Journal of cardiology最新文献

{"title":"Ejection fraction-dependent prognostic value of discharge albuminuria in acute decompensated heart failure.","authors":"Junichi Ohno, Kyung-Duk Min, Yuki Matsumoto, Isamu Sunayama, Aika Daimon, Eri Manabe, Makiko Oboshi, Kohei Azuma, Yoshiyuki Orihara, Masataka Sugahara, Akiyo Eguchi, Yoshiro Naito, Masanori Asakura, Masaharu Ishihara","doi":"10.1016/j.jjcc.2026.07.018","DOIUrl":"10.1016/j.jjcc.2026.07.018","url":null,"abstract":"<p><strong>Background: </strong>Post-discharge risk stratification remains challenging in patients with heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), where natriuretic peptides incompletely capture residual renal and microvascular stress. Albuminuria integrates glomerular and microvascular injury, yet whether its prognostic value depends on measurement timing-admission versus discharge-and whether this relationship differs by ejection fraction (EF) phenotype, has not been established.</p><p><strong>Methods: </strong>In 290 patients hospitalized for acute decompensated HF [126 HF with reduced ejection fraction (HFrEF), 164 HFmrEF/HFpEF], the urine albumin-to-creatinine ratio (UACR) was measured at admission and discharge. The primary outcome was the 1-year composite of all-cause death or HF rehospitalization. Sensitivity analyses sequentially adjusted for individual medication classes, and the interaction between UACR and EF phenotype was formally tested.</p><p><strong>Results: </strong>UACR decreased markedly during hospitalization (median 96.8 to 24.7 mg/gCr; p < 0.001), yet residual albuminuria was greater in HFmrEF/HFpEF at discharge (28.5 mg/gCr vs 18.7 mg/gCr; p = 0.038). During a 1-year follow-up, 98 patients (34%) experienced the composite endpoint. Per 1-SD increase in log-transformed discharge UACR, discharge UACR was independently associated with outcomes in HFmrEF/HFpEF across all four medication-adjusted models (HR range 1.37-1.40, all p ≤ 0.008), whereas admission UACR lost significance after adjustment. No meaningful associations were observed in HFrEF. The interaction between discharge UACR and EF phenotype was of borderline significance after adjustment (p for interaction = 0.047).</p><p><strong>Conclusions: </strong>Discharge UACR independently predicts adverse outcomes in HFmrEF/HFpEF, with associations that remained consistent after adjustment for individual HF medication classes. Predischarge UACR measurement may refine post-discharge risk stratification in HFmrEF/HFpEF in addition to natriuretic peptides.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630540","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":"Outcomes of balloon-expandable versus self-expandable valves in TAVR for mixed aortic valve disease.","authors":"Irsa Hasan, Justin C Wang, Xander Jacquemyn, Takuya Ogami, Jianhui Zhu, Floyd Thoma, Derek Serna-Gallegos, Dustin Kliner, Amber Makani, David West, Catalin Toma, Ibrahim Sultan","doi":"10.1016/j.jjcc.2026.07.015","DOIUrl":"10.1016/j.jjcc.2026.07.015","url":null,"abstract":"<p><strong>Background: </strong>The ideal valve choice for patients with mixed aortic stenosis defined as severe aortic stenosis with concomitant moderate or greater aortic regurgitation (AR) at the time of transcatheter aortic valve replacement (TAVR) remains unclear. This study aimed to compare outcomes between balloon-expandable valves (BEV) and self-expanding valves (SEV) in patients with mixed aortic valve disease undergoing TAVR.</p><p><strong>Methods: </strong>A retrospective analysis was performed using prospectively collected institutional data from January 2012 to November 2024. Patients with trace/mild AR, or valve-in-valve procedures were excluded. After 1:1 propensity score matching, clinical and echocardiographic outcomes were compared. Endpoints were defined according to Valve Academic Research Consortium-3 criteria.</p><p><strong>Results: </strong>A total of 796 patients with mixed aortic valve disease underwent TAVR with either a BEV (n = 474) or SEV (n = 322). Propensity score matching was performed to create balanced cohorts (n = 286 per group) based on baseline characteristics. Clinical outcomes were similar between groups except the incidence of stroke (p < 0.001) and major vascular complications (p = 0.015) was notably higher with SEV. The SEV group exhibited a significantly lower aortic valve mean gradient at 30 days (7.92 ± 4.11 mmHg vs. 12.1 ± 4.51 mmHg, p < 0.001) and 1 year (8.53 ± 4.33 mmHg vs 12.5 ± 6.85 mmHg, p < 0.001). Despite a higher paravalvular leak rate in the SEV group at 30 days, this did not persist at 1 year (p = 0.77). There was no significant difference in estimated mortality at 1 and 5 years.