Circulation Journal最新文献

{"title":"High Lipoprotein(a) Is a Predictor of Adverse Events and Heart Failure in Patients With Acute Myocardial Infarction.","authors":"Yang Wang, Tomoya Ueda, Akihiko Okamura, Saki Nobuta, Atsushi Kyodo, Yasuki Nakada, Yukihiro Hashimoto, Hitoshi Nakagawa, Taku Nishida, Kenji Onoue, Shungo Hikoso","doi":"10.1253/circj.CJ-26-0268","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0268","url":null,"abstract":"<p><strong>Background: </strong>Lipoprotein(a) (Lp(a)) is a well-established risk factor for atherosclerotic cardiovascular disease, but its prognostic role after acute myocardial infarction (AMI) remains unclear. This study investigated the association between Lp(a) and major adverse cardiovascular events (MACE), including heart failure (HF) with preserved ejection fraction (HFpEF), in patients with AMI.</p><p><strong>Methods and results: </strong>We analyzed 1,235 patients with AMI from the NARA-MI registry who underwent emergency percutaneous coronary intervention and had serum Lp(a) measured at admission. Based on receiver operating characteristic curve analysis, patients were categorized into high (≥24 mg/dL) and low (<24 mg/dL) Lp(a) groups. The primary endpoint was MACE, defined as all-cause death, recurrent AMI, HF hospitalization, or unplanned coronary revascularization. During a median follow-up of 3.6 years, 497 MACE events occurred. The incidence of MACE (48.0% vs. 38.3%; P=0.004) and HF hospitalization (9.3% vs. 5.0%; P=0.008) was significantly higher in the high Lp(a) group. In multivariable Cox regression analysis, high-Lp(a) independently predicted MACE (hazard ratio [HR] 1.41; 95% confidence interval [CI] 1.15-1.73; P=0.001) and HF hospitalization (HR 1.87; 95% CI 1.15-3.04; P=0.016). Among patients with HF, 39.7% were classified as HFpEF.</p><p><strong>Conclusions: </strong>Elevated Lp(a) is independently associated with adverse cardiovascular outcomes after AMI, particularly HF. Measurement of Lp(a) may improve risk stratification after AMI and help identify patients at high risk of developing HF, including HFpEF.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220706","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":"Reduced Adverse Events Without Survival Benefit With HeartMate 3 vs. HeartMate II in Japan.","authors":"Teruhiko Imamura, Masahiko Ando, Koichiro Kinugawa, Takashi Nishimura, Koichi Toda, Yoshikatsu Saiki, Hiroshi Niinami, Shinichi Nunoda, Goro Matsumiya, Hirokuni Arai, Masanobu Yanase, Norihide Fukushima, Takeshi Nakatani, Akira Shiose, Ikuko Shibasaki, Yasushi Sakata, Masaru Hatano, Minoru Ono","doi":"10.1253/circj.CJ-26-0640","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0640","url":null,"abstract":"<p><strong>Background: </strong>HeartMate 3 (Abbott Laboratories), a fully magnetically levitated left ventricular assist device (LVAD), has shown improved hemocompatibility vs. previous devices, but nationwide real-world data in Japan remain limited.</p><p><strong>Methods and results: </strong>Using the Japanese nationwide registry for Mechanically Assisted Circulatory Support (J-MACS), we analyzed patients who underwent de novo implantation of HeartMate 3 or HeartMate II between 2013 and 2025. The primary outcome was a composite of all-cause death, stroke, and device dysfunction requiring exchange or explantation within 2 years. In all, 978 patients were included in the study (HeartMate 3, n=486; HeartMate II, n=492). The 2-year cumulative incidence of the primary outcome was significantly lower in the HeartMate 3 group than in the HeartMate II group (9% vs. 23%; P<0.001). HeartMate 3 was independently associated with a lower risk of the primary outcome (adjusted hazard ratio 0.35; 95% confidence interval 0.23-0.51; P<0.001), which remained consistent in competing-risk and several statistically matched analyses. The incidence of hemocompatibility-related adverse events, including major bleeding, stroke, and device dysfunction, was significantly lower in the HeartMate 3 group. In contrast, 2- and 5-year overall mortality did not differ significantly between groups (<10% for both devices).</p><p><strong>Conclusions: </strong>In this nationwide Japanese registry, HeartMate 3 reduced major LVAD-related complications without improving survival, supporting its clinical advantages in contemporary LVAD management.