Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Advance online publication
Showing 1-50 articles out of 132 articles from Advance online publication
  • Mitsuaki Sawano, Shun Kohsaka, Hideki Ishii, Yohei Numasawa, Kyohei Ya ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-21-0098
    Published: June 24, 2021
    [Advance publication] Released: June 24, 2021
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    Background:Acute coronary syndrome (ACS) hospital survivors experience a wide array of late adverse cardiac events, despite considerable advances in the quality of care. We investigated 30-day and 1-year outcomes of ACS hospital survivors using a Japanese nationwide cohort.

    Methods and Results:We studied 20,042 ACS patients who underwent percutaneous coronary intervention (PCI) in 2017: 10,242 (51%) with ST-elevation myocardial infarction (STEMI), 3,027 (15%) with non-ST-elevation myocardial infarction (NSTEMI), and 6,773 (34%) with unstable angina (UA). The mean (±SD) age was 69.6±12.4 years, 77% of the patients were men, and 20% had a previous history of PCI. The overall 30-day all-cause, cardiac, and non-cardiac mortality rates were 3.0%, 2.4%, and 0.6%, respectively. The overall 1-year incidence of all-cause, cardiac, and non-cardiac death was 7.1%, 4.2%, and 2.8%, respectively. Compared with UA patients, STEMI patients had a higher risk of all fatal events, non-fatal ischemic stroke, and acute heart failure, and NSTEMI patients had a higher risk of heart failure.

    Conclusions:The results from our ACS hospital survivor PCI database suggest the need to improve care for the acute myocardial infarction population to lessen the burden of 30-day mortality due to ACS, heart failure, and sudden cardiac death, as well as 1-year ischemic stroke and heart failure events.

  • Hiromitsu Sekizuka, Keisuke Kida
    Type: EDITORIAL
    Article ID: CJ-21-0498
    Published: June 23, 2021
    [Advance publication] Released: June 23, 2021
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  • Takafumi Nakajima, Makoto Murata, Syogo Nitta, Tatsunori Shitara, Hiro ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-20-1215
    Published: June 22, 2021
    [Advance publication] Released: June 22, 2021
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    Background:Many heart failure (HF) guidelines recommend sodium restriction for patients with HF, but the outcome of sodium restriction counseling (SRC) for HF patients is still unknown. We wanted to clarify whether SRC reduces cardiac events in patients with HF.

    Methods and Results:Overall, 800 patients (77±12 years) who were hospitalized for HF were enrolled. During HF hospitalization, patients received SRC; patients were required to have a salt intake of <6 g/day. After discharge, death or HF rehospitalization events were investigated. During a mean follow-up of 319±252 days, 83 patients died, and 153 patients were rehospitalized for HF. SRC significantly decreased all-cause death (odds ratio, 0.42; 95% confidence interval [CI], 0.23–0.76; P<0.01), especially cardiac death of hospitalized HF patients after discharge. In the multivariate analysis adjusted for age, sex, SRC, body mass index, hypertension, dyslipidemia, β-blockers, and mineralocorticoid receptor antagonist intake, cardiac rehabilitation, and the type of HF, SRC remained a significant predictor of death. Kaplan-Meier analysis showed that SRC significantly reduced deaths and the combined outcome of HF rehospitalization and death. In patients with reduced left ventricular ejection fraction, SRC significantly decreased the mortality rate (odds ratio, 0.27; 95% CI, 0.10–0.71; P<0.01).

    Conclusions:SRC reduced the mortality rate after discharge of hospitalized HF patients.

  • Kengo Kusano, Nobuyoshi Sugishita, Masaharu Akao, Hikari Tsuji, Kunihi ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-20-1244
    Published: April 02, 2021
    [Advance publication] Released: April 02, 2021
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    Supplementary material

    Background:Direct oral anticoagulants have become a standard therapy for non-valvular atrial fibrillation (NVAF). However, little is known about their effectiveness/safety when prescribed by general practitioners to treat high-risk populations such as the elderly, those who are frail or have cognitive dysfunction.

    Methods and Results:In this multicenter, prospective study, a total of 5,717 NVAF patients (mean age 73.9 years) receiving rivaroxaban were registered by general practitioners, with a maximum 3-year follow up (mean 2.0±0.5 years). The primary endpoint was a composite of stroke and systemic embolism (SE). The annual incidence (per 100 person-years) of stroke/SE was 1.23% and for major bleeding, it was 0.63%. Multivariate analyses identified age ≥75 years (hazard ratio [HR]; 2.67, P<0.001) and history of ischemic stroke (HR; 1.89, P=0.005) as significant risk factors of stroke/SE, with history of major bleeding (HR; 14.9, P<0.001) and warfarin use (HR; 2.15, P=0.002) as risk factors for major bleeding events. Neither cognitive dysfunction, defined by the receipt of anti-dementia medications, nor frailty, evaluated by the classification of the Japanese Long-term Care Insurance system, correlated with stroke/SE or major bleeding events.

    Conclusions:The low incidence of adverse events, including stroke/SE and bleeding, in patients prescribed rivaroxaban by general practitioners supports its use as a safe and efficacious treatment in the standard clinical care of high-risk patient populations.

