Journal of cardiology最新文献

{"title":"Comparative outcomes of balloon-expandable and self-expanding valves in transcatheter aortic valve replacement: A systematic review and meta-analysis","authors":"Abdelrahman Hafez MD,&nbsp;Ahmed Sobhy MD,&nbsp;Ahmed Elshahat MD,&nbsp;Dara Bruce MS,&nbsp;Omar Abdulrahman Saad MBBCh,&nbsp;Mennatullah Ashour MBBCh,&nbsp;Karim Ali MD,&nbsp;Mohamed A. Shebl MD,&nbsp;Anmolika K. Bolla BS,&nbsp;Reyan Usmani BS,&nbsp;Mahmoud Aboudabash MBBCh,&nbsp;Amr Arafa MD,&nbsp;Shaimaa A. Shehata MD,&nbsp;Nouran Abdellatif MBBS,&nbsp;Abdalrahman Alagab MD,&nbsp;Ahmed Eldessouki,&nbsp;Richie Riccelli,&nbsp;Deepak Gir MD,&nbsp;Ghada Y.A. Elzewiei MD,&nbsp;Eman A. Toraih MD, PhD, MS,&nbsp;Hani Aiash MD, PhD","doi":"10.1016/j.jjcc.2026.06.009","DOIUrl":"10.1016/j.jjcc.2026.06.009","url":null,"abstract":"<div><h3>Background</h3><div>Balloon-expandable valves (BEVs) and self-expanding valves (SEVs) are the two primary platforms for transcatheter aortic valve replacement (TAVR), differing in design, deployment, and hemodynamic performance. Comparative evidence on their clinical and procedural outcomes remains limited and inconsistent.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted, searching PubMed, Scopus, Web of Science, and Cochrane Library up to July 2025 for studies comparing BEVs and SEVs in adults with severe aortic stenosis undergoing transfemoral TAVR. Outcomes included all-cause mortality, cardiovascular mortality, stroke, permanent pacemaker implantation, hemodynamic parameters, device success, and safety endpoints. Dichotomous and continuous outcomes were pooled as risk ratios (RR) and mean differences (MD) with corresponding 95% confidence intervals (CI) using a random-effects model.</div></div><div><h3>Results</h3><div>Fifty-three studies (<em>n</em> = 157,921) were included (6 randomized controlled trials, 12 prospective, and 35 retrospective cohorts). BEVs showed significant early survival benefits at 1 month (RR = 0.75, 95% CI 0.57–0.97, <em>p</em> = 0.03) and 6 months (RR = 0.33, 95%CI0.18–0.60, <em>p</em> &lt; 0.001), with reduced cardiovascular mortality at 12 months (RR = 0.88, 95% CI 0.79–0.99, <em>p</em> = 0.03). Permanent pacemaker implantation rates were consistently lower with BEVs (e.g. RR = 0.75, 95% CI 0.64–0.88, <em>p</em> &lt; 0.001 at 1 month). SEVs exhibited superior hemodynamics, with lower mean gradients (MD = −3.16 to −7.77 mmHg) and larger aortic valve areas (MD = +0.11 to +0.13 cm²). Long-term mortality and safety outcomes, including major bleeding, vascular complications, and myocardial infarction, were comparable.</div></div><div><h3>Conclusion</h3><div>BEVs offer early survival and conduction preservation advantages, while SEVs provide superior hemodynamic performance. These findings highlight the importance of individualized valve selection based on patient-specific factors. Further randomized trials with extended follow-up are needed to evaluate long-term durability and outcomes in diverse patient populations.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"88 4","pages":"Pages 297-320"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264679","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":"Lower in-hospital nighttime systolic blood pressure is associated with heart failure rehospitalization in heart failure with reduced ejection fraction","authors":"Yuki Kitagawa MD,&nbsp;Asahiro Ito MD, PhD,&nbsp;Shinji Ito MD,&nbsp;Tatsuya Sato MD,&nbsp;Nanaka Nomura MD,&nbsp;Mana Ogawa MD, PhD,&nbsp;Takenobu Shimada MD, PhD,&nbsp;Ryoko Kitada MD, PhD,&nbsp;Yusuke Hayashi MD, PhD,&nbsp;Atsushi Shibata MD, PhD,&nbsp;Kenichiro Otsuka MD, PhD, FJCC,&nbsp;Shinichi Iwata MD, PhD,&nbsp;Daiju Fukuda MD, PhD, FJCC","doi":"10.1016/j.jjcc.2026.06.006","DOIUrl":"10.1016/j.jjcc.2026.06.006","url":null,"abstract":"<div><h3>Background</h3><div>The prognostic significance of nighttime blood pressure (BP) in hospitalized patients with heart failure with reduced ejection fraction (HFrEF) remains uncertain. We investigated whether standardized in-hospital nighttime systolic BP (SBP) measured before discharge predicts post-discharge outcomes beyond casual SBP.