Journal of cardiology最新文献

{"title":"Clinically significant posture-related oxygen saturation variability in Fontan circulation: prevalence and determinants.","authors":"Hiroki Uchiyama, Aya Miyazaki, Takamichi Ishikawa, Nao Inoue, Daisuke Masui, Mikihiro Shimizu, Yasumi Nakashima","doi":"10.1016/j.jjcc.2026.08.002","DOIUrl":"10.1016/j.jjcc.2026.08.002","url":null,"abstract":"<p><strong>Background: </strong>Patients with Fontan circulation often have low baseline oxygen saturation (SpO₂), and posture-related SpO₂ variability is sometimes observed in clinical practice. However, the prevalence and determinants of clinically significant posture-related SpO₂ variability have not been systematically investigated.</p><p><strong>Methods: </strong>This observational study included 103 patients with Fontan circulation and 166 patients after biventricular repair. After 1:1 propensity score matching by age and sex, 103 patients in each group were analyzed. SpO₂ was measured in the sitting and supine positions, and the difference between supine and sitting SpO₂ (ΔSpO₂) was calculated. Clinically significant posture-related SpO₂ variability was defined as an absolute ΔSpO₂ of ≥3%. Clinical, hemodynamic, and imaging variables were compared between Fontan patients with and without significant variability. Multivariable logistic regression analysis was performed to identify independent determinants.</p><p><strong>Results: </strong>All patients in the biventricular group showed SpO₂ variability of ≤2%. In contrast, 28 of 103 Fontan patients (27%) had clinically significant posture-related SpO₂ variability. SpO₂ increased in the supine position in 26 patients and decreased in 2 patients. Patients with significant variability were older and had a longer duration since the Fontan procedure. Veno-venous collaterals (VVCs) were more prevalent in these patients, whereas pulmonary arteriovenous malformations (PAVMs) were not more prevalent. Five patients with significant variability had neither VVCs nor PAVMs. In multivariable analysis, VVCs were independently associated with clinically significant posture-related SpO₂ variability (odds ratio 4.85, 95% confidence interval 1.74-13.50, p = 0.003).</p><p><strong>Conclusions: </strong>Clinically significant posture-related SpO₂ variability occurs in approximately one-quarter of patients with Fontan circulation but not in patients after biventricular repair. This variability is independently associated with VVCs, although clear hemodynamic compromise was not demonstrated and mechanisms other than detectable right-to-left shunts may also contribute.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793538","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":"Left atrial appendage occlusion in patients with atrial fibrillation undergoing transcatheter aortic valve replacement: A meta-analysis.","authors":"Mustafa Abomohsen, Amr Elboliney, Ahmed Elmorsy Mohamed, Israi Mahgoub, Rana S Sayed, Abdul Hakim Almakadma, Ahmed Farid Gadelmawla, Ameer Awashra, Moshe Gunsburg, Hal L Chadow","doi":"10.1016/j.jjcc.2026.08.001","DOIUrl":"10.1016/j.jjcc.2026.08.001","url":null,"abstract":"<p><strong>Background: </strong>Stroke prevention after transcatheter aortic valve replacement (TAVR) in patients with atrial fibrillation remains clinically challenging because thromboembolic risk must be balanced against substantial bleeding vulnerability. Left atrial appendage occlusion (LAAO) has been proposed as a nonpharmacologic alternative to long-term anticoagulation in selected patients, but its comparative role in the TAVR population remains insufficiently defined.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of comparative studies evaluating TAVR plus LAAO versus TAVR plus medical therapy in patients with atrial fibrillation. Randomized trials and observational comparative cohorts were eligible. The primary outcome was stroke, transient ischemic attack, or systemic embolism. Secondary outcomes were major bleeding and all-cause mortality. Random-effects odds ratios (ORs) with 95% confidence intervals (CIs) were pooled.