  • Yousaku Okubo, Takehito Tokuyama, Sho Okamura, Yoshihiro Ikeuchi, Shun ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-20-1061
    Published: June 18, 2021
    [Advance publication] Released: June 18, 2021
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    Supplementary material

    Background:myBeat is a novel cutaneous patch device that continuously records electrocardiography and automatically detects atrial fibrillation (AF) by using a new algorithm based on RR intervals. We aimed to test the diagnostic ability of this novel device for screening silent AF in asymptomatic patients.

    Methods and Results:A multicenter randomized prospective clinical study was performed. To be eligible for inclusion in the study, patients had to be ≥65 years of age and have ≥1 of the following risk factors: hypertension, diabetes, heart failure, ischemic heart disease, stroke, and transient ischemic attack. Patients with prior AF, an implantable pacemaker, and previous palpitation or syncope were excluded. The 300 participants were divided into 2 groups, those using myBeat (n=150) or those undergoing 24-h Holter monitoring (control group; n=150), for AF screening. The rate of AF detection was significantly higher in the myBeat than control group (16 [10.7%] vs. 7 [4.7%], respectively; P=0.04). Multivariable logistic regression analysis revealed that prior heart failure was an independent predictor of silent AF (odds ratio 12.07; 95% confidence interval 1.67–86.27; P=0.01). A 7.7-fold difference in silent AF was found between subjects with CHA2DS2-VASc scores of 1 point and those with scores ≥4 points.

    Conclusions:The novel patch device using an original algorithm was beneficial for screening of silent AF.

  • Itta Kawamura, Toru Tanigaki, Hiroyuki Omori, Takuya Mizukami, Tetsuo ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-21-0122
    Published: June 18, 2021
    [Advance publication] Released: June 18, 2021
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    Supplementary material

    Background:Myocardial perfusion imaging (MPI) and fractional flow reserve (FFR) are established approaches to the assessment of myocardial ischemia. Recently, various FFR cutoff values were proposed, but the diagnostic accuracy of MPI in identifying positive FFR using various cutoff values is not well established.

    Methods and Results:We retrospectively studied 273 patients who underwent stress MPI and FFR within a 3-month period. Results for FFR were obtained from 218 left anterior descending artery (LAD) lesions and 207 non-LAD lesions. Stress MPI and FFR demonstrated a good correlation in the detection of myocardial ischemia. However, the positive predictive value (PPV) of FFR for detecting MPI-positive lesions at the optimal FFR thresholds was insufficient (44% for LAD and 65% for non-LAD lesions). This was caused by a sharp drop in PPV at an FFR threshold of 0.7 or more. Notably, 41% of the lesions with normal MPI demonstrated FFRs <0.80. However, MPI-negative lesions had an extremely low lesion rate with FFR <0.65 (6%). Conversely, 78% and 41% of MPI-positive lesions had FFR <0.80 and <0.65, respectively.

    Conclusions:The data confirmed that decisions based on MPI are reasonable because MPI-negative patients have an extremely low rate of lesions with a FFR below the cutoff point for a hard event, and MPI-positive lesions include many lesions with FFR <0.65.

  • Shun Kohsaka, Kenji Fukushima, Ippei Watanabe, Susumu Manabe, Nozomi N ...
    Type: REVIEW
    Article ID: CJ-21-0345
    Published: June 18, 2021
    [Advance publication] Released: June 18, 2021
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    Supplementary material

    Coronary artery disease (CAD) remains a leading cause of mortality and morbidity in developed countries. Although urgent revascularization is the cornerstone of management of acute coronary syndrome (ACS), for patients with stable CAD recent large-scale clinical trials indicate that a mechanical ‘fix’ of a narrowed artery is not obviously beneficial; ACS and stable CAD are increasingly recognized as different clinical entities. We review the perspectives on (1) modifying the diagnostic pathway of stable CAD with the incorporation of modern estimates of pretest probability, (2) non-imaging evaluations based on their availability, (3) the optimal timing of invasive coronary angiography and revascularization, and (4) the implementation of medical therapy during the work-up.

  • Shigeo Okuda, Yoshitake Yamada, Takehiro Nakahara, Masahiro Jinzaki
    Type: EDITORIAL
    Article ID: CJ-21-0388
    Published: June 18, 2021
    [Advance publication] Released: June 18, 2021
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  • Yoshinobu Murasato
    Type: EDITORIAL
    Article ID: CJ-21-0456
    Published: June 17, 2021
    [Advance publication] Released: June 17, 2021
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  • David del Val, Teresa Bastante, Carlos H. Gordillo, Rio Aguilar, Javie ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-21-0079
    Published: June 16, 2021
    [Advance publication] Released: June 16, 2021
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    Supplementary material
  • Yifen Lin, Shaozhao Zhang, Shuyi Wang, Xiangbin Zhong, Yuqi Li, Zhenyu ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-21-0109
    Published: June 15, 2021
    [Advance publication] Released: June 15, 2021
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    Background:To examine the association of low educational attainment with incident heart failure (HF) and explore potential behavioral mediators of the causal pathway.

