Background: Worsening of tricuspid regurgitation (TR) has been recognized after transvenous cardiac implantable electronic device implantation, but data on early echocardiographic TR deterioration after left bundle branch area pacing (LBBAP) remain limited.

Methods and Results: We retrospectively studied 239 consecutive patients who underwent successful LBBAP and transthoracic echocardiography before and within 1 week after implantation. TR severity was graded on a 5-point scale, and acute worsening was defined as an increase of ≥1 grade. Lead-to-tricuspid valve distance was measured echocardiographically, and lead type was classified as lumenless or stylet-driven. Acute TR worsening occurred in 27 patients (11.3%). The incidence of worsening did not differ between lumenless and stylet-driven leads (6/54 [11.1%] vs. 21/185 [11.4%], P=1.00). Median TR grade did not significantly change between baseline and early postprocedural assessment (1 [1–2] vs. 1 [1–2], P=0.29), but TR peak pressure gradient and estimated right ventricular systolic pressure decreased in paired analyses. In the multivariable analysis, atrial fibrillation (odds ratio [OR] 2.37, 95% confidence interval [CI] 1.04–5.42, P=0.041) and shorter lead-to-tricuspid valve distance (per 1-mm increase: OR 0.91, 95% CI 0.85–0.98, P=0.007) were independently associated with acute worsening.

Conclusions: Acute TR worsening occurred in approximately 1 in 10 patients after LBBAP. Atrial fibrillation and shorter lead-to-tricuspid valve distance, but not lead type, were independently associated with early TR deterioration.

Background: The extravascular implantable cardioverter-defibrillator (EV-ICD) has proven efficacy and a low complication rate in global populations, but data from Japanese patients is limited. We report the safety and efficacy of the EV-ICD system in a Japanese cohort through 12 months of follow-up.

Methods and Results: Patients from Japan with a Class I or IIa indication for a single-chamber ICD were enrolled and implanted with the EV-ICD system. Defibrillation success was determined following implant. System programming changes, device electrical performance, freedom from major system- or procedure-related complications through 12 months post-implant, and follow-up status at all visits were assessed. From February to September 2023, 14 patients (12 males, 2 females) were enrolled and successfully implanted across 2 sites (age: 53.6±14.7 years; left ventricular ejection fraction: 52.6±15.6%; secondary prevention: 42.9%). Defibrillation testing was successful in all patients (14/14, 100%). At 2 weeks and 12 months, freedom from major system- and/or procedure-related complications was 92.9% and 85.7%, respectively. One patient received 7 appropriate shocks that were successful in terminating the arrhythmia. There were no inappropriate shocks delivered, and a single inappropriate antitachycardia pacing therapy was delivered through follow-up.

Conclusions: The EV-ICD system was safely implanted and effective at terminating both induced and spontaneous ventricular arrhythmias in a small cohort of Japanese patients.

Background: We aimed to assess the effectiveness and safety of a new filtering feature (Spot ROI^TM, Canon Medical Systems, Japan) in reducing radiation exposure during radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF).

Methods and Results: The study involved 2 steps: (1) an ex vivo experiment to evaluate the radiation reduction of Spot ROI^TM(SROI); (2) a clinical study with 69 consecutive patients undergoing initial AF-RFCA, divided into conventional collimation (CC) and SROI groups. All procedures used 3-dimensional electroanatomical mapping guidance. In the ex vivo model, SROI reduced radiation exposure by 66.7%. Clinically, all predefined procedures were successful, with similar complication rates between groups (CC vs. SROI, 3.2% vs. 2.6%; P=0.88). The dose–area product for patients (CC vs. SROI: 17.5 [12.8–25.4] vs. 5.6 [3.6–9.8] Gy · cm², P<0.001) and scattered radiation at the operator’s chest level (13.0 [10.3–18.5] vs. 3.0 [1.8–5.3] µSv, P<0.001) were significantly lower with SROI. Procedural time (150 [125–167] vs. 150 [120–183] min, P=0.89), fluoroscopy time (13.6 [10.7–18.9] vs. 12.6 [9.6–15.2] min, P=0.09), and short- to intermediate-term recurrence rates were comparable between groups.

Conclusions: SROI reduced the radiation exposure of both patients and operators without compromising procedural success, complication rates or recurrence rates.

