{"title":"Causal effects of Annexin A1 and Annexin A2 on ischemic stroke and its subtypes: A two-sample Mendelian randomization study","authors":"Minglan Jiang MD , Lulu Sun MD, PhD , Yiming Jia MD, PhD , Xiao Ren MD , Longyang Han MD , Zhengbao Zhu MD, PhD , Xiaowei Zheng MD, PhD","doi":"10.1016/j.jjcc.2025.03.019","DOIUrl":"10.1016/j.jjcc.2025.03.019","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Preclinical studies have suggested that </span>Annexin A1<span> and Annexin A2 act as anti-inflammatory agents, slowing the progression of </span></span>atherosclerosis<span> and further potentially reducing the risk of ischemic stroke<span><span>. Since the causality of Annexins and </span>ischemic stroke<span> remains uncertain, this study aimed to investigate the causal effects of both using a two-sample Mendelian randomization (MR) method.</span></span></span></div></div><div><h3>Methods</h3><div>The genetic<span> instruments associated with Annexin A1<span> and Annexin A2<span> 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.</span></span></span></div></div><div><h3>Results</h3><div><span>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; </span><em>p</em> = 0.023) and large artery stroke (OR = 0.88; 95 % CI = 0.81–0.96; <em>p</em><span> = 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; </span><em>p</em> = 0.019) and large artery stroke (OR = 0.90; 95 % CI = 0.85–0.96; <em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 3","pages":"Pages 223-229"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","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":"An evidence-based tool for screening for heart failure with preserved ejection fraction in primary care: The BREATH2 score","authors":"Yuki Saito MD, PhD, FJCC , Nobuyuki Kagiyama MD, PhD , Tomonari Harada MD, PhD , Tomohiro Kaneko MD, PhD , Kazuki Kagami MD, PhD , Taishi Dotare MD, PhD , Naoki Yuasa MD , Eiichiro Sato MD , Hidemi Sorimachi MD, PhD , Azusa Murata MD, PhD , Masashi Kawagoshi MS , Yoichi Nishiya PhD , Atsutaka Yasui PhD , Yasuo Okumura MD, PhD, FJCC , Tohru Minamino MD, PhD, FJCC , Hideki Ishii MD, PhD, FJCC , Masaru Obokata MD, PhD","doi":"10.1016/j.jjcc.2025.03.018","DOIUrl":"10.1016/j.jjcc.2025.03.018","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (BREATH<sub>2</sub> score). The BREATH<sub>2</sub> score accurately discriminated HFpEF from controls [area under the curve (AUC) 0.84, <em>p</em> < 0.0001], with a superior diagnostic ability to the H<sub>2</sub>FPEF score. The diagnostic accuracy was confirmed in an external validation cohort (<em>n</em> = 105, AUC 0.78, <em>p</em> < 0.0001) and in patients whose diagnosis was determined by exercise right heart catheterization (<em>n</em> = 79, AUC 0.75, <em>p</em> = 0.0001). The BREATH<sub>2</sub> score classified each patient into different risk categories of having HFpEF, ranging from 4 % to 93 %.</div></div><div><h3>Conclusions</h3><div>The BREATH<sub>2</sub> score can be an effective screening tool in primary care settings to help refer patients to a secondary hospital for further evaluation.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 3","pages":"Pages 264-271"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","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":"Clinical implications of malnutrition on 30-day adverse events in patients with Takotsubo syndrome","authors":"Kyohei Onishi MD, Koichiro Matsumura MD, Eijiro Yagi MD, Nobuhiro Yamada MD, Yohei Funauchi MD, Kazuyoshi Kakehi MD, Ayano Yoshida MD, Kosuke Fujita MD, Takayuki Kawamura MD, Hiroki Matsuzoe MD, Masafumi Ueno MD, Gaku Nakazawa MD","doi":"10.1016/j.jjcc.2025.03.004","DOIUrl":"10.1016/j.jjcc.2025.03.004","url":null,"abstract":"<div><h3>Background</h3><div>The impact of malnutrition on clinical outcomes in patients with takotsubo syndrome<span> (TTS) is poorly understood. The purpose of this study was to investigate the relationship between malnutrition on admission and 30-day adverse events in patients with TTS.