Vasospastic angina (VSA) is an important and potentially treatable cause of cardiac arrest (CA) and may account for approximately 2–10% of otherwise unexplained cases of out-of-hospital CA. VSA can sometimes be diagnosed by spontaneous coronary spasm during emergency coronary angiography or by transient ST-segment elevation during a spontaneous attack after resuscitation. However, because coronary spasm is transient and may not be evident during the initial evaluation, provocation testing after clinical stabilization may be required to establish the diagnosis in otherwise unexplained cases. Once VSA is diagnosed, vasodilator therapy, particularly calcium-channel blockers, is the mainstay of treatment. Nevertheless, survivors of VSA-related CA may remain at risk of recurrent lethal ventricular arrhythmias despite medical therapy. Evaluation for alternative or overlapping arrhythmogenic disorders, including cardiomyopathies and channelopathies, should therefore be considered even after a diagnosis of VSA, and implantable cardioverter-defibrillator implantation may be considered in selected patients according to the risk of recurrence and response to medical therapy. Further prospective studies, including randomized controlled trials, are needed to determine whether systematic provocation testing followed by targeted therapy reduces recurrent ventricular arrhythmias and CA and improves long-term outcomes.

Background: The association of invasively measured mean left atrial pressure (LAP) during catheter ablation (CA) for atrial fibrillation (AF) with clinical characteristics and outcomes remains unclear.

Methods and Results: We analyzed the data of 480 patients from the Shinshu Catheter Ablation Registry who underwent CA for AF (median age, 69 years; 146 women [30.4%]; 207 patients [43.1%] with persistent AF). Patients were categorized by mean LAP as normal (<12 mmHg; n=318 [66.3%]), mildly elevated (12 to <15 mmHg; n=78 [16.3%]), or elevated (≥15 mmHg; n=84 [17.5%]). Study endpoints were early AF recurrence within the 8-week blanking period, late AF recurrence, and composite adverse clinical events (heart failure hospitalization, symptomatic stroke, or all-cause death) during the 1-year follow-up after CA. Patients in the higher LAP groups had a higher prevalence of obesity and persistent AF, and a larger left atrial volume index. Early AF recurrence differed significantly across the LAP groups and was highest in the elevated LAP group (log-rank P=0.017). After multivariable adjustment, early AF recurrence risk increased across the LAP groups (hazard ratio per-category increase, 1.41; 95% confidence interval, 1.04–1.90; P for trend=0.028). In contrast, late AF recurrence and composite adverse clinical events did not differ significantly across the LAP groups.

Conclusions: Mean LAP during CA for AF was associated with AF-related clinical characteristics and early AF recurrence.

Background: Intrarenal venous flow (IRVF) patterns assessed by Doppler ultrasonography enable non-invasive assessment of renal venous congestion in patients with heart failure (HF). IRVF patterns have also attracted attention as markers of cardiorenal interactions, but their prognostic significance relative to invasive hemodynamics remains unclear.

Methods and Results: We retrospectively analyzed 253 consecutive patients hospitalized for HF who underwent Swan-Ganz catheterization, echocardiography, and IRVF within 24 h of catheterization; 184 patients had a continuous and 69 had a discontinuous IRVF pattern. The endpoint was a composite of HF rehospitalization and cardiac death within 1 year. During follow-up, 22 composite events occurred. The incidence of the composite endpoint was significantly higher among patients with a discontinuous than continuous IRVF pattern (Gray’s test, P<0.001). On multivariable Fine–Gray analysis, a discontinuous IRVF pattern was independently associated with the composite endpoint (hazard ratio 5.21; 95% confidence interval 1.81–15.0; P<0.001). In subgroup analyses stratified by median cardiac index and fractional excretion of urea nitrogen (FE_UN), a discontinuous IRVF pattern was associated with significantly higher event rates only in the groups with a lower cardiac index (<2.33 L·min⁻¹·m⁻²) or lower FE_UN(<38.1%; P<0.05 for both).

Conclusions: A discontinuous IRVF pattern could be used as an independent predictor of poor prognosis in HF, particularly in patients with a low cardiac index. Combined assessment of IRVF with hemodynamic and renal markers may enhance clinical risk stratification.

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: 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: Dysphagia is common in older patients with heart failure (HF), but evidence regarding sarcopenic dysphagia remains limited. The purpose of this retrospective study was to clarify the prevalence of sarcopenic dysphagia and its relationship with swallowing-related measures and prognosis in older patients with HF.

