Circulation Journal最新文献

{"title":"Reduced Pulmonary Artery Compliance in a Conscious State Predicts Cardiac Event After Transcatheter Edge-to-Edge Repair in Patients With Ventricular Secondary Mitral Regurgitation.","authors":"Makoto Amaki, Shinichi Kurashima, Yuki Irie, Atsushi Okada, Soshiro Ogata, Shin Ito, Yu Kataoka, Hideaki Kanzaki, Takashi Kitai, Kazuhiro Yamamoto, Chisato Izumi","doi":"10.1253/circj.CJ-24-0541","DOIUrl":"10.1253/circj.CJ-24-0541","url":null,"abstract":"<p><strong>Background: </strong>Right ventricular (RV) dysfunction negatively affects mitral valve transcatheter edge-to-edge repair (M-TEER) outcomes in patients with ventricular secondary mitral regurgitation (vSMR). However, RV dysfunction occurs in the late phase of heart failure, when it may not respond to interventions. The pulsatile component of RV afterload, pulmonary artery (PA) compliance, is a sensitive parameter that decreases before RV dysfunction occurs. We explored the utility of PA compliance in predicting cardiac events after M-TEER.</p><p><strong>Methods and results: </strong>We analyzed 107 patients with vSMR who underwent M-TEER and in whom right heart catheter parameters were measured in a conscious state. Twenty-four patients had a cardiac event. There were no differences in patient characteristics or echocardiographic parameters between groups with and without cardiac events. PA compliance was significantly reduced in the event group, but other RV function parameters did not differ between the 2 groups. Receiver operating characteristic curve analysis revealed an optimal prognostic cut-off value for PA compliance of 2.7 mL/mmHg. In multivariate Cox regression, reduced PA compliance (<2.7 mL/mmHg) was strongly associated with cardiac events. Kaplan-Meier analysis revealed PA compliance had significant prognostic power for the composite outcome of cardiac events (log-rank P<0.01).</p><p><strong>Conclusions: </strong>Reduced PA compliance (hemodynamically derived in the conscious state) was a strong prognostic indicator in patients with vSMR who underwent M-TEER.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"1480-1487"},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257317","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":"Deep Learning-Based Fully Automated Aortic Valve Leaflets and Root Measurement From Computed Tomography Images　- A Feasibility Study.","authors":"Haruo Yamauchi, Gakuto Aoyama, Hiroyuki Tsukihara, Kenji Ino, Naoki Tomii, Shu Takagi, Katsuhiko Fujimoto, Takuya Sakaguchi, Ichiro Sakuma, Minoru Ono","doi":"10.1253/circj.CJ-24-1031","DOIUrl":"10.1253/circj.CJ-24-1031","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to retrain our existing deep learning-based fully automated aortic valve leaflets/root measurement algorithm, using computed tomography (CT) data for root dilatation (RD), and assess its clinical feasibility.</p><p><strong>Methods and results: </strong>67 ECG-gated cardiac CT scans were retrospectively collected from 40 patients with RD to retrain the algorithm. An additional 100 patients' CT data with aortic stenosis (AS, n=50) and aortic regurgitation (AR) with/without RD (n=50) were collected to evaluate the algorithm. 45 AR patients had RD. The algorithm provided patient-specific 3-dimensional aortic valve/root visualization. The measurements of 100 cases automatically obtained by the algorithm were compared with an expert's manual measurements. Overall, there was a moderate-to-high correlation, with differences of 6.1-13.4 mm²for the virtual basal ring area, 1.1-2.6 mm for sinus diameter, 0.1-0.6 mm for coronary artery height, 0.2-0.5 mm for geometric height, and 0.9 mm for effective height, except for the sinotubular junction of the AR cases (10.3 mm) with an indefinite borderline over the dilated sinuses, compared with 2.1 mm in AS cases. The measurement time (122 s) per case by the algorithm was significantly shorter than those of the experts (618-1,126 s).</p><p><strong>Conclusions: </strong>This fully automated algorithm can assist in evaluating aortic valve/root anatomy for planning surgical and transcatheter treatments while saving time and minimizing workload.