Wild-type transthyretin amyloid cardiomyopathy has undergone profound transformation over the past decade, evolving from a rarely recognized condition to a disease that should not be missed. This shift has been driven by the use of bone-avid tracer scintigraphy enabling non-biopsy diagnosis, as well as the advent and expansion of disease-modifying therapies. As a result, the number of diagnosed and treated patients has increased substantially. However, important gaps remain in clinical practice, particularly in detection, diagnostic accuracy, and therapeutic decision-making. This review highlights 4 key challenges that will shape the next decade. First, marked geographic disparities in detection suggest underdiagnosis and inequitable access to care. Second, variability in scintigraphic interpretation, particularly due to reliance on planar imaging and modified grading systems, may compromise diagnostic accuracy. Third, the expanding range of therapeutic options, including stabilizers and gene silencers, has increased the complexity of treatment selection and underscores the need for biologically guided strategies. Fourth, patient selection at the extremes of disease severity raises unresolved clinical, ethical, and economic questions regarding when to initiate or withhold therapy. Looking ahead, continued therapeutic innovation and a deeper understanding of disease pathogenesis will be essential. Importantly, characterization of the underlying disease in each patient remains central to advancing clinical care and therapeutic development. If these challenges are addressed, the decade ahead will be even more fruitful.

Far-infrared therapy, with wavelengths ranging from 3 to 25 μm, has emerged as a noninvasive photothermal and photobiomodulatory intervention with promising therapeutic applications in cardiovascular medicine, wound healing, and chronic inflammatory diseases. Far-infrared penetrates superficial and subcutaneous tissues, inducing mild, sustained hyperthermia and wavelength-specific molecular signaling. These effects activate mechanosensitive and thermosensitive pathways, including the transient receptor potential channels, phosphoinositide 3-kinase–Akt pathway, and adenosine monophosphate-activated protein kinase pathway. This activation leads to the phosphorylation of endothelial nitric oxide synthase, enhancing nitric oxide bioavailability and vascular homeostasis. In parallel, far-infrared attenuates oxidative stress by suppressing the activity of nicotinamide adenine dinucleotide phosphate oxidase, improving mitochondrial coupling, and activating the nuclear factor erythroid 2-related factor 2–antioxidant response element pathway, thereby increasing the expression of endogenous antioxidant enzymes. The resultant redox shift inhibits nuclear factor kappa B activation, reducing proinflammatory cytokine production, adhesion molecule expression, and leukocyte–endothelium interactions. Additionally, far-infrared promotes macrophage polarization toward an anti-inflammatory M2 phenotype and enhances angiogenic signaling, partly through vascular endothelial growth factor upregulation in a low-inflammatory milieu. Preclinical and clinical studies have shown that these combined antioxidant, anti-inflammatory, vasodilatory, and angiogenic effects contribute to improved microvascular perfusion, endothelial function, and tissue repair.

Background: The corrected QT interval (QTc) is essential for long QT syndrome (LQTS) screening. QTc values change with growth, and sex differences emerge at puberty. However, few longitudinal studies have assessed QTc changes across childhood and adolescence, and age- and sex-specific QTc cut-offs using Bazett’s and Fridericia’s formulas (QTcB and QTcF, respectively) near the onset of puberty have not been established.

Methods and Results: We retrospectively analyzed electrocardiograms from school-based screening. QT and RR intervals were measured manually, and QTcB and QTcF were calculated in 4th graders (n=2,753); subsets were additionally assessed in 1st graders (n=1,289) and 7th graders (n=1,351). Longitudinal changes in QTc were evaluated. QTc cut-offs for LQTS screening were determined using both the 99.5th percentile and histogram assessment. No significant sex difference in mean QTcB and QTcF values was found in 1st graders. These values in 4th graders were significantly shorter in males than in females (QTcB: 374±20 vs. 378±21 ms; QTcF: 389±23 vs. 395±24 ms; P<0.001). QTcB cut-offs (males/females) for 1st, 4th, and 7th graders were 453/448, 449/462, and 463/462 ms, respectively. The QTcF cut-off values (males/females) for 1st, 4th, and 7th graders were 425/436, 438/438, and 440/443 ms, respectively.

