{"title":"Diagnostic Accuracy of Point-of-Care Ultrasound for Patients With Cardiogenic Shock - A Meta-Analysis and Systematic Review.","authors":"Takumi Osawa, Naoki Nakayama, Tomoko Ishizu, Toru Kondo, Takahiro Nakashima, Takeshi Yamamoto, Hiroyuki Hanada, Katsutaka Hashiba, Jin Kirigaya, Yumiko Hosoya, Aya Katasako-Yabumoto, Yusuke Okazaki, Masahiro Yamamoto, Kazuo Sakamoto, Marina Arai, Akihito Tanaka, Kunihiro Matsuo, Junichi Yamaguchi, Toshiaki Mano, Sunao Kojima, Teruo Noguchi, Yasushi Tsujimoto, Migaku Kikuchi, Toshikazu Funazaki, Yoshio Tahara, Hiroshi Nonogi, Tetsuya Matoba","doi":"10.1253/circrep.CR-25-0105","DOIUrl":"10.1253/circrep.CR-25-0105","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock, cardiac tamponade, and pulmonary embolism are critical conditions in cardiovascular emergencies, characterized by high mortality rates. Early diagnosis and treatment are essential to improve outcomes. Point-of-care ultrasound (POCUS) has emerged as a noninvasive tool for evaluating shock. However, further assessment through the latest meta-analyses is necessary to comprehensively evaluate its diagnostic accuracy in cardiogenic emergencies. Therefore, in this study, we conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of POCUS in patients with cardiogenic and obstructive shock.</p><p><strong>Methods and results: </strong>Up to December 31, 2023, we systematically reviewed 9 studies reporting all 4 values (true positive, false positive, false negative, and true negative) published in the PubMed, Web of Science, and CENTRAL databases: 8 studies assessed cardiac shock, and 8 assessed obstructive shock separately. For cardiac shock, the pooled sensitivity was 86.1% (95% confidence interval [CI]: 71.5-93.9%), and specificity was 95.8% (95% CI: 94.0-97.2%). For obstructive shock, the pooled sensitivity was 77.5% (95% CI: 62.5-87.6%) and specificity was 97.6% (95% CI: 93.9-99.1%). The area under the curve was 0.96 (95% CI: 0.95-0.98) for cardiogenic shock and 0.94 (95% CI: 0.88-0.98) for obstructive shock.</p><p><strong>Conclusions: </strong>This meta-analysis suggested that POCUS has reasonable diagnostic accuracy for cardiogenic and obstructive shock, particularly with high pooled specificity.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 9","pages":"727-734"},"PeriodicalIF":1.1,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12419987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042949","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":"Timing of Catheter Ablation for Ventricular Tachycardia and Prognosis After Emergent Hospitalization - Results From the JROAD-DPC Database.","authors":"Mai Ishiwata, Koshiro Kanaoka, Reina Tonegawa-Kuji, Yoko Sumita, Toshihiro Nakamura, Satoshi Oka, Yuichiro Miyazaki, Akinori Wakamiya, Nobuhiko Ueda, Kenzaburo Nakajima, Tsukasa Kamakura, Mitsuru Wada, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Kengo Kusano, Takeshi Aiba","doi":"10.1253/circrep.CR-25-0037","DOIUrl":"10.1253/circrep.CR-25-0037","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation (CA) for ventricular tachycardia (VT) is an effective treatment for preventing VT recurrence. However, the optimal timing and outcomes of CA for VT during emergent admission remains unclear.</p><p><strong>Methods and results: </strong>We retrospectively investigated patients who underwent CA for VT after emergent admission between 2012 and 2021 using the Japanese Registry of All Cardiac and Vascular Diseases database. The clinical characteristics, complication and outcomes (primary outcome: in-hospital death; secondary outcome: emergent re-admission for VT within 30 days) were compared between the patients who underwent CA within (CA ≤3) and after (CA >3) the third day of admission. A total of 3,827 patients (787 patients had CA ≤3 days, and 3,040 patients had CA >3 days) was enrolled. Compared with the CA >3 days group, those with CA ≤3 were younger and had less comorbidities of underlying heart diseases and medications. After adjusting for baseline characteristics, CA ≤3 days or >3 days after emergent admission was not associated with in-hospital death and re-admission for VT. Furthermore, the emergent re-admission and overall complication rates were not significantly different between the 2 groups.</p><p><strong>Conclusions: </strong>The clinical background differed substantially between patients who underwent CA within 3 days and those who underwent CA later during emergency hospitalization. An emergency CA for VT is not strongly recommended; however, it might be acceptable in cases with unavoidable circumstances.