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"1499-1509"},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175532","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":"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":"1528-1537"},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","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":"Proposal for the Appropriate Frailty Assessment in the JCS/JHFS 2025 Guideline on Diagnosis and Treatment of Heart Failure　- Reply.","authors":"Hidenori Yaku, Takao Kato, Takeshi Kitai","doi":"10.1253/circj.CJ-25-0553","DOIUrl":"10.1253/circj.CJ-25-0553","url":null,"abstract":"","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"1577-1578"},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796011","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":"Estimation of Coronary Obstruction Risk for the Transcatheter Aortic Valve Implantation in Surgical Aortic Valve (TAV-in-SAV) Procedure.","authors":"Ai Kawamura, Kazuo Shimamura, Daisuke Yoshioka, Yusuke Misumi, Kizuku Yamashita, Shin Yajima, Koichi Maeda, Takuji Kawamura, Shunsuke Saito, Yutaka Matsuhiro, Shumpei Kosugi, Daisuke Nakamura, Isamu Mizote, Yasushi Sakata, Shigeru Miyagawa","doi":"10.1253/circj.CJ-24-1003","DOIUrl":"10.1253/circj.CJ-24-1003","url":null,"abstract":"<p><strong>Background: </strong>To consider transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV) as a secondary intervention, the risk of coronary obstruction during future TAV-in-SAV should be assessed prior to initial SAV replacement (SAVR), especially in Japanese patients with a small body size and aortic root anatomy. In this study we simulated the risk of coronary obstruction and identified associated anatomical factors.</p><p><strong>Methods and results: </strong>We retrospectively analyzed pre- and post-SAVR computed tomography scans of 115 patients and simulated the risk of coronary obstruction. High risk was defined as postoperative coronary arteries located below the risk plane (RP) and a valve-to-coronary distance <4 mm or a valve-to-aorta distance <2 mm; 28.7% of patients were classified as high risk. Preoperative right and left coronary artery heights of ≥22 and ≥18 mm, respectively, were important parameters for classifying patients with postoperative coronary arteries located above or below the RP. An expected valve-to-sinotubular junction (STJ) distance (defined as the difference between the preoperative STJ diameter and the expected internal valve diameter) ≥7 mm was another important parameter to stratify patients into low- and high-risk categories.</p><p><strong>Conclusions: </strong>TAV-in-SAV was anatomically unfeasible in 28.7% of patients, and the coronary obstruction risk was associated with aortic root anatomy and implanted valve size. These results may provide a basis for considering TAV-in-SAV as a secondary option in Japanese patients with a small body size and aortic root anatomy.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"1472-1479"},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602166","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":"Preoperative Longitudinal Strain on Computed Tomography Is a Sensitive Marker of Patient Prognosis After Transcatheter Aortic Valve Replacement.","authors":"Moe Matsumoto, Hiroyuki Takaoka, Manami Takahashi, Joji Ota, Yoshitada Noguchi, Shogo Okita, Yusei Nishikawa, Kazuki Yoshida, Katsuya Suzuki, Hiroaki Yaginuma, Shuhei Aoki, Hiroki Goto, Satomi Yashima, Makiko Kinoshita, Haruka Sasaki, Noriko Suzuki-Eguchi, Hideki Kitahara, Kaoru Matsuura, Goro Matsumiya, Yoshio Kobayashi","doi":"10.1253/circj.CJ-24-0863","DOIUrl":"10.1253/circj.CJ-24-0863","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the utility of myocardial strain analysis on computed tomography (CT) using state-of-the-art image analysis software to predict the prognosis of patients who underwent transcatheter aortic valve replacement (TAVR).</p><p><strong>Methods and results: </strong>We included 126 patients with severe aortic valve stenosis (AS) who underwent preoperative CT. Major adverse cardiovascular events (MACE) were defined as a composite of cardiac death (including unknown death based on medical records), hospitalization due to heart failure, and fatal arrhythmia. Twenty-four (19%) patients experienced MACE. Global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS) of the left ventricular (LV) myocardium (LVM), LV ejection fraction on CT, and the percentage of patients administered aspirin or statins was significantly lower among patients with than without MACE (all P<0.05). The percentage of patients with AF, a history of congestive heart failure, and tolvaptan or oral anticoagulants administration was significantly higher among patients with than without MACE (all P<0.05). In multivariate survival analysis using a Cox proportional hazard model, LV-GLS ≥-9.92% on CT (hazard ratio [HR] 4.45; 95% confidence interval [CI] 1.89-10.48; P=0.0007) and aspirin (HR 0.27; 95% CI 0.10-0.70; P=0.0074) or statin (HR 0.33; 95% CI 0.13-0.84; P=0.02) administration were significant predictors of prognosis after TAVR.</p><p><strong>Conclusions: </strong>Our findings indicate that LV-GLS on CT is a sensitive predictor of prognosis after TAVR.