Journal of cardiology最新文献

{"title":"Effect of PCSK9 inhibitor usage on coronary endothelial dysfunction in patients with hypercholesterolemia after coronary stenting: The CuVIC-2 trial.","authors":"Yusuke Akiyama, Shunsuke Katsuki, Yasuaki Koga, Mitsutaka Yamamoto, Kiyoshi Hironaga, Nobuhiro Suematsu, Kenji Miyata, Yasushi Mukai, Shujiro Inoue, Jun-Ichiro Nishi, Hideki Tashiro, Yasuhiro Nakano, Kouta Funakoshi, Koshiro Tagawa, Ikuyo Ichi, Hiroyuki Tsutsui, Kohtaro Abe, Tetsuya Matoba","doi":"10.1016/j.jjcc.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.jjcc.2025.04.002","url":null,"abstract":"<p><strong>Background: </strong>The effects of evolocumab on coronary endothelial dysfunction (CED), a hallmark of atherogenesis, are unknown. The aim of this study was to investigate whether evolocumab, in combination with high-dose statins, could ameliorate CED in patients who underwent coronary stenting.</p><p><strong>Methods: </strong>The CuVIC-2 trial was a multicenter randomized controlled trial. CED was defined as intracoronary acetylcholine (ACh)-induced contractile responses with signs of myocardial ischemia. We originally intended to enroll 160 participants but altered the study design due to the COVID-19 pandemic and then recruited 41 participants. The revised primary endpoint was the coronary contraction rate in response to ACh assessed in a core laboratory, ensuring a statistical power of over 80 % using the mixed model for repeated measures.</p><p><strong>Results: </strong>The evolocumab in combination with high-dose statins with or without ezetimibe (EV + S) group included 19 males and 4 females aged 62 ± 13 years. The high-dose statins with or without ezetimibe (S) group included 13 males and 5 females aged 64 ± 11 years. Compared with the S group, the EV + S group presented a significantly greater decrease in low-density lipoprotein cholesterol at 28 weeks; 83 ± 17 to 20 ± 16 mg/dL (-76 % from the baseline) in the EV + S group and 88 ± 16 to 81 ± 20 mg/dL (-7 % from the baseline) in the S group (p < 0.0001). At 28 weeks, there was no difference between the two groups in terms of the coronary artery constriction rate across all doses [mean difference: 4.8 % (95 % CI: -13.6 to 23.2); p = 0.6].</p><p><strong>Conclusions: </strong>Amelioration of CED by evolocumab was not observed in this trial with several limitations.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993176","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":"Non-invasive and quantitative evaluation of myocardial PET imaging: Next step for advanced therapy.","authors":"Atsushi Yamamoto, Michinobu Nagao, Kenji Fukushima, Junichi Yamaguchi","doi":"10.1016/j.jjcc.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.jjcc.2025.04.001","url":null,"abstract":"<p><p>Myocardial positron emission tomography (PET) is superior in detecting ischemia in patients with left main or multivessel disease, conditions that are challenging to assess using single-photon emission computed tomography (SPECT). Additionally, quantitative measurements of myocardial blood flow and myocardial flow reserve (MFR) have been established as significant prognostic indicators for patients with ischemic heart disease. Moreover, ¹³N-ammonia PET offers high temporal and spatial resolution, enabling the assessment of both left and right ventricular strain, a quantitative marker of regional myocardial wall motion. Ongoing research aims to translate these advanced PET-based methodologies into SPECT imaging. Furthermore, MFR has proven valuable for diagnosing and predicting cardiac allograft vasculopathy in heart transplant recipients. More recently, it has also been utilized to evaluate the efficacy of cardiac regeneration therapy in individuals with severe heart failure and reduced cardiac function. This review presents existing evidence and highlights recent advancements in myocardial PET.