Background: Because dysphagia is an important complication associated with poor prognosis in patients with acute heart failure (AHF), we examined the association between fasting management time and dysphagia at discharge.

Methods and Results: We retrospectively analyzed 644 patients without pre-admission dysphagia hospitalized for AHF, grouped by fasting management time (<48 vs. ≥48 h). After propensity score matching, 121 pairs were identified. In conditional logistic regression, oral intake resumption at <48 h was associated with lower odds of dysphagia at discharge than at ≥48 h (odds ratio 0.19, 95% confidence interval 0.10–0.38, P<0.001).

Conclusions: Shorter fasting management time was associated with lower odds of dysphagia at discharge.

Background: Hospitalization for the first episode of heart failure with reduced ejection fraction (HFrEF) represents an important opportunity to initiate evidence-based therapies. In this study, we aimed to clarify the role of vericiguat after first hospitalization for HFrEF in routine clinical practice.

Methods and Results: This multicenter retrospective cohort study included patients with HFrEF at their first hospitalization between June 2021 and September 2023 identified from the nationwide Verifying Characteristics and Outcomes in Heart Failure Patients Treated with Vericiguat registry (vericiguat group, n=104) and 2 institutional databases (control group, n=206) (mean age, 67 years; 71% male). The primary endpoint was a composite of cardiovascular death or HF rehospitalization within 1 year. In inverse probability of treatment weighting-adjusted Cox models, vericiguat use was associated with a lower risk of the primary endpoint, compared with controls (hazard ratio, 0.26; 95% confidence interval, 0.08–0.81). Sensitivity analysis using alternative weighting methods and a doubly robust model yielded consistent results.

Conclusions: In this real-world Japanese cohort of patients at first hospitalization for HFrEF, vericiguat initiation during index hospitalization was associated with a lower risk of cardiovascular death or HF rehospitalization after discharge. The observed association was directionally consistent with previous trials and pooled analyses, suggesting a potential benefit for this intermediate real-world population.

Background: International guidelines recommend integrating palliative care into heart failure (HF) management. In Japan, the additional medical fee for palliative care became applicable to endstage HF in 2018, but its adoption has remained very low, so we examined how well the current eligibility criteria capture HF hospitalizations with refractory symptoms or end-of-life care needs.

Methods and Results: This single-center retrospective study was conducted at a tertiary hospital in Japan. We reviewed 246 consecutive HF hospitalizations involving a multidisciplinary HF team between April 2018 and March 2022, and identified 43 HF hospitalizations with refractory symptoms or end-of-life care needs (39 patients), defined by in-hospital death, opioid use for refractory dyspnea or palliative sedation. Of these, only 20 (46.5%; 95% confidence interval, 30.8–61.7%) met all eligibility criteria. The main barrier was the requirement for ≥2 unplanned HF hospitalizations within the past year, which was fulfilled in only 53.5% of cases. Scenario analyses showed that removing this requirement would increase eligibility to 86.0%, and requiring ≥2 of the 3 mandatory criteria would increase it to 93.0%.

Conclusions: More than half of the HF hospitalizations did not meet the current eligibility criteria, mainly because of the repeated-hospitalization requirement. The findings suggested that the current criteria may not fully capture HF hospitalizations with refractory symptoms or end-of-life care needs.

Background: Predictors of successful venoarterial extracorporeal membrane oxygenation (VA-ECMO) weaning have been reported, but their integration into sequential reassessment remains unclear.

Methods and Results: We retrospectively analyzed 48 adults with cardiogenic shock receiving VA-ECMO. Exploratory stepwise models were constructed using variables available at ECMO initiation, 24, and 48 h. The 48-h model included female sex, pulse pressure, EtCO₂, levels of lactate, and creatinine.

Conclusions: Exploratory stepwise models using routinely available variables may provide a framework for sequential VA-ECMO weaning assessment. External validation is required.

Background: Apical aneurysm complicates apical hypertrophic cardiomyopathy (ApHCM), but its genetic determinants remain unclear.

Methods and Results: Whole-exome sequencing (WES) was performed in 72 Japanese patients with ApHCM, including 8 with apical aneurysms. Rare-variant burden was evaluated in core HCM genes, extended cardiomyopathy genes, and candidate remodeling pathways. No prespecified gene set was significantly enriched in aneurysm cases. ALPK3 missense variants were identified only in non-aneurysm cases.

Conclusions: In this exploratory cohort, WES did not detect a clear rare coding variant burden signal associated with apical aneurysm.

Background: The Japanese version of the high bleeding risk (J-HBR) criteria identifies patients with HBR undergoing percutaneous coronary intervention (PCI). We evaluated whether routine J-HBR calculation and peri-procedural discussion on dual-antiplatelet therapy (DAPT) duration were associated with changes in DAPT practice and clinical outcomes.

Methods and Results: We retrospectively evaluated 793 patients who underwent PCI between August 2019 and August 2021. Routine J-HBR calculation and peri-procedural discussion on DAPT duration were introduced in August 2020, and patients were categorized into post- and pre-J-HBR groups. The median DAPT duration was 174 and 188 days (P=0.47), and guideline-directed DAPT duration was achieved in 62.6% and 56.9%, respectively (P=0.13) in the post- and pre-J-HBR groups. Clinical outcomes did not differ significantly between groups, including net adverse clinical events (hazard ratio [HR], 1.08; 95% confidence interval [CI], 0.77–1.52; P=0.65), major cardiovascular or cerebrovascular events (HR, 0.76; 95% CI, 0.44–1.32; P=0.34), and major bleeding (HR, 1.30; 95% CI, 0.90–1.89; P=0.17). Multivariable Cox proportional hazards analysis showed that routine J-HBR calculation and peri-procedural discussion were not associated with a significant reduction in major bleeding (HR, 0.97; 95% CI, 0.65–1.46; P=0.88).

