{"title":"Usefulness of exercise stress echocardiography for predicting cardiovascular events and atrial fibrillation in hypertrophic cardiomyopathy","authors":"Tomohiro Yoshii MD , Masashi Amano MD, PhD , Kenji Moriuchi MD, PhD , Shoko Nakagawa MD, PhD , Hitomi Nishimura MS , Yurie Tamai MS , Ayaka Mizumoto MS , Aiko Koda MS , Yutaka Demura MS , Yoshito Jo MS , Yuki Irie MD , Takahiro Sakamoto MD, PhD , Makoto Amaki MD, PhD , Hideaki Kanzaki MD, PhD, FJCC , Teruo Noguchi MD, PhD , Kunihiro Nishimura MD, PhD , Takeshi Kitai MD, PhD , Chisato Izumi MD, PhD, FJCC","doi":"10.1016/j.jjcc.2024.08.010","DOIUrl":"10.1016/j.jjcc.2024.08.010","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 321-328"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","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}
Bekure B. Siraw MD, MPH , Mohamed A. Ebrahim MD , Shahin Isha MD , Parth Patel MD , Abdulrahim Y. Mehadi MD , Eli A. Zaher MD , Yordanos T. Tafesse MD, MPH , Biruk Siraw MD, MS
{"title":"The impact of liver cirrhosis on in-hospital outcomes among patients hospitalized for cardiogenic shock: A propensity score matched retrospective cohort study","authors":"Bekure B. Siraw MD, MPH , Mohamed A. Ebrahim MD , Shahin Isha MD , Parth Patel MD , Abdulrahim Y. Mehadi MD , Eli A. Zaher MD , Yordanos T. Tafesse MD, MPH , Biruk Siraw MD, MS","doi":"10.1016/j.jjcc.2024.09.004","DOIUrl":"10.1016/j.jjcc.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Cardiogenic shock poses a critical challenge characterized by diminished cardiac output and organ perfusion. Timely recognition and risk stratification are essential for effective intervention. Liver cirrhosis adds complexity due to its diverse systemic manifestations. The effect of liver cirrhosis on in-hospital outcomes in cardiogenic shock remains underexplored.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2020, matching cirrhotic patients with non-cirrhotic counterparts using propensity scores. The Cochran-Mantel-Haenszel method was used to assess the impact of cirrhosis on in-hospital mortality and complications. Simple linear regression models were used to assess differences in length of stay and cost of hospitalization.</div></div><div><h3>Results</h3><div>There were a total of 44,288 patients in the cohort, evenly distributed between the group with and without liver cirrhosis. Mean age of the cohort was 64 years (SD 12.5), 69.7 % were males, and 61.3 % were white. The overall in-hospital mortality rate in the cohort was 37.2 % with higher odds of in-hospital mortality in cirrhotic patients [OR = 1.3; 95 % CI (1.25, 1.35)]. Patients with cirrhosis exhibited increased risks of bowel ischemia, acute kidney injury, and sepsis compared to those without cirrhosis. Additionally, they had a heightened overall risk of major bleeding, particularly gastrointestinal bleeding, but a lower risk of intracranial hemorrhage and access site bleeding. Conversely, patients with cirrhosis had lower odds of deep vein thrombosis and pulmonary embolism, as well as arterial access site thrombosis and dissection, leading to reduced odds of peripheral angioplasty, thrombectomy, and amputation. Cirrhotic patients also had increased length of stay and cost of hospitalization.</div></div><div><h3>Conclusion</h3><div>Liver cirrhosis exacerbates outcomes in cardiogenic shock, necessitating tailored management strategies. Further research is warranted to optimize patient care and understand the underlying mechanisms.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 293-300"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288098","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":"Current status and future perspective of coronary artery calcium score in asymptomatic individuals","authors":"Yuko O. Kawaguchi MD, PhD , Shinichiro Fujimoto MD, PhD, FJCC , Yui O. Nozaki MD, PhD , Nobuo Tomizawa MD, PhD , Hiroyuki Daida MD, PhD, FJCC , Tohru Minamino MD, PhD, FJCC","doi":"10.1016/j.jjcc.2024.11.008","DOIUrl":"10.1016/j.jjcc.2024.11.008","url":null,"abstract":"<div><div>Atherosclerotic cardiovascular disease remains a major cause of death, and it is important to accurately estimate the cardiovascular events risk stratification even in asymptomatic patients. The coronary artery calcium score (CACS), which is quantitatively evaluated by electrocardiogram (ECG)-gated non-contrast chest computed tomography (CT) imaging, has been reported to be useful for cardiovascular event risk stratification in large studies. In the USA and Europe, guidelines recommend the use of the CACS in borderline or intermediate-risk asymptomatic individuals based on a high level of evidence. In Japan, however, the use of CACS in clinical practice is currently limited. Although it has been reported that the prevalence and distribution of coronary artery calcification (CAC) may differ by race and ethnicity, there are few data on its usefulness in stratifying the risk of cardiovascular events in asymptomatic Japanese individuals. While it is important to establish evidence for the usefulness of CACS in the Japanese population, for widespread clinical dissemination it would be beneficial to evaluate CAC and to perform accurate cardiovascular event risk stratification from non-ECG-gated non-contrast chest CT imaging performed during medical check-up and routine clinical practice. There have been reports on the usefulness of CAC assessed by non-ECG-gated chest CT imaging and on the relationship of CAC between ECG-gated and non-ECG-gated chest CT imaging. In recent years, a more accurate method of evaluating CACS from non-ECG-gated chest CT imaging has been developed using artificial intelligence, and further development is expected in the future.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 275-282"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780112","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}