Conclusions: Sex differences in QTc emerge in the 4th grade. Age- and sex-specific QTc cut-offs are required for screening in children and adolescents.

Background: Pre- and post-hospitalization gait speed are known prognostic indicators in patients undergoing transcatheter aortic valve implantation (TAVI); however, the impact of changes in gait speed during hospitalization on prognosis remains unclear. This study investigated the effect of in-hospital gait speed changes on survival outcomes.

Methods and Results: We retrospectively analyzed 1,082 patients (mean age 85 years) who underwent TAVI between 2013 and 2022. Gait speed was assessed at admission (pre-TAVI) and at discharge. Patients were classified into 4 groups based on baseline gait speed (normal/slow) and in-hospitalization change (non-decreased/decreased): Normal/Non-DG (n=420); Normal/DG (n=197); Slow/Non-DG (n=385); and Slow/DG (n=80). The primary outcome was post-discharge all-cause mortality. During a mean follow up of 3.1 years, 255 (24%) patients died. In a multivariable Cox model, compared with the Normal/Non-DG group, mortality risk was higher in the Normal/DG group (hazard ratio [HR] 1.905; 95% confidence interval [CI] 1.230–2.951; P=0.004) and the Slow/DG group (HR 2.102; 95% CI 1.186–3.728; P=0.011), whereas the Slow/Non-DG group showed no significant difference (HR 1.373; 95% CI 0.927–2.034; P=0.114).

Conclusions: A decline in gait speed during hospitalization was associated with a higher risk of post-discharge all-cause mortality. This association remained after multivariable adjustment, even among patients with normal gait speed at admission. These findings suggest that in-hospital gait speed change may serve as a clinically meaningful prognostic marker in patients undergoing TAVI.

Background: There have been no reports examining whether Registered Instructors of Cardiac Rehabilitation (RICRs) contribute to inpatient cardiac rehabilitation (CR) participation.

Methods and Results: Using data from the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination (JROAD-DPC) database, we calculated the inpatient CR participation rate for each prefecture from 2014 to 2023. The number of RICRs, cardiologists, general hospital physicians, general hospital nurses, and physical therapists per 100,000 population were also calculated for each prefecture. The median CR participation rate increased from 31.2% to 57.3%, and the total number of RICRs increased from 3,399 to 7,367 during the study period. In prefecture-level correlation analyses for 2023, the number of RICRs was positively associated with the CR participation rate (r=0.31; 95% confidence interval 0.02, 0.55; P=0.03). In contrast, the increase in the number of RICRs was not significantly associated with the growth of CR participation during the study period.

Conclusions: Regions with a greater number of RICRs consistently demonstrated higher levels of CR implementation; however, increases in the number of RICRs were not directly correlated with longitudinal growth in CR utilization.

Background: Hemoglobin (Hb) and red cell distribution width (RDW), are routinely measured hematological parameters that reflect anemia, inflammation, and nutritional status. The 6-min walk distance (6MWD) test is a well-established indicator of functional capacity. However, all these parameters are predominantly evaluated at a single time point, and the prognostic implications of their longitudinal changes during hospitalization in acute decompensated heart failure (ADHF) remain unclear. Therefore, in this study we investigated the association between longitudinal changes in the Hb-to-RDW ratio (∆Hb/RDW) during hospitalization and clinical outcomes in patients with ADHF.

Methods and Results: The data for 670 consecutive patients hospitalized with ADHF were analyzed. Hb/RDW and 6MWD were assessed at baseline and discharge, and ∆Hb/RDW was calculated. Kaplan–Meier and Cox regression analyses were used to examine the association between ∆Hb/RDW and all-cause death after discharge. During a median follow-up of 2.0 (1.0–3.3) years, 214 patients (31.9%) died. Kaplan–Meier analysis showed a significantly lower all-cause mortality rate in patients with increased ∆Hb/RDW compared with those without an increase. Exploratory analyses suggested graded differences in mortality risk when ∆Hb/RDW was considered together with changes in the 6MWD during hospitalization.

Conclusions: An increase in ∆Hb/RDW during hospitalization was associated with a lower risk of all-cause death in older patients with ADHF.