    Methods and Results:A total of 12,109 participants in the Atherosclerosis Risk in Communities Study (ARIC) were included. Educational attainment was measured at baseline, and the risk of HF across educational attainment groups was assessed by Cox proportional hazards models. Using mediation analysis, we evaluated the mediating role of behavioral factors in the causal pathway between educational attainment and HF. During a median follow-up of 25.1 years, 2,407 cases (19.9%) of HF occurred. Educational attainment showed an inverse association with HF risk (hazard ratio (HR), 1.41; 95% confidence interval (CI), 1,26–1.57 for low educational attainment; HR, 1.13; 95% CI, 1.02–1.25 for medium educational attainment). In the mediation analysis, the association between educational attainment and HF was partially mediated by income, waist-to-hip ratio, current smoking, body mass index, current drinking, sports and physical activity, which explained 24.3%, 20.2%, 13.8%, 10.1%, 7.7%, 7.3% and 4.5%, respectively, of the relationship. In total, all mediators contributed 56.3% of the total effect.

    Conclusions:Low educational attainment was associated with increased risk for HF. Income, obesity and current smoking mediated a great proportion of the total effect of educational attainment on HF. Our results provide underlying insights for the development of targeted public health interventions to reduce educational disparities on HF incidence.

  • Phillip Rubin, Paul C. Montana
    Type: LETTER TO THE EDITOR
    Article ID: CJ-21-0453
    Published: June 15, 2021
    [Advance publication] Released: June 15, 2021
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  • Masami Kosuge, Kazuo Kimura
    Type: AUTHOR’S REPLY
    Article ID: CJ-21-0486
    Published: June 15, 2021
    [Advance publication] Released: June 15, 2021
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  • Tomonori Itoh, Nozomu Toda, Michiko Yoshizawa, Takuya Osaki, Yuko Maeg ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-20-1044
    Published: June 12, 2021
    [Advance publication] Released: June 12, 2021
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    Supplementary material

    Background:This study aimed to clarify the incidence of takotsubo syndrome (TTS) after the Great East Japan earthquake (GEJ-E) between inland and coastal areas.

    Methods and Results:Consecutive hospitalized patients with TTS were registered between 2009 and 2016 in Iwate Prefecture. Patients were divided into 2 groups, by whether they lived inland or in the coastal area (both max. seismic intensity, 6). The incidence of TTS was calculated using the standardized incidence ratio (SIR) before and after the earthquake. The long-term prognosis of the 2 groups was compared by Kaplan-Meier analysis. A total of 112 patients with TTS were registered from the acute coronary syndrome records of each hospital (n=4,163); 9 patients with TTS were registered within 2 months of the earthquake. A significant monthly variation was observed in March and April 2011 compared with the other months (P=0.029). At 2 years after the earthquake, the SIR was significantly increased in the coastal area (P<0.01), but decreased after ≥3 years. There were no significant differences in the long-term prognosis between the 2 groups (P=0.20).

    Conclusions:The incidence of TTS was increased in the acute phase after the GEJ-E, particularly in the coastal area. The magnitude of the tsunami damage is presumed to be a factor in the increased incidence of TTS, even though the seismic intensity in both areas was comparable.

  • Soshiro Ogata, Kyohei Marume, Michikazu Nakai, Ryota Kaichi, Masanobu ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-20-1207
    Published: June 12, 2021
    [Advance publication] Released: June 12, 2021
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    Supplementary material

    Background:This study aimed to calculate incidence rates (IR) of acute coronary syndrome (ACS) including acute myocardial infarction (AMI), unstable angina (UAP), and sudden cardiac death (SCD) in Nobeoka city, Japan.

    Methods and Results:This was an observational study based on a city-wide comprehensive registration between 2015 and 2017 in Nobeoka city, Japan, using 2 databases: all patients with cardiogenic out-of-hospital cardiac arrest in Nobeoka city and hospitalized ACS patients from Miyazaki Prefectural Nobeoka Hospital in which all ACS patients in Nobeoka city were hospitalized except for possible rare cases of patients highly unlikely to be hospitalized elsewhere. The IRs of ACS based on the population size of Nobeoka city (125,000 persons), and their age-adjusted IRs by using the direct method and the 2015 model population of Japan were calculated. There were 260 eligible patients hospitalized with first-onset ACS (age [SD]=71.1 [12.4], 34.2% women) and 107 eligible SCD patients. Crude IRs of hospitalized ACS and SCD patients, and hospitalized AMI and SCD patients, respectively, were 130.2 (183.3 for men, 85.6 for women) and 107.5 (148.4 for men, 73.2 for women) per 100,000. Crude IRs of hospitalized ACS, AMI, and UAP patients, respectively, were 92.3 (132.8 for men, 58.1 for women), 69.6 (97.9 for men, 45.7 for women), and 22.7 (35.0 for men, 12.4 for women) per 100,000.

    Conclusions:The calculated IRs can be useful in building a health strategy for treating ACS.

