A novel telemonitoring system utilizing contactless sensor technologies combined with automated overnight respiratory stability time (RST) analysis has emerged as a sensitive and specific indicator of early deteriorating heart failure (HF). However, the association between RST and clinical parameters, including hemodynamics, remains unclear. Patients admitted to our institute due to worsening HF between February and December 2025 and underwent RST monitoring and simultaneous right heart catheterization were enrolled in this study. The relationship between RST and patient characteristics, hemodynamic parameters, and clinical outcomes was retrospectively investigated. A total of 30 patients (median age, 75 years; 70% male) were included. RST was negatively correlated with the number of HF hospitalizations, serum creatinine, plasma B-type natriuretic peptide, pulmonary artery pressure and dose of loop diuretics. During a median follow-up of 178 days, a lower RST (≤ 25s) group showed a numerically higher cumulative incidence of the composite outcomes of HF readmission and all-cause death compared with the higher RST group (50.6% versus 0%, p = 0.019). Lower RST may reflect heart failure severity, including pulmonary congestion. Further research is warranted to establish the clinical efficacy of RST-guided HF management.

As Japan becomes an aging society, the number of patients with heart failure (HF) is increasing. The European Society of Cardiology guidelines recommend noninvasive ICT monitoring from the perspective of self-care and team medical care; however, evidence regarding the effectiveness of remote monitoring in Japan is limited. This study assessed the usefulness of OMRON Connect with the Health Data Monitoring System, which provides simultaneous sharing of biomonitoring data of patients with HF using wireless devices. A prospective, single-arm, multicenter observational study for 84 days was performed, including 30 patients with HF (age 72 ± 5.6 years, male, n = 19). They were introduced to the measurement of body weight (BW), blood pressure (BP), electrocardiogram (ECG) recording, and patient-reported symptoms on a smartphone application (PRS on App) using OMRON Connect. The primary outcome was adherence to this system, and the secondary outcome included factors that influence adherence. The adherence measurements were as follows: BW, 97.0% (interquartile range [IQR] 92.3-100%); BP, 88.7% (IQR, 79.8-95.8%); and ECG, 88.7% (IQR, 64.9-94.1%). No patients dropped out during the 84-day period. No significant relationship was found between adherence and the following parameters: age, sex, prior HF admission, left ventricular ejection fraction, New York Heart Association class, serum brain natriuretic peptide level, renal function, cognitive impairment, and living alone or with family. However, the continuation rate of PRS on App gradually decreased to 53%. One of the patients was admitted for HF exacerbation, and this system could clearly detect BW increase before admission. In addition, fatal arrhythmias, such as a short run of premature ventricular contractions or advanced atrioventricular block, could be detected in ECG. The use of OMRON Connect for noninvasive ICT monitoring in patients with HF demonstrates good adherence in checking BP, BW change, and ECG changes. This method proves to be feasible for patient self-management and facilitates appropriate clinical intervention.

Accurate assessment of pulmonary congestion is essential for managing heart failure but remains challenging using conventional clinical methods. The Remote Dielectric Sensing (ReDS) system provides a non-invasive, objective measurement of lung fluid content. However, its high cost raises the question of whether clinicians can estimate congestion with similar accuracy without referencing such a technology. In this prospective study, 26 hospitalized patients with cardiovascular disease underwent ReDS measurement. A total of 112 ReDS value estimations were obtained from junior and senior clinicians, who were blinded to the actual values and estimated lung fluid content using routine clinical data. Estimation accuracy was evaluated using correlation analysis, Bland-Altman plots, and subgroup comparisons based on ReDS severity and clinician experience. Estimated and measured ReDS values showed a moderate correlation (R = 0.70, p < 0.001). However, more than 50% of estimations exhibited discrepancies of ≥ ± 3%, particularly in cases of mild congestion. Underestimation occurred in over 60% of cases and was more pronounced among senior clinicians. A regression formula incorporating estimated ReDS and B-type natriuretic peptide improved prediction accuracy (R = 0.78, p < 0.001). Clinicians frequently underestimate pulmonary congestion, especially when it is mild. This may lead to suboptimal diuretic management. The ReDS system can serve as a valuable adjunct to conventional assessment, particularly in less overt cases, and may enhance both diagnostic precision and therapeutic decision-making.

Patients with hyperuricemia may have an elevated risk of cardiovascular events. Owing to the relationship between uric acid (UA) levels and renal function, the impact of hyperuricemia may differ depending on the presence or absence of renal dysfunction. This study aimed to evaluate the impact of hyperuricemia on cardiac events in coronary artery disease (CAD) patients with or without renal dysfunction. This single-center observational study enrolled patients with stable CAD who underwent percutaneous coronary intervention. Hyperuricemia (high UA) was defined as a UA level ≥ 7mg/dL according to guideline criteria. The high- and low-UA groups were compared separately in patients with and without renal dysfunction, defined as an estimated glomerular filtration rate < 60mL/min/1.73 m2. The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, and hospitalization for heart failure. Overall, 1169 patients were included, with a mean age of 69.9 ± 9.8years; 80.3% were male. Hyperuricemia was present in 10.2% of patients without renal dysfunction (n = 616) and 32.0% of those with renal dysfunction (n = 553). The median follow-up period was 5.0years (interquartile range: 2.1-8.6years). Among patients without renal dysfunction, no significant difference was observed in MACE occurrence between the high- and low-UA groups (log-rank p = 0.19). In contrast, among patients with renal dysfunction, the incidence of MACE was higher in the high-UA group than in the low-UA group (log-rank p = 0.003). However, multivariable analyses indicated that high UA was not an independent predictor of MACE, even among patients with renal dysfunction. Hyperuricemia may serve as a useful marker for cardiac events, with a more apparent association in patients with renal dysfunction; however, UA itself may not have a direct causal role.

