Kentaro Jujo

Background: The prognosis of acute myocarditis (AM) is difficult to predict due to its variable presentation. We investigated the prognosticators of AM patients requiring hospitalization.Methods and Results: We conducted a multicenter observational study including 80 hospitalized AM patients. The primary endpoint was a composite of all-cause death, heart transplantation, and implantation of ventricular assist devices during the index hospitalization. Thirteen (16%) patients reached the endpoint. Longer QRS duration at admission independently predicted adverse outcomes, with an optimal cut-off of 130 ms.Conclusions: Prolonged QRS duration at admission might predict in-hospital prognosis in AM patients regardless of whether or not it was fulminant.

Patients with coronary artery disease (CAD) typically develop atherosclerosis proximal to the left anterior descending coronary artery (LAD). However, it is unclear how CAD location affects long-term prognosis in the era of drug-eluting stents. This study compared the clinical profiles and long-term outcomes of patients with and without LAD lesions after percutaneous coronary intervention (PCI). Of 2,497 consecutive patients with CAD who underwent PCI, 1,245 who underwent first-time PCI were enrolled. Baseline profiles and long-term prognoses, including major adverse cardiovascular events (MACE), were compared between patients with de novo CAD localized to the LAD (n=986) and non-LAD lesions (n=259). MACE included cardiovascular death, nonfatal myocardial infarction, and target vessel revascularization. Patients in the LAD group were more likely to be older; had an increased prevalence of diabetes, dyslipidemia, and impaired cardiac and renal function; and had significantly more multi-vessel disease, calcified lesions, and long lesions than the non-LAD group. Kaplan-Meier analysis revealed that the MACE rate was significantly higher in the LAD group (16.6% vs. 5.4%, pGraphical Abstract Prognostic comparisons of in-hospital mortality and MACE after PCI in patients with and without LAD lesions. Comparison of in-hospital mortality and MACE between patients with and without LAD lesions. LAD, left anterior descending artery; MACE, major adverse cardiovascular event; PCI, percutaneous coronary intervention.

Backgrounds/Objectives: Advances in prevention and medical care in the field of cardiology have led to an increase in the number of older patients with heart failure. In this population, assessment of nutritional status is particularly important. However, the prognostic impact of severity-based nutritional assessment at admission remains unclear. We conducted a study to elucidate the impact of malnutrition severity at admission on the prognosis of older patients hospitalized for acute heart failure (AHF). Methods: This study investigated the relationship between the Geriatric Nutritional Risk Index (GNRI) at admission and prognosis in 214 older patients aged ≥65 years who were hospitalized for AHF (mean age, 85 ± 8 years; male, 49%) between 2019 and 2023. GNRI was assessed by dividing patients into four groups: GNRI > 98 as normal (n = 64), 92 ≤ GNRI < 98 as mild risk (n = 54), 82 ≤ GNRI < 92 as moderate risk (n = 66), and GNRI < 82 as severe risk (n = 30). The discriminative performance of GNRI for 1-year all-cause mortality was compared with that of the Controlling Nutritional Status (CONUT) score and the Prognostic Nutritional Index (PNI). Results: During a median follow-up of 356 days, 76 deaths were observed. Worse GNRI categories were associated with older age, underweight, frailty, and anemia. Multivariable Cox proportional hazards models revealed that moderate GNRI risk (hazard ratio (HR), 2.69; 95% confidence interval (CI), 1.34–5.40) and severe GNRI risk (HR, 9.75; 95% CI, 4.30–22.10) were associated with higher all-cause mortality when compared with normal GNRI, along with age (HR per 1-year increase, 1.07; 95% CI, 1.03–1.11). Sensitivity analysis using GNRI as a continuous variable demonstrated similar results; GNRI was inversely associated with all-cause mortality (HR per 1 GNRI increase, 0.92; 95% CI, 0.90–0.95). In a subgroup analysis of age ≥85 years, the inverse association between GNRI and all-cause mortality was consistent. For 1-year all-cause mortality, GNRI showed moderate discrimination (area under the curve (AUC), 0.71; 95% CI, 0.63–0.80). Although the AUC of GNRI was not significantly different from that of the CONUT score or the PNI, GNRI demonstrated significantly better risk reclassification (net reclassification improvement, 0.47 vs. CONUT, p = 0.05; 0.43 vs. PNI, p = 0.02). Conclusions: In older patients with AHF including the oldest-old, nutritional status assessed by the GNRI at admission was predictive of prognosis. The importance of evaluating nutritional status at admission in clinical settings is reaffirmed.