Conclusions: Routine J-HBR calculation and peri-procedural discussion on DAPT duration were not associated with significant changes in overall DAPT duration or clinical outcomes.

Background: Pulsed field ablation (PFA) can provoke muscle contraction, cough, and body movement, potentially compromising catheter stability. We evaluated bispectral index (BIS)-guided transnasal humidified rapid-insufflation ventilatory exchange (THRIVE)-based deep sedation during variable-loop catheter PFA.

Methods and Results: We studied 111 consecutive patients undergoing atrial fibrillation ablation under standard deep sedation (n=20), THRIVE-based deep sedation (n=53), or general anesthesia (n=38). Catheter displacement was quantified using the CARTO 3 mapping system. Median displacement was 6.06, 2.40, and 3.30 mm, respectively (P<0.001). After multivariable adjustment, THRIVE was associated with smaller displacement than standard deep sedation (adjusted mean difference −3.62 mm; 95% confidence interval [CI] −4.56, −2.68; P<0.001), whereas the difference between THRIVE and general anesthesia was not significant (adjusted mean difference −0.55 mm; 95% CI −1.34, 0.25; P=0.178). Tissue proximity indicator positivity was higher with THRIVE and general anesthesia than with standard deep sedation (60.9%, 67.3%, and 67.3%, respectively; overall P=0.006; Holm-adjusted P=0.016 for THRIVE vs. standard deep sedation). Motion-related interruptions occurred in 30.0%, 1.9%, and 0%, and mapping-system resets in 20.0%, 0%, and 0%, respectively. Hypoxemic events occurred in 35.0%, 1.9%, and 0%, respectively.

Conclusions: THRIVE-supported BIS-guided deep sedation was associated with improved catheter stability during variable-loop PFA and may serve as an intermediate sedation option without intubation or neuromuscular blockade.

Background: Nutritional status at discharge is a prognostic factor in acute heart failure (AHF) patients, but its relationship with early-phase nutritional therapy in the cardiovascular intensive care unit (CICU) remains unclear, so we evaluated the effects of HF severity, respiratory management, and nutritional dosage on nutritional status in AHF patients.

Methods and Results: We retrospectively analyzed 141 of 160 AHF patients admitted to the CICU in 2021, excluding those with acute coronary syndrome, who had died, or had been discharged early. Patients were divided into 3 groups by respiratory support: invasive ventilation (IPPV, n=21), non-invasive ventilation (NPPV, n=36), and other forms of oxygen supplementation (O₂S, n=84). The mean age of the patients was 72±15 years. On day 3, the IPPV group received less nutrition than the O₂S group, but by day 7 there was no significant difference among the groups in the nutritional doses administered. No significant differences in the Geriatric Nutritional Risk Index (GNRI) at discharge were observed among the groups. Multiple regression analysis identified the energy (standardized β=0.210, P=0.029) and protein (standardized β=0.248, P=0.007) doses on day 3 as being correlated with the GNRI at discharge, independent of HF severity or respiratory management.

Conclusions: The nutritional dose on day 3, rather than HF severity, respiratory management or the day 7 nutritional dose, may be associated with the GNRI at discharge.

Background: We investigated annual sex-stratified patterns in willingness to chair scientific sessions among cardiologists aged 35–45 years.

Methods and Results: We retrospectively analyzed 5,051 responses to annual chair-availability questionnaires for Japanese Circulation Society Annual Scientific Meetings from 2021 through 2024. Willingness to chair Japanese-language sessions ranged from 62.9% to 72.1% among women, and from 81.6% to 88.9% among men; corresponding ranges for English-language sessions were 22.6–33.9% and 38.6–47.4%, respectively.

Conclusions: The proportion indicating willingness was lower among women than men, particularly for English-language sessions; cross-year comparisons require caution.

Background: Durable left ventricular assist device (LVAD) therapy was introduced in Korea in 2018 within a transplant environment characterized by frequent preoperative extracorporeal membrane oxygenation (ECMO) support. We evaluated nationwide outcomes and predictors of mortality after LVAD implantation.

Methods and Results: This registry-based cohort study included all durable LVAD implantations performed in Korea between September 2018 and December 2023 using the Korean Mechanically Assisted Circulatory Support registry. The primary outcome was all-cause mortality. Survival was assessed with Kaplan–Meier and competing risk analyses, and predictors were identified using multivariable Cox models. Among 465 patients (median age 62 years; 78% male), 367 underwent bridge-to-transplantation (BTT) and 98 destination therapy (DT). Preoperative ECMO was used in 27.5%. One-year survival was 83.1% overall and higher in BTT than DT (87.4% vs. 69.6%; P<0.001). At 1 year, 59.6% remained on LVAD support, 24.8% underwent transplantation, and 15.6% died. Arrhythmia, bleeding, and infection were the most common complications. In multivariable analysis, age 60–69 years (hazard ratio [HR] 3.80; 95% confidence interval [CI] 1.73–8.31) and preoperative ECMO (HR 2.85; 95% CI 1.76–4.60) independently predicted mortality, whereas treatment strategy did not.

Conclusions: In this high-acuity population with frequent preoperative ECMO support, nationwide LVAD outcomes were comparable to international benchmarks. Mortality was more closely associated with preoperative clinical status than with treatment strategy.