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985275","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":"An evidence-based tool for screening for heart failure with preserved ejection fraction in primary care: The BREATH₂ score.","authors":"Yuki Saito, Nobuyuki Kagiyama, Tomonari Harada, Tomohiro Kaneko, Kazuki Kagami, Taishi Dotare, Naoki Yuasa, Eiichiro Sato, Hidemi Sorimachi, Azusa Murata, Masashi Kawagoshi, Yoichi Nishiya, Atsutaka Yasui, Yasuo Okumura, Tohru Minamino, Hideki Ishii, Masaru Obokata","doi":"10.1016/j.jjcc.2025.03.018","DOIUrl":"10.1016/j.jjcc.2025.03.018","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) remains underdiagnosed in primary care settings, where echocardiography is not available. This study aimed to develop and validate a scoring system that does not include echocardiographic variables for HFpEF screening among patients with shortness of breath.</p><p><strong>Methods: </strong>A total of 622 consecutive patients referred for exercise stress echocardiography were evaluated (283 HFpEF and 339 controls). Diagnosis of HFpEF was determined by the HFA-PEFF algorithm Steps 2-3.</p><p><strong>Results: </strong>Multivariable logistic regression analysis identified age ≥65 years, coronary artery disease, elevated natriuretic peptide levels, anemia, cardiomegaly on chest radiography, and left ventricular high-voltage on electrocardiogram as independent predictors of having HFpEF. A weighted score, including the six predictors and atrial fibrillation, was created (BREATH₂ score). The BREATH₂ score accurately discriminated HFpEF from controls [area under the curve (AUC) 0.84, p < 0.0001], with a superior diagnostic ability to the H₂FPEF score. The diagnostic accuracy was confirmed in an external validation cohort (n = 105, AUC 0.78, p < 0.0001) and in patients whose diagnosis was determined by exercise right heart catheterization (n = 79, AUC 0.75, p = 0.0001). The BREATH₂ score classified each patient into different risk categories of having HFpEF, ranging from 4 % to 93 %.</p><p><strong>Conclusions: </strong>The BREATH₂ score can be an effective screening tool in primary care settings to help refer patients to a secondary hospital for further evaluation.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787753","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":"Causal effects of Annexin A1 and Annexin A2 on ischemic stroke and its subtypes: A two-sample Mendelian randomization study.","authors":"Minglan Jiang, Lulu Sun, Yiming Jia, Xiao Ren, Longyang Han, Zhengbao Zhu, Xiaowei Zheng","doi":"10.1016/j.jjcc.2025.03.019","DOIUrl":"10.1016/j.jjcc.2025.03.019","url":null,"abstract":"<p><strong>Background: </strong>Preclinical studies have suggested that Annexin A1 and Annexin A2 act as anti-inflammatory agents, slowing the progression of atherosclerosis and further potentially reducing the risk of ischemic stroke. Since the causality of Annexins and ischemic stroke remains uncertain, this study aimed to investigate the causal effects of both using a two-sample Mendelian randomization (MR) method.</p><p><strong>Methods: </strong>The genetic instruments associated with Annexin A1 and Annexin A2 originated from a European-descent genome-wide association study (GWAS) of 50,000 participants from the INTERVAL study. Summary statistics for ischemic stroke and ischemic stroke subtypes were derived from the MEGASTROKE consortium's GWAS dataset, involving 40,585 cases and 406,111 controls of European ancestry. The inverse-variance weighted method was utilized in the main analysis, followed by a series of sensitivity analyses for robustness validation.</p><p><strong>Results: </strong>In the primary analysis, genetically predicted high Annexin A1 levels were associated with decreased risks of ischemic stroke (OR = 0.96; 95 % CI = 0.93-0.99; p = 0.023) and large artery stroke (OR = 0.88; 95 % CI = 0.81-0.96; p = 0.004). Similarly, genetically predicted high Annexin A2 levels also had significant associations with decreased risks of ischemic stroke (OR = 0.97; 95 % CI = 0.95-1.00; p = 0.019) and large artery stroke (OR = 0.90; 95 % CI = 0.85-0.96; p = 0.001).</p><p><strong>Conclusion: </strong>In this two-sample MR study, we found that Annexins had causal protective effects against ischemic stroke, especially large artery stroke. Further basic mechanistic studies should be conducted to investigate the biological roles of these genes.