Background: In older patients with heart failure, frailty assessment tools potentially have different prognostic value for all-cause mortality. Objective: To compare the Frailty Screening Index (FSI), FRAIL scale and Fried phenotype. Design: Post hoc analysis of the FRAGILE-HF study. Subjects: Hospitalised patients (age ≥ 65 years) with heart failure. Methods: We assessed frailty status at discharge, considered preadmission conditions of patients, using the FSI, FRAIL scale and Fried phenotype models and evaluated the primary outcome (2-year all-cause mortality), prognostic performance using Cox regression analysis (adjusted for the Meta-analysis Global Group in Chronic Heart Failure risk score and log-transformed B-type natriuretic peptide) and discriminative and reclassification abilities (area under the receiver-operating characteristic curve and continuous net reclassification improvement, respectively). Results: Among 961 patients [median age: 80 (IQR, 74–85) years; 41.5% women], frailty was identified in 48.5%, 44.5% and 55.8% by the FSI, FRAIL scale and Fried models, respectively. During the 2-year follow-up, 187 (19.5%) patients died. On Kaplan–Meier analysis, frailty defined by the FRAIL and Fried was associated with significantly lower survival; FSI showed no significant difference. Adjusted Cox models showed that frailty was independently associated [HR (95% CI)] with mortality in FRAIL [1.31 (1.01–1.71)] and Fried [1.35 (1.04–1.75)] but not FSI [1.11 (0.84–1.37)]. The Fried model, incorporated into the baseline model, yielded the highest incremental prognostic value for 2-year all-cause mortality. Conclusions: Frailty assessment using different tools yields varying results, with notable differences in their prognostic value for 2-year all-cause mortality. The frailty assessment tool influences both frailty classification and risk stratification and warrants careful clinical selection.

Background: The prognostic value of handgrip strength, a simple and reliable indicator of sarcopenia, in older patients with heart failure remains uncertain. This study aimed to investigate the prognostic value of handgrip strength in hospitalized patients aged ≥65 years with heart failure. Methods: This post hoc analysis used data from FRAGILE‐HF (Prevalence and Prognostic Value of Physical and Social Frailty in Geriatric Patients Hospitalized for Heart Failure), a prospective, multicenter cohort study involving patients aged ≥65 years hospitalized for heart failure. Handgrip strength was measured before discharge using a dynamometer, with the higher value from 2 trials recorded. Measurements were standardized by dividing 28 and 18 kg for men and women, respectively, per 2019 Asian Working Group for Sarcopenia criteria. Patients were categorized into tertiles (tertile 1, highest; tertile 2, middle; and tertile 3, lowest). The primary outcome was 2‐year all‐cause death. Results: Among 1269 patients (median age, 81 years; 57.1% men), 275 died during follow‐up. Kaplan–Meier analysis revealed a stepwise increase in death across the lowest handgrip tertiles, which remained significant after multivariable adjustment (tertile 2 versus tertile 1: hazard ratio [HR], 1.64 [95% CI, 1.14–2.37]; P =0.007; tertile 3 versus tertile 1: HR, 2.03 [95% CI, 1.42–2.90]; P <0.001). The analysis using a linear model showed that the prognostic impact of reduced handgrip strength increased with age. Conclusions: Lower handgrip strength was independently associated with death in older patients with heart failure, with stronger associations observed in the oldest patients. These findings highlight the additional prognostic value of handgrip strength beyond conventional risk factors. Registration: URL: center6.umin.ac.jp ; Unique Identifier: UMIN000023929.

