Refining Bleeding Risk Stratification After TAVR: Added Value of CT-ADP Beyond High Breeding Risk Criteria.

Background: Acquired von Willebrand factor (vWF) deficiency is a key contributor to bleeding after transcatheter aortic valve replacement (TAVR).

Objective: To evaluate whether assessing primary hemostatic disorder using closure time of adenosine diphosphate (CT-ADP), a marker of vWF dysfunction, enhances bleeding risk stratification in TAVR patients at high bleeding risk (HBR).

Methods: We analyzed 884 patients from a prospective TAVR registry.

Association between baseline white blood cell count and future cardiovascular events in patients with stable coronary artery disease- Sub-analysis of the REAL-CAD trial.

Background: Elevated white blood cell (WBC) counts have been associated with major adverse cardiovascular events (MACE). However, their incremental prognostic values, especially considering factors such as race, sex difference, clinical characteristics, and statin dosage, are not well defined. This study aimed to explore the relationship between baseline WBC counts and subsequent MACE in Japanese patients with stable coronary artery disease (CAD) receiving high and low doses of pitavastatin, as a sub-analysis of the REAL-CAD study.

Long-term Outcomes Following Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Atheroma.

Although aorta atheroma morphology is associated with acute outcomes post-transcatheter aortic valve replacement (TAVR), its association with long-term outcomes post-TAVR remains unknown. This study evaluates the impact of severe aortic atheroma on long-term outcomes following TAVR. We enrolled 977 patients who underwent TAVR between February 2010 and May 2019, with available contrast-enhanced computed tomography data.

AI-Induced Vascular Ages Are a Measurable Residual Risk for Cardiovascular Diseases in the Japanese Population.

Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality, despite advances in treatment. Early detection of vascular aging is critical, as preclinical atherosclerosis often remains undiagnosed. AI-determined vascular age, originally developed using carotid-femoral pulse wave velocity (cf-PWV), may help to identify individuals at elevated risk.

Prevalence and management of hypertension in childhood, adolescent, and young adult cancer survivors: a systematic review and meta-analysis.

Improvements in cancer survival rates have drawn attention to the long-term cardiovascular health of childhood and adolescent/young adult (AYA) cancer survivors. Hypertension is a key modifiable risk factor contributing to elevated cardiovascular morbidity and mortality in this population. However, its prevalence and persistence remain underexplored.

Atrial Septal Defect With Right-to-Left Shunt Without Pulmonary Hypertension: Diagnosis Through Multimodality Imaging.

Background: Four-dimensional flow magnetic resonance imaging (MRI) enhances the evaluation of complex cardiovascular diseases. We used MRI and advanced imaging modalities to assess a right-to-left shunt through an atrial septal defect without pulmonary hypertension (PH).

Case Summary: An 84-year-old woman with persistent hypoxemia was found to have a significant right-to-left shunt without PH.

Effect of Intensified Multifactorial Treatments on Coronary Atherosclerosis in Patients With Coronary Artery Disease and Type 2 Diabetes Mellitus - Rationale and Design of the Randomized IMPACT-DM Trial.

Background: The effect of Intensified Multifactorial treatments on coronary atherosclerosis in PAtients with Coronary artery disease and Type 2 Diabetes Mellitus (IMPACT-DM) trial was designed to investigate the effects of intensified multifactorial treatments (IMT) on coronary plaque progression in patients with coronary artery disease (CAD) and diabetes.

Methods And Results: In this prospective, randomized, open-label, parallel assignment, multicenter study, eligible patients with diabetes who underwent successful percutaneous coronary intervention in culprit lesions are randomly assigned to receive either IMT or guideline-oriented standard treatments (Control) for 18 months. The IMT are managed according to strict target goals and step-by-step medical treatment protocols based on modern medical treatments.

A Significant Improvement in Exercise Tolerance and Liver Stiffness after Valve Replacement Surgery for Lead-related Tricuspid Regurgitation: A Case Report.

We herein report a case of pacemaker lead-related tricuspid regurgitation in a repaired congenital heart disease patient, with a significant improvement in exercise tolerance and liver stiffness after surgery. Optimizing the timing of invasive procedures for tricuspid regurgitation is challenging because of an insufficient ability to predict the outcome, and percutaneous therapies have shown promising advancements in recent years. In this case, close monitoring with abdominal ultrasound and echocardiography facilitated our ability to select the optimal timing for surgical intervention.

A case of acute acalculous cholecystitis after pulmonary vein isolation-novel phenotype of perioesophageal vagal nerve injury: a case report.

Background: Perioesophageal vagal nerve injury related to pulmonary vein isolation using radiofrequency catheter ablation sometimes causes somatic symptoms including gastric dilation and motility disorder. However, reports of acute acalculous cholecystitis after pulmonary vein isolation are rare.

Case Summary: We report a case of a 64-year-old man diagnosed with paroxysmal atrial fibrillation.

Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease and Left Ventricular Dysfunction.

Background: Data on clinical outcomes after intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with multivessel disease and left ventricular (LV) dysfunction are scarce.

Methods And Results: The OPTIVUS-Complex PCI study multivessel cohort was a prospective multicenter single-arm trial enrolling 1,010 patients undergoing multivessel IVUS-guided PCI including left anterior descending coronary artery target with an intention to meet the prespecified OPTIVUS criteria for optimal stent expansion. We compared clinical outcomes between patients with and without LV dysfunction.

Complex PCI and 1-year outcomes in the OPTIVUS-complex PCI study multivessel cohort.

