Public assistance in patients with acute heart failure: a report from the KCHF registry.

AIMS: There is a scarcity of data on the post-discharge prognosis in acute heart failure (AHF) patients with a low-income but receiving public assistance. The study sought to evaluate the differences in the clinical characteristics and outcomes between AHF patients receiving public assistance and those not receiving public assistance. METHODS AND RESULTS: The Kyoto Congestive Heart Failure registry was a physician-initiated, prospective, observational, multicentre cohort study enrolling 4056 consecutive patients who were hospitalized due to AHF for the first time between October 2014 and March 2016. The present study population consisted of 3728 patients who were discharged alive from the index AHF hospitalization. We divided the patients into two groups, those receiving public assistance and those not receiving public assistance. After assessing the proportional hazard assumption of public assistance as a variable, we constructed multivariable Cox proportional hazard models to estimate the risk of the public assistance group relative to the no public assistance group. There were 218 patients (5.8%) receiving public assistance and 3510 (94%) not receiving public assistance. Patients in the public assistance group were younger, more frequently had chronic coronary artery disease, previous heart failure hospitalizations, current smoking, poor medical adherence, living alone, no occupation, and a lower left ventricular ejection fraction than those in the no public assistance group. During a median follow-up of 470 days, the cumulative 1 year incidences of all-cause death and heart failure hospitalizations after discharge did not differ between the public assistance group and no public assistance group (13.3% vs. 17.4%, P = 0.10, and 28.3% vs. 23.8%, P = 0.25, respectively). After adjusting for the confounders, the risk of the public assistance group relative to the no public assistance group remained insignificant for all-cause death [hazard ratio (HR), 0.97; 95% confidence interval (CI), 0.69-1.32; P = 0.84]. Even after taking into account the competing risk of all-cause death, the adjusted risk within 180 days in the public assistance group relative to the no public assistance group remained insignificant for heart failure hospitalizations (HR, 0.93; 95% CI, 0.64-1.34; P = 0.69), while the adjusted risk beyond 180 days was significant (HR, 1.56; 95% CI, 1.07-2.29; P = 0.02). CONCLUSIONS: The AHF patients receiving public assistance as compared with those not receiving public assistance had no significant excess risk for all-cause death at 1 year after discharge or a heart failure hospitalization within 180 days after discharge, while they did have a significant excess risk for heart failure hospitalizations beyond 180 days after discharge. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT02334891 (NCT02334891) and https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000017241 (UMIN000015238).

Differences in coronary plaque morphology between East Asian and Western White patients: an optical coherence tomography study.

AIMS: Prevalence of coronary artery disease as well as cardiac mortality varies between Asian and White patients. However, the link between race and plaque characteristics in patients with coronary artery disease remains largely unexplored. Thus, we aimed to investigate the detailed culprit plaque characteristics between East Asian and White patients using optical coherence tomography. PATIENTS AND METHODS: A total of 101 East Asians were matched to 101 White patients. Matching parameters included age, sex, clinical presentation, hyperlipidemia, diabetes mellitus, and lesion location. RESULTS: There were no differences in underlying pathology (rupture vs. erosion) of acute coronary syndrome (P=0.935). Lesion length was longer (18.0±6.0 vs. 14.6±5.4 mm; P<0.002), lipid length was greater (9.4±4.6 vs. 7.2±3.8 mm; P<0.023), lipid index was higher (1635±987 vs. 1104±730; P=0.002), and mean reference area was larger (8.1±3.0 vs. 6.5±2.4 mm; P<0.021) in White patients compared with East Asian patients. CONCLUSION: There are significant differences in plaque morphology between East Asian and White patients even after controlling for confounders. Our findings underscore key differences in atherosclerosis between East Asian and White populations, and may have to be taken into consideration when interpreting the results of future research.

A novel guidewire-integrated embolic protection filter device with a handy-folding system: In vitro and in vivo performance assessment.