</p><p><strong>Results: </strong>Four studies comprising 652 patients were included, of whom 289 underwent TAVR plus LAAO and 363 received TAVR plus medical therapy. The evidence base included two randomized trials and two observational studies, with LAAO performed either concomitantly with TAVR or in a staged manner shortly thereafter. TAVR plus LAAO was not associated with a significant reduction in stroke/transient ischemic attack/systemic embolism compared with medical therapy (OR 0.83, 95% CI 0.40-1.74). There were also no significant differences in major bleeding (OR 1.10, 95% CI 0.68-1.77) or all-cause mortality (OR 0.93, 95% CI 0.62-1.40).</p><p><strong>Conclusions: </strong>In the currently available comparative evidence, adding LAAO to TAVR was associated with similar thromboembolic, bleeding, and mortality outcomes compared with medical therapy. These findings do not support routine LAAO for all patients with atrial fibrillation undergoing TAVR, but they leave room for selective use in carefully chosen patients in whom long-term anticoagulation is undesirable.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793613","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":"Baseline red cell distribution width-to-albumin ratio and 12-month outcomes in sodium-glucose cotransporter 2 inhibitor-treated heart failure.","authors":"Ivana Jurin, Marin Viđak, Ivan Čović, Dijana Bešić, Petar Lišnjić, Ante Lisičić, Šime Manola, Jasmina Ćatić","doi":"10.1016/j.jjcc.2026.07.021","DOIUrl":"10.1016/j.jjcc.2026.07.021","url":null,"abstract":"<p><strong>Background: </strong>Red cell distribution width-to-albumin ratio (RAR) is associated with heart failure (HF) prognosis, but its incremental value and performance in contemporary sodium-glucose cotransporter 2 inhibitor (SGLT2i)-treated cohorts remain uncertain.</p><p><strong>Methods: </strong>We re-audited a prospective registry and analyzed 641 unique patients with HF and baseline RAR measured before or on the day of SGLT2i initiation. The 12-month primary endpoint was all-cause death, unplanned hospitalization, or emergency department visit; event-free patients were right-censored at last contact or 365 days.</p><p><strong>Results: </strong>There were 199 first events in the full time-to-event cohort. RAR remained associated with the endpoint after adjustment including N-terminal pro B-type natriuretic peptide [hazard ratio (HR) 1.42 per standard deviation, 95% confidence interval (CI) 1.24-1.61]. The HR for death or HF hospitalization was 1.57 (95% CI 1.33-1.86). Adding RAR increased Harrell's C-index modestly from 0.694 to 0.710 (likelihood-ratio p < 0.001). No statistically significant interaction was observed by SGLT2i type or initiation setting.</p><p><strong>Conclusions: </strong>Baseline RAR provides modest, confirmatory prognostic information in SGLT2i-treated HF but is not established as a treatment-response biomarker or stand-alone decision rule.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678577","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":"Prognostic effect of invasively diagnosed coronary microvascular dysfunction: a systematic review and meta-analysis.","authors":"Konstantinos G Kyriakoulis, Kyriakos Dimitriadis, Athanasios Sakalidis, Nikolaos Pyrpyris, Eleni Adamopoulou, Stergios Soulaidopoulos, Panagiotis Tsioufis, Ioannis Doundoulakis, Angelos Papanikolaou, Konstantinos Aznaouridis, Petros Galanis, Natalija R Odanovic, Ivan Ilic, Elmir Omerovic, Edina Cenko, Konstantinos Tsioufis","doi":"10.1016/j.jjcc.2026.07.020","DOIUrl":"10.1016/j.jjcc.2026.07.020","url":null,"abstract":"<p><strong>Background: </strong>The association of epicardial obstructive coronary artery disease with major adverse cardiovascular events (MACE) is established; however, accumulating evidence emphasizes the significant role of coronary microvascular dysfunction (CMD). The aim of this meta-analysis is to summarize the available evidence on the prognostic effect of CMD in cardiovascular outcomes and mortality.</p><p><strong>Methods: </strong>Systematic literature search in MEDLINE/PubMed and Scopus was conducted to identify studies comparing the prognosis of CMD vs non-CMD using coronary flow reserve (CFR) and/or index of microcirculatory resistance (IMR) invasive indices. A meta-analysis to calculate pooled risk ratios (RR) was performed along with sensitivity and meta-regression analyses.