Allogeneic hematopoietic stem cell transplantation (allo-HSCT) and chimeric antigen receptor T-cell (CAR-T) therapy often lead to severe sarcopenia and cachexia during treatment, making it difficult to maintain exercise tolerance. Consequently, “cancer rehabilitation” programs have been implemented to sustain and improve physical activity and motor function. Hematologic malignancies often involve the use of cardiotoxic drugs. Moreover, graft-vs.-host disease associated with allo-HSCT and the cytokine release syndrome in CAR-T therapy elevate the risk of cardiovascular complications. Thus, establishing “cardio-oncology rehabilitation” (CORE) is essential to support cancer patients and survivors. CORE is expected to enhance quality of life, improve cardiopulmonary function, reduce cancer and cardiac events recurrence, and prolong survival. Our institution conducts cardiopulmonary exercise testing before HSCT and CAR-T therapy, with exercise prescriptions based on heart rate at the anaerobic threshold and guidance on resistance exercises. This report discusses current trends in CORE for patients undergoing HSCT and CAR-T therapy, along with future challenges.

Background: Prevention of death from in-hospital pulmonary thromboembolism (PE) is crucial, but research exploring the risk factors for this event remains limited.

Methods and Results: This retrospective analysis evaluated PE data among hospitalized patients, focusing on the diseases present on admission to hospital with the highest number of patients with in-hospital PE events, using the Medical Data Vision database (January 2017–December 2021). Endpoints included the incidence rate of in-hospital PE, patient characteristics, and PE prophylactic procedures. Overall, 4,684,659 patients (in-hospital PE cohort, n=5,007; non-PE cohort, n=4,679,952) were eligible: heart failure (n=208; n=87,160), femoral fracture (n=478; n=139,049), pneumonia (n=309; n=222,257), stroke (n=351; n=248,805), and cancer (n=934; n=764,413). The incidence rate of in-hospital PE in the overall population was 20.6/1,000 person-years: heart failure (34.6), femoral fracture (35.3), pneumonia (21.4), stroke (15.9), and cancer (25.6). History of venous thromboembolism (VTE) was a risk factor for in-hospital PE in >50% of patients in all subgroups. Prophylactic PE procedures were implemented in 33.8% of the overall population: femoral fracture (79.5%), cancer (49.7%), stroke (24.2%), heart failure (12.7%), and pneumonia (6.2%).

Conclusions: The incidence of in-hospital PE was not high overall but was higher in patients with a history of VTE and those with hospitalization due to heart failure or femoral fracture. Risk assessment for in-hospital PE, including medical history and diagnosis at admission, is preferred in hospitalized patients.

Background: This study assessed the prognostic value of submaximal cardiopulmonary exercise testing (CPET) in cardiac amyloidosis and explored CPET as an alternative to the 6-min walk test (6MWT).

Methods and Results: In this single-center prospective observational study, 160 patients with cardiac amyloidosis (87% male; mean age 78±7 years) were evaluated. A total of 145 performed maximum symptom limited CPET. The V̇E/V̇CO₂slope was 39±8, submaximal power output (SPO) was 24.75±11.50 W, and V̇O₂at anaerobic threshold (AT) was 8.13±2.29 mL/min/kg. During follow up, 34 (21.25%) patients died, and another 34 (21.25%) experienced heart failure (HF)-related hospitalization, with 15 (9.38%) patients experiencing both events. Univariate analysis showed that V̇E/V̇CO₂slope (hazard ratio [HR] 0.89; 95% confidence interval [CI] 0.86–0.93; P<0.001) and SPO (HR 0.91; 95% CI 0.87–0.96; P<0.001) were predictors of mortality. In multivariate analysis, V̇E/V̇CO₂slope remained a significant predictor (HR 0.92; 95% CI 0.88–0.97; P<0.001) for both all-cause mortality and HF-related hospitalization independently. A SPO cut-off of <28 W predicted a worse outcome for both measures independently. Moderate correlations for V̇E/V̇CO₂slope (−0.56 [CI −0.67, −0.42]) and SPO (0.55 [CI 0.42, 0.67]) with 6MWT distance have been found.

Conclusions: These findings highlight CPET parameters, particularly V̇E/V̇CO₂slope and SPO with a cut-off <28 W, as predictors of survival and HF-related hospitalization in cardiac amyloidosis.

Background: Constipation commonly coexists with heart failure (HF) and can increase blood pressure because of straining during defecation and accompanying mental stress. Daikenchuto, a Japanese herbal medicine to ameliorate gastrointestinal motility, may be effective as a complement to laxatives in improving outcomes in patients with HF and constipation.

