Circulation reports最新文献

{"title":"Effectiveness of Guideline-Directed Medical Therapy for Acute Heart Failure With Reduced Ejection Fraction in Frail Elderly Patients With Malnutrition.","authors":"Yoshimitsu Takaoka, Mahbubur Rahman, Taku Asano, Yasufumi Kijima, Jiro Aoki","doi":"10.1253/circrep.CR-25-0003","DOIUrl":"https://doi.org/10.1253/circrep.CR-25-0003","url":null,"abstract":"<p><strong>Background: </strong>The appropriateness of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) in malnourished elderly patients is unclear. This study aims to assess the effects of GDMT on acute heart failure (AHF) with reduced ejection fraction in this specific population using the Geriatric Nutritional Risk Index (GNRI).</p><p><strong>Methods and results: </strong>We retrospectively collected data of patients aged >75 years who were admitted to St. Luke's International Hospital for AHF with reduced ejection fraction from 2011 to 2022. Malnutrition was defined as a GNRI score <92. GDMT was defined as the prescription of 3 or more of the medications for HFrEF at the time of discharge. Among 467 patients, 345 (73.9%) had malnutrition. In the low GNRI group, GDMT was associated with a lower all-cause mortality at 1 year (HR 0.46; 95% CI 0.24-0.89; P=0.021), but not in heart failure (HF) readmission (HR 0.83; 95% CI 0.55-1.25; P=0.364) at 1 year after discharge. In the high GNRI group, GDMT was not significantly associated with these outcomes (all-cause mortality: HR 0.59; 95% CI 0.12-3.06; P=0.534; HF readmission: HR 0.55; 95% CI 0.29-1.05; P=0.069).</p><p><strong>Conclusions: </strong>Implementation of GDMT in AHF with reduced ejection fraction may enhance prognosis, even among elderly patients with malnutrition.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 4","pages":"267-274"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056597","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":"Machine-Learning-Based Prediction of Exercise Intolerance of Patients With Heart Failure Using Pragmatic Submaximal Exercise Parameters.","authors":"Taishi Kato, Hidetsugu Asanoi, Tomohito Ohtani, Yasushi Sakata","doi":"10.1253/circrep.CR-24-0135","DOIUrl":"https://doi.org/10.1253/circrep.CR-24-0135","url":null,"abstract":"<p><strong>Background: </strong>Low peak oxygen uptake (V̇O₂), especially ≤14 mL/min/kg, is a strong indicator of poor prognosis in patients with heart failure (HF). However, measuring this parameter is sometimes difficult if the maximal workload is not reached. This study developed a predictive classification model for low peak V̇O₂ in HF patients using machine learning (ML).</p><p><strong>Methods and results: </strong>We retrospectively analyzed the data for 343 patients with chronic HF and left ventricular ejection fraction <50% who underwent a symptom-limited cardiopulmonary exercise test and extracted 33 variables from their laboratory, echocardiographic, and exercise data up to the submaximal workload. The dataset was randomly divided into training and testing datasets in a 4 : 1 ratio. ML methods, including an exhaustive search for predictor selection, were used, and a support vector machine algorithm was applied for model optimization. We identified 5 important predictors: age, B-type natriuretic peptide, left ventricular end-diastolic diameter, V̇O₂ at rest, and V̇O₂ at respiratory exchange ratio of 1.00. Using these 5 predictors, an optimized predictive model was validated on the testing dataset, yielding an accuracy of 85%, F1 score of 0.81, and area under the receiver operating curve of 0.94 (95% confidence interval: 0.89-1.00).</p><p><strong>Conclusions: </strong>Using readily available parameters, ML methods can enable accurate prediction of low peak V̇O₂ in patients with HF.