Circulation Journal最新文献

{"title":"Clinical and Histopathological Characteristics of Patients With Myocarditis After mRNA COVID-19 Vaccination.","authors":"Taku Omori, Kazuaki Maruyama, Keiko Ohta-Ogo, Kinta Hatakeyama, Hatsue Ishibashi-Ueda, Kenji Onoue, Toshiyuki Nagai, Seiya Kato, Takahiro Okumura, Masayoshi Oikawa, Eisuke Amiya, Saeko Yoshizawa, Tadaki Suzuki, Hidemasa Goto, Kazufumi Nakamura, Takeo Fujino, Keishi Moriwaki, Shiro Nakamori, Toshihisa Anzai, Yasushi Sakata, Michiaki Hiroe, Kyoko Imanaka-Yoshida, Kaoru Dohi","doi":"10.1253/circj.CJ-24-0506","DOIUrl":"10.1253/circj.CJ-24-0506","url":null,"abstract":"<p><strong>Background: </strong>The effects of myocarditis after mRNA COVID-19 vaccination (mCV) on myocardial tissue, and the association between cardiomyocyte injury and clinical presentation, are not fully understood.</p><p><strong>Methods and results: </strong>We retrospectively registered patients clinically diagnosed with myocarditis after the first or second mCV who underwent endomyocardial biopsy or autopsy from 42 participating centers in Japan. We investigated the histological features and their association with clinical presentation based on cardiomyocyte injury. Forty patients who underwent endomyocardial biopsy were included in the study. Of these, 19 (47.5%) showed mild lymphocytic infiltration and interstitial edema without cardiomyocyte injury. The remaining 21 (52.5%) patients showed cardiomyocyte injury accompanied by infiltrating inflammatory cells: 11 with lymphocytic infiltration, 7 with eosinophilic infiltration, and 3 with myocarditis with both lymphocyte and eosinophil infiltration. Compared with patients without cardiomyocyte injury, those with cardiomyocyte injury were clinically characterized by older age, a balanced sex distribution, less frequent chest pain, and a lower left ventricular ejection fraction. Fifteen of 21 (71.4%) patients with cardiomyocyte injury developed fulminant myocarditis, with 13 (86.7%) requiring mechanical circulatory support; in contrast, none of those without cardiomyocyte injury developed fulminant myocarditis (P<0.001).</p><p><strong>Conclusions: </strong>Our histological examination of patients with myocarditis after mCV revealed varying degrees of cardiomyocyte injury, ranging from pronounced to absent, along with various types of myocarditis. Cardiomyocyte injury was strongly associated with the severity of myocarditis.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"120-129"},"PeriodicalIF":3.1,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577124","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":"Diagnostic Accuracy and Prognostic Value of Relative Apical Sparing in Cardiac Amyloidosis　- Systematic Review and Meta-Analysis.","authors":"Chung-Yen Lee, Yosuke Nabeshima, Tetsuji Kitano, Li-Tan Yang, Masaaki Takeuchi","doi":"10.1253/circj.CJ-24-0472","DOIUrl":"10.1253/circj.CJ-24-0472","url":null,"abstract":"<p><strong>Background: </strong>Although the relative apical sparing (RAPS) pattern of left ventricular (LV) longitudinal strain is a hallmark of cardiac amyloidosis, recent studies have raised concerns about its accuracy. The aim of this systematic review was to investigate diagnostic test accuracy (DTA) and prognostic impact of RAPS in cardiac amyloidosis.</p><p><strong>Methods and results: </strong>We searched PubMed, Embase, and Scopus for manuscripts that could potentially be used in the DTA arm and prognosis arm. Thirty-seven studies were used for DTA analysis. The pooled sensitivity, specificity, and diagnostic odds ratio were 61% (95% confidence interval [CI] 54-68%), 83% (95% CI 80-86%), and 8.9 (95% CI 6.1-13.1), respectively. These values did not differ regardless of the presence of aortic stenosis, but the diagnostic odds ratio differed significantly among analytical software packages. For the prognosis arm, 6 studies were dichotomously assessed for RAPS, and 5 were assessed quantitatively. The pooled proportion of RAPS was 49% and the pooled estimate of the RAPS ratio was 1.40. Although RAPS was associated with outcome (hazard ratio [HR] 1.87; 95% CI 1.15-3.04; P=0.011), its significance disappeared after trim and fill analysis (HR 1.42; 95% CI 0.85-2.38; P=0.184).</p><p><strong>Conclusions: </strong>RAPS has a modest DTA with a significant vendor dependency and does not provide robust prognostic information.