{"title":"Soluble Guanylate Cyclase Stimulator Vericiguat Attenuates Angiotensin II-Induced Oxidative Stress and Cardiac Remodeling.","authors":"Taisuke Harada, Hidekazu Kondo, Kodai Nakamura, Yu He, Shunsuke Goto, Masaki Takahashi, Hirochika Yamasaki, Naoki Matsuda, Masayuki Takano, Ichitaro Abe, Akira Fukui, Hidefumi Akioka, Yasushi Teshima, Kunio Yufu, Hirotaka Shibata, Naohiko Takahashi","doi":"10.1253/circj.CJ-24-0659","DOIUrl":"10.1253/circj.CJ-24-0659","url":null,"abstract":"<p><strong>Background: </strong>Vericiguat, an oral soluble guanylate cyclase stimulator, is a novel therapeutic agent for patients with heart failure with reduced ejection fraction; however, the detailed cardioprotective mechanism remains unclear. We aimed to explore the mechanism of the effect of vericiguat on the myocardium, particularly focusing on oxidative stress, using in vivo and in vitro experiments.</p><p><strong>Methods and results: </strong>Male 8-week-old mice were divided into a control group, angiotensin II (AngII) infusion group, and AngII infusion with low- or high-dose vericiguat treatment group. After 14 days of treatment, vericiguat did not affect the systolic or diastolic blood pressure increase caused by AngII infusion. AngII-induced cardiac hypertrophy and fibrosis in the left ventricle (LV) were significantly ameliorated by high-dose vericiguat treatment. AngII-induced O<sub>2</sub><sup>-</sup>overproduction and upregulation of messenger RNA levels of Nppa, Nppb, Myh7, Col1a1, Col3A1, and Tgfb1 in the LV were significantly attenuated by vericiguat in a dose-dependent manner. Incubation of neonatal rat cardiomyocytes using vericiguat and AngII revealed that preceding incubation with vericiguat directly reduced AngII-induced cardiomyocyte O<sub>2</sub><sup>-</sup>production and cardiac hypertrophy-associated gene expression. In addition, AngII-induced phosphorylation of ERK 1/2 or p38 MAPK was significantly attenuated by the incubation with vericiguat.</p><p><strong>Conclusions: </strong>Our study demonstrated that vericiguat suppresses myocardial oxidative stress via the regulation of ERK 1/2 or p38 MAPK signaling, leading to antihypertrophic/fibrotic effects.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"982-991"},"PeriodicalIF":3.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702111","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":"Prevalence, Characteristics, and Prognostic Associations of Cachexia Diagnosed Using Asian Working Group for Cachexia 2023 Criteria in Older Adults With Heart Failure.","authors":"Kakeru Hashimoto, Akihiro Hirashiki, Tatsuya Yoshida, Koki Kawamura, Ikue Ueda, Takahiro Kamihara, Manabu Kokubo, Hitoshi Kagaya, Hidenori Arai, Atsuya Shimizu","doi":"10.1253/circj.CJ-24-0805","DOIUrl":"10.1253/circj.CJ-24-0805","url":null,"abstract":"<p><strong>Background: </strong>Few studies have examined the characteristics of heart failure (HF) patients with cachexia using the Asian Working Group for Cachexia (AWGC) 2023 criteria. This study assessed the characteristics and clinical impact of cachexia in older adults with HF.</p><p><strong>Methods and results: </strong>Results of laboratory measurements, echocardiography, physical function, depression, nutritional status, and the prevalence of cachexia, frailty, and sarcopenia were assessed in older adults (≥65 years) with HF in a stable condition just before discharge. After discharge, all participants were prospectively followed for adverse clinical events. Patients were classified based on the presence or absence of cachexia, and their frailty, sarcopenia, and clinical outcomes were compared. The prevalence of cachexia diagnosed by AWGC 2023 and Evans criteria was 24.7% and 12.9%, respectively. Among HF patients with cachexia, 71.6% had frailty and 86.7% had sarcopenia. Patients with cachexia had significantly poorer physical function and nutrition than those without. Cox proportional hazards analysis identified cachexia as an independent predictor of all-cause and cardiovascular death.</p><p><strong>Conclusions: </strong>Cachexia in older adults with HF is strongly associated with poor physical function, malnutrition, and adverse clinical outcomes. Early identification and management of cachexia may help improve the prognosis in this population.