Ferric carboxymaltose (FCM) enables rapid iron repletion in gastrointestinal bleeding–related iron-deficiency anemia (IDA), but clinical factors associated with hemoglobin (Hb) recovery in real-world practice remain unclear. We aimed to identify clinical factors associated with achieving robust Hb recovery after FCM administration. This retrospective cohort study included adults aged ≥ 18 years who received FCM for suspected gastrointestinal bleeding–related IDA. Patients with baseline Hb ≥ 10.0 g/dL, malignant tumors, gynecologic bleeding, or anemia attributable to non-gastrointestinal causes were excluded. Robust Hb recovery was defined as an Hb increase ≥ 2.0 g/dL within 12 weeks without transfusion. Baseline characteristics were compared according to whether this criterion was met, followed by multivariable logistic regression. A sensitivity analysis excluding transfused patients was conducted. Of 601 patients who received FCM, 170 were eligible, and 94 (55.3

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: Recent advances in artificial intelligence (AI) have produced ChatGPT-4o, a multimodal large language model (LLM) capable of processing both text and image inputs. Although ChatGPT has demonstrated usefulness in medical examinations, few studies have evaluated its image analysis performance. Methods: This study compared GPT-4o and GPT-4 using public questions from the 116th–118th Japanese National Medical Licensing Examinations (JNMLE), each consisting of 400 questions. Both models answered in Japanese using simple prompts, including screenshots for image-based questions. Accuracy was analyzed across essential, general, and clinical questions, with statistical comparisons by chi-square tests. Results: GPT-4o consistently outperformed GPT-4, achieving passing scores in all three examinations. In the 118th JNMLE, GPT-4o scored 457 points versus 425 for GPT-4. GPT-4o demonstrated higher accuracy for image-based questions in the 117th and 116th exams, though the difference in the 118th was not significant. For text-based questions, GPT-4o showed superior medical knowledge, clinical reasoning, and ethical response behavior, notably avoiding prohibited options. Conclusion: Overall, GPT-4o exceeded GPT-4 in both text and image domains, suggesting strong potential as a diagnostic aid and educational resource. Its balanced performance across modalities highlights its promise for integration into future medical education and clinical decision support.

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.

Journal Article A collateral channel from the bronchial artery in chronic total occlusion of proximal right coronary artery Get access Kosuke Tsuda, Kosuke Tsuda Department of Cardiology, Hokusetsu General Hospital, 6-24 Kitayanagawa-cho, Takatsuki, Osaka 569-8585, JapanDepartment of Cardiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan Corresponding author. Tel: +81 72 696 2121, Fax: +81 72 690 3061, Email: kosuke.tsuda@ompu.ac.jp https://orcid.org/0000-0002-8987-661X Search for other works by this author on: Oxford Academic PubMed Google Scholar Wataru Nagamatsu, Wataru Nagamatsu Department of Cardiology, Hokusetsu General Hospital, 6-24 Kitayanagawa-cho, Takatsuki, Osaka 569-8585, Japan Search for other works by this author on: Oxford Academic PubMed Google Scholar Isao Morii Isao Morii Department of Cardiology, Hokusetsu General Hospital, 6-24 Kitayanagawa-cho, Takatsuki, Osaka 569-8585, Japan Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal, Volume 45, Issue 12, 21 March 2024, Page 1087, https://doi.org/10.1093/eurheartj/ehae036 Published: 25 January 2024

The diagnostic performance of B-type natriuretic peptide (BNP) for acute heart failure (HF) is impaired in patients with atrial fibrillation (AF). Increased AF burden in HF is associated with left atrial (LA) remodeling. Recent studies have revealed that LA remodel-ing may affect LV filling. We hypothesized that LA remodeling affects BNP secretion in acute HF conditions. The study investigated the clinical impact of LA remodeling on admission BNP levels in acute HF patients with and without AF. Consecutive acute HF hospitalized patients (n = 899) were divided into groups with (n = 382) or without AF (n = 507) and subdivided into disproportionately low BNP (LB) (<= 200 pg/ml), medium BNP (200 to 600 pg/ml) and high BNP (>= 600 pg/ml) subgroups. The AF group had a higher proportion of patients with LB than the non-AF group (23.6% vs 16.6%, p = 0.009). BNP levels in both groups were positively correlated with LV end-diastolic vol-ume and negatively correlated with LV ejection fraction in both groups. In contrast, BNP was positively correlated with LA volume index in the non-AF group, but negatively corre-lated in the AF group. The survival rates were significantly higher in the LB group than in the other groups in non-AF. Conversely, there were no significant differences across all groups in AF patients. In conclusion, in patients with acute HF and AF, disproportionately low BNP levels are associated with LA structural remodeling and poor prognosis. (c) 2023 The Author(s). 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/) (Am J Cardiol 2023;209:128-137)

