{"title":"Long-Term Risk of Incident Arrhythmias Associated With Early Repolarization Pattern - The Atherosclerosis Risk in Communities (ARIC) Study.","authors":"Qian He, Yi-Jian Liao, Jin-Jie Wang, Yan-Lin Chen, Min-Jing Huang, Mei-Ping Lin, Hai-Ling Zhou, Zi-En Chen, Qian Wu, Si-Long Lu, Shu-Lin Wu, Yu-Mei Xue, Xian-Hong Fang, Yun-Jiu Cheng","doi":"10.1253/circj.CJ-24-0964","DOIUrl":"10.1253/circj.CJ-24-0964","url":null,"abstract":"<p><strong>Background: </strong>The early repolarization pattern (ERP) is associated with cardiovascular death, but its connection with arrhythmias remains unknown. This study evaluated relationships between ERP and incident arrhythmias, including ventricular arrhythmias, bradyarrhythmias, and atrial fibrillation (AF)/flutter (Afl).</p><p><strong>Methods and results: </strong>We analyzed 14,679 middle-aged (45-64 years) participants from the Atherosclerosis Risk in Communities cohort, a prospective population-based study in the US. Participants were monitored for ERP status at baseline and at 3 subsequent follow-up visits. We examined associations between incident arrhythmias and baseline ERP, time-varying ERP, time-updated ERP, and changes in ERP over time using Cox models to estimate hazard ratios (HRs) adjusted for potential confounders. Over a 20-year follow-up, there were 1,252 ventricular arrhythmias, 890 bradyarrhythmias, and 2,202 cases of AF. Time-updated ERP was associated with increased HRs for ventricular arrhythmias (1.55; 95% confidence interval [CI] 1.35-1.77), bradyarrhythmias (1.76; 95% CI 1.48-2.08), and AF (1.25; 95% CI 1.10-1.43). Time-varying ERP also showed associations with these outcomes. Compared with individuals with consistently normal electrocardiogram results, those with new-onset or persistent ERP had increased risks of incident arrhythmias. In subjects with time-updated ERP, anterior leads and J wave amplitudes ≥0.2 mV were associated with a higher incidence of arrhythmias.</p><p><strong>Conclusions: </strong>Several types of ERP, including time-varying, time-updated, new-onset, and consistent, are associated with the incidence of arrhythmias in the middle-aged biracial (Black and White) population.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"809-818"},"PeriodicalIF":3.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702110","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":"Screening of 1-Month-Old Infants With Prolonged QT Interval and Its Cutoff Value.","authors":"Masao Yoshinaga, Hiroya Ushinohama, Seiichi Sato, Seiko Ohno, Tadayoshi Hata, Hitoshi Horigome, Nobuo Tauchi, Naokata Sumitomo, Eiki Nishihara, Keiichi Hirono, Fukiko Ichida, Hirohiko Shiraishi, Yuichi Nomura, Shinya Tsukano, Yumiko Ninomiya, Tatsuya Yoneyma, Hiroshi Suzuki, Hideto Takahashi, Hiromitsu Ogata, Naomasa Makita, Wataru Shimizu, Minoru Horie, Masami Nagashima","doi":"10.1253/circj.CJ-24-0148","DOIUrl":"10.1253/circj.CJ-24-0148","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of congenital long QT syndrome (LQTS) (1 : 2,000) is based on genetic testing and ECG data, but the prevalence of electrocardiographically determined prolonged corrected QT interval (pQTc) in infants is unclear.</p><p><strong>Methods and results: </strong>Subjects were 10,282 1-month-old infants who participated in 2 prospective ECG screening studies performed in 2010-2011 and 2014-2016. Infants with a QTc ≥0.45 using Bazett's formula [QTc(B)] at 1-month medical checks were re-examined. pQTc was defined as QTc ≥0.46 on 2 different ECGs in early infancy. Infants with QTc ≥0.50 or progressive prolongation of QTc to 0.50 were defined as at high risk. The prevalence of infants with a pQTc was 11/10,282 (1 : 935; 95% confidence interval, 1 : 588-1 : 2,283). Five infants were diagnosed as at high risk, and all infants had an abrupt increase in QTc(B) values in early infancy, mostly at 6-11 weeks after birth and when medication was started. No infants with a pQTc experienced LQTS-related symptoms. Statistical analysis showed that a cutoff QTc(B) ≥0.45 was optimal for screening infants with a pQTc.</p><p><strong>Conclusions: </strong>The prevalence of ECG-determined pQTc is approximately 1 : 1,000. An abrupt increase in QTc(B) values occurs in infants at high risk, mostly at 6-11 weeks after birth. A cutoff QTc(B) value ≥0.45 may be appropriate for 1-month-old screening in this population.