</span></div></div><div><h3>Methods</h3><div><span>We retrospectively evaluated 124 consecutive patients admitted for TTS at our hospital from April 2013 to July 2023. Malnutrition was assessed at admission using the Geriatric Nutritional Risk Index (GNRI), which is an objective and simple </span>nutritional assessment<span><span> method. Malnutrition was defined as GNRI <92. We defined 30-day adverse events as the composite of all-cause death, acute heart failure, </span>cardiogenic shock<span>, life-threatening arrhythmia, thrombotic events, and stroke. The primary endpoint was the comparison of the 30-day adverse event rates between patients with and without malnutrition.</span></span></div></div><div><h3>Results</h3><div>The median age was 78.0 (70.0–83.0) years, and 77 % of the patients were women. The median GNRI was 90.8 (81.5–98.0) and 55 % had malnutrition. The 30-day adverse events were shown in 64 patients. Compared with patients without malnutrition, the 30-day adverse event rate was significantly higher in those with malnutrition (32 % vs. 68 %, respectively; log-rank test <em>p</em><span> = 0.0001). The multivariable Cox proportional hazards model<span> revealed that malnutrition was independently associated with high 30-day adverse event rates adjusted by age, female sex, malignancy, B-type natriuretic peptide, and high-sensitivity C-reactive protein (hazard ratio: 1.97, 95 % confidence interval: 1.08–3.58; </span></span><em>p</em> = 0.02).</div></div><div><h3>Conclusions</h3><div>Malnutrition at admission was associated with high 30-day adverse event rates. Early identification and a considered treatment strategy for malnutrition are important in patients with TTS.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 3","pages":"Pages 244-248"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630524","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 PCSK9 inhibitor usage on coronary endothelial dysfunction in patients with hypercholesterolemia after coronary stenting: The CuVIC-2 trial","authors":"Yusuke Akiyama MD, PhD , Shunsuke Katsuki MD, PhD , Yasuaki Koga MD, PhD , Mitsutaka Yamamoto MD, PhD , Kiyoshi Hironaga MD, PhD , Nobuhiro Suematsu MD, PhD , Kenji Miyata MD, PhD , Yasushi Mukai MD, PhD, FJCC , Shujiro Inoue MD, PhD , Jun-ichiro Nishi MD, PhD , Hideki Tashiro MD, PhD , Yasuhiro Nakano MD, PhD , Kouta Funakoshi MD, PhD , Koshiro Tagawa MS , Ikuyo Ichi PhD , Hiroyuki Tsutsui MD, PhD, FJCC , Kohtaro Abe MD, PhD , Tetsuya Matoba MD, PhD","doi":"10.1016/j.jjcc.2025.04.002","DOIUrl":"10.1016/j.jjcc.2025.04.002","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>p</em> < 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); <em>p</em> = 0.6].</div></div><div><h3>Conclusions</h3><div>Amelioration of CED by evolocumab was not observed in this trial with several limitations.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 3","pages":"Pages 230-237"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","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}
António Rocha de Almeida MD, Marta Paralta Figueiredo MD, Rafael Viana MD, Kisa Congo MD, Manuel Trinca MD, Lino Patrício MD, PhD
{"title":"Gender disparities in acute coronary syndrome management and prognosis: National multicenter retrospective cohort study","authors":"António Rocha de Almeida MD, Marta Paralta Figueiredo MD, Rafael Viana MD, Kisa Congo MD, Manuel Trinca MD, Lino Patrício MD, PhD","doi":"10.1016/j.jjcc.2025.04.006","DOIUrl":"10.1016/j.jjcc.2025.04.006","url":null,"abstract":"<div><h3>Background</h3><div>Gender disparity in the management of cardiovascular disease (CVD) is still significant, leading to suboptimal treatment of acute coronary syndromes (ACS) in women. This study evaluates differences in the management and prognosis of ACS between women and men.</div></div><div><h3>Methods</h3><div>A multicenter retrospective cohort of 6000 patients with ACS was divided according to the patient’s gender. CV risk factors, time to first medical care (FMC), and to electrocardiogram (ECG), coronary angiography<span> (CAG), and percutaneous coronary intervention (PCI) were evaluated. The outcomes assessed were major adverse cardiac events (MACE), in-hospital and follow-up death, referral to cardiac rehabilitation, and hospital readmission.</span></div></div><div><h3>Results</h3><div>Of the 6000 patients, 30 % (<em>n</em> = 1784) were female. Women were significantly older (73 ± 13 years vs. 65 ± 13 years, <em>p</em> < 0.001). The time to FMC was longer in women (10.6 h vs. 9.5 h, <em>p</em> < 0.001), and the median time to ECG was similar (101 min vs. 110 min, <em>p</em> = 0.9). Non-ST segment elevation ACS was higher in women [65 % vs 61 % <em>p</em> < 0.001, OR 1.2 (1.1;1.4)].