Although the fibrosis-4 index (FIB-4) is associated with right atrial pressure or prognosis in acute heart failure (AHF), the prognostic impact of its reduction during hospitalization remains uncertain. We included 877 patients (age, 74.9 ± 12.0 years; 58

Abstract Aims Worsening renal function (WRF) often develops during heart failure (HF) treatment. However, prognostic implications of WRF in acute HF remain controversial, and risk stratification of WRF is challenging. Although the fibrosis‐4 index (FIB‐4) was initially established as a liver fibrosis marker, recent studies show that high FIB‐4 is associated with venous congestion and poor prognosis in acute HF. This study aimed to evaluate whether FIB‐4 could identify prognostically relevant and non‐relevant WRF in patients with acute HF. Methods and results We retrospectively analysed data from a single‐centre registry on acute HF at our university hospital between January 2015 and June 2021. This study included patients with acute HF aged ≥20 years who were immediately hospitalized and had brain natriuretic peptide levels ≥100 pg/mL at admission. WRF was defined as increases of ≥0.3 mg/dL and >25% in serum creatinine level from admission to discharge. FIB‐4 scores were calculated before discharge. The primary endpoint was all‐cause mortality within 1 year of discharge. Based on the presence of WRF and whether FIB‐4 scores were above the median, patients were stratified into four groups: no WRF and lower FIB‐4 scores, no WRF and higher FIB‐4 scores, WRF and lower FIB‐4 scores, and WRF and higher FIB‐4 scores. The patients were followed up via clinical visits or telephone interviews. Clinical outcomes were collected from the electronic medical records. Results Of the 969 patients hospitalized for acute HF (76 ± 11 years, 59% men), 118 patients (12%) had WRF at discharge. The median (interquartile range) FIB‐4 score at discharge was 2.36 (1.55–3.25). The primary endpoint occurred in 136 patients (14.0%). The 1 year mortality rates were 10.5% in the no WRF and lower FIB‐4 scores (≤2.36) group (n = 428), 16.1% in the no WRF and higher FIB‐4 scores (>2.36) group (n = 423), 12.5% in the WRF and lower FIB‐4 scores group (n = 56), and 25.8% in the WRF and higher FIB‐4 scores group (n = 62) (P = 0.005). Kaplan–Meier analysis demonstrated higher all‐cause mortality in the WRF and higher FIB‐4 group (log‐rank P = 0.003). In the Cox regression analysis, only the WRF and higher FIB‐4 scores group was associated with an increased risk of mortality compared with the no WRF and lower FIB‐4 scores group (hazard ratio = 2.11, 95% confidence interval: 1.07–4.18, P = 0.032), despite adjusting for other confounding factors. Conclusions FIB‐4 is a valuable risk stratification marker for WRF in patients with acute HF. The underlying mechanism and potential clinical importance of these observations require further investigation.

