Background: Type A acute aortic dissection (TAAAD) requires integrated care and often interfacility transfer. However, the association between transfer and outcome remains unclear.

Methods and Results: We analyzed 328 patients with TAAAD who were admitted within 48 h of onset and were enrolled in the Tokyo Acute Aortic Super-Network Database between November 2010 and October 2011. Patients with intramural hematoma, cardiopulmonary arrest before arrival, or those who refused surgery were excluded. Directly admitted patients who underwent fewer operations were more often treated at lower-volume institutes and experienced higher rates of respiratory failure and renal ischemia, with a shorter time from symptom onset to admission, than transferred patients. The 30-day mortality rate was higher in directly admitted patients (n=182) than in transferred patients (n=146; 25.8% vs. 14.4%; P=0.016). Logistic regression analysis identified age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01–1.09; P=0.025), pre-arrival complications (OR 3.09; 95% CI 1.40–6.86; P=0.005), and surgery (OR 0.084; 95% CI 0.031–0.23; P<0.001) as independent predictors of 30-day mortality, while transfer status was not predictive (OR 0.836; 95% CI 0.345–2.02; P=0.69).

Conclusions: Interfacility patient transfer did not appear to affect early mortality in patients with TAAAD; however, large scale studies are warranted to confirm this finding.

Background: The clinical implication of left atrial pressure (LAP) elevation during atrial fibrillation (AF) ablation remains uncertain.

Methods and Results: We retrospectively analyzed 189 patients undergoing their first AF thermal ablation. LAP was measured via the transseptal sheath at insertion (initial) and withdrawal (final), showing a median intraprocedural elevation of 4 mmHg (interquartile range 1–6). Patients were dichotomized by the median intraprocedural change (high LAP increase: ≥4 mmHg, n=95; low LAP increase: <4 mmHg, n=94). The primary endpoint was heart failure (HF) hospitalization within 1 year, and the secondary endpoint included identifying predictors with a high LAP increase. Procedural characteristics were similar. Although initial LAP values were comparable between groups, patients with a high LAP increase exhibited higher right atrial pressure (RAP) and RAP/LAP ratio (0.9±0.3 vs. 0.7±0.2; P<0.001). The cumulative incidence of HF hospitalization was significantly higher in the high LAP increase group (8.5% [95% confidence interval (CI) 2.7–13.9] vs. 1.1% [95% CI 0–3.2]; P=0.020). On multivariate analysis, female sex, persistent AF, higher body mass index, higher initial RAP/LAP ratio, and structural heart disease were independent predictors of a high LAP increase.

Conclusions: Intraprocedural LAP elevation was associated with a higher risk of HF hospitalization within 1 year after the procedure. Monitoring LAP at both the start and end of ablation provides a feasible approach for post-procedural risk stratification.

Background: The HELT-E₂S₂ score is a new risk assessment tool for ischemic stroke in Japanese patients with atrial fibrillation (AF), so we investigated its association with clinical outcomes after catheter ablation (CA) for AF.

Methods and Results: We analyzed 769 patients enrolled in the Shinshu Catheter Ablation (Shinshu-AB) Registry who underwent first-time CA for AF (median age, 70 years; 31.2% female; 40.8% persistent AF). AF recurrence after CA beyond the 3-month blanking period during the 1-year follow-up was evaluated in relation to the HELT-E₂S₂ score. Patients were categorized into 4 groups based on HELT-E₂S₂ score: 0 (group 1, n=155), 1 (group 2, n=287), 2 (group 3, n=216), and ≥3 (group 4, n=111). Overall, AF recurred in 170 patients (22.1%). Kaplan-Meier analysis showed that higher HELT-E₂S₂ scores were associated with increased risk of AF recurrence (log-rank P=0.003). After multivariable adjustment, the risk tended to increase across groups and was significant for group 4 compared with group 1 (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.03–4.00; P=0.041). When analyzed as a continuous variable, the HELT-E₂S₂ score was associated with AF recurrence after multivariable adjustment (HR, 1.26; 95% CI, 1.06–1.49; P=0.007).