Methods and Results: The study group included patients aged ≥65 years admitted with HF between June 2021 and December 2023. Patients were classified into 3 groups using the diagnostic algorithm for sarcopenic dysphagia at discharge: robust (without sarcopenia), sarcopenia (with sarcopenia only), and sarcopenic dysphagia (with sarcopenia and dysphagia). Outcomes were swallowing-related measures (maximal tongue pressure, geniohyoid muscle area, and geniohyoid muscle echogenicity) and a 1-year composite outcome (all-cause death or HF-related readmission). Of 524 screened patients, 363 were analyzed (median age 83 years [Q1–Q3: 78–90 years], 46.6% women); 61 patients were robust (16.8%), 215 had sarcopenia (59.2%), and 87 had sarcopenic dysphagia (24.0%). In the analysis of covariance, swallowing-related measures were poorer in the sarcopenic dysphagia group compared with the robust group (P<0.05). In the Cox regression analysis compared with robust, sarcopenia was not statistically significantly associated with prognosis, but sarcopenic dysphagia was associated with a higher risk (hazard ratio 2.53, 95% confidence interval 1.30–4.90, P=0.006).

Conclusions: Sarcopenic dysphagia affected 24.0% of patients with HF, and was associated with poorer swallowing-related measures and prognosis.

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: Heart failure is not only a mechanical impairment but also involves inflammation. This study investigated the association between quantitatively assessed coronary inflammation and cardiac dysfunction, and whether this relationship varied by coronary artery stenosis status.

Methods and Results: We studied 627 patients without prior coronary artery disease (CAD) who underwent coronary computed tomography angiography and transthoracic echocardiography. Coronary inflammation was quantified using the perivascular fat attenuation index (FAI) in the proximal segments of the 3 major epicardial coronary arteries. An inflamed artery was defined as a vessel-specific FAI >75th percentile, and patients were categorized by the number of inflamed arteries (0–3). Cardiac dysfunction was defined as either systolic dysfunction (left ventricular ejection fraction [LVEF] <50%) or diastolic dysfunction (LVEF ≥50% with ≥3 abnormal guideline-based criteria). Compared with none, adjusted odds ratios (ORs) for cardiac dysfunction were 1.39 (95% confidence interval [CI] 0.70–2.78) for 1, 2.63 (95% CI 1.28–5.42) for 2, and 6.50 (95% CI 3.13–13.45) for 3 inflamed arteries. Associations were consistent in patients without obstructive CAD, with adjusted ORs for cardiac dysfunction of 1.44 (95% CI 0.66–3.16), 2.67 (95% CI 1.18–6.07), and 3.85 (95% CI 1.57–9.48), respectively. Vessel-specific analyses demonstrated similar findings.

Conclusions: Greater coronary inflammatory burden was dose-dependently associated with cardiac dysfunction, even in the absence of significant coronary stenosis.

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: Patients with adult congenital heart disease (ACHD) are prone to complications and usually require surgical intervention, but the surgical risk factors remain poorly defined.

Methods and Results: We analyzed data from April 2013 to March 2023 in the nationwide Japanese Registry of All Cardiac and Vascular Disease-Diagnostic Procedure Combination (JROAD-DPC) to assess postoperative cardiac death and its predictors. This study included ACHD patients aged ≥18 years who underwent cardiovascular surgery, and the primary outcome was in-hospital death. A total of 10,535 patients (median age 53 [interquartile range 36–68] years; 50.4% female) were classified into mild (n=6,831), moderate (n=2,388), and severe (n=1,316) complexity groups. Among the 146 in-hospital deaths (1.4%), the highest mortality rate was observed in patients with severe complexity (2.4%). Multivariable analysis showed that age (hazard ratio [HR] 1.15), severe complexity (HR 1.77), renal disease (HR 1.74), pulmonary hypertension requiring medications (HR 2.01), chromosome abnormality (HR 6.22), and high-risk surgery (Fontan surgery or coronary artery bypass grafting) (HR 1.67) were significantly associated with increased in-hospital deaths. Subgroup analyses showed that age, renal disease, and high-risk surgery were prognostic factors in the mild group. Age was not significant in the moderate or severe groups.

Conclusions: The in-hospital mortality rate after cardiovascular surgery in ACHD was low overall but increased with disease complexity, supporting the need for disease complexity-based, individualized risk assessments in surgical planning.