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 4","pages":"257-266"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061320","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":"Prevalence and Determinants of Depression and Anxiety in Patients With Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension.","authors":"Yuzuki Mitsuyama, Ayumi Goda, Kaori Takeuchi, Hanako Kikuchi, Takumi Inami, Kyoko Soejima, Takashi Kohno","doi":"10.1253/circrep.CR-24-0113","DOIUrl":"https://doi.org/10.1253/circrep.CR-24-0113","url":null,"abstract":"<p><strong>Background: </strong>Depression and anxiety screening has not been adequately examined in patients with pulmonary hypertension (PH). We assessed depression and anxiety prevalence and their determinants in pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH).</p><p><strong>Methods and results: </strong>This cross-sectional study included 234 patients with PH (age 57 [42-68] years; 75% female; PAH/CTEPH/other: 103/126/5). Overall, 24% and 26% of patients had depression (Hospital Anxiety and Depression Scale [HADS]-depression score ≥8) and anxiety (HADS-anxiety score ≥8) respectively. Depression and anxiety prevalence was 18% and 19% in PAH and 27% and 30% in CTEPH, respectively. Among patients with PAH, depression was significantly associated with higher mean right atrial pressure (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.03-1.32; P=0.013), higher pulmonary vascular resistance (OR 1.08; 95% CI 1.01-1.16; P=0.034), lower arterial oxygen saturation (OR 0.89; 95% CI 0.80-0.98; P=0.021), pulmonary artery oxygen saturation (OR 0.93; 95% CI 0.87-0.99; P=0.020), and reduced use of phosphodiesterase-5 inhibitor (OR 0.30; 95% CI 0.11-0.86; P=0.025). In CTEPH, depression was significantly associated with the presence of a psychiatric disorder (OR 4.71; 95% CI 1.24-17.90; P=0.023). Anxiety was not significantly associated with any of the aforementioned parameters in PAH and CTEPH.</p><p><strong>Conclusions: </strong>Predicting depression and anxiety based on disease severity and hemodynamics was challenging, making individual assessments and approaches crucial.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 4","pages":"285-292"},"PeriodicalIF":0.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996596","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":"Caseous Calcification of the Mitral Annulus With Multiple Embolic Strokes.","authors":"Chie Ryou, Makoto Kanazawa, Jun-Ichiro Nishi, Hiroshi Yasunaga, Hideki Tashiro","doi":"10.1253/circrep.CR-24-0188","DOIUrl":"https://doi.org/10.1253/circrep.CR-24-0188","url":null,"abstract":"","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 4","pages":"313-314"},"PeriodicalIF":0.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059491","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":"Adverse Effects of Coronavirus Disease 2019 (COVID-19) on First Medical Contact to Reperfusion Time in Urban ST-Segment Elevation Myocardial Infarction Patients and Advantage of Prehospital Electrocardiography.","authors":"Kunio Yufu, Tsuyoshi Shimomura, Kyoko Kawano, Hiroki Sato, Keisuke Yonezu, Ichitaro Abe, Shotaro Saito, Hidekazu Kondo, Akira Fukui, Hidefumi Akioka, Tetsuji Shinohara, Yasushi Teshima, Teruo Sakamoto, Ryuzo Abe, Naohiko Takahashi","doi":"10.1253/circrep.CR-24-0174","DOIUrl":"https://doi.org/10.1253/circrep.CR-24-0174","url":null,"abstract":"<p><strong>Background: </strong>We have previously reported the advantages of a prehospital 12-lead electrocardiography system (P-ECG) for ST-segment elevation myocardial infarction (STEMI) patients (<i>Circ Rep</i> 2019; <i>Circ J</i> 2022, 2023). Since 2020 with Coronavirus disease 2019 (COVID-19), the patient transport situation has changed dramatically. We investigated how patient transport was changed by COVID-19. The effect of prehospital electrocardiography (ECG) was also evaluated.