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.

Hemodynamic force (HDF) analysis using vector flow mapping (VFM) enables noninvasive assessment of intraventricular pressure differences (IVPDs). In this study, we evaluated the apical suction from late systole to early diastole in patients with ischemic heart disease (IHD) with or without left ventricular aneurysm (LVA), validated against simultaneous left atrial-LV pressure measurements. A total of 37 participants were evaluated: 11 healthy controls, 11 patients with IHD without LVA, and 15 with LVA. VFM-derived IVPDs were quantified as IVPD recoil (late systole) or IVPD RF (early diastole). Patients with LVA showed markedly reduced IVPD recoil and the combined parameter (IVPDVFM recoil + RF) compared with those with IHD, indicating impaired apical suction. IVPD RF and the combined parameter (IVPDVFM recoil + RF) correlated with transmitral E-wave (r = 0.54, P < 0.01 and r = 0.45, P = 0.03); the combined parameter (IVPDVFM recoil + RF) showed significant correlation with catheter-derived simultaneous pressure differences (r = 0.40, P < 0.05). These findings demonstrate that VFM identifies loss of apical suction in LVA and reflects impaired LA-LV driving force. VFM offers a practical noninvasive tool for evaluating diastolic suction beyond Doppler indices and may improve physiological assessment in post-infarction LV remodeling.

Elevated systolic blood pressure (SBP) increases myocardial oxygen demand, whereas low diastolic blood pressure (DBP) can impair coronary perfusion. The prognostic impact of this high-SBP/low-DBP (HSLD) profile in patients with ST-elevation myocardial infarction (STEMI) remains unknown. We analyzed 696 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (PCI) from a prospective 11-center registry in Japan. Patients were categorized based on pre-procedural SBP (≥ 120 mmHg) and DBP (< 70 mmHg) into four groups: high-SBP/low-DBP (HSLD) high-SBP/high-DBP (HSHD), low-SBP/high-DBP (LSHD), and low-SBP/low-DBP (LSLD). The primary endpoint was a 1-year composite of cardiovascular death, non-fatal myocardial infarction, or stroke. Median follow-up was 369 days. The 1-year cumulative incidence of the primary endpoint was 7 (9.5%) in the HSLD group, 19 (4.2%) in the HSHD group, 2 (2.8%) in the LSHD group, and 5 (6.0%) in the LSLD group (log-rank p = 0.007). In multivariable Cox regression, the HSLD was independently associated with the primary endpoint compared to the HSHD group (hazard ratio 3.20, 95% CI 1.04-9.87; p = 0.043). The prognostic value of HSLD was consistent across major subgroups. A pre-procedural blood pressure pattern of SBP ≥ 120 mmHg combined with DBP < 70 mmHg independently predicts a higher risk of adverse cardiovascular events at 1 year in patients with STEMI. This simple measurement at admission identifies a previously unrecognized high-risk phenotype and presents a valuable opportunity for early risk stratification.

This study aimed to evaluate the clinical utility of a novel mitral valve repair technique, the Referring to the Anterior, Fixing on the Frontal (RAFF) method, which improves anatomical precision and enhances the reproducibility of loop-type artificial chordae ("neochordae") reconstruction. This retrospective study included 67 individuals who underwent isolated, elective mitral valve repair with neochordae between 2019 and 2024. Participants were divided into the RAFF (n = 36) and non-RAFF (n = 31) groups. In the RAFF technique, chordal length is determined by referencing the anterior leaflet chordae from the ipsilateral papillary muscle, with loop sets anchored to the frontal head of the papillary muscle. Leaflet resection was not performed in any case. Baseline demographics and lesion characteristics were similar between groups. The RAFF group demonstrated significantly less residual mitral regurgitation at the conclusion of surgery (p = 0.014). Use of the RAFF method was significantly associated with suppression of postoperative leaflet billowing and a lower recurrence rate of moderate or greater mitral regurgitation during follow-up. Frontal fixation of posterior leaflet neochordae, a defining feature of the technique, resulted in a significant increase in coaptation length without inducing systolic anterior motion or elevating transvalvular gradients. The method also significantly reduced aortic cross-clamp time without compromising hemodynamic performance. The RAFF technique offers a standardized and anatomically guided approach to neochordae reconstruction. It minimizes inter-surgeon variability and anatomical inconsistencies, and promotes durable mitral competence by optimizing leaflet coaptation without incurring adverse events.