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Background Recent studies revealed an association between small kidney volume and progression of kidney dysfunction in particular settings such as kidney transplantation and transcatheter aortic valve implantation. We hypothesized that kidney volume was associated with the incidence of kidney-related adverse outcomes such as worsening renal function (WRF) in patients with acute heart failure (AHF). Methods This study was a single-center retrospective cohort study. It included patients admitted for AHF treatment between 2011 and 2021 and who underwent computed tomography (CT) that included images of the kidneys on the date of admission. We measured the volume of the right and left kidneys using dedicated volume analyzing software for 3D-CT (SYNAPSE VINCENT, Fuji Film, Tokyo, Japan) and determined the total kidney volume by adding the volumes of the left and right kidneys. We defined the composite of death from any cause, initiating renal replacement therapy, and WRF during hospitalization as major adverse kidney events (MAKE). We conducted multivariate logistic regression analysis to evaluate the impact of MAKE and each component of MAKE adjusted for age, sex, body surface area, estimated Glomerular Filtration Rate (eGFR) on admission date and the factors that were significantly associated with the incidence of MAKE by bivariate analysis. Results In the 229 patients enrolled in the analysis, death from any cause, initiating RRT, and WRF occurred in 30 (13.1%), 10 (4.4%), and 85 (37.3%) patients, respectively. It was found that small kidney volume (≤ 250 ml) was independently associated with the increased incidence of MAKE (odds ratio 3.92, 95% confidence interval [1.18–13.08], p  = 0.026) and WRF (odds ratio 6.58, 95%confidence interval [1.85–23.42] p  = 0.004). The area under the receiver operating characteristic curve for multivariate logistic regression analysis of MAKE was 0.71. Conclusions Kidney volume on admission was independently associated with the increased incidence of kidney-related adverse outcomes during hospitalization in patients with AHF.

Adenosine‐sensitive atrial tachycardia (AT) is typically associated with a slow conduction zone (SCZ) near the atrioventricular node or tricuspid annulus. We report an unusual case of adenosine‐sensitive AT with a SCZ located between the left atrial appendage and the left atrial anterior septum, which was successfully ablated 9.2 mm from the left atrial earliest activation site. This case highlights the importance of advanced mapping and entrainment techniques in the identification and management of rare left‐sided SCZ variants of adenosine‐sensitive AT.

Epicardial ablation in patients with pericardial adhesions is challenging. This case is the first report of successful epicardial ventricular tachycardia ablation by combining hydrodissection with the previously reported blunt dissection techniques for pericardial adhesions. This approach demonstrates a promising technique for managing similar cases where traditional methods may fail, providing a safer and more effective solution for epicardial ablation in patients with pericardial adhesions.

Acid-fast staining, mycobacterial culture, interferon-gamma release assay (IGRA), and polymerase chain reaction (PCR) test of sputum and pleural fluid were all negative for Mycobacterium tuberculosis. Since increased pericardial thickening and calcification strongly suggested CP, we clinically diagnosed CP as a complication of cardiac surgery. [...]we ruled out postradiotherapy, malignancy, trauma, asbestosis, sarcoidosis, uremic pericarditis, connective tissue disorder, and systemic IgG4-related disease, based on the history and additional test results. [...]in this case, CP is a late complication of cardiac surgery.

Background N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a potential biomarker for monitoring the status of heart failure. However, the optimal monitoring interval of NT-proBNP is unknown. This study sought to investigate the minimal informative monitoring interval of NT-proBNP in patients with stable chronic heart failure. Methods This retrospective cohort study included patients who were admitted due to heart failure and subsequently followed with serial NT-proBNP measurements in a tertiary hospital. We analyzed NT-proBNP measured between six months after discharge and the earliest timepoint of: an alteration of medication regimen, readmission due to worsening of heart failure, or all-cause death. To distinguish progression of the disease from biological variability and measurement error, the signal-to-noise ratio method was applied with a random-effects model. Results In the 368 patients included, NT-proBNP was measured for a median 6 times. In the random-effects model, signal (progression of disease) exceeded noise (biological variability and measurement error) at 7.9 months (95% confidence interval [CI]: 5.1–9.6), while noise corresponded to a 61% increase from baseline. In stratified analysis using the AHEAD risk score, the minimal informative monitoring interval shortened as the risk score increased (0–1 point: 12.2 months [95%CI: 10.3–14.4]; 2–3 points: 8.0 months [95%CI: 6.8–9.7]; 4–5 points: 3.3 months [95%CI: 3.0–3.8]). Conclusions In patients with stable chronic heart failure, the minimal informative monitoring interval of NT-proBNP measurement was 7.9 months in the current population, which varied with underlying risks. The optimal monitoring interval could be lengthened for patients at lower risks.