</p><p><strong>Methods and results: </strong>Recent urban STEMI patients who received primary percutaneous coronary intervention (PCI) using P-ECG were assigned to a P-ECG group (n=87; age 69±14 years), and comparable urban STEMI patients not using P-ECG were assigned to a Conventional group (n=87; age 71±13 years). The pre-COVID-19 period is defined as the period before the pandemic began, and the COVID-19 period is the time thereafter. In the Conventional group, first medical contact (FMC)-to-reperfusion time (110±45 vs. 90±31 min; P=0.025) and door-to-reperfusion time (89±41 vs. 70±29 min; P=0.015) in the COVID-19 period were significantly longer than in the pre-COVID-19 period. However, in the P-ECG group, there was no difference in FMC-to-reperfusion time and door-to-reperfusion time between the 2 periods. In the Conventional group, Killip class (2.0±1.3 vs. 1.1±0.5; P=0.001) and left ventricular ejection fraction (49±12 vs. 57±9.0%; P=0.002) were significantly poorer in the COVID-19 period than in the pre-COVID-19 period. However, in the P-ECG group, there was no significant difference between the 2 periods.</p><p><strong>Conclusions: </strong>During the COVID-19 pandemic, P-ECG might have provided advantages for patient transport and outcomes in urban STEMI patients.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 4","pages":"239-246"},"PeriodicalIF":0.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063735","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":"Why Is Social Reintegration Support for Patients With Left Ventricular Assist Device Necessary?","authors":"Tomoko Inoue, Naoya Sakanaka, Misato Ota, Takahisa Noma, Yoichi Yamashita, Taiko Horii, Tetsuo Minamino","doi":"10.1253/circrep.CR-25-0004","DOIUrl":"10.1253/circrep.CR-25-0004","url":null,"abstract":"<p><p>Left ventricular assist devices (LVADs) serve as critical life-sustaining therapy for patients with end-stage heart failure awaiting heart transplantation, significantly improving survival rates and enabling social reintegration. However, many patients with LVAD face multiple challenges in their daily lives and social reintegration, such as anxiety about the device, low societal awareness, and economic and psychological burdens. In Japan, where prolonged waiting periods for heart transplants are inevitable, these challenges further exacerbate the economic and psychological burdens on both patients and caregivers. We present the case of a patient with an LVAD who expressed the desire to return to employment after receiving psychological counseling, and discuss the specific outcomes and challenges of employment support. A multidisciplinary team, including physicians, psychologists, and employment specialists, developed an individualized support plan. This led to successful steps toward social reintegration, which was accomplished in collaboration with the workplace. This case highlights the importance of early intervention during the heart transplant waiting period, specifically the LVAD implantation period, along with continuous psychological, economic, and employment support to improve quality of life post-transplant. Establishing a coordinated support system that involves healthcare providers, employers, and local communities is crucial for the successful social reintegration of patients with an LVAD. Specific measures, such as regular mental health counseling and flexible employment arrangements, are essential to achieving this goal.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 3","pages":"147-153"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598709","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":"Cardiovascular Events During Treatment With Xanthine Oxidoreductase Inhibitors in Patients With Gout and Hyperuricemia in Japan　- A JMDC Claims Database Study.","authors":"Kazuomi Kario, Seigo Akari, Hiroshi Kanegae","doi":"10.1253/circrep.CR-24-0178","DOIUrl":"10.1253/circrep.CR-24-0178","url":null,"abstract":"<p><strong>Background: </strong>Studies have shown an increased risk of cardiovascular events during treatment with febuxostat vs. allopurinol, but comparative data with another xanthine oxidoreductase inhibitor (XORi), topiroxostat, are lacking. In this retrospective study we compared the incidence of cardiovascular/renal events in Japanese patients with newly diagnosed hyperuricemia and/or gout treated with allopurinol, febuxostat or topiroxostat.