Introduction Guideline-directed medical therapy (GDMT) has been demonstrated to reduce morbidity and mortality in patients with heart failure (HF). In addition to the need for GDMT, a large number of cardiovascular and non-cardiovascular medications are prescribed to patients with HF, especially the elderly, due to multiple comorbidities and chronic health conditions, such as chronic pain, musculoskeletal problems, insomnia or gastrointestinal issues. Polypharmacy may reduce adherence to GDMT and compromise its optimisation, potentially leading to worse clinical outcomes in patients with HF.Methods and analysis The Polypharmacy Evaluation for improving adherence, Regimen Simplification, Enhancement and Utilization of Standard therapy in Heart Failure (PERSEUS-HF) trial is a prospective, multicentre, randomised, open-label trial testing whether a comprehensive medication management programme (CMMP) improves medication adherence at 6 months compared with standard of care in patients with HF and polypharmacy (≥ five regular oral medications). Three hundred patients are randomly assigned to receive either a CMMP or standard of care in a 1:1 ratio. The CMMP incorporates deprescribing potentially inappropriate medications based on the established Beers Criteria, structured medication education and counselling, optimising GDMT, reducing dosing frequency, using polypill, transitioning to as-needed medication and using unit-dose packaging. The primary endpoint is the change in total Adherence Starts with Knowledge 20 score from baseline to 6 months. The PERSEUS-HF trial will evaluate the efficacy of CMMP in improving medication adherence in patients with HF and polypharmacy.Ethics and dissemination This study was approved by the Institutional Review Board of the Gunma University Hospital, with the participants’ hospitals approving the execution of the study (IRB2025-070).Clinical trial registration jRCT1030250606

Dyslipidemia in adolescents represents an early and potentially modifiable stage in the lifelong trajectory of cardiovascular disease. However, optimal lipid screening strategies in this age group remain controversial, particularly regarding feasibility, biological relevance, and reliance on family history. Non-high-density lipoprotein cholesterol (non-HDL cholesterol) has emerged as a promising screening marker because it reflects the total burden of atherogenic lipoproteins and can be reliably assessed even without fasting, making it particularly suitable for large-scale pediatric screening settings. A recent nationwide population-based study of Korean adolescents provides robust real-world evidence supporting the utility of non-HDL cholesterol in dyslipidemia screening, across both sexes and independent of familial lipid risk. From a nutritional and public health perspective, non-HDL cholesterol is closely related to dietary habits, postprandial hyperlipidemia, and metabolic stress, and is particularly important in the modern food environment characterized by increased consumption of ultra-processed foods. This Opinion discusses the biological rationale, clinical feasibility, and population-level implications of non-HDL cholesterol-based screening in adolescents. By linking lipid biology with nutrition-focused prevention and lifelong cardiovascular health, non-HDL cholesterol may serve as a practical gatekeeper for early risk identification and upstream intervention.

Transthyretin amyloid cardiomyopathy (ATTR-CM) is increasingly recognized because of improved diagnostic modalities and disease-modifying therapy. We report the first Japanese case of hereditary ATTR-CM (ATTRv-CM) caused by the Ile68Leu variant, which has been previously described in European cohorts. A man in his 40s presented with heart failure and typical imaging findings of transthyretin amyloid cardiomyopathy (ATTR-CM). Genetic testing identified the Ile68Leu variant, which was absent in East Asian population databases. This case expands the genetic spectrum of ATTRv-CM in Japan and suggests that cardiac-predominant non-Val30Met TTR variants may occur in Japanese patients, with implications for the diagnosis, family counseling, and cascade screening in the future.

We present a case of a 36 year old adult with anomalous origin of the right pulmonary artery from the aorta (hemitruncus), pulmonary hypertension, and moderate mitral regurgitation. Moreover, selective contrast echocardiogram (agitated saline injection into the right pulmonary artery) performed during preoperative cardiac catheterization demonstrated a moderate amount and prompt appearance of echo contrast in the left atrium (right pulmonary arteriovenous fistula). We successfully performed a reconstruction of the right pulmonary artery using a woven Dacron graft (12 mm in diameter). Six months postsurgery, the pulmonary arteriovenous fistula had substantially regressed, and the pulmonary arterial pressure and mitral regurgitation had both dramatically improved.