</p><p><strong>Conclusion: </strong>In patients with mixed aortic valve disease, TAVR with SEV resulted in superior hemodynamic performance but was associated with a higher rate of paravalvular leak, stroke, and major vascular complications in the short-term. While long-term survival was similar between groups, further investigation is warranted to optimize valve selection in these patients.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630574","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":"Variation in echocardiographic stress and provocation maneuvers for hypertrophic obstructive cardiomyopathy across echocardiography Laboratories in Japan.","authors":"Akihisa Kataoka, Yasuaki Wada, Michael H Picard, Hirotsugu Yamada","doi":"10.1016/j.jjcc.2026.07.014","DOIUrl":"10.1016/j.jjcc.2026.07.014","url":null,"abstract":"<p><p>In this nationwide survey, we investigated the use of echocardiographic stress and provocation maneuvers for hypertrophic obstructive cardiomyopathy across Japan. Among 205 echocardiography laboratories, the self-directed Valsalva maneuver was the most commonly used technique. The party balloon inflation maneuver was adopted in a substantial minority of centers as a feasible Valsalva-type provocation maneuver, whereas the goal-directed Valsalva maneuver was rarely used. Maneuver utilization varied by institutional volume. These findings suggest a potential gap between guideline recommendations and real-world practice, underscoring the need for further discussion and harmonization of stress-testing approaches.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630506","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":"Self-care interventions using mobile applications in heart failure management.","authors":"Takashi Yokota","doi":"10.1016/j.jjcc.2026.07.010","DOIUrl":"10.1016/j.jjcc.2026.07.010","url":null,"abstract":"<p><p>Digital therapeutics using mobile technology offer potential advantages for facilitating patient-centered care. Driven by an increasing demand for digital health in the care of individuals with heart failure (HF), numerous mobile health applications (mHealth apps) have been developed to enhance self-care behaviors in patients with chronic HF. The key functional elements of HF apps include self-monitoring support, medication tracking and reminders, lifestyle modification guidance, sensor device connectivity and data transmission, educational materials, automated health status checks with alerts for potential HF exacerbation, and motivational support and feedback. Several randomized clinical trials (RCTs) have evaluated the efficacy and feasibility of self-care interventions for patients with chronic HF that use smartphone- or tablet-based apps designed as standalone or near-standalone systems. Although it has been observed that mHealth apps can improve patients' self-care behaviors, the evidence regarding the apps' impact on hard clinical endpoints (e.g. mortality and hospitalization) remains limited and inconsistent. The results of RCTs have demonstrated potential benefits, but it remains essential to address barriers to mHealth app adoption among both patients and healthcare professionals in order to successfully implement such apps into routine clinical practice. This narrative review examines mobile app-based self-care interventions and evaluates the evidence concerning their efficacy and feasibility in chronic HF patient populations.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584498","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":"Uric acid and heart failure.","authors":"Masanari Kuwabara, Arrigo F G Cicero, Naoyuki Akashi, Kazuhide Ogino, Ryusuke Ae, Takahide Kohro, Koki Kosami, Sunao Kojima, Mehmet Kanbay, Ana Andres-Hernando, Miguel A Lanaspa, Richard J Johnson, Claudio Borghi, Ichiro Hisatome","doi":"10.1016/j.jjcc.2026.07.009","DOIUrl":"10.1016/j.jjcc.2026.07.009","url":null,"abstract":"<p><p>The frequency of heart failure and hyperuricemia is increasing worldwide. Hyperuricemia as a complication of heart failure is known to be an indicator of poor prognosis. However, no consensus exists on whether treating hyperuricemia as a complication of heart