Background: The cholesterol efflux capacity (CEC) of high-density lipoprotein (HDL) (HDL-CEC) is inversely associated with atherosclerotic cardiovascular disease. Type 2 diabetes mellitus (T2DM) is frequently complicated by chronic kidney disease (CKD), usually associated with increased homocysteine (Hcy), and these conditions are likely to be involved in HDL dysfunction. However, the relationship between HDL-CEC and CKD, as well as Hcy levels in patients with T2DM remains unclear.

Methods and Results: This cross-sectional study involved 138 patients with T2DM. CEC was measured using a stable-isotope method with J774 macrophage-like cells and apolipoprotein B-depleted serum. Multiple regression analysis showed that sex (β=0.278; P=0.005), estimated glomerular filtration rate (eGFR; β=0.232; P=0.038), and HDL cholesterol (HDL-C; β=0.197; P=0.030) were independently associated with CEC.

Conclusions: Sex, eGFR, and HDL-C were independently associated with HDL-CEC in patients with T2DM. These findings suggest that impaired renal function may be related to impaired HDL function in this population, although causal relationships cannot be inferred from this cross-sectional analysis.

Background: Troponin surveillance may facilitate early detection of immune checkpoint inhibitor (ICI)-associated myocarditis, but mild elevations and baseline abnormalities complicate interpretation. We assessed early post-ICI troponin I (TnI) dynamics and the performance characteristics of clinically applicable peak TnI thresholds within 3 months of ICI initiation.

Methods and Results: We analyzed 281 participants from a cardio-oncology surveillance program. TnI was measured at predefined intervals. Using peak TnI levels within 3 months, we evaluated the performance characteristics of candidate TnI thresholds for identifying adjudicated clinically significant TnI elevation associated with clinically meaningful conditions (e.g., ICI-associated myocarditis) at cut-offs of 50, 100, and 500 pg/mL. Eleven (3.9%) patients had elevated baseline TnI. Within 3 months, clinically significant TnI elevation occurred in 5 (1.8%) patients: ICI-associated myocarditis (n=2); immune-related myositis (n=1); pulmonary embolism (n=1); and seizures (n=1). A 50 pg/mL cut-off yielded 100% sensitivity, 96.0% specificity, 31.3% positive predictive value, and 100% negative predictive value. A 100 pg/mL cut-off demonstrated 100% sensitivity, 99.6% specificity, 83.3% positive predictive value, and 100% negative predictive value. A 500 pg/mL cut-off yielded 40.0% sensitivity and 100% specificity.

Conclusions: In this exploratory study, a peak TnI threshold of 100 pg/mL within 3 months identified all clinically significant events with high specificity. This threshold may serve as a pragmatic trigger for expedited evaluation of myocarditis and alternative etiologies.

Background: Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is a progressive, underdiagnosed cause of heart failure, particularly among older adults. Despite updated Japanese Circulation Society (JCS) guidelines and advances in imaging and therapies, diagnostic delays and variability persist. Understanding real-world barriers is essential for improving patient outcomes.

Methods and Results: A mixed-methods approach was used to develop an evidenced care pathway for ATTR-CM in Japan. A literature review of guidelines and epidemiological data informed a draft pathway. Semistructured interviews with 5 cardiologists from JCS-certified and regional hospitals explored perceived deviations from guidelines and barriers to care. Thematic analysis highlighted 5 perceived challenges: variability in physician awareness, particularly outside heart failure subspecialties; the influence of symptom type and entry point on diagnostic delay; fragmented referral pathways; low patient awareness and disengagement due to complex processes; and limited access to and interpretation of diagnostic tests.

Conclusions: Removal of the tissue biopsy requirement for diagnosis and treatment prescription is an important step towards less invasive care and broader treatment access. However, challenges remain in ensuring that non-invasive diagnostic methods are widely available and correctly interpreted. The exploratory findings reported here suggest that addressing awareness gaps, referral fragmentation, and variations in diagnostic expertise may help realize the benefits of non-biopsy diagnosis in Japan.

Background: Sodium-glucose co-transporter 2 (SGLT2) inhibitors and loop diuretics have beneficial diuretic effects in patients with heart failure but may increase the risk of excessive water loss. Therefore, clinical guidelines recommend adjustment of loop diuretic doses when these agents are used concomitantly. However, real-world evidence regarding changes in loop diuretic dosing is limited. This study evaluated changes in prescribed doses of oral loop diuretics in patients with heart failure receiving dapagliflozin or empagliflozin before and after publication of the JCS/JHFS 2021 Guideline Focused Update on Diagnosis and Treatment of Acute and Chronic Heart Failure.

Methods and Results: Changes in prescribed dose trends were evaluated using monthly aggregated prescription data obtained from the Medical Data Vision database (Medical Data Vision, Inc., Tokyo, Japan). After publication of the guideline, statistically significant decreases were observed in the empagliflozin-prescribed group for azosemide (−0.1756 mg/month; P=0.0360), furosemide (−0.2180 mg/month; P=0.0485), and torsemide (−0.0387 mg/month; P=0.0378), and in the dapagliflozin-prescribed group for azosemide (−0.8221 mg/month; P=0.0260). The study period for dapagliflozin was too short to provide adequate statistical power.

Conclusions: The publication of the JCS/JHFS 2021 guideline was associated with decreases in prescribed doses of oral loop diuretics. Dose reduction of oral loop diuretics may be considered in patients receiving concomitant SGLT2 inhibitors in clinical practice.