Background: Patients with cardiovascular disease (CVD) admitted to community rehabilitation wards after acute care for cardiac rehabilitation (CR) continuation show improvements in activities of daily living (ADL). However, because the determinants of ADL improvement remain unclear, we aimed to identify the factors related to ADL recovery during post-acute CR.

Methods and Results: This interim analysis of the multicenter J-CREW CR registry included 198 patients with CVD (mean age: 78.1±8.8 years; 49.5% female). Data on demographics, ADL and frailty status before hospitalization, primary and comorbid conditions, nutritional risk, admission ADL, physical and cognitive function, length of stay (LOS), and rehabilitation dose were collected. The primary outcome was factors associated with Functional Independence Measure (FIM) gain, and the secondary outcome was FIM effectiveness. In the regression model (R²=0.435, P<0.001), admission Short Physical Performance Battery (SPPB; B=1.177, P=0.004), Mini-Mental State Examination (MMSE; B=1.272, P<0.001), and LOS (B=0.117, P<0.001) were significantly associated with FIM gain, whereas admission FIM was negatively associated (B=−0.623, P<0.001). Another model (R²=0.360, P<0.001) revealed comparable associations with FIM effectiveness.

Conclusions: Better physical and cognitive function at admission, together with sufficient LOS, contributed to greater ADL recovery. These indices may serve as practical indicators of effective post-acute CR strategies.

Background: Peak oxygen uptake (V̇O₂) is a clinically meaningful indicator of functional capacity and prognosis during cardiac rehabilitation (CR). Although home-based exercise is essential in outpatient CR, the impact of different exercise modalities on exercise capacity remains unclear.

Methods and Results: This retrospective observational study included 69 patients who underwent outpatient CR and completed cardiopulmonary exercise testing at baseline and follow up. Home-based exercises were classified as ergometer based or walking based. Exercise self-efficacy was assessed as a behavioral factor. When the peak V̇O₂was analyzed as a continuous outcome via analysis of covariance, ergometer-based home exercises were independently associated with a higher post-intervention peak V̇O₂after adjustment for baseline peak V̇O₂, age, and sex. This association was attenuated after additional adjustment for changes in exercise self-efficacy. The proportion of patients with ≥6% improvement in peak V̇O₂was non-significantly higher in the ergometer-based exercise group.

Conclusions: In an outpatient CR setting, ergometer-based home exercises were associated with modestly greater improvement in exercise capacity, assessed as peak V̇O₂, particularly as a continuous outcome. Although self-efficacy was not an independent predictor, its association with this relationship highlights the potential importance of behavioral engagement in the relationship between prescribed exercises and physiological improvements. The principles underlying ergometer-based exercise – such as structured intensity prescription and objective feedback – may be applicable to broader home-based exercise programs, including walking-based interventions.

Background: One of the challenges with off-pump coronary artery bypass grafting (OPCAB) in patients with low left ventricular ejection fraction (LVEF) is the transient increase in right ventricular (RV) afterload during cardiac displacement. We developed the “iNO bundle,” a protocol integrating pulmonary artery catheter (PAC)-guided navigation with titrated inhaled nitric oxide (iNO), to stabilize hemodynamics.

Methods and Results: This retrospective study evaluated 77 patients (LVEF <40%) undergoing isolated OPCAB at Kumamoto University Hospital between April 2015 and January 2026; 28 patients managed via the iNO bundle (February 2023–January 2026) were compared to 49 historical controls using inverse probability weighting. Hemodynamic instability was defined as a sustained decrease in mean arterial pressure (MAP) for >5 min, necessitating emergency conversion to on-pump surgery. In the iNO bundle group, mean pulmonary arterial pressure (PAP) decreased significantly (from 23.9 to 21.6 mmHg; P<0.001) and the MAP/PAP ratio improved (from 3.3 to 3.7; P=0.001). The pulmonary artery pulsatility index decreased in the iNO bundle group (from 2.0 to 1.6, P=0.003), suggesting therapeutic RV unloading. Notably, the incidence of emergency conversion to on-pump surgery was 0% in the iNO-Bundle group (vs. 4.1% for the historical controls). No iNO-related adverse events were observed.

