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: 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: 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: 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: 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: 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: 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: 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: Depression is common in patients with chronic kidney disease (CKD) and known to be associated with a greater risk of developing cardiovascular disease (CVD). However, it is uncertain whether, and to what extent, depression influences the incidence of CVD among individuals with CKD.

Methods and Results: We analyzed 281,961 individuals with CKD defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m²or proteinuria (≥ +1) including 14,527 (5.2%) individuals with depression registered in the DeSC database from April 2014 to August 2023. The DeSC database is commercially available from DeSC Healthcare Inc. A Cox proportional hazards regression analysis was conducted to estimate the hazard ratio associated with the presence of depression. The median age was 68 years and 47.8% were men. During the follow-up period, 48,359 composite CVD events were recorded. Multivariable Cox regression analysis showed that CKD individuals with depression had a greater risk of composite CVD events than those without (hazard ratio 1.36; 95% confidence interval 1.31–1.42). Given the limitations of real-world data, we performed multiple sensitivity analyses, which confirmed the results of our primary analysis. Notably, we found that the association between depression and a subsequent risk of developing CVD was not modified by eGFR.

Conclusions: Depression is independently associated with an increased risk of CVD among individuals with CKD regardless of baseline kidney function.

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: 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: 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: Although takotsubo syndrome (TTS) carries a substantial risk of recurrence, the factors associated with recurrence remain uncertain.

Methods and Results: A total of 236 consecutive patients with TTS (age 80 years [interquartile range (IQR) 71–85]), admitted between 2008 and 2023, were studied. The recurrence group (n=13; age 78 years [IQR 70–84]) was compared with the non-recurrence group (n=223, age 80 years [IQR 71–85]) based on clinical features at the initial TTS event. The recurrence rate was 5.5%. The absence of a definable trigger was more frequent (85% vs. 20%; P<0.001), and physical triggers were less frequent (0% vs. 64%; P<0.001) in the recurrence group. Of the initial diagnostic clues, chest pain/dyspnea was more frequent (77% vs. 35%; P=0.002), and electrocardiographic changes were less frequent (23% vs. 61%; P=0.006) in the recurrence group. A ballooning pattern was similar between episodes in 12 of the 13 patients with recurrence. In the multivariate analysis, the absence of a definable trigger (odds ratio 15.47 [95% confidence interval 3.10–77.60]; P<0.001) was associated with recurrence.

Conclusions: The recurrence rate of TTS was 5.5% over the 16-year period. Ballooning patterns at recurrence were largely similar to those at the initial TTS event. Patients who experienced TTS without a definable trigger had more frequent recurrences than those with identifiable triggers.

Background: Radiation-associated cardiac disease (RACD) remains a clinically relevant late toxicity of thoracic radiotherapy. Although modern techniques have reduced cardiac exposure, myocardial injury may still occur.

Methods and Results: We analyzed 355 patients with esophageal, lung, or left breast cancer who underwent baseline cardiac evaluation before cancer therapy. For the primary analysis, patients without radiotherapy (no RT; n=237) were compared with those who received radiotherapy involving the heart (cardiac RT; n=41). Patients who underwent thoracic radiotherapy without direct cardiac irradiation (n=77) were evaluated separately. Cardiac troponin I (cTnI) and echocardiographic parameters were assessed at 12 months. cTnI levels remained stable and showed no association with cardiac radiation exposure. Left ventricular ejection fraction was preserved, whereas the cardiac RT group exhibited lower septal e′ velocity and E/A ratio. Higher cardiac radiation dose was associated with lower E/A ratio (R=−0.448, P=0.009) and septal e′ velocity (R=−0.389, P=0.023). In multivariable logistic regression analysis, cardiac irradiation independently predicted a reduced E/A ratio (<0.8; odds ratio 2.46; 95% confidence interval 1.04–5.83; P=0.041).

Conclusions: Cardiac irradiation was associated with declines in diastolic indices despite stable cTnI. Diastolic impairment may represent an early subclinical manifestation of RACD, underscoring the importance of echocardiographic monitoring and minimizing cardiac radiation exposure.