Background: Swallowing dysfunction may complicate recovery in inpatients aged ≥75 years undergoing cardiac rehabilitation (CR). This study examined the prevalence of suspected dysphagia and its associations with physical function, activities of daily living, and discharge outcomes.

Methods and Results: This prospective single-center study enrolled 59 inpatients undergoing CR between May and December 2023. Patients were screened within 3 days of admission using the Eating Assessment Tool-10 (EAT-10; score ≥3) or the Repetitive Saliva Swallowing Test (RSST; <3 swallows/30 s). Twenty-nine patients (49.2%) screened positive. At admission, patients with suspected dysphagia had lower handgrip strength (mean [±standard deviation] 15.19±7.20 vs. 20.01±7.24 kg; P=0.013), smaller calf circumference (median [interquartile range] 28 [26–31] vs. 31 [29–33] cm; P=0.002), and lower Short Physical Performance Battery scores (median [interquartile range] 4 [3–9] vs. 8.5 [5–12]; P=0.004). The discharge Barthel Index was also lower (median [interquartile range] 80 [50–90] vs. 85 [80–100]; P=0.037). Among patients admitted from home (n=57), non-home discharge/in-hospital death was more frequent in those with suspected dysphagia (25.0% vs. 6.9%; odds ratio 4.50), as was long-term care insurance certification (67.9% vs. 20.7%; P<0.001).

Conclusions: Suspected dysphagia was common and associated with poorer physical function, lower activities of daily living at discharge, and greater care needs. Early swallowing screening may support discharge planning.

Background: Conventional bleeding risk scores after percutaneous coronary intervention (PCI) have limited discrimination and external validation, so we developed and validated a machine learning (ML)-based bleeding risk score using real-world data.

Methods and Results: The primary outcome was major bleeding. In the Clinical Deep Data Accumulation System (CLIDAS) cohort, bleeding events occurring >30 days after PCI were identified by chart review and classified as moderate or severe bleeding by the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries criteria. In the Health, Clinic, and Education Information Evaluation Institute (HCEI) cohort, major bleeding was identified using ICD-10 codes and Diagnosis Procedure Combination (DPC) data. We analyzed 2,502 acute coronary syndrome patients undergoing PCI from CLIDAS and externally validated the model in 10,928 patients from HCEI. A total of 5 ML algorithms were trained. Key predictors were age, body mass index, Btype natriuretic peptide, and hemoglobin. Logistic regression demonstrated the best performance (area under the curve [AUC] 0.748) and was used to derive the CLIDAS bleeding risk score. The CLIDAS score outperformed the binary J-HBR (AUC 0.74 vs. 0.63, P=0.007) and binary ARC-HBR (AUC 0.74 vs. 0.62, P=0.011), but in external validation the CLIDAS score demonstrated limited discrimination (AUC 0.64), lower than continuous conventional scores.

Conclusions: Our novel ML-based bleeding risk score showed better discrimination than conventional binary classifications in the derivation/internal validation, but external performance was limited.

Background: There are no previous reports exploring the interaction of proton-pump inhibitors (PPI) on the early effect of aspirin-free strategy compared with dual antiplatelet therapy (DAPT) after PCI.

Methods and Results: Among 5,654 patients who were discharged alive within 30 days after randomization in ShorT and OPtimal Duration of Dual AntiPlatelet Therapy-3 (STOPDAPT-3), 4,958 patients received PPI prescriptions (PPI subgroup; no-aspirin group, n=2,356; and DAPT group, n=2,602), and 696 patients did not (no-PPI subgroup; no-aspirin group, n=482; and DAPT group, n=214). The co-primary bleeding endpoint was Bleeding Academic Research Consortium type 3 or 5 bleeding, and the co-primary cardiovascular endpoint was a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke. No significant interaction was observed between PPI prescription and antiplatelet regimen on the bleeding endpoint (PPI: hazard ratio [HR] 0.90; 95% confidence interval [CI] 0.66–1.22; no-PPI: HR 0.52; 95% CI 0.17–1.54; P interaction=0.34). For the cardiovascular endpoint, there was a lower risk of no aspirin relative to DAPT in the no PPI subgroup (0.41% vs. 3.27%; HR 0.13; 95% CI 0.03–0.60), but not in the PPI subgroup (HR 1.29; 95% CI 0.86–1.93) with a significant interaction (P interaction=0.005).