</div></div><div><h3>Methods</h3><div>This single-center observational study included 235 symptomatic inpatients with HFrEF (left ventricular ejection fraction ≤40%; New York Heart Association class II-IV) admitted between 2013 and 2017. Nighttime BP was measured hourly from 23:00 to 06:00 in the supine position using a programmable oscillometric upper-arm device, and mean nighttime SBP was calculated from at least 6 readings. Casual SBP was the mean of 2 seated morning measurements obtained on the same day. The primary endpoint was heart failure (HF) rehospitalization analyzed using Fine-Gray competing-risk models with all-cause death as the competing event. All-cause mortality was analyzed using Cox models.</div></div><div><h3>Results</h3><div>During a median follow-up of 3.7 years, 77 patients (32.8%) had HF rehospitalization and 35 (14.9%) died. Mean nighttime SBP per 10-mmHg increase was inversely associated with HF rehospitalization after adjustment for age, sex, estimated glomerular filtration rate, log-transformed B-type natriuretic peptide, and left ventricular ejection fraction [subdistribution hazard ratio (SHR) 0.85, 95% confidence interval (CI) 0.75–0.95; <em>p</em> = 0.006]. The association remained significant after additional adjustment for casual SBP (SHR 0.85, 95% CI 0.75–0.98; <em>p</em> = 0.023), whereas casual SBP was not predictive. Adjustment for loop diuretic use attenuated the association. Additional Fine-Gray analyses showed similar results when cardiovascular death was treated as the competing event and after additional adjustment for ischemic heart disease. Nighttime SBP was not significantly associated with all-cause mortality.</div></div><div><h3>Conclusions</h3><div>Lower in-hospital nighttime SBP before discharge was associated with a higher risk of subsequent HF rehospitalization in HFrEF, providing prognostic information beyond casual SBP.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"88 4","pages":"Pages 280-286"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217803","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":"Does early catheter ablation (<1 year) reduce atrial fibrillation recurrence compared with delayed ablation: A systematic review and meta-analysis","authors":"Daniel Bradach BS,&nbsp;Srilakshmi Ajith MBBS,&nbsp;Thuslim Sheik MBBS,&nbsp;Syed Ateeba Qadri MBBS,&nbsp;Christabel Ugbodaga MD,&nbsp;Fatma Alshammari MD,&nbsp;Aida Feda Vanderpuye MBChB, MPH,&nbsp;Maheen Tahir MBBS,&nbsp;Subrahmanyan Valadi Ramakrishnan MD,&nbsp;Layal Omaruddin MBBS","doi":"10.1016/j.jjcc.2026.06.004","DOIUrl":"10.1016/j.jjcc.2026.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. Catheter ablation (CA) is an effective therapy for symptomatic AF. Emerging evidence indicates that early CA may attenuate disease progression and reduce major adverse cardiovascular and cerebrovascular events (MACCE). There is a lack of high-quality pooled data comparing clinical outcomes of early versus delayed CA using a standardized diagnosis-to-ablation time. This meta-analysis evaluates whether early CA (&lt;12 months) versus delayed CA (&gt;12 months) after AF diagnosis is linked to differences in clinical outcomes, including AF/atrial arrhythmia recurrence, mortality, AF-related hospitalization, and MACCE.</div></div><div><h3>Methods</h3><div>A systematic literature search of PubMed, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials and observational cohort studies until December 1, 2025, was conducted. The primary outcome was AF recurrence.</div></div><div><h3>Results</h3><div>A total of 10 studies including 22,748 patients were analyzed. For the primary outcome, early CA (&lt;12 months) was associated with a significantly lower risk of AF recurrence compared with delayed ablation (&gt;12 months) (RR 0.69; 95% CI, 0.54–0.88; <em>p</em> = 0.007, I² = 92). Subgroup analyses suggested a consistent benefit in persistent AF populations. For secondary outcomes, early ablation was associated with a reduced risk of AF-related hospitalization (RR 0.58; 95% CI 0.39–0.86; <em>p</em> = 0.04; I² = 0%) and repeat electrical cardioversion (RR 0.66; 95% CI 0.48–0.91; <em>p</em> = 0.03; I² = 34%). No significant differences were observed for all-cause mortality, repeat ablation, MACCE, cardiovascular hospitalization, antiarrhythmic drug use, stroke/transient ischemic attack, or all-cause hospitalization.