Conclusions: The PAC-guided iNO bundle provides a precision-medicine approach to hemodynamic management. By facilitating therapeutic RV unloading, this protocol is a proactive strategy to maintain hemodynamic stability during high-risk OPCAB.

Background: Cardiac-origin out-of-hospital cardiac arrest (CO-OHCA) remains a public health challenge, and variations in its incidence may reflect differences in cardiovascular care. We investigated whether the intensity of regional outpatient cardiovascular diagnostic testing was associated with the CO-OHCA incidence among adults aged 40–74 years in Japan.

Methods and Results: This prefecture-level ecological study (2014–2023) used the All-Japan Utstein Registry and National Database Open Data. The outcome was the age- and sex-standardized incidence ratio (SIR) of CO-OHCA. The intensity of outpatient 12-lead electrocardiography (ECG) testing was quantified as an observed/expected ratio. Among 248,633 patients, higher 12-lead ECG testing intensity was significantly associated with lower SIR after adjusting for calendar year and cardiometabolic risk factors (rate ratio [RR] 0.95 per 0.1-unit increase; 95% confidence interval [CI] 0.93–0.98; P<0.001). Conversely, higher obesity prevalence was associated with higher SIR (RR 1.35 per 10-percentage-point increase; 95% CI 1.16–1.57; P<0.001). No significant associations were seen for transthoracic echocardiography and B-type natriuretic peptide/N-terminal pro B-type natriuretic peptide testing.

Conclusions: In this nationwide ecological study, higher prefecture-level 12-lead ECG testing intensity was associated with lower CO-OHCA SIR among adults aged 40–74 years. Although causal interpretation is not possible, 12-lead ECG testing intensity may represent a prefecture-level indicator of regional outpatient cardiovascular care and offer a useful perspective for understanding geographic variations in CO-OHCA burden.

Background: The clinical impact of non-severe aortic stenosis (AS) on the response to cardiac resynchronization therapy (CRT) remains unclear. We investigated whether non-severe AS affects left ventricular (LV) reverse remodeling and long-term outcomes after CRT.

Methods and Results: We retrospectively analyzed 181 consecutive patients with chronic heart failure (mean age 70 years; 76% male) who underwent CRT at a single center. Patients were classified into a non-severe AS group (mild or moderate AS) and a no AS group. The primary endpoint was a composite of all-cause death and heart failure hospitalization. LV reverse remodeling, defined as a ≥15% reduction in LV end-systolic volume at 6 months, was evaluated as a secondary endpoint. Patients with non-severe AS were older and had a higher baseline LV ejection fraction. LV reverse remodeling occurred less frequently in the non-severe AS group (39% vs. 66%; P<0.05). Non-severe AS was independently associated with lower likelihood of LV reverse remodeling. During a median 3.5-year follow up, cumulative incidence of the composite endpoint was higher in the non-severe AS group. In multivariable Cox analysis, non-severe AS independently predicted adverse outcomes (hazard ratio 2.19; 95% confidence interval 1.19–4.16; P=0.01).

Conclusions: Non-severe AS is associated with attenuated LV reverse remodeling and worse outcomes after CRT and may represent a modifier of CRT response.

Background: This study aimed to evaluate the prognostic impact of left ventricular (LV) regional longitudinal strain (LS) in patients with immunoglobulin light-chain (AL) cardiac amyloidosis.

Methods and Results: The study population was part of the Japan Cardiac Amyloidosis Survey of typical Echocardiographic findings (J-CASE) study – a multicenter, retrospective study with 18 participating institutions in Japan. From a total of 324 patients with histologically proven cardiac amyloidosis enrolled between 2000 and 2020, we enrolled 81 patients with AL cardiac amyloidosis in the present study. During a median follow up of 278 days (interquartile range 63–1,133 days), 43 all-cause deaths occurred. LV-apical LS was significantly and independently associated with all-cause death after adjusting for conventional echocardiographic findings (hazard ratio 0.86; 95% confidence interval; P<0.05). Receiver operating characteristic curve analysis showed that the area under the curve for LV-apical LS for all-cause death was 68% and the best cut-off value for LV-apical LS was 15.9% (sensitivity 71%; specificity 54%). Kaplan–Meier analysis demonstrated a significantly higher risk of all-cause death in patients with low LV-apical LS (<15.9%, n=46) than in those with high LV-apical LS (≥15.9%, n=35; log-rank test P<0.05).