Conclusions: There was no interaction for bleeding between PPI prescription and antiplatelet regimen, but a significant interaction for cardiovascular events, requiring cautious interpretation due to the small no-PPI subgroup and baseline imbalances.

Background: Rapid access to emergency medical services (EMS) is essential to improve outcomes in patients with acute myocardial infarction (AMI). However, the outcomes of patients with AMI who are not transported by EMS remain unclear.

Methods and Results: Patients who self-transported to hospital were classified into 2 groups according to Killip classification at the time of admission: those with heart failure (HF; Killip III or IV) and those without HF (Killip I or II). We assessed temporal trends in self-transport and compared patient characteristics and in-hospital mortality between the 2 groups. In all, 124,942 patients self-transported to hospital, of whom 18,342 (14.7%) were classified having HF. The proportion of patients self-transporting to hospital decreased from 35.3% in 2012 to 24.8% in 2023. Factors associated with self-transport with HF included older age (odds ratio [OR] 1.18; 95% confidence interval [CI] 1.17–1.20), female sex (OR 1.10; 95% CI 1.06–1.14), admission to non-training facilities (OR 1.49; 95% CI 1.29–1.73), and weekend admission (OR 1.09; 95% CI 1.04–1.13). In-hospital mortality was recorded for 2,599 (8.6%) and 1,265 (1.3%) self-transported patients with and without HF, respectively.

Conclusions: Of self-transported patients with AMI, 14.7% had concomitant HF, highlighting a clinically non-negligible subgroup requiring careful attention.

Background: Hospital-associated disability (HAD) may affect long-term outcomes in heart failure (HF), but evidence remains limited, so in this study we aimed to evaluate the impact of HAD on long-term outcomes in acute decompensated HF (ADHF).

Methods and Results: We analyzed data from the Japanese Registry of Acute Decompensated Heart Failure (JROADHF), including patients enrolled from January 2013 to December 2017. HAD was defined as a decline of ≥5 points in the Barthel Index from admission to discharge. The primary outcome was all-cause death, and the secondary outcomes were cardiovascular (CV) death, non-CV death, and HF readmission. Of the 8,965 patients enrolled (mean age 76.9±12.7 years; 54.8% male), 537 (6.0%) had HAD. In the multivariate analysis, HAD was independently associated with all-cause death (hazard ratio [HR]: 1.58; 95% confidence interval [CI]: 1.31–1.91; P<0.001) and non-CV death (HR: 1.44; 95% CI: 1.08–1.92; P=0.013), but not with CV death or HF readmission. Subgroup analyses revealed a stronger association between HAD and all-cause death in patients under 80 years (<80 years: HR: 2.48; 95% CI: 1.80–3.41; ≥80 years: HR: 1.36; 95% CI: 1.09–1.71; P for interaction <0.001).

Conclusions: HAD significantly affects the long-term mortality rate in ADHF patients, particularly in those under 80 years of age. These findings highlight the importance of considering age-specific management approaches in this population.

Background: Because the number of asymptomatic individuals diagnosed with transthyretin amyloid cardiomyopathy (ATTR-CM) has been rising, it is important to identify myocardial tissue characteristics associated with heart failure (HF) development in asymptomatic patients with ATTR-CM.

Methods and Results: Among 113 patients with ATTR-CM, 14 were asymptomatic (mean age 75±6 years; 79% male) and underwent echocardiography and cardiac magnetic resonance imaging (CMR). Over a median follow-up of 770 days, 6 patients developed HF. Compared with those who remained asymptomatic, these patients had a higher left ventricular mass index (LVMI) on echocardiography (P=0.020). On CMR, native T1 was significantly higher at the basal inferior (P=0.0277) and inferolateral (P=0.0017) segments, whereas the extracellular volume (ECV) fraction was significantly higher at the basal inferolateral (P=0.0296) and anterolateral (P=0.0092) segments. LVMI correlated with native T1 (r=0.599, P=0.024) and ECV at the basal inferolateral (r=0.780, P<0.001) and anterolateral (r=0.624, P=0.017) segments. Kaplan–Meier analysis showed that patients with higher LVMI, native T1 at the basal inferolateral segment, and ECV at the basal anterolateral segment had a higher incidence of HF development.