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"16-23"},"PeriodicalIF":3.1,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577130","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":"Right Ventricular to Pulmonary Artery Uncoupling Is Associated With Impaired Exercise Capacity in Patients With Transthyretin Cardiac Amyloidosis.","authors":"Toru Hashimoto, Kei Ikuta, Shoei Yamamoto, Tomoaki Yoshitake, Tomoyasu Suenaga, Shunsuke Nakashima, Takashi Kai, Kayo Misumi, Takeo Fujino, Keisuke Shinohara, Shouji Matsushima, Rina Atsumi, Takuro Isoda, Shintaro Kinugawa, Kohtaro Abe","doi":"10.1253/circj.CJ-24-0402","DOIUrl":"10.1253/circj.CJ-24-0402","url":null,"abstract":"<p><strong>Background: </strong>Exercise capacity is related to mortality and morbidity in heart failure (HF) patients. Determinants of exercise capacity in transthyretin cardiac amyloidosis (ATTR-CA) have not been established.</p><p><strong>Methods and results: </strong>This single-center study retrospectively evaluated ATTR-CA patients and patients with non-amyloidosis HF with preserved/mildly reduced ejection fraction (HFpEF/HFmrEF) (n=32 and n=51, respectively). In the ATTR-CA group, the median age was 75.5 years (interquartile range [IQR] 71.3-78.8 years), 90.6% were male, and the median left ventricular (LV) ejection fraction was 53.5% (IQR 41.4-65.6%). Cardiopulmonary exercise tests revealed a median peak oxygen consumption and anaerobic threshold of 15.9 (IQR 11.6-17.4) and 10.6 (IQR 8.5-12.0] mL/min/kg, respectively, and ventilatory efficiency (minute ventilation/carbon dioxide production [V̇_E/V̇_CO2] slope) of 35.5 (IQR 32.0-42.5). Among exercise variables, V̇_E/V̇_CO2slope has the greatest prognostic value. Univariate analysis revealed a significant correlation between V̇_E/V̇_CO2slope and age, LV global longitudinal strain, tricuspid annular plain systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) ratio, and mixed venous oxygen saturation. In multivariate analyses, the TAPSE/PASP ratio was an independent predictor of V̇_E/V̇_CO2slope (95% confidence interval -44.5, -10.8; P=0.0067). In non-amyloidosis HFpEF/HFmrEF patients, the TAPSE/PASP ratio was not independently correlated with V̇_E/V̇_CO2slope.</p><p><strong>Conclusions: </strong>Right ventricular-pulmonary artery coupling estimated by the TAPSE/PASP ratio determines exercise capacity in ATTR-CA patients. This highlights the importance of early therapeutic intervention against underappreciated right ventricular dysfunction associated with ATTR-CA.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"31-40"},"PeriodicalIF":3.1,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331700","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":"Usefulness of the Slope of the Preload Recruitable Stroke Work Relationship for the Prediction of Rehospitalization After Transcatheter Mitral Edge-to-Edge Repair.","authors":"Yasushige Shingu, Jien Saito, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai, Satoru Wakasa","doi":"10.1253/circj.CJ-24-0497","DOIUrl":"10.1253/circj.CJ-24-0497","url":null,"abstract":"<p><strong>Background: </strong>Among patients with functional mitral regurgitation (FMR), responders to transcatheter mitral edge-to-edge repair (TEER) remain unclear. We investigated whether the slope of the preload recruitable stroke work relationship (M_w; calculated as stroke work / [EDV - k × EDV + {1 - k} × LV wall], where EDV is end-diastolic volume, k is a constant, and LV wall is the volume of the left ventricular wall) could predict rehospitalization in FMR patients after TEER.</p><p><strong>Methods and results: </strong>M_wwas calculated for 24 FMR patients using echocardiography. The median left ventricular ejection fraction was 27% and the median M_wwas 32. Over a 498-day median follow-up period, 38% of patients were rehospitalized for heart failure, and only M_whad a high area under the curve in time-dependent receiver operating characteristic analysis.</p><p><strong>Conclusions: </strong>M_wis an effective predictor for rehospitalization in FMR patients after TEER.