Min-Seok Kim

Ahn J, et al. Korean Circ J. 2027 ;57:e56. https://doi.org/10.4070/kcj.2025.0368

Background: Limited information exists regarding whether coronary revascularization by percutaneous coronary intervention (PCI) prior to left ventricular assist device (LVAD) implantation improves outcomes. This study aimed to investigate the clinical impact of complete revascularization (CR) by PCI before LVAD implantation in patients with severe ischemic cardiomyopathy (ICM). Methods: From July 2013 to August 2024, data were retrospectively collected from all patients who underwent LVAD implantation at two tertiary referral hospitals. ICM patients were selected, and those who did not undergo coronary evaluation before LVAD implantation or who received a coronary artery bypass graft within one year were excluded from the analysis. Primary outcome was all‐cause mortality at 2 years following LVAD implantation according to CR status. Results: Among the 118 patients included in the study, 42 (35.6%) patients underwent CR by PCI within 1 year before LVAD implantation. All‐cause death occurred in 18.3% of the patients in the CR group and 22.8% in the incomplete revascularization group (hazard ratio, 0.76; 95% confidence interval, 0.31–1.86; p = 0.554). There was also no significant difference in hospitalization for heart failure, ventricular arrhythmias, progressive right ventricular failure, or heart transplantation between patients in the CR group and those in the incomplete revascularization group. No acute coronary syndrome occurred during LVAD support regardless of CR status. Conclusion: CR by PCI before LVAD implantation in patients with severe ICM did not improve clinical outcomes following LVAD therapy. These findings suggest that revascularization should be carefully considered on a case‐by‐case basis, weighing potential risks and benefits.

Ventricular arrhythmias (VAs) are frequently observed in patients awaiting or who have already undergone left ventricular assist device (LVAD) implantation. However, the impact of LVAD implantation on the burden of VAs and the prognostic significance of postoperative VAs remain unclear. Between June 2015 and July 2024, 108 patients who underwent LVAD implantation were retrospectively analyzed. The burden of VAs was defined as the total number of documented VAs or implantable cardioverter-defibrillator therapies, including anti-tachycardia pacing and appropriate shocks. The incidence and burden of VAs before and after LVAD implantation were compared, and factors associated with postoperative VAs were evaluated using multivariable regression analysis. Among the 108 patients who successfully underwent LVAD implantation, the prevalence of VAs decreased after implantation (39.8% [n = 43] vs 25.9% [n = 28], P < .01). However, there was no significant difference in the burden of VAs before and after LVAD implantation (4.30 ± 31.42 vs 2.89 ± 13.11 events/mo, P = .50). The incidence of VAs, anti-tachycardia pacing, and appropriate shocks did not significantly decrease after LVAD implantation (2.34 ± 16.89 vs 2.26 ± 13.04, P = .26; 1.22 ± 7.68 vs 0.91 ± 5.82, P = .58; and 0.88 ± 7.24 vs 0.28 ± 1.29, P = .21, respectively). Multivariable regression analysis showed that only preoperative VAs were associated with postoperative VAs (hazard ratio 15.6 [95% confidence interval, 3.70–64.49]; P < .01). There was no significant difference in survival according to the occurrence of postoperative VAs ( P = .94). LVAD implantation does not reduce the burden of VAs. A history of preoperative VAs remains a strong risk factor for postoperative VAs. However, even if VAs occurred after LVAD implantation, the mortality risk did not increase.

Kim K, et al. Korean Circ J. 2026 ;56:e81. https://doi.org/10.4070/kcj.2025.0405

Objectives: In-hospital cardiac arrest (IHCA) is associated with high mortality and serious neurological sequelae. Although medical alert systems have evolved, the ability of these systems to influence changes in IHCA incidence and aetiology remains limited. Designs: Retrospective observational cohort study. Settings: A single tertiary hospital in South Korea, covering tertiary care levels. Participants: A total of 1994 adult patients (≥18 years) who experienced 2121 episodes of IHCA between January 2011 and December 2019. Patients with out-of-hospital cardiac arrest, those aged ≤18 years and those with do-not-resuscitate orders were excluded. The mean age of patients was 63.0 years (SD, 14.6); 64.1% were male. Interventions: Not applicable. Main outcome measures: The incidence and temporal trends of IHCA were stratified by aetiology (cardiac vs non-cardiac). Additional analyses examined changes in arrhythmic versus non-arrhythmic causes over time using Poisson regression. Results: Cardiac arrhythmia was the most common cause of IHCA (314 of 2121, 14.8%; incidence: 0.42/1000 admissions), including ventricular tachycardia (n=86), ventricular fibrillation (n=87) and Torsades de Pointes (n=79). Respiratory failure was the second most common cause (266 of 2121, 12.5%; incidence: 0.36/1000 admissions). The incidence of IHCA due to respiratory failure in 2011 was 0.63/1000 admissions, which decreased to 0.20/1000 admissions by 2019 (β=0.883, 95% CI 0.842 to 0.926, p for trend 0.007; Poisson p<0.001). In contrast, the incidence of IHCA due to arrhythmia in 2011 was 0.49/1000 admissions and remained similar over time (0.29/1000 admissions in 2019, β=0.972, 95% CI 0.932 to 1.015, p for trend 0.194; Poisson p=0.198). Conclusion: IHCA causes have shown significant temporal shifts. Arrhythmia has become the leading cause of IHCA, with incidences remaining stable, whereas a marked decrease has been observed in respiratory-related IHCA. Therefore, enhanced in-hospital cardiac monitoring systems are required for early detection.

