Background: Despite the use of vascular closure devices (VCDs) following catheter ablation for atrial fibrillation (AF) effectively shortening postprocedural immobilization time, they carry the risk of subcutaneous hemorrhage, which often requires extended bed rest, exceeding 2 h. We assessed whether combining skin adhesives (SAs) with a VCD can safely enable earlier mobilization without increasing bleeding risk.

Methods and Results: This retrospective analysis evaluated 244 patients who underwent catheter ablation for AF between April 2022 and March 2024 and achieved successful hemostasis with a VCD. Patients with cardiac surgery history, dual antiplatelet therapy, cognitive impairment, or intensive care needs were excluded. Ultrasound-guided VCDs were used in all procedures. The SA group (n=162) received Dermabond Mini® with immediate post-anesthesia mobilization. The control group (n=82) underwent angio-roll compression and followed physician-guided rest protocols. Endpoints included rest duration, total procedural time, hemorrhagic events, opioid administration, and length of hospital stay. Despite immediate post-anesthesia mobilization, the SA group showed shorter time to ambulation (129±95 vs. 513±440 min, P<0.01) with lower rates of hemorrhagic complications (BARC type 1: 1.2% vs. 6.1%, P=0.044; BARC type 2: 5.6% vs. 23.2%, P<0.01) than the control group. Procedural duration was comparable. The SA group required less fentanyl.

Conclusions: The combination of SA and VCDs enabled immediate post-anesthesia mobilization without increasing bleeding complications, improving patient outcomes and resource utilization.

Background: Prolonged hospital length of stay (LOS) remains a major clinical and economic challenge in heart failure (HF) management. Although early initiation of cardiovascular physical therapy improves functional capacity and prognosis in HF, the impact of delayed initiation on LOS has not been fully clarified. This study examined the association between the timing of cardiovascular physical therapy initiation and prolonged LOS in patients hospitalized for HF.

Methods and Results: This retrospective cohort study included 280 patients hospitalized for HF between January 2022 and December 2023. Patients were categorized into standard and prolonged LOS groups based on the median LOS of 17 days. Receiver operating characteristic curve analysis identified hospital Day 3 as the optimal cut-off for predicting prolonged LOS. Patients who initiated cardiovascular physical therapy on or after Day 3 had a significantly longer LOS than those who started within 2 days (24±14 vs. 19±12 days; P<0.01). Delayed initiation remained independently associated with prolonged LOS after adjustment for age, sex, Meta-Analysis Global Group in Chronic Heart Failure score, intensive care unit stay duration, and B-type natriuretic peptide.

Conclusions: Delayed initiation of cardiovascular physical therapy beyond hospital Day 3 was independently associated with prolonged hospitalization in HF patients. Early initiation guided by hemodynamic assessment during the acute phase may reduce LOS and improve the efficiency of HF care.

Background: Transcatheter aortic valve implantation (TAVI) results in shorter hospital stays and earlier discharge than conventional aortic valve replacement. Postoperative cardiac rehabilitation (CR) can improve the 6-min walk distance, activities of daily living, and mental function; however, the outpatient CR (OCR) attendance rate in Japan remains low, which limits its benefits. In this study, we investigated the effect of geographic factors on OCR adherence in patients who underwent TAVI.

Methods and Results: This single-center retrospective cohort study included 95 patients with aortic stenosis admitted for TAVI at Showa Medical University Hospital between January 2019 and December 2023. The participants were categorized into the OCR continuation and non-participation (non-OCR) groups. Primary evaluations included road distance, travel time by car, and straight-line distance to the hospital, and postoperative physical function changes. Geographic factors did not differ significantly between the 2 groups at OCR initiation. However, OCR group-restricted analysis revealed that participants who completed the 5-month OCR program had significantly shorter travel times than those who discontinued. A receiver operating characteristic curve analysis revealed that travel time by car was a significant predictor of OCR dropout (optimal cut-off 19.5 min).

Conclusions: This study revealed that geographic accessibility did not affect OCR initiation post-TAVI; however, it significantly impacted long-term adherence. Specifically, a travel time of >20 min led to program discontinuation.

