Background: Left heart abnormalities are risk factors for heart failure. However, echocardiography is not always available. Electrocardiograms (ECGs), which are now available from wearable devices, have the potential to detect these abnormalities. Nevertheless, whether a model can detect left heart abnormalities from single Lead I ECG data remains unclear.
Methods and Results: We developed Lead I ECG models to detect low ejection fraction (EF), wall motion abnormality, left ventricular hypertrophy (LVH), left ventricular dilatation, and left atrial dilatation. We used a dataset comprising 229,439 paired sets of ECG and echocardiography data from 8 facilities, and validated the model using external verification with data from 2 facilities. The area under the receiver operating characteristic curves of our model was 0.913 for low EF, 0.832 for wall motion abnormality, 0.797 for LVH, 0.838 for left ventricular dilatation, and 0.802 for left atrial dilatation. In interpretation tests with 12 cardiologists, the accuracy of the model was 78.3% for low EF and 68.3% for LVH. Compared with cardiologists who read the 12-lead ECGs, the model’s performance was superior for LVH and similar for low EF.
Conclusions: From a multicenter study dataset, we developed models to predict left heart abnormalities using Lead I on the ECG. The Lead I ECG models show superior or equivalent performance to cardiologists using 12-lead ECGs.
Circulation Journal Awards for the Year 2024
First Place in the Clinical Investigation Section
Background: In 2018, diagnostic criteria were introduced for IgG4-related periaortitis/periarteritis and retroperitoneal fibrosis (PA/RPF). This study assessed the existing criteria and formulated an improved version.
Methods and Results: Between August 2022 and January 2023, we retrospectively analyzed 110 Japanese patients diagnosed with IgG4-related disease (IgG4-RD) involving cardiovascular and/or retroperitoneal manifestations, along with 73 non-IgG4-RD patients (“mimickers”) identified by experts. Patients were stratified into derivation (n=88) and validation (n=95) groups. Classification as IgG4-RD or non-IgG4-RD was based on the 2018 diagnostic criteria and various revised versions. Sensitivity and specificity were calculated using experts’ diagnosis as the gold standard for the diagnosis of true IgG4-RD and mimickers. In the derivation group, the 2018 criteria showed 58.5% sensitivity and 100% specificity. The revised version, incorporating “radiologic findings of pericarditis”, “eosinophilic infiltration or lymphoid follicles”, and “probable diagnosis of extra-PA/-RPF lesions”, improved sensitivity to 69.8% while maintaining 100% specificity. In the validation group, the original and revised criteria had sensitivities of 68.4% and 77.2%, respectively, and specificities of 97.4% and 94.7%, respectively.
Conclusions: Proposed 2023 revised IgG4-related cardiovascular/retroperitoneal disease criteria show significantly enhanced sensitivity while preserving high specificity, achieved through the inclusion of new items in radiologic, pathological, and extra-cardiovascular/retroperitoneal organ categories.
Circulation Journal Awards for the Year 2024
Second Place in the Clinical Investigation Section
Background: Takayasu arteritis, affecting primarily young women, damages large arteries and organs. We examined the impact of disease duration and sex on organ damage and quality of life using Japan’s Intractable Disease Registry.
Methods and Results: After refining data, 2,013 of 2,795 patients were included in the study. Longer disease duration was related to a lower prevalence of disease activity symptoms, a higher prevalence of organ damage, and a higher proportion of patients requiring nursing care. Compared with men, women tended to have an earlier onset age, exhibiting longer disease duration. A higher proportion of women had aortic regurgitation and required nursing care. The proportion of female patients in employment was lower than that of the general female population, whereas no difference was observed between male patients and the general male population. Logistic regression analysis revealed that age at surveillance, brain ischemia, visual impairment/loss, and ischemic heart disease were significant factors associated with high nursing care needs (Level ≥2, with daily activity limitations).
Conclusions: Early diagnosis and effective treatment, particularly to prevent brain ischemia, visual impairment, and ischemic heart disease, may improve the quality of life of patients with Takayasu arteritis, especially women.
Circulation Journal Awards for the Year 2024
Second Place in the Clinical Investigation Section
Background: Abnormal coronary microcirculation is linked to poor patient prognosis, so the aim of the present study was to assess the prognostic relevance of basal microvascular resistance (b-IMR) in patients without functional coronary stenosis.