Methods and Results: We used the Diagnosis Procedure Combination database to identify patients aged ≥65 years who were admitted for HF, had constipation, and were discharged alive between April 2016 and March 2022. We divided the 115,544 eligible patients into 2 groups according to the prescription of Daikenchuto in addition to laxatives at discharge and compared the incidence of 1-year HF readmission using 1 : 4 propensity score matching. Daikenchuto was prescribed at discharge in 3,315 (2.9%) patients. In the unmatched cohort, patients treated with Daikenchuto were more often male and had a higher prevalence of malignancy than those treated without Daikenchuto. In the 1 : 4 propensity score-matched cohort (3,311 and 13,243 patients with and without Daikenchuto, respectively), no significant difference was noted in 1-year HF readmission between the groups (22.2% vs. 21.9%; hazard ratio=1.02, 95% confidence interval=0.94–1.11). This result was consistent across clinically relevant subgroups except for renal disease.

Conclusions: Complementary use of Daikenchuto in combination with laxatives was not associated with a lower incidence of HF readmission in patients with HF and constipation.

Background: Left ventricular reverse remodeling (LVRR) is associated with a good prognosis in patients with dilated cardiomyopathy (DCM), so in this study we examined the achievement rates of LVRR, the time taken to LVRR and the factors associated with LVRR in recent cases of DCM.

Methods and Results: We enrolled 121 patients with DCM. LVRR was defined as a left ventricular ejection fraction ≥40% at follow-up with a ≥10% improvement. LVRR was observed in 82 patients (68%). The median time to LVRR was 208 days. Multivariate analysis revealed that B-type natriuretic peptide (BNP) levels at discharge (per 1-SD increase, odds ratio: 0.483, 95% confidence interval (CI): 0.224–0.963; P=0.0385) and β-blocker dose (per 1-SD increase, odds ratio: 3.379, 95% CI: 1.644–7.702; P=0.0007) were independently associated with LVRR. When the patients were divided into 2 groups according to the first (2007–2017; n=64) and second (2018–2022; n=57) time periods, there was a significantly higher LVRR achievement rate (48.4% vs. 89.5%) and shorter time to LVRR in the second period than in the first.

Conclusions: The LVRR achievement rate in DCM has been increasing, and the time to LVRR has been shortened in recent years. Beta-blocker dose and BNP levels at discharge may be strongly associated with LVRR.

Background: Heart failure (HF) hospitalization is increasing in Japan’s aging population. Current guidelines recommend daily biometric monitoring for patients with HF to facilitate early clinical intervention. However, promoting patient self-management remains insufficient. Therefore, we assessed the usefulness of the LAVITA telemonitoring system, which automatically obtains and stores the biometric data of patients with HF via wireless devices.

Methods and Results: This prospective, single-arm, multicenter cohort study enrolled patients with HF. Patients were introduced to the LAVITA telemonitoring system and trained to measure body weight, blood pressure, pulse rate, oxygen saturation (SpO₂), physical activity with activity trackers (AT), and electronic patient-reported outcomes (ePRO). The primary outcome was the measurement rate of each cetology at 9–12 weeks post-discharge. The secondary outcomes included the subgroup analyses by age, sex, and left ventricular function. Thirty patients continued to use the system at home. The measurement rates of patient data were as follows: body weight 92.4% (interquartile range [IQR] 83.3–97.8%); blood pressure 95.6% (IQR 84.8–98.5%); pulse rate 96.5% (IQR 86.5–98.8%); SpO₂93.1% (IQR 76.6–97.9%); AT 88.4% (IQR 31.3–98.5%); and ePRO 76.9% (IQR 26.4–95.9%). The subgroup analysis did not significantly differ.

Conclusions: The LAVITA telemonitoring system had high measurement rates for the biometric data of patients with HF, including elderly patients. Hence, it can possibly improve patient self-management and facilitate early clinical intervention.

Background: Bioelectrical impedance plethysmography (IPG) for measuring human body fraction and disease has been progressing in the past half-century, and few studies have reported lower-extremity arterial disease (LEAD) in recent years.

Methods and Results: The present study enrolled patients who underwent examinations for LEAD. IPG with venous occlusion was performed, and flow volumes were compared with those measured using Doppler duplex ultrasonography, the ankle-brachial index (ABI), and assessments of arterial stenosis and collaterals using computed tomography and/or magnetic resonance angiographies. Fifty patients suspected of LEAD were enrolled; 15 had no arterial stenosis and 35 had LEAD. Arterial blood flow volume (BFV) was assessed. Although the area under the curve for IPG-BFV and Doppler-BFV in the popliteal artery with arterial stenosis were similar, IPG-BFV exhibited better diagnostic accuracy than Doppler-BFV (accuracy 0.765 and 0.694, respectively; McNemar’s test P<0.01). In the analysis of covariance with IPG-BFV adjustment, Doppler-BFV was significantly lower in patients with LEAD (ABI<0.9), and morphological arterial stenosis, particularly in those with collaterals than in those without (F-test P<0.05, respectively).