</div></div><div><h3>Conclusion</h3><div>Early CA (&lt;12 months) was associated with significantly lower rates of AF recurrence, electrical cardioversion, and AF-related hospitalizations compared with delayed CA (&gt;12 months). Future randomized controlled trials are needed to evaluate potential long-term benefits and to identify patient subgroups most likely to benefit from early CA.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"88 4","pages":"Pages 287-296"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217549","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":"CT-guided PCI: From diagnosis to treatment planning","authors":"Hirofumi Ohashi MD, PhD,&nbsp;Atomu Tajima MD,&nbsp;Koshiro Sakai MD, PhD,&nbsp;Hirohiko Ando MD, PhD,&nbsp;Yasushi Suzuki MD, PhD,&nbsp;Akihiro Suzuki MD, PhD,&nbsp;Ayako Kunimura MD, PhD,&nbsp;Kazuhiro Naito MD, PhD,&nbsp;Masanobu Fujimoto MD, PhD,&nbsp;Tomohiro Onishi MD, PhD,&nbsp;Wataru Suzuki MD, PhD,&nbsp;Masahiro Shimoda MD, PhD,&nbsp;Manami Ono MD,&nbsp;Juri Aoyama MD,&nbsp;Yasuhiro Nakano MD, PhD,&nbsp;Yu Takahashi MD, PhD,&nbsp;Frédéric Bouisset MD, PhD,&nbsp;Carlos Collet MD, PhD,&nbsp;Tetsuya Amano MD, PhD, FJCC","doi":"10.1016/j.jjcc.2026.03.010","DOIUrl":"10.1016/j.jjcc.2026.03.010","url":null,"abstract":"<div><div>Computed tomography-guided percutaneous coronary intervention (CT-guided PCI) represents a new paradigm that extends coronary CT angiography (CCTA) from diagnostic imaging to procedural planning. By integrating morphological and physiological information, CCTA enables a comprehensive understanding of lesion characteristics and supports individualized revascularization strategies before PCI. Advances in myocardial mass quantification, CT-derived physiology, and three-dimensional co-registration have enhanced the procedural relevance of CCTA. Emerging technologies, such as photon-counting CT, are expected to further refine accuracy and broaden clinical applicability. These innovations are transforming CCTA from a diagnostic modality into a central platform for precision PCI planning. Currently, the clinical utility of CT-guided PCI is being actively evaluated across multiple prospective trials and registries, reflecting growing interest in its role for guiding contemporary PCI. Collectively, these developments are transforming CCTA from a diagnostic modality into a central platform for precision PCI planning. The goal of this review is to outline the concept, workflow, and clinical applications of CT-guided PCI, highlighting the transition of CCTA from diagnosis to comprehensive procedural design and decision-making.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"88 4","pages":"Pages 244-254"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147529338","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":"Utility of simplified PESI score for mid-term mortality risk stratification: Insights from the combined COMMAND-VTE registries","authors":"Shigetaka Kageyama MD, PhD,&nbsp;Eri Ishikawa MD,&nbsp;Yugo Yamashita MD, PhD,&nbsp;Takeshi Morimoto MD, PhD, MPH,&nbsp;Kenki Matsunaga MD,&nbsp;Mei Onishi MD,&nbsp;Koichiro Murata MD,&nbsp;Ryuzo Nawada MD, PhD,&nbsp;Tomoya Onodera MD, PhD,&nbsp;Koh Ono MD, PhD, FJCC,&nbsp;Takeshi Kimura MD, PhD, FJCC","doi":"10.1016/j.jjcc.2026.05.008","DOIUrl":"10.1016/j.jjcc.2026.05.008","url":null,"abstract":"<div><h3>Background</h3><div>The simplified Pulmonary Embolism Severity Index (sPESI) is widely used to predict short-term mortality in acute pulmonary embolism (PE), but its value for 2–3-year mortality risk stratification remains unclear. We evaluated whether sPESI predicts 2.6-year all-cause mortality in a nationwide Japanese venous thromboembolism (VTE) cohort.</div></div><div><h3>Methods</h3><div>Post-hoc analysis of the combined COMMAND-VTE Registry 1 and 2 (<em>n</em> = 8224). Patients were classified as deep vein thrombosis (DVT) alone (<em>n</em> = 3722) or PE with sPESI categories of 0, 1, 2, 3, or 4–6 at presentation (<em>n</em> = 4502). All-cause death was assessed using Kaplan–Meier and univariate Cox models, including a 30-day landmark analysis (day 31 onward). These registries span the warfarin and direct oral anticoagulant eras in Japan. Scores 4–6 were combined to ensure stable estimates, consistent with prior analyses from the same registry.