Background: After tetralogy of Fallot (TOF) repair, pulmonary regurgitation (PR) frequently leads to right ventricular (RV) dilation and heart failure. Transcatheter pulmonary valve implantation (TPVI) reduces RV volume, but its impact on left ventricular (LV) function remains unclear. We hypothesized that LV torsion is a more sensitive indicator than LV ejection fraction (LVEF) and evaluated longitudinal changes in torsion using 3D cardiac cine magnetic resonance imaging (MRI) before and after TPVI.

Methods and Results: 30 patients with PR (25 with TOF, 4 with pulmonary artery stenosis, and 1 with double-outlet right ventricle; mean age, 42 years) underwent MRI before, 3 months, and 12 months after TPVI. LV time–torsion curves were derived from short-axis cine images using feature-tracking analysis. Torsion, biventricular function, and the PR fraction (PRF) were assessed. Torsion increased progressively (0.82±0.42 vs. 0.98±0.48 vs. 1.18±0.55 degrees/cm; all P<0.01), whereas LVEF showed no significant change (52.1±11.0% vs. 53.7±9.3% vs. 55.3±9.9%). RV end-diastolic volume index and PRF were significantly reduced at 12 months.

Conclusions: Despite unchanged LVEF, torsion improved after TPVI, reflecting LVEF-independent LV pump function and interventricular interaction.

Background: Understanding the effects of early direct oral anticoagulant (DOAC) (re)initiation after intracranial hemorrhage (ICH) in atrial fibrillation is crucial. Previous 30-day outcomes in the SAFE-ICH Registry showed acceptable ischemic/hemorrhagic risks; therefore, we evaluated the 12-month outcomes.

Methods and Results: The SAFE-ICH Registry, a prospective, observational cohort study conducted at 32 hospitals in Japan, included 240 patients with nonvalvular atrial fibrillation (NVAF) who experienced ICH and in whom DOAC therapy was (re)initiated ≤14 days after ICH. Short-term (≤30 days) and long-term (≤12 months) ischemic/hemorrhagic outcomes were investigated. Data were collected through clinical assessments, imaging or telephone interviews over 12 months. The 12-month composite outcome incidence (symptomatic ICH, any stroke, all-cause death) was 22.5% (29.1/100 person-years). The secondary outcome incidence was 6.3% (7.9/100 person-years) for symptomatic ICH, 6.7% (8.4/100 person-years) for any stroke (ischemic: 2.9% [3.6/100 person-years]; hemorrhagic: 3.8% [4.6/100 person-years]), and 14.2% (17.3/100 person-years) for all-cause death. The major bleeding incidence was 6.7% (8.4/100 person-years). Hemorrhagic stroke first appeared approximately 3 months after DOAC (re)initiation, and by month 10, its rate was comparable to that of ischemic stroke. Most deaths were due to aspiration pneumonia.

Conclusions: Early DOAC (re)initiation after ICH in NVAF was associated with a numerically higher long-term hemorrhagic than ischemic stroke risk. These risks warrant careful consideration when determining the optimal DOAC duration and timing after ICH.

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: Despite transcatheter aortic valve implantation (TAVI) reducing cardiovascular events in elderly patients with aortic stenosis (AS), the mortality rate is still high. Growth differentiation factor (GDF) 15 is reportedly a useful prognostic marker for clinical outcomes in the field of cardiovascular diseases, but it is still unclear if elevated serum GDF15 levels predict poor prognosis in patients with severe AS who undergo TAVI.

Methods and Results: We measured the pre- and postoperative serum concentrations of GDF15 in 148 patients. The primary and secondary endpoints were all-cause death and a composite event including cardiovascular death, heart failure rehospitalization, stroke, and adverse bleeding event, respectively. There were 30 all-cause deaths and 21 composite events during a median follow-up period of 1,023 days. Both pre- and postoperative serum GDF15 levels were significantly increased with advancing Society of Thoracic Surgeons Predicted Risk of Mortality score. Multivariate Cox proportional hazards analysis revealed that preoperative serum GDF15 level was independently associated with the primary and secondary endpoints, and the postoperative serum GDF15 level was independently associated with the primary endpoint after adjustment for confounding risk factors. Receiver operating characteristic curve analysis for the primary endpoint showed a comparable area under the curve for the pre- and postoperative serum GDF15 levels.

Conclusions: Both the pre- and postoperative GDF15 concentration could be a feasible marker for clinical outcomes in Japanese patients undergoing TAVI.

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: 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: 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: 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.