Seiko Ide

Background: We investigated the prognostic significance of angiographic thrombus burden in acute coronary syndromes and explored underlying plaque vulnerability features using optical coherence tomography (OCT). Methods: The prospective, multicenter OPTICO‐ACS (Optical‐Coherence Tomography in Acute Coronary Syndrome) study included 300 patients with acute coronary syndromes undergoing percutaneous coronary intervention. Angiographic thrombus burden (TB) was classified as high (HTB) and low, and optical coherence tomography was used to assess underlying culprit lesion morphology. Plaque vulnerability was defined by >2 features among thin‐cap fibroatheroma, large lipid arc (>180°), microcalcifications, and macrophage infiltration. The primary outcome was major adverse cardiac events, defined as cardiac death, nonfatal myocardial infarction, stroke, target vessel revascularization, or revascularization for angina. Secondary outcomes comprised individual components of the primary composite outcome and all‐cause mortality. Results: Patients with HTB displayed a higher prevalence of plaque vulnerability than those with low TB (89.0% versus 75.3%; P =0.002). Vulnerable plaques were independently associated with HTB (adjusted odds ratio, 2.5 [95% CI, 1.31–4.89]; P =0.005). At a median follow‐up of 12 months, patients with HTB had a significantly higher incidence of short‐term (12.3% versus 1.4%; P P =0.04) major adverse cardiac events. In multivariable Cox regression, HTB was identified as an independent predictor of long‐term major adverse cardiac events (adjusted hazard ratio, 2.2 [95% CI, 1.23–3.98]; P =0.008), whereas underlying plaque vulnerability did not. Conclusions: In acute coronary syndromes, culprit plaques with vulnerable morphology were associated with larger intracoronary thrombus, which was associated with adverse clinical outcomes after percutaneous coronary intervention. TB may represent the active and prognostically relevant expression of plaque vulnerability, bridging morphological instability and clinical outcomes. Registration: URL: https://clinicaltrials.gov/study/NCT03129503 .

Background: We investigated whether radiomic scores (RadScores), computed from high‐dimensional quantitative features extracted from cardiac magnetic resonance parametric mapping images, can predict left ventricular reverse remodeling (LVRR) in patients with nonischemic dilated cardiomyopathy. Methods: This retrospective analysis included 74 patients with nonischemic dilated cardiomyopathy who received optimized medical therapy and underwent cardiac magnetic resonance. LVRR was defined as a left ventricular ejection fraction ≥40% with ≥10% increase at least 180 days after cardiac magnetic resonance. RadScores were calculated for each case as linear combinations of selected radiomic features, with coefficients derived from least absolute shrinkage and selection operator–penalized logistic regression on native longitudinal relaxation time (T1) and extracellular volume (ECV) fraction maps. Predictive performance for LVRR was evaluated using logistic regression and receiver operating characteristic analyses. Results: Patients with LVRR (n=31, 42%) had higher T1‐RadScore (0.72±1.52 versus −1.54±2.66; P P =0.005), lower mean‐ECV (31.5%±3.8% versus 34.9%±6.0%; P =0.004), and lower extent of late gadolinium enhancement (0.19±0.58 versus 2.99±6.5; P =0.047) than those without LVRR. The area under the receiver operating characteristic curve for predicting LVRR was 0.834 (95% CI, 0.716–0.909) for the T1‐RadScore and 0.718 (95% CI, 0.573–0.827) for the ECV‐RadScore. Adding T1‐ and ECV‐RadScore combination to the extent of late gadolinium enhancement model significantly improved the area under the receiver operating characteristic curve from 0.618 to 0.903 ( P <0.0001). Conclusions: Radiomic scores extracted from native T1 and ECV maps may enhance LVRR prediction and provide incremental value beyond traditional late gadolinium enhancement assessment in patients with dilated cardiomyopathy.

Dilated cardiomyopathy (DCM) is a genetically heterogeneous disorder, characterized by ventricular dilatation and impaired systolic function, leading to heart failure and sudden cardiac death. Despite advances in genomic technologies, the genetic cause of DCM remains unidentified in more than half of the cases. Here, we performed an integrative analysis of genomic and transcriptomic data from patient-derived cardiac tissue to identify causative variants in genetically undiagnosed DCM. This approach enabled us to identify a homozygous splice-site variant (c.243+6T>A) in the sarcoglycan gene SGCB , which results in exon 2 skipping. This variant was significantly enriched in patients with DCM compared with the general population, with consistent genotype–phenotype correlations observed across multiple families. Protein-level analysis of cardiac tissue from homozygous individuals revealed loss of β-sarcoglycan, the protein product of SGCB , and destabilization of the sarcoglycan complex. Although SGCB has been previously associated with limb-girdle muscular dystrophy, these homozygous individuals showed no biochemical or clinical signs of skeletal muscle involvement, indicating an absence of myopathy. Compared with variant-negative patients with DCM, homozygous individuals also had a higher risk of early-onset adverse cardiac events. Together, these findings identify c.243+6T>A in SGCB as a cause of isolated DCM associated with unfavorable clinical outcomes.

This study validates the usefulness of myocardial strain analysis with cardiac cine magnetic resonance imaging (MRI) by evaluating the changes in the cardiac function and myocardial strain values longitudinally in a myocardial disease model. Six eight-week-old male Wistar rats were used as a model of myocardial infarction (MI). Cine images were taken in the short axis, two-chamber view longitudinal axis, and four-chamber view longitudinal axis directions in rats 3 and 9 days after MI and in control rats, with preclinical 7-T MRI. The control images and the images on days 3 and 9 were evaluated by measuring the ventricular ejection fraction (EF) and the strain values in the circumferential (CS), radial (RS), and longitudinal directions (LS). The CS decreased significantly 3 days after MI, but there was no difference between the images on days 3 and 9. The two-chamber view LS was −9.7 ± 2.1% at 3 days and −13.9 ± 1.4% at 9 days after MI. The four-chamber view LS was −9.9 ± 1.5% at 3 days and −11.9 ± 1.3% at 9 days after MI. Both the two- and four-chamber LS values were significantly decreased 3 days after MI. Myocardial strain analysis is, therefore, useful for assessing the pathophysiology of MI.

Frequency of alcohol drinking is a potential predictor of binge drinking of alcohol, a serious social problem for university students. Although previous studies have identified skipping breakfast as a predictor of various health-compromising behaviors and cardiometabolic diseases, few studies have assessed the association between skipping breakfast and the incidence of frequent alcohol drinking. This retrospective cohort study included 17,380 male and 8799 female university students aged 18–22 years admitted to Osaka universities between 2004 and 2015. The association between breakfast frequency (eating every day, skipping occasionally, and skipping often/usually) and the incidence of frequent alcohol drinking, defined as drinking ≥4 days/week, was assessed using multivariable-adjusted Cox proportional hazards models. During the median observational period of 3.0 years, 878 (5.1%) men and 190 (2.2%) women engaged in frequent alcohol drinking. Skipping breakfast was significantly associated with the incidence of frequent alcohol drinking (adjusted hazard ratios [95% confidence interval] of eating every day, skipping occasionally, and skipping often/usually: 1.00 [reference], 1.02 [0.84–1.25], and 1.48 [1.17–1.88] in men; 1.00 [reference], 1.60 [1.03–2.49], and 3.14 [1.88–5.24] in women, respectively). University students who skipped breakfast were at a higher risk of frequent alcohol drinking than those who ate breakfast every day.

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