  • Shunsuke Kawamoto
    Type: EDITORIAL
    Article ID: CJ-21-0407
    Published: June 12, 2021
    [Advance publication] Released: June 12, 2021
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  • Toru Kubo, Hiroyuki Morita
    Type: EDITORIAL
    Article ID: CJ-21-0424
    Published: June 12, 2021
    [Advance publication] Released: June 12, 2021
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  • Xiao-bing Wang, Fan-xin Kong, Guan Wang, Yong-huai Wang, Chun-yan Ma
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-21-0251
    Published: June 11, 2021
    [Advance publication] Released: June 11, 2021
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    Supplementary material
  • Tomofumi Moriyama, Kei Fukami
    Type: EDITORIAL
    Article ID: CJ-21-0394
    Published: June 09, 2021
    [Advance publication] Released: June 09, 2021
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  • Lusha W. Liang, Yuichi J. Shimada
    Type: REVIEW
    Article ID: CJ-21-0349
    Published: June 08, 2021
    [Advance publication] Released: June 08, 2021
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    Endotyping is an emerging concept in which diseases are classified into distinct subtypes based on underlying molecular mechanisms. Heart failure (HF) is a complex clinical syndrome that encompasses multiple endotypes with differential risks of adverse events, and varying responses to treatment. Identifying these distinct endotypes requires molecular-level investigation involving multi-“omics” approaches, including genomics, transcriptomics, proteomics, and metabolomics. The derivation of these HF endotypes has important implications in promoting individualized treatment and facilitating more targeted selection of patients for clinical trials, as well as in potentially revealing new pathways of disease that may serve as therapeutic targets. One challenge in the integrated analysis of high-throughput omics and detailed clinical data is that it requires the ability to handle “big data”, a task for which machine learning is well suited. In particular, unsupervised machine learning has the ability to uncover novel endotypes of disease in an unbiased approach. In this review, we will discuss recent efforts to identify HF endotypes and cover approaches involving proteomics, transcriptomics, and genomics, with a focus on machine-learning methods.

  • Masatsune Ogura
    Type: EDITORIAL
    Article ID: CJ-21-0356
    Published: June 05, 2021
    [Advance publication] Released: June 05, 2021
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  • Morihiko Takeda, Nobuyuki Shiba
    Type: EDITORIAL
    Article ID: CJ-21-0358
    Published: June 05, 2021
    [Advance publication] Released: June 05, 2021
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  • Byung Joo Sun, Jae-Hyeong Park
    Type: REVIEW
    Article ID: CJ-21-0373
    Published: June 05, 2021
    [Advance publication] Released: June 05, 2021
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    Unlike the left ventricle (LV), the left atrium (LA) has a thin-walled structure and has been regarded as a simple conduit chamber. However, the unique function of the LA to modulate LV filling has recently drawn much attention. Because LA structure and function are directly influenced by the LV filling pressure, LA assessment is an essential step in the diagnosis of diastolic dysfunction that can help predict new-onset atrial fibrillation, assess the risk of further embolic events, and identify high-risk patients for adverse cardiovascular events. Even in the recent era of multimodality imaging, 2-dimensional (2D) echocardiography is the most common imaging method and the central modality for evaluation of LA function. LA strain derived from 2D echocardiography can help assess LA function objectively and demonstrates the 3 distinct phasic motions of the LA cycle. Further, LA strain provides invaluable pathophysiologic information and helps to predict clinical prognosis in various cardiovascular diseases. In this review article, we focus on LA strain: basic concepts, advantages over conventional parameters, and some unresolved issues. Additionally, we present a brief history of the clinical evidence for LA strain. Through this review, we suggest echocardiography for LA strain assessment in clinical practice.

  • Wen-Han Cheng, Yi-Hsin Chan, Jo-Nan Liao, Ling Kuo, Shih-Ann Chen, Tze ...
    Type: REVIEW
    Article ID: CJ-21-0399
    Published: June 05, 2021
    [Advance publication] Released: June 05, 2021
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    Stroke prevention is the cornerstone of management of atrial fibrillation (AF), and non-vitamin K antagonist oral anticoagulants (NOACs) are commonly prescribed. Because routine monitoring of anticoagulant effects of NOACs is not necessary, appropriate dosing following the criteria of each NOACs defined in pivotal randomized trials is important. Real-world data demonstrate that underdosing NOACs is associated with a higher risk of ischemic stroke without a lower risk of major bleeding. Furthermore, renal function of AF patients should be assessed using the Cockcroft-Gault formula to prevent overestimation that could result in overdosing of NOACs. The assessment of bleeding risk is important, and the HAS-BLED score should be used to help identify patients at high risk of bleeding (HAS-BLED score ≥3). Moreover, the HAS-BLED score should be reassessed at periodic intervals to address potentially modifiable bleeding risk factors because bleeding risks of AF patients are not static. When managing NOAC-related bleeding episodes, the possibility of occult malignancies (e.g., grastrointestinal [GI] tract cancers for patients experiencing GI bleeding and bladder cancer for patients with hematuria) should be kept in mind. Addressing all of these issues is crucial to achieving better clinical outcomes for anticoagulated AF patients. More efforts are necessary to incorporate clear and easy-to-follow recommendations about optimal management of anticoagulation into the guidelines to improve AF patient care.

  • Thien Vu, Akira Fujiyoshi, Takashi Hisamatsu, Aya Kadota, Maryam Zaid, ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-20-1090
    Published: June 04, 2021
    [Advance publication] Released: June 04, 2021
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    Supplementary material

    Background:Risk factors for atherosclerotic disease including dyslipidemia have been shown to be associated with aortic valve calcification (AVC). Nuclear magnetic resonance (NMR)-measured lipoprotein particles, low-density and high-density lipoprotein particles (LDL-p, HDL-p) in particular, have emerged as novel markers of atherosclerotic disease; however, whether NMR-measured particles are associated with AVC remains to be determined. This study aimed to examine the association between NMR-based lipoprotein particle measurements and standard lipids with AVC. The primary variables of interest were LDL-p (nmol/L), HDL-p (μmol/L), LDL-cholesterol, and HDL-cholesterol (both in mg/dL).