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: Low vision is often observed in patients with chronic limb-threatening ischemia (CLTI) and tissue loss. However, the impact of low vision on wound healing in these patients has not been previously described. We aimed to investigate the relationship between low vision and the wound healing rate in CLTI patients with tissue loss.

Methods and Results: A total of 74 CLTI patients with de novo tissue loss who underwent endovascular therapy between January 2017 and December 2022 was enrolled in this study. The patients were divided into 2 groups based on the National Eye Institute’s criteria for low vision: a low vision group with 24 patients, and a normal vision group with 50 patients. The primary endpoint was the 2-year wound healing rate. The rates of diabetes and renal disease requiring hemodialysis were significantly higher in the low vision group. The 2-year wound healing rate was significantly lower in the low vision group than in the normal vision group (33.3% vs 76.0%; P<0.001). In multivariate analysis, low vision showed an independent association with wound healing outcomes.

Conclusions: The wound healing rate was lower in CLTI patients with low vision than in those without low vision. Low vision should be considered a factor associated with wound healing outcomes in CLTI patients.

Background: Many older adults lack eHealth literacy to effectively benefit from digital health technologies. We examined the association between daily digital device use and eHealth literacy among older adults hospitalized for heart failure (HF).

Methods and Results: This prospective multicenter cohort study enrolled patients aged ≥65 years hospitalized for HF. eHealth literacy was assessed at discharge using the eHealth Literacy Scale (eHEALS). Digital device use was evaluated based on daily usage time. Logistic regression analyses examined associations between digital device use and high eHealth literacy (eHEALS ≥26). In all, 219 patients (mean [±SD] age 82.0±7.9 years; 42.2% women) were analyzed. Device users had higher eHealth literacy than non-users. Daily digital device use >1 h/day was significantly associated with high eHealth literacy (odds ratio 13.01; 95% confidence interval 3.38–50.08). Among device users, high eHealth literacy was associated with a greater use of devices for emails or messaging, searching for health information, pedometer use, and administrative procedures (e-government services).

Conclusions: eHealth literacy among hospitalized older adults with HF was low but significantly associated with digital device use. Information-seeking and interactive digital behaviors were linked to higher eHealth literacy. Tailoring discharge education to individual eHealth literacy levels may be important for planning post-discharge self-management support.

Background: To examine hypotension during cardiac rehabilitation (CR) after angiotensin receptor-neprilysin inhibitor (ARNI) initiation in patients with acute decompensated heart failure (ADHF) and its clinical characteristics.

Methods and Results: We studied 124 ADHF patients who received ARNI (2022–2023). During CR, 26.6% had systolic blood pressure (SBP) <90 mmHg; 54.5% experienced interruption or difficulty mobilizing. ARNI were discontinued because of hypotension in 24.2% of patients. Logistic regression revealed low preARNI SBP and high B-type natriuretic peptide (BNP) levels as predictors.

Conclusions: Low SBP during CR after ARNI use occurred in 26.6% of patients and was associated with low preARNI SBP and high BNP levels.

Background: Although wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) is frequently observed in older patients with aortic stenosis (AS), its relationship with AS is unclear. Therefore, this exploratory study aimed to investigate the relationship between myocardial amyloid deposition and AS in patients with ATTRwt-CA.

Methods and Results: This study included 39 patients (mean age 76 years) with biopsy-confirmed ATTRwt-CA. Myocardial amyloid deposition was quantitatively analyzed using histological evaluation of the biopsied myocardium and the heart-to-contralateral (H/CL) ratio was evaluated using bone scintigraphy. These parameters were then compared between 5 patients with severe AS and 34 patients without severe AS, and predictors of severe AS were evaluated. Myocardial amyloid deposition was greater in ATTRwt-CA patients with severe AS than in those without severe AS (mean [±SD] 32.6±12.7% vs. 19.9±11.7%; P=0.0311) but there was no difference in the H/CL ratio between the 2 groups. Multivariate analysis identified only greater myocardial amyloid deposition (per 10%) as an independent determinant of severe AS in patients with ATTRwt-CA (odds ratio 2.91; 95% confidence interval 1.23–8.67; P=0.0254).