</div></div><div><h3>Results</h3><div>Median follow-up was 878 days. Among PE patients, 22.3% had sPESI = 0, 34.2% sPESI = 1, 24.7% sPESI = 2, 14.4% sPESI = 3, and 4.5% sPESI = 4–6. Each 1-point increase in sPESI was associated with higher mortality (hazard ratio 1.75; 95% confidence interval 1.67–1.84). Survival separated stepwise and persisted beyond 30 days (overall log-rank <em>p</em> &lt; 0.001). DVT alone showed survival comparable to PE with sPESI = 1 in exploratory comparisons.</div></div><div><h3>Conclusions</h3><div>sPESI provided clear mid-term risk stratification for mortality among PE patients in contemporary Japanese practice and may inform post-discharge risk assessment and follow-up intensity.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"88 4","pages":"Pages 329-330"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987602","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":"Association of 30-second chair stand test performance with exercise intolerance and hospitalization for symptomatic heart failure in type 2 diabetes and stage B heart failure","authors":"Yousuke Sugita PhD,&nbsp;Ayano Kudo (BSc),&nbsp;Sota Arakawa BSc,&nbsp;Satoshi Sakai MD, PhD","doi":"10.1016/j.jjcc.2026.07.003","DOIUrl":"10.1016/j.jjcc.2026.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Exercise intolerance (EI) predicts hospitalization for symptomatic heart failure (HF) in patients with type 2 diabetes mellitus (T2DM); however, cardiopulmonary exercise testing (CPET) is not always feasible in routine practice. The prognostic value of the 30-second chair stand test (CS30), a simple functional assessment correlated with peak oxygen uptake (peakVO₂), remains unclear. We investigated whether the CS30 reflects exercise capacity and predicts hospitalization for symptomatic HF in patients with T2DM and stage B HF.</div></div><div><h3>Methods</h3><div>A total of 502 outpatients with T2DM and stage B HF were prospectively enrolled. Exercise capacity was assessed using peakVO₂ from CPET and functional performance using CS30. EI was defined as peakVO₂ ≤80% predicted, and abnormal-CS30 as &lt;18 repetitions for males and &lt;16 for females. Participants were followed for the first hospitalization for symptomatic HF. Associations were assessed using multivariable Cox models, and discrimination using the 5-year time-dependent area under the receiver operating characteristic curve (AUC).</div></div><div><h3>Results</h3><div>The CS30 performance was significantly associated with peakVO₂. Over a median follow-up of 5.1 years, 91 patients were hospitalized for symptomatic HF. Abnormal-CS30 independently predicted hospitalization for symptomatic HF after adjustment for the WATCH-DM score, B-type natriuretic peptide, left ventricular hypertrophy, and atrial fibrillation. Adding the CS30 to resting risk models significantly improved the 5-year AUC, with performance comparable to that of EI.</div></div><div><h3>Conclusions</h3><div>In patients with T2DM and stage B HF, the CS30 reflected reduced exercise capacity and independently predicted hospitalization for symptomatic HF. Given its simplicity and feasibility, the CS30 may serve as a practical functional marker to complement resting risk models when CPET is unavailable.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"88 4","pages":"Pages 321-328"},"PeriodicalIF":3.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396745","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":"Palliative morphine use in patients aged 90 years or older with advanced heart failure receiving best supportive care.","authors":"Tomofumi Nakatsukasa, Mikinori Hashimoto, Yu Urakami, Yoshihito Okumura, Atsushi Hirohata","doi":"10.1016/j.jjcc.2026.09.007","DOIUrl":"https://doi.org/10.1016/j.jjcc.2026.09.007","url":null,"abstract":"<p><strong>Background: </strong>Morphine may be used for refractory dyspnea or distress in advanced heart failure near the end of life, but evidence in patients aged ≥90 years is limited and concerns remain regarding sedation and respiratory depression. We compared early symptom response and observed safety events after low-dose morphine initiation according to age.</p><p><strong>Methods: </strong>We retrospectively studied 173 consecutive patients with advanced heart failure receiving best supportive care at morphine initiation, categorized as <90 years (n = 110) or ≥ 90 years (n = 63). The primary outcomes were a ≥ 1-point improvement in the Facial Pain Scale (FPS) at 48 h and a sedation/respiratory event, defined as Richmond Agitation-Sedation Scale (RASS) ≤ -3 or an apnea-like event, within 48 h. An apnea-like event was defined as documented apnea or an apparent cessation of breathing in the medical record.