Coronary artery calcification (CAC), one of the greatest challenges of percutaneous coronary intervention (PCI), is associated with a poor prognosis. We therefore conducted a wire-derived physiological evaluation to investigate the influence of CAC modification using intravascular lithotripsy (IVL) and rotational atherectomy (RA) on the coronary circulation. A total of 154 patients with CAC requiring IVL or RA were enrolled in this single-center, retrospective study. Physiological assessments, particularly Index of microcirculatory resistance (IMR), coronary flow reserve (CFR), resistive reserve ratio (RRR), and microvascular resistance reserve (MRR) were performed using a temperature-sensor guidewire (Pressure Wire X, Abbott) pre- and post-PCI and compared between IVL and RA. Procedural and 30-day clinical outcomes were also evaluated. Seventy patients were treated with IVL and 84 with RA. IVL and RA demonstrated comparable lumen expansion. In the physiological assessments, RA significantly increased post-IMR compared to IVL (17.0 [10.5–32.8] vs.12.0 [9.00–19.0], p = 0.03), which was correlated with severity of periprocedural myocardial Infarction (MI) (Spearman’s ρ = 0.40, p = 0.01). Post-CFR, post-RRR, and post-MRR were significantly higher with IVL than RA (3.20 [2.00—4.60] vs. 1.55 [1.20—2.10], p < 0.01, 2.90 [2.10—4.70] vs. 1.60 [1.20–2.42], p < 0.01, 2.77 [2.05—4.54] vs. 1.50 [1.20—2.37], p < 0.01, respectively). Use of RA was associated with post-PCI coronary microvascular dysfunction (OR: 4.77, 95

Background:The micro-axial intravascular flow pump (mAFP) may potentially improve the prognosis of cardiogenic shock (CS). Despite its advanced hemodynamic profile, efficacy remains undetermined. Safety and mid-term outcomes were compared between the mAFP and intra-aortic balloon pump (IABP). Methods:This single-center, cross-sectional study retrospectively evaluated 205 consecutive patients treated using the IABP or mAFP at Osaka Medical and Pharmaceutical University from January 2017 to June 2023. After exclusion of those with CS who were treated with only extracorporeal membrane oxygenation (ECMO), patients who required IABP or mAFP were enrolled in the current study. The primary outcome was 180-day mortality. Secondary outcomes were major [major bleeding (Bleeding Academic Research Consortium criteria 3-5), limb ischemia and stroke] and other complications (hemolysis, thrombocytopenia, acute kidney impairment and requirement of renal replacement therapy). Those outcomes were compared between IABP and mAFP. Results:Of all patients, 62 (30.2%) received the mAFP and 143 (69.8%) the IABP. There were no significant differences in 180-day mortality between the devices (P=0.86). Further investigation according to the Society for Cardiovascular Angiography and Intervention (SCAI) shock stage classification demonstrated that the mortality rate for SCAI C was significantly lower in the mAFP group (P=0.02), while mortality was not significantly different for SCAI D/E (P=0.71). The major and other complications were more frequent in the mAFP group (61.3% vs. 46.0%, P=0.02 and 90.3% vs. 68.8%, P<0.001, respectively). In multivariate analysis, age ≥75 years [hazard ratio (HR): 2.37, 95% confidence interval (CI): 1.42-3.97], out-of-hospital cardiopulmonary arrest (OHCPA) (HR: 2.05, 95% CI: 1.04-4.08), ECMO use (HR: 5.05, 95% CI: 2.85-8.95) and major complications (HR: 2.11, 95% CI: 1.07-4.17) were independently associated with mortality. Moreover, age ≥75 years (HR: 2.06, 95% CI: 1.08-3.92) and ECMO use (HR: 6.67, 95% CI: 3.32-13.42) were independent predictors of major complications, whereas mAFP (vs. IABP) (HR: 5.27, 95% CI: 1.71-16.30), age ≥75 years (HR: 2.80, 95% CI: 1.28-6.11) and ECMO use (HR: 8.34, 95% CI: 2.33-29.9) were independent predictors of other complications. Conclusions:Classical CS attained benefit from the mAFP, whereas it is still challenging for patients with severe CS, particularly OHCPA and requirement for ECMO. The use of mAFP was associated with more complications and its true impact on clinical outcomes remains to be determined.

