The aim of this study was to analyze the correlation between left ventricular mass index (LVMI) and the prognosis of patients with acute myocardial infarction (AMI).

The study retrospectively analyzed the Registry of New-onset Atrial Fibrillation Complicating Acute Myocardial Infarction-Shanghai database and included 1957 patients with AMI who were hospitalized from February 2014 to March 2018, with a median follow-up of 2.7 ± 1.3 years; it calculated the number of all-cause mortalities after AMI. Through receiver operating characteristic curve analysis of LVMI, the optimal LVMI cutoff value was obtained, and the enrolled patients were grouped accordingly. The effects of different LVMI levels on the occurrence of cardiovascular and cerebrovascular adverse events were evaluated in patients with AMI. In addition, the risk assessment and prognostic value of the combined application of LVMI and the GRACE score was explored in patients with AMI.

The incidences of all-cause mortality, cardiovascular death, heart failure readmission rate, and reinfarction in patients with AMI in LVMI ≥ 98.90 group were significantly higher than those in LVMI < 98.90 group (P< 0.05). The value of LVMI combined with the GRACE score in predicting the risk of post-AMI all-cause mortality as well as cardiovascular death seemed to be better than that of using the GRACE score alone. LVMI, old age, male sex, renal insufficiency, previous heart failure, stroke history, and decreased left ventricular ejection fraction were independent risk factors for all-cause mortality after AMI.

High LVMI may be closely associated with all-cause mortality and adverse cardiovascular events after AMI, especially in patients with AMI with LVMI > 98.9. The risk of all-cause mortality after AMI can also be assessed in combination with LVMI and GRACE scores.

Although state-of-the-art therapy for left main disease (LMD) has been demonstrated to improve overall cardiovascular outcomes, it remains unclear whether differences in strategy and outcomes for Japanese and non-Japanese patients can be observed in a contemporary treatment.

In this international multicenter registry, we analyzed 314 patients who received state-of-the-art management for LMD, including physiology-guided revascularization, coronary interventions using the latest drug-eluting stents aided by intracoronary imaging, or surgical procedures employing internal thoracic artery grafts, in conjunction with guideline-directed medical therapy. The patient cohort was divided into Japanese (n = 122) and non-Japanese (n = 192) groups. The primary endpoint was major adverse cardiovascular events (MACE), defined as death, non-fatal myocardial infarction, and ischemia-driven target lesion revascularization. Propensity score matching was utilized to account for baseline clinical variables.

Baseline and lesion characteristics differed among groups, demonstrating higher frequency of diabetes and chronic kidney disease, higher SYNTAX score, and more severe stenosis in the Japanese cohort, resulting in a higher rate of revascularization performed (P < 0.05 for all). Percutaneous coronary intervention was significantly more frequently selected as the revascularization option (P < 0.001). While there were no significant differences in MACE between the 2 groups before adjustment, following adjustment, the Japanese cohort demonstrated significantly lower MACE at 4 years (6.3% versus 16.7%; HR: 0.37; 95%CI: 0.14-0.97; P = 0.042). Multivariate analysis further confirmed an independent association between Japanese patients and a reduced 4-year MACE risk (HR: 0.37; 95%CI: 0.14-0.96; P = 0.040).

In a contemporary study with state-of-the-art therapy for LMD, patients who underwent treatment in Japan demonstrated better cardiovascular outcomes.

There is no consensus on the ideal sweep gas flow volume for achieving targeted blood partial gas pressures during cardiopulmonary bypass (CPB). The sweep gas flow rate is one of the oxygenator's main gas exchange variables. High sweep gas flow rates can lead to respiratory and hypocapnic cerebral alkalosis, which can cause neurological complications.

This study included 84 patients aged > 18 years who were scheduled to undergo elective open-heart surgery with CPB. Before rewarming, the participants were randomly assigned to one of the three groups based on their sweep gas flow rates (Group 1, 1.35 L/m²/minute; Group 2, 1.2 L/m²/minute; and Group 3, 1 L/m²/minute). During the surgery, arterial blood gases were sampled at six different time points, and regional cerebral oxygen saturation (rSO₂) levels were monitored bilaterally on the forehead.