The association between polypharmacy/multiple drug use (MDU) and prognosis in patients hospitalized with heart failure (HF) is unclear. It is also unknown whether the prognostic values of MDU vary depending on the presence/absence of a previous history of HF and preserved/reduced left ventricular ejection fraction (LVEF). We analyzed consecutive 1,034 patients hospitalized with HF (age, 74.9 ± 11.5 years; 58.7% male). MDU was defined as ≥5 drugs at discharge. The primary endpoint was a composite of all-cause death and HF readmission. MDU was observed in 695 patients (67.2%). Patients with MDU use had higher prevalences of a previous history of HF, reduced LVEF, and comorbidities than those without MDU. Cox proportional hazard analysis showed that MDU was significantly associated with the primary endpoint after adjustment for possible confounders (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.03-1.79; P = 0.030). There was significant interaction between the presence/absence of a history of HF and the prognostic impact of MDU (HF history [-]: HR, 0.86; 95% CI, 0.54-1.40; P = 0.553; HF history [+]: HR, 1.72; 95% CI, 1.16-2.55; P = 0.007; P for interaction = 0.005). However, there was no significant interaction between preserved/reduced LVEF and the prognostic impact of MDU (P for interaction = 0.274). In conclusion, MDU at discharge is an independent risk factor for the composite of death or HF readmission in patients hospitalized with HF. We observed a significant interaction between the presence of de novo versus recurrent HF and the prognostic value of MDU.

The fibrosis-4 index, albumin-bilirubin score and neutrophil-lymphocyte ratio are all prognostic markers in patients with heart failure. Recently, the FAN score, which includes all 3 of these markers, was developed as a useful risk stratification tool in patients with cancer. However, its cut-off values have not been validated for heart failure. We aimed to investigate the optimal cut-off and prognostic values of the FAN score in patients with heart failure. We analyzed 669 consecutive patients hospitalized with heart failure (age, 75.8 ± 11.3 years). Their median values of the fibrosis-4 index, albumin-bilirubin score, and neutrophil-lymphocyte ratio at discharge were 2.12, -2.25, and 2.41, respectively. The FAN score for heart failure (HF-FAN score) was calculated using these median values. The primary outcome was a composite of all-cause death and heart failure rehospitalization. Patients were divided into 4 groups according to HF-FAN scores of 0 (n = 112), 1 (n = 231), 2 (n = 242) and 3 (n = 84). Patients with HF-FAN scores of 3 were older, had higher brain natriuretic peptide levels, and larger inferior vena cava diameters. Kaplan-Meier analysis showed a direct correlation between higher HF-FAN scores and occurrence of the primary endpoint (log-rank P < 0.001). Cox proportional hazard analysis revealed a higher HF-FAN score was significantly associated with a worse prognosis even after adjustment for possible prognostic factors. Changing from the FAN score to HF-FAN score provided significant continuous net reclassification improvement. In conclusion, the HF-FAN score at discharge was useful for risk stratification in patients hospitalized with heart failure. The HF-FAN score might be more suitable for patients with heart failure than the FAN score.

A 56-year-old man who developed chest discomfort was referred to our hospital. He had no history of prior cardiac disease and allergies. The electrocardiogram revealed no ST-segment change. Echocardiogram demonstrated mildly reduced left ventricular ejection fraction with diffuse hypertrophy and regional asynergy in the inferior wall. Laboratory test showed elevated cardiac biomarker (cTnI: 5911.5 ng/L—reference <26.2 ng/L) with mildly increased eosinophils (609/µL, 7.1% of leukocytes). His coronary arteries were almost normal by coronary angiogram. Therefore, myocardial infarction with non-obstructive coronary arteries (MINOCA) was considered as a working diagnosis. Subsequently, cardiac magnetic resonance (CMR) was performed to investigate the etiology of MINOCA. Both native T1 and T2 mapping values and late gadolinium enhancement have indicated serious cardiac injury and oedema suggesting myocarditis (Panels 1A–1D). Surprisingly, there was a significant discrepancy between his mild symptoms and severity of findings following CMR. Endomyocardial biopsy was performed, the specimen showed cardiac injury...