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"139-144"},"PeriodicalIF":3.1,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711761","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":"Newly Diagnosed Cancer After Diagnosis of Venous Thromboembolism　- Insights From the COMMAND VTE Registry-2.","authors":"Yugo Yamashita, Takeshi Morimoto, Ryuki Chatani, Yuji Nishimoto, Nobutaka Ikeda, Yohei Kobayashi, Satoshi Ikeda, Kitae Kim, Moriaki Inoko, Toru Takase, Shuhei Tsuji, Maki Oi, Takuma Takada, Kazunori Otsui, Jiro Sakamoto, Yoshito Ogihara, Takeshi Inoue, Shunsuke Usami, Po-Min Chen, Kiyonori Togi, Norimichi Koitabashi, Seiichi Hiramori, Kosuke Doi, Hiroshi Mabuchi, Yoshiaki Tsuyuki, Koichiro Murata, Kensuke Takabayashi, Hisato Nakai, Daisuke Sueta, Wataru Shioyama, Tomohiro Dohke, Ryusuke Nishikawa, Kazuhisa Kaneda, Koh Ono, Takeshi Kimura","doi":"10.1253/circj.CJ-24-0786","DOIUrl":"https://doi.org/10.1253/circj.CJ-24-0786","url":null,"abstract":"<p><strong>Background: </strong>Previous randomized clinical trials did not support a benefit of screening for occult cancer after diagnosis of venous thromboembolism (VTE), although screening may be of potential benefit for selected high-risk patients.</p><p><strong>Methods and results: </strong>The COMMAND VTE Registry-2 enrolled consecutive patients with acute symptomatic VTE between 2015 and 2020 from 31 centers across Japan. The 3,706 patients in the registry without known active cancer at the time of VTE diagnosis were divided into 2 groups: those with (n=250) and without (n=3,456) newly diagnosed cancer during the follow-up period. The cumulative incidence of newly diagnosed cancer was 1.5% at 30 days, 3.7% at 1 year, and 7.0% at 3 years. The multivariable Cox proportional hazard model demonstrated that older age (hazard ratio [HR] 1.02 per 1 year increase; 95% confidence interval [CI] 1.01-1.03; P<0.001), a history of cancer (HR 3.57; 95% CI 2.73-4.64; P<0.001), autoimmune disorders (HR 1.48; 95% CI 1.06-2.02; P=0.02), a history of major bleeding (HR 1.64; 95% CI 1.04-2.48; P=0.04), and the absence of transient provoking risk factors for VTE (HR 1.44; 95% CI 1.08-1.92; P=0.01) were independently associated with newly diagnosed cancer.</p><p><strong>Conclusions: </strong>The incidence of newly diagnosed cancer after VTE diagnosis was 3.7% at 1 year, and several independent risk factors for newly diagnosed cancer after VTE diagnosis were identified.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878444","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":"Safety of Calcium Channel Blockers in Patients With Severe Aortic Stenosis and Hypertension.","authors":"Ko Yamamoto, Yasuaki Takeji, Tomohiko Taniguchi, Takeshi Morimoto, Shinichi Shirai, Takeshi Kitai, Hiroyuki Tabata, 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, Mamoru Toyofuku, Shojiro Tatsushima, Norio Kanamori, 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, Kenji Ando, Tatsuhiko Komiya, Koh Ono, Kenji Minatoya, Takeshi Kimura","doi":"10.1253/circj.CJ-24-0771","DOIUrl":"https://doi.org/10.1253/circj.CJ-24-0771","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of data on safety of calcium channel blockers (CCB) in patients with severe aortic stenosis (AS) and hypertension.</p><p><strong>Methods and results: </strong>Among 2,460 patients with severe AS and hypertension receiving antihypertensive therapy in the CURRENT AS registry-2, we compared the clinical outcomes between patients taking antihypertensive therapy with CCB (CCB group) and without CCB (no CCB group). In the entire study population, CCB was prescribed in 1,763 patients (71.7%), which was the most commonly prescribed antihypertensive agents. The prescription rates of angiotensin converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, and thiazides were 61.9%, 25.6%, and 7.3% in the CCB group, and 75.8%, 54.4%, and 6.0% in the no CCB group. In the propensity score matched cohort, the cumulative 3-year incidence of all-cause death or hospitalization for heart failure was not different between the CCB and no CCB groups (38.3% vs. 38.7%, log-rank P=0.65; HR, 0.94; 95%CI, 0.77-1.15; P=0.56). The cumulative 3-year incidence of syncope was low regardless of CCB prescription (1.1% vs. 1.0%, P=0.74).</p><p><strong>Conclusions: </strong>Among patients with severe AS and hypertension, CCB was the most commonly prescribed antihypertensive agents, and antihypertensive therapy with CCB was associated with comparable clinical outcomes to antihypertensive therapy without CCB. Syncope was rarely seen in patients with severe AS and hypertension receiving antihypertensive therapy regardless of CCB prescription.