Akira Taruya

Background: It remains debated whether just ostial stenting (JOS) or crossover stenting (COS) is optimal for isolated ostial lesions of the left anterior descending (LAD) artery, and available comparative data on intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) remains limited. We aim to compare clinical outcomes between the strategies and identify determinants of strategy selection. Methods and results: This retrospective study included 172 patients with isolated ostial LAD lesions who underwent IVI-guided PCI with either JOS ( n = 112) or COS ( n = 60) between 2018 and 2025. The primary endpoint was two-year major adverse cardiac events (MACEs), defined as all-cause mortality, myocardial infarction, and any revascularization. MACE rates did not differ significantly in both strategies (23% vs.17%; adjusted hazard ratio: 0.74; 95% confidence interval [CI]: 0.37–1.49; P = 0.40). LAD diameter on angiography (odds ratio [OR] 2.04, 95% CI 1.03–4.05, P = 0.040) and LAD proximal reference area measured by IVI (OR 1.26, 95% CI 1.02–1.55, P = 0.033) were independently associated with selecting JOS over COS. Optimal minimum stent areas (MSA) were achieved in most cases in both groups (89% vs. 98%, P = 0.032). Conclusions: Under IVI-guided PCI, clinical outcomes showed no significant difference between JOS and COS, and LAD anatomy determined the strategy. These findings support individualized, anatomy-driven technique selection and IVI-guided procedural optimization for ostial LAD lesions.

Background: Non-dilated left ventricular cardiomyopathy (NDLVC) is a newly defined cardiomyopathy phenotype. The presence of non‑ischemic late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is a characteristic finding in NDLVC; however, the prognostic value of multiple LGE lesions remains unclear. This study investigated whether multiple scarring on LGE-CMR is associated with adverse outcomes in patients with NDLVC.Methods: We retrospectively analysed consecutive patients who underwent CMR at Wakayama Medical University Hospital between 2014 and 2024. Multiple scarring was defined as two or more LGE lesions located in non-adjacent left ventricular (LV) segments. The primary endpoint was a composite of sudden cardiac death (SCD), aborted SCD, and hospitalization for worsening heart failure.Results: Among 1,385 patients, 109 fulfilled the diagnostic criteria for NDLVC, including 22 with multiple scarring and 87 without it. Over a median follow-up of 1,103 days, composite cardiac events occurred in six patients (27%) with multiple scarring and six patients (6.9%) without it. Most adverse events (83%) in the multiple scarring group were SCD or aborted SCD, highlighting their predominantly arrhythmic nature. Event-free survival was significantly lower in patients with multiple scarring (log-rank P = 0.003). Multiple scarring remained an independent predictor of adverse cardiac outcomes after adjustment for age, sex, and LV ejection fraction <40% (adjusted hazard ratio 4.19, 95% confidence interval 1.29–13.62, P = 0.017).Conclusions: Multiple scarring on LGE-CMR independently predicts adverse cardiac events and may serve as a simple and clinically meaningful marker for stratifying the risk of malignant ventricular arrhythmias.

Background: Visceral fat (VF), particularly epicardial adipose tissue (EAT), plays a crucial role in the development of coronary artery disease (CAD). Cathelicidin (LL37) is an antimicrobial peptide involved in innate immunity and has been implicated in inflammatory processes. However, the relationship between VF accumulation, cathelicidin, and atherosclerosis remains unclear.Methods and Results: Seventy-eight subjects without CAD were enrolled and classified by obesity type: normal-weight (normal; n=20), subcutaneous fat (SF; n=19), and VF (n=39). Plasma LL37 concentrations were compared across groups. LL37 expression in EAT was assessed in 9 patients undergoing open-heart surgery, stratified by CAD status. In animal experiments, angiotensin II-infused wild-type and Apoe−/−mice fed a Western-type diet were treated with cathelicidin-related antimicrobial peptide (CRAMP) small interfering RNA (siRNA), scrambled siRNA, or vehicle. Atherosclerotic lesions were evaluated by enface Sudan IV staining. Plasma LL37 concentrations were higher in the VF than in the normal-weight and SF groups (median [IQR] 99.11 [91.70–129.86] vs. 58.63 [50.03–70.05] and 69.81 [54.64–87.39] ng/mL, respectively; P<0.001) and were correlated with VF area and EAT volume. LL37 expression in EAT was higher in patients with than without CAD (2.34 [2.06–3.90] % vs. 1.34 [0.81–1.49] %; P=0.034). Treatment with CRAMP siRNA significantly reduced atherosclerotic lesion area in Apoe−/−mice without affecting blood pressure or lipid profiles.Conclusions: LL37 is associated with VF accumulation and CAD. However, these findings are exploratory and warrant prospective validation to determine its potential utility as a biomarker.

