Characterization of Malnutrition in Atrial Functional Mitral Regurgitation.

Background: In this study we sought to characterize the prevalence, clinical characteristics, and outcomes of malnutrition in patients with atrial functional mitral regurgitation (AFMR).

Methods: This multicentre, observational study included 802 patients diagnosed with AFMR. The eriatric utritional isk ndex (GNRI) was used as a nutritional risk metric.

Left bundle branch area pacing preserves left ventricular ejection fraction in patients with preserved systolic function: A comparison with right ventricular pacing and the influence of left bundle branch capture.

Background: Left bundle branch area pacing (LBBAP), which includes left bundle branch pacing (LBBP) that captures the left bundle branch (LBB) and left ventricular septal pacing (LVSP) that does not, has been reported to improve clinical outcomes compared to right ventricular pacing (RVP). However, the clinical impact of LBB capture remains unclear.

Objective: To compare the incidence of pacing-induced cardiomyopathy (PICM) and post-operative left ventricular ejection fraction (LVEF) between RVP and LBBAP in patients with normal pre-implantation LVEF, and to assess the impact of LBB capture.

Enhanced Expression of Hemoglobin Scavenger Receptor is Associated With Aortic Valve Stenosis in Patients With Bicuspid Aortic Valve.

Recent studies suggest that intraleaflet hemorrhage is more common in bicuspid aortic valves (BAV) than in tricuspid valves (TAV), possibly contributing to the faster progression of aortic stenosis (AS) in BAV. Hemoglobin (Hb)-induced oxidative damage occurs via haptoglobin (Hp), which irreversibly binds extracorpuscular Hb, forming an Hp-Hb complex. In valve leaflets, this complex is cleared only by macrophages mediated by the CD163 receptor.

Rationale and Design of an Exploratory, Randomized, Open-Label, Multicenter Clinical Trial to Investigate the Efficacy of Long-Acting β2-Agonist/Long-Acting Muscarinic Antagonist on Heart Failure Complicated by Chronic Obstructive Pulmonary Disease (COPD-HF Trial).

Background: Chronic obstructive pulmonary disease (COPD) is one of the most common comorbidities in patients with chronic heart failure (CHF). A growing number of patients are suffering from both COPD and CHF, and these conditions worsen each other. Inhaled bronchodilator therapy with long-acting muscarinic antagonist (LAMA) and long-acting β2-agonist (LABA) in combination is currently the mainstay of treatment for COPD.

Validation of Guideline Recommendation on Sudden Cardiac Death Prevention in Hypertrophic Cardiomyopathy.

Background: To prevent sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM), the HCM Risk-SCD calculator and guideline recommendations are used to aid decision making for implantable cardioverter-defibrillator placement.

Objectives: The aim of this study was to assess the clinical profiles and occurrence of SCD by phenotypes of HCM and validate the performance of the current guidelines from a large-scale Japanese multicenter registry.

Methods: This was a retrospective, multicenter, observational, longitudinal cohort study that enrolled 3,611 consecutive patients with HCM.

A Case of Intraoperative Changes in the Nonselective Left Bundle Branch Pacing Morphology: Is Lead Dislodgment the Cause?

Introduction: The QRS morphology in left bundle branch area pacing (LBBAP) is utilized to assess procedural success and to confirm left bundle branch (LBB) capture.

Methods And Results: We present a case in which the QRS morphology of the left bundle branch pacing (LBBP) changed during the procedure despite the maintenance of LBB capture throughout.

Conclusion: This case highlights the necessity for operators to be aware of this pitfall and raises potential questions regarding the determination of LBB capture.

Characteristics, determinants, and prognostic impact of severe tricuspid regurgitation in patients with atrial functional mitral regurgitation: Insights from the REVEAL-AFMR registry.

Aims: Tricuspid regurgitation (TR) is often seen in patients with atrial functional mitral regurgitation (AFMR). The aim of this study was to investigate the characteristics, determinants, and prognostic impact of severe TR coexisting with AFMR.

Methods And Results: In 26 facilities in Japan, patients with significant AFMR defined with moderate or severe functional mitral regurgitation with dilated left atrium and preserved left ventricular function were enrolled.

Echocardiographic cardiac damage classification and clinical outcomes in atrial functional mitral regurgitation.

Background: Atrial functional mitral regurgitation (AFMR) arises from left atrial (LA) dilation, commonly associated with atrial fibrillation, and leads to progressive cardiac damage. This study evaluated the prognostic value of a novel echocardiographic cardiac damage classification system for patients with moderate or severe AFMR.

Methods: In a retrospective multicentre study, 1007 patients with AFMR were stratified into four groups based on echocardiographic findings: group 1, LA damage (dilation); group 2, left ventricular damage (reduced ejection fraction and/or dilation); group 3, right heart damage (tricuspid regurgitation and/or pulmonary hypertension); and group 4, combined left and right heart damage.

A case of successful salvage despite right ventricular perforation during AVEIR VR leadless pacemaker implantation.

To prevent cardiac tamponade caused by catheter tip slippage during the retraction of the protective sleeve in Aveir VR implantation, it is crucial to carefully evaluate not only the bulge of the protective sleeve but also the shape of the system's shaft using fluoroscopic imaging.

Qualitative and quantitative assessment of atrial functional mitral regurgitation: analysis from the REVEAL-AFMR registry.

Aims: The prevalence, characteristics, and prognosis of atrial functional mitral regurgitation (AFMR) based on severity remain unclear. No studies have systematically evaluated quantitative thresholds, such as effective regurgitant orifice area (EROA) or regurgitant volume, in relation to outcomes in AFMR. This multicentre study aimed to clarify the clinical implications of both qualitative and quantitative assessments of AFMR severity.