Abstract Aims Recently, liver fibrosis markers, such as the fibrosis‐4 index (FIB‐4), have been shown to be associated with prognosis in patients with heart failure. The fibrosis‐5 (FIB‐5) index, which assesses albumin, alkaline phosphatase, aspartate transaminase, alanine aminotransferase and platelet count, is a simple liver fibrosis marker that was reported to be superior to FIB‐4 for differentiation of liver fibrosis. This study aimed to compare the prognostic value of FIB‐4 and FIB‐5 in patients with heart failure. Methods and results The FIB‐4 and FIB‐5 scores were calculated at discharge in 906 patients hospitalized with heart failure. The patients were stratified into three groups based on their FIB‐5 scores: low (n = 303), middle (n = 301), and high (n = 302) FIB‐5 groups. The primary endpoint was a composite of cardiac death or rehospitalization for heart failure. The low FIB‐5 group was older and had larger inferior vena cava diameters and higher brain natriuretic peptide levels than the other two groups. The primary endpoint occurred in 156 (51.5%), 110 (36.5%), and 54 patients (17.9%) in the low, middle, and high FIB‐5 groups, respectively (P < 0.001). On Cox proportional hazard analysis, the low FIB‐5 was independently associated with the primary endpoint after adjustment for confounding factors. The association was consistent in both patients with preserved and reduced left ventricular ejection fraction (LVEF), and there was no significant interaction between LVEF phenotypes in terms of the prognostic impact of FIB‐5 (P for interaction = 0.311). FIB‐5 was superior to FIB‐4 as a prognostic indicator of the primary endpoint (continuous net reclassification improvement, 0.530; 95% confidence interval [CI], 0.399–0.662; P < 0.001; integrated discrimination improvement, 0.072; 95% CI, 0.057–0.088; P < 0.001). Conclusions The FIB‐5 is a useful risk stratification marker with better prognostic value than FIB‐4 in patients hospitalized with heart failure.

Introduction: B-type natriuretic peptide (BNP) has been widely used for the diagnosis of heart failure. Previous data suggest a lower diagnostic accuracy of BNP in HF patients with atrial fibrillation (AF). However, little is known about disproportionately low BNP levels in AF patients even during acute heart failure conditions. Hypothesis: The factors related to disproportionately low BNP might be different between AF and sinus rhythm (SR) in patients with acute decompensated heart failure (ADHF). Methods: Among 424 patients hospitalized for ADHF between January 2015 and December 2017, we divided into two groups based on the rhythm at hospital admission (AF group, n=201 and SR group, n=223) and subdivided them into four groups (Q1-Q4) according to each quartile of BNP levels at hospital admission (BNP lowest quartile (Q1) group (LB): < 320 pg/mL in SR; Q1 < 240 pg/mL in AF). Results: The proportion of patients with unexpectedly low BNP (BNP < 200 pg/mL) was higher in AF group (19.9%) than in SR group (12.1%, p=0.03). BNP was correlated with left ventricular end-diastolic volume index (LVEDVi), left ventricular ejection fraction (LVEF) in both groups (AF: r=0.28, p<0.01; r=-0.43, p<0.01, SR: r=0.41, p<0.01; r=-0.39, p<0.01, respectively) . On the other hand, BNP was positively correlated with left atrial diameter in SR group but negatively correlated in AF group (r=0.14, p=0.039 vs. r=-0.21, p<0.01, respectively, Figure). Furthermore, survival rates significantly increased along BNP tertiles in SR group. On the contrary, in AF group, Q1 (LB) did not show the highest survival rates (p=0.02, Figure). Conclusions: A higher proportion of ADHF with disproportionately low BNP was seen in AF than in SR group. In ADHF patients with AF, LB may be reflected by LA structural remodeling. Furthermore, LB was related to good prognosis in SR group, but not in AF group.

Background Patients with familial hypercholesterolemia who harbored both low-density lipoprotein receptor (LDLR) and PCSK9 (proprotein convertase subtilisin/kexin type 9) gene variants exhibit severe phenotype associated with substantially high levels of low-density lipoprotein cholesterol. In this study, we investigated the cardiovascular outcomes in patients with both LDLR and PCSK9 gene variants. Methods and Results A total of 232 unrelated patients with LDLR and/or PCSK9 gene variants were stratified as follows: patients with LDLR and PCSK9 (LDLR/PCSK9) gene variants, patients with LDLR gene variant, and patients with PCSK9 gene variant. Clinical demographics and the occurrence of primary outcome (nonfatal myocardial infarction) were compared. The observation period of primary outcome started at the time of birth and ended at the time of the first cardiac event or the last visit. Patients with LDLR/PCSK9 gene variants were identified in 6% of study patients. They had higher levels of low-density lipoprotein cholesterol (P=0.04) than those with LDLR gene variants. On multivariate Cox regression model, they experienced a higher incidence of nonfatal myocardial infarction (hazard ratio, 4.62; 95% CI, 1.66-11.0; P=0.003 versus patients with LDLR gene variant). Of note, risk for nonfatal myocardial infarction was greatest in male patients with LDLR/PCSK9 gene variants compared with those with LDLR gene variant (86% versus 24%; P<0.001). Conclusions Patients with LDLR/PCSK9 gene variants were high-risk genotype associated with atherogenic lipid profiles and worse cardiovascular outcomes. These findings underscore the importance of genetic testing to identify patients with LDLR/PCSK9 gene variants, who require more stringent antiatherosclerotic management.