OBJECTIVES: We developed a novel guidewire-integrated filter device with a handy-folding system (IFD: Inoue filter device). In vitro and in vivo studies were conducted to evaluate the feasibilityof the IFD. BACKGROUND: Although distal atheromatous and thrombotic embolizations remain unresolved critical issues during catheter interventions, distal protection devices are infrequently used partly because of reduced lower maneuverability. METHODS: In the in vitro experiment, we created an experimental circulation model composed of silicone latex tubes, a reservoir, and a roller pump. After the filter device was deployed in the tube, polystyrene fluorescent microspheres were injected and the capture rate was calculated. Ten trials were performed using the IFD and Spider FX. In the in vivo study, five independent operators deployed, and they retrieved the IFD in swine common iliac and internal carotid arteries. The procedural success rate as well as the delivery and retrieval time was evaluated. RESULTS: In the in vitro study, the mean capture rate was 94% and 35% in the IFD and Spider groups, respectively. In the in vivo study, all procedures were successful, with no complications. The mean delivery time was 281 ± 87 s and 194 ± 67 s and the mean retrieval time was 24 ± 9 and 13 ±1 s in the left internal carotid and the left common iliac arteries, respectively. CONCLUSION: Although further studies and improvements are required, the study results indicate that the IFD is feasible.

In vitro assessment of physiological impact of recipient artery intervention on the contralateral donor artery.

BACKGROUND: Donor artery fractional flow reserve (FFR) often improves after treatment of recipient artery stenosis, but the physiological mechanism underlying this phenomenon has not been elucidated. This study aimed to assess two novel equations that explain the donor-recipient artery interaction. METHOD: Eq. (A) predicts the donor artery FFR after complete release of recipient artery stenosis, while Eq. (B) predicts the donor artery FFR after partial release of recipient artery stenosis. Eq. (B) is a general form of Eq. (A). FFR'1−pred = ((FFR1−CFI1)(FFR2−CFI2)−CFI1CFI2(1−FFR1)(1−FFR2)+CFI1(1−FFR1)(1−CFI2))/((1−C FI1)(FFR2−CFI2)) (A) FFR''1−pred = ((FFR1−CFI1)(FFR2−CFI2)−CFI1CFI2(1−FFR1)(1−FFR2)+CFI1(1−FFR1)(1−CFI2))FFR'2/((1−C FI1)(FFR2−CFI2)) (B) Eqs. (A) and (B) were assessed using an in vitro model of coronary circulation with a collateral channel connecting the donor and recipient arteries. RESULTS: The donor artery FFR always improved after releasing the recipient artery stenosis. A good linear correlation was found between the predicted FFR of Eq. (A) and the actual FFR (n=40, r=0.95, p<0.0001) and between the predicted FFR of Eq. (B) and the actual FFR (n=40, r=0.94, p<0.0001). CONCLUSIONS: Eqs. (A) and (B) accurately predicted the true FFR value of the donor artery in a coronary circulation model and explain the donor-recipient artery interaction observed in clinical practice.

In vitro assessment of mathematically-derived fractional flow reserve in coronary lesions with more than two sequential stenoses.

BACKGROUND: Myocardial fractional flow reserve (FFR) is a reliable index in coronary intervention. A simple FFR measurement does not predict the true functional severity of an individual stenosis in multiple sequential coronary stenoses because of complex interaction between the stenoses. Application of the theoretical equations to predict the true FFR of individual stenosis is limited in a tandem lesion. Two novel equations applicable to a multiple sequential coronary stenoses are mathematically derived. One predicts the true FFR of each stenosis (equation A), and the other predicts the true FFR after releasing a given stenosis (equation B). The present study aimed to validate the two derived equations in an in vitro model of coronary circulation. METHODS AND RESULTS: Predictive FFR was compared with true FFR in an in vitro model of three sequential stenoses using linear regression analysis. The difference between apparent FFR and true FFR was compared with the difference between predictive FFR and true FFR. The legitimacy of equation A was first assessed. A close correlation was found between predictive FFR and true FFR (r² = 0.92). The difference between predictive FFR and true FFR was significantly lower compared to the difference between apparent FFR and true FFR (0.18 ± 0.10 vs 0.05 ± 0.05; P<.001). The legitimacy of equation B was also assessed, and a close correlation was found (r² = 0.97). The difference was significantly lower when we applied equation B (0.13 ± 0.06 vs 0.04 ± 0.02; P<.001). CONCLUSIONS: Equations A and B strongly predict the true value of FFR in the experimental model of coronary circulation.