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856567","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 of Blood Urea Nitrogen With Incident Heart Failure in the Community　- The Atherosclerosis Risk in Communities (ARIC) Study.","authors":"Hairong Liu, Junichi Ishigami, Lena Mathews, Suma Konety, Michael Hall, Patricia P Chang, Chiadi Ndumele, Wayne Rosamond, Kunihiro Matsushita","doi":"10.1253/circj.CJ-24-0502","DOIUrl":"https://doi.org/10.1253/circj.CJ-24-0502","url":null,"abstract":"<p><strong>Background: </strong>The association between blood urea nitrogen (BUN) levels and incident heart failure (HF) in the general population is still unclear.</p><p><strong>Methods and results: </strong>We assessed the association of BUN level with incident HF in 14,167 ARIC participants without a history of HF at baseline (1987-1989) (mean age 54.1 years, 54.4% female, 25.2% Black). BUN levels (mg/dL) were divided into quartiles, with the highest quartile further divided into tertiles (Q1 ≤13, Q2 13-15, Q3 15-17, Q4a 17-19, Q4b 19-21, Q4c >21). HF events were identified through to December 31, 2019, using diagnostic codes on discharge records or death certificates. Hazard ratios (HRs) were estimated using multivariable Cox models. During a median follow-up of 26.2 years, 3,482 participants developed HF (incidence rate 10.7 per 1,000 person-years). In a multivariable Cox model adjusted for sociodemographic variables, the highest BUN quartile (Q4) had a HR of 1.19 (95% confidence interval [CI] 1.09, 1.31) compared with Q1. HRs for Q4a, Q4b, and Q4c were 1.14 (95% CI 1.02, 1.28), 1.11 (0.96, 1.28), and 1.42 (1.22, 1.63), respectively. After further adjustment for clinical factors, the association remained significant for Q4c (HR 1.23 [1.06, 1.43]). Associations were consistent across demographic and clinical subgroups.</p><p><strong>Conclusions: </strong>In this community-based cohort, higher BUN levels were significantly associated with incident HF. BUN, routinely measured in clinical care, may help identify individuals at risk of HF.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814912","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":"Orthostatic Heart Rate Changes and Prognostic Outcomes in Patients With Heart Failure.","authors":"Haruki Sato, Kentaro Kamiya, Nobuaki Hamazaki, Kohei Nozaki, Masashi Yamashita, Shota Uchida, Takumi Noda, Kensuke Ueno, Ken Ogura, Takashi Miki, Kazuki Hotta, Emi Maekawa, Minako Yamaoka-Tojo, Atsuhiko Matsunaga, Junya Ako","doi":"10.1253/circj.CJ-24-0414","DOIUrl":"https://doi.org/10.1253/circj.CJ-24-0414","url":null,"abstract":"<p><strong>Background: </strong>Heart rate typically increases during postural changes from a supine to a standing position due to autonomic and hemodynamic factors. Changes in heart rate during orthostasis may reflect the extent of autonomic dysfunction in patients with heart failure (HF). Thus, orthostatic heart rate changes may be useful for evaluating autonomic function and may predict prognosis. This study examined the association between orthostatic heart rate changes and prognosis in patients with HF.</p><p><strong>Methods and results: </strong>We included 320 patients with HF in sinus rhythm (median age 70 years, 70.9% men) who were admitted to Kitasato University Hospital for HF treatment and whose heart rate was evaluated in the supine and upright positions during the stable period before discharge. We calculated heart rate changes based on supine and upright heart rate. We examined the association of orthostatic heart rate changes with patient prognosis (i.e., a composite of all-cause mortality or rehospitalization for HF). During the follow-up period (median 3.8 years; interquartile range 0.8-7.0 years), 129 events occurred. Orthostatic heart rate changes were associated with low composite event rates (log-rank P=0.015). After adjusting for potential confounders, increasing orthostatic heart rate changes were associated with decreased composite event rates (adjusted hazard ratio 0.954; 95% confidence interval 0.925-0.985; P=0.004).</p><p><strong>Conclusions: </strong>In patients with HF, poor orthostatic heart rate changes were associated with a worse prognosis.