Key Points Two main strategies have been adopted in studies into the optimal duration of dual antiplatelet therapy (DAPT): abbreviated and prolonged DAPT regimens Shorter duration of DAPT is associated with better bleeding outcomes, whereas longer duration of DAPT is associated with inconsistent results in all-cause mortality, myocardial infarction, and stent thrombosis Current European and US guidelines recommend ≥6 months of DAPT for patients with stable coronary artery disease; for patients at high risk of bleeding, DAPT duration can be shorter Care must be taken when interpreting results from randomized clinical trials of DAPT duration owing to the heterogeneity of end points, bleeding definition, and time of randomization The concept of single antiplatelet therapy after stent implantation is based on the pharmacodynamic characteristics of potent P2Y 12 -receptor inhibitors Ongoing trials to test single antiplatelet therapy after implantation of drug-eluting stents will contribute to optimizing the medical management of patients treated with these stents The optimal duration and type of antiplatelet therapy after implantation of a drug-eluting stent (DES) remains uncertain. In this Review, Miyazaki et al . summarize the evidence on the duration of dual antiplatelet therapy and the risk of bleeding and adverse cardiac events after DES implantation, and describe the pitfalls of trial interpretation. Ongoing trials to test single antiplatelet therapy after DES implantation are also discussed. The optimal duration and type of antiplatelet therapy after implantation of a drug-eluting stent (DES) remains uncertain. At the time of the first-in-man implantation of the sirolimus DES in 1999, the protocol-defined dual antiplatelet therapy (DAPT) duration was only 2 months. Subsequently, DAPT duration was extended to 1 year on the basis of anecdotal historical data, and this practice was then incorporated into clinical guidelines. For >1 decade, trialists have sought to compare the safety and efficacy of abbreviated (<6 months) and prolonged (>12 months) DAPT regimens. However, the body of evidence is limited by the heterogeneity of end points, time of randomization, and bleeding criteria used in each trial. Pharmaceutical advances led to the introduction of new ADP-receptor antagonists, which are thought to be more effective than clopidogrel. The ADP-receptor antagonists moved the focus from the optimal duration of DAPT to the potential efficacy of single antiplatelet therapy after DES implantation. In this Review, we summarize the current evidence on the duration of DAPT and the risk of bleeding and adverse cardiac events after DES implantation, and describe the pitfalls of trial interpretation. The ongoing, prospective trials to test single antiplatelet therapy after DES implantation are also discussed.

Key Clinical Message In addition to the reentrant map, the wave speed map can be helpful in accurately identifying the CTI gap during radiofrequency application for atrial flutter(AFL). However, in complex cases involving extensive scarring and multiple low‐velocity local areas, this technique may not be useful. A 73‐year‐old male patient with a history of pulmonary vein isolation and cavotricuspid isthmus ablation underwent a second catheter ablation owing to recurrent atrial flutter (AFL). The AFL was diagnosed as cavotricuspid isthmus‐dependent AFL caused by the reconnection of the previous cavotricuspid isthmus ablation. Wave speed mapping was performed at the same site, and results comprehensively revealed a low‐velocity local area. The AFL was terminated after the first radiofrequency application, and the block line was easily completed. Therefore, this technique could be an adjunctive tool for cavotricuspid isthmus gap identification and minimal radiofrequency application.