Conclusions: In asymptomatic ATTR-CM patients, HF development was associated with increased LVMI and regional myocardial tissue abnormalities in the basal lateral wall detected by native T1 and ECV on CMR; however, these findings should be considered exploratory and require validation in larger studies.

Background: Anemia and functional decline are common in older patients hospitalized for heart failure. We examined whether anemia severity at admission was associated with frailty at discharge, hospitalization-associated disability (HAD), and 1-year mortality after discharge.

Methods and Results: This multicenter analysis of the J-Proof HF registry included 8,691 patients aged ≥65 years, classified as non-anemia, anemia, or severe anemia (hemoglobin <10 g/dL). Frailty was defined using the Japanese Cardiovascular Health Study criteria (≥3), and HAD as a ≥5-point decline in the Barthel Index from pre-admission to discharge. Multivariable logistic regression and Cox models were used. Higher anemia severity was independently associated with frailty at discharge in both the primary and fully expanded models (fully expanded model: odds ratio 1.18; 95% confidence interval 1.10–1.27). The association with HAD was significant in the primary model but was attenuated after adjustment for serum albumin and was no longer statistically significant in the fully expanded model. Anemia and severe anemia were associated with higher 1-year mortality after adjustment for frailty and HAD, but these associations were also attenuated and no longer significant in the fully expanded model.

Conclusions: Admission anemia severity was consistently associated with frailty at discharge, whereas associations with HAD and 1-year mortality were attenuated after expanded adjustment. Admission hemoglobin may serve as an early marker of functional vulnerability and broader clinical complexity.

Background: Inhaled nitric oxide (iNO) selectively dilates pulmonary vessels and reduces pulmonary vascular resistance, potentially improving right ventricular (RV) function. However, its clinical benefit in patients with cardiogenic shock requiring ECPELLA (i.e., combined Impella® (ABIOMED) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains unclear. The aim of this study was to evaluate the impact of iNO on RV function in this critical population.

Methods and Results: Between September 2017 and June 2023, we retrospectively analyzed 54 consecutive patients with cardiogenic shock treated with ECPELLA. Patients were divided into 2 groups based on the use of iNO. RV function was assessed using the pulmonary artery pulsatility index (PAPi) at the time of ECPELLA initiation (Pre-PAPi) and VA-ECMO weaning (Post-PAPi). The iNO group had a significantly lower Pre-PAPi, prompting propensity-score matching to adjust for baseline differences. After matching, the Post-PAPi was significantly higher in the iNO group than in the non-iNO group (1.95 [1.63–3.00] vs. 1.40 [0.50–2.05], P<0.05). A significant interaction between iNO use and PAPi change was observed (P=0.006), suggesting an iNO-mediated improvement in RV function.

Conclusions: In patients with cardiogenic shock requiring ECPELLA support, adjunctive iNO therapy was associated with greater improvement in PAPi at the time of VA-ECMO weaning. These findings suggest a potential role for iNO in optimizing hemodynamics during the transition from ECPELLA to Impella-only support.

Background: The Fibrosis-4 (Fib-4) index, a non-invasive liver fibrosis marker, is useful for assessing cardiovascular risk; however, its role and profiles in patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) remain unclear.

Methods and Results: We analyzed 5,150 patients (ACS: 2,274; CCS: 2,876) from the Clinical Deep Data Accumulation System-Percutaneous Coronary Intervention (CLIDAS-PCI) database. The Fib-4 index was calculated 1–3 months post-PCI to avoid acute-phase transaminase elevation. Patients were stratified into low (<1.3), intermediate (1.3–2.67), and high (>2.67) Fib-4 categories. Longitudinal changes were assessed every 6 months for 2 years. The primary outcome was 3-point major adverse cardiovascular events (3P-MACE): cardiovascular death, non-fatal myocardial infarction, and stroke. Compared with CCS, ACS patients had fewer comorbidities and more intensive medical therapy. The Fib-4 index was lower in ACS than in CCS (1.83 vs. 1.93; P<0.001), and this difference persisted throughout follow up. Kaplan–Meier analysis demonstrated clear risk stratification across Fib-4 categories in both ACS and CCS. A higher Fib-4 index was independently associated with increased 3P-MACE risk after adjustment for C-reactive protein levels and coronary syndrome type (adjusted hazard ratio 1.15; 95% confidence interval 1.12–1.19; P<0.001).