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"826-834"},"PeriodicalIF":3.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494460","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":"Developing and Validating a New Atrial Fibrillation Risk Score Using Medical Examination Items in a Japanese Population - The Suita Study.","authors":"Ahmed Arafa, Yuka Kato, Satoko Sakata, Toshiharu Ninomiya, Paramita Khairan, Haruna Kawachi, Yoko M Nakao, Chisa Matsumoto, Atsushi Mizuno, Yoshihiro Kokubo","doi":"10.1253/circj.CJ-24-0939","DOIUrl":"10.1253/circj.CJ-24-0939","url":null,"abstract":"<p><strong>Background: </strong>The aim of this was to develop an atrial fibrillation (AF) risk score using items usually included in Japanese governmental health check-ups.</p><p><strong>Methods and results: </strong>We analyzed data from 6,476 Japanese participants registered in the Suita Study. At baseline, the participants were aged ≥30 years and were free from AF. Cox regression analysis was used to identify AF risk factors, and a 0-100 score was developed to predict AF events within 10 years. Within a median follow-up of 14.6 years, 278 participants developed AF. The risk score incorporated age [<50 years (16 points for men, 0 for women), 50-59 years (26 points for men, 14 for women), 60-69 years (41 points for men, 37 for women), ≥70 years (54 points for men, 51 for women)], current smoking with a smoking index >500 (7 points), heavy alcohol consumption (8 points), body mass index ≥25 kg/m<sup>2</sup>(6 points), hypertension (7 points), urinary proteins (4 points), glutamic-pyruvic transaminase >50 IU/dL (4 points), and cardiovascular disease history (10 points). The 10-year AF event probabilities were 7.1%, 8.4%, 10.8%, and 15.9% for scores of 47-54, 55-58, 59-69, and ≥70, respectively.</p><p><strong>Conclusions: </strong>The new risk score to predict AF uses items similar to those used in Japanese governmental health check-ups.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"819-825"},"PeriodicalIF":3.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617737","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 Impact of Genetic Testing for Long QT Syndrome - Evidence From a Nationwide LQTS Registry in Japan.","authors":"Takeshi Aiba, Seiko Ohno, Misa Takegami, Yoshiaki Kato, Heima Sakaguchi, Keiko Shimamoto, Keiko Sonoda, Kazufumi Ida, Naokata Sumitomo, Taisuke Nabeshima, Takashi Murakami, Yumiko Ninomiya, Koichi Kato, Megumi Fukuyama, Takeru Makiyama, Kenshi Hayashi, Kunio Ohta, Hiroshi Morita, Tadashi Nakajima, Yoshiaki Kaneko, Nobue Yagihara, Sou Otsuki, Tomoki Kosho, Yoko Yoshida, Motoki Takamuro, Michihiko Ueno, Tatsunori Takahashi, Yasuya Inden, Yasunobu Hayabuchi, Shota Muraji, Shigeo Watanabe, Kunihiro Nishimura, Yoshihiro Asano, Hitoshi Horigome, Masao Yoshinaga, Minoru Horie, Wataru Shimizu, Kengo Kusano","doi":"10.1253/circj.CJ-25-0105","DOIUrl":"10.1253/circj.CJ-25-0105","url":null,"abstract":"<p><strong>Background: </strong>Genetic testing for long QT syndrome (LQTS) is useful for diagnosis, risk stratification, and therapeutic strategies. This study investigated the clinical impact of genetic testing for LQTS patients.</p><p><strong>Methods and results: </strong>Total 3,851 patients (proband: 2,316 [60%]; female: 2,283 [59%]; median age: 14 years [interquartile range 9-36 years]) diagnosed with LQTS (LQTS score ≥3.5, QTc ≥500 ms, pathogenic variants in LQTS-associated genes, or unexplored syncope with QTc 480-499 ms) were enrolled in this study. Of these patients, 1,146 (29.8%) experienced syncope and 322 (8.5%) experienced ventricular fibrillation (VF) or cardiopulmonary arrest (CPA) at ≤70 years of age. Genetic testing using a next-generation sequencing panel and/or Sanger sequencing was performed for 3,770 (98%) patients, genotype was then identified in the following LQTS-associated genes: KCNQ1 (45%), KCNH2 (34%), SCN5A (8%), KCNE1 (0.1%), KCNE2 (0.03%), KCNJ2 (2.7%), CACNA1C (1.2%), and CALM1,2 (0.3%). Forty-seven (1.2%) patients had double or compound heterozygous variants in LQTS-associated genes, whereas the genotype remained unknown in 220 (5.8%) patients. When comparing phenotype with genotype, QTc was significantly longer in CALM1,2 patients than in others except for CACNA1C, whereas QTc was almost normal in KCNJ2 patients. The incidence of the first cardiac event (syncope, VF/CPA) differed among the genotypes, and prognosis was significantly worse for CALM1,2 patients.