Background: The prognostic value of the Short Physical Performance Battery (SPPB), which is widely used to assess physical function and prognostic risk in patients with heart failure (HF), is unclear in patients with high SPPB scores. In this study we evaluated whether sarcopenia-related factors defined by the Asian Working Group for Sarcopenia in 2019 provided additional prognostic value in this population.

Methods and Results: This retrospective multicenter cohort study of the J-Proof HF registry included 3,044 patients aged ≥65 years with a discharge SPPB score ≥10. Impairments in handgrip strength, five-times chair stand test, and calf circumference were aggregated into a composite physical function score (range, 0–3). The primary outcome was the composite of all-cause death or rehospitalization for HF within 1 year, which occurred in 25.0% of the cohort. The composite outcome risk increased in a stepwise manner with each additional impaired domain (adjusted hazard ratio per 1-point increase, 1.245; 95% confidence interval 1.132–1.370; P<0.001). The fully adjusted model showed acceptable discrimination (Harrell’s C-index=0.694). Each domain independently demonstrated a similar magnitude of association with the outcome.

Conclusions: Even among older patients with HF and preserved physical performance (SPPB ≥10), accumulation of sarcopenia-related impairments was associated with an increased risk of adverse outcomes. Supplementing the SPPB with simple functional assessments may improve risk stratification in clinical practice.

Background: Because the prognostic significance of right bundle branch block (RBBB) in the general population remains uncertain, we conducted a systematic review and meta-analysis to evaluate the association of RBBB with clinical outcomes in general population cohorts.

Methods and Results: We systematically searched major databases for population-based cohort studies reporting associations between RBBB and clinical outcomes. Hazard ratios (HRs) were pooled using a random-effects model. A total of 14 studies were included in the systematic review, of which 5 (all-cause mortality), 4 (cardiovascular mortality), and 2 studies (pacemaker implantation) were included in the meta-analyses. RBBB was associated with a modest increase in all-cause mortality (HR 1.08; 95% confidence interval (CI), 1.01–1.16), although the association was attenuated in the sensitivity analysis excluding the largest-weight study (HR 1.04; 95% CI, 0.87–1.24). No significant association was observed between RBBB and cardiovascular mortality (HR 1.20; 95% CI, 0.90–1.59). RBBB was associated with an increased risk of pacemaker implantation (HR 3.03; 95% CI, 1.70–5.38), although the number of studies was limited.

Conclusions: RBBB was associated with a modest and partially unstable increase in all-cause mortality, but no significant association with cardiovascular mortality was observed. RBBB may reflect underlying risk profiles or progressive conduction system abnormalities, rather than serving as a strong independent predictor of mortality.

Background: We aimed to elucidate the prognostic impact of in-hospital emergencies among patients who require non-surgical intensive care.

Methods and Results: In total, 4,483 patients requiring non-surgical intensive care from 2011 to 2021 were included. Patient backgrounds, in-hospital management, and prognoses were compared among 4 groups according to the hospitalization route: walk-ins (group A; n=636); ambulance (group B; n=2,748); helicopter/car-based emergency medical service (group C; n=565); and in-hospital emergencies (group D; n=534). The proportion of patients admitted to the intensive care unit after in-hospital emergencies was 38.0% among those with sepsis and 29.7% among those with other non-cardiovascular diseases. Furthermore, acute heart failure (AHF), sepsis and other non-cardiovascular disease were the most common diseases in patients with in-hospital emergencies (24.3%, 23.2% and 21.5%, respectively). Kaplan–Meier curve analysis revealed that the prognosis (365-day all-cause mortality) was significantly poorer in group D than in the other groups. A multivariable Cox regression model identified group D as an independent predictor of 365-day all-cause mortality (hazard ratio 1.227; 95% confidence interval 1.027–1.467) relative to out-of-hospital admissions, especially in AHF and non-cardiovascular disease.

Conclusions: Patients who required non-surgical intensive care after in-hospital emergencies mainly have AHF and non-cardiovascular etiologies such as sepsis. In-hospital emergency was identified as a significant factor associated with a higher 365-day mortality rate. A clinical approach to reduce their mortality is urgently needed.

Background: Recurrent ischemic events after acute myocardial infarction (AMI) may arise from treated culprit lesions (CLs) or untreated non-CLs (NCLs). However, temporal trends in CL- and NCL-attributed revascularization in contemporary clinical practice remain unclear.

Methods and Results: We analyzed data from the Mie ACS Registry, a multicenter registry enrolling patients with AMI who underwent primary percutaneous coronary intervention. Patients with previous coronary artery bypass grafting were excluded. The coprimary endpoints were the times to the first CL- and NCL-attributed revascularization over a 2-year follow-up period. Death was treated as a competing event. Temporal trends and predictors were evaluated using competing-risk analyses. Among 6,363 patients, 2,860 were enrolled in 2013–2017 and 3,503 were enrolled in 2018–2022. The cumulative incidence of CL-attributed revascularization was significantly lower in the later era (6.2% vs. 3.5%; P<0.001), whereas NCL-attributed revascularization showed only modest temporal improvement from 2013–2017 to 2018–2022 (6.6% vs. 5.5%, respectively; P=0.091). In multivariable analyses, late-era (2018–2022) enrollment was independently associated with a lower risk of CL-attributed revascularization (subdistribution hazard ratio [sHR] 0.56; 95% confidence interval [CI] 0.44–0.71; P<0.001), whereas multivessel disease was the strongest predictor of NCL-attributed revascularization (sHR 2.31; 95% CI 1.84–2.91; P<0.001).

Conclusions: Despite temporal reductions in CL-attributed revascularization, NCL-attributed events remained relatively unchanged. NCLs continue to represent an important source of residual coronary risk after AMI.

