Korean Circulation Journal最新文献

{"title":"Real-World Outcomes of Cryoballoon vs. Radiofrequency Ablation in Atrial Fibrillation: A Multicenter Propensity-Matched Analysis of Short- and Long-term Efficacy.","authors":"Yeji Kim, Joo Hee Jeong, Hong Euy Lim, Il-Young Oh, Myung-Jin Cha, So-Ryoung Lee, Ju Youn Kim, Chang Hee Kwon, Sung Ho Lee, Ki-Hun Kim, Pil-Sung Yang, Jun Hyung Kim, Seung-Young Roh, Junbeom Park, Dong-Hyeok Kim, Jaemin Shim","doi":"10.4070/kcj.2025.0259","DOIUrl":"https://doi.org/10.4070/kcj.2025.0259","url":null,"abstract":"<p><strong>Background and objectives: </strong>Thermal energy-based catheter ablation techniques, including cryoballoon ablation (CBA) and radiofrequency ablation (RFA), are widely utilized for rhythm control in patients with atrial fibrillation. However, direct comparisons of CBA and RFA using real-world data are limited. This study aims to evaluate the short- and long-term outcomes of CBA and RFA.</p><p><strong>Methods: </strong>A total of 4,868 patients who underwent procedures between January 2018 and July 2022 were selected from the Korean CBA Registry and a multicenter RFA cohort. The primary outcome was the atrial tachyarrhythmia recurrence. To reduce selection bias, 1:1 propensity score matching (PSM) was performed, yielding 1,843 patients in each group.</p><p><strong>Results: </strong>After PSM, RFA demonstrated significantly lower recurrence rates compared with CBA at both 1 year (20.9% vs. 27.9%; hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.61-0.79) and 3 years (31.9% vs. 35.2%; HR, 0.72; 95% CI, 0.65-0.81). In multivariable Cox regression analysis, RFA was independently associated with lower recurrence risk, with a 30% relative risk reduction at 1 year (HR, 0.70; 95% CI, 0.61-0.80) and a 27% relative risk reduction at 3 years (HR, 0.73; 95% CI, 0.65-0.81). When cavotricuspid isthmus (CTI) ablation was performed in addition to pulmonary vein isolation (PVI), recurrence rates were comparable between RFA and CBA.</p><p><strong>Conclusions: </strong>In this large, multicenter real-world cohort, RFA consistently demonstrated more favorable short- and long-term outcomes than CBA, even after PSM and multivariable adjustment. However, outcomes were comparable when CTI ablation was additionally performed, underscoring the importance of procedural strategies beyond PVI.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729440","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":"Contemporary Approaches to Isolated Ostial Side Branch Diseases: A Comprehensive Review of Medina 0.0.1 Bifurcation Lesions.","authors":"Cheol Hyun Lee, Chang-Wook Nam","doi":"10.4070/kcj.2026.0010","DOIUrl":"https://doi.org/10.4070/kcj.2026.0010","url":null,"abstract":"<p><p>Isolated ostial side branch (SB) lesions (Medina 0.0.1) have traditionally been considered clinically minor because of their angiographically simple appearance and the limited myocardial territory supplied by most SBs. As a result, they have been underrepresented in clinical trials, creating an unmet need for evidence-based assessment and treatment strategies. This review summarizes emerging data demonstrating that Medina 0.0.1 lesions are not benign. Contemporary registries consistently report high rates of target lesion failure, comparable to true bifurcation lesions. These outcomes are driven by unique anatomical and physiological characteristics of the SB ostium, including disturbed flow, negative remodeling, elastic recoil, and frequent underestimation of disease severity by angiography. Intravascular imaging and physiological assessment often reveal occult plaque burden, hidden main vessel involvement, or clinically relevant ischemia. Clinically, these findings support an individualized approach, with a provisional strategy as the default and selective use of drug-coated balloons in carefully chosen cases. This article redefines Medina 0.0.1 lesions as a distinct high-risk entity and highlights the need for dedicated prospective studies.