The study found that all groups experienced a decrease in partial pressure of arterial carbon dioxide (PaCO₂) levels after the onset of hypothermia, which decreased to below the normal range at a moderate hypothermia level of 32°C. During both the baseline and hypothermic periods, the PaCO₂ were similar between the groups; however, after rewarming, Group 3 had significantly higher PaCO₂ than Groups 1 and 2 (P< 0.001). During the same period, Group 3 had significantly higher rSO₂ levels than Groups 1 and 2 (P = 0.005). For all patients, there was a significant correlation between delta-PaCO₂ and delta-rSO₂ levels after rewarming (r = 0.45, P< 0.001).

This study demonstrated that low sweep gas flow prevented alkalosis and preserved cerebral autoregulation.

Few reports have provided detailed characteristics of incident coronary artery disease (CAD) and its risk factors in patients undergoing ablation (ABL) for atrial fibrillation (AF).

Patients undergoing ablation for AF with no documented CAD were retrospectively studied at our institution. Patients were divided into 2 groups: those in whom significant stenosis was detected incidentally on coronary angiography (CAG) performed at the same time as ablation, and those without. The detection rate and its predictors were examined.

Of the 550 patients, 20 had incidental CAD (detection rate: 3.6%). We compared the clinical data between these 20 patients (ABL-CAD group) and the 530 patients who displayed no significant stenosis on CAG. In multivariate analysis, age, hemoglobin A1c (HbA1c), and high-density lipoprotein cholesterol (HDL-chol) were predictive factors (odds ratio: 1.08, 2.43, 1.58, 95% CIs: 1.01-1.14, 1.53-3.86, 0.92-0.99; P = 0.014, 0.004, 0.024, respectively) for identification of CAD. Multivariate analysis based on cut-off values from receiver operating characteristic analysis identified age, HbA1c ≥ 6.1%, and HDL-chol ≤ 49 mg/dL as predictors (odds ratios: 1.06, 4.04, 3.07; 95% CIs: 1.00-1.12, 1.58-10.3, 1.1-8.01; P = 0.04, 0.01, 0.021, respectively). The area under the curve was significantly greater for age and HbA1c ≥ 6.1% and HDL-chol ≤ 49 mg/dL than for age alone (0.810 versus 0.672; P = 0.005).

Patients undergoing ablation for AF appear likely to have CAD if HbA1c is ≥ 6.1% and HDL-chol is ≤ 49 mg/dL.

The impact of HCU management on the short-term prognosis of STEMI patients undergoing primary percutaneous coronary intervention (PCI) remains unclear.

We retrospectively assessed 694 STEMI patients who underwent primary PCI at 8 regional general hospitals in Iwate Prefecture from 2014-2018. The patients were categorized based on the hospital to which they were admitted with or without HCUs (353 versus 341 patients, from 3 versus 5 hospitals, respectively). There was no significant between-group difference for overall in-hospital mortality (7% versus 10%, P = 0.174). However, in the Killip Class II or higher, in-hospital mortality was significantly lower among patients admitted to the HCU (20% versus 44%, P < 0.001). After propensity score matching, we found that overall in-hospital mortality was significantly lower in patients admitted to HCUs (2% versus 8%, P = 0.008). Furthermore, mortality rates for patients requiring mechanical ventilation or circulatory support were significantly lower for patients admitted to HCUs, with mortality rates of 30% versus 50% (P = 0.037).

Our findings suggest that in hospitals without CCUs, systemic management through HCUs may significantly improve the survival prognosis of STEMI patients with Killip classification of II or higher.

Electrical cardioversion is the first-line rhythm control therapy for symptomatic persistent atrial fibrillation (AF). Although the anterior-posterior and anterior-lateral electrode positions are widely used as the standard for external cardioversion in the current guidelines, they are ineffective in > 10% of patients. Therefore, we assessed the efficacy of the anterior upper lateral electrode positioning on defibrillation electrodes during cardioversion in AF.

In this randomized, investigator-initiated, open-label trial, we randomly assigned patients with AF scheduled for elective cardioversion to either the anterior-lateral or anterior-posterior electrode positioning groups. The primary outcome was the proportion of patients with sinus rhythm after the first shock. The secondary outcome was the proportion of patients in sinus rhythm after up to 3 shocks escalating to maximum energy. Safety outcomes included arrhythmia during or after cardioversion, skin redness, and patient-reported periprocedural pain.