Background: Exercise-based cardiac rehabilitation is effective for improving the prognosis of patients with heart failure (HF), but little is known about its interactions with dietary components. We investigated the impacts of dietary fat intake and its source on the cardioprotective effects of exercise in mice with HF.

Methods and Results: Endurance exercise and diets with different fat composition, including a normal diet (NE: 11% fat), a soybean oil-rich diet (SE: 32% fat) and a lard-rich diet (LE: 32% fat), were provided for 4 weeks to mice with HF induced by transverse aortic constriction. Exercise improved left ventricular systolic function and suppressed cardiac hypertrophy in the NE and SE groups, but these effects were attenuated in the LE group. The LE group exhibited a reduction in linoleic acid content within mitochondrial phospholipids such as phosphatidylcholine and phosphatidylethanolamine, concurrent with the promotion of cardiolipin remodeling pathways. This resulted in a marked reduction in tetralinoleoyl cardiolipin (L₄CL), which is crucial for maintaining mitochondrial membrane function. This was supported by the finding that assembly of mitochondrial respiratory chain supercomplexes was partially impaired in the LE group.

Conclusions: Lard intake may attenuate the exercise-induced cardioprotective effects against HF by reducing myocardial L₄CL levels and impairing mitochondrial supercomplex assembly involved in mitochondrial respiratory capacity.

Background: Robotic mitral valve repair (MVr) offers superior visualization and dexterity, potentially overcoming challenges in severe thoracic deformity such as pectus excavatum. This study compared surgical outcomes after MVr in patients with and without thoracic deformity and assessed the impact of thoracic deformity on operative times in robotic MVr.

Methods and Results: We reviewed 359 patients undergoing robotic MVr for degenerative mitral regurgitation (2018–2022). Patients with a Haller index ≥3.25 categorized as the deformity group (Group D; n=35), and those with a Haller index <3.25 were in the non-deformity group (Group N; n=324). Group D was younger, but repair techniques and concomitant surgery were similar. In the results, there was no significant difference in operative time and aortic cross-clamp time (80±29 vs. 80±30 min; P=0.969) between the 2 groups. No correlation was found between thoracic dimensions and cross-clamp time. Early outcomes, including intensive care unit stay (1.92±1.59 vs. 1.77±1.26 days; P=0.519), hospital stay, mortality, stroke, and re-exploration, were comparable. Perioperative redo occurred in 4 patients in Group N (hemolysis from regurgitant jet, residual P2 prolapse, suture dehiscence) and 2 patients in Group D (systolic anterior motion-induced mitral regurgitation, poor posterior leaflet coaptation). One-year mitral regurgitation grade, survival, and freedom from reoperation were similar.

Conclusions: Among patients with thoracic deformity deemed suitable for robotic MVr, outcomes were not worse compared with patients without deformity.

Background: While international guidelines recommend 5–10% body weight reduction, evidence characterizing the dose-response relationship between specific weight loss amounts and metabolic syndrome (MetS) resolution in real-world populations is limited.

Methods and Results: In this retrospective study, we analyzed a large-scale health check-up database provided by DeSC Healthcare (Tokyo, Japan). We identified 37,256 individuals with baseline MetS eligible for the Specific Health Guidance (SHG) program (2014–2023). Logistic regression assessed the association between 1-year weight changes and subsequent MetS status. Weight loss was significantly linked to MetS resolution. Compared with weight maintenance, a weight loss of 2.0–2.9 kg showed an adjusted odds ratio (OR) of 0.45 (95% confidence interval [CI] 0.41–0.49), and a loss of ≥3.0 kg showed an OR of 0.19 (95% CI 0.18–0.21). These associations were consistent across age and sex subgroups. Secondary analyses confirmed significant improvements in waist circumference, blood pressure, lipid profiles, and HbA1c.

Conclusions: Weight loss over 1 year is significantly associated with MetS resolution among SHG-eligible individuals. These findings support the validity of weight loss recommendations in the fourth phase of the SHG program and offer empirical data for future health guidance design.