</p><p><strong>Conclusions: </strong>Comprehensive genetic testing, including non-major LQTS genes, is important for diagnosis and risk stratification of LQTS.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"835-844"},"PeriodicalIF":3.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755786","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":"Post-Marketing Surveillance of the Safety of Landiolol in Patients With Recurrent Hemodynamically Unstable Ventricular Tachyarrhythmias.","authors":"Tsuyoshi Shiga, Masato Shiozaki, Rika Takahashi, Ryoji Matsumoto, Masato Fukui","doi":"10.1253/circj.CJ-24-0898","DOIUrl":"10.1253/circj.CJ-24-0898","url":null,"abstract":"<p><strong>Background: </strong>Landiolol is a short-acting, intravenously administered β<sub>1</sub>-adrenergic receptor blocker that can rapidly control heart rate in refractory and urgent fatal arrhythmias (ventricular fibrillation [VF] and hemodynamically unstable ventricular tachyarrhythmia [VT]). This indication was approved in Japan in 2019 based on results of the J-Land II clinical trial. We conducted post-marketing surveillance (PMS) to assess the safety and effectiveness of landiolol in real-world settings in Japan.</p><p><strong>Methods and results: </strong>This PMS examined the safety, focusing on adverse drug reactions (ADRs) related to the safety specifications (<sub>SS</sub>), namely hypotension-decreased blood pressure<sub>SS</sub>, bradycardia<sub>SS</sub>, and heart failure<sub>SS</sub>, and effectiveness (physician-rated) in patients treated with landiolol for the target indication. Among 253 registered patients, 13.0% experienced ADRs related to the safety specifications: bradycardia<sub>SS</sub>(7.1%), hypotension-decreased blood pressure<sub>SS</sub>(6.7%), and heart failure<sub>SS</sub>(1.2%). Serious ADRs related to the safety specifications occurred in 6.7% of patients, including those related to bradycardia<sub>SS</sub>(3.2%), hypotension-decreased blood pressure<sub>SS</sub>(3.2%), and heart failure<sub>SS</sub>(1.2%). The effectiveness of landiolol within 48 h after starting treatment was rated as effective (52.4%), slightly effective (27.0%), not effective (18.7%), and indeterminate (2.0%).</p><p><strong>Conclusions: </strong>The safety profile of landiolol in this PMS was similar to that observed in a prior clinical trial, and no new safety signals were identified. Landiolol is an option for treating refractory and potentially fatal VF or hemodynamically unstable VT.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"784-792"},"PeriodicalIF":3.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030615","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":"2025 Japanese Heart Rhythm Society / Japanese Circulation Society Consensus Statement on the Appropriate Use of Ambulatory and Wearable Electrocardiographs.","authors":"Takanori Ikeda, Takashi Ashihara, Yu-Ki Iwasaki, Maki Ono, Nobuyuki Kagiyama, Takehiro Kimura, Kengo Kusano, Ritsuko Kohno, Keita Saku, Tetsuo Sasano, Keitaro Senoo, Seiji Takatsuki, Naohiko Takahashi, Mitsuru Takami, Yukiko Nakano, Kenichi Hashimoto, Katsuhito Fujiu, Tadashi Fujino, Atsushi Mizuno, Koichiro Yoshioka, Eiichi Watanabe, Wataru Shimizu, Koichi Node","doi":"10.1253/circj.CJ-24-0960","DOIUrl":"10.1253/circj.CJ-24-0960","url":null,"abstract":"<p><p>Recently, some clinicians have been diagnosing and treating arrhythmias on the basis of electrocardiogram (ECG) devices with low accuracy. In Europe and the US, several statements on the use of ECGs have already been published by related academic societies. In addition, with the relaxation of regulations on media advertising ambulatory/wearable ECG devices, the frequency of use of simple ECG devices by the general public will increase in the future. Therefore, this statement describes the functions and features of non-invasive