Conclusions: This exploratory study suggests that severe AS may be associated with myocardial amyloid deposition in patients with ATTRwt-CA, although larger prospective research is needed to validate our results.

Background: Ischemic stroke (IS) is a serious but underexplored complication of acute decompensated heart failure (ADHF). We assessed the incidence, subtypes, and phase-specific association between hemoglobin and IS risk.

Methods and Results: The West Tokyo Heart Failure Registry-2 is a prospective multicenter cohort enrolling consecutive patients hospitalized for ADHF at 11 tertiary hospitals in Tokyo (2018–2024). Board-certified neurologists confirmed IS and classified subtypes using the TOAST criteria. IS incidence and subtypes were evaluated during the early (≤30 days) and late (>30 days) phases after hospitalization relative to hemoglobin levels (anemic/non-anemic). Among 5,106 patients (median age 79 years; 58% male; median left ventricular ejection fraction 45%), 115 (2.3%; 3.6% per person-year) developed IS during a median 13-month follow-up. IS incidence peaked in the early phase, with a median onset of 7 days (interquartile range 3–12 days; P_trend=0.002). Cardioembolic stroke (61.7%) predominated across both phases. Early-phase IS patients were younger, had less prior anticoagulant use, and had higher hemoglobin levels. In multivariable Fine–Gray models accounting for competing risk of death, non-anemia was independently associated with increased early-phase IS risk (subdistributional hazard ratio 2.04; 95% confidence interval 1.09–3.82; P=0.03), but not with late-phase IS.

Conclusions: IS occurred most frequently within 30 days after ADHF hospitalization, and was predominantly cardioembolic. Non-anemia identified patients at higher risk of IS in the early phase, suggesting its potential value for early risk stratification.

Background: We aimed to examine the association between tooth count and prognosis in older patients with heart failure.

Methods and Results: In this single-center retrospective study of 287 patients aged ≥65 years with heart failure (median age 81 years; 52.8% male), natural and functional tooth counts at discharge were assessed. In Cox regression analyses, higher natural tooth count (hazard ratio 0.951; 95% confidence interval 0.917–0.985; P=0.006) and higher functional tooth count (hazard ratio 0.924; 95% confidence interval 0.882–0.968; P<0.001) were associated with lower 1-year mortality.

Conclusions: Higher natural and functional tooth counts were associated with a better prognosis.

Background: The number of patients with heart failure (HF) is increasing with aging of the population, resulting in a shift in care from hospitals to community settings. Although predicting medium-term prognosis after discharge could improve community-based management and reduce readmissions, no established model has integrated structured multidimensional assessments into HF prognostic modeling.

Methods and Results: This multicenter study developed and validated machine learning (ML) models (i.e., logistic regression, random forest, extreme gradient boosting, and light gradient boosting) to predict 180-day mortality or emergency hospitalization in 4,904 patients with HF. Patients were randomly divided into training and validation sets (8 : 2). Nursing care needs, derived from structured nursing assessments that capture patients’ physical status and care dependency, were included as a predictive feature. All models demonstrated acceptable discriminative performance based on the area under the precision-recall curve, favorable calibration assessed by the calibration slope and Brier score, and effective risk stratification. The Shapley additive explanations algorithm identified nursing care needs as an important prognostic factor, alongside established laboratory variables for HF prognosis.

Conclusions: ML models incorporating nursing care needs effectively predicted the 180-day prognosis of patients with HF. The prominent contribution of nursing care needs underscores the value of incorporating structured multidimensional care-related information into prognostic modeling and highlights the importance of team-based post-discharge HF management.

Background: Locomotive syndrome (LS), an early predictor of physical frailty, is frequently evaluated during health screenings in Japan. However, its relationship with early cardiac dysfunction remains unclear. We investigated the association between LS severity and N-terminal pro B-type natriuretic peptide (NT-proBNP) concentration, a myocardial stress biomarker, in a general health screening population.