</p><p><strong>Results: </strong>Baseline FPS was 3 (Heidenreich et al., 2022; McDonagh et al., 2021 [3,4]) in patients aged <90 years and 3 (Kitai et al., 2025; McDonagh et al., 2021 [2,4]) in those aged ≥90 years. The initial morphine dose was 5 [2.5, 5] mg/day in both groups. At 48 h, FPS was 1 [0,1] in each group. A ≥ 1-point improvement occurred in 72/80 evaluable patients (90.0%) aged <90 years and 41/44 (93.2%) aged ≥90 years (odds ratio 1.51, 95% confidence interval 0.34-9.34; p = 0.745). Sedation/respiratory events occurred in 35/98 (35.7%) and 20/59 (33.9%) patients, respectively (odds ratio 0.92, 95% confidence interval 0.44-1.91; p = 0.864). Sensitivity and adjusted analyses were generally consistent, although ≥2-point FPS improvement was less frequent among patients aged ≥90 years in the analysis restricted to in-hospital deaths.</p><p><strong>Conclusions: </strong>We found no clear evidence that age ≥ 90 years was associated with a lower early response rate or a higher frequency of observed sedation/respiratory events after low-dose morphine initiation. However, the limited sample size does not allow equivalence between the age groups to be established.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080834","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":"Safety profile of finerenone: Pooled analysis of different types of arrhythmic events.","authors":"George Bazoukis, Esther Victoria Clarke, Gary Tse","doi":"10.1016/j.jjcc.2026.09.008","DOIUrl":"10.1016/j.jjcc.2026.09.008","url":null,"abstract":"<p><strong>Background: </strong>Finerenone reduces kidney and cardiovascular events in patients with chronic kidney disease and type 2 diabetes mellitus, but its safety profile in terms of arrhythmic outcomes remains uncertain.</p><p><strong>Methods: </strong>We systematically searched PubMed, Cochrane Library, and ClinicalTrials.gov (inception-March 2026) for randomized trials reporting arrhythmias or conduction disorders with finerenone versus control. Risk ratios (RRs) were pooled using fixed-effects models; heterogeneity was assessed with I².</p><p><strong>Results: </strong>Six trials (21,015 patients; mean age 67.2 years; 33.9% women) were included. Finerenone was not associated with increased atrial or ventricular arrhythmias, high-grade atrioventricular block, or cardiac arrest (all RRs non-significant; low heterogeneity).</p><p><strong>Conclusions: </strong>Finerenone shows no clear increase in clinically reported arrhythmic events in the pooled analysis; however, the included studies were not designed to assess the rate of arrhythmic outcomes and might have underestimated the true rates.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074723","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":"Contemporary lipid management and achievement of LDL-C targets after acute myocardial infarction in Japan: Insights from the K-ACTIVE registry.","authors":"Norihiko Kamioka, Yohei Ohno, Yuji Ikari, Yoshitaka Iso, Yoshihiro Akashi, Junya Ako, Toshiaki Ebina, Kouichi Tamura, Masayuki Shibata, Kiyoshi Hibi, Kazuki Fukui, Ichiro Michishita, Hiroshi Suzuki","doi":"10.1016/j.jjcc.2026.09.006","DOIUrl":"10.1016/j.jjcc.2026.09.006","url":null,"abstract":"<p><strong>Background: </strong>There are limited data on contemporary lipid management practices after acute myocardial infarction (AMI) in Japan and on factors associated with achieving the low-density lipoprotein cholesterol (LDL-C) target recommended by current Japanese guidelines (<70 mg/dL).</p><p><strong>Methods: </strong>We retrospectively analyzed 2984 patients with AMI treated at tertiary percutaneous coronary intervention-capable centers in Kanagawa, Japan. Serial LDL-C levels were assessed at baseline, 3 months, and 1 year. Multivariable logistic regression analysis was performed to identify factors associated with achieving LDL-C < 70 mg/dL at 1 year.