We randomly selected 333 patients. The primary outcome occurred in 125 (75%) patients in the anterior upper lateral electrode position group and 88 (53%) patients in the anterior-lateral electrode position group (risk difference, 22 percentage points, 95% CI: 14-35; P < 0.001). After the final cardioversion shock, 155 (93%) patients were in the anterior upper lateral electrode positioning group and 141 (85%) patients were in the anterior-posterior electrode positioning group (risk difference, 8 percentage points, 95% CI: 2-15). There were no significant differences in any safety outcomes between the groups.

The anterior upper lateral electrode positioning was more effective than the anterior-lateral electrode positioning for biphasic cardioversion in AF. There were no significant differences in the safety outcomes.

The prognostic value of defibrillators in cardiac resynchronization therapy (CRT) for primary prevention remains debatable. Predicting ventricular arrhythmias (VAs) before implantation is useful for deciding whether to add a defibrillator to a CRT device. This study aimed to determine the risk factors for VA events after CRT device implantation and to construct a scoring model. A total of 153 patients who underwent CRT device implantation, with no history of sustained ventricular tachycardia or ventricular fibrillation (including 25 patients with CRT pacemakers) and with follow-up period >1 year after implantation were included. We assessed VA events requiring implantable cardioverter-defibrillator therapy and sustained VA events requiring clinical treatment. During a mean follow-up of 6.3 years, 24 patients (16%) received therapy for VA. Multivariate analysis revealed age ≤ 70 years (hazard ratio [HR] 2.936, P = 0.037), administration of tolvaptan (HR 11.259, P < 0.001), and coronary artery disease (HR 2.444, P = 0.045) were independent predictors for VA events. Risk scores were assigned based on the HR for each predictor, and the population was divided into 3 risk groups (low: 0 points; moderate: 1-3 points; high: 4-5 points). VAs occurred less frequently in the low-risk group than in the other risk groups (low: 8.1%; moderate: 18%; high: 21%) (log-rank, P < 0.001). No significant differences in mortality were observed between the groups, whereas hospitalization for heart failure occurred more frequently in the high-risk group than in the other groups. In conclusion, a scoring system using specific background information may help predict VA events in prophylactic CRT recipients.

Ventricular septal myectomy (modified Morrow procedure) is the gold standard surgical intervention for hypertrophic obstructive cardiomyopathy (HOCM). However, the indications for a concomitant mitral valve (MV) procedure to relieve mitral regurgitation (MR) or intrinsic MV pathological changes remain controversial. We aimed to retrospectively analyze this series of patients to evaluate the safety and efficiency of the procedure at our center.

We retrospectively reviewed a total of 56 consecutive patients with HOCM who underwent concomitant MV surgery with modified Morrow procedures at our center between January 2019 and December 2021. The baseline characteristics, perioperative data, and postoperative outcomes were examined.

The operative mortality rate was 0% among all 56 patients. Two patients had complete atrioventricular block, two patients experienced renal failure, and one patient required reoperation for bleeding. The peak gradient of the left ventricular outflow tract decreased from 93.6 ± 34.4 mm Hg to 20.5 ± 13.0 mm Hg. MR was significantly relieved, and the systolic anterior motion of the MV resolved completely after concomitant MV surgery. During a mean follow-up of 13.8 ± 7.1 months, no patient required cardiac reoperation.

Concomitant surgery of the MV during the modified Morrow procedure was performed safely and effectively in the treatment of most types of HOCM in our practice.

Hypokinetic non-dilated cardiomyopathy (HNDC), a preclinical state of dilated cardiomyopathy (DCM), is characterized by left ventricular (LV) dysfunction without LV dilatation. Although myocardial fibrosis and microvascular dysfunction in DCM are associated with LV remodeling and poor outcome, these characteristics concerning HNDC remain unclear. We compared DCM and HNDC with regard to their clinical characteristics and prognosis.

We retrospectively enrolled 100 patients with DCM (n = 64) or HNDC (n = 36) who underwent cardiac magnetic resonance (CMR). DCM and HNDC were classified based on an LV end-diastolic diameter index (LVEDDI). The association of LVEDDI with the composite outcome of all-cause mortality, heart failure hospitalization, or ventricular arrhythmia occurrence was assessed. Phase-contrast cine imaging was performed in a subset of 17 patients (12 with DCM and 5 with HNDC) and 7 control subjects to assess coronary flow reserve (CFR).

