{"title":"Expert Consensus Statement on the Evaluation, Treatment, and Transfer of Cardiogenic Shock Using a Delphi Method Approach - A Report of the Japan Critical Care Cardiology Committee (J4CS).","authors":"Takahiro Nakashima, Toru Kondo, Jun Nakata, Keita Saku, Shoji Kawakami, Masanari Kuwabara, Takeshi Yamamoto, Migaku Kikuchi, Ichiro Takeuchi, Kuniya Asai, Naoki Sato","doi":"10.1253/circj.CJ-25-0192","DOIUrl":"https://doi.org/10.1253/circj.CJ-25-0192","url":null,"abstract":"","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755792","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":"Characteristics of Patients With Acute Coronary Syndrome and Lipid Management Status Insights From the Optimal Therapy for All Kagoshima Acute Coronary Syndrome (OK-ACS) Registry.","authors":"Daisuke Kanda, Akihiro Tokushige, Takashi Kajiya, Takashi Arima, Tetsuro Kataoka, Ryo Arikawa, Mitsuru Ohishi","doi":"10.1253/circj.CJ-25-0083","DOIUrl":"https://doi.org/10.1253/circj.CJ-25-0083","url":null,"abstract":"<p><strong>Background: </strong>With aging of the population, atherosclerotic diseases have increased in Japan, with acute coronary syndrome (ACS) a significant cause of morbidity and mortality. In Kagoshima Prefecture, ACS mortality rates exceed the national average, reflecting challenges in lipid management and access to care.</p><p><strong>Methods and results: </strong>The Optimal Therapy for All Kagoshima Acute Coronary Syndrome (OK-ACS) Registry, initiated in April 2022, enrolled 2,328 ACS patients across Kagoshima. This study evaluated the impact of a standardized lipid management pathway, the \"Kagoshima Style,\" on low-density lipoprotein cholesterol (LDL-C) control and guideline adherence, as well as the regional profile of ACS in Kagoshima. The pathway was implemented at all percutaneous coronary intervention facilities to optimize lipid management and secondary prevention. LDL-C levels decreased significantly (P<0.0001) from admission to discharge and at 3 months (113.3±39.9, 74.6±28.0, and 69.2±25.9 mg/dL, respectively), with no difference according to place of residence. The proportion of patients with LDL-C <70 mg/dL increased from 12% at admission to 59% at 3 months. Maximum tolerated doses of high-intensity statin use increased from 7% at baseline to 9.3% after pathway implementation. Geographic disparities were evident, with patients from isolated islands experiencing delayed treatment access.</p><p><strong>Conclusions: </strong>The Kagoshima Style pathway improved lipid management, reducing LDL-C and enhancing guideline adherence. This interim analysis provides insights into lipid management and regional disparities in patients with ACS across Kagoshima prefecture.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755784","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":"Efficacy and Safety of Bempedoic Acid in Japanese Patients With Hypercholesterolemia - A Randomized, Double-Blind, Placebo-Controlled Phase 3 Study (the CLEAR-J Trial).","authors":"Shizuya Yamashita, Arihiro Kiyosue, Hitomi Fujita, Daisuke Yokota, Yumiko Nakamura, Satoshi Yasuda","doi":"10.1253/circj.CJ-25-0089","DOIUrl":"https://doi.org/10.1253/circj.CJ-25-0089","url":null,"abstract":"<p><strong>Background: </strong>Statins can effectively reduce low-density lipoprotein cholesterol (LDL-C), but additional options are needed for inadequate responses to statins or statin intolerance. Bempedoic acid is a small-molecule oral LDL-C-lowering drug that inhibits ATP citrate lyase, an enzyme 2 steps upstream of 3-hydroxy-3-methylglutaryl coenzyme A reductase in the metabolic pathway for cholesterol synthesis.</p><p><strong>Methods and results: </strong>The CLEAR-J trial evaluated bempedoic acid 180 mg/day for 12 weeks in Japanese patients with inadequately controlled LDL-C. Percentage changes in LDL-C between baseline and Week 12 (primary endpoint) were -25.25% and -3.46% in the bempedoic acid and placebo groups, respectively, with a significant between-group difference (-21.78%; 95% confidence interval [CI] -26.71%, -16.85%; P<0.001). Changes in secondary endpoints in the bempedoic acid and placebo groups were as follows: non-high-density lipoprotein cholesterol, -20.33% and -2.76%, respectively (between-group difference -17.57%; 95% CI -22.03%, -13.12%); total cholesterol -16.36% and -2.23%, respectively (between-group difference -14.13%; 95% CI -17.79%, -10.47%); and apolipoprotein B -18.10% and -0.67%, respectively (between-group difference -17.43%; 95% CI -21.97%, -12.89%). At 12 weeks, 62.5% of the bempedoic acid group had achieved target LDL-C values. Treatment-emergent adverse events appeared in 3 patients taking bempedoic acid and 2 patients taking placebo.</p><p><strong>Conclusions: </strong>This study confirmed the safety and efficacy of bempedoic acid after 12 weeks treatment in Japanese patients with high LDL-C who had inadequate response to statins or statin intolerance.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755791","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":"Hemodynamic Changes After Wire Frame Occluders vs. Metal Mesh Devices for Atrial Septal Defect.","authors":"Mitsutaka Nakashima, Yoichi Takaya, Kentaro Ejiri, Takashi Miki, Rie Nakayama, Koji Nakagawa, Teiji Akagi, Kazufumi Nakamura, Shinsuke Yuasa","doi":"10.1253/circj.CJ-24-0966","DOIUrl":"https://doi.org/10.1253/circj.CJ-24-0966","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter atrial septal defect (ASD) closure is the first treatment option for secundum ASD, but parameters for optimal device selection have not been established. We compared outcomes between occluders with a wire frame and metal mesh devices.