AIMS:Homozygous Familial hypercholesterolemia (HoFH) is a rare genetic disease characterized by very high levels of low-density lipoprotein cholesterol (LDL-C). Owing to LDL receptor activity being completely or nearly all lost in HoFH, LDL-C levels greatly exceed normal levels, and are even higher than in heterozygous (HeFH), which can cause fatal cardiovascular disease even in infancy. The current study updates differences in clinical characterization, therapeutic strategies and cardiovascular outcomes between HoFH and HeFH. METHODS:A total of 157 patients who were genetically or clinically diagnosed with FH (HoFH: 15, HeFH: 142) were retrospectively analyzed. Clinical characteristics, lipid profiles and atherosclerotic prognosis were evaluated between HoFH and HeFH patients. RESULTS:Age and sex were similar between the two groups. Untreated LDL-C in HoFH was about double that in HeFH (498.4±164.3 vs. 232.0±60.5 mg/dL, p＜0.001), while on-treatment LDL-C with lipid lowering therapies did not differ significantly (83.8±59.1 vs. 127.1±59.6 mg/dL, p = 0.15). There was wide diversity in lipid lowering therapies between the two groups and a significantly higher prevalence of coronary artery and valvular disease in HoFH. Consequently, HoFH patients were more likely to receive percutaneous and surgical interventions at a younger age compared to HeFH patients. CONCLUSIONS:The findings of this observational study show the clinical relevance of FH. Although both HeFH and HoFH are inherited disorders of lipoprotein metabolism, HoFH should be treated with a different, stricter therapeutic strategy to prevent premature ASCVD.

AIM:The clinical effect of high-intensity statin therapy after percutaneous coronary intervention (PCI) in Japanese patients with chronic coronary syndrome (CCS) remains unclear. We investigated the association between high-intensity statin therapy and the cardiovascular outcomes following PCI in patients with CCS. METHODS:We retrospectively evaluated 716 patients with CCS who underwent PCI and categorized them into high- or non-high-intensity statin groups, according to the Japan Atherosclerosis Society guidelines. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and revascularization, while the secondary outcome was all-cause death. The outcomes were further assessed according to the low-density lipoprotein cholesterol (LDL-C) levels (＜55 mg/dL, 55-69 mg/dL, and ≥ 70 mg/dL). The hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox model. RESULTS:Over a median follow-up of 2 years, high-intensity statin therapy reduced the incidence of the primary outcome (HR, 0.32; 95% CI, 0.17-0.61; P＜0.01) and all-cause death (HR, 0.18; 95% CI, 0.06-0.57; P＜0.01). This association with the primary composite outcome was consistently observed across the achieved LDL-C categories. CONCLUSIONS:High-intensity statin therapy was associated with a reduced risk of cardiovascular events after PCI in Japanese patients with CCS, independent of the achieved LDL-C levels.

