Circulation JournalPub Date : 2026-09-25Epub Date: 2026-08-11DOI: 10.1253/circj.CJ-26-0685
Takeshi Soeki
{"title":"Glucose Fluctuations and Epicardial Adipose Tissue - A New Paradigm for Diabetic Myocardial Damage.","authors":"Takeshi Soeki","doi":"10.1253/circj.CJ-26-0685","DOIUrl":"10.1253/circj.CJ-26-0685","url":null,"abstract":"","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"1409-1411"},"PeriodicalIF":5.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725149","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":"Impact of Right Ventricular Involvement on Bleeding and Mortality in Patients With Right Coronary Artery-Related Myocardial Infarction - Insights From Nationwide Registry.","authors":"Satoshi Honda, Kensaku Nishihira, Misa Takegami, Sunao Kojima, Yasuhide Asaumi, Mike Saji, Jun Yamashita, Kohei Wakabayashi, Kiyoshi Hibi, Jun Takahashi, Yasuhiko Sakata, Morimasa Takayama, Tetsuya Sumiyoshi, Teruo Noguchi, Hisao Ogawa, Satoshi Yasuda","doi":"10.1253/circj.CJ-26-0028","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0028","url":null,"abstract":"<p><strong>Background: </strong>Right ventricular involvement (RVI) in acute myocardial infarction (AMI) patients is recognized as a high-risk subset. However, its impact on bleeding and mortality is not well defined in patients with right coronary artery (RCA)-related ST-segment elevation acute myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).</p><p><strong>Methods and results: </strong>Using data from the multicenter, prospective Japan AMI Registry including 3,411 patients, we analyzed 993 patients with RCA-related STEMI who underwent PCI. The incidence of all-cause mortality and major bleeding, defined as Bleeding Academic Research Consortium Type 3 or 5, was compared between patients with and without RVI. RVI was present in 9% (n=92) of patients. During a 12-month follow-up, RVI was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio [HR] 2.05; 95% confidence interval [CI] 1.11-3.79) and major bleeding (adjusted HR 2.28; 95% CI 1.13-4.57) in Cox analysis, although this bleeding association was attenuated in adjusted competing-risk analysis (adjusted subdistribution HR 1.87; 95% CI 0.90-3.89). Among patients with RVI, those who experienced major bleeding had a significantly higher risk of death (HR 4.88, 95% CI 1.63-14.58).</p><p><strong>Conclusions: </strong>In patients with RCA-related STEMI treated with PCI, RVI was associated with increased mortality and appeared to be associated with a higher risk of bleeding.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983511","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":"Radial Wall Strain Derived From Coronary Angiography Reflects Plaque Morphology of Future Acute Coronary Syndrome.","authors":"Mayuka Masuda, Takayoshi Toba, Yoichiro Sugizaki, Hiroyuki Kawamori, Takashi Hiromasa, Daichi Fujimoto, Tetsuya Yamamoto, Seigo Iwane, Hiroshi Tsunamoto, Shota Naniwa, Masayoshi Fujii, Yuki Sakamoto, Yuta Fukuishi, Koshi Matsuhama, Kotaro Higuchi, Hiroya Okamoto, Nobuhiro Watanabe, Ken Takata, Shotaro Yoshida, Masamichi Iwasaki, Amane Kozuki, Junya Shite, Tomofumi Takaya, Hiromasa Otake","doi":"10.1253/circj.CJ-26-0372","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0372","url":null,"abstract":"<p><strong>Background: </strong>Radial wall strain (RWS) is a potential marker of plaque vulnerability; however, its association with plaque morphology in future acute coronary syndrome (ACS) remains unclear.</p><p><strong>Methods and results: </strong>We retrospectively enrolled 98 patients with ACS who underwent optical coherence tomography-guided percutaneous coronary intervention and had a prior coronary angiography (CAG) 1 month to 5 years before ACS. RWS was calculated as the maximum percentage change in lumen diameter within a cardiac cycle (RWS<sub>max</sub>). Mild-to-intermediate stenotic lesions on the index CAG were classified as culprit lesions (CLs) and non-CLs (NCLs) of ACS. CLs were further categorized as plaque rupture (PR) or erosion (PE). We identified 74 CLs (50 PRs, 24 PEs) and 96 NCLs. Angiographic and physiological parameters were comparable across the groups; however, RWS<sub>max</sub>was significantly higher in both PRs and PEs than in NCLs (15.8% vs. 12.6%, P<0.001; 14.1% vs. 12.6%, P=0.012, respectively). In Cox regression analysis, RWS<sub>max</sub>was associated with subsequent PRs (hazard ratio [HR] 1.56; 95% confidence interval [CI] 1.34-1.82; P<0.001) and PEs (HR 1.33; 95% CI 1.05-1.67; P=0.017). Multinomial logistic regression showed that higher RWS<sub>max</sub>favored PR, lower RWS<sub>max</sub>favored NCL, and the estimated probability of PE remained low across the RWS<sub>max</sub>spectrum.</p><p><strong>Conclusions: </strong>RWS<sub>max</sub>was independently associated with subsequent PR and PE, with a higher estimated probability of PR than of PE.