    Methods and Results:A community-based random sample of Japanese men aged 40–79 years examined in 2006–2008, in Shiga, Japan was studied. Presence of AVC was defined as an Agatston score >0. Lipoprotein particles were measured using NMR spectroscopy. In the main analysis, multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for the prevalence of AVC across the higher quartiles of lipids in reference to the lowest ones were obtained. Of 874 participants analyzed, 153 men had AVC. Multivariable-adjusted ORs of prevalent AVC for the highest vs. the lowest quartile were significantly elevated for LDL-p (OR, 2.20; 95% CI: 1.23–3.93) and LDL-cholesterol (OR, 2.16; 95% CI: 1.23–3.78). In contrast, neither HDL-p nor HDL-cholesterol was associated with AVC.

    Conclusions:The association of prevalent AVC with NMR-based LDL-p was comparable to that with LDL-cholesterol.

  • Hiroyuki Omori, Hideaki Ota, Takuya Mizukami, Yoshiaki Kawase, Toru Ta ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-21-0211
    Published: June 04, 2021
    [Advance publication] Released: June 04, 2021
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    Supplementary material
  • Yousuke Hashimoto, Yukio Ozaki, Shino Kan, Koichi Nakao, Kazuo Kimura, ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-20-1115
    Published: June 03, 2021
    [Advance publication] Released: June 03, 2021
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    Background:The impact of chronic kidney disease (CKD) on long-term outcomes following acute myocardial infarction (AMI) in the era of modern primary PCI with optimal medical therapy is still in debate.

    Methods and Results:A total of 3,281 patients with AMI were enrolled in the J-MINUET registry, with primary PCI of 93.1% in STEMI. CKD stage on admission was classified into: no CKD (eGFR ≥60 mL/min/1.73 m2); moderate CKD (60>eGFR≥30 mL/min/1.73 m2); and severe CKD (eGFR <30 mL/min/1.73 m2). While the primary endpoint was all-cause mortality, the secondary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause death, cardiac failure, myocardial infarction (MI) and stroke. Of the 3,281 patients, 1,878 had no CKD, 1,073 had moderate CKD and 330 had severe CKD. Pre-person-days age- and sex-adjusted in-hospital mortality significantly increased from 0.014% in no CKD through 0.042% in moderate CKD to 0.084% in severe CKD (P<0.0001). Three-year mortality and MACE significantly deteriorated from 5.09% and 15.8% in no CKD through 16.3% and 38.2% in moderate CKD to 36.7% and 57.9% in severe CKD, respectively (P<0.0001). C-index significantly increased from the basic model of 0.815 (0.788–0.841) to 0.831 (0.806–0.857), as well as 0.731 (0.708–0.755) to 0.740 (0.717–0.764) when adding CKD stage to the basic model in predicting 3-year mortality (P=0.013; net reclassification improvement [NRI] 0.486, P<0.0001) and MACE (P=0.046; NRI 0.331, P<0.0001) respectively.

    Conclusions:CKD remains a useful predictor of in-hospital and 3-year mortality as well as MACE after AMI in the modern PCI and optimal medical therapy era.

  • Hidehira Fukaya
    Type: EDITORIAL
    Article ID: CJ-21-0343
    Published: June 03, 2021
    [Advance publication] Released: June 03, 2021
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  • Yuichiro Maekawa
    Type: EDITORIAL
    Article ID: CJ-21-0371
    Published: June 03, 2021
    [Advance publication] Released: June 03, 2021
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  • Jeehoon Kang, Jung-Kyu Han, Han-Mo Yang, Kyung Woo Park, Hyun-Jae Kang ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-20-0999
    Published: June 02, 2021
    [Advance publication] Released: June 02, 2021
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    Supplementary material

    Background:It has not been determined which specific 2-stenting strategy is the best for bifurcation lesions. Our aim was to investigate the clinical outcomes of various 2-stenting strategies in the era of 2nd-generation drug-eluting stents (2G-DES).

    Methods and Results:We analyzed 454 patients who finally underwent 2-stenting for a bifurcation lesion, from among 2,648 patients enrolled in the COBIS III registry. The primary outcome was target lesion failure (TLF). Patients were analyzed according to stenting sequence (provisional [main vessel stenting first] vs. systemic [side branch stenting first]) and stenting technique (crush vs. T vs. culotte vs. kissing/V stenting). Overall, 4.4 years’ TLF after 2-stenting treatment for bifurcation lesion was excellent: TLF 11.2% and stent thrombosis 1.3%. There was no difference in TLF according to 2-stenting strategy (11.1% vs. 10.5%, P=0.990 for provisional and systemic sequence; 8.6% vs. 14.4% vs. 12.9% vs. 12.2%, P=0.326 for crush, T, culotte, kissing/V technique, respectively). Only left main (LM) disease and a shorter duration of dual antiplatelet therapy (DAPT) were associated with TLF. The distribution of DAPT duration differed between patients with and without TLF, and the time-point of intersection was 2.5 years. Also, the side branch was the most common site of restenosis.