</p><p><strong>Methods and results: </strong>Data came from the JMDC Claims Database from September 2013-September 2019. Participants (n=24,112, age ≥20 years, ≥93% male) were diagnosed with hyperuricemia and/or gout and prescribed XORi treatment in the same month or the following month. Using a Poisson regression model, the adjusted risk (rate ratio [RR]; 95% confidence interval [CI]) of major adverse cardiovascular events was slightly lower with topiroxostat vs. allopurinol (0.63; 0.28-1.41) and febuxostat (0.64; 0.31-1.30). Adjusted risks (RR [95% CI]) for events during treatment with topiroxostat vs. febuxostat and allopurinol were 0.22 [0.10-0.48] and 0.26 [0.11-0.63], respectively, for heart failure, 0.43 [0.27-0.67] and 0.51 [0.31-0.86], respectively, for total cardiovascular events, and 0.46 [0.30-0.69] and 0.62 [0.39-0.98], respectively, for total cardiovascular + renal events. Adjusted risks of atrial fibrillation, heart failure, dialysis, total cardiovascular events, and total cardiovascular + renal events were significantly higher with febuxostat vs. allopurinol.</p><p><strong>Conclusions: </strong>Topiroxostat may provide a better tolerated option for the treatment of hyperuricemia and/or gout in Japanese patients with respect to cardiovascular events.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 3","pages":"183-190"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598696","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":"Phase 2 Study to Evaluate the Efficacy and Safety of Inhaled Nitric Oxide Therapy in Patients With Severe Right Heart Failure Associated With Pulmonary Hypertension　- Protocol for the PHiNO Study.","authors":"Jin Ueda, Akihiro Tsuji, Tatsuo Aoki, Ryotaro Asano, Takatoyo Kiko, Hiroya Hayashi, Hiroyuki Endo, Naruhiro Nishi, Ryo Takano, Shinya Fujisaki, Mitsumasa Akao, Koko Asakura, Haruko Yamamoto, Takeshi Ogo","doi":"10.1253/circrep.CR-24-0125","DOIUrl":"https://doi.org/10.1253/circrep.CR-24-0125","url":null,"abstract":"<p><strong>Background: </strong>Acute right heart failure (RHF) is a syndrome characterized by sudden right ventricular dysfunction leading to systemic hypoperfusion, which carries a poor prognosis, particularly in patients with pulmonary hypertension (PH). Early reduction of pulmonary vascular resistance (PVR) is crucial for improving RHF and reducing acute mortality. Compared with pulmonary vasodilators approved for pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH), inhaled nitric oxide (iNO) therapy has the advantages of being fast acting, an excellent selective pulmonary vasodilation, and has less effect on systemic blood pressure.</p><p><strong>Methods and results: </strong>We describe a phase II, investigator-initiated, randomized, open-label trial (Japan Registry of Clinical Trials jRCT2051220042) to evaluate the efficacy and safety of iNO therapy (INOflo® for inhalation 800 ppm), as an acute-phase treatment for severe RHF associated with PAH or CTEPH over a 1-week course. Thirty patients will be enrolled and randomized to receive the study drug, or not, in addition to conventional therapy. The primary endpoint is the change in PVR from baseline to 30 min after the start of inhalation, measured using right heart catheterization. Secondary endpoints include changes in hemodynamic parameters, arterial blood tests, and echocardiography findings, and the safety of iNO therapy, assessed through blood methemoglobin concentration, blood pressure, and adverse events.</p><p><strong>Conclusions: </strong>iNO therapy is expected to play a significant role in rapidly improving acute severe RHF associated with PH.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 4","pages":"308-312"},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056603","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":"Prognostic Value of B-Type Natriuretic Peptide Level in Patients With Heart Failure With a Higher Left Ventricular Ejection Fraction.","authors":"Nobuyuki Ohte, Shohei Kikuchi, Noriaki Iwahashi, Yoshiharu Kinugasa, Kaoru Dohi, Hiroyuki Takase, Katsuji Inoue, Takahiro Okumura, Kenta Hachiya, Emiyo Sugiura, Kenya Kusunose, Shuichi Kitada, Yoshihiro Seo","doi":"10.1253/circrep.CR-24-0172","DOIUrl":"10.1253/circrep.CR-24-0172","url":null,"abstract":"<p><strong>Background: </strong>In heart failure (HF) patients with a higher left ventricular ejection fraction (LVEF), the B-type natriuretic peptide (BNP) level is yet to be fully assessed. Accordingly, we hypothesized that the BNP level should be higher in patients with a higher LVEF range based on the previous finding that such patients were associated with a worse prognosis.