Nagoya Heart Center

In congenital diaphragmatic hernia, postoperative right-left asymmetry of pulmonary perfusion affects outcome. Although pulmonary perfusion scintigraphy (PPS) is widely used to assess pulmonary perfusion, it requires the use of radionuclides and peripheral venous access. In contrast, dynamic digital radiography (DDR) visualizes and analyzes pulmonary perfusion by extracting subtle changes in X-ray attenuation from sequential images acquired using a pulsed X-ray generator and a flat-panel detector. This study aimed to evaluate the accuracy of DDR for assessing pulmonary perfusion in children and verify the associated radiation dose. Consecutive congenital diaphragmatic hernia survivors aged 5-7years scheduled for routine PPS between January 2024 and June 2025 underwent DDR on the same day. The images were analyzed using a dedicated workstation. For each modality, we calculated the blood-flow ratio in the affected lung and assessed the agreement using Pearson correlation and Bland-Altman analysis. Effective doses were also compared. Thirteen children (median age, 6.07years; 10 left-sided diaphragmatic hernia) were included in the study. DDR-derived blood-flow ratio strongly correlated with PPS (r=0.977, P<0.01), with absolute inter-method blood-flow ratio differences <5%. Neither fixed nor proportional bias was observed. The median effective dose for DDR was 0.16mSv-significantly lower than that for PPS (2.09mSv). The blood-flow ratio calculated using DDR correlated well with the scintigraphy results. DDR could serve as a minimally invasive, low-dose alternative to PPS for the evaluation of pulmonary perfusion. Future validation in a broader pediatric population is warranted.

Owing to the aging population, patients are increasingly undergoing endovascular therapy (EVT) for chronic limb-threatening ischemia (CLTI). CLTI onset causes patients to become increasingly frail and less able to perform daily activities, preventing their discharge home. However, the association of discharge destination with clinical backgrounds and outcomes in these patients has not been fully evaluated. In this study, data from 606 patients with CLTI who underwent EVT between March 2021 and December 2023 and survived to discharge were obtained from a multicenter registry (mean age, 74.5 years; 61.4% men). Non-home discharge was defined as transfer to another hospital or nursing home. Logistic regression analysis was used to identify independent predictors of non-home discharge. Mortality rates within two years of discharge were compared between the home and non-home discharge groups. Of the 606 patients, 108 underwent non-home discharge. Multivariate analysis identified mild frailty (odds ratio [OR] 2.32, 95% confidence interval [CI] 1.34-4.02, p = 0.003), advanced frailty (OR 3.50, 95% CI 1.95-6.28, p < 0.001), a Hemoglobin level < 11 g/dL (OR 1.87, 95% CI 1.15-3.02, p = 0.011), and a Wound, Ischemia, and Foot Infection grade 4 (OR 7.27, 95% CI 2.16-24.46, p = 0.001) as significant predictors of non-home discharge. During the two-year follow-up period, 161 patients died. Cumulative all-cause mortality was significantly higher in the non-home discharge group than in the home discharge group (58.6% vs. 33.7%; log-rank p < 0.001). The findings of this study reveal that non-home discharge occurred in one-sixth of patients with CLTI undergoing EVT, and was linked to a more severe clinical status and worse prognosis than home discharge.

The management of very low-gradient (LG) severe aortic stenosis (AS) remains challenging. Moreover, limited evidence exists regarding the outcomes of patients with very LG severe AS following transcatheter aortic valve implantation (TAVI). Weaimedto elucidate the prognosis of patients with very LG severe AS after TAVI and the influence of flow status. Data were retrospectively collected from the OCEAN-TAVI multicenter registry in Japan, including patients with severe AS who underwent TAVI. In total, 7103 patients were classified into three groups based on their baseline mean pressure gradient (MPG): very LG (MPG ≤ 20 mmHg), LG (20 < MPG < 40 mmHg), and high-gradient (HG) (MPG ≥ 40 mmHg). The primary endpoint was a composite of all-cause mortality and hospitalization for heart failure. During a median follow-up period of 741 days, the composite endpoint was reached in 2081 patients. Patients with very LG severe AS had a higher prevalence of comorbidities. Kaplan-Meier analysis showed that very LG severe AS was associated with significantly lower event-free survival compared to that with LG and HG severe AS. Multivariable Cox regression analysis identified very LG severe AS as an independent poor prognostic indicator, regardless of the flow state. Moreover, within the very LG severe AS group, a low body mass index and myocardial infarction history were associated with worse outcomes. This study indicates that patients with very LG severe AS have worse prognoses compared to those with LG or HG severe AS following TAVI, regardless of the flow state.

Transcatheter edge-to-edge repair (TEER) is used to treat patients with mitral regurgitation(MR).The Geriatric Nutritional Risk Index (GNRI) is a well-known nutritional marker that predictsmortality risk. The objectives of this study were to elucidate the clinical association between the degree of GNRI and different etiologies of MR and to clarify the patient samples for whom GNRI is more relevant to clinical outcomes following TEER. Data from 3,554 patients with MR who underwent TEER were analyzed using a Japanese multicenter registry. The patients were classified into 4 groups: GNRI<82, GNRI 82 to 92, GNRI 92 to 98, and GNRI >98. Procedural and clinical outcomes were compared between GNRI groups. Short- and long-term all-cause mortality were explored using Cox regression analysis. Among the 3,554 patients, the median GNRI was 92.3. The mean follow-up period was 586.8±436.5days; 806 patients died during the follow-up period. Thirty-day mortality occurred in 51 patients (1.4%), and the GNRI<82 group had the highest 30-day mortality rate. Kaplan-Meier curves showed significantly better prognoses for the entire cohort, functional MR, and degenerative MR across the 4 groups (P<0.001). GNRI values, even after adjustment for multiple confounders, showed a stepwise increase in risk of death in the GNRI 92 to 98, GNRI 82 to 92, and GNRI<82 groups compared to GNRI >98 as the reference. Regardless of MR etiology, GNRI is a useful predictor of short- and long-term mortality in patients undergoing TEER. Although TEER is effective for MR patients in malnourished states, further studies focused on the value of identifying and addressing malnutrition in this population are needed.

Paclitaxel-coated balloons (PCBs) are widely used for femoropopliteal artery (FPA) diseases. However, data on recurrence and recurrence patterns after PCB angioplasty are limited. This study investigated the association between recurrence patterns, baseline characteristics, and clinical outcomes in the cases following PCB angioplasty. This multicenter, retrospective study included 1159 limbs in 1031 patients treated for de novo FPA lesions using PCBs. Patients were classified into three groups (patency, restenosis, and reocclusion) according to patency or recurrence patterns within 2 years after the index PCB angioplasty. The primary outcome was the incidence of target lesion revascularization (TLR), and the secondary outcome was the pattern of re-recurrence within 2 years following TLR using PCBs. When comparing the three groups, reocclusive cases were characterized by more complex lesions, including chronic total occlusion, at baseline. Following the index PCB angioplasty, approximately 70% of recurrent cases underwent TLR, which was performed more frequently in reocclusive than in restenotic cases (82.1% vs 63.7%). Conversely, a higher percentage of restenotic cases did not require TLR compared to reocclusive cases (10.3% vs 27.8%). In cases where TLR was performed using PCBs, the rate of re-recurrence with occlusive morphology was significantly higher in reocclusive than in restenotic cases (52.3% vs 24.3%). After PCB angioplasty for FPA lesions, symptomatic recurrence and requirement for TLR were more frequent in reocclusive cases. Even after TLR using PCBs, reocclusive cases tend to recur with occlusion.