Background Although immediate recurrence of atrial fibrillation (IRAF) after cardioversion has been proposed as a surrogate for atrial substrate vulnerability, its broad definition may insufficiently discriminate patients at highest risk of postablation recurrence. We introduced the concept of ultra‐early recurrence of AF (URAF)—defined as recurrence within 10 s after direct current cardioversion (CV) under deep sedation—as a novel marker of advanced remodeling in persistent atrial fibrillation (AF). Objective To evaluate whether URAF independently predicts late recurrence following pulmonary vein isolation (PVI) in patients with persistent or long‐standing persistent AF. Methods We retrospectively analyzed 104 patients undergoing first‐time PVI for persistent AF. Among 93 patients who underwent external CV, URAF, and IRAF were defined as AF recurrence within 10 and 90 s, respectively. Recurrence of atrial arrhythmias was assessed at 12 m postablation. Results URAF was observed in 10/104 patients (9.6%) and was associated with higher 12‐m recurrence compared with URAF‐negative patients (50% vs. 18%, p = 0.02), whereas IRAF (20/104, 19.2%) showed no significant difference (30% vs. 19%, p = 0.28). On multivariable logistic regression, URAF (Odds Ratio (OR): 4.8; 95% Confidence Interval (CI): 1.16–19.98; p = 0.029) and long‐standing AF (OR: 5.5; 95% CI: 1.70–17.78; p = 0.004) emerged as independent predictors of recurrence. Kaplan–Meier analysis showed worse recurrence‐free survival for URAF (log‐rank p = 0.02; HR 4.5, 95% CI 1.18–17.41). Conclusion URAF may represent a promising intra‐procedural marker associated with post‐ablation recurrence in persistent AF, but prospective validation in larger cohorts is required. Ultra‐early recurrence of AF (URAF) within 10 s after cardioversion predicted late recurrence after PVI in persistent AF. (OR: 4.8; 95% CI: 1.16–19.98; p = 0.029). URAF may represent a promising intraprocedural marker associated with postablation recurrence in persistent AF.

Background Entamoeba histolytica ( E. histolytica ) is rarely identified as a cause of amebic pericarditis. We report a case of amebic pericarditis complicated by cardiac tamponade, in which the diagnosis was missed initially and was made retrospectively by polymerase chain reaction (PCR) testing of a stored sample of pericardial fluid. Furthermore, we performed a systematic review of the literature on amebic pericarditis. Case presentation A 71-year-old Japanese man who had a history of sexual intercourse with several commercial sex workers 4 months previously, presented to our hospital with left chest pain and cough. He was admitted on suspicion of pericarditis. On hospital day 7, he developed cardiac tamponade requiring urgent pericardiocentesis. The patient’s symptoms temporarily improved, but 1 month later, he returned with fever and abdominal pain, and multiple liver lesions were found in the right lobe. Polymerase chain reaction of the aspiration fluid of the liver lesion and pericardial and pleural fluid stored from the previous hospitalization were all positive for E. histolytica . Together with the positive serum antibody for E. histolytica , a diagnosis of amebic pericarditis was made. Notably, the diagnosis was missed initially and was made retrospectively by performing PCR testing. The patient improved with metronidazole 750 mg thrice daily for 14 days, followed by paromomycin 500 mg thrice daily for 10 days. Conclusions This case suggests that, although only 122 cases of amebic pericarditis have been reported, clinicians should be aware of E. histolytica as a potential causative pathogen. The polymerase chain reaction method was used to detect E. histolytica in the pericardial effusion and was found to be useful for the diagnosis of amebic pericarditis in addition to the positive results for the serum antibody testing for E. histolytica . Because of the high mortality associated with delayed treatment, prompt diagnosis should be made.

The Kidney Disease: Improving Global Outcomes chronic kidney disease (CKD) guidelines recommend that CKD be classified based on the etiology, glomerular filtration rate (GFR) and degree of albuminuria. The present study aimed to establish a method that predicts the presence of microalbuminuria by measuring the total urine protein-to-creatinine ratio (TPCR) in patients with cardiovascular disease (CVD) risk factors. We obtained urine samples from 1,033 patients who visited the cardiovascular clinic at St. Luke's International Hospital from February 2012 to August 2012. We measured the TPCR and the urine albumin-to-creatinine ratio (ACR) from random spot urine samples. We performed correlation, receiver operating characteristic (ROC) curve, sensitivity, and subgroup analyses. There was a strong positive correlation between the TPCR and ACR (R2 = 0.861, p<0.001). A ROC curve analysis for the TPCR revealed a sensitivity of 94.4%, a specificity of 86.1%, and an area under the curve of 0.903 for detecting microalbuminuria for a TPCR cut-off value of 84 mg/g of creatinine. The subgroup analysis indicated that the cut-off value could be used for patients with CVD risk factors. These results suggest that the TPCR with an appropriate cut-off value could be used to screen for the presence of microalbuminuria in patients with CVD risk factors. This simple, inexpensive measurement has broader applications, leading to earlier intervention and public benefit.