Conclusions: Higher HELT-E₂S₂ scores were associated with an increased risk of AF recurrence after CA.

Background: This study investigated the effects of pre- and post-hospitalization exercise habits on readmission among older (age ≥65 years) heart failure (HF) patients.

Methods and Results: The study included 98 older patients who were admitted to Odawara Municipal Hospital because of HF (mean [±SD] age 80.6±7.8 years; 41.8% female). Patients were categorized into 4 groups based on pre- and post-hospitalization exercise habits: persistent non-exercisers; exercise dropouts; new exercisers; and persistent exercisers. Exercise was defined as engaging in ≥30 min of moderate or vigorous exercise at least once a week. The primary outcome was all-cause readmission during the 1-year follow-up period. Twenty (20.4%), 25 (25.5%), 39 (39.8%), and 14 (14.3%) patients were classified as persistent non-exercisers, exercise dropouts, persistent exercisers, and new exercisers, respectively. Of the 98 patients in the study, 46 (46.9%) were readmitted during the 1-year follow-up period. In Cox proportional hazards analyses, newly exercising (hazard ratio [HR] 0.14; 95% confidence interval [CI] 0.03–0.53; P=0.004) and persistent exercising (HR 0.23; 95% CI, 0.09–0.57; P=0.001) remained independent prognostic factors for reduced rates of readmission, even after adjusting for confounding factors.

Conclusions: We found that continuing or starting exercise after hospital discharge is associated with lower rates of readmission among HF patients. Regular post-discharge assessments of exercise habits are essential for older HF patients.

Background: To contribute to the treatment and management of venous thromboembolism (VTE) patients with cancer, we used data from the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination database to clarify the impact of chemotherapy on 30-day all-cause in-hospital mortality. Annual changes in oral anticoagulant use were also evaluated.

Methods and Results: We identified 106,404 VTE patients who were hospitalized for the management of VTE between 2012 and 2021. The primary outcome was all-cause in-hospital mortality within 30 days after admission for VTE. After adjusting for covariates using propensity score (PS) matching, outcomes were compared between patients with and without chemotherapy. In the PS-matched cohort, subgroup analyses estimated the association between specific anticancer agents or hormone therapy and 30-day all-cause mortality. Mortality was significantly lower in the group with than without chemotherapy group (odds ratio 0.46; P<0.001). However, the analysis revealed no significant association between any anticancer agent or therapy and 30-day mortality. Warfarin use decreased markedly from 100% in 2012 to 7% in 2021, whereas the use of oral direct Factor Xa inhibitors increased significantly (P for trend <0.001).

Conclusions: In this study, 30-day mortality was lower in the group with than without chemotherapy group. Among VTE patients with cancer, direct Factor Xa inhibitors appear to be preferred over warfarin due to bleeding risk.

Background: Although the COVID-19 pandemic altered hospitalization trends for acute cardiovascular diseases (CVD) in Japan, the effects of a concomitant COVID-19 diagnosis on mortality in this high-risk population remains unclear. We investigated the association between COVID-19 infection and 30-day mortality among patients hospitalized for acute CVD using a nationwide database.

Methods and Results: This retrospective cohort study used data from the Japanese Registry of All Cardiac and Vascular Diseases–Diagnosis Procedure Combination (JROAD-DPC) database from January 2020 to March 2022. We included patients hospitalized for acute myocardial infarction, acute heart failure, aortic rupture, or venous thromboembolism. We compared patients with and without COVID-19, with 30-day mortality as the primary outcome. We used 1 : 1 propensity score matching to balance baseline patient and hospital characteristics. Of 395,671 eligible patients in the JROAD-DPC database, 41,794 (10.6%) had a concomitant COVID-19 diagnosis. In the matched cohort of 41,794 pairs, the risk of 30-day mortality was significantly higher patients for patients with than without COVID-19 (6.6% vs. 5.8%; odds ratio 1.14; 95% confidence interval 1.08–1.21; P<0.001). This increased risk was consistent across all major diagnostic subgroups (P for interaction >0.3).