It remains unknown whether intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) can improve the clinical outcomes of complex PCI to a level equivalent to that of non-complex PCI. In the OPTIVUS-Complex PCI (Optimal Intravascular Ultrasound-Guided Complex PCI) Study multivessel cohort, a total of 1011 patients who underwent multivessel PCI involving a target lesion in the left anterior descending coronary artery (LAD) were divided into 2 groups: complex PCI (N = 760) and non-complex PCI groups (N = 251). Complex PCI was defined as a procedure with the following characteristics: 3 vessels treated, 3 stents implanted, 3 lesions treated, bifurcation with 2 stents implanted, total stent length > 60 mm, or target of chronic total occlusion.

Cutting balloon versus standard balloon for lesion preparation of drug-coated balloon treatment in de-novo coronary artery lesions: Rationale and Design of the Randomized NATURE trial.

Background: Drug-coated balloons (DCBs) have emerged as an alternative to drug-eluting stents (DESs) for percutaneous coronary intervention (PCI) in de novo coronary artery diseases (CADs). However, the optimal predilatation strategy prior to DCB dilatation has yet to be validated.

Methods/design: The NATURE (Non-stent PCI with an appropriate dilatation by means of cutting balloon and drug-coated balloon in de novo lesion) study is a prospective, multi-center, randomized controlled trial designed to evaluate the safety and efficacy of a cutting balloon compared to standard balloons (semi-compliant or non-compliant balloons) for lesion preparation prior to DCB treatment in normal-sized vessels.

Protruding and Ulcerated Aortic Atheromas as Predictors of Periprocedural Ischemic Stroke Post-Transcatheter Aortic Valve Replacement.

Background: Aortic atherosclerosis can affect the strategy and outcomes of transcatheter aortic valve replacement (TAVR). Limited investigation exists into how aortic atheroma morphology influences outcomes post-TAVR.

Objectives: This study aimed to assess the influence of protruding and ulcerated aortic atheromas on periprocedural ischemic stroke post-TAVR.

Prognostic value of computed tomography-derived myocardial extracellular volume in aortic stenosis: a meta-analysis of all-cause mortality and heart failure hospitalization.

Aims: Pre-existing myocardial fibrosis before aortic valve replacement (AVR) is a major cause of postoperative heart failure (HF). Evaluation of fibrosis by computed tomography extracellular volume (CT-ECV) may allow risk stratification for patients with severe aortic stenosis (AS) scheduled for transaortic AVR (TAVR) or surgical AVR (SAVR). We performed a meta-analysis to determine the prognostic value of CT-ECV for the prediction of adverse events in patients with severe AS scheduled for AVR.

Polymer-free sirolimus- and probucol-eluting stents versus durable polymer-based everolimus-eluting stents for percutaneous coronary revascularization: A prospective multicenter randomized clinical trial.

Background: Owing to the advent of new generation drug-eluting stents, percutaneous coronary intervention (PCI) outcomes are improving. However, the polymers, which have been the most common type of coatings used in drug-eluting stents, have some issues. The study aim was to evaluate the clinical outcomes of patients undergoing PCI with polymer-free sirolimus- and probucol-eluting stents (NP023).

Current Status and Prospects of Regional Collaborative Pathways for Management of Acute Coronary Syndrome in Japan - A Nationwide Survey.

Background: Comprehensive management of acute coronary syndrome (ACS) requires seamless treatment across institutions, including intensive care centers and local clinics. However, maintaining guideline-directed medical therapy remains challenging. One promising option to improve the situation may be the implementation of regional collaborative clinical pathways.

Expert consensus statement for quantitative measurement and morphologic assessment of optical coherence tomography: update 2025.

In this updated expert consensus document, the methods for the quantitative measurement and morphologic assessment of optical coherence tomography (OCT) / optical frequency domain imaging images (OFDI) are briefly summarized. The focus is on the clinical application and the clinical evidence of OCT / OFDI to guide percutaneous coronary interventions.

CVIT 2025 clinical expert consensus document on intravascular ultrasound.

Intravascular ultrasound (IVUS) provides precise anatomic information in coronary arteries including quantitative measurements and morphological assessment. To standardize the IVUS analysis in the current era, this updated expert consensus document summarizes the methods of measurements and assessment of IVUS images and the clinical evidence of IVUS use in percutaneous coronary intervention.

Mortality risk stratification for Takotsubo syndrome: Evaluating CRP measurement alongside the InterTAK prognostic score.

Background And Objectives: Initially described as a benign acute cardiomyopathy, Takotsubo syndrome has been linked to elevated mortality rates. Emerging evidence suggests that unresolved myocardial inflammation may contribute to this adverse prognosis. This study aimed to evaluate the incremental prognostic utility of C-reactive protein (CRP) in conjunction with the InterTAK prognosis score for stratifying long-term mortality in Takotsubo syndrome.

Influence of Worsening Renal Function and Baseline Chronic Kidney Disease on Clinical Outcomes in Patients With Chronic Coronary Syndromes: Insights From the REAL-CAD Study.

Background: The effect of worsening renal function and baseline chronic kidney disease (CKD) on outcomes in patients with chronic coronary syndrome in the setting of optimal medical therapy remains unknown.

Methods And Results: The REAL-CAD (Randomized Evaluation of Aggressive or Moderate Lipid Lowering Therapy With Pitavastatin in Coronary Artery Disease) study is a prospective, multicenter, randomized trial of high-dose (pitavastatin 4 mg/day) or low-dose (pitavastatin 1 mg/day) statin therapy in 12 118 patients with chronic coronary syndrome. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, stroke, or unstable angina requiring hospitalization (major adverse cardiac and cerebral events [MACCE]).