</div><div>Women were less likely to undergo CAG [68 % vs. 79 %, <em>p</em> < 0.001, OR 0.6 (0.5;0.7)] and PCI than men [82 % vs. 86 % <em>p</em><span> < 0.001, OR 0.7 (0.6;0.8)]. Still, unfavorable anatomy cases were comparable (63 % vs 66 %, </span><em>p</em> = 0.5). Women had less multivessel disease (12 % vs 18 % <em>p</em> < 0.001). Successful PCI was similar among groups (95 % <em>p</em> = 0.9).</div><div>Women were associated with higher in-hospital death and MACE than men [12 % vs 7 % <em>p</em> < 0.001 OR 1.8 (1.5;2.2) and 7 % vs 5 % <em>p</em> = 0.005, OR 1.5 (1.1;2)]. Women were associated with fewer cardiac rehabilitation referrals [33 % vs 38 % <em>p</em> < 0.001 OR 0.8 (0.7;0.9)].</div><div>During the follow-up of 16 ± 7 months, women had a significant association with mortality during follow-up [15 % vs 11 % <em>p</em> < 0.001, OR 1.5 (1.2;1.7)]. Also, women were significantly associated with more hospital readmissions [28 % vs 24 % <em>p</em> = 0.004, OR 1.2 (1.1;1.4)].</div></div><div><h3>Conclusion</h3><div>Despite enhanced awareness, CVD in women remains underestimated. Women take longer to seek medical care and are less likely to undergo CAG and PCI. This ends in a worse early and long-term prognosis, with higher mortality and MACE on follow-up.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 3","pages":"Pages 238-243"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063969","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":"Twelve-year trends of hospitalizations and survival of acute decompensated heart failure: Data from a regional tertiary center","authors":"Keiichi Tsuchida MD , Naohito Tanabe MD, PhD , Komei Tanaka MD , Kazue Ozeki RN , Akihiko Miyasaka PT , Tatsuya Inazuki PT , Mio Abe PT , Hikaru Katagiri Ph , Ryuji Kobayashi Ph , Yuko Kurashima RD , Norihito Oyanagi MD , Shintaro Yoneyama MD , Asami Kashiwa MD , Yuka Hayashi MD , Yukio Hosaka MD , Kazuyuki Ozaki MD, FJCC , Kazuyoshi Takahashi MD","doi":"10.1016/j.jjcc.2025.03.012","DOIUrl":"10.1016/j.jjcc.2025.03.012","url":null,"abstract":"<div><h3>Background</h3><div>Recent trends in in-hospital acute decompensated heart failure<span> (ADHF) have been reported in several registry studies demonstrating no improvement in terms of mortality rate and readmission rate due to heart failure (HF) exacerbation. Trends in management of ADHF may be different in areas where the aging rate is faster.</span></div></div><div><h3>Methods</h3><div>We retrospectively enrolled 1121 ADHF patients hospitalized between 2008 and 2019. The study patients were classified into three groups based on 4-year periods. Our primary study interests were trends over time in age, length of hospital stay, and clinical outcomes, with endpoints, including 1-year mortality and readmission for HF (reHF).</div></div><div><h3>Results</h3><div>During the 12-year period, the length of hospital stay was not reduced, but rather prolonged in Period 3 (<em>p</em><span><span> < 0.001). Temporal trends in 1-year clinical outcomes showed both 1-year all-cause and cardiovascular mortality tended to increase. No improvement in 1-year reHF rates was observed over time. All-cause mortality was associated with Period 2 (95%CI 1.02–4.97), Period 3 (95%CI 1.30–6.05), older age (≥79 years, 95%CI 1.01–3.20), decreased left ventricular ejection fraction (95%CI 1.08–3.62), higher </span>loop diuretics dose (95%CI 1.07–1.25), higher B-type natriuretic peptide (BNP) levels (95%CI 1.00, 1.01), and decreased hemoglobin levels (95%CI 0.74–0.97). Factors associated with cardiovascular mortality included Period 3 (95%CI 1.02–7.31), higher loop diuretics dose (HR 1.17, 95%CI 1.07–1.27), higher BNP levels (95%CI1.00–1.01), and lower estimated glomerular filtration rate (eGFR) levels on admission (95%CI 0.70–0.95). Predictors of reHF were number of previous HF hospitalizations (95%CI 1.13–1.94), lower eGFR levels (95%CI 0.79–0.94) on admission and suboptimal guideline-directed medical therapy (95%CI 0.50–0.79).</span></div></div><div><h3>Conclusions</h3><div>Despite the recent advances in medical therapy, readmission rate in patients with ADHF did not improve during the 12-year observation period. The mortality rate worsened over time. These findings warrant prompt establishment of more effective approaches to prevent and treat ADHF.