Managing severe aortic stenosis (AS) alongside complex coronary artery disease (CAD) in frail patients is challenging. A 79-year-old female with resting dyspnea was diagnosed with severe AS and CAD. While coronary artery bypass grafting (CABG) was the appropriate treatment for CAD, surgical aortic valve replacement was deferred due to a porcelain aorta and left ventricular dysfunction. The carotid approach was the only feasible option for transcatheter aortic valve implantation (TAVI), yet it posed an increased risk of ischemic stroke due to inadequate cerebral collateral circulation. She underwent simultaneous on-pump beating CABG and transcarotid TAVI using cardiopulmonary bypass with selective cerebral perfusion. A 20-mm Sapien 3 valve (Edwards Lifesciences, Irvine, CA, USA) was successfully implanted. Postoperatively, her condition improved without any signs of cerebral ischemia, and she was discharged in stable condition. This innovative approach ensured cerebral perfusion, minimized stroke risk, and effectively addressed severe CAD in a single procedure. Learning objective:To demonstrate the clinical applicability of combining coronary artery bypass grafting and transcatheter aortic valve implantation (TAVI) via carotid artery access in a small-statured, high-risk patient.To discuss the novel use of an extracorporeal cardiopulmonary bypass-assisted carotid perfusion or cerebral protection during TAVI in a patient with inadequate collateral cerebral circulation.

BACKGROUND:Vortioxetine, an antidepressant, acts on multiple 5-hydroxytryptamine receptors in addition to inhibiting the 5-hydroxytryptamine transporter. Currently, data on the effect of vortioxetine on the QT interval are limited. To the best of our knowledge, whether vortioxetine can safely be used for congenital long QT syndrome (LQTS) has not been reported. CASE PRESENTATION:We here present the case of a 50-year-old Japanese woman who was rushed to our hospital because of a sudden cardiopulmonary arrest. Her corrected QT interval was prolonged to 535 ms. After a thorough examination in the cardiology department, she was diagnosed with congenital LQTS and an implantable cardioverter defibrillator (ICD) implanted. Thereafter, she gradually developed severe depression because of stress associated with ICD implantation. Mirtazapine induced daytime somnolence and duloxetine was relatively ineffective, prompting replacement with vortioxetine at 20 mg daily, which relieved her depression. During the treatment period, her corrected QT interval did not exceed 500 ms, beyond which the risk of cardiac events increases. To our knowledge, this is the first report of the safe use of vortioxetine in a patient with depression comorbid with congenital LQTS. CONCLUSIONS:After ICD implantation, a patient's mental status should be monitored carefully. Our findings suggest that vortioxetine may be a safe treatment option for depression associated with congenital LQTS.

To examine the impact of preoperative weight fluctuations on postoperative outcomes in patients underwent elective cardiovascular surgery. This retrospective study included 157 consecutive patients who underwent elective cardiovascular surgery between April 2018 and March 2023. We assessed weight changes during a median surgical waiting period of 42 days. The primary outcome was the postoperative length of hospital stay. Patients were stratified into two groups—weight loss and weight maintenance—based on a 1-standard deviation (SD) reduction in weight variability. Multiple regression analysis was performed with adjustments for confounding factors. The mean weight change was + 1.9