BACKGROUND: The ongoing residual cardiovascular risks despite lowering low-density lipoprotein cholesterol (LDL-C) levels suggest the need to identify additional drivers associated with atherosclerosis. Circulating lipoprotein(a) [Lp(a)] promotes formation of foam cells via its proatherogenic properties. However, whether a lower Lp(a) level in combination with favorable LDL-C control could induce a more stable form of disease remains unknown. Near-infrared spectroscopy (NIRS) generates maximum lipid-core burden index in 4 mm (MaxLCBI4 mm ) which is a histologically validated measure of lipidic plaque material in vivo. Therefore, the current study employed NIRS imaging to characterize lipidic plaque in association with LDL-C < 70 mg/dL and Lp(a) < 50 mg/dL. METHODS: We analyzed 439 patients with coronary artery disease (CAD) (554 de-novo target lesions receiving percutaneous coronary intervention) in the REASSURE-NIRS registry (NCT04864171). Clinical characteristics and NIRS-derived MaxLCBI(4mm)were compared among 4 groups according to LDL-C of 70 mg/dL and Lp(a) of 50 mg/dL. RESULTS: Almost one-third of study subjects (33.4%) exhibited both LDL-C < 70 mg/dL and Lp(a) < 50 mg/dL. They were more likely male with a lower frequency of acute coronary syndrome and lipid lowering therapies were more frequently used in those with LDL-C < 70 mg/dL and Lp(a) < 50 mg/dL. On NIRS imaging analysis, a smaller MaxLCBI(4mm) ( P < .001) and a lower frequency of MaxLCBI(4mm) >= 400 ( P = .001) were observed in those with both LDL-C < 70 mg/dL and Lp(a) < 50 mg/dL. On multivariable logistic regression analysis, the coexistence of these 2 lipid controls showed an approximately 70% lower risk (adjusted odds ratio: 0.30; 95% CI: 0.13-0.68) of MaxLCBI(4mm) >= 400 compared with the reference group (LDL-C >= 70 mg/dL and Lp(a) >= 50 mg/dL). CONCLUSION: Our findings suggest circulating Lp(a) as a potential therapeutic target to stabilize coronary atherosclerosis in CAD patients who achieved LDL-C < 70 mg/dL. (c) 2025 National Lipid Association. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/)

Introduction: Current guidelines recommend a "treat to target" approach for lipid-lowering therapy in patients with chronic coronary syndrome (CCS), achieving the low-density lipoprotein cholesterol (LDL-C) levels target based on individual patient risk. However, it remains unclear whether the use of high intensity statins or non-high intensity statins to achieve the LDL-C goal in patients with CCS after percutaneous coronary intervention (PCI). Aim: We investigated the association between statin intensity and cardiovascular outcomes in patients who achieved LDL-C targets after PCI. Methods: A total of 455 Japanese patients with CCS who achieved an LDL-C level < 70mg/dL after PCI were enrolled. We divided patients into 4 groups according to the LDL-C levels and statin intensity prescribed after PCI: LDL-C < 55mg/dL with high intensity statins group (n = 81), LDL<55mg/dL with non-high intensity statins group (n = 170), LDL 55-70 mg/dL with high intensity statins group (n = 55), and LDL 55-70 mg/dl with non-high intensity statins group (n = 149). High-intensity statins were defined as the maximum approved doses of strong statins in Japan. Cardiovascular outcomes were defined as a composite of cardiovascular events, including cardiovascular death, acute coronary syndrome, stroke, and revascularization. Results: The mean age of the current study population was 73 years, and 75% were male. Among both achieved LDL-C goal groups, there was no significant difference in LDL-C levels between high intensity statins group and non-high intensity statins group (LDL-C < 55mg/dL: 43 ± 9 mg/d L vs. 43 ± 9 mg/d L; LDL-C 55-70 mg/d L: 62 ± 4 mg/d L vs. 61 ± 4 mg/d L). Kaplan-Meier survival analysis revealed a significantly lower incidence of cardiovascular events in the high intensity statins groups than the non-high intensity statins groups (log-rank test < 0.02) (Figure). Conclusions: Among patients with CCS who achieved LDL-C goal after PCI, high-intensity statin therapy was associated with a lower incidence of major adverse cardiovascular events compared to non-high-intensity statin therapy, regardless of the achieved LDL-C level.