failure would alleviate symptoms or improve prognosis in patients with heart failure. There is insufficient evidence regarding whether treatment with uric acid-lowering agents can alleviate symptoms and improve prognosis in patients with heart failure. However, considering the prevention of gout, hypertension, and chronic kidney disease caused by hyperuricemia, if the serum uric acid level does not fall below 8 mg/dL with improvement in lifestyle habits, uric acid-lowering agents can be a treatment option. In an US cohort study comprising approximately 100,000 participants using Medicare data, less aggravation of heart failure was observed in patients who were administered febuxostat compared to allopurinol. Recent evidence further suggests that serum uric acid may reflect not only a biomarker of disease severity but also underlying xanthine oxidase activity and oxidative stress, which may be therapeutically targetable in selected subgroups of heart failure patients. Moreover, differential effects among uric acid-lowering agents raise the possibility that drug-specific properties, rather than uric acid reduction per se, may influence cardiovascular outcomes. In this review, we discuss clinical trials on hyperuricemia with heart failure and its treatment. Further large-scale, high-quality, prospective intervention studies on the efficacy of treating hyperuricemia as a complication of heart failure are required.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549139","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":"Comparison of intracoronary physiological assessment for the non-left anterior descending artery in patients with non-obstructive coronary artery disease: Insight from ¹³N-ammonia positron emission tomography findings.","authors":"Shiro Miura, Atsutaka Okizaki, Osamu Manabe, Hiraku Kumamaru, Akira Ando, Chihoko Miyazaki, Takehiro Yamashita","doi":"10.1016/j.jjcc.2026.07.007","DOIUrl":"10.1016/j.jjcc.2026.07.007","url":null,"abstract":"","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421185","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":"Methodological and interpretative pitfalls in the noninvasive assessment of vascular endothelial function.","authors":"Yukihito Higashi","doi":"10.1016/j.jjcc.2026.07.008","DOIUrl":"10.1016/j.jjcc.2026.07.008","url":null,"abstract":"<p><p>Noninvasive assessment of vascular endothelial function, most commonly via brachial artery flow-mediated vasodilation and peripheral arterial tonometry-derived reactive hyperemia index, has become a cornerstone of cardiovascular research. These techniques provide clinically relevant surrogate indices of vascular health and have been associated with future cardiovascular risks. However, their interpretation is complex because they are influenced by a wide range of methodological, physiological, and pathobiological factors. A nuanced understanding of these limitations is essential, particularly in mechanistic and intervention studies.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421270","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":"Coronary ¹⁸F‑sodium fluoride PET imaging: State-of-the-art technology and translational clinical perspectives.","authors":"Hidenobu Hashimoto, Keiichiro Kuronuma, Daniel S Berman, Piotr J Slomka","doi":"10.1016/j.jjcc.2026.07.002","DOIUrl":"10.1016/j.jjcc.2026.07.002","url":null,"abstract":"<p><p>Coronary artery disease remains the leading cause of morbidity and mortality worldwide. Acute coronary events are frequently triggered by biologically active, rupture-prone atherosclerotic plaques that are not reliably identified by conventional anatomical imaging. Although coronary computed tomography angiography (CCTA) provides robust assessments of plaque burden and stenosis severity, it offers limited insight into ongoing biological activity within the plaque microenvironment. ¹⁸F‑sodium fluoride (¹⁸F-NaF)-positron emission tomography (PET) has emerged as a promising molecular imaging modality capable of detecting active microcalcifications, a key biological process associated with plaque vulnerability and rupture. Preclinical and translational studies have established the biological basis of ¹⁸F-NaF uptake, demonstrating preferential binding to newly formed hydroxyapatite deposits that reflect inflammation-driven osteogenic activity within atherosclerotic plaques. Clinical investigations have shown that ¹⁸F-NaF uptake localizes to the