Explore the vast range of titles available.

Background Guidelines have recommended that physicians screen for coronary artery disease (CAD) at the initiation of dialysis. The purpose of this study was to examine the effects of CAD screening at the initiation of dialysis on prognosis after starting dialysis Methods This retrospective cohort study involved 224 consecutive incident dialysis patients without advanced cardiac disease. Pharmacological stress myocardial perfusion imaging (MPI) was performed to routinely screen incident dialysis patients within 3 months of starting dialysis therapy. The influence of MPI on prognosis after starting dialysis was explored by the propensity score adjustment method. The study outcome was defined as all-cause mortality and cardiac death. Results Of the 224 patients, 164 (73.2 %) underwent MPI screening at initiation of dialysis. During the median follow-up period of 5.5 years, 77 patients died, among whom 17 (22.1 %) cardiac deaths were observed. The patients who received MPI had a significantly higher survival rate for all-cause mortality and cardiac death compared with the patients without MPI (log-rank test, p  < 0.001, p  = 0.021, respectively). In multiple Cox regression analysis, MPI screening continued to have a statistically significant negative association with all-cause mortality after adjusting for confounding variables (hazard ratio 0.581, p  = 0.034) and propensity score (hazard ratio 0.568, p  = 0.025). Conclusions MPI CAD screening at dialysis initiation could improve prognosis after starting dialysis.

Background The mechanisms underlying cardiorenal benefits of finerenone remain unclear. This mechanistic trial aimed to evaluate the effects of finerenone on vascular stiffness, as assessed using the cardio-ankle vascular index (CAVI), and cardiorenal biomarkers in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). Methods Eligible patients with T2D and CKD (estimated glomerular filtration rate [eGFR], 25 to < 90 mL/min/1.73 m 2 ; urinary albumin-to-creatinine ratio [UACR], 30 to < 3500 mg/g Cr) were randomly allocated to receive either dose-adjusted finerenone or matching placebo. The primary endpoint was the change in CAVI at week 24. The key secondary endpoint was the proportional change in UACR from baseline over 24 weeks. As an exploratory analysis, changes in circulating proteins were measured by using the Olink® Target 96 Cardiovascular III and Inflammation panels. Results This investigator-initiated, multicentre, prospective, two-arm parallel, placebo-controlled, double-blind, randomised clinical trial was conducted at 13 sites in Japan. Among 102 patients randomised, 101 (66.3% men; median age, 73 years; eGFR, 56.2 mL/min/1.73 m 2 ; and UACR, 193.8 mg/g Cr) were analysed. Changes in CAVI at week 24 were − 0.023 (95% confidence interval [CI], − 0.299 to 0.254) for finerenone and 0.011 (95% CI, − 0.245 to 0.267) for placebo. The group difference was − 0.057 (95% CI, − 0.428 to 0.314; P  = 0.760). Compared with placebo, finerenone led to a 29% reduction in UACR levels at weeks 12 (group ratio 0.706 [95% CI, 0.504 to 0.989; P  = 0.043]) and 24 (0.709 [95% CI, 0.506 to 0.994; P  = 0.046]). Finerenone also resulted in an early and sustained eGFR decline over 24 weeks, without increasing levels of urinary biomarkers of acute tubular injury. Finerenone, compared with placebo, was associated with nominal changes in the expression of 11 proteins among the 181 circulating proteins tested. Conclusions Finerenone did not affect changes in vascular stiffness but led to a significant and sustained reduction in albuminuria in patients with T2D and CKD. The clinical benefits of finerenone may result from lowering intraglomerular pressure rather than from its effect on vascular stiffness. Registration ClinicalTrial.gov (NCT05887817) and Japan Registry of Clinical Trials (jRCTs021230011). Graphical abstract This mechanistic clinical trial involving patients with T2D and CKD found that 24-week finerenone therapy did not significantly reduce CAVI from baseline compared with placebo (−0.057; 95% CI, −0.428 to 0.314), led to a 29% reduction (group ratio [finerenone vs. placebo] of 0.71) in UACR levels, and was associated with nominal changes in 11 circulating proteins (six upregulated and five downregulated) over 24 weeks. CAVI, cardio-ankle vascular index; CI, confidence interval; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; T2D, type 2 diabetes; UACR, urinary albumin-to-creatinine ratio.