ambulatory or wearable ECG devices that have been approved as medical devices in Japan (and that can record ECGs remotely), as well as points to note when using them; provides an overview of data storage and security for ambulatory/wearable ECG devices and implantable loop recorders (ILRs), as well as discussing differences between their use and the use of non-invasive ambulatory/wearable ECG devices; and provides classes of recommendation for the use of these devices and their evaluation for each arrhythmia type or condition. We describe lead-based ambulatory ECG devices (classical 24-h Holter ECG monitoring), handheld ECG devices, handheld-based ECG devices using a smartphone, wearable ECG devices (smartwatch and garment ECG devices), and patch ECG devices. In addition, we provide information on methods that are not based on the original ECG, such as photoplethysmography and oscillometric blood pressure measurement, and describe the limitations of their use. We hope that the publication of this statement will lead to the appropriate use of ambulatory/wearable ECG devices in Japan.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"850-876"},"PeriodicalIF":3.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755778","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}
Yusuke Kondo, Toshinori Chiba, Maiko Osawa, Yohei Kawasaki, Tadahiro Goto, James A Coles, Sayaka Ono, Katsuhiko Imai, Masahiko Takagi, Satoaki Matoba, Yoshio Kobayashi, Hiroshi Tada
{"title":"Medical Cost Analysis of Implantable Cardioverter Defibrillators for Primary Prevention Among Cardiac Arrest Patients.","authors":"Yusuke Kondo, Toshinori Chiba, Maiko Osawa, Yohei Kawasaki, Tadahiro Goto, James A Coles, Sayaka Ono, Katsuhiko Imai, Masahiko Takagi, Satoaki Matoba, Yoshio Kobayashi, Hiroshi Tada","doi":"10.1253/circj.CJ-25-0195","DOIUrl":"https://doi.org/10.1253/circj.CJ-25-0195","url":null,"abstract":"<p><strong>Background: </strong>In Japan, the implantation of implantable cardioverter defibrillators (ICD) for the primary prevention of sudden cardiac death (SCD) is not covered by insurance reimbursement, and the underuse of ICDs has been noted. Therefore, this study analyzed the medical costs incurred due to a lack of primary prevention ICD therapy for SCD.</p><p><strong>Methods and results: </strong>This retrospective cohort study analyzed data from 4 advanced critical care centers between January 2020 and December 2024. From a database of 3,606 cases of cardiac arrest, there were 348 patients with a documented rhythm at the time of arrest that could have been treated with an ICD. Of these patients, 43 (12.4%) had documented evidence of heart failure treatment and were eligible for ICD implantation before experiencing a cardiac arrest. The total mean (±SD) medical cost for these patients was US $11,679±14,666 (¥1,775,150±2,229,272).</p><p><strong>Conclusions: </strong>In this multicenter retrospective analysis, we identified a subset of patients who were eligible for primary prevention ICD therapy but did not receive it prior to experiencing sudden cardiac arrest. These cases were associated with substantial post-arrest medical costs. Our findings highlight the potential clinical and economic impact of the underutilization of ICDs in Japan and suggest that broader implementation of guideline-directed ICD therapy for primary prevention may reduce both mortality and healthcare expenditure.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121411","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 Value of the 6-Minute Walk Test in Patients With Severe Aortic Stenosis.","authors":"Norio Kanamori, Yasuaki Takeji, Tomohiko Taniguchi, Takeshi Morimoto, Shinichi Shirai, Kenji Ando, Hiroyuki Tabata, Takeshi Kitai, Nobuhisa Ohno, Ryosuke Murai, Kohei Osakada, Koichiro Murata, Masanao Nakai, Hiroshi Tsuneyoshi, Tomohisa Tada, Masashi Amano, Shin Watanabe, Hiroki Shiomi, Hirotoshi Watanabe, Yusuke Yoshikawa, Ryusuke Nishikawa, Yuki Obayashi, Ko Yamamoto, Mamoru Toyofuku, Shojiro Tatsushima, Makoto Miyake, Hiroyuki Nakayama, Kazuya Nagao, Masayasu Izuhara, Kenji Nakatsuma, Moriaki Inoko, Takanari Fujita, Masahiro Kimura, Mitsuru Ishii, Shunsuke Usami, Fumiko Nakazeki, Kiyonori Togi, Yasutaka Inuzuka, Tatsuhiko Komiya, Koh Ono, Takeshi Aoyama, Kenji Minatoya, Takeshi Kimura","doi":"10.1253/circj.CJ-25-0056","DOIUrl":"https://doi.org/10.1253/circj.CJ-25-0056","url":null,"abstract":"<p><strong>Background: </strong>The prognostic significance of the 6-minute walk distance (6MWD) in patients with severe aortic stenosis (AS) has not been thoroughly investigated.