culprit lesions in acute myocardial infarction and correlates with high-risk plaque features on CCTA. Quantitative metrics, such as coronary microcalcification activity, enable reproducible whole-heart evaluation of disease activity. Multiple observational and prospective studies have demonstrated that increased ¹⁸F-NaF activity independently predicts myocardial infarction and major adverse cardiovascular events. Recent advances in PET technology, including motion correction algorithms, high-resolution reconstruction, and digital silicone photomultiplier detectors, have substantially improved image quality and reproducibility. This review summarizes the biological rationale, technical considerations, and emerging clinical evidence supporting the use of ¹⁸F-NaF PET for imaging coronary plaque.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421248","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":"Rituximab for antibody-mediated rejection after heart transplantation: A single-center retrospective study.","authors":"Hala Joharji, Nathem Akhras, Leena Al Jawhari, Wejdan Ibrahim Aburas, Fatimah S Alzahrani, Edmarie Janine Antonio","doi":"10.1016/j.jjcc.2026.07.005","DOIUrl":"10.1016/j.jjcc.2026.07.005","url":null,"abstract":"<p><p>Antibody-mediated rejection (AMR) is an important cause of graft dysfunction and mortality following heart transplantation. Evidence supporting the use of rituximab as adjunctive therapy remains limited. We conducted a retrospective single-center study of adult heart transplant recipients with biopsy-confirmed AMR treated with plasmapheresis and/or intravenous immunoglobulin between 2009 and 2018. Outcomes were compared between patients who received rituximab and those who did not. Rituximab-treated patients demonstrated higher numerical trends of AMR resolution (71% vs. 50%, p = 0.2), lower recurrence at 1 year (14% vs. 50%, p = 0.09), and higher one-year survival (93% vs. 75%, p = 0.5); however, none of these differences reached statistical significance. Improvements in left ventricular ejection fraction were observed more frequently in the rituximab group, while rates of graft dysfunction and readmission were similar between groups. These findings suggest a potential clinical signal for rituximab-containing regimens; however, the absence of statistically significant differences and the limitations of a small, retrospective cohort warrant cautious interpretation. Further prospective studies are needed to better define the role of rituximab in the management of AMR following heart transplantation.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412031","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":"Evolution of the complication profile of AF ablation in the pulsed field era.","authors":"Keita Watanabe, Jacob S Koruth","doi":"10.1016/j.jjcc.2026.07.006","DOIUrl":"10.1016/j.jjcc.2026.07.006","url":null,"abstract":"<p><p>Pulsed field ablation (PFA) has revolutionized atrial fibrillation (AF) treatment by leveraging non-thermal irreversible electroporation and relative myocardial tissue selectivity. While early clinical data and large registries demonstrated near-elimination of conventional thermal injuries-including atrioesophageal fistula, persistent phrenic nerve injury, and pulmonary vein stenosis-the ongoing accumulation of real-world experience has revealed a spectrum of energy-specific adverse events (AEs), some of which are relatively unique to PFA, such as coronary artery spasm and hemolysis. Multicenter registries such as MANIFEST-17 K and MANIFEST-US confirm a low overall major AE rate (<1%), highlighting the safety of PFA. However, some of these distinct AEs continue to be reported at clinically significant frequencies. Furthermore, recent reports have raised concerns regarding rare but life-threatening delayed arrhythmic events possibly related to coronary spasm. These findings suggest that the safety profile of PFA for AF has changed to involve different events rather than an overall improvement. Traditional AEs associated with venous access and left atrial instrumentation remain. This review summarizes the evolving landscape of AEs seen with PFA for AF, focusing on energy-specific AEs, their underlying mechanisms, and the clinical implications for procedural optimization and postprocedural management.</p>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411985","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}