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"893-900"},"PeriodicalIF":3.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997258","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":"Clinical Characteristics and Outcomes of Cardiac Surgery and Transcatheter Procedures in Patients With Adult Congenital Heart Disease - Insights From Japanese Registry Data.","authors":"Takumi Osawa, Tomoko Machino-Ohtsuka, Ruriko Numata, Ayako Kuraoka, Mike Saji, Koshiro Kanaoka, Yoko Sumita, Naoto Kawamatsu, Hideyuki Kato, Yuji Hiramatsu, Tomoko Ishizu","doi":"10.1253/circj.CJ-24-0843","DOIUrl":"10.1253/circj.CJ-24-0843","url":null,"abstract":"<p><strong>Background: </strong>Adult congenital heart disease (ACHD) patients often require additional interventions or surgeries in adulthood, presenting new clinical challenges. However, clinical research on the current status and outcomes of cardiac procedures in ACHD patients remains limited.</p><p><strong>Methods and results: </strong>We analyzed the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC) database between April 2013 and March 2021. Patients with ACHD (aged >15 years) who underwent major cardiac surgery and transcatheter procedures were included. We assessed clinical background, treatment, length of hospital stay, and in-hospital mortality. In all, 22,490 patients with ACHD (median age 56 years [interquartile range 36-69 years], 51.1% female) were enrolled. Emergency hospitalizations and in-hospital deaths were observed in 3.7% and 1.1% of cases, respectively. Congenital heart operations with high in-hospital mortality (>5.0%) included aortic arch repair, systemic-to-pulmonary artery shunts, cardiac tumor resection, coronary artery bypass grafting, 3-valve replacement, and ventricular assist device implantation. Although stent graft procedures had the highest in-hospital mortality rate (2.6%), other transcatheter procedures, such as transcatheter patent ductus arteriosus closure, atrial septal defect closure, and catheter ablation, had in-hospital mortality rates of <1.0%.</p><p><strong>Conclusions: </strong>This study provides fundamental insights into the current clinical characteristics and outcomes associated with procedures in patients with ACHD. The in-hospital mortality rates for both cardiac surgery and transcatheter procedures in Japanese ACHD patients were low, demonstrating acceptable outcomes.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"946-956"},"PeriodicalIF":3.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144235","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 Patent Foramen Ovale Closure in Japan - Results From 1-Year Follow-up of the Amplatzer<sup>TM</sup> PFO Occluder Japan Post-Marketing Surveillance Study.","authors":"Teiji Akagi, Hidehiko Hara, Hideaki Kanazawa, Shigefumi Fukui, Yoichiro Hashimoto, Yasuyuki Iguchi, Toru Iwama, Hiroharu Kataoka, Akio Kawamura, Hiroyuki Kawano, Koichi Oki, Hiroshi Yamagami","doi":"10.1253/circj.CJ-25-0115","DOIUrl":"https://doi.org/10.1253/circj.CJ-25-0115","url":null,"abstract":"<p><strong>Background: </strong>The Amplatzer<sup>TM</sup>PFO Occluder was approved for marketing in Japan in May 2019, and the Amplatzer PFO Occluder Japan Post-Marketing Surveillance (PFO Japan PMS) study started in December 2019. This analysis presents clinical outcomes of study patients through 1 year of follow-up.</p><p><strong>Methods and results: </strong>PFO Japan PMS is a prospective single-arm multicenter clinical study. Eligible patients were indicated for patent foramen ovale (PFO) closure and underwent an implant attempt with the Amplatzer<sup>TM</sup>PFO Occluder, with no age restrictions. PFO closure was evaluated at 1 year via a bubble study, and patients will be followed for 3 years. From December 2019 to July 2021, 500 patients were enrolled across 53 sites. The mean (±SD) patient age was 52.7±15.4 years, with 29.8% of patients aged >60 years. Low adverse event rates were observed through 1 year of follow-up, including atrial fibrillation (2.4%; predominantly transient and within the first 30 days) and ischemic stroke (0.6%). Among patients in whom a 1-year bubble study was performed, a high rate (91.5%) of clinically relevant PFO closure (<20 bubbles) was achieved.