Background: Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality, so accurate early risk stratification is essential for predicting adverse events. We investigated whether combining the Creactive protein/albumin ratio (CAR) with the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) risk score was associated with an increased risk of 1-year major adverse cardiac events (MACE), and assessed its efficacy in the risk stratification of patients with AMI undergoing primary percutaneous coronary intervention (PCI).

Methods and Results: In total, 554 patients were enrolled. The rate of 1-year MACE was 10.5%. Both the CADILLAC risk category and CAR tertile were independent predictors of 1-year MACE, after adjustment for covariates (hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.34–2.92, P=0.001; HR 1.65, 95% CI 1.14–2.37, P=0.007, respectively). Compared to patients with a low CADILLAC risk score and a low CAR tertile, those with a high CADILLAC risk score and a high CAR tertile had the highest 1-year MACE (adjusted HR 8.13, 95% CI 1.88–35.2, P=0.005). Adding CAR to a model that combined the CADILLAC risk score with the baseline factors significantly improved the prediction of 1-year MACE.

Conclusions: Combining the CAR with the CADILLAC risk score significantly contributed to predicting 1-year MACE in patients with AMI undergoing primary PCI.

Background: As populations age, cardiovascular disease (CVD) increasingly affects functional independence, an issue of growing importance among older adults. However, long-term trajectories of functional decline in patients receiving contemporary CVD care remain poorly characterized, so the Niigata Cardiovascular Disease Registry using Health Insurance Claims (NiCARDIA) was established to address this gap by integrating hospital-based clinical data with administrative datasets through a prefecture-wide data-sharing platform.

Methods and Results: NiCARDIA is a multicenter, prospective observational cohort enrolling 8,500 adults hospitalized with CVD at 16 hospitals across Niigata Prefecture, Japan. Baseline data include demographics, biomarkers, echocardiographic findings, and other clinical variables. Eligible participants are insured under Japan’s public health insurance schemes, enabling deterministic linkage to longitudinal medical, long-term care, and health check-up data. Administrative datasets will be updated every 6–12 months through to 2045. The primary outcome is longitudinal change in functional independence assessed by certified long-term care-need levels. Secondary outcomes include death, hospitalizations, treatment patterns, and prediction of functional decline.

Conclusions: By linking detailed clinical data with population-level administrative datasets, NiCARDIA will enable comprehensive evaluation of long-term functional trajectories and their clinical and social determinants in contemporary CVD patients.

Background: Individuals with post-stroke lateropulsion are unable to shift their body weight to the non-paralytic side and consequently lean toward the paralytic side, thereby lengthening the rehabilitation process and hindering independent walking. We developed REHA-glasses, a device that allows the wearer to rotate the perceived visual field in accordance with their incorrect perception of verticality, thereby adjusting their posture to an upright position. No clinical practice guidelines exist for the rehabilitation of patients with post-stroke lateropulsion.

Methods and Results: This will be a single-center, exploratory participant- and evaluator-blinded randomized controlled clinical trial (jRCT1052250005). Individuals with acute stroke admitted to hospital within 48 h of onset will be recruited. Participants will be allocated randomly to 2 groups: wearing REHA-glasses during gait rehabilitation or wearing sham REHA-glasses that do not modulate visual input. A total of 5 gait rehabilitation sessions with REHA-glasses will be completed. Outcome measures will be collected at 3 time points: baseline, post-intervention, and 90 (±14) days after stroke onset. The primary outcome is the proportion of participants who improve by ≥1 point in the Functional Ambulation Categories from baseline to post-intervention.

Conclusions: This will be the first trial to investigate the effect and feasibility of REHA-glasses for independent walking in individuals with acute stroke lateropulsion.

Background: Malnutrition is a common geriatric syndrome associated with adverse long-term outcomes in hospitalized patients with heart failure (HF). However, its prognostic impact in outpatients with stage B HF remains unclear.

Methods and Results: This multicenter, retrospective cohort study was conducted at 4 outpatient cardiology clinics between June 2021 and May 2023. Among 331 outpatients aged ≥65 years with stage B HF, 307 were included in the final analysis. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI). The primary endpoint was a composite of all-cause death or hospitalization for worsening HF during the 2-year follow-up period. The median GNRI was 102.8, and 22% (67/307) of patients were classified into the low-GNRI group (GNRI ≤ 98.0). Kaplan–Meier analysis showed that the low-GNRI group had a significantly higher incidence of the composite endpoint than the high-GNRI group (14.9% vs. 3.8%; log-rank P<0.001). In multivariable Cox proportional hazards models, a low GNRI was independently associated with adverse events (hazard ratio 3.41; 95% confidence interval 1.34–8.69; P=0.01).

Conclusions: Low GNRI scores were independently associated with poorer long-term outcomes in older outpatients with stage B HF. Thus, the GNRI may serve as a simple and practical tool for early risk stratification of this population.

Background: Left atrial enlargement (LAE) is common in patients undergoing transcatheter aortic valve implantation (TAVI), but its prognostic significance may vary according to the clinical drivers of atrial remodeling. We examined whether prognostic factors differ by clinically attributed LAE subtype in patients undergoing TAVI with preserved left ventricular ejection fraction (LVEF).