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674207","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":"Tricuspid Regurgitation Can Improve After LVAD: Right Ventricular Reserve Should Not Be Overlooked.","authors":"Soo Yong Lee","doi":"10.4070/kcj.2026.0020","DOIUrl":"https://doi.org/10.4070/kcj.2026.0020","url":null,"abstract":"","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674405","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":"Transradial Access vs. Transfemoral Access for Primary PCI in ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock: Findings from a National, Multicenter Registry and Meta-Analysis.","authors":"Minghui Zhang, Zixu Zhao, Yu Liu, Haoran Ma, Kexin Wang, Tian Liu, Wangyang Yang, Yichen Zhao, Wei Luo, Xuedong Zhao, Keyang Zheng, Chengqian Yin, Xinyong Zhang, Hai Gao, Can Zhou, Dong Zhao","doi":"10.4070/kcj.2025.0251","DOIUrl":"https://doi.org/10.4070/kcj.2025.0251","url":null,"abstract":"<p><strong>Background and objectives: </strong>Transradial access (TRA) is recommended for percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) due to lower mortality and bleeding risk, but evidence in STEMI with cardiogenic shock (STEMI-CS) remains limited. To evaluate the efficacy and safety of TRA versus transfemoral access (TFA) for primary PCI in STEMI-CS.</p><p><strong>Methods: </strong>Using data from a nationwide, multicenter registry, we compared TRA and TFA with multivariable-adjusted Cox regression, propensity score matching, and inverse probability treatment weighting. The primary outcome was in-hospital all-cause mortality. Other outcomes included major bleeding and major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, cardiac arrest, reinfarction, stroke, or in-stent thrombosis. A meta-analysis was conducted to compare short-term outcomes of interest during hospitalization or within 30 days of hospital discharge.</p><p><strong>Results: </strong>Among 837 eligible patients, 669 underwent TRA. Multivariable Cox regression showed that TRA was associated with a lower risk of in-hospital mortality (adjusted hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.42-0.91), MACE (adjusted HR, 0.63; 95% CI, 0.43-0.91), but a non-significantly lower risk of major bleeding (adjusted HR, 0.72; 95% CI, 0.35-1.49) compared to TFA. Meta-analysis of 65,943 patients from 17 studies confirmed lower short-term mortality (odds ratio [OR], 0.50; 95% CI, 0.43-0.57), major bleeding (OR, 0.58; 95% CI, 0.48-0.71), and MACE (OR, 0.65; 95% CI, 0.53-0.80) with TRA.</p><p><strong>Conclusions: </strong>Our findings indicate that, in STEMI-CS, TRA is associated with lower short-term all-cause mortality compared with TFA, supporting the potential advantages of TRA in this population.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02306616.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674459","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":"Visceral Ischemia and Gastric Perforation in Acute Type B Aortic Dissection.","authors":"Yang Liu, Xingpeng Chen, Qiliang Lei, Jie Hu, Zhu Liu, Heng Huang, Shanshan Xie, Zhigang Liu","doi":"10.4070/kcj.2025.0519","DOIUrl":"https://doi.org/10.4070/kcj.2025.0519","url":null,"abstract":"","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674528","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":"Risk Factors of Stroke After Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis.","authors":"Chao Wan, Meng-Wei Ge, Wei Li, Lu-Ting Shen, Jia-Xin Wang, Yi-Zhu Zhou, Xiao Han, Attiq Ur Rehman, Kun Liu, Hong-Lin Chen","doi":"10.4070/kcj.2025.0443","DOIUrl":"https://doi.org/10.4070/kcj.2025.0443","url":null,"abstract":"<p><strong>Background and objectives: </strong>Stroke is a leading cause of death and disability in left ventricular assist device (LVAD) patients. Previous studies have identified some risk factors for post-LVAD stroke, but more systematic, quantitative evidence is needed.</p><p><strong>Methods: </strong>The literature on risk factors related to post-LVAD stroke was searched and sorted using PubMed and Web of Science. Risk quantification employed standardized mean differences (SMDs)/odds ratios (ORs). Subgroup analyses, sensitivity analyses, and publication bias assessments were conducted.