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 3","pages":"Pages 256-263"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673928","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":"Performance of convolutional neural network-enhanced electrocardiography in detecting acute coronary syndrome: focusing on subtypes and reduced leads","authors":"Koichiro Hori MD , Shinya Suzuki MD, PhD , Naomi Hirota MD, PhD , Jun Motogi , Takuya Umemoto , Hiroshi Nakai , Wataru Matsuzawa , Tsuneo Takayanagi , Akira Hyodo , Keiichi Satoh , Takuto Arita MD , Naoharu Yagi MD , Mikio Kishi MD , Hiroto Kano MD , Shunsuke Matsuno MD , Yuko Kato MD, PhD , Takayuki Otsuka MD, PhD , Tokuhisa Uejima MD, PhD , Junji Yajima MD, PhD , Yasuo Okumura MD, PhD, FJCC , Takeshi Yamashita MD, PhD, FJCC","doi":"10.1016/j.jjcc.2025.05.014","DOIUrl":"10.1016/j.jjcc.2025.05.014","url":null,"abstract":"<div><h3>Background</h3><div>Early and accurate diagnosis of acute coronary syndrome (ACS), particularly non-ST-elevation ACS (NSTE-ACS), remains a critical challenge in emergency settings. Despite advancements in diagnostic modalities, conventional electrographic (ECG) interpretation often fails to detect subtle ischemic changes, particularly in NSTE-ACS, highlighting the need for artificial intelligence (AI)-driven approaches.</div></div><div><h3>Methods</h3><div>This study retrospectively analyzed data from a single-center cohort (Shinken Database 2010–2022, <em>n</em> = 32,167) to develop AI-driven ECG models for ACS detection. A convolutional neural network (CNN) model and an integrated neural network (INN) model, which incorporated diagnostic probabilities for ACS subtypes and target vessels, were evaluated using area under the receiver operating characteristics curve (AUROC), area under the precision-recall curve (AUPRC), sensitivity, and F1 scores for all‑lead ECG and reduced‑lead ECG models.</div></div><div><h3>Results</h3><div><span>The CNN model using all‑lead ECG achieved an AUROC of 0.877, an AUPRC of 0.391, and an F1 score of 0.184, while the INN model showed similar results (AUROC 0.889, AUPRC 0.356, and F1 score 0.188). For subtypes related to NSTE-ACS, the CNN model using all‑lead ECG (CNN model using double‑lead ECG) model achieved an AUROC of 0.785 (0.783), sensitivity of 0.723 (0.672), and specificity of 0.699 (0.768) for unstable angina<span>, and an AUROC of 0.795 (0.786), sensitivity of 0.527 (0.567), and specificity of 0.878 (0.849) for NSTE-myocardial infarction. Among patients with troponin testing (</span></span><em>n</em><span> = 4169), the CNN model achieved a sensitivity of 76 %, a positive predictive rate (PPR) of 32 %, and an F1 score of 0.452, while the INN model achieved 78 %, 35 %, and 0.483, respectively. The leads I and II model demonstrated the highest AUROC among reduced‑lead models (0.866), with F1 scores in patients with troponin testing of 0.395 and 0.390 for the CNN and INN models, respectively.</span></div></div><div><h3>Conclusion</h3><div>Both CNN and INN-enhanced ECGs demonstrated good performance in detecting ACS including NSTE-ACS with subtle ischemic ECG changes. However, low PPR limit these models' standalone diagnostic utility. Instead, they hold promise as supportive tools, especially in resource-limited settings where reduced‑lead ECGs may be beneficial.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 3","pages":"Pages 301-311"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187098","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":"Temporal trends in management strategies and clinical outcomes of venous thromboembolism in Japan from 2017 to 2023","authors":"Wei Xiong MD, PhD , Yugo Yamashita MD, PhD , Toshiki Fukasawa PhD , Chikashi Takeda MD, PhD , Hiroki Shiomi MD, PhD , Takahiro Horie MD, PhD , Koh Ono MD, PhD, FJCC","doi":"10.1016/j.jjcc.2025.03.007","DOIUrl":"10.1016/j.jjcc.2025.03.007","url":null,"abstract":"<div><h3>Background</h3><div><span>Venous thromboembolism (VTE) is a major health problem worldwide. There are scarce data on the recent temporal trends of patients with VTE after the widespread use of </span>direct oral anticoagulants (DOACs).