Prospective investigations for the frequency of hypoattenuated leaflet thickening (HALT) and its clinical implications in transcatheter aortic valve implantation (TAVI) patients are limited. We initiated a prospective screening program of TAVI patients for HALT beginning in July 2015. Eligible patients were evaluated with gated, contrast-enhanced multidetector computed tomography within 30 days of TAVI, and examined for HALT and clinical outcomes. During the study period, 287 patients (81 ± 8 years; 53% men) who underwent TAVI with commercially approved devices were examined. Overall, 26 patients (9.1%) had occurrence of HALT, and only one of these patients had detectable hemodynamic changes on echocardiography at diagnosis. Notably, 9 of 26 HALT patients had been receiving warfarin, however, the HALT patients more often had subtherapeutic international normalized ratio whereas using warfarin than patients without HALT on index multidetector computed tomography imaging (p = 0.01). Patients who developed HALT had lower baseline aortic gradient, valvuloarterial impedance, and peak aortic velocity, and more commonly had been treated with balloon-expandable valves (73% of all HALT cases) with a higher incidence among those who received larger prostheses. All patients with HALT were placed on anticoagulation at diagnosis, and valvular function remained unchanged at follow-up. Two patients with HALT (7.7%) experienced ischemic stroke. A statistical trend for more major adverse clinical events was present in HALT patients. In conclusion, HALT was detected in 9% of TAVI cases in this prospective observational cohort, with a greater frequency in patients with large, balloon-expandable prostheses. Prospective screening may be considered as early HALT is reversible by timely therapeutic anticoagulation.

The establishment of an optimal strategy for elderly patients with acute decompensated heart failure (ADHF) is currently an important issue. Particularly in very elderly (VE) patients, ADHF is associated with a poor prognosis. We therefore aimed to evaluate the efficacy and safety of the early use of tolvaptan (TLV) in VE patients. Of 245 patients with ADHF admitted between March 2013 and July 2014, we prospectively enrolled 111 patients with TLV first administered within 24 h of hospitalization. These were divided into two groups according to the age: VE (≥85 years, n=45) and not very elderly (NVE, <85 years, n=66). The endpoints were the incidence of worsening renal function, death by any cause, or the length of hospital stay. There were no significant differences between the two groups in the incidence of worsening renal function (26.7% in VE vs. 25.8% in not VE, p=0.92), dose of TLV after hospitalization (7.4±0.7 vs. 7.5±1.3 mg/day, p=0.63), mean duration of the use of TLV (4.3±3.5 vs. 5.4±4.8 days, p=0.17), or mean length of hospital stay (16.5±7.8 vs. 15.7±8.0 days, p=0.64). TLV shows similar efficacy and safety in both VE and NVE groups. Even for VE patients with ADHF, initiation of TLV with standard diuretic treatment may have the potential not to increase the incidence of worsening renal function.

BackgroundAntiplatelet therapy is a cornerstone of treatment following acute myocardial infarction (AMI). Recently, prasugrel, a new and potent antiplatelet agent, has been introduced in clinical practice. To date, however, real-world in-hospital and follow-up data in Japanese patients with AMI remain limited.ObjectivesTo examine ischemic and bleeding events in Japanese patients with AMI and the association between these events and antiplatelet therapy.MethodsThe Japan AMI Registry (JAMIR) is a multicenter, nationwide, prospective registry enrolling patients with AMI from 50 institutions. The inclusion criterion is spontaneous onset of AMI diagnosed based on either the universal definition or Monitoring Trends and Determinants in Cardiovascular disease (MONICA) criteria. The major exclusion criteria are hospital admission ≥ 24 h after onset, no return of spontaneous circulation on admission following out-of-hospital cardiopulmonary arrest, and AMI as a complication of percutaneous coronary intervention or coronary artery bypass grafting. The primary end point of the study is the composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Major safety end points include major bleeding based on Thrombolysis in Myocardial Infarction (TIMI) criteria and type 3 or type 5 bleeding based on Bleeding Academic Research Consortium (BARC) criteria. Between December 2015 and May 2017, a total of 3411 patients (mean age 68.1 ± 13.2 years, 23.4% female) were enrolled in the study. Patients will be followed for 1 year.ConclusionsJAMIR will provide important information regarding contemporary practice patterns in the management of Japanese patients with AMI, their demographic and clinical characteristics, in-hospital and post-discharge outcomes, and how they are related to antiplatelet therapy.

The realization of fast fault-tolerant quantum gates on a single spin is the core requirement for solid-state quantum-information processing. As polarized light shows geometric interference, spin coherence is also geometrically controlled with light via the spin–orbit interaction. Here, we show that a geometric spin in a degenerate subspace of a spin-1 electronic system under a zero field in a nitrogen vacancy centre in diamond allows implementation of optical non-adiabatic holonomic quantum gates. The geometric spin under quasi-resonant light exposure undergoes a cyclic evolution in the spin–orbit space, and acquires a geometric phase or holonomy that results in rotations about an arbitrary axis by any angle defined by the light polarization and detuning. This enables universal holonomic quantum gates with a single operation. We demonstrate a complete set of Pauli quantum gates using the geometric spin preparation and readout techniques. The new scheme opens a path to holonomic quantum computers and repeaters. Ground-state spin rotations in a nitrogen–vacancy centre in diamond are manipulated within nanoseconds of a near-resonant light field being applied. Pauli quantum gates are demonstrated using the geometric spin preparation and read-out techniques.