</p><p><strong>Results: </strong>Thirty-one studies were included (n = 13,016, weighted mean age 58 years, males 57%, left ventricular ejection fraction 58%, CFR 2.6, IMR 24.4, CMD 33%). Meta-analysis of 24 studies (n = 8294) indicated a pooled RR for MACE of 2.55 (2.11, 3.10) for CMD vs non-CMD comparison. Consistent findings were observed for all-cause [1.88 (1.52, 2.33)] and cardiovascular mortality [2.76 (2.02, 3.76)], myocardial infarction [2.18 (1.56, 3.05)], revascularization [1.67 (1.06, 2.64)], heart failure hospitalization [3.46 (1.90, 6.30)], and stroke risk [1.85 (1.26, 2.71)]. The CFR and IMR-based analyses provided similar findings. Worse outcomes were observed in acute coronary syndrome patients and in those with the structural CMD endotype (abnormal CFR/abnormal IMR).</p><p><strong>Conclusion: </strong>Invasively diagnosed CMD is associated with a 2.5-fold increase in MACE and a 3-fold increase in cardiovascular mortality. This finding highlights the importance of a more comprehensive assessment of coronary vasculature, including both the macro- and the microcirculation.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669614","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":"SGLT2 inhibitors and tafamidis in ATTR-CM: Promise or premature optimism?","authors":"Abdülmelik Birgün MD,&nbsp;Macit Kalçık MD,&nbsp;Lütfü Bekar MD","doi":"10.1016/j.jjcc.2025.11.017","DOIUrl":"10.1016/j.jjcc.2025.11.017","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"88 2","pages":"Page 147"},"PeriodicalIF":3.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of stricter lipid control on cardiovascular outcomes in a regional hospital-clinic referral system","authors":"Hirofumi Sugiyama MD,&nbsp;Teruno Saito RN,&nbsp;Norio Yamamoto PhD,&nbsp;Mariko Kitajima PhD,&nbsp;Kojiro Mochiduki MA,&nbsp;Koji Tanaka MD,&nbsp;Eriko Kojima MD,&nbsp;Takuya Nakagawa MD,&nbsp;Eri Ishikawa MD,&nbsp;Yoshinori Tokumasu MD,&nbsp;Shigetaka Kageyama MD, PhD,&nbsp;Koichiro Murata MD,&nbsp;Ryuzo Nawada MD, PhD,&nbsp;Tomoya Onodera MD, PhD","doi":"10.1016/j.jjcc.2025.12.017","DOIUrl":"10.1016/j.jjcc.2025.12.017","url":null,"abstract":"<div><h3>Background</h3><div>Real-world attainment of contemporary guidelines-recommended, stringent low-density lipoprotein cholesterol (LDL-C) targets for secondary prevention of cardiovascular events in patients with coronary artery disease (CAD) remains inadequate. This study aimed to assess LDL-C control in patients within a regional ischemic heart disease (IHD) referral system after the 2022–2023 guideline updates and examine its association with long-term cardiovascular outcomes.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed annual serum LDL-C levels and achievement of guideline-recommended serum LDL-C target level (&lt;70 mg/dL) of 1334 patients with CAD [acute coronary syndrome (ACS) or chronic coronary syndrome (CCS)] enrolled in a regional IHD referral system and followed up at Shizuoka City Shizuoka Hospital (2021–2024). The primary endpoint was the annual serum LDL-C level trend; secondary endpoints were major adverse cardiovascular events (MACE: cardiovascular death, nonfatal myocardial infarction, and coronary revascularization) and their associations with serum LDL-C levels.</div></div><div><h3>Results</h3><div>The mean serum LDL-C level declined from 80.2 ± 22.0 mg/dL in 2021 to 71.8 ± 20.7 mg/dL in 2024, with improved target attainment (29.8 % vs. 46.3 %; <em>p</em> &lt; 0.001 for both). MACE occurred in 14.2 % of patients (mean follow-up period, 6.1 years), with its incidence in patients who achieved the target level significantly lower than in those who did not (6.8 % vs. 18.6 %, <em>p</em> &lt; 0.001). Patients with ACS and CCS had similar benefits. In multivariate Cox regression analysis, target level attainment was independently associated with a reduced MACE risk (hazard ratio 0.326; 95 % CI 0.21–0.52; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>In a real-world cohort of patients with CAD managed under a structured IHD referral system, serum LDL-C levels progressively decreased over time, and patients who achieved stricter LDL-C control experienced a significantly lower incidence of major cardiovascular events.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"88 2","pages":"Pages 81-87"},"PeriodicalIF":3.