BACKGROUND: Current guidelines advocate achieving a fixed low-density lipoprotein cholesterol (LDL-C) target and >= 50% reduction in LDL-C levels. However, sufficient LDL-C reduction is often not achieved even in patients achieving a fixed LDL-C target. OBJECTIVE: This study investigated the clinical impact of insufficient LDL-C reduction following lipid lowering therapy on cardiovascular outcomes in acute coronary syndrome (ACS) patients. METHODS: A total of 561 consecutive ACS patients who had undergone percutaneous coronary intervention (PCI) and LDL-C level measurement at index PCI and 12 months afterwards were evaluated retrospectively. We investigated a relationship between >= 50% LDL-C reduction and cardiovascular events including the composite of cardiac death, myocardial infarction, target vessel revascularization and stent thrombosis. RESULTS: Of the patients, 145 (25.8%) achieved >= 50% LDL-C reduction within 12 months. There were no significant differences in cardiovascular events between patients achieving the LDL-C target of 55 mg/dL and those not achieving it (23.6% vs 19.3%, P = .77), whereas the incidence of cardiovascular events was higher in the < 50% LDL-C reduction group than the >= 50% LDL-C reduction group (26.0% vs 12.4%, P = .009). Even in patients with LDL-C < 55 mg/dL, cardiovascular events were more frequently in the < 50% LDL-C reduction group than the >= 50% LDL-C reduction group (28.8% vs 13.2%, P = .04). Cox proportional hazard models revealed that < 50% LDL-C reduction was an independent predictor of cardiovascular outcomes (hazard ratio: 2.03, 95% CI: 1.23-3.36). CONCLUSION: The current study underscores the significance of achieving >= 50% LDL-C reduction in addition to a target of 55 mg/dL in preventing additional cardiovascular events in ACS patients. (c) 2024 National Lipid Association. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Aims: Elevated lipoprotein (a) (Lp[a]), predominantly determined by genetic variability, causes atherosclerotic cardiovascular disease (ASCVD), particularly in patients with familial hypercholesterolemia (FH). We aimed to elucidate the clinical impact of Lp(a) and cumulative exposure to low-density lipoprotein cholesterol (LDL-C) on CAD in patients with FH. Methods: One hundred forty-seven patients clinically diagnosed with heterozygous familial hypercholesterolemia (HeFH) were retrospectively investigated. Patients were divided into 2 groups according to the presence of CAD. Their clinical characteristics and lipid profiles were evaluated. Results: There were no significant differences in untreated LDL-C levels between the 2 groups (p 0.4), whereas the cumulative exposure to LDL-C and Lp(a) concentration were significantly higher in patients with CAD (11956 vs. 8824 mg-year/dL, p 0.01; 40 vs. 14 mg/dL, p 0.001, respectively). A receiver operating characteristic (ROC) curve analysis demonstrated that the cutoff values of Lp(a) and cumulative LDL-C exposure to predict CAD in patients with FH were 28 mg/dL (AUC 0.71) and 10600 mg-year/dL (AUC 0.77), respectively. A multivariate analysis revealed that cumulative LDL-C exposure >= 10600 mg-year/dL (p0.0001) and Lp(a) level >= 28 mg/dL (p 0.001) were independent predictors of CAD. Notably, the risk of CAD remarkably increased to 85.7% with smoking, Lp(a) >= 28 mg/dL, and cumulative LDL-C exposure >= 10600 mg-year/dL (odds ratio: 46.5, 95%CI: 5.3-411.4, p 0.001). Conclusions: This study demonstrated an additive effect of Lp(a) and cumulative LDL-C exposure on CAD in patients with HeFH. Interaction with traditional risk factors, particularly smoking and cumulative LDL-C exposure, enormously enhances the cardiovascular risk in this population.