During the follow-up period (median: 22.0 months; interquartile range: 9.0-33.8 months), patients with DCM showed higher risk of the primary outcome than those with HNDC (P = 0.026). A higher LVEDDI was significantly associated with clinical outcomes even after adjusting for covariates (i.e., brain natriuretic peptide, the presence of late gadolinium enhancement, and LV ejection fraction; adjusted hazard ratio, 1.350; 95% confidence interval, 1.008-1.808; P = 0.044). CFR in HNDC was significantly higher than that in DCM (P < 0.05) and comparable to that in the control group.

LV dilatation is an independent predictor of adverse events in DCM and HNDC.

This study aimed to evaluate the impact of obesity on in-hospital outcomes of patients with HF undergoing AF catheter ablation. This population-based, retrospective observational study extracted data from the US Nationwide Inpatient Sample (NIS) database 2005-2018. Patients ≥ 20 years with HF and undergoing catheter ablation for AF were eligible for inclusion. Propensity-score matching (PSM) was utilized to balance the baseline characteristics between obese and non-obese groups. Univariate and multivariable regression analyses were used to determine the associations between obese status and other variables with the in-hospital outcomes. These outcomes included non-home discharge, prolonged length of stay (LOS), complications, and a composite outcome that encompassed these outcomes along with in-hospital mortality. A total of 18,751 patients were included. After PSM, 8,014 patients remained in the study sample. The mean age was 64.6 ± 0.1 years. After adjustment, significant association was detected between obesity and greater odds of non-home discharge (adjusted odd ratio [aOR] = 1.18), prolonged LOS (aOR = 1.18), complications (aOR = 1.30), respiratory failure/mechanical ventilation (aOR = 1.56) and acute kidney injury (AKI) (aOR = 1.28), central nervous system and peripheral neuropathy (aOR = 1.33), and transient ischemic attack (aOR = 8.16), as well as poor composite outcome (aOR = 1.28) compared with non-obese patients. In US patients with HF undergoing AF catheter ablation, obesity is associated with a higher risk for non-home discharge, prolonged LOS, and several major complications. Clinicians should exercise heightened vigilance when administering therapy to this subgroup of patients.

Patients with Fontan circulation (Fontan) have a higher venous pressure (VP) and lower cardiac index (CI) than those with biventricular circulation (BiV). Although the cost to increase VP per unit CI (ΔVP/ΔCI) during exercise is expected to be higher in Fontan than in BiV, to our knowledge, no previous study has specifically tested ΔVP/ΔCI as the main variable.

We included 9 patients with Fontan and 10 with postoperative BiV in this pilot study and assessed their hemodynamics via an ergometer-based exercise test. CI was continuously measured using impedance cardiography.

The median age and quartile range values in patients with Fontan (15.0 [13.6, 16.7] years) were significantly higher than those in patients with BiV (12.9 [11.3, 14.3] years, P = 0.028). The ΔVP/ΔCI values were significantly higher in the Fontan group than in the BiV group at 25 W (4.5 [4.3, 6.0] versus 1.1 [0.9, 2.6] mmHg/ (L/minute/m²), respectively; P = 0.0008) and peak exercise (3.6 [33, 4.5] versus 1.1 [0.9, 1.5] mmHg/ (L/minute/m²), respectively; P = 0.0002) irrespective of age. The areas under the curve values of the 2 receiver operating curves (at 25 W and peak exercise time points) were 0.961 and 0.967, respectively. Patients with Fontan exhibited the 3 highest ΔVP/ΔCI values at peak exercise had an elevated New York Heart Association functional class (IIm-III) and hemodynamic concerns.

Patients with Fontan displayed a higher cost to increase VP per unit CI. ΔVP/ΔCI may be a potential circulatory or prognostic marker for these patients and its value should be validated via larger prospective studies.

The incidence of anthracycline-induced cardiotoxicity typically occurs within the first year after chemotherapy, but the changes in cardiac function and biomarkers beyond this initial year have not been adequately investigated. We analyzed 105 consecutive patients followed for 24 months after anthracycline-containing chemotherapy at Fukushima Medical University Hospital from June 2018 to April 2021. Echocardiography and blood tests for cardiac troponin I and B-type natriuretic peptide (BNP) were conducted at baseline, and 3, 6, 12, and 24 months after chemotherapy initiation. In the whole patient cohort, BNP levels increased from 10.5 [6.3-18.3] pg/mL at baseline to 19.2 [12.1-34.5] pg/mL at 24 months after chemotherapy (P < 0.01). Based on BNP levels at 24 months, the patients were divided into 2 groups: a BNP-elevated group (n = 57) and a BNP-normal group (n = 48). In the BNP-elevated group, time-course changes revealed that BNP levels remained stable until 12 months, but increased at 24 months. Multivariate logistic analysis identified age, total anthracycline dose, and baseline BNP levels as predicting factors for elevated BNP levels at 24 months. Subclinical BNP elevation was observed at 24 months of follow-up after initiation of anthracycline-containing chemotherapy.