</p><p><strong>Methods and results: </strong>This study included secundum ASD patients implanted with a wire frame occluder (GORE<sup>®</sup>CARDIOFORM ASD occluder [GCA]; W.L. Gore & Associates) or metal mesh devices (Amplatzer septal occluder device [Abbott] and Occlutech Figulla Flex II device [Occlutech]). The presence of residual shunt and B-type natriuretic peptide (BNP) levels after implantation were compared. Of the 970 patients with either GCA (n=48) or a metal mesh device (n=922; control), 42 patients from each group were analyzed after propensity score matching. The prevalence of residual shunt was significantly lower in the GCA group 1 day and 1 month after implantation (P<0.001 and P=0.017, respectively), whereas there was no significant difference between the 2 groups 6 months later (P=0.088). BNP levels at 1 month were significantly higher in the GCA group (ratio of change 1.36; 95% confidence interval [CI] 1.01-1.83), but did not differ significantly between the 2 groups at 6 months (ratio of change 1.04; 95% CI 0.65-1.65).</p><p><strong>Conclusions: </strong>Patients implanted with a wire frame occluder had a lower prevalence of residual shunt and a greater increase in BNP levels in the early period after implantation.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732843","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":"High-Humidity Care May Prevent the Development of Patent Ductus Arteriosus in Premature Infants.","authors":"Michisato Hirata, Rika Aoki, Kazuhiro Iwama, Takahiro Kemmotsu, Toshihiro Misumi, Utako Yokoyama, Shuichi Ito","doi":"10.1253/circj.CJ-24-0705","DOIUrl":"10.1253/circj.CJ-24-0705","url":null,"abstract":"<p><strong>Background: </strong>Recently, the role of a rapid increase in serum osmolality in the inhibition of postnatal ductal closure has garnered attention. This study evaluated the efficacy of high-humidity care in preventing the onset of patent ductus arteriosus (PDA) in extremely premature infants.</p><p><strong>Methods and results: </strong>The high-humidity group (HHG) comprised 28 infants (24<sup>0</sup>to 27<sup>6</sup>weeks gestational age) recruited prospectively within 6 h after birth between July 2019 and September 2021; these infants were cared for in 90% humidity for the first 72 h of life. The incidence of PDA within the first 7 days of life and the rate of increase in serum sodium concentrations were compared between the HHG and a conventionally managed historical control group (CG; 29 infants born in 2016-2017). Twelve (43%) infants in the HHG and 22 (76%) in the CG developed PDA (P=0.016). Multivariate logistic regression analysis revealed that high-humidity care was effective in reducing the incidence of PDA onset (odds ratio 0.265; 95% confidence interval 0.078-0.907). The rate of increase in serum sodium concentrations was significantly lower in the HHG than CG (median 0.29 [interquartile range 0.21-0.39] vs. 0.46 [interquartile range 0.32-0.62] mEq/L/h, respectively; P<0.001).</p><p><strong>Conclusions: </strong>High-humidity care for the first 72 h of life may help reduce the onset of PDA in extremely preterm infants by avoiding rapid increases in serum sodium concentrations.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"500-508"},"PeriodicalIF":3.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617742","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 Cardiorenal Anemia Syndrome on the Prognosis of Patients With Chronic Heart Failure in Japan - Insights From the KUNIUMI Registry Chronic Cohort.","authors":"Sae Ujiro, Wataru Fujimoto, Makoto Takemoto, Koji Kuroda, Soichiro Yamashita, Junichi Imanishi, Masamichi Iwasaki, Takafumi Todoroki, Manabu Nagao, Akihide Konishi, Masakazu Shinohara, Ryuji Toh, Kunihiro Nishimura, Masanori Okuda, Hiromasa Otake","doi":"10.1253/circj.CJ-24-0957","DOIUrl":"10.1253/circj.CJ-24-0957","url":null,"abstract":"<p><strong>Background: </strong>With the aging of the population, the number of patients with chronic heart failure (CHF) and comorbidities is increasing in Japan. Among the comorbidities, cardiorenal anemia syndrome (CRAS) is particularly important, but the age-specific prevalence and prognosis of CRAS remain unclear.</p><p><strong>Methods and results: </strong>The KUNIUMI registry chronic cohort is a prospective observational study of CHF (Stages B-D) in Awaji Island. In this study, we analyzed 1,646 patients registered in the KUNIUMI registry and categorized them into 4 groups: Group 1 included patients without cardiac failure (Stage B); Group 2 consisted of patients with cardiac failure but without renal failure or anemia; Group 3 comprised patients with both cardiac failure and renal failure but without anemia; and Group 4 (CRAS) included patients with cardiac failure, renal failure, and anemia. The primary endpoint was composite of all-cause-death and heart failure hospitalization. The proportion of patients with CRAS increased with age. Furthermore, Group 4 showed a significantly worse prognosis than other groups (log-rank P<0.01). On Cox proportional hazard regression analysis, compared with patients without cardiac failure, renal failure, or anemia, the age- and sex-adjusted hazard ratio for the primary endpoint in those with CRAS was 8.94 (95% confidence interval: 5.36-14.92).</p><p><strong>Conclusions: </strong>The prevalence of CRAS in CHF increases with age, and the prognosis associated with CRAS is generally worse compared with other comorbidities.</p>","PeriodicalId":50691,"journal":{"name":"Circulation Journal","volume":" ","pages":"463-469"},"PeriodicalIF":3.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538041","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":"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":"450-456"},"PeriodicalIF":3.1,"publicationDate":"2025-03-25","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}
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