Background Lp(a) has been considered as a potential therapeutic target associated with atherosclerosis. In particular, Lp(a) ≧50 mg/dL has been shown to predict an elevated cardiovascular risk even under lowering LDL-C level, indicating that lowering of both LDL-C and Lp(a) may be more beneficial to halt atherogenesis. However, atherosclerotic features with favorable control of these lipid targets have not been fully characterized yet. The REASSURE-NIRS registry (NCT04864171) is an on-going multi-center registry which enrolls CAD patients receiving near-infrared spectroscopy (NIRS)/IVUS-guided PCI in Japan. Given that NIRS enables to quantitatively evaluate lipidic plaque materials, this registry provides an opportunity to investigate lipidic plaque features in association with LDL-C and Lp(a) levels. Objectives The aim of this study was to elucidate NIRS-derived characteristics of coronary atheroma in patients with CAD who exhibited both LDL-C<1.8 mmol/L and Lp(a) <50 mg/dL. Methods From the REASSURE-NIRS registry (n=1013), we investigated 549 culprit lesions in 498 patients with measurement of both LDL-C and Lp(a) levels at the index of PCI. Maximum 4-mm lipid core burden index (max LCBI4mm) at culprit lesions were measured with NIRS imaging prior to PCI. Study subjects were stratified into 4 groups according to LDL-C and Lp(a) levels: LDL-C<1.8mmol/L and Lp(a)<50mg/dL, LDL-C≧1.8mmol/ and Lp(a)<50mg/dL, LDL-C<1.8mmol/L and Lp(a)≧50mg/dL, LDL-C≧1.8mmol/L and Lp(a)≧50mg/dL. Clinical characteristics and max LCBI4mm were compared in 4 groups. Results In the current study, 30.6% of patients was ACS. Under the use of lipid-lowering therapies (statin: 68.4% and high-intensity statin: 26.0%), 33.1% of study population exhibited both LDL-C<1.8mmol/L and Lp(a)<50mg/dL. Patients with LDL-C<1.8mmol/L and Lp(a)<50mg/dL were more likely to be male (p=0.002) and smoker (p=0.002) and have a history of previous MI (p<0.001). As expected, statin was more frequently used in those with both LDL-C<1.8mmol/L and Lp(a)<50mg/dL (p<0.001). On NIRS imaging analysis, patients with low LDL-C<1.8mmol/L and Lp(a)<50mg/dL were associated with significantly lower max LCBI4mm (Figure). Of note, even in patients with LDL-C<1.8mmol/L, max LCBI4mm was lower in those achieving Lp(a) <50 mg/dL compared to those with Lp(a) ≧50 mg/dL (p=0.001). Multivariate analysis adjusting for ACS, LDL-C levels and statin use, Lp(a) levels revealed emerged as independent predictor of maxLCBI4mm (β=1.0, 95%CI: 0.06 to 2.04, p=0.04). Conclusion Patients with LDL-C<1.8mmol/L and Lp(a)<50mg/dL more likely exhibited a smaller amount of lipidic plaque materials on NIRS imaging. Our findings support that lowering both LDL-C and Lp(a) may be more beneficial to modulate lipidic plaque component, which ultimately results in the further reduction of ASCVD risks.Comparison of clinical characteristics

Background: Although atrial fibrillation (AF) is the major comorbid condition in heart failure with preserved ejection fraction (HFpEF), the evidence, which supports the efficacy of rhythm control for AF in HFpEF is limited. Hypothesis: Electrical cardioversion (EC) of AF for maintenance of sinus rhythm (SR) improves recovery in patients with HFpEF. Methods: We analyzed 162 subjects hospitalized for acute decompensated heart failure which were documented AF on admission and left ventricular ejection fraction ≥ 50%. We defined the conservative treatment (CT) group as not attempting cardioversion during hospitalization and EC groups as successful EC of AF and maintenance of SR until discharge. Clinical characteristics, composite event of cardiovascular death and heart failure rehospitalization were compared between the two groups. Results: Among all patients with AF on admission, 24 subjects (14.8%) were succeeded in restoring and maintaining SR by EC. They exhibited younger (70.8 years vs. 80.3 years, p < 0.01) and a lower level of BNP (88.3 ng/L vs. 156.0 ng/L, p < 0.01) than the CT group (n = 111). The findings from echocardiography demonstrated a smaller left atrial dimension (44.7 mm vs. 55.7 mm, p < 0.01) and lower E wave levels (81.5 cm/s vs. 110.0 cm/s) in the EC group. Concerning medical therapy, the rate of using anti-arrhythmia drugs in the EC group was higher (41.7% vs. 5.2%, p < 0.01). During the observational period (median = 1.6 years), successful restoration of SR was associated with a less frequent incidence of a composite event of cardiovascular death and heart failure rehospitalization (hazard ratio = 0.19, 95% confidence interval = 0.06 - 0.60, p < 0.01). Conclusions: Our findings highlight those patients with HFpEF, and AF treated with rhythm control by EC may improve, healthwise. Randomized controlled studies should evaluate the efficacy of EC and the effect of rhythm control for AF about atrial remodeling in HFpEF.