The aim of this study was to explore the association between angiotensin-converting enzyme (ACE) gene insertion/deletion polymorphism in the 16th intron and the occurrence of left ventricular hypertrophy (LVH) in hypertensive individuals.

This study included 269 patients with hypertension from Dushu Lake Hospital Affiliated to Soochow University who underwent echocardiographic examinations. Among them, 55 patients had hypertension combined with LVH, while 214 patients with hypertension did not have LVH, serving as the case and control groups, respectively. Polymerase chain reaction-restriction fragment length polymorphism was used to perform genetic testing for hypertension in all 269 patients. The Hardy-Weinberg equilibrium test was used to assess genetic equilibrium. The differences in genotype frequencies between the case and control groups were analyzed using the chi-square test. All statistical analyses were performed using SPSS software (version 27.0.1), with statistical significance set at P < 0.05.

Genotype distribution in the case and control groups conformed to the Hardy-Weinberg equilibrium (P > 0.05). There was a significant difference in genotype distribution between the case and control groups.

Conclusion: ACE gene polymorphism is associated with an increased risk of hypertension combined with LVH.

Reminiscence therapy (RT) promotes cognitive and psychological health in elderly individuals. This study assessed the impact of the reminiscence therapy-involved care program (RTIC) on cognition, anxiety, depression, and satisfaction among patients with elderly acute coronary syndrome (ACS) who received percutaneous coronary intervention (PCI).

In total, 152 elderly patients with ACS undergoing PCI were randomized into the RTIC (n = 76) and routine care (RC) (n = 76) groups to receive the corresponding 6-month interventions. The mini-mental state examination (MMSE) scores were evaluated at discharge (M0), 3rd month (M3), and 6th month (M6). The hospital anxiety and depression scale for anxiety/depression (HADS-A/HADS-D) and patient satisfaction scores were assessed at M0, 1st month (M1), M3, and M6.

The MMSE score at M6 (27.6 ± 2.0 versus 26.7 ± 2.1, P = 0.011) increased, whereas the percentage of cognitive impairment at M6 (27.9% versus 44.8%, P = 0.042) declined in the RTIC group versus the RC group. Moreover, the RTIC group achieved a low HADS-D score at M3 (6.5 ± 2.0 versus 7.4 ± 2.6, P = 0.035) and M6 (6.3 ± 1.9 versus 7.2 ± 2.5, P = 0.016), but a similar HADS-A score and percentages of depression and anxiety at any assessment point versus the RC group. Patient satisfaction at M3 (82.3 ± 12.0 versus 77.7 ± 11.4, P = 0.020) and M6 (85.6 ± 11.0 versus 79.4 ± 12.0, P = 0.002) was higher in the RTIC group than in the RC group. In the subgroup analysis, patients with and without cognitive impairment at M0 and those with depression at M0 benefited from RTIC. RTIC promotes cognition, psychological health, and satisfaction among elderly patients with ACS undergoing PCI.

Myocardial ischemia and hypoxia are the main causes of heart failure, and cardiomyocyte apoptosis induced by mitochondrial injury is the basis of adverse heart remodeling and heart failure. Upstream stimulatory factor 2 (USF2), a transcription factor involved in multiple cellular processes, was recently shown to play an active role in mitochondrial function and energy homeostasis. However, its involvement in cardiovascular disease has not been previously reported. In this study, we demonstrated that under hypoxic conditions, USF2 protein expression can be degraded via the ubiquitin-proteasome pathway in cardiomyocytes. The deletion of USF2 results in mitochondrial dysfunction and exacerbates mitochondrial damage, ultimately promoting apoptosis. Mechanistically, we demonstrated that USF2 deficiency induces apoptosis in cells by modulating the AMPK/mTOR signaling pathway. In conclusion, this study provides new insights into the protective role of USF2 in hypoxic cardiomyocyte injury and indicates that USF2 could be a potential therapeutic target for myocardial hypoxia.