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983562","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":"Determinants of Disproportionality in Functional Mitral Regurgitation - Importance of Mitral Valve Morphology.","authors":"Yoshihito Arao, Nobuyuki Kagiyama, Yuki Izumi, Satonori Maekawara, Tomohiro Kaneko, Mai Terada, Mike Saji, Nobuo Iguchi, Ryosuke Higuchi, Itaru Takamisawa, Mamoru Nanasato, Toyoaki Murohara, Mitsuaki Isobe","doi":"10.1253/circj.CJ-26-0057","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0057","url":null,"abstract":"<p><strong>Background: </strong>Disproportionate (d-) functional mitral regurgitation (FMR) is characterized by greater mitral regurgitation (MR) severity than expected from left ventricular (LV) dilatation. Morphological determinants of this imbalance remain unclear.</p><p><strong>Methods and results: </strong>Consecutive patients who underwent transcatheter edge-to-edge repair (TEER) for symptomatic FMR were divided into 2 groups: d-FMR and proportionate (p-) FMR (effective regurgitant orifice area [EROA]/LV end-diastolic volume [LVEDV] >0.20 or ≤0.20 mm<sup>2</sup>/mL, respectively). Of the 114 FMR patients included, those with d-FMR (n=66) were more likely to be female and had a significantly larger EROA than patients with p-FMR (n=48), despite a smaller LVEDV index and lower tenting height. Metrics of LV dyssynchrony and etiologies were similar between the 2 groups, but the d-FMR group had a higher proportion of pseudo-prolapse (28.8% vs. 8.3%; P=0.007), extreme mitral annular dilatation (>700 mm<sup>2</sup>/m<sup>2</sup>; 53.0% vs. 29.2%; P=0.011), and deep indentation (24.2% vs. 4.2%; P=0.004). Although these factors were prevalent in the population, no patient with MR due purely to any of these factors underwent TEER. After adjustment by age, sex, and LVEDV index, the number of factors present was associated with d-FMR (odds ratio 4.15; P<0.001). Similar results were obtained when using an EROA/LVEDV cut-off of 0.14 mm<sup>2</sup>/mL.</p><p><strong>Conclusions: </strong>Additional morphological factors were associated with greater MR severity beyond LV size and with residual MR after TEER, supporting a phenotype-based interpretation of FMR disproportionality.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983474","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":"Unexplained Syncope in Patients With Congenital Long QT Syndrome - Role of Implantable Loop Recorders in Diagnostic Evaluation.","authors":"Yuichiro Miyazaki, Takeshi Aiba, Koichi Kato, Hideo Fukunaga, Hiroshi Morita, Takahisa Noma, Tatsunori Takahashi, Akira Mizukami, Toshihiro Nakamura, Satoshi Oka, Akinori Wakamiya, Nobuhiko Ueda, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Satoshi Nagase, Kengo Kusano","doi":"10.1253/circj.CJ-26-0111","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0111","url":null,"abstract":"<p><strong>Background: </strong>Syncope is common in patients with congenital long QT syndrome (LQTS). However, not all episodes of syncope or loss of consciousness are caused by torsades de pointes (TdP); some are attributable to bradycardia or non-cardiac causes. This study investigated the clinical utility of implantable loop recorders (ILRs) in patients with LQTS presenting with unexplained syncope.</p><p><strong>Methods and results: </strong>We retrospectively studied 18 patients with LQTS (7 with LQTS type (LQT) 1, 3 with LQT2, 1 with LQT3, and 7 genotype-negative LQTS) who underwent ILR implantation for recurrent syncope. Multiple causes of syncope were suspected in each patient; there were 14 cases of arrhythmia, 4 of epilepsy, 8 of neurally mediated syncope (NMS), and 9 of unknown cause. During a mean (±SD) follow-up of 37±22 months after ILR implantation, 8 (44%) patients experienced recurrent syncope. Four episodes were caused by TdP and the remaining 4 episodes were attributed to epilepsy or NMS (cardioinhibitory type). No significant difference was observed in baseline clinical characteristics between patients with and without TdP following ILR implantation, but female sex (P=0.051) and a higher Schwartz score (P=0.08) tended to be associated with TdP.</p><p><strong>Conclusions: </strong>Syncope in patients with LQTS is not always attributable to TdP, and non-arrhythmic causes should be considered. Although ILRs may aid in diagnostic evaluation, careful risk stratification remains essential in patients with suspected arrhythmic syncope.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921296","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":"Development and Validation of Risk Models for Outcomes of Isolated Coronary Artery Bypass Grafting - A Nationwide Analysis in Japan.","authors":"Sachiko Hayashi, Hiraku Kumamaru, Shiori Nishimura, Aya Saito, Hideyuki Shimizu, Noboru Motomura","doi":"10.1253/circj.CJ-26-0160","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0160","url":null,"abstract":"<p><strong>Background: </strong>Reliable preoperative risk assessment is essential in cardiac surgery. In Japan, coronary artery bypass grafting (CABG) risk models have been developed from the Japan Cardiovascular Surgery Database - Adult section (JCVSD-A), with JapanSCORE I and II released previously. To reflect contemporary practice, we developed and validated JapanSCORE III, an updated risk model for isolated CABG, using JCVSD-A.