Conclusions: In this large nationwide study of patients hospitalized for acute CVD in Japan, concomitant COVID-19 infection was associated with a significant increase in 30-day mortality. These findings suggest that COVID-19 infection is associated with increased mortality in this vulnerable patient population.

Background: Cancer therapy-related cardiac dysfunction (CTRCD) is a recognized complication of breast cancer treatment. Although early detection using cardiac biomarkers such as cardiac troponin I (cTnI) is recommended, the impact of CTRCD on cancer prognosis remains unclear.

Methods and Results: We conducted a prospective observational study of 273 patients with breast cancer treated with anthracycline-based chemotherapy and/or human epidermal growth factor receptor 2 (HER2)-targeted therapy at Fukushima Medical University between January 2016 and July 2022. Serial measurements of cTnI, B-type natriuretic peptide (BNP), and echocardiographic parameters were performed at baseline and at 3, 6, 12, and 24 months. CTRCD was defined based on declines in left ventricular ejection fraction (LVEF) and categorized as mild, moderate, or severe. CTRCD occurred in 40 (14.7%) patients. Even mild CTRCD was associated with greater reductions in LVEF at 12 months in patients with elevated cTnI, although recovery was observed by 24 months. Kaplan-Meier analysis revealed significantly shorter progression-free survival in the CTRCD group. In multivariable analysis, CTRCD was an independent predictor of cancer progression (hazard ratio 2.50; 95% confidence interval 1.17–5.36; P=0.018).

Conclusions: CTRCD following cardiotoxic chemotherapy was associated with reduced progression-free survival in patients with breast cancer. These findings underscore the importance of early CTRCD detection not only for cardiac protection but also as a prognostic indicator in cancer management.

Background: The increasing prevalence of heart failure (HF) in aging populations challenges healthcare systems, especially in rural and insular regions of super-aged societies. This study examines hospitalization incidence rates (IRs) and the association between physician experience and HF prognosis in an insular super-aged cohort.

Methods and Results: We conducted a retrospective population-based observational study including patients first hospitalized for HF between 2015 and 2019. Among 218 patients, 30 in-hospital deaths were excluded and 188 patients were followed up. We estimated hospitalization and readmission IRs and analyzed the association between physician experience and HF prognosis. Additionally, we conducted a landmark analysis 90 days post-discharge for readmissions. The first hospitalization IR for HF was 135/100,000 person-years (112 men, 157 women), and both rates increased with age. The median age was 86 years; 33% were ≥90 years, and 58% were female. Landmark analysis showed that 90-day all-cause mortality was significantly higher in patients with readmission than in those without (P=0.02). The multivariate Cox model confirmed a significant association between 90-day readmissions and all-cause mortality. The physician experience was not significantly associated with HF prognosis.

Conclusions: This study highlighted the hospitalization IR for HF in a super-aged society and the high risk of all-cause mortality associated with 90-day readmissions. No significant association was identified between physician experience and HF prognosis.

Background: Heart failure (HF) is increasing in Japan’s rapidly aging population, yet use of implantable cardioverter defibrillators and cardiac resynchronization therapy remains lower than in Western countries. Using data from HINODE, which prospectively evaluated Japanese patients with cardiac devices, we developed interpretable machine learning (ML) models to improve risk stratification and identify key predictors of adverse outcomes.