Heart failure (HF) is a complex disease. The reduced blood flow associated with HF triggers the activation of neurohormonal systems, leading to symptoms such as pulmonary congestion and peripheral edema. The precise mechanisms responsible for edema in HF are poorly understood. In this study, we aimed to analyze the differentially expressed proteins in HF-induced pulmonary edema (HF-PE) and explore the potential underlying mechanisms. Proteins in the serum of patients with HF-PE (n = 10) and patients with HF without PE or those who have not developed PE yet (n = 10) were screened using tandem mass tag-labeling proteomics. The identified proteins were screened for differentially expressed proteins, which were then analyzed using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses as well as protein-protein interaction (PPI) visualization. Rats with HF were induced by myocardial infarction, whereas PE was induced by LPS. Finally, the rats were injected with lentiviruses to manipulate the expression of differentially expressed proteins. A total of 1796 proteins were identified. In the serum of patients with HF-PE, there were 143 significantly upregulated proteins and 147 significantly downregulated proteins. TLN1 interacted with multiple proteins and was upregulated in patients with HF-PE. TLN1 was significantly upregulated in the lung tissues of rats with HF-PE, and the progression of HF-PE was inhibited by TLN1 knockdown. This tandem mass tag-labeling proteomics profiling study revealed that TLN1 upregulation contributes to the progression of PE in patients with HF.

An 81-year-old woman was admitted to our hospital due to dyspnea on exertion, attributed to severe aortic stenosis, and was scheduled for transcatheter aortic valve implantation (TAVI). The day before the procedure, she experienced chest pain radiating to the left shoulder after consuming a hospital meal that was large compared to her usual meal size. An electrocardiogram (ECG) in the supine position showed ST-segment elevation in leads II, III, aVF, and reciprocal ST-segment depression in leads V1-V4. Interestingly, these changes resolved when she was in the sitting position. Chest computed tomography (CT) revealed a giant hiatal hernia slipping under the heart, with no other abnormal findings. During the TAVI procedure, the supine position again triggered chest symptoms, and subsequent coronary angiography demonstrated disruption of the left circumflex coronary artery (LCx) in the middle portion. Following drainage of the gastric contents, the coronary flow in the LCx improved to normal levels. Cardiac enzymes, including CK-MB, were elevated after TAVI. These findings suggest that the giant hiatal hernia directly compressed the coronary artery, leading to LCx flow disturbance and myocardial infarction. This case report highlights that a hiatal hernia is a common condition in the elderly and can be a potential cause of ischemic heart disease. It underscores the importance of recognizing that the cardiac effects of a hiatal hernia can vary significantly depending on the morphology of the hernia and the position of the patient.

This case report presents a novel approach for ventricular tachycardia (VT) ablation in a patient with cardiac sarcoidosis, utilizing the Map Merge function of the CARTO 3 system to integrate mapping data from multiple ablation sessions. A 62-year-old male with recurrent VT underwent initial endocardial ablation, where voltage mapping revealed no low-voltage areas (LVA) in the endocardium, though pace mapping matched clinical VT morphology. Fragmentation potentials were noted in the coronary vein, indicating a probable epicardial substrate. Ablation successfully suppressed VT, but recurrence occurred within 4 days, prompting a second, epicardial approach. During this session, voltage mapping identified broad LVAs with late potentials in the epicardium, aligning with prior endocardial sites. The Map Merge function enabled superimposing maps from both sessions, confirming spatial consistency between endocardial and epicardial LVAs and enhancing the precision of ablation targeting. Post-ablation, no VT recurrence was observed.

This case underscores the clinical value of Map Merge, which improves procedural accuracy by integrating data across temporally distinct sessions, especially in VT cases involving epicardial substrates. By enabling comprehensive mapping without repeated epicardial mapping, Map Merge facilitates efficient identification and alignment of LVAs and abnormal potentials. This approach may improve outcomes in VT ablation by ensuring precise targeting, particularly in cases requiring endo-epicardial intervention.

A 66-year-old elderly woman undergoing regular dialysis for chronic renal failure was admitted to our hospital with acute pancreatitis. Coronary angiography revealed stress cardiomyopathy and cardiogenic shock. The patient was successfully treated with early Continuous Renal Replacement Therapy (CRRT). After 3 weeks of hospitalization, her left ventricular ejection fraction improved significantly.