Methods and Results: Analyses of 226 patients who underwent intracoronary physiological assessment of the left anterior descending artery included primary endpoints of all-cause death and heart failure, as well as secondary endpoints of cardiovascular death and atherosclerotic vascular events. During a median follow-up of 2 years, there were 12 (5.3%) primary and 21 (9.3 %) secondary endpoints. The optimal b-IMR cutoff for the primary endpoints was 47.1 U. Kaplan-Meier curve analysis demonstrated worse event-free survival of the primary endpoints in patients with a b-IMR below the cutoff (χ2=21.178, P<0.001). b-IMR was not significantly associated with the secondary endpoints (P=0.35). A low coronary flow reserve (CFR; <2.5) had prognostic value for both endpoints (primary endpoints: χ2=11.401, P=0.001; secondary endpoints: (χ2=6.015; P=0.014), and high hyperemic microvascular resistance (≥25) was associated only with the secondary endpoints (χ2=4.420; P=0.036). Incorporating b-IMR into a clinical model that included CFR improved the Net Reclassification Index and Integrated Discrimination Improvement for predicting the primary endpoints (P<0.001 and P=0.034, respectively).
Conclusions: b-IMR may be a specific marker of the risk of death and heart failure in patients without functional coronary stenosis.
Circulation Journal Awards for the Year 2024
Second Place in the Clinical Investigation Section
Background: Proton pump inhibitors (PPIs) reportedly reduce upper gastrointestinal bleeding (UGIB) in patients undergoing percutaneous coronary intervention (PCI). However, whether the benefits of PPIs differ in high-risk subgroups is unknown.
Methods and Results: Among 24,563 patients undergoing first PCI in the CREDO-Kyoto registry Cohort-2 and -3, we evaluated long-term effects of PPI for UGIB, defined as GUSTO moderate/severe bleeding, in several potential high-risk subgroups. In the study population, 45.6% of patients were prescribed PPIs. Over a median 5.6-year follow-up, PPIs were associated with lower adjusted risk of UGIB (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.50–0.80; P<0.001) and a non-significant but numerically lower risk of any gastrointestinal bleeding (HR 0.84; 95% CI 0.71–1.01; P=0.06). PPIs were not associated with a lower risk of GUSTO moderate/severe bleeding (HR 1.04; 95% CI 0.94–1.15; P=0.40) or a higher adjusted risk of myocardial infarction or ischemic stroke (HR 1.00; 95% CI 0.90–1.12; P=0.97), but were associated with higher adjusted mortality risk (HR 1.18; 95% CI 1.09–1.27; P<0.001). The effects of PPIs for UGIB, myocardial infarction or ischemic stroke, and all-cause death were consistent regardless of age, sex, acute coronary syndrome, high bleeding risk, oral anticoagulant use, and type of P2Y12inhibitor.
Conclusions: PPIs were associated with a lower risk of UGIB and a neutral risk of ischemic events regardless of high-risk subgroup.
Circulation Journal Awards for the Year 2024
Second Place in the Clinical Investigation Section
JCS/JHFS 2025 Guideline on Diagnosis and Treatment of Heart Failure
Released on J-STAGE: June 25, 2025 |
Article ID CJ-25-0002
Takeshi Kitai, Shun Kohsaka, Takao Kato, Eri Kato, Kimi Sato, Kanako Teramoto, Hidenori Yaku, Eiichi Akiyama, Masahiko Ando, Chisato Izumi, Tomomi Ide, Yu-ki Iwasaki, Yohei Ohno, Takahiro Okumura, Neiko Ozasa, Shuichiro Kaji, Takeshi Kashimura, Hiroaki Kitaoka, Yoshiharu Kinugasa, Shintaro Kinugawa, Koichi Toda, Toshiyuki Nagai, Makiko Nakamura, Shungo Hikoso, Masatoshi Minamisawa, Satoru Wakasa, Yuta Anchi, Shogo Oishi, Akiko Okada, Masaru Obokata, Nobuyuki Kagiyama, Naoko P. Kato, Takashi Kohno, Takuma Sato, Yasuyuki Shiraishi, Yodo Tamaki, Yuichi Tamura, Kazuya Nagao, Yuji Nagatomo, Naoko Nakamura, Kotaro Nochioka, Akihiro Nomura, Seitaro Nomura, Yu Horiuchi, Atsushi Mizuno, Ryosuke Murai, Takayuki Inomata, Koichiro Kuwahara, Yasushi Sakata, Hiroyuki Tsutsui, Koichiro Kinugawa, on behalf of the Japanese Circulation Society and the Japanese Heart Failure Society Joint Working Group
