JACC. AsiaPub Date : 2025-02-01DOI: 10.1016/j.jacasi.2024.11.012
Anugrah Nair DM , Jenish P. Shroff DM , Lukah Q. Tuan BSc , Adriana Tokich BSc , Deep Chandh Raja DM , Abhinav Mehta BSc , Walter P. Abhayaratna MBBS, PhD , Prashanthan Sanders MBBS, PhD , Francis E. Marchlinski MD , Kalyanam Shivkumar MD, PhD , Rajeev K. Pathak MBBS, PhD
{"title":"Electrocardiographic Characteristics and Ablation Outcomes Associated With Para-Hisian Ventricular Arrhythmias","authors":"Anugrah Nair DM , Jenish P. Shroff DM , Lukah Q. Tuan BSc , Adriana Tokich BSc , Deep Chandh Raja DM , Abhinav Mehta BSc , Walter P. Abhayaratna MBBS, PhD , Prashanthan Sanders MBBS, PhD , Francis E. Marchlinski MD , Kalyanam Shivkumar MD, PhD , Rajeev K. Pathak MBBS, PhD","doi":"10.1016/j.jacasi.2024.11.012","DOIUrl":"10.1016/j.jacasi.2024.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Ventricular arrhythmias (VAs) near the His-bundle comprise 9% of unexplained VAs and present challenges for ablation caused by the risk of atrioventricular block.</div></div><div><h3>Objectives</h3><div>The authors studied the electrocardiographic (ECG) and electrophysiological characteristics of Para-Hisian (PH) VAs, comparing them with septal right ventricular outflow tract VAs.</div></div><div><h3>Methods</h3><div>From 210 patients with VAs between 2018 and 2024, 31 (14.7%) with PH-VAs and 23 (10.9%) with septal right ventricular outflow tract VAs were included. ECG characteristics of both were compared, and features differentiating left and right PH and supra- and infra-Hisian VAs were identified.</div></div><div><h3>Results</h3><div>Of 31 patients, 15 had VAs from the right PH site and 16 from the left. Median follow-up was 15 months (Q1-Q3: 14-21 months) for left infra-Hisian, 16 months (Q1-Q3: 14-20 months) for left supra-Hisian, and 14 months (Q1-Q3: 14-16 months) for right infra-Hisian and right supra-Hisian VAs (Q1-Q3: 14-15 months). PH-VAs had narrower QRS complexes (134 ± 19.6 ms vs 169 ± 24 ms; <em>P</em> < 0.05), R-wave in lead aVL (100% [31 of 31] vs 4.3% [1 of 23]; <em>P</em> < 0.001), and earlier R-wave transition at or before lead V<sub>3</sub> (80.6% [25 of 31] vs 47.8% [11 of 23]; <em>P</em> < 0.05). Left PH-VAs had earlier R-wave transition at lead V<sub>2</sub> (50% [8 of 16] vs 20% [3 of 15]; <em>P =</em> 0.036). Right PH VAs had deeper S-wave relative to the preceding sinus beat in lead V<sub>1</sub> (73.3% [11 of 15] vs 37.5% [6 of 16]; <em>P =</em> 0.04) and lead aVR (80% [12 of 15] vs 56.3% [9 of 16]; <em>P =</em> 0.01). Postprocedure heart block occurred in 1 patient.</div></div><div><h3>Conclusions</h3><div>PH-VAs exhibit unique ECG features based on their origins, and can be effectively treated without affecting atrioventricular conduction.</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 2","pages":"Pages 299-312"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evaluating Pericoronary Adipose Tissue Attenuation to Predict Cardiovascular Events","authors":"Takahiro Nishihara MD, PhD , Toru Miyoshi MD, PhD , Kentaro Ejiri MD, PhD , Kazuhiro Osawa MD, PhD , Soichiro Fuke MD, PhD , Kousuke Seiyama MD , Masayuki Doi MD, PhD , Mitsutaka Nakashima MD, PhD , Takashi Miki MD, PhD , Shinsuke Yuasa MD, PhD","doi":"10.1016/j.jacasi.2024.09.009","DOIUrl":"10.1016/j.jacasi.2024.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Pericoronary adipose tissue attenuation (PCATA) is a novel imaging biomarker of pericoronary inflammation associated with coronary artery disease. Several studies have reported the usefulness of PCATA among people of European ethnicity; however, data are lacking concerning those of Asian ethnicity.