</p><p><strong>Methods and results: </strong>This study evaluated 998 patients with severe AS who underwent a 6-min walk test as part of a large multicenter prospective cohort. Patients were categorized as either fast walkers (6MWD ≥300 m; n=515) or slow walkers (6MWD <300 m; n=483). During a median follow-up of 2.3 years, 861 (86.3%) patients underwent surgical or transcatheter aortic valve replacement (AVR; 87.0% of fast walkers vs. 85.5% of slow walkers). The cumulative 3-year incidence of death was significantly lower among fast walkers than slow walkers (10.9% vs. 31.7%; P<0.001). After adjusting for confounders, slow walkers had a significantly higher risk of all-cause mortality than fast walkers (hazard ratio 2.36; 95% confidence interval 1.55-3.58; P<0.001). Stratified analysis by initial treatment strategy revealed that the cumulative 3-year incidence of all-cause death was consistently lower among fast walkers than slow walkers (initial AVR strategy: 10.1% vs. 28.1% [P<0.001]; conservative strategy: 13.4% vs. 46.7% [P<0.001]). Among asymptomatic patients managed conservatively, fast walkers demonstrated a remarkably low cumulative 3-year incidence of all-cause death (8.1%).</p><p><strong>Conclusions: </strong>The 6MWD is a reliable prognostic marker for patients with severe AS, regardless of initial treatment strategy.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121433","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":"Rationale, Design, Feasibility, and Profile of the Japanese Circulation Society Chest Pain Registry - Single-Center Pilot Study.","authors":"Satoshi Yoshimura, Kanna Arimoto, Hirotoshi Nishikita, Yohei Fushimura, Yasuyuki Sumida, Hirokazu Yokoi, Chika Nishiyama, Takuya Taniguchi, Tetsuya Amano, Tomonori Itoh, Satomi Konno, Nogiku Niwamae, Masashi Sakuma, Kayoko Sato, Yasuhiro Satoh, Yoshio Tahara, Kenichi Tsujita, Yayoi Tetsuou Tsukada, Yasunori Ueda, Takeyuki Kiguchi, Kosuke Kiyohara, Tetsuhisa Kitamura, Taku Iwami","doi":"10.1253/circj.CJ-24-0832","DOIUrl":"https://doi.org/10.1253/circj.CJ-24-0832","url":null,"abstract":"<p><strong>Background: </strong>Acute coronary syndrome (ACS) requires prompt diagnosis and treatment. Although \"OPQRST\" (Onset, Provocation, Quality, Region/Radiation, Symptoms, and Time) is commonly used, the evidence linking emergency department (ED) chest pain characteristics to ACS remains inconclusive. This study evaluated detailed symptoms in ED patients with and without ACS using a broad chest pain registry with symptom data.</p><p><strong>Methods and results: </strong>This single-center prospective study was conducted at Rakuwakai-Otowa Hospital in Kyoto, Japan, as a pilot study for a multicenter registry. We enrolled 420 consecutive adult patients presenting with chest pain at the ED from June 2022 to May 2023. Baseline characteristics (including symptoms) and outcomes were recorded. Of the 420 patients, 65 (15.5%) were diagnosed with ACS. Patients with and without ACS differed in the proportion with sudden onset (58.5% vs. 27.6%, respectively), radiation to the tooth (9.2% vs. 0.6%, respectively), and cold sweat (diaphoresis; 44.6% vs. 16.9%, respectively). In the overall population, positive likelihood ratios were 2.12 (95% confidence interval [CI] 1.63-2.76) for sudden onset, 16.38 (95% CI 3.38-79.41) for radiation to the tooth, and 2.64 (95% CI 1.85-3.77) for diaphoresis.</p><p><strong>Conclusions: </strong>This study in a suburban area of Japan (one of the most super-aged societies) identified key chest pain characteristics in a broad chest pain cohort (i.e., sudden onset, radiation to the tooth, and diaphoresis) that may help with the rapid triage and diagnosis of ACS.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121436","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}
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