Conclusions: Low LV-apical LS is a significant and independent prognostic factor in patients with AL cardiac amyloidosis.

Background: A higher atherogenic index of plasma (AIP; calculated as log₁₀[triglycerides/high-density lipoprotein cholesterol]) is an indicator of atherogenic dyslipidemia. Whether the cumulative AIP (cAIP) burden provides prognostic information beyond the cumulative low-density lipoprotein cholesterol (cLDL-C) burden remains unclear.

Methods and Results: This retrospective study analyzed data for 11,402 adults with at least 3 health checkups. cAIP and cLDL-C burdens were calculated from the first 3 lipid-complete visits, with the third visit defined as the index date. The primary outcome was first non-fatal myocardial infarction (MI) or ischemic stroke. Cox models were adjusted for conventional cardiovascular risk factors and cLDL-C burden. Over a mean follow-up of 4.96 years, 435 primary events occurred. Per 1-SD increase, cAIP burden was independently associated with the primary outcome after full adjustment including cLDL-C burden (hazard ratio 1.14; 95% confidence interval 1.02–1.27). Restricted cubic splines showed a progressive increase in risk with higher AIP burden. In discordance analysis, low cLDL-C/high cAIP burden, but not high cLDL-C/low cAIP burden, was associated with a higher risk than low cLDL-C/low cAIP burden (hazard ratio 1.40; 95% confidence interval 1.04–1.89). The addition of AIP burden did not improve global discrimination or reclassification.

Conclusions: cAIP burden was associated with incident non-fatal MI or ischemic stroke and identified excess risk despite low cLDL-C burden, supporting its complementary value for characterizing residual lipid-related risk.

Background: We investigated the association between nutritional risk and improvement in physical function during hospitalization among patients with cardiovascular disease, particularly those with heart failure, admitted to a community-based care ward.

Methods and Results: We retrospectively analyzed 84 patients who underwent cardiac rehabilitation in a community-based care ward between July 2023 and May 2025. Nutritional risk on admission was assessed using the Mini Nutritional Assessment–Short Form (MNA-SF). Patients were classified into 2 groups: non-malnourished (normal/at risk; MNA-SF ≥8, n=43) and malnourished (MNA-SF ≤7, n=41). The primary outcome was no improvement in physical function (change in Short Physical Performance Battery (SPPB) [∆SPPB] ≤0). Sensitivity analysis used an alternative definition (∆SPPB ≤2). The association between malnutrition and outcome was analyzed using modified Poisson regression adjusted for propensity score. Overall, 21 patients (25.0%) showed no improvement in physical function (∆SPPB ≤0), whereas 53 (63.1%) showed no improvement using the alternative definition. Malnutrition was not associated with no improvement in physical function in the primary analysis (adjusted risk ratio: 1.16; 95% cconfidence interval [CI]: 0.52–2.64; P=0.71), whereas a significant association was observed in sensitivity analysis (adjusted risk ratio: 2.3; 95% CI: 1.19–4.42; P<0.001).

Conclusions: Nutritional risk was not associated with no improvement in physical function in the primary analysis, although an association was observed in sensitivity analyses using the alternative definition.

Background: Sunitinib is a multitargeted tyrosine kinase inhibitor with antiangiogenic and antitumor effects. Angiogenesis inhibitor-induced hypertension results from both short-term changes in vasoactive substances and by long-term microvascular rarefaction. This study investigated the relationship between late-onset hypertension and prognosis of cancer patients treated with sunitinib.