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 9","pages":"756-763"},"PeriodicalIF":1.1,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12419941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042903","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":"Differences in P2Y<sub>12</sub> Reaction Units Between Prasugrel and Clopidogrel by Ischemic Cerebrovascular Disease Subtypes - Subanalysis From ACUTE-PRAS.","authors":"Shigeru Fujimoto, Yasuyuki Iguchi, Hiroshi Yamagami, Masatoshi Koga, Ryo Itabashi, Yusuke Yakushiji, Kazuma Kowata, Naoto Kimura, Yuka Terasawa, Takahiro Shimizu, Yuichi Miyazaki, Koichi Oki, Osamu Masuo, Hideki Matsuoka, Shuji Arakawa, Toshihiro Ueda, Ryota Tanaka, Wataru Hashimoto, Satoru Abe, Go Kato, Taketoshi Furugori, Kazumi Kimura","doi":"10.1253/circrep.CR-25-0077","DOIUrl":"10.1253/circrep.CR-25-0077","url":null,"abstract":"<p><strong>Background: </strong>We previously reported that prasugrel treatment resulted in stable inhibition of platelet aggregation compared with clopidogrel in patients with acute large artery atherosclerosis (LAA) or high-risk transient ischemic attack (TIA). However, the differences by disease subtypes were not assessed. This subgroup analysis of the open-label ACUTE-PRAS study examined differences in P2Y<sub>12</sub> reaction units between prasugrel and clopidogrel by disease subtypes (acute LAA and high-risk TIA).</p><p><strong>Methods and results: </strong>We measured platelet reaction units (PRU) by disease subtypes for each treatment arm. Eighty-eight patients were included in each treatment arm in the full analysis. In the prasugrel group, there were 61 (69.3%) patients with LAA and 27 (30.7%) patients with high-risk TIA. In the clopidogrel group, there were 64 (72.7%) patients with LAA and 24 (27.3%) patients with high-risk TIA. Among patients with LAA, PRU at Day 5 were numerically lower in the prasugrel group than in the clopidogrel group (arithmetic mean±standard deviation at Day 5: 128.8±49.0 vs. 178.9±60.5). In contrast, PRU at Day 5 were similar between prasugrel and clopidogrel in patients with high-risk TIA.</p><p><strong>Conclusions: </strong>Prasugrel may have the potential to elicit stronger platelet aggregation inhibitory effects compared with clopidogrel in patients with acute LAA.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 9","pages":"817-825"},"PeriodicalIF":1.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042956","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}
Circulation reportsPub Date : 2025-07-15eCollection Date: 2025-09-10DOI: 10.1253/circrep.CR-25-0096
Masayuki Goto
{"title":"Physiological Changes in the Cardiovascular System During Space Flight - Current Countermeasures and Future Vision.","authors":"Masayuki Goto","doi":"10.1253/circrep.CR-25-0096","DOIUrl":"10.1253/circrep.CR-25-0096","url":null,"abstract":"<p><strong>Background: </strong>With the recent acceleration of manned space exploration, health care in space has become an important issue. Cardiovascular problems, mainly caused by the microgravity environment in space, include decreased red blood cell volume, myocardial atrophy and aerobic capacity, and reduced orthostatic tolerance after return. However, complete physiological countermeasures have not been established and more research is needed.</p><p><strong>Methods and results: </strong>A search on PubMed was conducted for English-language articles on cardiovascular changes in space and their countermeasures and post return rehabilitation. Early in space flight, diuresis associated with fluid shifts causes changes in erythrocyte volume, and after prolonged stays, the vestibular and cardiocirculatory systems are induced to show orthostatic intolerance due to decreased blood pressure increasing reflexes, decreased circulating plasma volume, and myocardial atrophy. The main countermeasures include aerobic exercise and strength training in space 6 days a week, for approximately 2 h a day, and a rehabilitation program after return to re-adapt to the Earth's gravitational environment.</p><p><strong>Conclusions: </strong>In the near future, when people with heart disease and the elderly will fly in space, new health management techniques that combine the knowledge accumulated in space flight and cardiac rehabilitation on the ground will be necessary for in-flight countermeasures against cardiovascular changes in space and for post-return rehabilitation.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 9","pages":"742-749"},"PeriodicalIF":1.