BACKGROUND AND AIMS:Atrial functional mitral regurgitation (AFMR) commonly affects elderly and frail individuals. The prognostic impact of transcatheter edge-to-edge repair (TEER) for AFMR has not been investigated. METHODS:Patients with AFMR who underwent TEER were selected from the OCEAN-Mitral registry, and medically managed controls were selected from the REVEAL-AFMR registry, using an identical AFMR definition. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization. The secondary endpoint was all-cause mortality. RESULTS:A total of 1081 patients (mean age 80.1 ± 8.2 years, 60.5% female) with moderate or severe AFMR were included, of whom 441 underwent TEER and 640 remained on medical treatment. Overlap weighting based on the propensity score yielded well-balanced characteristics (n = 441 vs 640; all standardized mean differences <0.01), where TEER was associated with a lower incidence of the primary (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.43-0.99, P = .044) and secondary endpoints (HR 0.58, 95% CI 0.35-0.99, P = .044). In an exploratory subgroup analysis, favourable outcomes might be pronounced in patients with ≤mild residual AFMR after TEER, while event rates in those with ≥ moderate residual AFMR were comparable with the medication group. As sensitivity analyses, inverse probability of treatment weighting (n = 158 vs 173), propensity score matching (n = 104 vs 104), and multivariable Cox regression (n = 441 vs. 640) all confirmed favourable associations of TEER with both endpoints. CONCLUSIONS:In real-world data, TEER for patients with moderate or severe AFMR were associated with a lower incidence of adverse events compared with medical treatment.
Gastric cancer remains a significant health burden, especially in Asia. Potassium-competitive acid blockers (P-CABs) provide stronger acid suppression than proton pump inhibitors (PPIs), but their long-term impact on metachronous gastric cancer (MGC) remains unclear. This study evaluated the incidence and duration-dependent risk of MGC in P-CAB/PPI users. This multicenter retrospective cohort study included patients from 15 institutions in Japan who underwent endoscopic or surgical resection for gastric cancer between 2014 and 2022. After exclusions, 7172 patients who had received H. pylori eradication were analyzed. Chronic use of P-CAB/PPI was defined as administration for more than 3 months. The primary outcome was the incidence of MGC. Cox regression models were used, along with subgroup analyses based on duration and initial treatment type (endoscopy versus surgery). During a median follow-up of 5.8 years, MGC developed in 342 patients. The incidence was highest among P-CAB users (20.9 per 1,000 person-years), followed by PPI users (13.5) and non-users (7.1). Both P-CAB and PPI use were independently associated with increased MGC risk (hazard ratio 3.89 and 1.75, respectively). The association between P-CAB use and MGC was stronger with longer durations of use (hazard ratio 3.44 for < 1 year, 3.95 for 1–3 years, and 9.36 for > 3 years) and was particularly evident in the post-endoscopic group (hazard ratio 4.22) in subgroup analyses. Chronic use of P-CAB/PPI were associated with MGC. Longer duration may be associated with increased risk of MGC. Further studies are warranted to validate these findings.
The success of drug-coated balloon (DCB) therapy for de novo coronary lesions relies on optimal lesion preparation. However, evidence supporting the use of cutting balloons (CBs) for lesion preparation in DCB-only strategies remains limited. The NATURE trial assessed the effectiveness of CB compared with standard balloon (SB) predilatation in achieving optimal lesion preparation for a DCB-only strategy. The NATURE trial was a prospective, multicentre, randomised study conducted at 19 Japanese centres. Patients with de novo coronary lesions suitable for a DCB-only strategy were randomised (1:1) to lesion preparation with CB or SB. Post-predilatation assessment included coronary angiography, intravascular ultrasound (IVUS), and fractional flow reserve (FFR). The primary endpoint was optimal lesion preparation, defined as the simultaneous presence of: (1) no flow-limiting dissection, (2) residual diameter stenosis ≤ 30 This central illustration summarises the study design, procedural workflow, and key findings of the NATURE trial. Patients with de novo coronary lesions were randomised to lesion preparation with a cutting balloon or a standard balloon before a drug-coated balloon (DCB)–only strategy. Multimodality assessments using quantitative coronary angiography (QCA) and fractional flow reserve (FFR) were performed serially from pre–percutaneous coronary intervention through post-predilatation and post-DCB treatment, and intravascular ultrasound (IVUS) was performed after predilatation. The primary endpoint—achievement of optimal lesion preparation defined as the absence of flow-limiting dissection, residual diameter stenosis ≤ 30
AIMS:Treatment of obesity with glucagon-like peptide-1 (GLP-1) receptor agonists improves cardiovascular outcomes. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide and GLP-1 receptor agonist, achieves greater weight loss than GLP-1 receptor agonists alone; however, direct real-world comparisons of clinical outcomes are limited. MATERIALS AND METHODS:We conducted a retrospective, active-comparator, new-user cohort study using the TriNetX global federated electronic health record database. Adults (≥ 18 years) without diabetes who initiated tirzepatide or semaglutide for the treatment of obesity between November 2023 and August 2024 were included. Patients with recent atherosclerotic events, prior heart failure (HF), or crossovers to the comparator were excluded. The primary outcome was major cardiovascular events including all-cause death, acute coronary syndrome, stroke, or new-onset HF at 12 months. RESULTS:One-to-one propensity score matching yielded 35 336 pairs. Tirzepatide was associated with a lower incidence of the composite outcome compared with semaglutide (1.90% vs. 2.18%; hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.77-0.97; p = 0.01), driven by reduced new-onset HF (1.04% vs. 1.29%; HR, 0.79; 95% CI, 0.68-0.92; p = 0.002), including both HF with reduced and preserved ejection fraction. No significant differences were observed in all-cause mortality, acute coronary syndrome, or stroke. Mean weight loss was greater with tirzepatide (-9.8 kg vs. -8.0 kg; p < 0.001). Adverse event rates were comparable, with no new safety signals. CONCLUSIONS:In obese individuals without diabetes, tirzepatide was associated with a lower risk of cardiovascular events, especially incident HF, compared with semaglutide, with a similar safety profile.
Background/Objectives: Frequency-to-place mismatch between cochlear implant (CI) electrodes and cochlear tonotopy has been suggested to affect postoperative speech perception. This study aimed to examine the associations between frequency-to-place mismatch and speech perception outcomes across multiple linguistic levels in patients with CI and to assess how these associations change over time using postoperative computed tomography. Methods: This retrospective cohort study included 44 postlingually deafened adults who underwent unilateral cochlear implantation with a Flex28 electrode by a single surgeon at a tertiary care hospital. Speech perception was assessed using CI-2004, a Japanese speech perception test consisting of monosyllables, consonants, words, and sentences, in quiet settings at 3, 6, and 12 months after CI activation. Partial correlation analyses between frequency-to-place mismatch and postoperative speech perception scores were performed in 35 of the 44 patients, controlling for age and mean preoperative pure-tone thresholds. Results: Negative associations were observed between frequency-to-place mismatch and CI-2004 scores, particularly for monosyllable and consonant perception in uncorrected analyses. After correction for multiple comparisons, only consonant perception at 3 months after CI activation remained significant (r = -0.52, p = 0.002). Similar patterns were observed for other speech measures and at later time points, although these did not remain significant after correction. Conclusions: Frequency-to-place mismatch was associated with postoperative speech perception outcomes, particularly those involving phoneme-level recognition. After correction for multiple comparisons, only consonant perception at 3 months after CI activation remained significant.