</p><p><strong>Results: </strong>The mean age was 69.5 years, and approximately three-quarters of the patients were male. At discharge, only 3.6% of patients were prescribed high-intensity statin therapy according to the American College of Cardiology and the American Heart Association definition, whereas 41.5% were categorized as high-intensity according to the Japan Atherosclerosis Society definition. At 3 months, the mean LDL-C level decreased to 67.3 mg/dL, and approximately 60% of patients achieved LDL-C < 70 mg/dL; this proportion was maintained through 1 year. Factors independently associated with achieving LDL-C < 70 mg/dL at 1 year included absence of baseline dyslipidemia (OR, 1.31; 95% CI, 1.05-1.65), baseline LDL-C levels (OR, 0.99; 95% CI, 0.99-1.00), ST-segment elevation myocardial infarction (OR, 1.53; 95% CI, 1.19-1.96), use of moderate- or high-intensity statins (OR, 2.37; 95% CI, 1.79-3.15), and ezetimibe prescription (OR, 1.95; 95% CI, 1.51-2.52).</p><p><strong>Conclusions: </strong>Although approximately 60% of patients achieved the current LDL-C target, this proportion may be insufficient in light of the anticipated transition toward a lower LDL-C threshold (<55 mg/dL) proposed in recent Japanese scientific statements and aligned with contemporary international guidelines. Early intensification of lipid-lowering therapy, including high-intensity statins and ezetimibe, may be warranted in selected patients to optimize secondary prevention.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017015","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":"Association of in-hospital mineralocorticoid receptor antagonist initiation with outcomes according to guideline-defined eGFR and potassium eligibility in patients with heart failure.","authors":"Kosuke Tsuda, Daichi Maeda, Yumiko Kanzaki, Kazushi Sakane, Kanako Akamatsu, Yuka Sakatani, Takahide Ito, Takahiro Okuno, Keisuke Kida, Nobuyuki Enzan, Masataka Ikeda, Takahiro Okumura, Takeshi Kitai, Takeshi Tohyama, Tatsunori Taniguchi, Shouji Matsushima, Yuya Matsue, Hiroyuki Tsutsui, Masaaki Hoshiga, Hideaki Morita","doi":"10.1016/j.jjcc.2026.09.005","DOIUrl":"10.1016/j.jjcc.2026.09.005","url":null,"abstract":"<p><strong>Background: </strong>Evidence on the use of mineralocorticoid receptor antagonists (MRAs) in patients hospitalized for heart failure (HF) with concomitant advanced chronic kidney disease or hyperkalemia remains limited. We evaluated whether the association between in-hospital MRA initiation and outcomes differed according to eligibility defined by estimated glomerular filtration rate (eGFR) and serum potassium levels.</p><p><strong>Methods: </strong>This was a sub-analysis of JROADHF-NEXT, a prospective, nationwide, multicenter registry of patients hospitalized for HF in Japan between February 2019 and June 2021. This study included patients who were MRA-naive at admission. Those with an admission eGFR ≤30 mL/min/1.73 m² or serum potassium ≥5.0 mmol/L were classified as ineligible; those with eGFR >30 mL/min/1.73 m² and serum potassium <5.0 mmol/L were classified as eligible. Clinical outcomes were compared according to in-hospital MRA initiation within each eligibility group. The primary endpoint was a composite of cardiovascular death or hospitalization for HF within 2 years after discharge.</p><p><strong>Results: </strong>Among 2792 patients (mean age 73 ± 14 years; 61% male), 1332 (48%) initiated MRAs during hospitalization, and 751 (27%) were classified as ineligible. Over a median follow-up of 731 days, the primary endpoint of cardiovascular death or HF hospitalization occurred in 684 patients (24.5%). In Cox proportional hazards analysis, in-hospital MRA initiation was associated with a lower risk of the primary endpoint [adjusted hazard ratio (aHR), 0.75; 95% confidence interval (CI), 0.64-0.88; p < 0.001]. No statistically significant interaction was observed according to MRA eligibility (ineligible: aHR, 0.70; 95% CI, 0.52-0.93; eligible: aHR, 0.83; 95% CI, 0.68-1.01; p for interaction = 0.326).</p><p><strong>Conclusions: </strong>In this nationwide real-world cohort, in-hospital MRA initiation was associated with a lower 2-year risk of the primary endpoint, and no statistically significant interaction was detected according to eGFR- and potassium-based eligibility. These hypothesis-generating findings warrant prospective evaluation with systematic safety monitoring.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016928","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}