    Conclusions:The stenting sequence or technique did not affect clinical outcomes, but LM disease and shorter DAPT were associated with TLF, in patients with bifurcation lesions undergoing 2-stenting with 2G-DES.

  • Seiji Takatsuki
    Type: EDITORIAL
    Article ID: CJ-21-0274
    Published: May 26, 2021
    [Advance publication] Released: May 26, 2021
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  • Akihiko Nogami, Takashi Kurita, Haruhiko Abe, Kenji Ando, Toshiyuki Is ...
    Type: JCS GUIDELINES
    Article ID: CJ-20-0637
    Published: June 01, 2021
    [Advance publication] Released: June 01, 2021
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  • Masanobu Ishii, Kyohei Marume, Michikazu Nakai, Soshiro Ogata, Ryota K ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-21-0071
    Published: June 01, 2021
    [Advance publication] Released: June 01, 2021
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    Supplementary material

    Background:Cancer is a known prognostic factor in patients with acute coronary syndrome (ACS), but few risk assessments of cancer development after ACS have been established.

    Methods and Results:Of the 573 consecutive ACS admissions between January 2015 and March 2018 in Nobeoka City, Japan, 552 were analyzed. Prevalent cancer was defined as a treatment history of cancer, and incident cancer as post-discharge cancer incidence. The primary endpoint was post-discharge cancer incidence, and the secondary endpoint was all-cause death during follow-up. All-cause death occurred in 9 (23.1%) patients with prevalent cancer, and in 17 (3.5%) without cancer. In the multivariable analysis, prevalent cancer was associated with all-cause death. To develop the prediction model for cancer incidence, 21 patients with incident cancer and 492 without cancer were analyzed. We compared the performance of D-dimer with that of the prediction model, which added age (≥65 years), smoking history, and high red blood cell distribution width to albumin ratio (RAR) to D-dimer. The areas under the receiver-operating characteristics curves of D-dimer and the prediction model were 0.619 (95% confidence interval: 0.512–0.725) and 0.774 (0.676–0.873), respectively. Decision curve analysis showed superior net benefits of the prediction model.

    Conclusions:By adding elderly, smoking, and high RAR to D-dimer to the prediction model it became clinically useful for predicting cancer incidence after ACS.

  • Noriaki Iwahashi, Jin Kirigaya, Masaomi Gohbara, Takeru Abe, Mutsuo Ho ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-21-0183
    Published: June 01, 2021
    [Advance publication] Released: June 01, 2021
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    Background:Three-dimensional (3D) speckle tracking echocardiography (STE) after ST-elevation acute myocardial infarction (STEMI) is associated with left ventricular (LV) remodeling and 1-year prognosis. This study investigated the clinical significance of 3D-STE in predicting the long-term prognosis of patients with STEMI.

    Methods and Results:A total of 270 patients (mean age 64.6 years) with first-time STEMI treated with reperfusion therapy were enrolled. At 24 h after admission, standard 2D echocardiography and 3D full-volume imaging were performed, and 2D-STE and 3D-STE were calculated. Patients were followed up for a median of 119 months (interquartile range: 96–129 months). The primary endpoint was occurrence of a major adverse cardiac event (MACE: cardiac death, heart failure with hospitalization), and 64 patients experienced MACEs. Receiver operating characteristic curves and Cox hazard multivariate analysis showed that the 3D-STE indices were stronger predictors of MACE compared with those of 2D-STE. Additionally, 3D-global longitudinal strain (GLS) was the strongest predictor for MACE followed by 3D-global circumferential strain (GCS). The Kaplan-Meier curve demonstrated that 3D-GLS >−11.0 was an independent predictor for MACE (log-rank χ2=132.2, P<0.0001). When combined with 3D-GCS >−18.3, patients with higher values of 3D-GLS and 3D-GCS were found to be at extremely high risk for MACE.

    Conclusions:Global strain measured by 3D-STE immediately after the onset of STEMI is a clinically significant predictor of 10-year prognosis.

  • Ji Seong Kim, Yoonjin Kang, Suk Ho Sohn, Ho Young Hwang, Jae Woong Cho ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-20-1193
    Published: May 29, 2021
    [Advance publication] Released: May 29, 2021
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    Background:This study evaluated the long-term outcomes for up to 20 years after On-X mechanical valve implantation in the left side of the heart.

    Methods and Results:Between 1999 and 2015, 861 patients (mean age=51.6±10.9 years) who underwent prosthetic valve replacement using the On-X valve in the aortic or mitral position were enrolled (aortic=344, mitral=325, double=192). The mean clinical follow-up duration was 10.5±5.3 (median 10.9) years. Operative mortality occurred in 26 patients (3.0%), and linearized late cardiac mortality was 0.9%/patient-year without an intergroup difference. Linearized thromboembolism, bleeding, prosthetic valve endocarditis, non-structural valve deterioration (NSVD), and reoperation rates were 0.8%/patient-year, 0.6%/patient-year, 0.2%/patient-year, 0.5%/patient-year, and 0.5%/patient-year, respectively. Prosthetic valve endocarditis was more frequent after double valve replacement than after aortic or mitral valve replacement (P=0.008 and 0.005, respectively). NSVD and reoperation rates were significantly lower aortic valve replacement than after mitral or double valve replacement (P=0.001 and 0.002, P=0.001 and <0.001, respectively). Valve replacement in the mitral position was the only risk factor for NSVD (hazard ratio [95% confidence interval]=5.247 [1.608–17.116], P=0.006).