Conclusions: The Fib-4 index efficiently stratifies cardiovascular risk in ACS and CCS, independent of systemic inflammation. ACS patients consistently exhibited lower Fib-4 values than CCS patients.

Background: Coronary microvascular dysfunction (CMD) is an established mechanism in cardiovascular diseases and is associated with adverse outcomes. However, CMD in hemodialysis (HD) patients remains poorly characterized. This study evaluated the prevalence, physiological profiles, and prognostic implications of CMD in this high-risk population.

Methods and Results: Among 894 patients who underwent intracoronary physiological assessment of the left anterior descending artery, 87 were on HD. A control group of 87 non-HD patients was selected using propensity score matching for established CMD risk factors. Microvascular resistance reserve (MRR) and the baseline index of microvascular resistance (b-IMR) and hyperemic IMR were compared. MRR was significantly lower in HD than non-HD patients (median [interquartile range (IQR)] 2.4 [1.9–3.4] vs. 3.8 [2.6–5.0], P<0.001). This was driven primarily by lower b-IMR in the HD than non-HD group (median [IQR] 42.3 [23.6–61.0] vs. 68.7 [42.7–90.9], P<0.001); IMR was comparable between the 2 groups (18.6 [12.0–24.7] vs. 18.3 [12.7–26.0], respectively; P=0.65). In HD patients, an MRR of 2.1 was optimal for predicting the composite endpoint (all-cause mortality, heart failure, and acute myocardial infarction). Kaplan–Meier analysis showed event-free survival was significantly worse in HD patients with MRR <2.1 (log-rank P=0.001).

Conclusions: CMD is highly prevalent in HD patients and is characterized by markedly reduced b-IMR. In this population, MRR serves as a potent prognostic indicator.

Background: The use of high-intensity statins is recommended to improve the prognosis of coronary artery disease. However, it remains unclear whether they offer a short-term benefit after percutaneous coronary intervention (PCI), regardless of the acute coronary syndrome (ACS) status.

Methods and Results: We performed a post hoc analysis of STOPDAPT-3, which compared 1-month aspirin-free prasugrel monotherapy followed by clopidogrel monotherapy with 1-month dual antiplatelet therapy (DAPT) followed by aspirin monotherapy in patients with ACS or a high bleeding risk undergoing PCI. High-intensity statins were defined as the maximum approved dose of strong statins in Japan (e.g., rosuvastatin 10 mg, atorvastatin 20 mg, or pitavastatin 4 mg). Two co-primary endpoints were the study-defined cardiovascular composite endpoint and bleeding endpoint, assessed between hospital discharge and 1 year after randomization. Among 5,823 patients discharged alive, 2,829 (48.6%) received high-intensity statins (ACS 54.4%; non-ACS 31.5%; P<0.001). The 1-year post-discharge cumulative incidence of cardiovascular events was similar between patients who received high-intensity statins and those who did not (3.90% vs. 4.27%, P=0.51; adjusted HR 1.03; 95% CI 0.74–1.44; P=0.84).

Conclusions: In STOPDAPT-3, high-intensity statin therapy at discharge was not associated with a reduced risk of cardiovascular events 1 year after PCI, under the limitations of having no laboratory test or prescription data available during the follow up.

Background: Calcified nodules (CN) are a challenging coronary lesion subset often treated with orbital atherectomy (OA), which, although effective, carries a risk of coronary artery injury (CAI), including hematoma and perforation. In this study we assessed the relationship between intravascular ultrasound (IVUS) findings, particularly the wire bias pattern, and CAI during OA for CN.

Methods and Results: We retrospectively analyzed 67 patients with CN who underwent IVUS-guided percutaneous coronary intervention with OA between August 2020 and August 2023. The primary endpoint was CAI, defined as hematoma or perforation. IVUS findings, including tenting sign, undesirable wire position, and a newly classified wire bias pattern (Types A–D), were evaluated. 9 patients (13.4%) developed CAI: 8 hematomas (11.9%) and 1 perforation (1.5%). Type D wire bias showed the highest incidence of CAI (47.1%, P<0.001). Multivariate logistic regression identified Type D as the sole independent predictor of CAI (odds ratio 22.43; 95% confidence interval 2.61–192.9; P=0.005). Neither tenting sign nor undesirable wire position was significantly associated.