Methods and Results: Among 354 HINODE participants, 332 with adequate data were analyzed. Predictive models (XGBoost; 5-fold cross-validation) targeted HF hospitalization and all-cause mortality. Missingness was handled with multiple imputation; calibration was assessed by calibration plots and Hosmer-Lemeshow tests. Model discrimination was strong (area under the curve 0.83 and 0.85 for HF events and mortality). Shapley additive explanations (SHAP) highlighted QRS duration, QT interval, left ventricular (LV) volumes, and selected medications as major contributors. Using top SHAP features, K-means (k=2) identified low-risk (n=236) and high-risk (n=86) clusters. The high-risk cluster had larger LV volumes, wider QRS, and higher event rates. Kaplan-Meier curves showed significant differences between clusters for HF events (15.7% vs. 47.7%, log-rank P<0.001) and mortality (8.1% vs. 20.9%; hazard ratio 2.58, 95% confidence interval 1.45–4.60). Performance was temporally stable across enrollment periods.

Conclusions: Interpretable ML provided accurate risk prediction and phenotype-based stratification in Japanese HF patients with cardiac devices, supporting personalized management.

Background: The usefulness of the sinus of Valsalva wall thickness for diagnosing concomitant amyloid cardiomyopathy is not evaluated in patient with aortic stenosis (AS).

Methods and Results: We investigated 70 consecutive patients with moderate to severe AS who underwent ^{99 m}Tc-pyrophosphate (PYP) scintigraphy at Kumamoto University Hospital between 2012 and 2020. The patients were divided into 2 groups based on ^{99 m}Tc-PYP scintigraphy positivity (n=15) or negativity (n=55). The sinus of Valsalva wall thickness and relative apical longitudinal strain (LS) index (RapLSI, apical LS / [basal LS + mid LS]) were significantly associated with ^{99 m}Tc-PYP scintigraphy positivity when adjusted for severe AS (odds ratio [OR] 3.76; 95% confidence interval [CI] 1.36–10.38; P<0.05; and OR 20.7; 95% CI 2.00–215.44; P<0.05, respectively). Receiver-operating characteristic curve analysis showed that the sinus of Valsalva wall thickness had an area under the curve of 0.77 (95% CI 0.63–0.90; P<0.01) for ^{99 m}Tc-PYP scintigraphy positivity and that the best cut-off value was 1.75 mm (sensitivity 87%, specificity 55%). The ^{99 m}Tc-PYP scintigraphy positivity rate in patients with a sinus of Valsalva wall thickness ≥1.75 mm and RapLSI ≥1.0 was 66.7% and the negativity rate in those with a sinus of Valsalva wall thickness <1.75 mm and RapLSI <1.0 was 96.2%.

Conclusions: The sinus of Valsalva wall thickness was useful for predicting ^{99 m}Tc-PYP scintigraphy positivity in patients with AS.

Background: The left atrial volume index (LAVi) is a sensitive surrogate marker for left ventricular diastolic dysfunction (LVDD) and is associated with poor outcomes. Although LVDD is associated with coronary microvascular dysfunction (CMD), the prognostic significance of coexisting elevated LAVi and CMD remains unclear. This study aimed to assess the significance of coexisting elevated LAVi and CMD.

Methods and Results: We studied 330 patients who underwent intracoronary physiological assessment for suspected ischemia with non-obstructive coronary artery disease. Among these patients, 75 had LVDD, and 107 had coronary flow reserve (CFR) <2.5. Patients were classified into 4 groups: Group 1, normal LAVi and CFR; Group 2, elevated LAVi only; Group 3, impaired CFR only; and Group 4, abnormal LAVi and CFR. The primary endpoints were major adverse cardiovascular events (MACE), including cardiovascular death, acute coronary syndrome, and heart failure requiring hospitalization. During a median follow-up of 759 days, 16 (4.8%) patients experienced 18 events. Event-free survival was significantly lower in Group 4 than in the other groups (P<0.01).

Conclusions: The coexistence of elevated LAVi and impaired CFR is associated with a significantly higher risk of MACE. The combination of LAVi and CFR may improve risk stratification in patients without epicardial coronary stenosis.