Methods and Results: This cross-sectional study analyzed 8,593 individuals who underwent health checkups between 2018 and 2023 in Aichi, Japan. LS was assessed using the Short Test Battery for LS, including physical tests and a 25-item questionnaire, and NT-proBNP was measured from blood samples. Individuals were categorized by LS stage (non-LS and stages 1–3) and NT-proBNP concentration (<55, 55–124, 125–299, ≥300 pg/mL). Logistic regression was used to evaluate the association between LS severity and elevated NT-proBNP (cut-off ≥125 pg/mL). A stepwise increase in NT-proBNP was observed with higher LS stage (P_trend<0.001). Compared with non-LS, LS stages 2 (odds ratio [OR] 2.24; 95% confidence interval [CI] 1.35–3.72) and 3 (OR 3.51; 95% CI 2.02–6.12) were independently associated with elevated NT-proBNP.

Conclusions: The increase in NT-proBNP with LS severity suggests a link between myocardial stress progression and physical function decline in asymptomatic individuals. LS assessment may help identify early stage cardiovascular dysfunction, although the causal relationship between LS and cardiac dysfunction remains to be clarified.

Background: Significant atrial low-voltage zones (LVZs), indicative of advanced atrial fibrillation (AF), are associated with atrial arrhythmia (AA) recurrence following catheter ablation. Although preoperative prediction remains challenging, a low plasma atrial natriuretic peptide (ANP) level relative to B-type natriuretic peptide (BNP) reflects atrial fatigue with impaired ANP secretion and may indicate advanced atrial remodeling and LVZs.

Methods and Results: We retrospectively evaluated 166 consecutive patients with persistent AF who underwent initial catheter ablation using a 3-dimensional mapping system. The optimal ANP/BNP ratio cut-off for predicting LVZ presence was determined using receiver operating characteristic curve analysis. The primary outcome was AA recurrence. An ANP/BNP ratio of 0.7 was optimal for predicting LVZ presence (area under the curve 0.76; sensitivity 81%; specificity 60%). Patients with an ANP/BNP ratio ≤0.7 (n=91) had a significantly higher prevalence of LVZs (52% vs. 15%; P<0.001) and higher AA recurrence risk following initial pulmonary vein isolation (log-rank P=0.025; hazard ratio 1.85; 95% confidence interval 1.09–3.14; median follow-up period 583 days).

Conclusions: Serum ANP/BNP ratio is a useful surrogate biomarker for predicting advanced atrial remodeling with significant LVZs and AA recurrence following catheter ablation. ANP secretion assessment may help in candidate selection among patients with persistent AF who can benefit from catheter ablation.

Background: Transcatheter aortic valve implantation (TAVI) has enhanced outcomes in patients with severe aortic stenosis (AS). However, the additional effect of introducing outpatient cardiac rehabilitation (OCR) remains unclear. In this study, we investigated how OCR participation is associated with post-discharge all-cause mortality among patients who underwent TAVI.

Methods and Results: A retrospective cohort study involving 1,446 patients with AS who underwent elective TAVI was conducted. The patients were classified into the OCR participation group (n=100) and the non-participation group (n=1,346) based on whether they participated in OCR after discharge. Propensity score matching was conducted to adjust for confounding factors. The mean follow-up period was 2.9±2.0 years. Patients undergoing OCR experienced a lower all-cause mortality rate (log-rank test P=0.001). Multivariate analysis showed that OCR participation was independently associated with all-cause mortality after discharge, even after adjusting for known prognostic factors.

Conclusions: OCR participation after TAVI in patients with AS is an independent prognostic factor of life outcome. Cardiac rehabilitation teams should actively encourage patients to participate in OCR.

Background: Despite growing interest in cardio-oncology rehabilitation (CORE), data on cardiopulmonary exercise testing (CPX/CPET) in Japanese cancer patients remain scarce.