Durability of output-dependent QRS transition and left bundle branch capture in left bundle branch area pacing.

Background: Although output-dependent QRS transition is a specific indicator that confirms left bundle branch (LBB) capture during left bundle branch area pacing (LBBAP), its durability remains unclear.

Objective: The purpose of this study was to evaluate the presence of output-dependent QRS transition and capture thresholds of the LBB and left ventricular septal myocardium immediately and up to 1 year after the LBBAP procedure.

Methods: We enrolled 129 patients with successful LBBAP who were available for 1-year follow-up postoperatively.

Rationale and Design of Prospective, Multicenter, Double-Arm Clinical Trial to Investigate the Efficacy of Tofogliflozin on Left Ventricular Diastolic Dysfunction in Patients with Heart Failure with Preserved Ejection Fraction and Type 2 Diabetes Mellitus (TOP-HFPEF Trial).

Background: Recent large clinical trials have revealed that sodium-glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular outcomes not only in patients with heart failure with reduced ejection fraction, but also in patients with heart failure with mildly reduced or preserved ejection fraction (HFpEF). However, the effect of SGLT2 inhibitors on left ventricular (LV) diastolic function is still controversial.

Methods And Results: The TOP-HFPEF trial (Efficacy of Tofogliflozin on Left Ventricular Diastolic Dysfunction in Patients with Heart Failure with Preserved Ejection Fraction and Type 2 Diabetes Mellitus) is a multicenter, double-arm, open-label, confirmatory, investigator-initiated clinical study to investigate the effect of SGLT2 inhibitor on LV diastolic function in patients with HFpEF and type 2 diabetes mellitus.

Guidance for performance, utilization, and education of cardiac and lung point-of-care ultrasonography from the Japanese Society of Echocardiography.

In recent years, bedside ultrasound examinations have been used in many clinical departments and are called point-of-care ultrasound (POCUS). Regarding POCUS in the cardiac field, a protocol called focus (focused) cardiac ultrasound (FoCUS) has been developed in Europe and the United States, is being used clinically, and an educational syllabus has been created. According to them, FoCUS is defined as a point-of-care cardiac ultrasound examination using standardized limited sections and protocols.

Enhanced expression of neopterin in valve tissue of bicuspid aortic stenosis.

Background: Aortic valve stenosis (AS) occurs in bicuspid aortic valve (BAV) patients at a relatively young age compared to tricuspid aortic valve (TAV) patients. However, the underlying cause of this phenomenon remains unknown. Neopterin, which is a by-product of the guanosine triphosphate (GTP) pathway, enhances the oxidative potential of reactive oxygen species.

Large Tissue Debris Causing Cerebral Embolism After Transcatheter Aortic Valve Replacement.

Cerebral vascular embolism is one of the complications of transcatheter aortic valve replacement (TAVR). Thrombolytic therapy is not expected to be effective when embolic material consists of a large tissue fragment. Instead, mechanical aspiration may be more effective therapy for acute cerebral infarction after TAVR.

Acute impact of atrial fibrillation on pacemaker lead-induced tricuspid regurgitation: Case report.

Unlabelled: We report a case of worsening lead-induced tricuspid regurgitation (TR) after new-onset atrial fibrillation (AF) evaluated using three-dimensional (3D) transthoracic echocardiography (TTE) from admission through TR improvement. An 84-year-old man experienced worsening lead-induced TR with new-onset AF, acutely resulting in low output syndrome. Less invasive interventions, such as rhythm control therapy and diuretics administration worked effectively.

Efficacy of azilsartan on left ventricular diastolic dysfunction compared with candesartan: J-TASTE randomized controlled trial.

Characterized by ventricular and vascular stiffness, heart failure with preserved ejection fraction (HFpEF) has led to high morbidity and mortality. As azilsartan is an angiotensin receptor blocker with the highest myocardial and vascular affinities, azilsartan may improve the left ventricular (LV) diastolic function in patients with hypertension and either HFpEF or HF with mildly reduced ejection fraction (HFmrEF) more than candesartan. In this randomized, open-label trial, we randomly assigned 193 hypertensive patients with HF and LV ejection fraction ≥ 45% to 20 mg of azilsartan (n = 95) or 8 mg of candesartan (n = 98), once daily for 48 weeks.

Prevalence of transthyretin amyloidosis among heart failure patients with preserved ejection fraction in Japan.

Aims: Heart failure with preserved ejection fraction (HFpEF), which is caused by wide various conditions, has become a major public health problem. Transthyretin amyloid cardiomyopathy (ATTR-CM), which is thought to be an underdiagnosed disease, can cause HFpEF. Non-invasive diagnosis using Technetium (Tc)-pyrophosphate (PYP) scintigraphy enables accurate diagnosis of ATTR-CM.

Utility of Routine Transthoracic Echocardiographic Parameters to Predict Functional Recovery after Catheter Ablation Therapy in Patients with Atrial Fibrillation and Left Ventricular Systolic Dysfunction.

Arrhythmia-induced cardiomyopathy (AIC) occurring in patients with atrial fibrillation (AF) is a reversible form of cardiomyopathy characterized by LV systolic dysfunction. However, it is difficult to predict the reversibility before rhythm control therapy. We performed this study to develop a parameter for the identification of AIC in routine transthoracic echocardiography (TTE) in patients with presumptive AIC due to AF.