</p><p><strong>Conclusions: </strong>Through 1 year of follow-up in this real-world Japanese study with 30% of patients aged >60 years, a high degree of closure was achieved with the Amplatzer<sup>TM</sup>PFO Occluder, along with low rates of atrial fibrillation, ischemic stroke, and overall adverse events.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303424","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":"Chronic Active Myocarditis and Inflammatory Cardiomyopathy - Challenges in Diagnosis and Treatment.","authors":"Toshiyuki Nagai, Masato Katsuki, Kisaki Amemiya, Akinori Takahashi, Noriko Oyama-Manabe, Keiko Ohta-Ogo, Kyoko Imanaka-Yoshida, Hatsue Ishibashi-Ueda, Toshihisa Anzai","doi":"10.1253/circj.CJ-25-0246","DOIUrl":"https://doi.org/10.1253/circj.CJ-25-0246","url":null,"abstract":"<p><p>Myocarditis is a heterogeneous disease with diverse etiologies and clinical trajectories. Traditionally, its diagnosis has been guided by the Dallas criteria, which focus on histopathological features. Clinically, myocarditis is categorized as acute or chronic based on the duration since symptom onset. However, recent expert consensus, particularly in Western countries, has redefined myocarditis as either acute myocarditis or chronic inflammatory cardiomyopathy, including inflammatory dilated cardiomyopathy, reflecting advancements in viral genome analysis and histopathology. In 2023, the Japanese Circulation Society proposed the concept of chronic active myocarditis, a high-risk phenotype characterized by persistent inflammation and ongoing cardiomyocyte injury. The transition from acute myocarditis to its chronic phase involves complex immune mechanisms, with sustained myocardial inflammation driving ventricular remodeling and progression to heart failure. Cardiac magnetic resonance imaging and endomyocardial biopsy remain pivotal diagnostic modalities, though their diagnostic yield varies according to disease phase. Management strategies focus on heart failure treatment, arrhythmia control, and, in select cases, immunosuppressive therapy, particularly for virus-negative inflammatory cardiomyopathy. Although antiviral therapy has shown promise, its clinical efficacy remains uncertain. Given the evolving understanding of the chronic phase of myocarditis, further research is warranted to refine the diagnostic criteria and optimize personalized therapeutic strategies. This review gives a comprehensive overview of the pathophysiology, classification, and management of chronic myocarditis, with an emphasis on emerging disease concepts and their clinical implications.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200676","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":"Association Between Sodium- and Potassium-Related Urinary Markers and the Prevalence of Atrial Fibrillation.","authors":"Sayuri Tokioka, Naoki Nakaya, Rieko Hatanaka, Kumi Nakaya, Mana Kogure, Ippei Chiba, Masato Takase, Kotaro Nochioka, Kai Susukita, Hirohito Metoki, Tomohiro Nakamura, Mami Ishikuro, Taku Obara, Yohei Hamanaka, Masatsugu Orui, Tomoko Kobayashi, Akira Uruno, Eiichi N Kodama, Satoshi Nagaie, Soichi Ogishima, Yoko Izumi, Nobuo Fuse, Shinichi Kuriyama, Satoshi Yasuda, Atsushi Hozawa","doi":"10.1253/circj.CJ-24-0780","DOIUrl":"10.1253/circj.CJ-24-0780","url":null,"abstract":"<p><strong>Background: </strong>The primary prevention of atrial fibrillation (AF), which increases mortality through complications including stroke and heart failure, is important. Excessive salt intake and low potassium intake are risk factors for cardiovascular disease; however, their association with AF remains inconclusive. This study investigated the association between sodium- and potassium-related urinary markers and AF prevalence.