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220807","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":"Nationwide Evolution of Durable Left Ventricular Assist Device Outcomes Following Introduction of the HeartMate 3 and Destination Therapy in Japan　- The Third Official Report From J-MACS.","authors":"Teruhiko Imamura, Koichiro Kinugawa, Takashi Nishimura, Koichi Toda, Yoshikatsu Saiki, Hiroshi Niinami, Shinichi Nunoda, Goro Matsumiya, Hirokuni Arai, Masanobu Yanase, Norihide Fukushima, Takeshi Nakatani, Akira Shiose, Ikuko Shibasaki, Yasushi Sakata, Masaru Hatano, Minoru Ono","doi":"10.1253/circj.CJ-26-0575","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0575","url":null,"abstract":"<p><strong>Background: </strong>The nationwide impact in Japan of contemporary improvement in the clinical management of durable left ventricular assist device (LVAD), together with the introduction of the HeartMate 3 (Abbott, Pleasanton, CA, USA), on clinical outcomes remains uncertain.</p><p><strong>Methods and results: </strong>Using the Japanese Registry for Mechanically Assisted Circulatory Support (J-MACS), we analyzed all patients undergoing durable LVAD implantation in Japan between 2011 and 2025. Patients were divided into an early era (up to 2018) and the contemporary era (since 2019), reflecting introduction of the HeartMate 3 in Japan. The primary outcome was all-cause mortality during LVAD support. Among 1,859 patients, 1,587 underwent bridge-to-transplantation and 272 underwent destination therapy. Survival improved significantly in the contemporary era compared with the early era (5-year survival 84% vs. 76%, respectively; P=0.0002). Device dysfunction-free, pump thrombus-free, stroke-free, major bleeding-free, and pump exchange-free survival also improved significantly after 2019 (all P<0.0001). Right ventricular failure and ventricular arrhythmia that required appropriate defibrillation remained frequent complications. Among patients who received a durable LVAD since 2019, destination therapy recipients had lower survival than bridge-to-transplantation recipients (3-year survival 81% vs. 91%; P=0.0057).</p><p><strong>Conclusions: </strong>Clinical outcomes after durable LVAD implantation improved substantially following the introduction of HeartMate 3 in Japan, particularly regarding pump-related and hemocompatibility-related complications. However, right ventricular failure and ventricular arrhythmia remain major unresolved challenges.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185821","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":"Phenotyping Heart Failure With Preserved Ejection Fraction in Japan　- Position Paper on Current Evidence and Future Directions.","authors":"Yasushi Sakata, Yuki Matsuoka, Kotaro Nochioka, Atsushi Kyodo, Shun Kohsaka, Masaru Obokata, Toshiyuki Nagai, Toshihisa Anzai, Tomohito Ohtani, Yoshio Yasumura, Katsuki Okada, Yohei Sotomi, Shungo Hikoso","doi":"10.1253/circj.CJ-26-0356","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0356","url":null,"abstract":"<p><p>Heart failure with preserved ejection fraction (HFpEF) is rapidly increasing in Japan in parallel with population aging, rising from just over half of all heart failure cases in 2015 to approximately 54% in 2025 and projected to reach nearly 57% by 2040-2050. HFpEF is a multifactorial syndrome shaped by diverse clinical and pathophysiological drivers. In East Asia, where obesity is less prevalent than in Western countries, the relative contribution of these different drivers may differ, underscoring the need for region-specific phenotypic characterization. In recent years, multiple Japanese registries have reported machine learning-based phenotyping analyses in HFpEF, identifying broadly similar but not identical patient clusters. In this position paper, we provide an integrative overview of major Japanese HFpEF cohorts and synthesize these findings to propose a pragmatic consensus framework for interpreting HFpEF heterogeneity in Japan. Despite methodological differences across cohorts, several clinical domains consistently emerged, including atrial remodeling/atrial fibrillation, vascular-cardiorenal dysfunction, metabolic burden, and systemic vulnerability. Based on these shared features, we propose 4 consensus phenogroups: (1) low structural and comorbidity burden; (2) vascular and cardiorenal remodeling; (3) atrial remodeling with right heart dysfunction; and (4) systemic vulnerability. This framework may support interpretation of HFpEF heterogeneity and guide future phenotype-informed research.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167634","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 Impact of Left Ventricular Apical Aneurysm Identified by Echocardiography in Hypertrophic Cardiomyopathy　- A Multicenter Retrospective Study in Japan.","authors":"Junya Komatsu, Naoki Arima, Yuri Ochi, Toru Kubo, Yu-Ki Nishimura, Hayato Hosoda, Ryu-Ichiro Imai, Yoko Nakaoka, Shinji Mito, Shu-Ichi Seki, Sho-Ichi Kubokawa, Hiroaki Kitaoka, Kazuya Kawai, Naohisa Hamashige, Yoshinori L Doi","doi":"10.1253/circj.CJ-26-0311","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0311","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the prognostic impact of left ventricular (LV) apical aneurysm identified by transthoracic echocardiography (TTE) in a Japanese cohort with hypertrophic cardiomyopathy (HCM).