Background: Oral frailty (OF), defined as a multidimensional decline in oral function, is an early marker of functional vulnerability in older adults. Although frailty is linked to cardiovascular disease incidence and prognosis, the relationship between OF, heart disease (HD), and multimorbidity (MM) remains unclear.

Methods and Results: We conducted a cross-sectional analysis of 16,294 community-dwelling adults aged ≥65 years in the 2022 Japan Gerontological Evaluation Study. OF was assessed using the Oral Frailty 5-item Checklist. Among 1,575 participants with HD, we compared those with HD alone and those with HD plus comorbidities (HD+MM). We also compared OF and its components across the 4 groups based on HD and MM status. The overall prevalence of OF was 33.9%, increasing to 42.9% in individuals with HD. OF was significantly more prevalent in the HD+MM group than in the HD-only group (44.3% vs. 36.2%). Respiratory, digestive, immune, and ear diseases were strongly associated with OF. Furthermore, OF, lower Tokyo Metropolitan Institute of Gerontology Index of Competence scores, and higher body mass index were independently associated with a greater comorbidity burden in older adults.

Conclusions: OF is common in older adults with HD, particularly in those with MM. Incorporating oral function assessment into cardiovascular risk evaluation may help identify high-risk individuals and support comprehensive management strategies for the aging population.

Background: Older patients with heart failure (HF) often present with multiple age-related conditions, but these are commonly evaluated in isolation. We aimed to describe the prevalence, overlap, and prognostic implications of physical dysfunction, cachexia, and dysphagia in older patients with HF.

Methods and Results: We conducted a single-center retrospective study enrolling hospitalized patients with HF aged ≥65 years who were ambulatory at discharge. Complications at discharge were defined as follows: physical dysfunction was defined as a Short Physical Performance Battery score ≤9, cachexia according to the Asian Cachexia Working Group, and dysphagia as a Food Intake Level Scale score ≤8. Patients were categorized by the number of complications (0–3). The outcome was 1-year all-cause mortality. Among 468 patients (median age 81 years; 43.2% female), physical dysfunction, cachexia, and dysphagia were identified in 50.2%, 43.2%, and 19.4% of patients, respectively. The proportion of patients with 0, 1, 2, and 3 complications was 33.4%, 30.1%, 26.9%, and 9.6%, respectively. In Cox regression analysis, a higher number of complications was associated with higher mortality (hazard ratio 1.97; 95% confidence interval 1.35–2.87; P<0.001). Adding the number of complications to a pre-existing risk model increased the area under the curve from 0.684 to 0.779 (P<0.001).

Conclusions: Concurrent assessment of physical function, cachexia, and dysphagia provides incremental prognostic information beyond established risk predictors in older patients with HF.

Background: Acute decompensated heart failure (ADHF) often causes functional decline in older adults, leading to frailty and poor outcomes. This study aimed to identify factors linked to inadequate functional recovery during hospitalization and to assess how early in-hospital functional status predicts recovery at discharge.

Methods and Results: We enrolled 166 patients aged ≥75 years hospitalized for ADHF who had maintained basic activities of daily living before admission (Barthel Index [BI] ≥70). Functional status was assessed weekly during hospitalization using the BI. We then investigated the clinical factors associated with insufficient improvement in BI. Multivariable logistic regression analysis revealed that advanced age (odds ratio [OR] 1.11; 95% confidence interval [CI] 1.03–1.20; P=0.010), concomitant dementia (OR 3.17; 95% CI 1.34–7.52; P=0.008), and BI <50 1 week after admission (OR 4.94; 95% CI 2.07–11.80; P<0.001) were significantly associated with inadequate functional recovery (BI <70) at discharge. Furthermore, BI <50 1 week after admission was associated with higher cardiovascular mortality and rehospitalization for heart failure (HF) after discharge compared with those who improved (log-rank P=0.044).

Conclusions: In older patients with ADHF, advanced age, concomitant dementia, and insufficient BI improvement 1 week after admission were associated with inadequate functional recovery during hospitalization. Insufficient early functional recovery was also linked to adverse post-discharge outcomes. Therefore, early BI assessment may facilitate risk stratification for functional recovery at discharge in older HF patients.