Methods and Results: We reviewed 440 CPX examinations at Toranomon Hospital (2018–2023) and identified 37 tests from 28 patients with active cancer and cardiovascular problems. CPX parameters included peak oxygen uptake (peak V̇O₂), anaerobic threshold (AT), ventilatory efficiency (V̇E vs. V̇CO₂slope), and metabolic equivalents (METs). Patients were classified into those with cancer therapy-related cardiac dysfunction (CTRCD or subclinical CTRCD) and those without. Various anticancer agents had been used, with anthracycline exposure more frequent in the CTRCD group. No patient received rehabilitation before CPX. Median age was 60 years; 68% female. Cancers included breast (n=17), lymphoma (n=5), leukemia (n=3), and others. Cardiovascular problems comprised CTRCD/subclinical CTRCD (n=15), ischemic heart disease (n=2), and others. Median peak V̇O₂was 14.7 mL/kg/min (63% predicted), with 43% below the prognostic threshold of 14 mL/kg/min. Median AT was 10.9 mL/kg/min and V̇E vs. V̇CO₂slope 30.7, indicating reduced cardiorespiratory function. No significant differences were observed between the CTRCD and non-CTRCD groups. In 4 patients with serial CPX, exercise capacity changes did not always parallel left ventricular ejection fraction.

Conclusions: In cancer patients with cardiovascular problems, CPX revealed reduced exercise tolerance beyond cardiac function. These findings highlight the need for individualized rehabilitation inform future CORE protocols.

Background: Periprocedural myocardial injury (PMI) is a common complication of percutaneous coronary intervention (PCI). Elevated post-PCI index of microcirculatory resistance (IMR) has been linked to PMI. The angiography-derived IMR (angio-IMR) serves as a pressure-wire-free method to assess coronary microvascular function. This study aimed to establish the association between post-PCI angio-IMR and PMI.

Methods and Results: We retrospectively analyzed 101 consecutive elective PCI cases where PMI diagnosis and post-PCI angio-IMR calculation were feasible. Angio-IMR was computed using computational flow and pressure simulations. Patients were categorized into 2 groups based on PMI status: PMI (n=33), and non-PMI (n=68). The PMI group had significantly higher post-PCI angio-IMR values than the non-PMI group (31.8±5.9 vs. 23.8±6.0; P<0.001). Both univariate and multivariate logistic regression analyses revealed an association between post-PCI angio-IMR and PMI. Patients with post-PCI angio-IMR ≥29 had a significantly higher incidence of PMI (67.6% vs. 12.5%; P<0.001).

Conclusions: Increased post-PCI angio-IMR values were strongly associated with PMI. Post-PCI angio-IMR might serve as a useful non-invasive predictive of PMI following elective PCI.

Background: The relationship between the reduction in aortic valve pressure gradient (AVG) after transcatheter aortic valve implantation (TAVI) and improvements in left ventricular ejection fraction (LVEF) or long-term survival remains unclear.

Methods and Results: We retrospectively analyzed 121 patients with aortic stenosis (AS) and LVEF <50% who underwent TAVI. Transthoracic echocardiography (TTE) was performed before and after TAVI, and the difference in mean AVG was defined as delta-AVG. LVEF improvement was defined as a ≥10% increase from baseline at 1 year. Among 82 patients with 1-year TTE evaluation, LVEF improvement was observed in 37 (45.1%) patients. A higher delta-AVG was identified as an independent predictor of LVEF improvement (odds ratio 1.04; 95% confidence interval [CI] 1.01–1.07; P=0.002), and receiver operating characteristic analysis indicated the optimal cut-off was 20.5 mmHg (sensitivity 48.9%; specificity 89.2%; area under curve 0.723; P=0.002). During a mean follow up of 1,042.6±577.5 days, 5 cardiac deaths occurred. Cox proportional hazards analysis revealed that a low delta-AVG was identified as an independent predictor of cardiac death (hazard ratio 0.91; 95% CI 0.7–0.99; P=0.023). Additionally, a greater delta-AVG was significantly associated with a larger increase in delta-stroke volume between post-TAVI to 1 year (r=0.255; P=0.021).