Background: Acute myocardial infarction (AMI) is a fatal cardiovascular disease with varying prognosis. Recent studies suggest a close relationship between cardiovascular disease and metabolic dysfunction-associated fatty liver disease (MAFLD), but because the prognostic value of MAFLD in patients with AMI remains unclear, we investigated the relationship between MAFLD and clinical outcomes in patients with AMI.

Methods and Results: This retrospective study included 1,142 patients with AMI who underwent percutaneous coronary intervention (PCI) to the culprit lesion of AMI and were classified as MAFLD (n=231) and non-MAFLD (n=911). Hepatic steatosis was diagnosed by a liver-to-spleen attenuation (L/S) ratio <1 on computed tomography. The primary outcome was major adverse cardiovascular events (MACE), which were defined as a composite of all-cause death, non-fatal MI, and readmission for heart failure. Over a median follow-up of 609 days, MACE was less frequently observed in the MAFLD group than in the non-MAFLD group (P=0.015). However, the multivariate Cox hazard analysis showed that MAFLD was not associated with MACE (hazard ratio 0.80, 95% confidence interval 0.564–1.140, P=0.219) after controlling for confounding factors.

Conclusions: We could not show a significant association between MAFLD and MACE in patients with AMI, suggesting the absence of strong association between MAFLD and long-term clinical outcomes in these patients.

Background: Coronary artery brightness (CAB) on echocardiography has been observed during the acute phase of Kawasaki disease (KD), but its clinical relevance remains unclear. This study aimed to quantify CAB and evaluate its clinical significance using unsupervised machine learning (ML).

Methods and Results: Echocardiographic still images from 89 patients with acute-phase KD were analyzed. Pixel values of the coronary arteries (CAs) were extracted and standardized as Z-scores using brightness around the right coronary cusp as a reference. Mean and median pixel intensity (Z-scores) within the coronary artery region were calculated for each major CA branch. Based on these parameters, K-means clustering stratified patients into 2 clusters. Cluster 1 had significantly greater CA diameters and Z-scores in all 3 major coronary branches, with a higher proportion of patients with a maximum CA Z-score ≥2.5. In addition, levels of total bilirubin and pentraxin 3, both known predictors of intravenous immune globulin (IVIG) resistance, were significantly higher in Cluster 1.

Conclusions: Quantitative CAB analysis combined with unsupervised ML effectively stratified KD patients into subgroups with distinct coronary and biomarker profiles. This method may serve as a novel non-invasive tool to evaluate disease severity and predict IVIG resistance in acute-phase KD.

Background: In-stent occlusions in femoropopliteal lesions (FP-ISOs) remain a significant clinical issue. Excimer laser atherectomy (ELA) can ablate tissue, including thrombi, and may therefore be effective in FP-ISOs, which frequently contain both thrombi and neointimal hyperplasia. Angioscopy can directly visualize the stent lumen, making it useful for distinguishing thrombi from neointimal hyperplasia. Here, we investigated whether angioscopy-guided ELA was useful for FP-ISOs.

Methods and Results: We studied 10 consecutive patients with FP-ISO who underwent endovascular therapy (EVT) with ELA between August 2020 and May 2023. Based on preprocedural angioscopy, patients were divided into 2 groups (n=5 in each): M (thrombi <70% of lesion length) and S (thrombi ≥70%). Outcomes, including Thrombolysis in Myocardial Infarction (TIMI) flow grade and major adverse events (MAE; restenosis, amputation, and death) were compared. There were no significant differences between the 2 groups in TIMI grade 3 flow just after EVT or in the ankle-brachial pressure index 1 month after EVT. Clinical outcomes after ELA were similar between the M and S groups (6-month patency: 60% vs. 80%, respectively [P=0.49]; MAE rate: 40% vs. 60%, respectively [P=0.53]). Five patients receiving direct oral anticoagulants (DOACs) had no events.

Conclusions: ELA effectively vaporized thrombi in FP-ISOs, achieving comparable outcomes regardless of thrombus burden. Angioscopy-guided ELA, particularly combined with DOAC therapy, may represent a useful strategy for managing FP-ISOs.