The spleen is associated with inflammation, and the size of the spleen is affected by hemodynamic congestion and sympathetic stimulation. However, the association between splenic size and prognosis in patients with heart failure remains unknown. Between January 2015 and March 2017, we analyzed 125 patients with acute decompensated heart failure who were assessed by computed tomography (CT) on the day of admission. The spleen was measured by 3-dimensional CT and then the patients were assigned to groups according to their median splenic volume indexes (SpVi; splenic volume/body surface area). We then compared their baseline characteristics and rates of readmission for heart failure after one year. The median SpVi was 63.7 (interquartile range: 44.7-95.3) cm3/m2. Age did not significantly differ between the groups. Patients with a high SpVi had more significantly enlarged left atria and left ventricles. Multiple regression analysis identified significant positive correlations between SpVi and posterior wall thickness as well as left ventricular mass index. Kaplan-Meier analysis revealed lower event-free rates in the patients with a high, than a low SpVi (P = 0.041, log-rank test). After adjustment for potential cofounding factors, SpVi was independently associated with readmission for heart failure (Hazard ratio, 2.25; 95% confidence interval, 1.01-5.02; P = 0.047). In conclusion, increased splenic volume is independently associated with readmission for heart failure among patients with acute decompensated heart failure.

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.

BACKGROUND The International Atherosclerosis Society (IAS) has proposed "severe familial hypercholesterolemia" (FH) as a phenotype with the highest cardiovascular risk. However, whether this criteria could appropriately stratify a high-risk Japanese patient with FH remains unknown. OBJECTIVES This study sought to characterize atherosclerotic cardiovascular diseases in IAS-defined Japanese subjects with severe FH. METHODS This study analyzed 380 clinically diagnosed subjects with heterozygous FH without any history of atherosclerotic cardiovascular diseases. Severe FH was defined as untreated low-density lipoprotein cholesterol >400 mg/dL, >310 mg/dL plus 1 high-risk feature, or >190 mg/dL plus 2 high-risk features according to IAS-proposed statement. The occurrence of first and subsequent composite outcomes (cardiac [cardiac death + coronary artery disease + coronary revascularization] and noncardiac events [stroke + peripheral artery disease] was compared between subjects with severe (n = 135) and non-severe (n = 227) FH. RESULTS Severe FH was identified in 40.3% of study population. They had higher low-density lipoprotein cholesterol (P < 0.001) and lipoprotein(a) (P = 0.03) levels. Moreover, they more frequently received high-intensity statin (P < 0.001), PCSK9 inhibitor (P < 0.001), and lipoprotein apheresis (P = 0.01) than nonsevere FH subjects did, which resulted in a lower on-treatment low-density lipoprotein cholesterol level of subjects with severe FH (113 + 47.2 vs 130 + 53.9 mg/dL; P = 0.007). However, during the 7.4-year observational period, subjects with severe FH exhibited a 9.3-, 15.4-, and 5.9-fold greater risk for first composite (P < 0.001), cardiac (P < 0.001), and noncardiac outcomes (P = 0.02), respectively. Multivariate Cox proportional hazard model consistently revealed the 7.8-and 7.9-fold elevated risks of first (P < 0.001) and of subsequent (P < 0.001) composite outcomes in subjects with severe FH. CONCLUSIONS Japanese subjects with severe FH present profound risks of both first and subsequent atherosclerotic cardiovascular diseases in the primary prevention settings. These findings support the clinical applicability of IAS-defined severe FH in Japanese patients, which identifies those who require further