</div></div><div><h3>Objectives</h3><div>This multicenter study aimed to evaluate the effect of PCATA on prognosis in East Asian patients.</div></div><div><h3>Methods</h3><div>Between August 2011 and December 2016, 2,172 patients underwent clinically indicated coronary computed tomography angiography (CTA) at 4 hospitals in Japan. Among them, 1,270 patients were analyzed. PCATA was evaluated using coronary CTA to measure pericoronary adipose tissue density surrounding the 3 major coronary arteries. The outcomes were composite cardiovascular events, including cardiovascular death and acute coronary syndrome; 33 cardiovascular events observed during a median follow-up of 6.0 years (Q1-Q3: 3.6-8.2 years).</div></div><div><h3>Results</h3><div>Right coronary artery (RCA)-PCATA was significantly higher in patients with cardiovascular events than in those without (−63.7 ± 8.9 HU vs −67.4 ± 9.1 HU, respectively; <em>P =</em> 0.021). High RCA-PCATA was significantly associated with cardiovascular events in a model that included the Hisayama risk score and adverse coronary CTA findings (HR: 1.55; 95% CI: 1.07-2.24; <em>P =</em> 0.019).</div></div><div><h3>Conclusions</h3><div>High RCA-PCATA showed significant association with future cardiovascular events after adjusting conventional risk factors and adverse coronary CTA findings in East Asian patients who underwent clinically indicated coronary CTA.</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 1","pages":"Pages 1-11"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JACC. AsiaPub Date : 2025-01-01DOI: 10.1016/j.jacasi.2024.10.021
Yang Wang MD, PhD , Han Qi PhD , Hao Jia MD , Dan Wang MD , Yue Sun MD , Bo-Wen Zhang MPH , Ming-Fei Du MD , Gui-Lin Hu MD , Zi-Yue Man MD , Chao Chu MD, PhD , Xiao-Jun Yang MPH , Teng Zhang MD , Tong-Shuai Guo MD , Xi Zhang MD , Yu Yan MD , Zheng Liu PhD , Ming-Ke Chang MD , Hao Li MD , Fang-Yao Chen PhD , Yu-Ming Kang PhD , Jian-Jun Mu MD
{"title":"Long-Term Time in Target Range for Systolic Blood Pressure Since Childhood and Midlife Arterial Stiffness","authors":"Yang Wang MD, PhD , Han Qi PhD , Hao Jia MD , Dan Wang MD , Yue Sun MD , Bo-Wen Zhang MPH , Ming-Fei Du MD , Gui-Lin Hu MD , Zi-Yue Man MD , Chao Chu MD, PhD , Xiao-Jun Yang MPH , Teng Zhang MD , Tong-Shuai Guo MD , Xi Zhang MD , Yu Yan MD , Zheng Liu PhD , Ming-Ke Chang MD , Hao Li MD , Fang-Yao Chen PhD , Yu-Ming Kang PhD , Jian-Jun Mu MD","doi":"10.1016/j.jacasi.2024.10.021","DOIUrl":"10.1016/j.jacasi.2024.10.021","url":null,"abstract":"<div><h3>Background</h3><div>Elevated blood pressure (BP) in childhood is associated with adult hypertension and arterial stiffness. However, the effect of long-term time in target range (TTR) for BP since childhood on the risk of arterial stiffness in midlife remains unclear.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to determine the independent association of TTR for systolic blood pressure (SBP) from childhood to midlife with arterial stiffness in adulthood.</div></div><div><h3>Methods</h3><div>This study used data from the ongoing cohort of the Hanzhong Adolescent Hypertension Study. SBP-TTR was assessed over 36 years, with the target ranges of SBP defined as the 90th to 95th percentile of SBP for age, sex, and height in childhood, and 110 to 130 mm Hg in adulthood. Arterial stiffness was defined as brachial-ankle pulse wave velocity >1,400 cm/s.