Background: Lipoprotein(a) is a risk factor for atherosclerotic cardiovascular disease (ASCVD). However, its distribution based on coronary artery disease (CAD) in the Japanese population remains unclear. We compared lipoprotein(a) distributions among patients with acute coronary syndrome (ACS), patients with chronic coronary syndrome (CCS), and controls.

Methods and Results: We analyzed 3,710 individuals who visited Kagawa Prefectural Central Hospital from April 2019 to March 2024. Patients who underwent percutaneous coronary intervention (PCI) were classified into ACS (n=724) and CCS (n=579) groups. Another 2,407 individuals without ASCVD undergoing medical check-ups were the controls. Lipoprotein(a) levels were measured before PCI or during check-up. Distributions and associations with prevalent CAD were assessed using multivariable logistic regression. The mean ages were 70, 72, and 56 years in the ACS, CCS, and control groups, respectively (P<0.001). Median lipoprotein(a) levels were 13, 14, and 10 mg/dL in the ACS, CCS, and control groups, respectively (P<0.001). Proportions of patients with lipoprotein(a) >30 mg/dL were 19.1% and 26% (P<0.05), and proportions of patients with lipoprotein(a) >50 mg/dL were 7.8% and 11.5% in the ACS and CSS groups, respectively (P<0.05). Restricted cubic splines suggested continuous associations between lipoprotein(a) and prevalent ACS and CCS. Statin use did not affect intergroup differences.

Conclusions: Lipoprotein(a) levels were higher in patients with CAD than in the controls, supporting its role as an independent risk marker.

Background: The mortality rate for acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) remains high despite advances in mechanical circulatory support (MCS). The Society for Cardiovascular Angiography and Interventions (SCAI) has proposed a 5-stage classification of CS, and in this study we compared the clinical outcomes of AMI patients with SCAI shock stage A with those in stage B.

Methods and Results: We retrospectively analyzed 257 AMI patients, classified into modified stage A (n=180) and modified stage B (n=77) groups. The primary endpoint was in-hospital adverse events, defined as a composite of in-hospital death, initiation of MCS, and mechanical complications. The secondary endpoint was long-term major adverse cardiovascular events (MACE), including all-cause death, re-admission for heart failure, or non-fatal myocardial infarction. The median follow-up duration was 786 days. Compared with modified stage A, modified stage B group had a significantly lower left ventricular ejection fraction (44.6% vs. 54.4%, P<0.001). In-hospital adverse events were comparable between the groups (P=0.128). Kaplan-Meier analysis showed a higher incidence of MACE in modified stage B (P=0.029); however, multivariate analyses revealed no significant association between modified stage B and either in-hospital adverse events or long-term MACE.

Conclusions: As compared to SCAI shock modified stage A, modified stage B was not independently associated with in-hospital and long-term clinical outcomes after controlling confounding factors.

Background: Invasive hemodynamic assessment is critical in patients with ST-segment elevation myocardial infarction (STEMI) classified as Killip classes 3–4. However, the prognostic utility of pulmonary arterial elastance (PaE) remains unclear.

Methods and Results: We retrospectively analyzed 145 consecutive patients with STEMI classified as Killip classes 3–4 undergoing primary percutaneous coronary intervention, all with complete pulmonary artery catheter data. PaE was calculated as systolic pulmonary artery pressure divided by stroke volume. In total, 27 patients died in hospital (18.6%), and 118 patients (81.4%) survived to discharge. Non-survivors were older, more often women, and had lower estimated glomerular filtration rate and left ventricular ejection fraction than survivors. PaE was significantly higher in non-survivors than in survivors (1.40 vs. 0.81 mmHg/mL, P<0.001). After adjusting for confounders, PaE was independently associated with in-hospital death (P<0.05). In the receiver operating characteristic curve analyses, PaE showed superior discriminative ability (area under the curve [AUC], 0.729) than pulmonary vascular resistance (AUC, 0.648) and pulmonary arterial pulsatility index (PAPI; AUC, 0.501; both, P<0.05) but was comparable to cardiac power output (AUC, 0.705; P=0.351). Furthermore, the in-hospital mortality rate increased with increasing PaE, consistently across PAPI strata.