There is a lack of established methods to explore the etiology of sudden cardiac arrest. We herein report sudden cardiac arrest as pulseless electrical activity in a young woman triggered by coronary artery spasm. There were no health issues except for situs inversus totalis, but the patient experienced sudden cardiac arrest after suffering chest pain. ST-segment depression was observed in leads V3-V6 on electrocardiography. However, urgent angiography did not reveal any coronary stenosis. Cardiac magnetic resonance imaging revealed myocardial edema localized to the inferior and posterior segments without evidence of late gadolinium enhancement. Additionally, a provocation test with acetylcholine confirmed a coronary artery spasm. Inexplicable sudden cardiac arrest may result in missing the chance to detect hidden cardiac disease. Cardiac MRI may help to elucidate the etiology of sudden cardiac arrest.

Introduction: Insufficient nutrient intake is a strong independent predictor of mortality in elderly patients with heart failure. However, it is unclear to what extent energy intake affects their prognosis. This study investigated the association between patient outcomes and actual measured energy intake in elderly patients (≥65 years) with heart failure. Methods: This study enrolled 139 elderly patients who were hospitalized with worsening heart failure at Shingu Municipal Medical Center, Shingu, Japan, between May 2017 and April 2018. Energy intake was evaluated for three days (from three days prior to the day of discharge until the day of discharge). Based on basal energy expenditure calculated using the Harris–Benedict equation, the patients were classified into a low-energy group (n = 38) and a high-energy group (n = 101). We assessed the prognosis in terms of both all-cause mortality and readmission due to worsening heart failure as a primary outcome. Results: Compared to the patients in the high-energy group, the patients in the low-energy group were predominantly female, less frequently had smoking habits and ischemic heart diseases, and had a higher left ventricular ejection fraction. The low-energy group had higher mortality than the high-energy group (p = 0.028), although the two groups showed equivalent event rates of the primary outcome (p = 0.569). Conclusion: Calculations based on the Harris–Benedict equation revealed no significant difference in the primary outcome between the two groups, with a secondary outcome that showed worse mortality in the low-energy group. Given this result, energy requirement-based assessments using the Harris–Benedict equation might help in the management of elderly heart failure patients in terms of improved life outcomes.

Background: Deep vein thrombosis (DVT) is a common peripheral vascular disease arising from endothelial damage and can frequently result in pulmonary embolism. C-C chemokine receptor 5 (CCR5) is essentially involved in skin wound healing and pulmonary fibrosis, but the role of CCR5 still remains elusive. Methods: Deep vein thrombus was induced by the ligation of the inferior vena cava (IVC) in wild-type (WT) mice and Ccr5 ^-/- mice, and thrombi were collected over time and various analyzes were performed. Results: After ligation of the IVC in WT mice, a venous thrombus developed progressively until 5 days, and then resolved. Concomitantly, IVC ligation enhanced intrathrombotic gene and protein expression of Ccr5 and its ligand, Ccl5 , and both were expressed mainly by intrathrombotic macrophages. The same treatment of Ccr5 ^-/- mice resulted in significantly greater thrombus mass than WT mice. Moreover, the administration of a specific CCR5 inhibitor to WT mice recapitulated similar phenotypes as Ccr5 ^-/- mice while that of CCL5 caused the opposite phenotypes. In Ccr5 ^-/- mice, the production of intrathrombotic vascular endothelial growth factor (VEGF), tissue plasminogen activator (tPA), and urokinase-type plasminogen activator (uPA) from macrophages was significantly reduced and intrathrombotic recanalization was also suppressed compared to WT mice. Moreover, CCL5 enhanced Vegf, Plat, and Plau gene expression in WT - derived peritoneal macrophages by activating the ERK MAPK signaling pathway in vitro. Conclusions: CCR5-deficient mice exhibited reduced expression of Vegf, Plat, and Plau, with concomitant attenuated neovascularization and reduced thrombus resolution. the Thus, the augmentation of the CCL5-CCR5 axis may be effective for DVT treatment by enhancing thrombolysis.

Refractory angina is an independent predictor of adverse events in patients with vasospastic angina (VSA). The aim of this study was to investigate the relationship between coronary lumen complexity and refractory symptoms in patients with VSA. Seventeen patients with VSA underwent optical coherence tomography. The patients were divided into the refractory VSA group (n = 9) and the stable VSA group (n = 8). A shoreline development index was used to assess the coronary artery lumen complexity. Shear stress was estimated using a computational fluid dynamics model. No difference was observed in the baseline characteristics between the two groups. The refractory VSA group showed the higher shoreline development index (refractory VSA 1.042 [1.017–1.188] vs stable VSA 1.003 [1.006–1.025], p = 0.036), and higher maximum medial thickness (refractory VSA 184 ± 17 μm vs stable VSA 148 ± 31 μm, p = 0.017), and higher maximum shear stress (refractory VSA 14.5 [12.1–18.8] Pa vs stable VSA 5.6 [3.0–10.5] Pa, p = 0.003). The shoreline development index positively correlates with shear stress (R² = 0.46, P = 0.004). Increased medial thickness of the coronary arteries provokes lumen complexity and high shear stress, which might cause refractory symptoms in patients with VSA. The shoreline index could serve as a marker for irritability of the medial layer of coronary arteries and symptoms.