</p><p><strong>Methods and results: </strong>Data from the Tohoku Medical Megabank Project Community-based Cohort Study were used in this cross-sectional study. The urinary sodium-to-potassium (Na/K) ratio and estimated 24-h sodium and potassium excretion were calculated using spot urine samples and categorized into quartiles (Q1-Q4). The prevalence of AF was the primary outcome. Of the 26,506 participants (mean age 64.8 years; 33.2% males) included in this study, 630 (2.4%) had AF. Using Q1 as the reference group, the odds ratios for AF prevalence in Q4 were 1.35 (95% confidence interval [CI] 1.07-1.73) and 1.59 (95% CI 1.20-2.12) for 24-h estimated urinary Na/K ratio and estimated 24-h sodium excretion, respectively. Estimated 24-h potassium excretion was not associated with AF prevalence.</p><p><strong>Conclusions: </strong>AF prevalence was positively associated with the urinary Na/K ratio and estimated 24-h urinary sodium excretion, but not with estimated 24-h urinary potassium excretion. Although further prospective studies are warranted, the findings of this study suggest that salt intake may be a modifiable risk factor for AF.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"757-764"},"PeriodicalIF":3.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980569","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}
Circulation JournalPub Date : 2025-05-23Epub Date: 2025-05-11DOI: 10.1253/circj.CJ-24-0931
Limin Liu, Le Li, Simin Cai, Aiyue Chen, Mengtong Xu, Yuchen Dong, Likun Zhou, Yongqing Li, Minjie Lu, Lihui Zheng, Ligang Ding, Xiaohan Fan, Yan Yao
{"title":"Prognostic Value of Multiple Circulating Biomarkers for Ventricular Arrhythmias in Left Ventricular Hypertrabeculation - Longitudinal Cohort Study.","authors":"Limin Liu, Le Li, Simin Cai, Aiyue Chen, Mengtong Xu, Yuchen Dong, Likun Zhou, Yongqing Li, Minjie Lu, Lihui Zheng, Ligang Ding, Xiaohan Fan, Yan Yao","doi":"10.1253/circj.CJ-24-0931","DOIUrl":"10.1253/circj.CJ-24-0931","url":null,"abstract":"<p><strong>Background: </strong>Ventricular arrhythmia (VA) is an independent risk factor for adverse outcomes in patients with left ventricular hypertrabeculation (LVHT). This study explored the predictive value of biomarkers for VAs in LVHT.</p><p><strong>Methods and results: </strong>This cohort study retrospectively enrolled 265 LVHT patients (mean [±SD] age 44.2±17.0 years, 65.7% male) with data available for N-terminal pro B-type natriuretic peptide, big endothelin-1, high-sensitivity C-reactive protein, uric acid, and free fatty acid. The primary outcome was a composite of non-sustained ventricular tachycardia, sustained ventricular tachycardia, ventricular fibrillation, and appropriate implantable cardioverter defibrillator therapy. Over a median follow-up of 4.34 years, 82 (30.9%) patients experienced VAs. Multivariable Cox regression analysis revealed that baseline concentrations of big endothelin-1 were independently associated with the occurrence of VAs (hazard ratio 1.513; 95% confidence interval 1.136-2.013; P=0.005). Restricted cubic spline analysis showed that susceptibility to VAs increased markedly with increases in big endothelin-1 concentrations. Subgroup analysis revealed that LVHT patients with big endothelin-1 concentrations >0.63 pmol/L should be closely monitored for VAs, particularly when higher concentrations are accompanied by cardiomyopathies, left ventricular (LV) end-diastolic diameters ≥60 mm, or LV ejection fraction <50%. Individuals with elevated big endothelin-1 concentrations and isolated hypertrabeculation in the LV lateral wall had a significantly greater risk of VAs (log-rank P=0.002).</p><p><strong>Conclusions: </strong>Big endothelin-1 concentrations and the location of hypertrabeculation can help with risk stratification for VAs in LVHT.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"793-802"},"PeriodicalIF":3.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059944","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":"\"Aquarium Sign\" Observed in All Four Cardiac Chambers During Mechanical Ventilation in a Heart Failure Patient.","authors":"Kenji Harada, Shunsuke Saito, Sumika Wachi, Masafumi Sato, Yukiyo Ogata, Kazuomi Kario","doi":"10.1253/circj.CJ-25-0125","DOIUrl":"10.1253/circj.CJ-25-0125","url":null,"abstract":"","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"846"},"PeriodicalIF":3.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990940","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}