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787718","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":"Prognosis of low-flow low-gradient aortic valve stenosis with atrial fibrillation.","authors":"Ryo Nishinarita, Jun Oikawa, Kenshiro Arao, Kenichi Sugisaki, Takahiro Yamashita, Ayane Yozawa, Yae Ota, Hisashi Sato, Uiri Ooki, Yusuke Tamanaha, Taku Kasahara, Takaaki Mase, Akira Satoh, Junya Ako","doi":"10.1016/j.jjcc.2025.03.017","DOIUrl":"10.1016/j.jjcc.2025.03.017","url":null,"abstract":"<p><strong>Background: </strong>The prognosis for patients with low-flow low-gradient (LFLG) aortic valve stenosis (AS) remains controversial. In general, atrial fibrillation (AF) is one factor determining the LF status in patients with severe AS (SAS). However, the association between concomitant AF in LFLG AS and the risk of heart failure (HF) remains unclear.</p><p><strong>Methods: </strong>This study evaluated 278 consecutive patients with SAS (indexed aortic valve area < 0.6 cm²/m²). Among them, we enrolled patients with high-gradient (HG) SAS [mean pressure gradient (mPG) ≥40 mmHg] and LFLG AS (stroke volume index ≤35 ml/m², mPG <40 mmHg). The two groups were further categorized into four subgroups following the presence or absence of AF as HG SAS with AF (n = 27), HG SAS without AF (n = 68), LFLG AS with AF (n = 30), and LFLG AS without AF (n = 67). The primary endpoint was worsening HF that required unplanned hospitalization or HF drug therapy.</p><p><strong>Results: </strong>We observed worsening HF in 65 patients. The Kaplan-Meier curve revealed a higher rate of worsening HF in LFLG AS with AF than that in HG SAS without AF (log-rank p < 0.001) without any significant difference compared to HG SAS with AF. The Cox hazard analysis among LFLG AS patients identified the presence of AF as an independent predictor for worsening HF [hazard ratio (HR): 2.79; 95 % confidence interval (CI): 1.17-6.96; p = 0.021]. In addition, the Kaplan-Meier analysis curve revealed a higher risk of worsening HF in patients with LFLG AS and paroxysmal AF (PAF) or chronic AF (CAF) than in those without AF (PAF: HR: 4.71, 95 % CI: 1.79-11.9, p = 0.0024; CAF: HR: 3.22, 95 % CI: 1.29-7.83, p = 0.013, respectively).</p><p><strong>Conclusions: </strong>Patients with LFLG AS and concomitant AF exhibited an unfavorable prognosis for HF, with no significantly different rate of worsening HF compared with patients with HG SAS and conc.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787895","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":"Relationship between left atrial/left ventricular diameter ratio and outcomes in patients with hypertrophic cardiomyopathy","authors":"Keigo Kanbayashi MD,&nbsp;Yuichiro Minami MD, PhD, FJCC,&nbsp;Shintaro Haruki MD, PhD,&nbsp;Chihiro Saito MD, PhD,&nbsp;Junichi Yamaguchi MD, PhD, FJCC","doi":"10.1016/j.jjcc.2024.09.003","DOIUrl":"10.1016/j.jjcc.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Although diastolic dysfunction is the main pathophysiological feature of hypertrophic cardiomyopathy (HCM), it remains to be clarified whether parameters of diastolic function can reliably determine HCM prognosis. In patients with reduced left ventricular (LV) distensibility, chronic elevation of LV diastolic pressure is seen with a smaller than expected LV size. Accordingly, patients with HCM with severe LV diastolic dysfunction typically demonstrate left atrial (LA) dilation and a disproportionately smaller left ventricle. Therefore, we investigated the relationship between LA/LV diameter ratio, as a potential indicator of disease progression, and outcomes in patients with HCM.</div></div><div><h3>Methods</h3><div>We included 468 patients in whom LA and LV end-diastolic diameter were successfully evaluated by echocardiography at the initial assessment. We divided the patients into two groups: those with an LA/LV diameter ratio &gt; 1 and those with an LA/LV diameter ratio ≤ 1. We compared the HCM-related death rates between the two groups.</div></div><div><h3>Results</h3><div>Of the 468 patients, 96 patients (20.5 %) with HCM showed an LA/LV diameter ratio &gt; 1. In the univariate analysis, patients with an LA/LV diameter ratio &gt; 1 had a significantly greater likelihood of HCM-related death than patients with an LA/LV diameter ratio ≤ 1 (log-rank <em>p</em> = 0.002). In the multivariate Cox proportional hazards analysis, when including LA/LV diameter ratio &gt; 1 and imbalanced baseline variables, an LA/LV diameter ratio &gt; 1 was an independent determinant of HCM-related death (adjusted hazard ratio: 1.87, 95 % confidence interval: 1.08–3.24; <em>p</em> = 0.024).