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12419952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042965","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":"Rationale and Design of the ESPIAL Trial - A Prospective, Randomized, Exploratory Study to Evaluate the Effect of Esaxerenone on Reduction of Urinary Albumin to Creatinine Ratio in Hypertensive Patients Concomitant With Heart Failure and Albuminuria.","authors":"Shinichiro Suna, Yuki Matsumoto, Katsuyuki Niki, Hiroshi Asanuma, Yoshiharu Higuchi, Yoshio Yasumura, Takahiko Kawarabayashi, Masahiro Izumi, Yoshitaka Okuhara, Shinji Hasegawa, Akiko Goda, Yasunori Ueda, Takao Maruyama, Yasushi Sakata, Yasuo Okumura, Masataka Igeta, Tetsuya Takagawa, Masanori Asakura, Masaharu Ishihara","doi":"10.1253/circrep.CR-25-0070","DOIUrl":"10.1253/circrep.CR-25-0070","url":null,"abstract":"<p><strong>Background: </strong>Hypertension and coronary artery disease (CAD) are predominant factors of heart failure (HF). The American College of Cardiology/American Heart Association and the Japanese Circulation Society/Japanese Heart Failure Society stages of HF emphasize the development and progression of disease, and advanced stages and progression are associated with reduced survival. In patients with new-onset or worsening HF, albuminuria is consistently associated with clinical and circulating biomarkers of congestion. Esaxerenone is an oral, non-steroidal, selective mineralocorticoid receptor antagonist. It has not been elucidated whether esaxerenone reduces the urinary albumin-to-creatinine ratio (UACR) in hypertensive patients concomitant with HF and albuminuria.</p><p><strong>Methods and results: </strong>The ESPIAL trial (jRCTs 051210066) is a multicenter, randomized, open-label, active-controlled, parallel-group, exploratory, investigator-initiated clinical study to evaluate whether esaxerenone reduces UACR in hypertensive patients concomitant with HF and albuminuria. This study enrolled hypertensive patients concomitant with HF and albuminuria. The patients were randomized to an esaxerenone group or an amlodipine group in a 1 : 1 ratio. The primary outcome was the ratio of UACR before treatment and 24 weeks after treatment.</p><p><strong>Conclusions: </strong>The ESPIAL trial evaluates the effect of esaxerenone on reduction of UACR in hypertensive patients concomitant with HF and albuminuria.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 9","pages":"826-831"},"PeriodicalIF":1.1,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12419988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042919","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":"Use of a Pulmonary Artery Catheter in Patients With Cardiogenic Shock - A Systematic Review and Meta-Analysis.","authors":"Toru Kondo, Takahiro Nakashima, Takeshi Yamamoto, Naoki Nakayama, Hiroyuki Hanada, Katsutaka Hashiba, Jin Kirigaya, Tomoko Ishizu, Yumiko Hosoya, Aya Katasako-Yabumoto, Yusuke Okazaki, Masahiro Yamamoto, Kazuo Sakamoto, Marina Arai, Takumi Osawa, Akihito Tanaka, Kunihiro Matsuo, Junichi Yamaguchi, Toshiaki Mano, Sunao Kojima, Teruo Noguchi, Yasushi Tsujimoto, Migaku Kikuchi, Toshikazu Funazaki, Yoshio Tahara, Hiroshi Nonogi, Tetsuya Matoba","doi":"10.1253/circrep.CR-25-0088","DOIUrl":"10.1253/circrep.CR-25-0088","url":null,"abstract":"<p><strong>Background: </strong>A pulmonary artery catheter (PAC) provides detailed hemodynamic data, and managing a patient with cardiogenic shock (CS) using a PAC potentially improves patient outcomes. Therefore, in this systematic review and meta-analysis we aimed to evaluate whether a PAC is associated with better outcomes in patients with CS.</p><p><strong>Methods and results: </strong>Studies comparing PAC and non-PAC management in patients with CS were identified from the PubMed, Web of Science, and CENTRAL databases. There were no randomized controlled trials (RCTs). Of the 19 studies that met the inclusion criteria, 12 without a critical risk of bias were analyzed. PAC use was associated with lower in-hospital mortality when evaluated as a dichotomous outcome. Similar trends were observed in the time-to-event analyses. Substantial heterogeneity was observed across the studies. Subgroup analysis revealed better outcomes with PAC in patients with CS related to heart failure, but not in those with acute coronary syndrome. Sensitivity analyses, which included studies with a critical risk of bias, showed consistent trends favoring PAC use for crude in-hospital mortality. The overall certainty of the evidence was very low because of inconsistencies and biases.</p><p><strong>Conclusions: </strong>The PAC-guided CS management was associated with better in-hospital mortality, particularly in patients with heart failure-related CS. However, RCTs that evaluated the efficacy of PAC use as a primary purpose were not included, necessitating further RCTs to confirm these findings.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 8","pages":"589-598"},"PeriodicalIF":1.