h3>Results</h3><div>During the follow-up period, 519 (20.6 %) patients died. Worsened MELD-XI score was independently associated with all-cause death [adjusted hazard ratio (aHR): 1.099; 95 % confidence interval (CI): 1.061–1.138; <em>p</em> &lt; 0.001]. CR participation was associated with low mortality, even in the increased MELD-XI score group (aHR: 0.498; 95 % CI: 0.333–0.745; <em>p</em> &lt; 0.001). Trajectory of the MELD-XI score was not associated with physical function changes. There were no time by MELD-XI score interaction effects on handgrip strength (<em>p</em> = 0.084), leg strength (<em>p</em> = 0.082), walking speed (<em>p</em> = 0.583), and 6-min walking distance (<em>p</em> = 0.833) in patients participating in outpatient CR.</div></div><div><h3>Conclusions</h3><div>Hepato-renal dysfunction predicts high mortality. CR participation may be helpful for a better prognosis of patients with HF and hepato-renal dysfunction.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"84 6","pages":"Pages 355-361"},"PeriodicalIF":2.5,"publicationDate":"2024-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}