</p><p><strong>Methods and results: </strong>We retrospectively enrolled 369 consecutive HCM patients from 2 centers (2016-2023). LV apical aneurysm was defined on TTE as a discrete, thin-walled dyskinetic/akinetic apical outpouching with a wide neck. Primary outcomes were all-cause death and cardiovascular (CV) death. Secondary outcomes were hospitalization for worsening heart failure, systemic embolism, sustained ventricular tachycardia (VT), and sudden cardiac death (SCD)-equivalent events (resuscitated cardiac arrest or appropriate implantable cardioverter defibrillator therapy). LV apical aneurysm was present in 47 of 369 patients (12.7%). There were no significant between-group differences in all-cause death (log-rank P=0.162) or CV death (P=0.103). Patients with LV apical aneurysm more frequently had baseline sustained VT and SCD-equivalent events; however, Kaplan-Meier analyses indicated no significant differences between groups in incident sustained VT and SCD-equivalent events after enrollment. In multivariable Cox models, age, B-type natriuretic peptide (BNP), and SCD-equivalent events were independently associated with all-cause death; BNP and SCD-equivalent events were independently associated with CV death.</p><p><strong>Conclusions: </strong>In this cohort, echocardiography-identified LV apical aneurysm was associated with a greater burden of baseline arrhythmic events, but not higher mortality. TTE provides a practical means of identifying this phenotype. BNP and SCD-equivalent events were more closely associated with mortality.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128820","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":"In-Hospital Guideline-Directed Medical Therapy Intensification and Long-Term Outcomes in Patients Hospitalized for Heart Failure in the Current Clinical Paradigm　- Insights From the QHEART-R Study.","authors":"Toru Hashimoto, Ryuichi Matsukawa, Shouji Matsushima, Kayo Misumi, Takeo Fujino, Keisuke Shinohara, Masaki Fujiwara, Shintaro Umemoto, Shun Furusawa, Akihito Ishikita, Kosei Ishimaru, Hiroshi Kisanuki, Masahiro Tokumoto, Tomoaki Yoshitake, Kei Ikuta, Gentaro Taniguchi, Kohtaro Abe","doi":"10.1253/circj.CJ-26-0697","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0697","url":null,"abstract":"<p><strong>Background: </strong>The real-world impact of in-hospital intensification of guideline-directed medical therapy (GDMT) on clinical outcomes in patients with heart failure (HF) remains uncertain. We evaluated the association between in-hospital GDMT intensification and long-term outcomes using data from the multicenter QHEART-R cohort.</p><p><strong>Methods and results: </strong>We analyzed 3,190 patients hospitalized for worsening HF. In-hospital GDMT intensification was quantified by the change in the simple GDMT score from admission to discharge (∆S-GDMT). The primary outcome was a composite of all-cause death or hospitalization for HF (HHF). The mean (±SD) age of the cohort was 77.7±14.0 years, 53% were male, and the mean hospital stay was 20±16 days. The cohort included 1,477 (46%) patients with HF with reduced ejection fraction (HFrEF), 435 (14%) with HF with mildly reduced ejection fraction (HFmrEF), and 1,276 (40%) with HF with preserved ejection fraction. Four-year event-free survival was 32.4% for the primary outcome, 82.5% for cardiovascular (CV) death, and 50.4% for HHF. In patients with HFrEF/HFmrEF, a greater ∆S-GDMT was independently associated with a lower risk of the primary outcome (adjusted hazard ratio 0.90; 95% confidence interval 0.86-0.93; P<0.001), regardless of the number of prior HHF or the simple GDMT score at discharge.</p><p><strong>Conclusions: </strong>In-hospital GDMT intensification was associated with improved long-term outcomes in patients with HFrEF/HFmrEF. Hospitalization represents a critical opportunity to optimize GDMT and improve prognosis.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117910","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 Stratification for Pericardial Effusion After Leadless Pacemaker Implantation　- Multicenter Study.","authors":"Yuya Komai, Hitoshi Minamiguchi, Masayuki Ishimura, Yuichiro Sakamoto, Masahiro Nakano, Takatsugu Kajiyama, Miyo Nakano, Toshinori Chiba, Satoko Ryuzaki, Yukiko Takanashi, Yusei Nishikawa, Takashi Kanda, Mikiko Matsumura, Naoki Mori, Yuma Hamanaka, Takashige Sakio, Yuki Shibuya, Daisuke Yoshimoto, Yuko Uemura, Shoko Narumi, Yoshio Kobayashi, Yusuke Kondo","doi":"10.1253/circj.CJ-25-1061","DOIUrl":"https://doi.org/10.1253/circj.CJ-25-1061","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pericardial effusion (PPE) is a known complication associated with the use of leadless pacemakers (LPMs). The risk score (RS) is a useful tool for risk stratification. This study evaluated the utility of risk stratification using the RS in Japanese patients who received the Micra LPM.