Methods and Results: We retrospectively analyzed time to hypertension and time to disease progression in patients treated with sunitinib. Of 92 patients, 62 were eligible for analysis. Clinical outcomes were compared among patients who remained normotensive, those who developed hypertension within 3 months, and those who developed hypertension after 3 months following the initiation of sunitinib treatment. At baseline, blood pressure was below 140/90 mmHg in all groups. Sunitinib was administered for renal cell carcinoma (74.2%), pancreatic neuroendocrine tumor (14.5%), and gastrointestinal stromal tumor (11.3%). Hypertension developed in 27 (43.5%) patients after sunitinib treatment. The severity of hypertension did not differ between the early onset (within 3 months) and late-onset (after 3 months) groups. Progression-free survival for all cancer types and for renal cell carcinoma was significantly longer in the late-onset hypertension group than in the normotensive or early onset hypertension groups.

Conclusions: Late-onset hypertension was associated with prolonged progression-free survival in sunitinib-treated patients. Long-term structural changes in the vasculature may underlie the association between late-onset hypertension and a better prognosis.

Background: Pulmonary arterial hypertension (PAH) is characterized by a progressive increase in pulmonary arterial pressure (PAP) and pulmonary vascular resistance (PVR), imposing an increased workload on the right ventricle and ultimately leading to right heart failure. Macitentan is a potent dual endothelin receptor antagonist that blocks both endothelin receptor subtypes A and B, and is approved for adult patients with PAH, but evidence in pediatric PAH patients is limited.

Methods and Results: This was an open-label, multicenter, Phase III study enrolling Japanese pediatric PAH patients aged ≥3 months to <15 years. A total of 7 patients were enrolled. Efficacy was evaluated by assessing pulmonary hemodynamics after 24 weeks of treatment, and safety was assessed over a 52-week period. The geometric mean fold change in PVR index (PVRI) at Week 24 was 59.43%, which met the prespecified success criterion of ≤81.6% (primary endpoint). Other pulmonary hemodynamic parameters, including mean PAP, mean right atrial pressure, and total pulmonary resistance, also showed improvement. Additionally, at Week 52, functional outcomes such as 6-minute walk test performance and quality-of-life reports, demonstrated a trend toward improvement. Safety findings were favorable, with no unexpected concerns among the 7 treated participants. Most adverse events were mild to moderate in severity, and none were considered related to macitentan.

Conclusions: Macitentan showed clinically meaningful reduction in PVRI and improved pulmonary hemodynamics in Japanese pediatric patients with PAH, with a favorable safety profile over 52 weeks of treatment.

Background: The optimal timing of pulmonary valve replacement (PVR) in repaired tetralogy of Fallot (TOF) remains debated. We examined the influence of right ventricular (RV) diastolic dysfunction on post-PVR outcomes and investigated whether age ≥35 years at PVR is universally associated with adverse outcomes or represents a risk factor only in specific patient subgroups.

Methods and Results: We reviewed 81 patients who underwent PVR for repaired TOF at Osaka University between 2002 and 2022. Adverse outcomes were defined as catheter ablation or pacemaker implantation for arrhythmia, or unplanned hospitalization for heart failure. RV diastolic dysfunction was defined as RV end-diastolic pressure ≥12 mmHg and/or a right atrial (RA) volume index ≥83 mL/m². Cox regression analysis was used to identify factors associated with adverse outcomes, with subgroup analyses stratified by the presence or absence of RV diastolic dysfunction. Adverse outcomes occurred in 24 patients (30%). The RA volume index was the only independently significant predictor of adverse outcomes. Age ≥35 years at PVR was significantly associated with reduced freedom from adverse events, but only in patients with RV diastolic dysfunction.

Conclusions: RV diastolic dysfunction was significantly associated with post-PVR clinical outcomes. Age ≥35 years at PVR was a significant risk factor only in patients with RV diastolic dysfunction, but not in those without, suggesting that advanced age alone does not uniformly confer increased risk.

Background: Data on the association of weekend vs. weekday diagnosis with clinical outcomes of venous thromboembolism (VTE) in the direct oral anticoagulant (DOAC) era are limited.