Aims: The Global Leadership Initiative on Sarcopenia (GLIS) defines sarcopenia based on muscle mass, muscle strength, and muscle-specific strength, considering physical performance as an outcome rather than a diagnostic criterion. This study aimed to evaluate whether the GLIS model can effectively assess the prognostic value and impaired physical performance in older patients with heart failure. A post hoc analysis of the FRAGILE-HF study, a multicentre prospective observational cohort study, was conducted. Methods and results: The analysis included 891 patients [median age: 81 (interquartile range: 74–86) years; 41.9% women] hospitalized for heart failure. Sarcopenia and possible sarcopenia were assessed using the GLIS model. The primary outcome was 2-year all-cause mortality, and the secondary outcome was impaired physical performance, including 6-min walk distance. According to the GLIS model, sarcopenia and possible sarcopenia were observed in 186 (20.9%) and 539 (60.5%) patients, respectively. Sarcopenia was associated with significantly increased 2-year mortality [adjusted hazard ratio 3.38, 95% confidence interval (CI) 1.74–6.56, P < 0.001]. Sarcopenia and possible sarcopenia were significantly associated with impaired physical performance. The diagnosis of sarcopenia based on the GLIS model provided superior prognostic discrimination compared to the diagnosis based on the conventional Asian Working Group for Sarcopenia 2019 model (net reclassification improvement 0.269, 95% CI 0.141–0.397, P < 0.001). Conclusion: The diagnosis of sarcopenia based on the GLIS model was associated with prognosis and impaired physical performance in older patients with heart failure.

Backgrounds Malnutrition is associated with increased risk of all-cause mortality in patients with acute heart failure (AHF). However, the increasing mortality risk associated with the severity of malnutrition in older adults with AHF remained unclear. We aimed to investigate the prognostic impact of malnutrition severity on all-cause mortality of older adults with AHF. Methods This single-center study included older adults (aged ≥65) hospitalized for AHF between 2019 and 2023. We used the Geriatric Nutritional Risk Index (GNRI) as a proxy for nutritional status, dividing patients into the normal (GNRI>98, n=64), mild risk (GNRI 92-98, n=54), moderate risk (GNRI 82-Results We included 214 patients (mean age, 85±8 years; male, 49%). During the median follow-up of 356 days (interquartile range, 66-919 days), 76 deaths were observed. In the patients’ background, worse GNRI was associated with older age, underweight, frailty, and anemia. Multivariable Cox hazard analysis revealed that moderate risk (HR, 2.69; 95%CI, 1.34-5.40; p=0.01) and severe risk (HR, 9.75; 95% CI, 4.30-22.10; pConclusions The moderate and severe GNRI risk categories were associated with higher all-cause mortality. Malnutrition severity assessed by the GNRI could be useful in estimating the risk of older adults with AHF, even in the oldest-old (those aged 85 years or older).

Aim: The six‐minute walk test (6MWT) allows patients to slow down, stop and rest as needed. However, the prognostic significance of 6MWT interruption remains unclear. Therefore, this study investigated the prognostic implications of 6MWT interruption in patients with heart failure (HF). Methods: Patients hospitalized with HF who underwent 6MWT before discharge were included. They were stratified into three groups: those who completed the 6MWT, those who interrupted the test because of dyspnea or leg fatigue and those who interrupted the test for other reasons. The primary outcome was 2‐year mortality. Results: In total, 1180 patients were analyzed; 749 completed the 6MWT, 341 interrupted it because of dyspnea or leg fatigue and 90 interrupted it for other reasons. During the 2‐year follow‐up period, 238 patients (20.2%) died. In the Kaplan–Meier analysis, 6MWT interruption due to dyspnea/leg fatigue was associated with a significantly higher 2‐year mortality rate, which remained significant even after adjustment for conventional risk factors, including the 6MWD and the Borg score measured after the 6MWT. However, 6MWT interruption for other reasons was not significantly associated with mortality. Conclusion: In hospitalized patients with HF, 6MWT interruption due to dyspnea or leg fatigue was independently associated with higher 2‐year mortality, regardless of the 6MWD. These findings suggest that 6MWT interruption might be a valuable prognostic marker for HF management. Geriatr Gerontol Int 2025; 25: 1475–1480 .

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