</p><p><strong>Results: </strong>Data from 34 studies (65,962 patients) revealed that the most significant risk factors for post-LVAD stroke were identified as pump thrombosis (OR, 3.26; 95% confidence interval [CI], 2.32, 4.59) and infection (OR, 2.44; 95% CI, 1.81, 3.28). However, atrial fibrillation was not associated with post-LVAD stroke (OR, 0.93; 95% CI, 0.83, 1.04). Other risk factors included white race (OR, 1.09; 95% CI, 1.01, 1.18), cancer (OR, 1.61; 95% CI, 1.14, 2.27), chronic obstructive pulmonary disease (OR, 1.16; 95% CI, 1.01, 1.33), age (SMD=0.06; 95% CI, 0.01, 0.1), albumin (SMD=-0.44; 95% CI, -0.80, -0.09), diabetes (OR, 1.22; 95% CI, 1.04, 1.44), peripheral vascular disease (OR, 1.21; 95% CI, 1.04, 1.39), and international normalized ratio (SMD=-0.10; 95% CI, -0.19, -0.01).</p><p><strong>Conclusions: </strong>This study further revealed a series of risk factors associated with post-LVAD stroke, as well as differences in risk factors in the new device era. These findings provide a basis for clinical device selection and precision interventions, aiding in the focused identification and reduction of post-LVAD stroke risk.</p><p><strong>Trial registration: </strong>International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42024617821.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674395","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":"YTHDF3 Hinders the Proliferation of Ang II-Induced Vascular Smooth Muscle Cells While Promoting Apoptosis and Inflammation in Abdominal Aortic Aneurysm via SIRT2/FOXO1.","authors":"Jiangbo Chen, Weilin Wang, Jinhui Ma, Xiaoyang Fu","doi":"10.4070/kcj.2025.0377","DOIUrl":"https://doi.org/10.4070/kcj.2025.0377","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study investigates the diagnostic value of YTHDF3 for abdominal aortic aneurysm (AAA) and further determines its regulatory mechanism in angiotensin II (Ang II)-induced vascular smooth muscle cells (VSMCs).</p><p><strong>Methods: </strong>YTHDF3 expression in abdominal aortic tissues and adjacent non-aneurysm aortic tissues of AAA patients was tested via reverse transcription-quantitative polymerase chain reaction and Western blot. The diagnostic value of YTHDF3 protein expression for AAA was evaluated by receiver operating characteristic curve. VSMCs were stimulated by Ang II in vitro and transfected with sh-YTHDF3. Cell proliferation was assessed via 5-ethynyl-2'-deoxyuridine and cell counting kit-8 assays. Apoptosis was measured via caspase-3/9 activity and TUNEL assays. Tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6 levels were detected via enzyme-linked immunosorbent assay. The regulatory mechanism of YTHDF3/sirtuin 2 (SIRT2)/FOXO1 was determined via methylated RNA immunoprecipitation-qPCR, RNA immunoprecipitation, actinomycin D treatment, cycloheximide, and co-immunoprecipitation.</p><p><strong>Results: </strong>YTHDF3 is highly expressed in AAA tissues and positively correlated with AAA diameter, TNF-α, IL-1-β, and IL-6 levels. YTHDF3 has certain diagnostic value for AAA. Knockdown of YTHDF3 alleviates the inhibitory effect of Ang II on VSMC proliferation, as well as its promoting effect on apoptosis and inflammation. Mechanistically, N6 methyladenosine reader YTHDF3 directly binds to SIRT2 mRNA and maintains its stability, facilitates the deacetylation of FOXO1, and reduces the stability of FOXO1 protein.</p><p><strong>Conclusions: </strong>YTHDF3 is highly expressed in AAA tissues and Ang II-induced VSMCs. YTHDF3 hinders the proliferation of Ang II-induced VSMCs while promoting apoptosis and inflammation. YTHDF3 deficiency exerts protective effect by interfering with SIRT2/FOXO1 axis.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674473","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":"Long-Term Outcomes of Aspirin vs. Clopidogrel After PCI in High-Risk Patients With Cardiovascular Comorbidities: A Post Hoc Analysis of the HOST-EXAM Extended Trial.","authors":"Huijin Lee, Jeehoon Kang, Doyeon Hwang, Kyung Woo Park, Han-Mo Yang, Hyun-Jae Kang, Jung-Kyu Han, Eun-Seok Shin, Bon-Kwon Koo, Hyo-Soo Kim","doi":"10.4070/kcj.2025.0272","DOIUrl":"https://doi.org/10.4070/kcj.2025.0272","url":null,"abstract":"<p><strong>Background and objectives: </strong>The HOST-EXAM Extended trial demonstrated the long-term benefits of clopidogrel over aspirin monotherapy following dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). This sub-study evaluated these therapies in patients with and without previous cardiovascular disease (CVD).