Background: Lower extremity artery disease (LEAD) is a common disease associated with a higher risk of amputation and death. The Geriatric Nutritional Risk Index (GNRI) is a useful marker for assessing nutritional status; however, its relationship with outcomes in patients with LEAD following endovascular therapy (EVT) remains unclear.

Methods and Results: This study included 127 patients who underwent initial EVT between April 2010 and December 2022. Patients were divided into 2 groups based on a GNRI score of 92. The primary endpoint was all-cause mortality; the secondary endpoint was major amputation after EVT. The median follow-up period was 47.5 months (interquartile range 34.0–61.8 months). All-cause mortality and major amputation were significantly higher in the group with a GNRI score <92 (log-rank P<0.01). GNRI was independently associated with all-cause mortality after EVT (hazard ratio 0.95 per 1-unit increase in GNRI; 95% confidence interval 0.92–0.97; P<0.01). In addition, in the claudication group, all-cause mortality and major amputation were significantly higher in the group with a GNRI score <92 (log-rank P=0.01 and P=0.02, respectively).

Conclusions: All-cause mortality and major amputation after EVT were significantly higher in the patients with a GNRI score <92 overall, as well as in the claudication group. These findings highlight the importance of addressing nutritional status in the early stages of LEAD to improve clinical outcomes.

Background: This study evaluated the impact of Rheocarna® (Kaneka Medix, Osaka, Japan) after endovascular treatment (EVT) in patients with chronic limb-threatening ischemia (CLTI).

Methods and Results: We retrospectively analyzed consecutive data from 913 patients who underwent EVT for infrainguinal lesions between March 2021 and December 2023 at 8 centers in Japan. Patients were categorized into 2 groups based on whether they received Rheocarna: EVT alone and EVT combined with Rheocarna. Propensity score matching (PSM) was used to adjust for differences in patient and lesion characteristics. The primary outcome was the 1-year wound healing rate. Secondary outcomes included wound healing time, major amputation rate, and reintervention at 1 year. After PSM, 88 matched pairs were identified, with no significant differences in baseline characteristics between the 2 groups. Among patients with severe disease small artery disease (SAD2), the combination of EVT and Rheocarna significantly improved the wound healing rate vs. EVT alone (66.6% vs. 26.0%, respectively; P=0.01) No significant differences were observed between the 2 groups for the other endpoints.

Conclusions: Among patients with CLTI and SAD2, EVT combined with Rheocarna significantly improved the wound healing rate at 1 year, although there were no significant differences in terms of wound healing time, major amputation rate, and reintervention at 1 year. These findings suggest that patients with CLTI and SAD2 may be suitable candidates for Rheocarna treatment following EVT.

Background: Complex aortic atheroma (CAA) is a high-risk source of ischemic stroke, yet predictors of recurrent vascular events in CAA-related stroke remain poorly defined. We evaluated the prognostic value of high-sensitivity C-reactive protein (hsCRP).

Methods and Results: This single-center, prospective, observational registry enrolled consecutive patients with stroke within 1 week of onset. Transesophageal echocardiography (TEE) was not protocol-mandated but used at physician discretion, mainly for embolic-source evaluation. CAA was defined as any plaque ≥4 mm in thickness or a plaque with ulceration or mobile components on TEE. Patients were dichotomized by hsCRP at 3.0 mg/L. The primary outcome was 1-year major adverse cardiovascular events (MACE), including stroke, acute coronary syndrome, and vascular death. Among 1,214 patients, TEE was performed in 335; CAA was identified in 83 (24.8%). Seventy-six with hsCRP data were analyzed, with 1-year follow up obtained in 73 (96.1%). Over 1 year, 17 patients had at least 1 vascular event, yielding an event rate of 23.2%. The incidence of MACE was significantly higher in patients with hsCRP ≥3.0 mg/L than in those with hsCRP <3.0 mg/L (42.2% vs. 15.3%; log-rank P=0.010). In multivariable Cox analysis, hsCRP ≥3.0 mg/L independently predicted MACE (hazard ratio 4.68; 95% confidence interval 1.43–15.32).