</div></div><div><h3>Methods and results</h3><div><span>In a Japanese nationwide hospital administrative database, we identified 20,217 patients with VTE from 2017 to 2023, and evaluated their temporal trends in management strategies and clinical outcomes. The proportions of outpatient treatment among patients with out-of-hospital isolated deep vein thrombosis increased significantly (</span><em>p</em> trend <0.001, Pearson's <em>R</em> = 0.046) over time from 2017 to 2023. The proportions of warfarin use decreased significantly over time from 2017 to 2023 (<em>p</em><span> trend <0.001, Pearson's R = -0.053), whereas the use of most DOACs increased. The proportions of thrombolysis (</span><em>p</em> trend <0.001, Pearson's R = -0.046) and inferior vena cave filter (<em>p</em><span> trend <0.001, Pearson's R = -0.048) use decreased significantly over time from 2017 to 2023. The incidence of 6-month all-cause death, VTE recurrence, and bleeding was 9.1 %, 2.1 %, and 4.4 %, respectively. The incidence decreased in 6-month all-cause death (</span><em>p</em> trend = 0.018, Pearson's R = -0.017) and bleeding (<em>p</em> trend <0.001, Pearson's R = -0.029) over time from 2017 to 2023.</div></div><div><h3>Conclusions</h3><div>The current Japanese nationwide hospital administrative database provided the recent temporal trends in the real-world management strategies and clinical outcomes of VTE, which revealed several temporal changes in these aspects after the widespread use of DOACs.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 3","pages":"Pages 294-300"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639629","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}
Gnanaraj Justin Paul DM , Steaphen Anne Princy DM , Surendran Anju DM , Anish Keepanasseril MD, MRCPI[OG]
{"title":"Predicting adverse cardiac events using DEVI and CARPREG-I score in pregnant with valvular heart disease: External validation study from MPAC registry","authors":"Gnanaraj Justin Paul DM , Steaphen Anne Princy DM , Surendran Anju DM , Anish Keepanasseril MD, MRCPI[OG]","doi":"10.1016/j.jjcc.2025.03.015","DOIUrl":"10.1016/j.jjcc.2025.03.015","url":null,"abstract":"<div><h3>Background</h3><div>While numerous risk assessment tools exist for pregnant women with valvular heart disease (VHD), validation studies assessing their performance in diverse settings are few. Such validation is crucial before applying these tools routinely in clinical practice.</div></div><div><h3>Objectives</h3><div>To validate and establish the clinical utility of two risk stratification tools – DEVI (VHD-specific tool) and CARPREG-I in predicting adverse cardiac events in pregnant women with VHD.</div></div><div><h3>Methods</h3><div>This cohort study involved consecutive pregnancies complicated with VHD enrolled in the prospective Medical College Pregnancy and Cardiac (MPAC) registry from July 2016 to December 2019. Individual risk for adverse composite cardiac events was calculated using DEVI and CARPREG-I models. Performance was assessed through discrimination and calibration characteristics. Clinical utility was evaluated with decision curve analysis.</div></div><div><h3>Results</h3><div>Of the 1029 pregnancies, 609 had VHD. Mitral regurgitation (67.2 %; 409/609) was most common; 11.5 % (70/609) experienced at least one component of the composite outcome. The area under the receiver operating characteristic curve was 0.747, with 95 % confidence intervals (CI) (0.685–0.809) for DEVI and 0.705 (95%CI 0.646–0.765) for CARPREG-I models. Calibration plots suggested that the DEVI score overestimates risk at higher probabilities, while the CARPREG-I score underestimates risk at most probabilities. Decision curve analysis demonstrated that both models were useful across predicted probability thresholds between 10 % and 60 %.</div></div><div><h3>Conclusion</h3><div>In this external validation study in pregnant women with VHD, both DEVI and CARPREG-I scores showed good discriminative ability and clinical utility across various probabilities. However, both models need recalibration to improve the agreement between the predicted and observed events.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"86 3","pages":"Pages 280-285"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730264","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}