</p><p><strong>Methods and results: </strong>We retrospectively enrolled 443 patients who received Micra LPMs that were implanted at 4 institutions between August 2017 and August 2024. Patients were risk stratified using the RS into 3 groups: low risk (score ≤0), intermediate risk (score 1), and high risk (score ≥2). PPEs were observed in 9.0% (20/221), 11.7% (9/77) and 17.9% (26/145) of patients in the low-, intermediate-, and high-risk groups, respectively (P=0.041). In multivariable analysis, chronic obstructive pulmonary disease was a significant risk factor (P=0.014) for PPE, whereas prior cardiac surgery significantly reduced the risk of PPE (P=0.023). Older age, being female, and hemodialysis were not identified as risk factors. Subsequently, we modified the RS (mRS). Using the mRS, PPEs were observed in 8.8% (27/306), 16.5% (14/85), and 26.9% (14/52) of patients in the low-, intermediate-, and high-risk groups, respectively (P<0.001).</p><p><strong>Conclusions: </strong>The original RS is useful for PPE risk stratification after Micra LPM implantation. However, the mRS provides better risk discrimination and may therefore be a more suitable tool for use in the Japanese population.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117828","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":"Multiple Calcified Nodules Associated With 3 Temporally Distinct Myocardial Infarctions.","authors":"Chiharu Nishino, Shun Nishino, Nehiro Kuriyama, Yoshisato Shibata, Yujiro Asada","doi":"10.1253/circj.CJ-26-0813","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0813","url":null,"abstract":"","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117837","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":"Comprehensive Cardiac Computed Tomography for Anatomical Assessment, Functional Analysis, and Myocardial Tissue Characterization in a Patient With Coronary Anomaly and Cardiac Amyloidosis.","authors":"Hiroyuki Takaoka, Noriko Suzuki-Eguchi, Ken Kato, Yoshitada Noguchi, Katsuya Suzuki, Shuhei Aoki, Kazuki Yoshida, Haruto Matsumoto, Satomi Yashima, Makiko Kinoshita, Haruka Sasaki, Yoshio Kobayashi","doi":"10.1253/circj.CJ-26-0803","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0803","url":null,"abstract":"","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117844","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":"Platelet-Albumin-Bilirubin Index for Predicting Hospitalization and Mortality in Pulmonary Hypertension.","authors":"Mehmet A Gelen, Görkem Yıldız, Hasan A Bolayır, Mehdi Karasu, Yusuf Akın, İlker Özer","doi":"10.1253/circj.CJ-26-0436","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0436","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hypertension (PH), a progressive multisystemic disorder characterized by right ventricular failure and hepatic congestion, significantly alters platelet dynamics and liver function. This study evaluated the ability of the platelet-albumin-bilirubin index (PALBI), a marker of the hepatic-cardiac axis, to discriminate between PH patients and healthy individuals and to predict 360-day all-cause mortality and heart failure-related hospitalizations (HFH).</p><p><strong>Methods and results: </strong>This retrospective study included 3,432 individuals (1,520 PH patients, identified based on high-risk echocardiographic parameters to reflect real-world clinical practice). PH patients had higher PALBI scores than healthy controls (-2.08 vs. -2.50; P=0.001). For disease discrimination, PALBI had an area under the curve (AUC) of 0.748 (cut-off -2.27; sensitivity 77%, specificity 80%), outperforming the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein. In the PH cohort (21.5% mortality; 36.4% HFH), PALBI was an independent predictor of 360-day mortality and HFH (odds ratios 1.24 [P=0.003] and 1.18 [P=0.006], respectively). PALBI (cut-off -1.98) outperformed estimated glomerular filtration rate, age, and NLR in predicting mortality; when combined with N-terminal pro B-type natriuretic peptide, mortality prediction accuracy rose by 15.6%. Kaplan-Meier analysis confirmed a significant stepwise decline in survival across PALBI tertiles (P<0.001). In Group I PH, the AUC for the combination of PALBI+REVEAL risk score was 0.064 higher than that for the REVEAL risk score alone (P<0.05).</p><p><strong>Conclusions: </strong>PALBI is a robust, cost-effective prognostic tool for PH. It independently predicts short-term mortality and HFH, offering enhanced risk stratification for high-risk patients in clinical settings.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117861","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}