Conclusions: Elevated hsCRP is independently associated with an increased risk of MACE in CAA-related stroke. hsCRP may aid risk stratification and underscores the role of systemic inflammation in this high-risk subgroup.

Background: The impact of the coronavirus disease 2019 (COVID-19) pandemic on the volume of endovascular therapy (EVT) procedures for symptomatic PAD in Japan has not been systematically studied.

Methods and Results: We analyzed data from the nationwide EVT procedural registry in Japan (2012–2023). The volume for chronic limb-threatening ischemia (CLTI) remained stable during and after the pandemic, but the volume for intermittent claudication was lower than forecasted after 2020, and the decrease in volume lasted even after the COVID-19 pandemic.

Conclusions: The impact of the COVID-19 pandemic on EVT volumes differs based on limb severity.

Background: The impact of emergency surgery for acute type A aortic dissection (ATAAD) on renal function in patients with autosomal dominant polycystic kidney disease (ADPKD) remains unclear.

Methods and Results: The renal function of 4 patients with ADPKD undergoing emergency ATAAD surgery remained unchanged up to 30 days postoperatively. During follow-up of 2 patients, 1 progressed from Stage 4 chronic kidney disease (CKD) preoperatively to Stage 5 at 3 years postoperatively, while the other progressed from Stage 3b CKD preoperatively to Stage 4 at 5 years postoperatively.

Conclusions: Emergency surgery for ATAAD had no effect on renal function.

Background: Functional tricuspid regurgitation (TR) develops in atrial fibrillation (AF), but its natural history after transcatheter aortic valve replacement (TAVR) remains unclear.

Methods and Results: Of 981 patients from a single-center registry, AF/atrial flutter (AFL) was present in 169. Over 5 years, severe TR developed in 11.7% with AF/AFL vs. 0.8% without. AF/AFL independently predicted TR progression (sub-distribution hazard ratio 1.82, 95% confidence interval: 1.34–2.47).

Conclusions: AF/AFL significantly increases TR progression risk post-TAVR, highlighting the importance of surveillance and preventive strategies.

Background: Zinc deficiency is frequent in heart failure (HF) and may worsen prognosis.

Methods and Results: We retrospectively analyzed 157 HF patients hospitalized between 2016 and 2019. Zn deficiency was defined as ≤60 µg/dL. Correlations between Zn and clinical indices were examined, and 1-year outcomes were evaluated. Zn deficiency correlated with anemia, malnutrition, and reduced muscle indices but not with dietary intake. Zn-deficient patients had higher rates of mortality/readmission (43% vs. 25%, P=0.027), especially in HF with preserved ejection fraction (HFpEF: 62% vs. 26%, P=0.01).

Conclusions: Zn deficiency predicted poor prognosis in HF, particularly HFpEF, and may serve as a simple biomarker for risk stratification.

Background: The significance of routine electrocardiogram (ECG)-based cardiovascular disease (CVD) screening, particularly whether routine ECGs contribute to primary prevention or early detection of CVD, remains controversial worldwide.

Methods and Results: A literature review was conducted to compare and contrast policies across countries. In Western countries, regular ECG screening is not recommended due to uncertain clinical efficacy; however, recent Japanese studies have supported routine periodic ECGs. Furthermore, analysis of national statistical indicators compiled by the Ministry of Health, Labour and Welfare in Japan, broken down by prefecture, suggested that regions with higher rates of regular ECG screening have higher rates of new outpatient visits for CVD and lower cerebrovascular mortality rates.

Conclusions: Routine ECG screening for CVD in adults has the potential to contribute to early detection, optimization of treatment interventions, and improvement of CVD prognosis.