Ken Kato MD, PhD, FJCC , Davide Di Vece MD , Mari Kitagawa MD, PhD , Kayo Yamamoto MD , Ko Miyakoda MD , Shuhei Aoki MD , Hiroki Goto MD, PhD , Hideki Kitahara MD, PhD , Yoshio Kobayashi MD, PhD, FJCC , Christian Templin MD, PhD
{"title":"Clinical characteristics and outcomes in takotsubo syndrome -Review of insights from the InterTAK Registry-","authors":"Ken Kato MD, PhD, FJCC , Davide Di Vece MD , Mari Kitagawa MD, PhD , Kayo Yamamoto MD , Ko Miyakoda MD , Shuhei Aoki MD , Hiroki Goto MD, PhD , Hideki Kitahara MD, PhD , Yoshio Kobayashi MD, PhD, FJCC , Christian Templin MD, PhD","doi":"10.1016/j.jjcc.2025.01.009","DOIUrl":"10.1016/j.jjcc.2025.01.009","url":null,"abstract":"<div><div>Takotsubo syndrome (TTS) is a complex cardiovascular condition characterized by transient left and/or right ventricular dysfunction in the absence of a coronary artery culprit lesion. The InterTAK registry, a large international collaborative registry, has significantly advanced our understanding of TTS. This review summarizes key findings from the InterTAK registry, including epidemiology, clinical presentation, comorbidities, outcomes, and treatment. The registry has revealed the diverse clinical spectrum of TTS, including atypical presentations, and identified various risk factors associated with adverse outcomes. The InterTAK registry has been instrumental in shaping the current understanding of TTS and will continue to guide future research and clinical practice.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 263-267"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074639","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":"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 MD, Yuichi Saito MD, Shunsuke Nakamura MD, Yuya Tanabe MD, Hideki Kitahara MD, Yoshio Kobayashi MD, FJCC","doi":"10.1016/j.jjcc.2024.08.009","DOIUrl":"10.1016/j.jjcc.2024.08.009","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>The combined assessment of FFR with RFR and resting Pd/Pa stratified TVF risks in vessels with intermediate coronary stenosis.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"85 4","pages":"Pages 315-320"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","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}
Gnanaraj Justin Paul, Steaphen Anne Princy, Surendran Anju, Anish Keepanasseril
{"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, Steaphen Anne Princy, Surendran Anju, Anish Keepanasseril","doi":"10.1016/j.jjcc.2025.03.015","DOIUrl":"10.1016/j.jjcc.2025.03.015","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 %.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-24","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}
{"title":"Pathophysiology and management of adults with complex congenital heart disease after biventricular repair.","authors":"Mitsutaka Nakashima, Norihisa Toh, Takashi Miki, Yoichi Takaya, Koji Nakagawa, Kazuhiro Omori, Toru Miyoshi, Kazufumi Nakamura, Hiroshi Morita, Teiji Akagi, Shinsuke Yuasa","doi":"10.1016/j.jjcc.2025.03.014","DOIUrl":"10.1016/j.jjcc.2025.03.014","url":null,"abstract":"<p><p>Surgical management of congenital heart disease encompasses a spectrum of procedures, ranging from biventricular repair to univentricular palliation, each tailored to the specific anatomical and hemodynamic features of individual cases. Among these, biventricular repair, which preserves a functional ventricle to sustain pulmonary circulation, is prioritized whenever feasible. Advances in approaches have significantly improved outcomes, enabling many patients with congenital heart disease to reach adulthood, including the majority who have undergone biventricular repair. Despite these advancements, long-term complications-such as valvular disease, arrhythmias, heart failure, outflow tract obstruction, and dysfunction of extracardiac conduits-pose persistent challenges in the lifelong care of these patients. This review examines the distinct challenges and management strategies associated with adult patients who have undergone biventricular repair for complex congenital heart disease. The discussion focuses on key conditions, including repaired tetralogy of Fallot, transposition of the great arteries following atrial or arterial switch procedures, surgically managed or untreated congenitally corrected transposition of the great arteries with significant tricuspid regurgitation necessitating intervention, pulmonary atresia with intact ventricular septum, and Ebstein's anomaly. By addressing the long-term complications and therapeutic considerations unique to this patient population, this review aims to provide a comprehensive framework for optimizing care as these individuals transition into adulthood.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692288","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, Naohito Tanabe, Komei Tanaka, Kazue Ozeki, Akihiko Miyasaka, Tatsuya Inazuki, Mio Abe, Hikaru Katagiri, Ryuji Kobayashi, Yuko Kurashima, Norihito Oyanagi, Shintaro Yoneyama, Asami Kashiwa, Yuka Hayashi, Yukio Hosaka, Kazuyuki Ozaki, Kazuyoshi Takahashi","doi":"10.1016/j.jjcc.2025.03.012","DOIUrl":"10.1016/j.jjcc.2025.03.012","url":null,"abstract":"<p><strong>Background: </strong>Recent trends in in-hospital acute decompensated heart failure (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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>During the 12-year period, the length of hospital stay was not reduced, but rather prolonged in Period 3 (p < 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 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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-20","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}