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818966","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":"Feasibility and Safety of Atrial Biopsy - Evidence From 1,000 Cases.","authors":"Toyokazu Otsubo, Kodai Shinzato, Takanori Yamaguchi, Kana Nakashima, Yuya Takahashi, Kotaro Tsuruta, Makoto Edayoshi, Shigeki Shichida, Ryosuke Osako, Yuki Nishimura, Yuki Kawano, Kensuke Yokoi, Akira Fukui, Kei Hirota, Masateru Takigawa, Kai Miyazaki, Yukako Shintani-Domoto, Kaoru Ito, Shigehisa Aoki, Atsushi Kawaguchi, Seitaro Nomura, Tetsuo Sasano, Naohiko Takahashi, Koichi Node","doi":"10.1253/circrep.CR-25-0101","DOIUrl":"10.1253/circrep.CR-25-0101","url":null,"abstract":"<p><strong>Background: </strong>Atrial biopsy is technically challenging owing to the atria's thin walls and relatively thick endocardium. This study assessed the feasibility and safety of echocardiography-guided atrial biopsy in a consecutive cohort of 1,000 patients who underwent catheter ablation for atrial tachyarrhythmias or percutaneous left atrial (LA) appendage occlusion.</p><p><strong>Methods and results: </strong>Atrial biopsy was performed at the limbus of the fossa ovalis through the femoral vein using a 5.5-Fr (n=233) or a 7.0-Fr (n=767) bioptome under intracardiac (n=963) or transesophageal (n=37) echocardiography guidance, alongside fluoroscopy. For histological analysis, 5 tissue samples were collected from the same site. Biopsy was successfully completed in 996 (99.6%) patients. Patients were divided based on histological depth into Group A (biopsy beyond the endocardium; n=885) and Group B (endocardial-only biopsy; n=111). Multivariable logistic regression identified larger LA volume, use of a 5.5-Fr bioptome, and amyloid deposition as independent predictors of Group B (P=0.009, P<0.001, and P=0.001, respectively). Moreover, biopsy-related complications were unrecorded.</p><p><strong>Conclusions: </strong>Echocardiography-guided atrial biopsy is a feasible and safe technique. However, atrial enlargement, smaller bioptome size, and amyloid deposition are associated with unsuccessful endocardial penetration and collection of myocardial tissue.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 9","pages":"764-773"},"PeriodicalIF":1.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12419951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042935","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":"Comparison of Short-Term Clinical Outcomes Between Intravascular Lithotripsy and Rotational Atherectomy for Calcified Coronary Stenosis in Patients With Acute Coronary Syndrome.","authors":"Yasuhiro Honda, Kensaku Nishihira, Nehiro Kuriyama, Makoto Takamatsu, Keisuke Yamamoto, Shun Nishino, Kosuke Kadooka, Takeaki Kudo, Kenji Ogata, Toshiyuki Kimura, Kengo Ayabe, Keiichi Ashikaga, Yoshisato Shibata","doi":"10.1253/circrep.CR-25-0086","DOIUrl":"10.1253/circrep.CR-25-0086","url":null,"abstract":"<p><strong>Background: </strong>The optimal revascularization strategy for calcified lesions in patients with acute coronary syndrome (ACS) remains unclear. This study aimed to compare the short-term outcomes of intravascular lithotripsy (IVL) and rotational atherectomy (RA) for patients with ACS resulting from calcified lesions.</p><p><strong>Methods and results: </strong>Among 3,556 consecutive patients with ACS who underwent primary percutaneous coronary intervention (PCI) between 2016 and 2024, we retrospectively analyzed 52 patients who received drug-eluting stents with either IVL (n=24) or RA (n=28) for calcified lesions. The primary outcome was the incidence of major adverse cardiovascular events (MACE). In addition, we evaluated slow-flow or no-reflow phenomena incidence during PCI and the procedural success rate. Compared with patients with RA, those with IVL had a smaller preprocedural minimum lumen diameter and a larger preprocedural reference vessel diameter. Primary outcomes and procedural success rates were comparable between both groups. However, the slow-flow or no-reflow incidence was significantly lower in the IVL group than in the RA group. After adjusting for confounders, IVL was independently associated with a lower slow-flow or no-reflow incidence.</p><p><strong>Conclusions: </strong>In patients with ACS due to calcified lesions, there was no significant difference in 30-day MACE incidence between both groups. However, slow-flow incidence was lower in the IVL group.</p>","PeriodicalId":94305,"journal":{"name":"Circulation reports","volume":"7 8","pages":"612-618"},"PeriodicalIF":1.1,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818957","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}
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