Methods and Results: We retrospectively analyzed 317 consecutive patients with symptomatic severe aortic stenosis (AS) undergoing TAVI who had preserved LVEF and LAE. Patients were classified as AS-associated LAE (no atrial fibrillation [AF] and <moderate mitral regurgitation [MR]) or AF/MR-associated LAE (AF and/or ≥moderate MR). The primary endpoint was all-cause death. During a median follow-up of 2.7 years, 69 patients (21.8%) died. The all-cause mortality rate was higher in the AF/MR-associated group than in the AS-associated LAE group (30.7% vs. 19.0%; log-rank P<0.01), but this association was attenuated after adjustment for eGFR, log-BNP, and LAVI. In the AS-associated LAE group, higher log-BNP (hazard ratio (HR) 1.45, 95% confidence interval (CI) 1.06–1.98), higher E/e′ (HR 1.03, 95% CI 1.01–1.06), and lower TAPSE (HR 0.89, 95% CI 0.81–0.99) predicted death. In the AF/MR-associated LAE group, lower eGFR (HR 0.96, 95% CI 0.93–1.00) and higher log-BNP (HR 1.98, 95% CI 1.09–3.59) predicted death after adjustment for age. Interactions were significant for eGFR and E/e′.

Conclusions: Prognostic markers after TAVI differ by clinically attributed LAE subtype, supporting subtype-informed risk stratification.

Background: Tafamidis is used in patients with wild-type transthyretin cardiac amyloidosis (ATTRwt-CA), but the effect of diabetes mellitus (DM) on the efficacy of tafamidis is unknown.

Methods and Results: We included 57 patients (median age, 77 years) with ATTRwt-CA to compare global longitudinal strain (GLS) before and 1 year after treatment with tafamidis in patients with and without DM (Non-DM, 43 patients; DM, 14 patients). GLS was only ameliorated in patients without DM.

Conclusions: The change in GLS at 1 year after tafamidis treatment may be different in ATTRwt-CM patients with and without DM.

Background: Congestive hepatopathy in congenital heart disease (CHD) can lead to portal hypertension. Liver native T1 relaxation time (LT1) was reported to be associated with elevated central venous pressure and liver injury in CHD. This study investigated the utility of spleen native T1 relaxation time (ST1) in children with CHD, particularly those with Fontan circulation, and its association with hemodynamic parameters and biomarkers of liver injury.

Methods and Results: This study included 120 patients with CHD (biventricular repair, 39; bidirectional Glenn shunt, 31; and Fontan circulation, 50) who underwent blood tests, cardiac catheterization, and cardiac magnetic resonance imaging performed within 48 h. Age-corrected ST1 (cST1; expressed as a percentage of normal) was calculated based on data from 22 control subjects (healthy children: no structural heart disease, normal cardiac function, normal systemic hemodynamics). cST1 was significantly correlated with net inferior vena cava (IVC) flow in both the overall cohort (r=0.364, P<0.001) and Fontan group (r=0.368, P<0.009). Multiple linear regression analysis showed that aspartate aminotransferase (AST) (P=0.011), LT1 (P=0.005), and net IVC flow (P=0.041) remained independent predictors of cST1 in the overall cohort, whereas AST (P<0.001) and non-alcoholic fatty liver disease fibrosis scores (P=0.029) were independent predictors in the Fontan group.

Conclusions: Age-corrected ST1 may serve as a non-invasive surrogate marker of systemic venous congestion and hepatic involvement in children with CHD.

Background: We evaluated the safety and efficacy of ponatinib, a multi-target tyrosine kinase inhibitor, for pulmonary tumor thrombotic microangiopathy (PTTM).

Methods and Results: We conducted a single-center, open-label, single-arm, prospective study; 3 patients associated with ovarian, breast, and gastric carcinomas were enrolled and received oral ponatinib for 2 weeks. All died from PTTM progression with no severe ponatinib-related adverse events.

Conclusions: This study failed to demonstrate ponatinib efficacy. Further studies may evaluate the effect of different biochemical targets on PTTM.

Background: Achieving pulmonary vein isolation (PVI) through contiguous lesions is important for durable PVI treatment of atrial fibrillation (AF). We hypothesized that the flexible-tip TactiFlex catheter, with its enhanced stability, would allow for successful acute PVI even with an extended interlesion distance (ILD) of 6 mm.

Methods and Results: The WILD (Wide ILD) PVI trial was a prospective, multicenter, single-blind randomized non-inferiority trial. A total of 94 patients with paroxysmal AF were enrolled and randomly allocated to either a wide ILD group (≤6 mm, n=52) or a standard ILD group (≤4 mm, n=42). The primary endpoint was acute PVI success, defined as first pass isolation without early reconnection. The non-inferiority margin was set at −10.0%. The 6-mm group did not meet the criteria for non-inferiority compared to the 4-mm group (56.7% vs. 68.7%; absolute difference: −11.9% [95% confidence interval: −25.7 to 1.8%]; P for non-inferiority=0.664). Conversely, the 6-mm strategy significantly reduced the total number of RF applications (47±10 vs. 73±17, P=0.001) and total ablation time (528±119 s vs. 825±233 s, P<0.001) compared to the 4-mm group.

Conclusions: The 6-mm ILD strategy was inferior to the standard 4-mm strategy for acute PVI success. Despite significant gains in procedural efficiency, maintaining an ILD ≤4 mm is recommended to ensure high acute procedural success when using the TactiFlex catheter.

Background: Real-world data describing the clinical course after vutrisiran initiation in patients with variant transthyretin amyloid cardiomyopathy (ATTRv-CM) in non-endemic regions remain limited, particularly in Asian cohorts and in patients transitioning from patisiran. We evaluated preliminary real-world changes after vutrisiran initiation in patients with ATTRv-CM.