</p><p><strong>Methods and results: </strong>We identified patients undergoing isolated CABG between 2018 and 2023 in the JCVSD-A. The dataset was temporally split into development (2018-2022) and validation (2023) cohorts. A least absolute shrinkage and selection operator model was developed to predict operative mortality, incorporating imaging-based predictors and clinically relevant factors. Secondary outcome models were constructed for stroke, reoperation, prolonged ventilation, renal failure, deep sternal wound infection (DSWI), gastrointestinal complications, and intensive care unit stay >7 days. Model performance was assessed by areas under the curve (AUC) and calibration plots. Among 70,180 patients (mean age 69.3 years; 20% women), operative mortality was 2.7%. The incidence of stroke, reoperation, prolonged ventilation, renal failure, DSWI, gastrointestinal complications, and prolonged ICU stay was 1.8%, 1.5%, 3.7%, 2.0%, 1.1%, 1.3%, and 13.2%, respectively. Operative mortality and renal failure models demonstrated good discrimination (AUC >0.8) and calibration in validation.</p><p><strong>Conclusions: </strong>Operative outcomes remained stable despite increasing predicted risk. The JapanSCORE III models showed good predictive performance, providing valid tools for preoperative risk stratification.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882357","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":"Changes in Remote Monitoring for Patients With Cardiac Implantable Electronic Devices After a Reimbursement Revision - An Interrupted Time-Series Analysis.","authors":"Koki Takegawa, Koshiro Kanaoka, Haruka Matsuura, Shoko Chishaki-Kawabata, Yoshitaka Iwanaga, Tetsuo Sasano, Yoshihiro Miyamoto","doi":"10.1253/circj.CJ-26-0548","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0548","url":null,"abstract":"<p><strong>Background: </strong>Remote monitoring (RM) enables early detection of abnormalities in cardiac implantable electronic devices (CIED), but implementation remains suboptimal.</p><p><strong>Methods and results: </strong>We analyzed 396,296 patients hospitalized for CIED implantation and evaluated changes after RM reimbursement revision using an interrupted time-series analysis. The proportion increased by 4.89% (95% confidence interval [CI]: 3.71 to 6.06%) in the pacemaker implantation cohort, but no significant increase was observed in the implantable cardioverter defibrillator and cardiac resynchronization therapy cohort (0.79%; 95% CI: -1.12 to 2.71%).</p><p><strong>Conclusions: </strong>The effect of reimbursement policy changes on RM adoption may differ according to the type of CIED.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860692","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":"Updated 2026 Japanese Diagnostic Criteria for Takayasu Arteritis.","authors":"Hajime Yoshifuji, Haruhito A Uchida, Yasuhiro Onishi, Yoshia Miyawaki, Eisuke Amiya, Ryotaro Asano, Takuya Hashimoto, Tomonori Ishii, Jun Ishizaki, Shuichi Ito, Toru Iwahashi, Naomi Iwata, Takatoyo Kiko, Yasuhiro Maejima, Takako Miyamae, Hiroko Nagafuchi, Kunihiro Shigematsu, Tsuyoshi Shirai, Natsuka Umezawa, Takahiko Sugihara, Yoshiko Watanabe, Naoto Tamura, Yoshikazu Nakaoka","doi":"10.1253/circj.CJ-26-0679","DOIUrl":"https://doi.org/10.1253/circj.CJ-26-0679","url":null,"abstract":"<p><p>Takayasu arteritis (TAK) is a chronic, refractory large-vessel vasculitis designated as a Designated Intractable Disease in Japan. The Japanese diagnostic criteria for TAK, last revised in 2017, have been updated to the 2026 version as part of the Japanese Circulation Society 2026 guidelines on the management of large vessel vasculitis, and are presented here in English for the first time. The revision was conducted through a 3-round modified Delphi process involving a panel of 21 experts, supplemented by email discussion and an in-person meeting. The updated criteria incorporate 3 major changes: new symptoms were added and a qualifying statement introduced in Section A; pulmonary artery involvement was elevated to a main criterion in Section B; and IgG<sub>4</sub>-related periaortitis, Cogan syndrome, and drug-induced aortitis were added in Section C. These updates reflect advances in imaging technology and international classification frameworks, with an emphasis on improving diagnostic sensitivity to reduce missed diagnoses.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833432","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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