Conclusions: PaE independently predicts in-hospital death of patients with STEMI classified as Killip classes 3–4. Its robust performance across subgroups and ease of calculation support its use in early risk stratification.

Background: In patients with COVID-19-related fulminant myocarditis (COVID-FM), multisystem inflammatory syndrome (MIS) influences clinical outcomes. Multisystemic inflammation (MSI) based on clinical symptoms correlates with the prognosis of non-COVID-FM diagnosed by endomyocardial biopsy. The effect of MSI on clinically diagnosed non-COVID-FM regarding age and prognosis remains unclear.

Methods and Results: This retrospective cohort study included 736 patients clinically diagnosed with non-COVID-FM. MSI was defined by clinical symptoms at admission aligned with MSI criteria. We compared all-cause death according to MSI status. Baseline balance was adjusted using inverse probability treatment weighting (IPTW). Overall, 275 (37.4%) non-COVID-FM patients met the MSI status. The MSI (+) group was younger, with fewer male patients and complications such as hypertension, diabetes, chronic kidney disease, and dyslipidaemia. When stratified per age, MSI was highest in patients aged <50 years (48.7%). Overall, the probability of all-cause death was lower in the MSI (+) group (30-day: 25.1% vs. 32.1%, P=0.053, 3-year: 36.1% vs. 42.5%, P=0.004). After IPTW, the MSI (+) group, especially in patients <50 years, was associated with significantly lower risk difference and risk ratio for 30-day all-cause death compared to the MSI (−) group, but not 3-year all-cause death.

Conclusions: In patients with non-COVID-FM, MSI often developed at a younger age, and was associated with lower 30-day mortality rate, particularly in patients <50 years.

Background: Below-the-ankle (BTA) disease is increasingly prevalent in chronic limb-threatening ischemia (CLTI), particularly in diabetes and end-stage renal disease, but its determinants and prognostic impact after revascularization remain unclear.

Methods and Results: We retrospectively analyzed 185 CLTI limbs with complete pedal angiography undergoing revascularization at 2 vascular centers between 2002 and 2023. Using the Global Limb Anatomic Staging System (GLASS) inframalleolar/pedal artery descriptor (IPD), limbs were classified as BTA (IPD-P2; n=40) or nonBTA (IPD-P0 or P1; n=145). Logistic regression identified factors associated with BTA. Kaplan-Meier compared limb-based patency (LBP), wound healing, limb salvage, and survival. BTA limbs presented with more severe limb status (WIfI stage 4: 72.5% vs. 41.0%; P=0.001), whereas GLASS stage was similar. On multivariable analysis, nonambulatory status independently predicted BTA disease (adjusted odds ratio 2.65; 95% confidence interval 1.19–5.94; P=0.02). BTA disease was associated with lower 1year primary/secondary LBP (55.6% and 72.4% vs. 75.2% and 86.1%; P=0.004 and P=0.005), 6month wound healing (54.0% vs. 83.2%; P=0.0002), 1year limb salvage (77.3% vs. 97.2%; P<0.0001), and 1year survival rates (67.9% vs. 85.6%; P=0.003).

Conclusions: Non-ambulatory status was independently associated with advanced BTA disease. Despite similar GLASS stage, BTA involvement predicted worse patency, limb outcomes, and survival, suggesting pedal arterial status reflects systemic disease severity.

Background: High-risk pulmonary embolism (PE) is associated with substantial mortality, and contemporary guidelines recommend prompt reperfusion therapy when feasible. However, real-world data describing how reperfusion is used in practice, and its outcomes, remain limited.

Methods and Results: We conducted an observational analysis of patients with high-risk PE enrolled in the Tokyo Cardiovascular Care Unit Network registry between 2020 and 2022. High-risk PE was defined as a presentation complicated with shock, sustained hypotension, or cardiac arrest. Reperfusion therapies included systemic thrombolysis, catheter-based therapy, and surgical embolectomy. Of 1,217 patients with PE, 185 (15.2%) met the high-risk PE criteria. Reperfusion therapy was administered to 43.8% of patients (systemic thrombolysis, 27.6%; surgical embolectomy, 13.0%; catheter-based therapy, 3.2%), and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was used in 29.7% of patients. Overall, in-hospital mortality was 14.6%. Mortality was lower with than without reperfusion therapy (8.6% vs. 19.2%), without significant differences in bleeding events. In multivariable logistic regression analysis, cardiac arrest, VA-ECMO use, and lack of reperfusion therapy were independently associated with increased in-hospital mortality risk.