    Conclusions:On-X valve implantation in the left side heart had favorable clinical outcomes with acceptable early and late mortality and a low incidence of prosthetic valve-related complications. Particularly in the aortic position, the On-X valve had better long-term non-structural durability.

  • Takafumi Okuyama, Tomonori Watanabe, Kenji Harada, Hiroaki Watanabe, A ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-21-0121
    Published: May 29, 2021
    [Advance publication] Released: May 29, 2021
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  • Saki Iwai, Makoto Watanabe, Akihiko Okamura, Atsushi Kyodo, Kazutaka N ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-20-1233
    Published: May 27, 2021
    [Advance publication] Released: May 27, 2021
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    Background:Optical coherence tomography (OCT) has the potential to characterize the detailed morphology of calcified coronary plaques. This study examined the prognostic impact of calcified plaque morphology in patients with coronary artery calcification (CAC) who underwent newer-generation drug-eluting stent (DES) implantation.

    Methods and Results:In all, 251 patients with moderate to severe CAC who underwent OCT-guided DES implantation were reviewed retrospectively and divided into 3 groups according to OCT findings of the target lesion: 25 patients (10.0%) with calcified nodules (CN), 69 patients (27.5%) with calcified protrusion (CP) without CN, and 157 patients (62.5%) with superficial calcific sheet (SC) without CN and CP. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR). Kaplan-Meier survival analysis revealed that, among the 3 groups, the rates of MACE-free survival (log-rank test, P=0.0117), myocardial infarction (log-rank test, P=0.0103), and TLR (log-rank test, P=0.0455) were significantly worse in patients with CN. Multivariate Cox proportional hazards analysis demonstrated that CN was an independent predictor of MACE (hazard ratio 4.41; 95% confidence interval 1.63–10.8; P=0.0047).

    Conclusions:Target lesion CN was associated with higher cardiac event rates in patients who underwent newer-generation DES implantation for lesions with moderate to severe CAC.

  • Tetsuhiro Yamano, Kan Zen, Satoaki Matoba
    Type: EDITORIAL
    Article ID: CJ-21-0413
    Published: May 27, 2021
    [Advance publication] Released: May 27, 2021
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  • Kenji Okada
    Type: EDITORIAL
    Article ID: CJ-21-0415
    Published: May 27, 2021
    [Advance publication] Released: May 27, 2021
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  • Koki Fujimori, Ayako Okada, Hiroaki Tabata, Morio Shoda, Koichiro Kuwa ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-21-0164
    Published: May 26, 2021
    [Advance publication] Released: May 26, 2021
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    Supplementary material
  • Kihei Yoneyama, Yoshihiro J. Akashi
    Type: EDITORIAL
    Article ID: CJ-21-0322
    Published: May 26, 2021
    [Advance publication] Released: May 26, 2021
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  • Eitaro Kodani
    Type: EDITORIAL
    Article ID: CJ-21-0342
    Published: May 26, 2021
    [Advance publication] Released: May 26, 2021
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  • Madoka Ihara, Yuhei Nojima, Nobuyuki Koh, Hidenori Adachi, Tetsuya Kur ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-21-0102
    Published: May 25, 2021
    [Advance publication] Released: May 25, 2021
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  • Akihiro Tobe, Akihito Tanaka, Yoshiyuki Tokuda, Sho Akita, Taro Fujii, ...
    Type: RAPID COMMUNICATION
    Article ID: CJ-21-0354
    Published: May 25, 2021
    [Advance publication] Released: May 25, 2021
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    Background:The changes in electrocardiographic left ventricular hypertrophy (ECG-LVH) after transcatheter aortic valve implantation (TAVI) are not fully elucidated.

    Methods and Results:The study group included 64 patients who underwent TAVI for aortic stenosis. Their 12-lead ECGs before and at 2 days and 1, 6 and 12 months after TAVI were analyzed, and ECG-LVH was evaluated using various definitions. Values and prevalence of each ECG-LVH parameter significantly decreased between 1 and 6 months after TAVI. Values of ECG-LVH parameters decreased especially in patients with ECG-LVH at baseline.

    Conclusions:Regression of ECG-LVH was observed between 1 and 6 months after TAVI.

  • Raisuke Iijima, Masato Nakamura
    Type: EDITORIAL
    Article ID: CJ-21-0334
    Published: May 22, 2021
    [Advance publication] Released: May 22, 2021
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  • Satoshi Yasukochi
    Type: EDITORIAL
    Article ID: CJ-21-0340
    Published: May 22, 2021
    [Advance publication] Released: May 22, 2021
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  • Thuy Vy Nguyen, Minh Thu Tran Vu, Thi Nam Phuong Do, Thi Huynh Nga Tra ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-21-0077
    Published: May 20, 2021
    [Advance publication] Released: May 20, 2021
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    Supplementary material

    Background:Dilated cardiomyopathy (DCM) is an important cause of heart failure and cardiac transplantation. This study determined the prevalence of DCM-associated genes and evaluated the genotype-phenotype correlation in Vietnamese patients.

