As Japan becomes an aging society, the number of patients with heart failure (HF) is increasing. The European Society of Cardiology guidelines recommend noninvasive ICT monitoring from the perspective of self-care and team medical care; however, evidence regarding the effectiveness of remote monitoring in Japan is limited. This study assessed the usefulness of OMRON Connect with the Health Data Monitoring System, which provides simultaneous sharing of biomonitoring data of patients with HF using wireless devices. A prospective, single-arm, multicenter observational study for 84 days was performed, including 30 patients with HF (age 72 ± 5.6 years, male, n = 19). They were introduced to the measurement of body weight (BW), blood pressure (BP), electrocardiogram (ECG) recording, and patient-reported symptoms on a smartphone application (PRS on App) using OMRON Connect. The primary outcome was adherence to this system, and the secondary outcome included factors that influence adherence. The adherence measurements were as follows: BW, 97.0% (interquartile range [IQR] 92.3-100%); BP, 88.7% (IQR, 79.8-95.8%); and ECG, 88.7% (IQR, 64.9-94.1%). No patients dropped out during the 84-day period. No significant relationship was found between adherence and the following parameters: age, sex, prior HF admission, left ventricular ejection fraction, New York Heart Association class, serum brain natriuretic peptide level, renal function, cognitive impairment, and living alone or with family. However, the continuation rate of PRS on App gradually decreased to 53%. One of the patients was admitted for HF exacerbation, and this system could clearly detect BW increase before admission. In addition, fatal arrhythmias, such as a short run of premature ventricular contractions or advanced atrioventricular block, could be detected in ECG. The use of OMRON Connect for noninvasive ICT monitoring in patients with HF demonstrates good adherence in checking BP, BW change, and ECG changes. This method proves to be feasible for patient self-management and facilitates appropriate clinical intervention.

Atrial fibrillation (AF) is a prevalent comorbidity among patients undergoing transcatheter aortic valve implantation (TAVI); however, its prognostic implications remain uncertain. This study aimed to elucidate the impact of preprocedural AF on clinical outcomes following TAVI in patients with aortic stenosis (AS). We conducted a single-center, retrospective cohort study comprising 297 consecutive AS patients who underwent TAVI (mean age 83 ± 4 years; 69% female). Pre-existing AF was identified in 89 (30%) patients. Patients were stratified into two groups based on the presence or absence of AF, and propensity score matching (PSM) was employed, resulting in 68 matched pairs. The study endpoint was the incidence of net adverse clinical events (NACE) and all-cause mortality. NACE was defined as a composite of all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke, systemic thromboembolism, valve thrombosis, and major bleeding events. These clinical outcomes were analyzed according to the presence and subtype of pre-existing AF and further stratified across body mass index (BMI) categories. To further assess the combined impact of AF and BMI, patients were additionally categorized into four groups according to the presence or absence of AF and low BMI (< 18.5 kg/m), and multivariable Cox regression analysis was performed across these groups. The median duration of follow-up was 2.3 [1.0-3.7] years. While baseline characteristics, including age and gender, were comparable between groups, patients with pre-existing AF exhibited a higher prevalence of prior heart failure hospitalizations and reduced renal function. There were no statistically significant differences in the incidence of NACE and all-cause mortality between the AF and non-AF groups, both before and after PSM. However, among patients with AF, those with a low BMI < 18.5 kg/m experienced a significantly higher rate of adverse clinical events compared to those with normal or high BMI. This was supported by multivariable analysis. Although preprocedural AF was not independently associated with adverse clinical outcomes following TAVI, the coexistence of AF and low BMI was linked to significantly worse prognosis. These findings suggest a potential synergistic effect warranting further investigation and individualized risk stratification.

The incidence and progression of atrial fibrillation (AF), the most common type of cardiac arrhythmia, correlate with atrial fibrosis. An increased epicardial adipose tissue (EAT) volume is associated with increased atrial fibrosis. Although the presence and severity of atrial fibrosis have been evaluated through various invasive and noninvasive methods, reports examining the association between EAT volume (EATV) and the left atrial (LA) stiffness index through echocardiography or LA compliance as determined by LA pressure are lacking. Therefore, we investigated the relationship between EAT and the LA stiffness index and directly measured LA pressure in patients undergoing AF ablation.

Coronary microvascular dysfunction (CMD) represent a crucial and often underdiagnosed cause of myocardial ischemia and dysfunction. It is closely linked to the prognosis of patients with coronary artery disease. Increased microvascular resistance (whether due to CMD or vascular rarefaction) is more frequent in the setting of coronary chronic total occlusions (CTO). Whether recanalization contributes to the recovery of microvascular function and whether measures of microvascular resistance can potentially be used as prognostic parameter to predict long-term success of CTO recanalization remains unknown. The aim of this study was to investigate CMD in patients with CTO and the effect of successful CTO recanalization. As well, we investigate whether CMD can be identified as a risk factor for restenosis after CTO recanalization. 119 patients underwent successful CTO recanalization at the University Medical Center in Mainz. After a follow-up period of 6 months, invasive control was carried out, in which 79 patients continued to have sufficient revascularization and 40 presented with restenosis. Angiography-based microvascular resistance (Angio-IMR) measurements were performed directly after successful CTO recanalization and at 6 months follow-up offline using a software package (QAngio XA 3D; Medis Medical Imaging Systems). 64% of the patients were male with an average age of 62 ±  9 years. The mean follow-up period was 191 ± 80 days. Median J-CTO Score was 1.8 ± 0.7. The CTO was localized at the RCA in 60%, at the LAD in 20% and at the LCX in 24% of the patients. All included patients had a good result after CTO recanalization confirmed by Quantitative flow ratio (QFR) of 0.94 ± 0.04 directly after PCI. Angio-IMR values immediately after CTO recanalization were pathological (> 25) in 78% of the patients and showed a significant decrease at 6 months follow-up (31.7 ± 7.1 vs. 28.6 ± 5.3¸ p = 0.0024). Post-procedural angio-IMR values did not predict restenosis at 6-month follow-up (31.7 ± 8 vs. 29.8 ± 7.5, p = 0.173). CMD can be detected in a majority of patients after successful CTO PCI. At 6 months follow-up we found significant improved angio-IMR values; CMD was not a predictor of restenosis.