Methods and Results: This single-center retrospective observational study included 18 patients with ATTRv-CM from the Oita-ATTR-CM cohort. Ten patients who initiated small interfering RNA therapy with vutrisiran were classified as the vutrisiran-naive group, and 8 patients who switched from patisiran to vutrisiran were classified as the vutrisiran-switch group. Changes in transthyretin (TTR), N-terminal pro B-type natriuretic peptide (NT-proBNP), troponin T, and echocardiographic parameters from baseline to 1 year were descriptively evaluated. Vutrisiran markedly reduced TTR in both groups. NT-proBNP significantly decreased in both groups, and troponin T decreased only in the vutrisiran-naive group. E/e′ significantly decreased in both groups, whereas left ventricular ejection fraction, interventricular septal thickness, and left ventricular mass remained largely unchanged. During follow up, 2 patients were hospitalized for heart failure and 1 died of a non-cardiovascular cause; all events occurred in the vutrisiran-switch group.

Conclusions: In this preliminary single-center real-world cohort, vutrisiran use was feasible and was accompanied by sustained TTR suppression and descriptive decreases in NT-proBNP and E/e′ over 1 year. These findings should be interpreted as exploratory real-world observations rather than evidence of definitive efficacy.

Background: Transitional care is essential for patients with childhood-onset chronic diseases to ensure age-appropriate lifelong care. In contrast to congenital heart disease (CHD), for which transition/transfer systems have been relatively well established, childhood-onset cardiomyopathy (ChO-CM) lacks an established transitional care system in Japan. Our previous nationwide survey clarified the pediatric cardiologists’ perspective, but awareness of and perceived need for transitional care among adult cardiologists have remained unclear. Therefore, this study investigated adult cardiologists’ awareness of and perceived need for transitional care for ChO-CM.

Methods and Results: A nationwide questionnaire survey was conducted in 1,347 cardiovascular departments in Japan to examine adult cardiologists’ awareness of and perceived need for transitional care for ChO-CM. Valid responses were obtained from 332 departments. Among the respondents, 157 (47.3%) were aware of transitional care, whereas 200 (60.2%) answered that transitional care was necessary for all CM cases. Multivariable logistic regression analysis showed that experience in treating hypertrophic cardiomyopathy (HCM) was independently associated with both awareness of transitional care and perceived need for it.

Conclusions: Awareness of transitional care for ChO-CM among adult cardiologists in Japan remains limited. However, most respondents recognized the need for transitional care. Clinical experience with HCM may promote recognition of the importance of transitional care. These findings highlight the need to develop structured transition systems for patients with ChO-CM in Japan.

Background: Religiosity is a well-described core component of palliative care in the end-of-life (EOL) care of cancer patients. However, studies examining associations between religiosity, physical symptoms, quality of care (QOC), and quality of death (QOD) in cardiovascular disease (CVD) patients at EOL are lacking.

Methods and Results: This nationwide cross-sectional mortality follow-back survey sent a questionnaire to bereaved caregivers of patients who had died of CVD in 2017. Responses to the Memorial Symptom Assessment Scale (MSAS), Care Evaluation Scale (CES), and Good Death Inventory (GDI) were assessed, stratified by the presence of religiosity. Responses regarding religiosity were analyzed for 4,436 of 15,047 questionnaires. In all, 795 (17.9%) caregivers reported the patient was supported by religiosity in the 1 month before death. The group with religiosity was older (mean [±SD] age 88.9±8.7 vs. 86.7±9.4 years; P<0.001), more likely to be female (70.9% vs. 60.3%; P<0.001), less likely to have been hospitalized before death (15.8% vs. 24.0%; P<0.001), reported significantly fewer symptoms on the MSAS, and had better QOC and QOD according to CES and GDI subscores. Total CES and GDI scores were significantly better in the group with than without religiosity (CES: 69.2±21.9 vs. 63.6±24.2, respectively [P<0.001]; GDI: 65.4±17.0 vs. 53.7±22.1, respectively [P<0.001]).

Conclusions: Religiosity may contribute to reduced physical symptoms and improved QOC and QOD among CVD patients at EOL.

Background: Cancer therapy-related cardiovascular toxicity is increasingly recognized as a major issue in cancer care, underscoring the need for multidisciplinary onco-cardiology. Although pharmacists are expected to play important roles in this field, their real-world involvement and challenges in onco-cardiology practice in Japan remain unclear.

Methods and Results: We conducted a cross-sectional web-based survey of early career pharmacists (aged ≤45 years) in Japan between July and August, 2025. The questionnaire assessed pharmacists’ background, awareness of onco-cardiology and related clinical guidelines, areas of interest, clinical experience, perceived challenges, interprofessional collaboration, and educational needs. A total of 105 pharmacists responded. Approximately 80% of respondents reported moderate to high interest in onco-cardiology. However, clinical experience in onco-cardiology was limited; 56.2% of respondents managed only 1–5 cases per month, and 20.0% reported no prior experience. Collaboration scores differed significantly across domains, with hospital pharmacy–community pharmacy collaboration being significantly lower than collaboration between pharmacists and oncologists or cardiologists (P<0.001). Major challenges included insufficient knowledge, limited educational opportunities, and difficulties in multidisciplinary collaboration.

Conclusions: Although early career pharmacists participating in this study demonstrate strong interest in onco-cardiology, their clinical involvement remains limited, and interprofessional collaboration is suboptimal. Structured educational programs and strengthened collaboration frameworks, particularly between hospital and community pharmacy settings, are needed to facilitate pharmacists’ integration into multidisciplinary onco-cardiology care.

Background: Eating difficulty is an important complication in patients with acute heart failure (AHF), but no AHF-specific tool has been established for the early prediction of eating difficulty. We aimed to develop and internally validate the Development of eating Difficulty Assessment Score in acute Heart failure (D-DASH) using variables available during early hospitalization.