Methods and Results: The COMMAND VTE Registry-2 is a multicenter registry that enrolled 5,197 consecutive acute symptomatic VTE patients from 31 centers in Japan between January 2015 and August 2020. Baseline characteristics, anticoagulation strategies, and 30-day outcomes were compared between patients diagnosed on weekends (n=537; 10.3%) and those diagnosed on weekdays (n=4,660, 89.7%). Compared with patients diagnosed on weekdays, those diagnosed on weekends more frequently presented with pulmonary embolism (PE; 74.7% vs. 51.2%; P<0.001) and more often received thrombolysis and cardiopulmonary support. The cumulative 30-day incidence of all-cause death in PE patients was significantly higher in patients diagnosed on weekends than in those diagnosed on weekdays (7.5% vs. 4.1%; P=0.003), but the difference was not significant after multivariable adjustment (hazard ratio 1.51; 95% confidence interval [CI] 0.99–2.30; P=0.056). The 30-day risk of major bleeding was significantly higher in weekend PE patients after multivariable adjustment (hazard ratio 1.79; 95% CI 1.11–2.88; P=0.02).

Conclusions: VTE patients diagnosed on weekends presented more often with PE and with greater severity. Although the higher crude 30-day mortality in weekend PE patients was attenuated after adjustment, a weekend diagnosis remained associated with higher 30-day major bleeding risk.

Background: Manually tracking research trends in extensive conference programs is challenging, so we used a natural language processing approach to automatically extract trending topics from PDF-formatted programs of the Japanese Circulation Society (JCS).

Methods and Results: Programs from JCS2023 to JCS2026 were analyzed by GiNZA and Latent Dirichlet Allocation. Among the 42,400 extracted text blocks, there were 8 primary research themes, including sustained interests in coronary artery syndrome and heart failure, an increase in interprofessional collaboration and emerging clusters in arrhythmia and valvular intervention.

Conclusions: The automated workflow successfully visualized evolving academic trends, providing a robust tool for comprehensive research exploration.

Background: Methamphetamine-associated pulmonary arterial hypertension (Meth-PAH) is increasingly recognized in Western countries, but Japanese data remain limited.

Methods and Results: Of 363 patients with PAH, we identified 5 patients with Meth-PAH (1.4%); 4 were women, with a mean age of 37.6±7.2 years. Patients receiving PAH-specific therapy showed favorable hemodynamic responses, although 40% of patients experienced treatment discontinuation and methamphetamine reuse.

Conclusions: In this case series of 5 Japanese patients with Meth-PAH, there was a high rate of treatment discontinuation and methamphetamine reuse, which suggests possible underdiagnosis of Meth-PAH and barriers to sustained care in Japan.

Background: Management of patients after bleeding associated with Factor Xa inhibitors (FXa-I) remains challenging due to limited available data on unpredictable sequencing of bleeding and thromboembolic events.

Methods and Results: This cohort study identified 5,349 patients with FXa-I-related major bleeding. During the 360-day follow-up, bleeding events were highest in the first 90 days (42.2 per 100 person-years), declining to 18.6 by days 271–360. Conversely, thromboembolic events showed a reverse pattern, increasing from 17.3 to 28.6.

Conclusions: Patients surviving FXa-I-related bleeding experience a risk transition from bleeding to thromboembolic risk, suggesting the need for time-dependent management strategies.

Background: Impella and other percutaneous mechanical circulatory support (MCS) devices are increasingly used for cardiogenic shock complicating acute myocardial infarction. Although they provide rapid hemodynamic stabilization, some patients do not achieve myocardial recovery and are not candidates for heart transplantation or durable MCS. In such situations, Impella may become a “bridge to nowhere”, raising ethical and clinical questions about continuation or withdrawal.

Methods and Results: We present illustrative cases of acute myocardial infarction-related cardiogenic shock managed with Impella and reviewed through multidisciplinary ethical deliberation. In Case 1, support was defined as a time-limited trial with a predefined exit strategy, followed by transition to palliative-focused care. In Case 2, escalation from Impella CP to Impella 5.5 stabilized hemodynamics and enabled recovery of decision-making capacity; however, the patient declined heart transplantation and long-term MCS, resulting in elective withdrawal of Impella support and initiation of end-of-life care.

Conclusions: When recovery or durable therapy is not achievable or acceptable, Impella can unintentionally function as a “bridge to nowhere”. Multidisciplinary deliberation and early integration of palliative care are essential for goal-concordant withdrawal decisions.