Conclusions: IPG-BFV could have a better ability to discern the presence of arterial stenosis compared with Doppler-BFV and might not be confounded by the presence of collateral circulation when assessing blood flow in the entire lower extremity, which could be an advantage of IPG-BFV.

Background: Predictors of the clinical characteristics of pregnant women at risk of peripartum cardiomyopathy (PPCM) remain unclear.

Methods and Results: We enrolled 450 cases of high-risk pregnancy with any risk factor from among ≥35 years of age, hypertensive disorders of pregnancy (HDP), multiple gestation, or other systemic or obstetric complications except for a history of cardiac disease. All the women underwent echocardiography and plasma B-type natriuretic peptide (BNP) measurement during the second/third trimester and the early/late postpartum period. Logistic regression analyses identified clinical factors associated with left ventricular (LV) dysfunction. The incidence of PPCM was 0.89%, which was higher than in previous reports. Early diastolic mitral annular velocity (e′) was significantly negatively associated with the occurrence of PPCM, and the BNP level showed a significant positive association with the occurrence of PPCM. The percentages of cases of e′ <7 cm/s, and BNP level ≥100 pg/mL were 25.3%, and 20.4%, respectively. Multivariate regression analysis revealed that HDP was independently associated with e′. A negative correlation between e′ and BNP level was observed in HDP.

Conclusions: High-risk pregnancy was associated with an increased incidence of PPCM. Measurement of BNP levels and echocardiographic assessment of LV diastolic function during pregnancy may be useful in predicting PPCM.

Background: Intensive lipid-lowering therapy (ILLT) is crucial for preventing secondary acute coronary syndrome (ACS). However, achieving target low-density lipoprotein cholesterol (LDL-C) levels remains challenging in clinical practice.

Methods and Results: This retrospective study included 534 patients with ACS who underwent primary percutaneous coronary intervention (PCI) between September 2016 and August 2022. The ILLT protocol, wherein ezetimibe and statins are prescribed, was introduced in September 2019. We compared the rate of achievement of the LDL-C target of <70 mg/dL at the first outpatient visit and the incidence of cardiovascular events during the 3-year observation period after PCI between the conventional therapy (n=226) and ILLT (n=308) groups. The ILLT group had a higher achievement rate than the conventional therapy group (71.8% vs. 48.7%; P=0.001). In the ILLT group, 17% of statin-naïve patients did not achieve the LDL-C target, and the cutoff value of LDL-C on admission for predicting non-achievement of this target was 146 mg/dL. Patients in the ILLT group showed a significantly lower incidence of cardiovascular events than those in the conventional therapy group (hazard ratio 0.57; 95% confidence interval 0.34–0.97).

Conclusions: Implementing the ILLT protocol using statins and ezetimibe helped achieve the target LDL-C level early in patients with ACS and may consequently improve prognosis. However, patients with LDL-C levels ≥146 mg/dL on admission may need more intensive treatment.

Background: Although cardiac auscultation plays an essential role in detecting valvular heart diseases, false-positive rates due to innocent heart murmurs remain a concern because accelerated transaortic valve blood flow can be a major contributor to systolic heart murmurs. In this study we investigated the effect of transaortic valve flow velocity on the development of systolic heart murmurs.

Methods and Results: Cardiac auscultation was performed in 571 patients referred for echocardiography and systolic heart murmur was detected in 103 (18.0%). Maximum transaortic valve flow velocity was higher in patients with murmurs than in those without (2.02 vs. 1.34 m/s, P<0.001; area under the receiver operating characteristic curve, 0.82). A cutoff maximum transaortic flow velocity of 1.7 m/s predicted systolic heart murmurs (sensitivity, 65%; specificity, 88%). The incidence of heart murmur was associated with higher maximum transaortic valve flow velocity (<1.7 m/s, 7.3%; 1.7–2.5 m/s, 50.0%; >2.5 m/s, 73.5%). Multivariate analysis revealed the maximum transaortic valve flow velocity as an independent predictor of systolic heart murmurs (hazard ratio, 9.18; 95% confidence interval, 5.35–15.75; P<0.001).

Conclusions: Accelerated transaortic valve flow velocity is an important determinant of systolic heart murmurs. Systolic heart murmurs can be heard before the transaortic valve flow velocity reaches the clinically significant aortic stenosis criterion, which can constitute a considerable number of innocent heart murmurs.