Conclusions: In this contemporary multicenter registry, reperfusion therapy was used in fewer than half of patients with high-risk PE and was associated with lower in-hospital mortality, although residual confounding cannot be excluded given the observational study design. These findings highlight both the potential benefit and the incomplete real-world adoption of guideline-recommended reperfusion strategies.

Background: Robotic mitral valve repair (r-MVr) offers potential advantages, but its safety and feasibility in patients aged ≥80 years remain unclear.

Methods and Results: This single-center retrospective cohort study included 53 consecutive patients aged ≥80 years who underwent MVr for degenerative mitral regurgitation between April 2011 and July 2025: 31 patients underwent r-MVr using the da Vinci Xi system, and 22 underwent conventional MVr (c-MVr). The primary outcomes were 30-day mortality, major complications, lengths of intensive care unit and hospital stay, and postoperative echocardiography findings. One 30-day death occurred after r-MVr (3.2%) due to intestinal ischemia, and none occurred after c-MVr. The postoperative hospital stay was shorter after r-MVr (12 [interquartile range (IQR), 8–13] vs. 13 [IQR, 12–15] days; P=0.04). The transmitral pressure gradient was lower in the r-MVr group than in the c-MVr group (2.1 [IQR, 2.0–3.0] vs. 3.0 [IQR, 2.0–3.9] mmHg; P=0.02). At the mid-term follow-up, there were no significant differences between the groups in 5-year overall survival (83.3% vs. 95.2%; P=0.32) or freedom from recurrent mitral regurgitation ≥ grade 3 (95.2% vs. 100%; P=0.49).

Conclusions: r-MVr can be a safe and feasible minimally invasive option with acceptable short- and mid-term outcomes in octogenarians.

Background: Heart failure re-hospitalization often results from inadequate self-management. We developed a Heart Failure Exacerbation Symptom Response System to facilitate early detection regardless of professional experience.

Methods and Results: A 3-round Delphi survey among 19 healthcare professionals evaluated system appropriateness. Item-Content Validity Index (I-CVI) and Scale-Content Validity Index/Average (S-CVI/AVE) were calculated. Round 1 showed 50% of items with I-CVIs <0.78 (S-CVI/AVE=0.77), prompting revisions. Final I-CVIs exceeded 0.78 for >95% of items.

Conclusions: Expert consensus confirmed content validity for supporting consistent assessments and early intervention. Further validation in home healthcare is warranted.

Background: His bundle pacing (HBP) preserves physiological pacing in atrioventricular block (AVB) but may have unstable thresholds. We evaluated practical septal pacing (PSP) for AVB.

Methods and Results: We studied 92 AVB patients (41 HBP, 51 PSP). PSP was finalized at the narrowest attainable pQRSd with acceptable pacing parameters. Implant pQRSd was similar, while PSP had lower thresholds (0.5 vs. 1.0V; P<0.01) and remained lower at 18 months; thresholds ≥2.5V occurred less often (2% vs. 27%). No septal perforation occurred, and 1-year survival and heart failure hospitalization were comparable.

Conclusions: PSP may offer a simple method with stable thresholds.

Background: Conventional lung perfusion scintigraphy relies on relative tracer distribution and has limited utility for longitudinal assessment of regional pulmonary perfusion in chronic thromboembolic pulmonary hypertension (CTEPH).

Methods and Results: We applied CT-derived, lung volume–normalized standardized uptake value (SUV_LV)-based 3-color SPECT/CT mapping in a patient with CTEPH undergoing staged balloon pulmonary angioplasty followed by pulmonary endarterectomy. This approach visualized regional perfusion redistribution and vascular steal patterns not clearly identified by conventional SPECT/CT and demonstrated close spatial concordance with pulmonary angiographic findings throughout multimodal treatment.