</p><p><strong>Methods and results: </strong>In our multicenter, prospective, observational cohort for the composite endpoint of all-cause death and readmission due to HF, including patients with LVEF >40% at hospital discharge, we obtained LVEF, E/e', and BNP levels in 231 patients. The concurrent atrial fibrillation (AF) was confirmed by electrocardiogram. Patients were divided into HF with mildly reduced EF (HFmrEF), HF with preserved EF (HFpEF) with LVEF ≥50 and <60%, and HFpEF with LVEF ≥60%. The BNP levels were not significantly different among these groups (median [interquartile range]: 195 [110-348] vs. 242 [150-447] vs. 220 [125-320] pg/mL, respectively; P=0.422). In contrast, a BNP level of ≥377 pg/mL could significantly differentiate event-free survival (P<0.001). In the multi-covariate Cox proportional hazards model, the BNP level was significantly related to event-free survival independent of LVEF, E/e', and concurrent AF.</p><p><strong>Conclusions: </strong>Without confounding the effects of LVEF, E/e', and concurrent AF, higher BNP levels are significantly and independently associated with event-free survival in HF patients with LVEF>40%.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 3","pages":"191-197"},"PeriodicalIF":0.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598706","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":"Clinical Features of Acute on Chronic Lower Limb Ischemia and the Importance of Underlying Arterial Disease for Revascularization.","authors":"Tsutomu Doita, Shinsuke Kikuchi, Yuya Tamaru, Takayuki Uramoto, Kazuki Takahashi, Keisuke Kamada, Seima Ohira, Hiroya Moriyama, Takamitsu Tatsukawa, Naoya Kuriyama, Yuri Yoshida, Daiki Uchida, Keisuke Miyake, Shigeru Miyagawa, Nobuyoshi Azuma","doi":"10.1253/circrep.CR-24-0173","DOIUrl":"10.1253/circrep.CR-24-0173","url":null,"abstract":"<p><strong>Background: </strong>Acute lower extremity limb ischemia (ALI) is a common vascular surgery emergency, primarily caused by embolism or atherosclerotic in situ thrombosis-acute on chronic limb ischemia (AoCLI). This study aimed to examine the clinical features and treatment challenges of AoCLI.</p><p><strong>Methods and results: </strong>Between January 2014 and December 2022, 73 patients with AoCLI (n=35) or embolic ALI (n=38) were analyzed. The time from ALI onset was significantly longer (P<0.01), and the rate of contralateral diseases was higher in AoCLI than embolic ALI (P<0.01). Treatment and intraoperative findings showed higher rates of failed thrombectomy (P=0.027), difficulty in crossing lesions (P<0.01), defined as failure of Fogarty catheter crossing despite guidewire navigation and requirement of the balloon angioplasty for the lesions, additional revascularization (P<0.01), and multi-segment treatment (P<0.01) in AoCLI. In multivariate analysis, unfavorable factors for endovascular therapy (EVT) were >2.5 days from ALI onset (odds ratio [OR] 1.4; 95% confidence interval [CI] 1.0-2.0), non-atrial fibrillation (OR 4.2; 95% CI 1.0-16.7), and collateral development (OR 9.0; 95% CI 1.0-81.5). Rates of failed EVT were 0% for no factors, 18% for 1 factor, 43% for 2 factors, and 90% for 3 factors.</p><p><strong>Conclusions: </strong>AoCLI had more complex and multi-segment arterial lesions, making limb perfusion restoration difficult. The unfavorable factors for EVT could help stratify the optimal treatment of ALI in emergency settings.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 3","pages":"168-175"},"PeriodicalIF":0.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598698","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}