Objective Although life-threatening cardiac complications in influenza infection are rare, subclinical influenza-associated cardiac abnormalities may occur more frequently. We investigated the prevalence of subclinical cardiac findings. Methods After obtaining their written informed consent, 102 subjects were enrolled in the present study. The study subjects underwent a first set of examinations, which included electrocardiography (ECG), echocardiography, and the measurement of their cardiac enzyme levels. Those with one or more abnormal findings among these examinations were encouraged to undergo a repeat examination 2 weeks later. Results Among the 102 subjects enrolled, 22 (21.6%) were judged to have cardiac findings, including ST-T abnormalities, pericardial effusion, diastolic dysfunction, and cardiac enzyme elevation. Eighteen of these 20 subjects underwent a second screening at a median of 14 days later, and it was found that 11 of the 18 subjects were free from cardiac findings on this second examination. This suggested that the abnormalities were only transient and they therefore might have been associated with influenza. Approximately 20% of the influenza patients enrolled had cardiac findings, including ST-T segment abnormalities, pericardial effusion, and cardiac enzyme elevation. Conclusion Among the 102 patients who were studied, the cardiac findings were only mild and transient; however, physicians should be aware of influenza infection-associated cardiac abnormalities because such abnormalities may not be rare.

Immunoglobulin G4 (IgG4)-related disease, that is characterized by the elevation of circulating IgG4 level and the tissue-infiltration of IgG4-positive plasma cells, can target the cardiovascular tissue, although the diagnosis of IgG4-related cardiovascular lesion is not easy owing to the substantial risk for the tissue sampling. We herein examined the serum IgG4 levels among cardiac patients. In patients who were admitted to the cardiology department (n=477) and those who underwent computed tomography coronary artery angiography (n=401), elevated serum IgG4 level (>= 135 mg/dL) was found 23 (4.8%) and 17 (4.2%), respectively. However, among those with elevated serum IgG4, only two patients could be clinicopathologically diagnosed with IgG4-related disease. Cardiovascular organ involvement may aggravate the prognosis of IgG4-related disease which in general not life-threatening. Considering that the non-negligible prevalence of high IgG4 level among cardiac patients who were not diagnosed with IgG4-related disease, however, physicians should not count too much on the serum IgG4 levels for the diagnosis of IgG4-related cardiovascular lesions, especially when histopathologic findings are not available, or when other-tissue involvement of IgG4related disease is not apparent. (This is a translation of J Jpn Coll Angiol 2017; 57: 91-98.)

Background and Aims: Combination of Eicosapentaenoic Acid (EPA) and HMG-CoA reductase inhibitor (statin) are known to be an effective therapy for cardiovascular diseases, however, their biological roles in the favorable effect on adverse event have not been studied well. In this study, we aimed to investigate the effect of EPA and statins focusing on plaque formation in a rabbit plaque model. Methods: Rabbit carotid artery was injured with a balloon followed by feeding with a normal diet for 4 w and then with a high-cholesterol diet for 4 w. The rabbits were either received pitavastatin alone, EPA alone, combination (pitavastatin+EPA) or vehicle (control) for 4 w with a high-cholesterol diet. The injured carotid arteries were harvested and analysed morphometrically and immunohistochemically. Results: In control group, smooth muscle cells were located on the luminal side of the plaque and lipidrich macrophages accumulated in the center of the plaque expressing Matrix Metalloproteinase-9 (MMP-9), Tissue Factor (TF), and NF-kB, those are characteristic of unstable plaques. In contrast, EPA reduced the expression of TF and NF-kB and increased the expression of PPAR-α in the plaque. Pitavastatin also reduced the expression of MMP-9, TF, and NF-kB, but not PPAR-α in the plaque. Combination of pitavastatin and EPA significantly reduced the expression of MMP-9, TF, and NF-kB increasing the expression of PPAR-α resulting in the inhibition of intimal hyperplasia and plaque formation in carotid arteries. Conclusions: Pitavastatin and EPA synergistically played a role for inhibitory effect on plaque formation decreasing the expression of inflammation-related molecules and increasing the expression of PPAR-α in injured artery.