Conclusions: A Type D wire bias pattern on IVUS (defined as the guidewire tracking along the healthy vessel wall proximal and distal to the CN) was an independent predictor of CAI during OA. Preprocedural identification of this pattern may improve risk stratification and procedural strategies to minimize complications.

Background: Cardiac conduction disturbances are frequently observed in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). Because their relationships with other clinical factors have not been fully investigated, in this study we evaluated changes in atrioventricular conduction disturbances (AVCD) and intraventricular conduction disturbances (IVCD) in patients with ATTR-CM undergoing tafamidis treatment, with the aim of identifying clinical factors, including cardiac magnetic resonance (CMR) parameters, related to AVCD and IVCD.

Methods and Results: We studied 50 patients with wild-type ATTR-CM who underwent baseline CMR and subsequently commenced treatment with tafamidis. Data of cardiac biomarkers and left ventricular (LV) parameters on CMR were acquired at baseline. Changes in the PQ interval (∆PQ) and QRS duration (∆QRS) on ECG were assessed over 1 year. Despite tafamidis treatment, both the PQ interval and QRS duration significantly increased over 1 year. After adjusting for medications that might affect the cardiac conduction system, the native myocardial T1 value (T1_native) was shown to determine the baseline PQ interval (β=0.31, P=0.039), baseline QRS duration (β=0.30, P=0.038), and ∆QRS (β=0.29, P=0.035), whereas Ln (serum high-sensitivity cardiac troponin T [hs-cTnT]) was a determinant of ∆QRS (β=0.32, P=0.036).

Conclusions: In patients with wild-type ATTR-CM undergoing tafamidis treatment, AVCD and IVCD progress over 1 year. Baseline T1_nativeand hs-cTnT are predictors of progression of IVCD under tafamidis treatment, and T1_nativeis associated with AVCD and IVCD in disease-modifying therapy-naïve conditions.

Background: The administration of human epidermal growth factor receptor 2 inhibitors (HER2i) has improved the survival of patients with breast cancer; however, cancer therapy-related cardiac dysfunction (CTRCD) has been reported as an adverse effect. In this study we evaluated the incidence of CTRCD associated with HER2i treatment and explored risk factors for a decrease in left ventricular function.

Methods and Results: This retrospective study included 94 female patients with breast cancer treated at Kanazawa Medical University Hospital from January 1, 2017, to August 31, 2023. Clinical, hematologic and echocardiographic data were collected. The median pretreatment body mass index (BMI; 22.3 kg/m²) was used to divide patients into low- and high-BMI groups. Changes in red cell distribution width (RDW), left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS) were evaluated. A total of 32 patients showed a decrease in LVEF 6 months after treatment initiation, and 2 had LVEF <50% with a ≥10% decrease. The rate of LVEF decrease was significantly greater in the low-BMI group than in the high-BMI group (−5.1% vs. −0.4%, P=0.023). No association was observed between RDW or GLS and LVEF.

Conclusions: Low BMI was associated with a greater risk of cardiotoxicity during HER2i treatment. Careful cardiac monitoring is particularly recommended for patients with low BMI.

Background: Physical activity influences functional capacity and long-term health in adults with congenital heart disease (ACHD), but the accuracy of self-reported activity remains uncertain.

Methods and Results: In this cross-sectional study, subjects with ACHD underwent physical activity assessment using triaxial accelerometers to quantify sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Participants were classified into 4 activity profiles based on cohort-specific median values of accelerometer-derived SB time and MVPA. Self-reported activity and SB time were assessed using the International Physical Activity Questionnaire (IPAQ) short form. Agreement between self-reported and accelerometer-derived measures was evaluated, and receiver operating characteristic analysis was performed. Among the 177 participants analyzed, accelerometer-derived SB, LPA, and MVPA, as well as IPAQ-derived SB time, differed significantly across activity profiles (all P<0.001). IPAQ-derived SB time showed good discrimination for identifying the sedentary–inactive profile (area under the curve [AUC]: 0.811). In contrast, IPAQ-derived MVPA showed limited discrimination (AUC: 0.663), largely owing to a pronounced floor effect, with more than half of the participants reporting 0 min of MVPA per week.

Conclusions: IPAQ-reported SB time showed reasonable agreement with objectively measured SB and may be useful for identifying sedentary–inactive individuals with ACHD. However, IPAQ-derived MVPA demonstrated limited agreement with accelerometer-based measures and should be interpreted cautiously.