Views: 2,399
JCS/JHRS 2024 Guideline Focused Update on Management of Cardiac Arrhythmias
Released on J-STAGE: February 14, 2025 |
Article ID CJ-24-0073
Yu-ki Iwasaki, Takashi Noda, Masaharu Akao, Tadashi Fujino, Teruyuki Hirano, Koichi Inoue, Kengo Kusano, Toshiyuki Nagai, Kazuhiro Satomi, Tetsuji Shinohara, Kyoko Soejima, Yohei Sotomi, Shinya Suzuki, Teiichi Yamane, Tsukasa Kamakura, Hiroyuki Kato, Arimi Katsume, Yusuke Kondo, Kenji Kuroki, Hisaki Makimoto, Hiroshige Murata, Takafumi Oka, Nobuaki Tanaka, Nobuhiko Ueda, Hiro Yamasaki, Seigo Yamashita, Ryobun Yasuoka, Kenji Yodogawa, Kazutaka Aonuma, Takanori Ikeda, Toru Minamino, Hideo Mitamura, Akihiko Nogami, Ken Okumura, Hiroshi Tada, Takashi Kurita, Wataru Shimizu, on behalf of the Japanese Circulation Society and Japanese Heart Rhythm Society Joint Working Group
Views: 799
JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease
Released on J-STAGE: December 09, 2022 |
Article ID CJ-22-0234
Shigeru Makita, Takanori Yasu, Yoshihiro J Akashi, Hitoshi Adachi, Hideo Izawa, Shunichi Ishihara, Yoshitaka Iso, Hideo Ohuchi, Kazuto Omiya, Yusuke Ohya, Koichi Okita, Yutaka Kimura, Akira Koike, Masahiro Kohzuki, Shinji Koba, Masataka Sata, Kazunori Shimada, Tomoki Shimokawa, Hirokazu Shiraishi, Naokata Sumitomo, Tetsuya Takahashi, Tomoyuki Takura, Hiroyuki Tsutsui, Masatoshi Nagayama, Emiko Hasegawa, Yoshihiro Fukumoto, Yutaka Furukawa, Shin-ichiro Miura, Satoshi Yasuda, Sumio Yamada, Yuichiro Yamada, Dai Yumino, Toshiko Yoshida, Takuji Adachi, Toshimi Ikegame, Kazuhiro P Izawa, Takeshi Ishida, Neiko Ozasa, Naohiko Osada, Hiroaki Obata, Naoya Kakutani, Yusuke Kasahara, Masaaki Kato, Kentaro Kamiya, Shintaro Kinugawa, Yuji Kono, Yasuyuki Kobayashi, Teruyuki Koyama, Kazuhiro Sase, Shinji Sato, Tatsuhiro Shibata, Norio Suzuki, Daisuke Tamaki, Minako Yamaoka-Tojo, Michio Nakanishi, Eisaku Nakane, Mari Nishizaki, Taiki Higo, Kanta Fujimi, Tasuku Honda, Yasuharu Matsumoto, Noriko Matsumoto, Ikuko Miyawaki, Makoto Murata, Shusuke Yagi, Masanobu Yanase, Midori Yamada, Miho Yokoyama, Noboru Watanabe, Haruki Ito, Takeshi Kimura, Syunei Kyo, Yoichi Goto, Ryuji Nohara, Ken-Ichi Hirata, on behalf of the Japanese Circulation Society/the Japanese Association of Cardiac Rehabilitation Joint Working Group
Views: 776
JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease
Released on J-STAGE: April 25, 2024 | Volume 88 Issue 5 Pages 763-842
Akira Fujiyoshi, Shun Kohsaka, Jun Hata, Mitsuhiko Hara, Hisashi Kai, Daisaku Masuda, Naomi Miyamatsu, Yoshihiko Nishio, Masatsune Ogura, Masataka Sata, Kenji Sekiguchi, Yasushi Takeya, Kouichi Tamura, Akihiko Wakatsuki, Hiroshi Yoshida, Yoshio Fujioka, Ryuji Fukazawa, Osamu Hamada, Aya Higashiyama, Mai Kabayama, Koshiro Kanaoka, Kenjiro Kawaguchi, Shintaro Kosaka, Ayako Kunimura, Ayumi Miyazaki, Masaki Nii, Mitsuaki Sawano, Masakazu Terauchi, Shusuke Yagi, Takashi Akasaka, Tohru Minamino, Katsuyuki Miura, Koichi Node, on behalf of the Japanese Circulation Society Joint Working Group
Views: 720
JCS 2023 Guideline on the Diagnosis and Treatment of Myocarditis
Released on J-STAGE: March 31, 2023 |
Article ID CJ-22-0696
Toshiyuki Nagai, Takayuki Inomata, Takashi Kohno, Takuma Sato, Atsushi Tada, Toru Kubo, Kazufumi Nakamura, Noriko Oyama-Manabe, Yoshihiko Ikeda, Takeo Fujino, Yasuhide Asaumi, Takahiro Okumura, Toshiyuki Yano, Kazuko Tajiri, Hiroyuki Matsuura, Yuichi Baba, Haruki Sunami, Shingo Tsujinaga, Yasutoshi Ota, Keiko Ohta-Ogo, Yusuke Ishikawa, Hideo Matama, Nobutaka Nagano, Kimi Sato, Kazushi Yasuda, Yasushi Sakata, Koichiro Kuwahara, Tohru Minamino, Minoru Ono, Toshihisa Anzai, on behalf of the Japanese Circulation Society Joint Working Group
Views: 709