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933525","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":"Comment on “Association of trace element abnormalities and adverse outcomes in patients with acute heart failure”","authors":"Ankur Sharma PhD,&nbsp;Varshini Vadhithala MD,&nbsp;Arun Kumar MD,&nbsp;Sushma Verma PhD,&nbsp;Sushma Narsing Katkuri MD","doi":"10.1016/j.jjcc.2026.01.001","DOIUrl":"10.1016/j.jjcc.2026.01.001","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"88 2","pages":"Pages 149-150"},"PeriodicalIF":3.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948388","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":"Comment on “Effect of night-time onset on neurologically favourable survival between patients with and without bystander cardiopulmonary resuscitation”","authors":"Bin Cao (MD),&nbsp;Binning Ma (MD),&nbsp;Zhenxing Deng (MD)","doi":"10.1016/j.jjcc.2025.11.007","DOIUrl":"10.1016/j.jjcc.2025.11.007","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"88 2","pages":"Pages 144-145"},"PeriodicalIF":3.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573732","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":"Gap between guideline-based indications and real-world implementation of wearable cardioverter-defibrillators after acute myocardial infarction","authors":"Terumori Satoh MD, PhD,&nbsp;Yoshihisa Naruse MD, PhD,&nbsp;Yusuke Mizuno MD,&nbsp;Yuichi Suzuki MD,&nbsp;Ryota Sato MD, PhD,&nbsp;Satoshi Mogi MD,&nbsp;Atsushi Sakamoto MD, PhD,&nbsp;Nobuyuki Wakahara MD, PhD,&nbsp;Shigetaka Kageyama MD, PhD,&nbsp;Masayoshi Asai MD, PhD,&nbsp;Keita Kodama MD,&nbsp;Hiroyuki Takase MD, PhD,&nbsp;Kohei Sawasaki MD, PhD, FJCC,&nbsp;Yoshitaka Kawaguchi MD,&nbsp;Yuichiro Maekawa MD, PhD, FJCC","doi":"10.1016/j.jjcc.2026.02.001","DOIUrl":"10.1016/j.jjcc.2026.02.001","url":null,"abstract":"<div><h3>Background</h3><div>To prevent sudden cardiac death after acute myocardial infarction (AMI), current guidelines recommend the use of a wearable cardioverter-defibrillator (WCD) as bridging therapy before implantable cardioverter-defibrillator implantation in patients with left ventricular ejection fraction ≤35% and New York Heart Association class ≥ II at discharge. However, real-world data regarding the implementation of guideline-based indications for WCD therapy—and the reasons for their underuse—remain limited in Japan.</div></div><div><h3>Purpose</h3><div>This study aimed to evaluate the gap between guideline-based indications and real-world implementation of WCD therapy after AMI, and to identify physician- and system-related barriers contributing to WCD underuse.</div></div><div><h3>Methods and results</h3><div>We analyzed data from the SING (Shizuoka Catheter INtervention Group)-AMI registry, a prospective multicenter cohort of patients with AMI who underwent primary percutaneous coronary intervention at seven hospitals in Shizuoka Prefecture, Japan. Among 229 patients (mean age, 70.7 years; 76.3% male), 15 sustained ventricular arrhythmia events (ventricular tachycardia/ventricular fibrillation [VT/VF]) occurred in 15 patients (6.6%) during hospitalization. At discharge, 12 patients (5.2%) met guideline-based WCD eligibility; however, no WCDs were prescribed. Although physicians identified 10 patients as WCD candidates, 8 were misclassified due to misinterpretation of eligibility criteria. Furthermore, WCD use was not discussed with 19 of 20 eligible or potentially eligible patients, primarily due to lack of recognition of eligibility, limited physician familiarity, or patient-related concern.</div></div><div><h3>Conclusions</h3><div>In this prospective Japanese registry, 5.2% of AMI patients met guideline-based indications for WCD therapy; however, no WCDs were prescribed. While these findings are limited by the small sample size, they suggest a potential gap between clinical guidelines and their implementation in real-world practice.</div></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"88 2","pages":"Pages 95-101"},"PeriodicalIF":3.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142226","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":"Clinical engagement and cardiovascular outcomes of screening-detected atrial fibrillation in working-age adults","authors":"Yuichiro Mori MD, MPH, PhD,&nbsp;Shingo Fukuma MD, PhD","doi":"10.1016/j.jjcc.2026.03.014","DOIUrl":"10.1016/j.jjcc.2026.03.014","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"88 2","pages":"Pages 142-143"},"PeriodicalIF":3.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618738","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}