Background: Circulating soluble urokinase-type plasminogen activator receptor (suPAR), which can reflect immune activation and low-grade inflammation, may be a novel biomarker of cardiovascular disease. Methods: We investigated the potential association between suPAR and the prevalence of atrial fibrillation (AF) by analyzing patients with either sinus rhythm, paroxysmal atrial fibrillation (PAF), or non paroxysmal atrial fibrillation (NPAF), which indicates either permanent or persistent AF. Results: Among 426 patients enrolled (mean age 71.4 +/- 9.2 years; 110 (25.8%) female), 310, 62, and 54 were diagnosed with sinus rhythm, PAF, and NPAF, respectively. NPAF was > 10-fold more prevalent in the highest suPAR quartile ( > 3534 pg/mL; 32 (30.2%) of 106 patients) than in the lowest suPAR quartile ( < 1802 pg/mL; 3 (2.8%) of 107 patients). Logistic regression analysis showed that, as compared with the lowest suPAR quartile, the highest suPAR quartile was associated with NPAF with an odds ratio of 6.48 (95% confidence interval, 1.71-24.5) after adjustment for sex, age, log(eGFR), C-reactive protein, and systolic blood pressure. In multivariate receiver operating characteristic analysis to predict NPAF, the area under the curve (AUC) for the combination of age, sex, log(eGFR), and C-reactive protein was 0.777 (standard error [SE], 0.036); the addition of log(suPAR) slightly improved the prediction (AUC, 0.812; SE, 0.034, P=0.084). Conclusions: Serum suPAR was associated with AF, particularly NPAF, as demonstrated by multivariate logistic regression analysis. Whether suPAR promotes or maintains AF should be investigated in further studies. (C) 2017 Japanese Heart Rhythm Society. Published by Elsevier B.V.

Background and Purpose: Albumin-to-globulin ratio (AGR) is a marker for chronic inflammation and cancer prognosis. We investigated the relationship between AGR and readmissions after hospitalization for heart failure (HF). Methods and Results: In total, 132 discharged patients (mean age 72.9 years) with the diagnosis of HF were enrolled in the study. Of these, 33 (25%) were readmitted due to the worsening of HF during the median followed-up period of 142 days. It was found that patients with lower AGR group showed significantly higher rate of readmission (Figure). Compared with the patients with the highest AGR tertile, those in the lowest AGR had significantly higher risk of readmission with the hazard ratio of 1.95 (P = .012). Conclusions: HF patients with low AGR were at higher risk of readmissions due to heart failure.

Serum levels of the soluble urokinase-type plasminogen activator receptor (suPAR) reflect immune and inflammatory activation, and are shown to be associated with cardiovascular outcomes. We herein investigated the potential association between suPAR and left ventricular diastolic dysfunction among patients with preserved left ventricular ejection fraction (LVEF) and sinus rhythm. Among 291 patients who had sinus rhythm and an LVEF of ≥50% enrolled in the study, 26 (8.9%) were considered to have diastolic dysfunction. Patients with diastolic dysfunction had lower estimated glomerular filtration rate (eGFR), and higher systolic blood pressure (BPs), BNP, C-reactive protein, and suPAR than those without diastolic dysfunction. As compared with the first suPAR quartile, the fourth suPAR quartile was significantly associated with both diastolic dysfunction with an odds ratio of 8.95 [95% confidence interval (CI), 1.04–77.0, P < 0.05] after adjusting for sex, age, BPs log(eGFR), CRP, and diuretic use. On the other hand, receiver-operating characteristic curve (ROC) analysis showed that addition of log(suPAR) to the combination of age, sex, and log(eGFR), CRP, and diuretic use did not significantly improve the prediction of diastolic dysfunction. Among cardiac patients with preserved LVEF, serum suPAR was associated with diastolic dysfunction independent of confounding factors by logistic regression analysis. However, according to the ROC analysis, the utility of suPAR as a biomarker for diastolic dysfunction may be limited from a clinical point of view.