</div></div><div><h3>Results</h3><div>Of the total 1,959 participants, 55.5% (1,088 of 1,959) were men, and the mean age was 49 years. The risk of arterial stiffness exhibited a gradual decrease with increasing SBP-TTR over the 36-year follow-up. Compared with the participants in the lowest quartile of SBP-TTR from childhood to midlife, those in the highest quartile showed significantly reduced arterial stiffness risk in midlife. This association persisted even after adjusting for mean SBP and SBP variability. Furthermore, men in the highest quartile of SBP-TTR demonstrated a markedly lower arterial stiffness risk than those in the lowest quartile, whereas this effect was not observed in women.</div></div><div><h3>Conclusions</h3><div>Higher long-term SBP-TTR from childhood to midlife is associated with a reduced risk of arterial stiffness in midlife, regardless of the mean SBP or SBP variability.</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 1","pages":"Pages 101-112"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JACC. AsiaPub Date : 2025-01-01DOI: 10.1016/j.jacasi.2024.11.021
Anna van Veelen MD, PhD, Bimmer E.P.M. Claessen MD, PhD
{"title":"Expanding the Role of Drug-Coated Balloons in Treating De Novo Coronary Artery Disease","authors":"Anna van Veelen MD, PhD, Bimmer E.P.M. Claessen MD, PhD","doi":"10.1016/j.jacasi.2024.11.021","DOIUrl":"10.1016/j.jacasi.2024.11.021","url":null,"abstract":"","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 1","pages":"Pages 25-27"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intravascular Imaging-Guided Percutaneous Coronary Intervention in Patients With End-Stage Renal Disease on Maintenance Dialysis","authors":"Chia-Pin Lin MD , Fu-Chih Hsiao MD , Ying-Chang Tung MD , Tzyy-Jer Hsu MD , Shing-Hsien Chou MD , Yu-Sheng Lin MD , Shao-Wei Chen MD, PhD , Pao-Hsien Chu MD","doi":"10.1016/j.jacasi.2024.10.006","DOIUrl":"10.1016/j.jacasi.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Patients with end-stage renal disease (ESRD) are at a higher risk of cardiovascular diseases. Intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) or intravascular ultrasound (IVUS) has been shown to result in better clinical outcomes than angiography guidance. Nevertheless, the clinical outcomes of IVI-guided PCI in ESRD patients remain uncertain.</div></div><div><h3>Objectives</h3><div>This study aimed to compare the clinical outcomes of OCT- and IVUS-guided PCIs in ESRD patients and to report the trend of IVI-guided PCI in Taiwan.</div></div><div><h3>Methods</h3><div>Patients with ESRD on maintenance dialysis, who underwent OCT- or IVUS-guided PCI from 2015 to 2021, were compared by propensity-score matching. The primary outcome was composite cardiovascular outcomes, including coronary revascularization, cardiovascular death, and acute myocardial infarction.</div></div><div><h3>Results</h3><div>In 2021, IVI was used to guide PCIs in 27% (15,613 of 57,845) of general and 27.5% (1,754 of 6,387) of ESRD patients. Among 4,759 eligible ESRD patients, 443 and 4,316 patients underwent OCT- and IVUS-guided PCIs, respectively. After matching, the incidence of the primary outcome was comparable between the OCT and IVUS groups (42.1 [95% CI: 36.2-48.0] vs 47.6 [95% CI: 43.0-52.2] events per 100 person-years; HR: 0.88; 95% CI: 0.74-1.06). The results were similar for all components of the primary outcome and in subgroup analyses.</div></div><div><h3>Conclusions</h3><div>The number of PCI- and IVI-guided procedures has progressively increased in the past decade in Taiwan in both the general and ESRD populations. Among ESRD patients on maintenance dialysis, the clinical outcomes were comparable between OCT- and IVUS-guided PCI.</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 1","pages":"Pages 28-41"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}