</p><p><strong>Methods: </strong>A total of 5,438 patients were randomized to aspirin (100 mg daily) or clopidogrel (75 mg daily) monotherapy. Previous CVD was defined as previous myocardial infarction, cerebrovascular accident, or peripheral artery disease, present in 1,137 patients; 4,301 had no CVD. The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to ACS, and major bleeding (Bleeding Academic Research Consortium [BARC] type 3 or 5). Secondary endpoints included thrombotic and any bleeding events (BARC type ≥2). Median follow-up was 5.8 years.</p><p><strong>Results: </strong>The primary endpoint occurred more frequently in patients with previous CVD than in those without (18.1% vs. 13.7%, hazard ratio [HR], 1.045; 95% confidence interval [CI], 1.037-1.054; p<0.001). Regarding the treatment estimates for the primary endpoint between those with and without previous CVD, no significant interaction was observed (CVD group: HR, 0.784; 95% CI, 0.596-1.033 and non-CVD group: HR, 0.794; 95% CI, 0.675-0.934, respectively; interaction p=0.951). For thrombotic and bleeding composite endpoints, CIs were overlapping across CVD strata, indicating no clear heterogeneity.</p><p><strong>Conclusions: </strong>Clopidogrel was associated with a lower risk of the primary endpoint versus aspirin after PCI, with no evidence of effect modification by previous CVD.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674449","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":"Real-World Efficacy of Tafamidis in Korean ATTR-CM Patients: A Retrospective Observational Strain Analysis.","authors":"Heayoung Shin, Kina Jeon, Darae Kim, David Hong, Meesoon Park, Sang Eun Yoon, Seok Jin Kim, Jung-Sun Kim, Kihyun Kim, Jin-Oh Choi","doi":"10.4070/kcj.2025.0196","DOIUrl":"10.4070/kcj.2025.0196","url":null,"abstract":"<p><strong>Background and objectives: </strong>Transthyretin amyloid cardiomyopathy (ATTR-CM) is an under-recognized condition with high mortality if untreated. Tafamidis, a transthyretin stabilizer, reduces mortality and cardiovascular events in ATTR-CM, but data in Korean populations are limited. This study evaluated the impact of tafamidis on survival and disease progression in Korean ATTR-CM patients using strain analysis of the left ventricle (LV), right ventricle (RV) and left atrium (LA).</p><p><strong>Methods: </strong>This multicenter, retrospective study included 77 patients with confirmed ATTR-CM between July 2010 and June 2024. Patients were grouped as untreated or treated with tafamidis 20 mg or 80 mg. Strain analysis was performed at baseline and follow-up. The primary outcome was a composite of all-cause mortality and worsening heart failure.</p><p><strong>Results: </strong>Compared with the untreated group, the tafamidis 20 mg group had a lower risk of the composite outcome (hazard ratio [HR], 0.29; 95% confidence interval [CI], 0.12, 0.73), with similar benefit in the 80 mg group (HR, 0.23; 95% CI, 0.06, 0.83). LV global longitudinal strain showed no significant difference (p=0.904). In contrast, LA stiffness index (LASI) and RV-pulmonary circulation coupling index deteriorated markedly in the untreated group. Over a median follow-up of 17.5 months, LASI worsened by 43.2% in the untreated group, compared to 8.0% and 8.7% increases in the 20 mg and 80 mg groups. RV-pulmonary circulation coupling index decreased by 35.8% and 1.2%, but increased by 10.9%, respectively.</p><p><strong>Conclusions: </strong>Tafamidis was associated with improved survival and slower disease progression in Korean ATTR-CM. LASI and RV-pulmonary circulation coupling index may serve as sensitive markers of treatment response.</p>","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":"232-246"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145724228","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":"The First Korean Clinical Evidence With Tafamidis in ATTR-CM.","authors":"Jooyeon Lee, Jaewon Oh","doi":"10.4070/kcj.2025.0451","DOIUrl":"10.4070/kcj.2025.0451","url":null,"abstract":"","PeriodicalId":17850,"journal":{"name":"Korean Circulation Journal","volume":" ","pages":"247-249"},"PeriodicalIF":3.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010936","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}