Conclusions: SUV_LV-normalized 3-color SPECT/CT enables intuitive visualization of dynamic pulmonary perfusion redistribution during staged interventions.

Background: We evaluated the educational effectiveness of a structured simulation-based module focused on the initial management of ST-elevation myocardial infarction (STEMI) for medical students.

Methods and Results: After basic videos, lectures, and a pretest, a total of 128 students participated in a national board examination content-based simulation scenario that required STEMI diagnosis, critical arrhythmia management, and transfer to catheterization suite. All groups achieved transfer within 30 min (mean, 19 min 11 s). Post-test scores significantly improved compared with pretest scores (17.1±4.2 vs. 19.4±2.6, P<0.001).

Conclusions: Simulation-based education provides a scalable and standardized approach to STEMI training for medical students.

Background: Whether upstroke time (UT) predicts outcomes after percutaneous coronary intervention (PCI) in patients with normal ankle-brachial index (ABI) remains unclear.

Methods and Results: In a registry, 713 patients with ABI 0.90–1.40 and no atrial fibrillation or known severe aortic stenosis were analyzed. UT was measured from brachial-ankle pulse volume recordings and classified as <180 or ≥180 ms. Prolonged UT was associated with high risk of unplanned revascularization for de novo lesions (adjusted hazard ratio 1.84, P=0.015).

Conclusions: UT prolongation indicates risk of de novo revascularization after PCI despite normal ABI.

Background: As part of work-style reform for physicians, task shifting to non-physician healthcare professionals has been promoted in Japan. We previously reported task shifting results for percutaneous coronary interventions (PCI), but the status in arrhythmia treatment remains unclear.

Methods and Results: This subanalysis of a survey conducted by the Japanese Circulation Society Chugoku-Shikoku Branch examined task shifting in facilities performing both cardiac ablations and PCIs. A 30-item questionnaire was sent in March 2024 to 93 facilities managing acute coronary syndrome. Among 81 responding facilities (87.1% response rate), 51 performed cardiac ablations. Approximately 40% had only 1 ablation operator. The engagement rate as second operators was lower for ablations than for PCI (21.6% vs. 29.4%, P<0.001). Task shifting implementation showed no significant difference based on ablation operator numbers (N=1: 30.0% vs. N≥2: 16.1%, P=0.304), whereas facilities with fewer PCI operators had higher task shifting rates (P=0.026). Clinical engineers were the predominant profession in task shifting for both procedures.

Conclusions: Task shifting of sterile procedures was limited in ablation facilities compared with PCI, reflecting the procedural characteristics such as single-operator feasibility and mapping-intensive workflows. With substantial workload demands, continued collaboration with highly specialized medical staff is essential, along with appropriate incentives and attention to work-life balance.

Background: Approximately 70% of older patients with acute heart failure (AHF) exhibit inspiratory muscle weakness (IMW). Inspiratory muscle training (IMT) may improve respiratory function and functional capacity, yet evidence regarding its efficacy, safety, and optimal dosing in this population remains limited. The IMT-AHF trial aims to verify the efficacy and safety of IMT in older patients with AHF.

Methods and Results: The IMT-AHF trial is a single-center, multi-arm, parallel-group randomized controlled trial enrolling older patients aged ≥65 years with AHF who have IMW and can ambulate independently. Participants are stratified by age (<85 vs. ≥85 years), sex, and baseline 2-min walk distance (2MWD; <70 vs. ≥70 m) and are randomized to high-intensity IMT (HI-IMT), low-intensity IMT (LI-IMT), or sham IMT. Training intensities for HI-IMT, LI-IMT, and sham IMT are set at 60%, 30%, and 0% of maximum inspiratory mouth pressure, respectively. The intervention is performed 5 times per week and consists of 3 sets of 15 repetitions per day. The primary endpoint is change in 2MWD from baseline to discharge.

Conclusions: The findings of the IMT-AHF trial are expected to strengthen evidence for cardiac rehabilitation and inform IMT prescription in older patients with AHF.