</div></div><div><h3>Conclusion</h3><div>LA/LV diameter ratio can be easily evaluated and may be useful for risk stratification of HCM-related death in patients with HCM.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 309-314"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142265371","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 MD, PhD ,&nbsp;Koichi Maeda MD, PhD ,&nbsp;Kyongsun Pak PhD ,&nbsp;Kazuo Shimamura MD, PhD ,&nbsp;Ai Kawamura MD, PhD ,&nbsp;Isamu Mizote MD, PhD ,&nbsp;Masaki Taira MD ,&nbsp;Daisuke Yoshioka MD, PhD ,&nbsp;Shigeru Miyagawa MD, PhD","doi":"10.1016/j.jjcc.2024.07.009","DOIUrl":"10.1016/j.jjcc.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 &lt; 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.</div></div><div><h3>Conclusions</h3><div>The risk model was a good indicator to estimate the prognosis in dialysis patients undergoing TAVR.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 329-333"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","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":"The role of myocardial regeneration, cardiomyocyte apoptosis in acute myocardial infarction: A review of current research trends and challenges","authors":"Dan Yan PhD ,&nbsp;Shifang Zhan MM ,&nbsp;Chenyu Guo MM ,&nbsp;Jiawen Han MM ,&nbsp;Lin Zhan PhD ,&nbsp;Qianyi Zhou PhD ,&nbsp;Dan Bing ,&nbsp;Xiaoyan Wang PhD","doi":"10.1016/j.jjcc.2024.09.012","DOIUrl":"10.1016/j.jjcc.2024.09.012","url":null,"abstract":"<div><h3>Purpose</h3><div>This paper aims to review the research progress in repairing injury caused by acute myocardial infarction, focusing on myocardial regeneration, cardiomyocyte apoptosis, and fibrosis. The goal is to investigate the current research trends and challenges in the field of myocardial injury repair.</div></div><div><h3>Methods</h3><div>The review delves into the latest research on myocardial regeneration, cardiomyocyte apoptosis, and fibrosis following acute myocardial infarction. It highlights stem cell transplantation and gene therapy as key areas of current research focus, while emphasizing the significance of cardiomyocyte apoptosis and fibrosis in the myocardial injury repair process. Additionally, the review addresses the challenges and unresolved issues that require further investigation in the field of myocardial injury repair.</div></div><div><h3>Summary</h3><div>Acute myocardial infarction is a prevalent cardiovascular condition that results in myocardial damage necessitating repair. Myocardial regeneration plays a crucial role in repairing myocardial injury, with current research focusing on stem cell transplantation and gene therapy. Cardiomyocyte apoptosis and fibrosis are key factors in the repair process, significantly impacting the restoration of myocardial structure and function. Nonetheless, there remain numerous challenges and unresolved issues that warrant further investigation in the realm of myocardial injury repair.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 283-292"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406430","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":"Extensive ablation for elderly patients with persistent atrial fibrillation: insights from the EARNEST-PVI prospective randomized trial","authors":"Yuki Matsuoka MD ,&nbsp;Yohei Sotomi MD, PhD ,&nbsp;Shungo Hikoso MD, PhD ,&nbsp;Akihiro Sunaga MD, PhD ,&nbsp;Daisaku Nakatani MD, PhD ,&nbsp;Katsuki Okada MD, PhD ,&nbsp;Tomoharu Dohi MD, PhD ,&nbsp;Taiki Sato MD, PhD ,&nbsp;Hirota Kida MAS ,&nbsp;Daisuke Sakamoto MD ,&nbsp;Tetsuhisa Kitamura MD, MSc, DrPH ,&nbsp;Nobuaki Tanaka MD ,&nbsp;Masaharu Masuda MD, PhD ,&nbsp;Tetsuya Watanabe MD, PhD ,&nbsp;Hitoshi Minamiguchi MD ,&nbsp;Yasuyuki Egami MD ,&nbsp;Takafumi Oka MD, PhD ,&nbsp;Miwa Miyoshi MD, PhD ,&nbsp;Masato Okada MD ,&nbsp;Yasuhiro Matsuda MD ,&nbsp;Yasushi Sakata MD, PhD, FJCC","doi":"10.1016/j.jjcc.2024.09.001","DOIUrl":"10.1016/j.jjcc.