Background In recent years, the population of very elderly heart failure (HF) patients has been rising, but there are few reports on their characteristics, treatment, and prognosis. Methods This study included patients aged 18 years or older with acute HF admitted to a single hospital between April 1, 2016, and March 31, 2021. Patients were classified into three groups according to their echocardiographic left ventricular ejection fraction (LVEF): HF with reduced LVEF (LVEF < 40%: HFrEF), HF with mildly reduced LVEF (LVEF between 40% and 49%: HFmrEF), and HF with preserved LVEF (LVEF ≥ 50%: HFpEF). Results Of 524 admitted patients, 437 were discharged, including 124 with HFrEF, 62 with HFmrEF, and 251 with HFpEF. The median age was 86 years, and patients with HFmrEF and HFpEF were older than those with HFrEF. Overall, the in-hospital mortality rate was 14.1%, the 1-year composite event rate of cardiac death and heart failure readmission was 37.7%, and the 1-year all-cause death rate was 19.7%. In particular, the composite event rate was higher in patients with HFrEF than in those with HFpEF (44.0% vs. 32.8%, P = 0.03). Conclusions The high incidence of in-hospital mortality, composite events, and all-cause mortality in this very elderly population warrants prospective consideration of appropriate treatment choices and goal setting for these patients.

Immune-related adverse events occurring in the heart (cardiac immune-related adverse events; irAEs) by immune checkpoint inhibitors (ICIs) include myocarditis, arrhythmia, conduction disturbance, pericardial diseases, and takotsubo cardiomyopathy. Cardiac irAEs are rare but life-threatening. In cardio-oncology, the study of cardiac disorders caused by cancer treatment has recently attracted attention, and such studies may elucidate the pathophysiology of cardiac irAEs and contribute to management strategies. This review discusses the pathogenic mechanisms underlying cardiac irAEs and the role of echocardiography in patients treated with ICIs.

We report a case of a 58-year-old woman with secondary adrenocortical insufficiency due to adrenocorticotropic hormone (ACTH) deficiency after pembrolizumab treatment that required differentiation from low cardiac output syndrome. The patient had chronic heart failure due to radiation cardiomyopathy and underwent implantation of cardiac resynchronization therapy defibrillator (CRT-D). One year ago, she was diagnosed with squamous cell lung cancer and started combination therapy with carboplatin, paclitaxel, and pembrolizumab. She was hospitalized for anorexia, nausea, and hypotension. A diagnosis of secondary hypoadrenocorticism due to isolated ACTH deficiency was made, and from the course of the disease, it was diagnosed as a side effect of immune checkpoint inhibitors (ICIs). As the indications for ICIs continue to expand, it is necessary to understand the screening and management of their side effects.

Background In Wolff-Parkinson-White (WPW) syndrome, accessory atrioventricular pathways (AP) result in abnormal pre-excitation around the atrioventricular annuli and produce a dyssynchronous contraction of cardiac chambers. Identification of the AP affects the outcome of catheter ablation. Case summary We report a case of WPW syndrome and paroxysmal atrial fibrillation in a 65-year-old man. Wolff-Parkinson-White syndrome Type B was suspected from lead V1, but when two-dimensional speckle-tracking echocardiography (2D-STE) was performed, a decrease in regional strain was observed in the anterior basal wall of the left ventricle. We identified the earliest site of atrioventricular conduction, and improvement in the regional strain at the site of ablation was observed after successful AP ablation. Discussion Various echocardiographic techniques have been investigated as non-invasive alternatives for AP localization. Longitudinal 2D-STE accurately identified contractile abnormalities associated with the AP, allowing us to non-invasively estimate the localization of the AP in WPW syndrome.

Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome (ACS), myocardial infarction and sudden death, particularly among young to middle-aged women and individuals with few conventional atherosclerotic risk factors.[1 2][1] The most common precipitant is high

•IDH is a rare mechanical complication.•Transthoracic echocardiography showed a hypoechoic area from the septum to the apex.•Familiarity with echocardiography is essential to diagnose IDH.

Tetany is characterized by numbness and stiffness in the hands and feet caused by hypocalcemia, hypomagnesemia, and hyperventilatory alkalosis, primarily at peripheral neuromuscular junctions. Although hypocalcemia is common in critically ill patients, its diagnosis of hypocalcemia is complicated and sometimes overlooked. We encountered an 82-year-old woman with tetany that exacerbated heart failure. Pain and respiratory failure due to tetany are conditions that can lead to exacerbation of heart failure. Chronic renal failure is frequently associated with chronic heart failure, and regular follow-up of calcium, phosphorus, and magnesium levels is necessary for such patients.