BACKGROUND: The timing of surgery in asymptomatic severe mitral regurgitation remains controversial. This observational study sought to compare long-term outcomes of early surgery with a conventional treatment strategy in asymptomatic patients with severe mitral regurgitation. METHODS: From 1996 to 2016, a total of 1063 consecutive asymptomatic patients (673 men; mean±SD age, 51±14 years) with severe degenerative mitral regurgitation and preserved left ventricular function were enrolled, and followed prospectively for a median of 12 years (interquartile range, 8–17 years). Early surgery was performed on 545 patients and the conventional treatment strategy was chosen for 518 patients. We compared overall and cardiac mortality rates between these 2 treatment strategies using propensity score adjustment. RESULTS: In the early surgery group, no operative deaths occurred, and mitral valve repair was successfully performed in 97% of patients. During follow-up, 8 (1.5%) patients in the early surgery group and 54 (10.4%) in the conventional management group died from cardiovascular causes (hazard ratio, 0.17 [95% CI, 0.07–0.40]; P P =0.046). For the 358 propensity score matched pairs, the early surgery group had a significantly lower risk of cardiac mortality than the conventional treatment group (hazard ratio, 0.18 [95% CI, 0.08–0.43]; P P =0.002). Compared with the conventional treatment group, the early surgery group also had a significantly lower risk of overall mortality (hazard ratio, 0.66 [95% CI, 0.47–0.93]; P =0.018) and significantly lower overall mortality rates (28.2% versus 33.9% at 20 years; P =0.015). CONCLUSIONS: Compared with conventional management, early surgery is associated with better long-term outcomes among asymptomatic patients with severe mitral regurgitation and preserved left ventricular function. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01703806.

Purpose: Apixaban is recommended for patients with atrial fibrillation. Although routine monitoring of plasma concentrations is not typically advised, factors such as ethnicity, sex, and comorbidities can influence these levels. Our study analyzed the plasma apixaban concentrations (PAC) in patients to explore whether these levels, along with underlying conditions, offer enhanced insights for risk stratification. Methods: This study analyzed 49 patients with atrial fibrillation who had been taking apixaban for over a month, examined factor Xa levels within 6 h post-administration, and correlated PAC with clinical characteristics such as age, body weight, estimated glomerular filtration rate (eGFR), presence of heart failure, and bleeding events. Results: The mean plasma concentration of apixaban in all patients was 160.3 ± 77.5 ng/mL. Those taking apixaban 5 mg twice daily had higher plasma concentrations than those taking 2.5 mg twice daily (191.2 ± 75.3 ng/mL vs. 137.2 ± 72.0 ng/mL, p = 0.014). Among the patients receiving a reduced dose, renal function and heart failure were significantly associated with plasma concentrations. No factors were associated with the plasma concentrations in patients receiving the standard dose. Notably, reduced-dose patients with heart failure had plasma concentrations comparable to those of individuals receiving the standard dose and exhibited a higher incidence of bleeding than the other groups. Conclusions: PAC measurement revealed that apixaban dosages, classified based on age, body weight, and eGFR, were generally effective. Nonetheless, heart failure may increase plasma levels and correlate with an increased bleeding risk in Korean patients on reduced doses. Therefore, tailoring apixaban prescriptions to account for heart failure and other comorbidities may enhance treatment efficacy.

Background: The timing of surgery in asymptomatic severe mitral regurgitation (MR) remains controversial. This study sought to compare long-term outcomes of early surgery with a conventional treatment strategy in asymptomatic patients with severe MR. Methods: From 1996 to 2016, a total of 1,063 consecutive asymptomatic patients (673 men, age; 51±14 years) with severe degenerative MR and preserved left ventricular function were enrolled, and followed prospectively for a median of 12 years (interquartile range: 8 to 17 years). Early surgery was performed on 545 patients, while the conventional treatment strategy was chosen for 518. We compared overall and cardiac mortality between these two treatment strategies using propensity score adjustment. Results: In the early surgery group, there was no operative mortality and mitral valve repair was successfully performed in 97% of patients. During follow-up, 8 patients (1.5%) in the early surgery group and 54 (10.4%) in the conventional management group died from cardiovascular causes (hazard ratio [HR], 0.17; 95% CI, 0.15 to 0.64; P = 0.001). A total of 74 deaths (13.6%) from any cause occurred in the early surgery group, whereas 116 (22.4%) occurred in the conventional management group (HR, 0.72; 95% CI, 0.52 to 0.99; P = 0.046). For the 358 propensity-score matched pairs, the early surgery group had a significantly lower risk of cardiac mortality than the conventional treatment group (HR, 0.18; 95% CI, 0.08 to 0.43; P < 0.001) and significantly lower cardiac mortality rates (5.6% vs. 17.4 % at 20 years; P < 0.001). Compared with the conventional treatment group, the early surgery group also had a significantly lower risk of overall mortality (HR, 0.66; 95% CI, 0.47 to 0.93; P = 0.018) and significantly lower overall mortality rates (28.2% vs. 33.9% at 20 years; P = 0.022). Conclusions: Compared with conventional management, early surgery is associated with reduced long-term cardiac and overall mortality among asymptomatic patients with severe MR and preserved left ventricular function (ClinicalTrials.gov number, NCT01703806 ).

Hyun J, et al. Korean Circ J. 2025 Jul;55:e105. https://doi.org/10.4070/kcj.2025.0052