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"1488-1498"},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227479","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 and Associated Factors of Subclinical Hemolysis With a Fifth-Generation Balloon-Expandable Transcatheter Heart Valve.","authors":"Nozomu Kanehama, Ryo Ninomiya, Kai Ninomiya, Kaho Shimada, Kengo Tosaka, Tetsuya Fusazaki, Hajime Kin, Yoshihiro Morino","doi":"10.1253/circj.CJ-25-0018","DOIUrl":"10.1253/circj.CJ-25-0018","url":null,"abstract":"<p><strong>Background: </strong>The SAPIEN 3 Ultra RESILIA (S3UR) is the latest balloon-expandable valve used in transcatheter aortic valve implantation (TAVI). However, hemolysis is a potential concern with the S3UR. This Japanese single-center retrospective study evaluated the prevalence and associated factors of subclinical hemolysis in the S3UR compared with the SAPIEN 3 (S3).</p><p><strong>Methods and results: </strong>We analyzed data for 339 patients who underwent TAVI for severe aortic stenosis and completed a 1-month follow-up (S3UR, n=69; S3, n=270). Subclinical hemolysis was defined as an increase lactate dehydrogenase >2.5-fold from baseline. The prevalence of subclinical hemolysis at 1 month was significantly higher in the S3UR than S3 group (14.5% vs. 2.7%; P<0.001). Notably, subclinical hemolysis was more frequently observed in the S3UR group when mild paravalvular leak (PVL) remained at 1 month. Univariate analysis revealed that mild or greater PVL at 1 month, decreasing annular oversizing, and increasing the difference between the mean diameter of the sinus of Valsalva (SOV) and transcatheter heart valve (THV) size were associated with subclinical hemolysis in the S3UR group.</p><p><strong>Conclusions: </strong>Remaining mild or greater PVL and using an undersized THV relative to the annulus and SOV were associated with subclinical hemolysis in the S3UR. These findings highlight the importance of selecting a THV size that appropriately matches the aortic valve complex and ensuring adequate THV expansion to prevent subclinical hemolysis.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"1462-1471"},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327597","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":"Early Outcomes Following Transcatheter Closure With the Amplatzer Vascular Plug and Duct Occluder for Mitral Paravalvular Leak in Japanese Patients.","authors":"Hiroki Niikura, Kenji Makino, Norihiro Kogame, Go Hashimoto, Yoshiyuki Yazaki, Hidehiko Hara","doi":"10.1253/circj.CJ-24-0544","DOIUrl":"10.1253/circj.CJ-24-0544","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter closure of paravalvular leak (PVL) has become an established treatment for patients at prohibitive surgical risk. However, few studies have examined the feasibility of transcatheter closure using Amplatzer occluders in Japanese patients with mitral PVL.</p><p><strong>Methods and results: </strong>Twelve patients (mean [±SD] age 78±7 years) with heart failure, hemolytic anemia, or both after surgical mitral prosthetic valve replacement (mechanical valve, 75%) underwent transcatheter PVL closure with Amplatzer Vascular Plug II (AVP-II)/Amplatzer Duct Occluder II (ADO-II) between 2014 and 2021 at Toho University Ohashi Medical Center. We examined procedural, in-hospital, 30-day, and 1-year outcomes. All procedures were performed under general anesthesia using an antegrade transseptal approach, and the procedures were successful in all cases. The mean (±SD) number of Amplatzer occluders deployment per patient was 2.9±1.1, and in 2 patients the combined use of ADO-II was required. The mitral PVL grade decreased notably from 3+ to 1+, with residual PVL being mild or absent in 9 patients. There were no all-cause mortalities, major adverse events, or device-related complications at the 30-day follow-up. At 1 year, all-cause mortality was 16.7% and 3 (25%) patients required reintervention because of the recurrence of clinical symptoms.</p><p><strong>Conclusions: </strong>Our findings suggest that transcatheter PVL closure with AVP-II/ADO-II can be feasible and safe in Japanese patients with mitral PVL, leading to satisfactory early clinical outcomes.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"1519-1527"},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741250","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":"Legacy Effects of Transient Intensive Lipid-Lowering With Alirocumab on Plaque Stabilization.","authors":"Ryohei Akashi, Seiji Koga, Koji Maemura","doi":"10.1253/circj.CJ-25-0451","DOIUrl":"10.1253/circj.CJ-25-0451","url":null,"abstract":"","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"1575"},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683508","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":"Proposal for the Appropriate Frailty Assessment in the JCS/JHFS 2025 Guideline on Diagnosis and Treatment of Heart Failure.","authors":"Takahiro Kobayashi, Hidenori Arai","doi":"10.1253/circj.CJ-25-0480","DOIUrl":"10.1253/circj.CJ-25-0480","url":null,"abstract":"","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"1576"},"PeriodicalIF":3.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796012","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}