Conclusions: In patients with severe AS and reduced LVEF, delta-AVG could be a novel predictor of 1-year LVEF improvement and long-term survival after TAVI.

Background: Early detection of heart failure (HF) relies on community-based interventions supported by seamless coordination. In this study, we examined the challenges and opportunities in developing HF support system, drawing on hospital-led community collaboration activities and a participant survey.

Methods and Results: A cross-sectional survey of 31 participants in a regional multidisciplinary meeting yielded 13 responses (41.9%). Non-medical professionals demonstrated lower baseline knowledge but higher satisfaction and learning effectiveness. Principal component analysis revealed occupational differences.

Conclusions: Foundational education was effective, particularly for non-medical professionals, and highlighted the need to address disparities in knowledge and tool utilization.

Background: The original cardiovascular–kidney–metabolic (CKM) staging system uniformly categorized all individuals with type 2 diabetes (T2D) as Stage 2. We aimed to improve the prognostic accuracy for chronic kidney disease (CKD) progression by incorporating the Kidney Disease: Improving Global Outcomes risk categories – based on estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) – into CKM Stage 2.

Methods and Results: This study included 600 individuals with T2D from Kure Medical Center and Chugoku Cancer Center. The primary outcome was CKD progression, defined as a ≥30% decline in eGFR. The refined system significantly improved risk stratification for CKD progression compared with the original system, showing a higher area under the receiver operating characteristic curve and greater integrated discrimination improvement. The risk of CKD progression, reflected by hazard ratios derived from the Fine–Gray subdistribution hazard models, increased progressively across the refined CKM stages after adjustment for potential confounders, including baseline eGFR. However, the independent prognostic value of the refined system was attenuated when baseline UACR was additionally included in the model.

Conclusions: Integrating eGFR and UACR into the original CKM staging system enhances the prognostic performance for CKD progression in individuals with T2D. This refined system, incorporating these renal biomarkers, provides superior risk stratification compared with the original system, and serves as a more robust tool for clinical prognostic assessment.

Background: Falls are a serious medical problem. With the aging of patients with cardiovascular disease (CVD), falls have become an important clinical outcome. However, evidence regarding falls in this population is limited, and the impact of cardiac rehabilitation (CR) remains unclear. This study investigated the incidence of falls and examined the association between outpatient CR (OCR) and falls among older patients with CVD.

Methods and Results: This single-center prospective cohort study included 110 patients with CVD aged ≥65 years who participated in early phase II CR (mean age 77±6 years; 36% women). The occurrence and frequency of falls within 1 year of discharge were assessed using a mailed self-reported questionnaire. Participants were divided into non-OCR and OCR groups. The overall incidence rate of falls was 20.9%. The non-OCR group had a significantly higher occurrence and frequency of falls than the OCR group. Negative binomial and modified Poisson regression analyses demonstrated that OCR participation was significantly associated with a lower fall rate (adjusted incidence rate ratio 0.42; 95% confidence interval [CI] 0.23–0.76; P<0.01) and risk (adjusted risk ratio 0.39; 95% CI 0.18–0.89; P=0.02).

Conclusions: Among older patients with CVD, approximately 20% experienced a fall within 1 year after hospital discharge. Patients who participated in the OCR program had significantly lower fall rates and risks.

Background: The Kumamoto criteria are proposed for predicting ^{99 m}Tc-pyrophosphate (PYP) uptake, but real-world performance is uncertain.

Methods and Results: We reviewed 102 consecutive patients who underwent PYP scintigraphy; grade ≥2 was positive, and grade 1 equivocal/negative. Of them, 15 were positive; 11 had scores 0–1 yet were positive, while 8 scored 2 and yet were negative. Adding age, sex, PR interval, and atrial fibrillation improved the area under the curve (AUC) from 0.598 to 0.866; excluding sex yielded AUC 0.842.

Conclusions: Using the Kumamoto criteria alone showed limited discrimination; combining routine variables may help select patients for PYP scintigraphy.