Red cell distribution width is a prognostic marker of adverse outcomes in adults with heart disease, including congenital heart disease. However, its significance has not been clarified in pediatric patients. We investigated the relationship between red cell distribution width and cardiovascular events in school-age children with congenital heart disease and uniform reference intervals. We performed a retrospective cohort study of pediatric patients with congenital heart disease between January 2018 and March 2023. Children aged 7-15 years were included, and the results of the first blood test during the study period were considered as baseline data. Cardiovascular events were defined as all-cause mortality, non-scheduled hospitalizations for cardiovascular reasons, heart failure, arrhythmias, thromboembolism, and unplanned intervention. In total, 101 children were included. The median red cell distribution width was 12.3% (interquartile range 11.9-12.8%). Cardiovascular events occurred in 15 patients (14.9%) during follow-up. The Kaplan-Meier analysis showed significantly worse cardiovascular event-free survival in the higher red cell distribution width group. Univariate Cox regression revealed that a higher red cell distribution width group (p < 0.001), Fontan circulation (p < 0.001), oxygen saturation (p < 0.001), aspartate aminotransferase (p < 0.001), alanine aminotransferase (p < 0.001), and gamma-glutamyl transpeptidase (p < 0.001) were associated with cardiovascular events. When adjusted for other variables respectively, only a higher red cell distribution width group and Fontan circulation remained independently significant. The red cell distribution width and Fontan circulation were independently associated with cardiovascular events in school-age children with congenital heart disease.

Our purpose was to determine the outcome of pregnancy and delivery in patients with coronary artery lesions and myocardial involvement caused by Kawasaki disease after half a century after the first report of this disease. We investigated 67 deliveries in 39 patients with coronary artery lesions caused by Kawasaki disease in our institution between 1991 and 2022. The age at delivery ranged from 18 to 42 years, with a median of 31 years. Twenty-four patients (62%) had stenotic lesions, including 11 with coronary arterial bypass grafting. Low-dose aspirin was given to 26 patients (67%). The deliveries were vaginal in 29 patients (74%), albeit that 16 required assistance by forceps or vacuum extraction under epidural anesthesia. Caesarean sections were performed in 10 patients (26%), 5 (13%) for cardiac disease. There were two patients with worsening ventricular tachycardia and two patients with ST-T depression on Holter monitoring during pregnancy. Three patients experienced an increase in isolated ventricular premature contractions during pregnancy. No severe maternal cardiac events occurred in any patients. There were four preterm babies less than 35 weeks of gestation (6%). The results of the pregnancy and delivery in patients without myocardial ischemia and involvement were favorable, even if they had stenotic lesions. Ventricular tachycardia can worsen during pregnancy in patients with myocardial involvement, and myocardial ischemia may also occur in patients with coronary artery occlusions. Their evaluation during pregnancy by Holter-electrocardiograms is helpful in deciding the management of the pregnancy and mode of delivery.

The impact of inflammatory and nutritional indices in patients undergoing transcatheter aortic valve implantation (TAVI) remains controversial. Therefore, we aimed to analyze the prognostic impact of Geriatric Nutritional Risk Index (GNRI) and C-reactive protein (CRP) in these patients. We included 122 patients who underwent elective TAVI for aortic valve stenosis (AS) between April 2017 and May 2023. The primary outcome was all-cause mortality, and secondary outcomes were major adverse cerebral/cardiovascular events (MACCEs). Patients with a low GNRI, high CRP levels, and a combination of a low GNRI and high CRP levels exhibited significantly high all-cause mortality. The GNRI and CRP levels alone were significantly associated with late mortality in the univariate analysis; however, this trend was absent in the multivariate analysis. The combination of a low GNRI and high CRP levels was significantly associated with late mortality in the univariate and multivariate analyses. The GNRIs at 6 months showed no significant changes, and the low GNRI in patients before surgery persisted after TAVI. There was no association between low GNRI after TAVI and late mortality or MACCE. The combination of malnutrition (indicated by a low GNRI) and inflammation (indicated by high CRP levels) may be a risk factor for long-term mortality in patients undergoing TAVI for AS.

This Letter to the Editor responds to the recent study by Kanejima et al. on the association between health literacy (HL) and behavioral changes during phase I cardiac rehabilitation (CR). While acknowledging the study's valuable contribution, we contest the conclusion that low HL is an inherent barrier to behavioral change. Drawing on recent evidence, we highlight that HL is a modifiable factor that can be improved through targeted interventions, program designs, and the rehabilitation process itself. We present six key arguments: (1) digital health technologies and structured education can enhance HL and foster behavioral adaptation in low-HL populations; (2) non-literacy barriers such as logistical constraints often play a larger role; (3) comparable cardiovascular interventions have shown sustained benefits despite low baseline HL; (4) CR programs themselves can directly improve HL; (5) modern CR designs employ adaptive, individualized approaches effective across HL levels; and (6) nurse-led and home-based strategies can successfully overcome HL limitations. Collectively, these points suggest that low HL should be viewed as a dynamic and addressable factor rather than a fixed constraint. We urge future research to incorporate HL-enhancing interventions and longitudinal follow-up to better understand HL's evolving role in CR outcomes.