Background: Balloon pulmonary angioplasty (BPA) is an established therapy for chronic thromboembolic pulmonary hypertension (CTEPH), but its optimal lesion-specific endpoint remains unclear. This study aimed to clarify the optimal endpoint for pressure-guided BPA (PG-BPA) based on the distal pulmonary artery pressure waveform (Pd-WF).

Methods and Results: We retrospectively analyzed 23 patients with CTEPH who underwent 118 PG-BPA sessions involving 424 lesions. The pressure ratio (PR; i.e., the distal-to-proximal mean pulmonary artery pressure ratio) and Pd-WF were evaluated for each lesion. Complete arterialization of the Pd-WF (Pd-CA), defined as a distal-to-proximal pulse pressure ratio >0.5, was used as the physiological endpoint. PR improved significantly from a median of 0.52 (interquartile range [IQR] 0.39–0.66) to 0.80 (IQR 0.73–0.89) after balloon dilatation (P<0.001), and Pd-CA was achieved in 63.9% of lesions. Significant decreases were seen in both mean pulmonary artery pressure (median 34 [IQR 26–50] to 19 [IQR 18–25] mmHg) and pulmonary vascular resistance (median 8.3 (IQR 5.6–13.6) to 2.7 (IQR 2.1–4.0 Wood units; both P<0.0001). The number of lesions achieving Pd-CA correlated with the percentage reduction in pulmonary vascular resistance (r=−0.52, P=0.011). Receiver operating characteristic analysis identified a PR cut-off value of 0.77 for predicting Pd-CA (area under the curve 0.86; P<0.0001).

Conclusions: Pd-CA may represent an optimal physiological endpoint for PG-BPA and enable lesion-level optimization beyond angiographic assessment alone.

Background: Data on transcatheter strategies in patients with severe mitral regurgitation (MR) and advanced chronic heart failure requiring Impella support remain limited.

Methods and Results: We retrospectively analyzed 33 patients with severe MR and advanced chronic heart failure requiring Impella support, treated with a transcatheter strategy (n=17) or a conservative strategy (n=16). In an overlapweighted Cox model, the transcatheter strategy was associated with a lower in-hospital mortality rate (hazard ratio, 0.13; 95% confidence interval, 0.03–0.52; P=0.004).

Conclusions: A transcatheter strategy had survival benefit for this high-risk population.

Background: Autonomic nervous system (ANS) modification with cryoballoon pulmonary vein isolation using conventional cryoballoon (Arctic Front Advance^TM) has been reported, but data on the novel cryoballoon (POLARx^TM) remain limited.

Methods and Results: This subanalysis of the CONTRAST-CRYO trial compared ANS modification in the first ablation of paroxysmal atrial fibrillation (AF; 58 conventional, 47 novel), based on postprocedural sinus cycle length (SCL). The proportions of patients with ≥5/10/15/20% SCL reduction at 12 months were comparable between systems. Patients with ANS modification (≥20% SCL reduction) had lower baseline heart rates; however, AF-free survival did not differ.

Conclusions: Both systems produced comparable ANS modification effects.

Background: Stroke risk scores for atrial fibrillation (AF) were developed from established AF cohorts conditioned on pre-entry stroke-free status, potentially underestimating risk in newly diagnosed AF.

Methods and Results: To evaluate the transportability of these scores, we calibrated frailty survival models to score-deriving cohorts and mapped stroke risks at cohort entry back to AF diagnosis. Under model assumptions, risks near 1%/year remained stable; higher risks were mapped to substantial, scenario-dependent initial levels.

Conclusions: Our conceptual modeling provides theoretical reassurance for score-guided decision-making in patients with newly diagnosed AF, while suggesting a potential urgency for those at high risk.

Background: Factors associated with hospitalization-associated disability (HAD) in older patients with cardiovascular disease (CVD) and sarcopenia remain unclear.

Methods and Results: We retrospectively analyzed 202 older patients with CVD and sarcopenia. HAD occurred in 81 patients (40.1%). Multivariable analysis identified prehospitalization Barthel Index, initial Short Physical Performance Battery score, and intensive care unit stay as independent factors associated with HAD. Physical function was associated with HAD only in patients with high levels of prehospitalization activities of daily living.

Conclusions: Factors associated with HAD may differ according to prehospitalization functional status.