Methods and Results: This single-center retrospective observational study included 644 patients hospitalized for AHF who had no eating difficulty before admission. The outcome was eating difficulty at discharge, defined as a Food Intake LEVEL Scale ≤8. A multivariable logistic regression model was constructed using age, dementia, New York Heart Association class IV, albumin, and maximal tongue pressure. Eating difficulty at discharge occurred in 110 (17.1%) patients. Older age (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01–1.07), dementia (OR 2.66; 95% CI 1.44–4.85), lower albumin (OR 0.59; 95% CI 0.39–0.89), and lower maximal tongue pressure (OR 0.94; 95% CI 0.90–0.98) were independently associated with eating difficulty at discharge. The model showed moderate discrimination (area under the curve 0.749; 95% CI 0.700–0.797) with acceptable calibration. Bootstrap internal validation demonstrated an optimism-corrected C-index of 0.739 and a calibration slope of 0.940.

Conclusions: This study developed a predictive scoring system to identify patients with AHF at risk of eating difficulty, enabling timely intervention to mitigate this risk.

Background: Arterial stiffness is an established predictor of cardiovascular morbidity and mortality. Circulating amino acids have emerged as metabolic markers linked to cardiovascular risk, but longitudinal evidence in community-dwelling Japanese older adults remains limited. Therefore, we investigated whether baseline amino acid profiles predict progression of arterial stiffness, as assessed by the cardio–ankle vascular index (CAVI), in this population.

Methods and Results: This prospective analysis of the Kyotango Longevity Cohort Study included 592 participants aged ≥65 years with repeated CAVI measurements (mean follow-up 3.2±0.5 years). Fasting blood samples were analyzed for 23 amino acids with sufficient data availability at baseline. Primary screening analyses adjusted for age, sex, and baseline CAVI identified glutamic acid, isoleucine, and leucine as significantly associated with greater CAVI increase (q<0.10). After multivariable adjustment for cardiovascular risk factors, these associations remained significant. No significant interactions were observed between the identified amino acids and markers of inflammation (interleukin 6 and high-sensitivity C-reactive protein), oxidative stress (8-hydroxy-2′-deoxyguanosine), or physical function (grip strength). Branched-chain amino acids and Fischer ratio were also independently associated with CAVI progression.

Conclusions: Circulating amino acid profiles, particularly glutamic acid, leucine, and isoleucine, together with branched-chain amino acid-derived indices, independently predict longitudinal progression of arterial stiffness as assessed by CAVI in Japanese older adults.

Human epididymis protein 4 (HE4), originally identified as a tumor biomarker, has emerged as a regulator of tissue remodeling, with roles that extend beyond oncology. Recent findings suggest that HE4 is involved in extracellular matrix turnover, immune system modulation, and maintenance of epithelial balance, indicating its complex role in fibrosis and tissue remodeling. In cardiovascular diseases, the circulating HE4 level is consistently associated with disease severity, myocardial fibrosis, and adverse clinical outcomes in conditions such as heart failure, aortic stenosis, and ischemic heart disease, suggesting its role as a marker of fibrosis-driven remodeling in diverse cardiovascular conditions. Mechanistically, HE4 influences fibrosis via protease inhibition, fibroblast activation, and immune signaling pathways, and may function as a mediator of inter-organ communication. In particular, its strong association with renal dysfunction and expression in injured kidney tissues supports its role in cardiorenal interactions. Recent findings suggest that HE4 plays a role in systemic remodeling processes that extend beyond heart function, including those associated with pulmonary vascular disease. Collectively, these insights propose a conceptual framework in which HE4 acts as a context-dependent regulator of tissue remodeling, integrating structural, immune, and inter-organ communication pathways. This perspective positions HE4 as a biomarker and a mechanistically relevant mediator of disease progression, with potential implications for risk stratification and therapeutic targeting in cardiovascular disease.

Background: In patients with lower extremity artery disease (LEAD), coexisting coronary artery disease (CAD) is common, but the angiographic features associated with occult CAD remain poorly characterized. We performed a hypothesis-generating angiographic phenotyping analysis to examine whether lower extremity lesions treated with endovascular therapy (EVT), particularly below-the-knee (BK) lesions, were associated with coexisting occult CAD on preprocedural coronary computed tomography angiography (CCTA) in patients undergoing EVT.

Methods and Results: Among 223 consecutive CCTA-screened LEAD patients without prior coronary revascularization, occult CAD (≥50% stenosis) was present in 127 (57.0%). In multivariable analysis, diabetes mellitus (adjusted odds ratio [aOR] 1.93, P=0.030) and EVT-treated BK lesions (aOR 3.27, P=0.034) remained associated with occult CAD after adjustment; the BK association was based on a small subgroup (n=32). During a mean follow-up of 716 days, occult CAD was associated with major adverse cardiovascular events (MACE) in univariable Cox analysis (hazard ratio 2.59, 95% CI 1.04–6.47, P=0.041), but did not persist after exploratory Firth’s penalized adjustment for diabetes mellitus and hemodialysis (adjusted hazard ratio 2.01, 95% CI 0.85–5.39, P=0.114).

Conclusions: In this hypothesis-generating angiographic phenotyping analysis of CCTA-eligible LEAD patients undergoing EVT, EVT-treated BK lesions emerged as a candidate angiographic feature associated with coexisting occult CAD. An independent prognostic effect of occult CAD on MACE was not established. These exploratory findings require validation in larger prospective cohorts.