stringent antiatherosclerotic management. (JACC: Asia 2021;1:245-255) (c) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction: Elevated right atrial pressure (RAP) exhibits residual congestion and poor clinical outcomes in patients with heart failure (HF). In HF patients, persistent high RAP causes liver damage, which leads to liver fibrosis. Recent advances in T1 mapping of the liver using MRI allow the quantification of liver fibrosis. Hypothesis: Hepatic T1 mapping value may predicts high RAP in patients with chronic HF. Methods: We examined the data from the consecutive 40 patients with DCM ( 60 ± 13 years, 27 men) who underwent 3 Tesla cardiac and liver MRI, which were conducted within seven days of right heart catheterization. RV end-diastolic volume (RVEDV), end-systolic volume (RVESV), RV ejection fraction (RVEF), right atrial (RA) and left atrial (LA) volume, left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), LV ejection fraction (LVEF) and LV mass index (LVMI) were calculated from cine cardiac MRI. Native T1 mapping image (T1 short modified look locker inversion recovery-ShMOLLI- sequence) was acquired the heart and the liver (Figure A). Patients were divided into two groups according to RAP; high ( ≥ 8 mmHg; n=10) and low ( <8 mmHg; n=30). Results: Ten patients had high RAP. There were no significant differences in LVEDV,LVESV, LVEF, LVMI, RVEDV, RVESV and RVEF between patients with high RAP group and those without ( 192 ± 54 ml vs 212 ± 57 ml; 136 ± 49 ml vs 154 ± 51 ml; 30 ± 9 % vs 28 ± 8 %; 79 ± 21 g/m 2 vs 81 ± 22 g/m 2 ; 45 ± 27 ml vs 46 ± 19 ml; 27 ± 18 ml vs 25 ± 15 ml; 42 ± 19% vs 46 ± 18%, respectively). The hepatic T1 mapping value was higher in the high RAP group ( 845 ± 47 ms vs 759 ± 90 ms, p < 0.01) and exhibited a positive correlation with RAP ( R = 0.34, P < 0.05). The hepatic T1 mapping value of ≥ 820ms was the optimal cutoff values for identifying high RAP ( T1: sensitivity, 89%; specificity, 72%; AUC, 0.80, Figure B). Conclusion: Increased native T1 mapping value of the liver may be helpful in non-invasively estimating elevated RAP.

BACKGROUND:Lowering low-density lipoprotein cholesterol (LDL-C) levels using a statin is a cornerstone of preventive therapeutic management following acute myocardial infarction (AMI). In addition to its anti-atherosclerotic effects, recent studies reported a lower occurrence of heart failure (HF) under statin therapy. However, there is a wide variability in statin response. The association between the response to statin and the occurrence of HF in AMI subjects remains unclear. The purpose of present study is to examine whether the variability in statin response affects HF risk after AMI.METHODS:We analyzed 505 statin-naïve AMI subjects undergoing primary percutaneous coronary intervention (PCI) who commenced atorvastatin, rosuvastatin, or pitavastatin. Statin hyporesponse was defined as a reduction in LDL-C levels <15% from baseline to 1 month after statin therapy. HF outcomes were compared between patients with and without statin hyporesponse.RESULTS:Statin hyporesponse was identified in 15.2% (77/505) of study subjects. During a median 4.4-year observational period, statin hyporesponse was associated with a greater likelihood of HF [hazard ratio (HR) =3.01, 95% confidence interval (CI): 1.27-6.79, P=0.01]. This increased HF risk in statin hyporesponders was consistently observed in a multivariate Cox proportional hazards model (HR =2.74, 95% CI: 1.01-6.75, P=0.04), a propensity score-matched cohort (HR =12.30, 95% CI: 1.50-100.3, P=0.01) and in an inverse probability of treatment weights analysis with average treatment effects (coefficient =7.02, 95% CI: 2.29-21.58, P=0.0006).CONCLUSIONS:Hyporesponse to statins increases HF risk after AMI. Our findings highlight statin hyporesponse as a high-risk feature associated with HF events.