    Methods and Results:This study analyzed 58 genes from 230 patients. The study cohort consisted of 64.3% men; age at diagnosis 47.9±13.7 years; familial (10.9%) and sporadic DCM (82.2%). The diagnostic yield was 23.5%, 44.0% in familial and 19.6% in sporadic DCM.TTNtruncating variants (TTNtv) were predominant (46.4%), followed byTPM1,DSP,LMNA,MYBPC3,MYH6,MYH7,DES,TNNT2,ACTC1,ACTN2,BAG3,DMD,FKTN,PLN,TBX5,RBM20,TCAP(2–6%). Familial DCM, genotype-positive andTTNtv-positive patients were younger than those with genotype-negative and sporadic DCM. Genotype-positive patients displayed a decreased systolic blood pressure and left ventricular wall thickness compared to genotype-negative patients. Genotype-positive patients, particularly those withTTNtv, had a family history of DCM, higher left atrial volume index and body mass index, and lower right ventricle-fractional area change than genotype-negative patients. Genotype-positive patients reached the combined outcomes more frequently and at a younger age than genotype-negative patients. Major cardiac events occurred more frequently in patients positive with genes other thanTTNtv.

    Conclusions:The study findings provided an overview of Vietnamese DCM patients’ genetic profile and suggested that management of environmental factors may be beneficial for DCM patients.

  • Yugo Yamashita, Yuuki Maruyama, Hirono Satokawa, Yuji Nishimoto, Ichiz ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-21-0169
    Published: May 20, 2021
    [Advance publication] Released: May 20, 2021
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    Background:Coronavirus disease 2019 (COVID-19) reportedly causes venous thromboembolism (VTE), but the status of this complication in Japan was unclear.

    Methods and Results:The VTE and COVID-19 in Japan Study is a retrospective, multicenter cohort study enrolling hospitalized patients with COVID-19 who were evaluated with contrast-enhanced computed tomography (CT) examination at 22 centers in Japan between March 2020 and October 2020. Among 1,236 patients with COVID-19, 45 (3.6%) were evaluated with contrast-enhanced CT examination. VTE events occurred in 10 patients (22.2%), and the incidence of VTE in mild, moderate, and severe COVID-19 was 0%, 11.8%, and 40.0%, respectively. COVID-19 patients with VTE showed a higher body weight (81.6 vs. 64.0 kg, P=0.005) and body mass index (26.9 vs. 23.2 kg/m2, P=0.04), and a higher proportion had a severe status for COVID-19 compared with those without. There was no significant difference in the proportion of patients alive at discharge between patients with and without VTE (80.0% vs. 88.6%, P=0.48). Among 8 pulmonary embolism (PE) patients, all were low-risk PE.

    Conclusions:Among a relatively small number of patients undergoing contrast-enhanced CT examination in Japanese real-world clinical practice, there were no VTE patients among those with mild COVID-19, but the incidence of VTE seemed to be relatively high among severe COVID-19 patients, although all PE events were low-risk without significant effect on mortality risk.

  • Hayato Tada, Hirofumi Okada, Atsushi Nohara, Masakazu Yamagishi, Masay ...
    Type: ORIGINAL ARTICLE
    Article ID: CJ-21-0193
    Published: May 20, 2021
    [Advance publication] Released: May 20, 2021
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    Supplementary material

    Background:Recent studies suggest that cumulative exposure to low-density lipoprotein-cholesterol (LDL-C) leads to the development of atherosclerotic cardiovascular disease (ASCVD). However, few studies have investigated whether this link extends to individuals with familial hypercholesterolemia (FH), a relevant patient population.

    Methods and Results:We retrospectively investigated the health records of 1,050 patients with clinical FH diagnosis between April 1990 and March 2019. We used Cox proportional hazards models adjusted for established ASCVD risk factors to assess the association between cholesterol-year-score and major adverse cardiovascular events (MACEs), including death from any cause or hospitalization due to ASCVD events. Cholesterol-year-score was calculated as LDL-C max × [age at diagnosis/statin initiation] + LDL-C at inclusion × [age at inclusion − age at diagnosis/statin initiation]. The median follow-up period for MACE evaluation was 12.3 (interquartile range, 9.1–17.5) years, and 177 patients experienced MACEs during the observation period. Cholesterol-year-score was significantly associated with MACEs (hazard ratio, 1.35; 95% confidence interval, 1.07–1.53; P=0.0034, per 1,000 mg-year/dL), independent of other traditional risk factors including age and LDL-C, based on cross-sectional assessment. Cholesterol-year-score improved the discrimination ability of other traditional risk factors for ASCVD events (C-index, 0.901 vs. 0.889; P=0.00473).

    Conclusions:Cumulative LDL-C exposure was strongly associated with MACEs in Japanese patients with FH, warranting early diagnosis and treatment initiation in these patients.

  • Hiroaki Watanabe, Hiroaki Kise, Takako Toda, Yosuke Kono, Yohei Hasebe ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-21-0199
    Published: May 19, 2021
    [Advance publication] Released: May 19, 2021
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    Supplementary material
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