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814950","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":"Novel Risk Scoring Model to Predict the Implementation of Veno-Arterial Extracorporeal Membrane Oxygenation in Patients With Acute Myocarditis.","authors":"David Hong, Minjung Bak, Hyukjin Park, Hyung Yoon Kim, Seonhwa Lee, In-Cheol Kim, Junho Hyun, So Ree Kim, Mi-Na Kim, Kyung-Hee Kim, Jeong Hoon Yang","doi":"10.1253/circj.CJ-24-0684","DOIUrl":"https://doi.org/10.1253/circj.CJ-24-0684","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to identify risk factors associated with the implementation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with acute myocarditis and to develop a predictive model.</p><p><strong>Methods and results: </strong>This retrospective study included 841 patients from 7 hospitals in Korea with biopsy-proven or clinically suspected acute myocarditis. Logistic regression analysis was used to identify the clinical characteristics of patients who required VA-ECMO and to construct a scoring system to predict the implementation of VA-ECMO. Among the study population, 217 (25.8%) patients underwent VA-ECMO. The study population was divided into training (n=621) and testing (n=220) cohorts according to participating center. The final predictive model of VA-ECMO insertion derived from the training cohort included the following: initial mean blood pressure <65 mmHg, cardiac arrest, Glasgow Coma Scale score ≤12, platelet count <100×10³/mL, pulmonary congestion on chest X-ray, QRS interval ≥120 ms, left or right bundle branch block, and left ventricular ejection fraction <40%. Using this predictive model, a β coefficient-weighted Korean Acute Myocarditis (KAM) score was developed. External validation of the predictive model and KAM score using the testing cohort showed excellent discriminant ability (areas under the curve of 0.945 and 0.921, respectively).</p><p><strong>Conclusions: </strong>A risk scoring system based on simple clinical and laboratory parameters at initial presentation could predict the implementation of VA-ECMO and clinical course in patients with acute myocarditis.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814941","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":"Genetic Variants in Severe Hypertriglyceridemia Among Taiwanese Participants　- Insights From Genome-Wide Association and Whole-Exome Sequencing Analyses.","authors":"Hsien-Yu Fan, Ming-Chieh Tsai, Chih-Jun Lai, Chiu-Li Yeh, Hsin-Yin Hsu, Po-Jui Lai, Hsiu-Ching Hsu, Ta-Chen Su, Hung-Ju Lin, Yen-Feng Lin, Tzu-Pin Lu, Kuo-Liong Chien","doi":"10.1253/circj.CJ-24-0491","DOIUrl":"https://doi.org/10.1253/circj.CJ-24-0491","url":null,"abstract":"<p><strong>Background: </strong>There are limited data on the use of whole-exome sequencing (WES) to diagnose severe hypertriglyceridemia. Our aim was to identify candidate genes linked to triglyceride levels via a genome-wide association study (GWAS) and to recruit participants with severe hypertriglyceridemia for WES to assess allelic variants in the candidate genes.</p><p><strong>Methods and results: </strong>A GWAS was conducted involving 120,140 participants to identify lead loci associated with blood triglyceride levels. Following the identification of these lead loci, WES was performed on DNA samples from 29 participants with hypertriglyceridemia whose triglyceride levels exceeded 800 mg/dL to assess variations in the corresponding genes. In the GWAS of 120,140 participants, the apolipoprotein A5 (APOA5) locus on chromosome 11 showed the strongest association with blood triglyceride levels (lead single nucleotide polymorphism [SNP] rs2075291; P=3.07×10^-108), along with 5 independent SNPs (most significant P=7.84×10^-167). Other key loci included BUD13 homolog (BUD13; P=2.73×10^-62), glucokinase regulator (GCKR; P=2.63×10^-24), and lipoprotein lipase (LPL; P=1.50×10^-11). WES in 29 hypertriglyceridemia patients identified additional genes, including ALDH1A2, APOC1, LPL, RGS7, and SIK3, showing significant allele frequency variations and potential roles in lipid metabolism.</p><p><strong>Conclusions: </strong>Our study confirms the role of known genetic loci in triglyceride metabolism and hypertriglyceridemia while uncovering novel loci, offering new perspectives on lipid regulation and potential avenues for therapeutic advancements.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814931","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}