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>In patients with persistent atrial fibrillation (AF), extensive ablation for substrate modification, such as linear ablation or complex fractionated atrial electrogram ablation in addition to pulmonary vein isolation (PVI) remains controversial. Previous studies investigating extensive ablation have demonstrated its varying efficacy, suggesting the possible heterogeneity of its efficacy. Aging is a major risk factor for AF and is associated with atrial remodeling. We aimed to compare the efficacy and safety of the extensive ablation strategy compared with PVI alone strategy between young and elderly patients.</div></div><div><h3>Methods</h3><div>This study is a post-hoc analysis of the multicenter, randomized controlled, noninferiority trial investigating the efficacy and safety of PVI-only (PVI-alone arm) compared with extensive ablation (PVI-plus arm) in patients with persistent AF (EARNEST-PVI trial). We divided the overall population into 2 groups based on age and assessed treatment effects.</div></div><div><h3>Results</h3><div>In the young group (age &lt;65 years, <em>N</em> = 206), there was no significant difference in the recurrence rate between the PVI-alone group and PVI-plus group [hazard ratio (HR): 1.00, 95 % CI: 0.57–1.73, <em>p</em> = 0.987], whereas the recurrence rate was significantly lower in the PVI-plus group compared to the PVI-alone group in the elderly group (age ≥65 years, <em>N</em> = 291) (HR: 0.47, 95 % CI: 0.29–0.76, <em>p</em> = 0.0021) (<em>p</em> for interaction = 0.0446). There were no fatal procedural complications.</div></div><div><h3>Conclusion</h3><div>In patients with persistent AF, the extensive ablation strategy was more effective than the PVI-alone strategy in elderly patients, while the effectiveness of both approaches was comparable in young patients.</div></div><div><h3>Trial registration</h3><div>URL: <span><span>https://clinicaltrials.gov</span><svg><path></path></svg></span>; Unique identifier: <span><span>NCT03514693</span><svg><path></path></svg></span>.</div><div>URL: <span><span>https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000022454</span><svg><path></path></svg></span></div><div>Unique ID issued by UMIN: UMIN000019449.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 301-308"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142265370","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":"Current evidence and indications for left atrial appendage closure","authors":"Masaya Shinohara MD, PhD ,&nbsp;Mike Saji MD, PhD ,&nbsp;Hideki Koike MD, PhD ,&nbsp;Hiroshi Ohara MD, PhD ,&nbsp;Yoshinari Enomoto MD, PhD ,&nbsp;Rine Nakanishi MD, PhD ,&nbsp;Tadashi Fujino MD, PhD ,&nbsp;Takanori Ikeda MD, PhD, FJCC","doi":"10.1016/j.jjcc.2025.01.014","DOIUrl":"10.1016/j.jjcc.2025.01.014","url":null,"abstract":"<div><div>Atrial fibrillation (AF) is the most common arrhythmia worldwide and its prevalence increases with age. The main and most severe complication of AF is ischemic stroke, yet an estimated 50 % of eligible patients cannot tolerate or are contraindicated to receive oral anticoagulation (OAC). In patients with AF, the left atrial appendage (LAA) is the main source of thrombus formation. Percutaneous LAA closure (LAAC) has emerged over the past two decades as a valuable alternative to OAC for reducing the risk of strokes and systemic embolisms in patients with AF who cannot tolerate long-term OAC. With newer generation devices such as the Watchman (Boston Scientific, Natick, MA, USA) and Amulet (Abbott, Abbott Park, IL, USA) gaining approval from the US Food and Drug Administration in recent years, the safety and efficacy of LAAC in specific populations intolerant to OAC have increased and more patients are being treated. This systematic review provides the indications for LAAC and the evidence for evaluating the use of the currently available device therapies. We also examine the current unsolved problems with patient selection and postprocedural antithrombotic regimens.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 268-274"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080083","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}