Efficacy and safety of remote cardiac rehabilitation in the recovery phase of cardiovascular diseases (RecRCR study): A multicenter, nonrandomized, and interventional trial in Japan.

Backgrounds: Remote cardiac rehabilitation has proven useful in patients with cardiovascular disease; however, the methodology had not been fully validated. This study aimed to investigate the efficacy and safety of remote cardiac rehabilitation (RCR) with real-time monitoring and an ergometer using a bidirectional communication tool during the recovery phase of cardiovascular diseases. Methods: This multicenter, nonrandomized, interventional study was conducted at 29 institutions across Japan and enrolled patients with cardiovascular diseases who met indications for cardiac rehabilitation (CR) after receiving in-hospital treatment. The RCR group exercised at home using an ergometer and was monitored in real-time using interactive video and monitoring tools for 2-3 months. Educational instructions were provided concurrently through e-learning approaches. The safety of the RCR protocol and the improvement in peak oxygen consumption (VO2) were compared with those of the historical control group that participated in center-based CR. Results: Fifty-three patients from the RCR group were compared with 103 historical controls having similar background characteristics. No patients in RCR experienced significant cardiovascular complications while engaging in exercise sessions. After 2-3 months of RCR, the peak VO2 improved significantly, and the increases in the RCR group did not exhibit any significant differences compared to those in the historical controls. During follow-up, the proportion of patients whose exercise capacity increased by 10% or more was also evaluated; this finding did not indicate a statistically significant distinction between the groups. Conclusions: RCR during the recovery phase of cardiovascular diseases proved equally efficient and safe as center-based CR.

A case report of recovery of sinus node abnormalities associated with right atrial involvement of 'early-stage' cardiac sarcoidosis.

Background: Cardiac sarcoidosis (CS) is a chronic inflammatory disease characterized by impaired contractility of the myocardium secondary to cardiac conduction system abnormalities, which result in atrio-ventricular (AV) conduction block and ventricular tachyarrhythmias. Notably, sinus node (SN) abnormalities are rarely associated with CS. Case summary: We herein present a case of CS presenting with SN abnormalities associated with atrial involvement of the CS and describe the utility of cardiac magnetic resonance imaging (cMRI), fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG-PET-CT) scans, and cardiac biopsy, in making an initial early diagnosis of early-stage CS. Fortunately, an initial appropriate immunosuppression therapy with methylprednisolone for the CS thus far can help the SN and AV conduction function recover and has provided a good clinical course without the implantation of a pacemaker or implantable cardio-defibrillator. Discussion: Although the diagnosis of CS may be elusive, the initial clinical suspicion and use of advanced imaging may be important for an early diagnosis of CS. Furthermore, because CS may sometimes rapidly progress, the early diagnosis and treatment of early-stage CS may also be important to help the SN and AV conduction function recover, and avoid implantation of a pacemaker, as in this present case.

Achievement rate of blood pressure <140/90 mmHg and <130/80 mmHg in subjects with hypertension; findings from a Japanese health checkup in 2017.

Blood pressure (BP) control status was investigated using data of a health checkup held in a Japanese city. In fiscal year 2017, 54,287 persons (age, 40-74 years; males, 49%) underwent the checkup; 28,167 examinees had a systolic BP ≥140 mmHg, a diastolic BP ≥90 mmHg, or took antihypertensive agents. Of these subjects, 20,153 subjects took antihypertensive agents. A BP <140/90 was achieved in 66.6% (13,426) of the treated subjects; however, a BP <130/80 was achieved only in 30.7% (6,188). In conclusion, in 2017, although a relatively large proportion of treated subjects achieved a BP <140/90 mmHg with antihypertensive agents, only approximately half of these subjects reached a BP <130/80 mmHg, which is the latest treatment target for persons aged 75 years or less according to the Japanese hypertension guidelines 2019.

Relationship among multifaceted factors including blood pressure at discharge and long-term clinical outcome in patients with cardiovascular diseases.

The relationship among blood pressure (BP) levels at discharge, other multifaceted factors assessed in cardiac rehabilitation programs, and prognosis for up to 2 years was examined in 154 consecutive cases (132 patients; 69 males; 79 ± 12 years, mean ± SD). A total of 72 composite events occurred (58 rehospitalizations from cardiovascular causes and 14 all-cause death events). The relationship between the systolic BP (SBP) at discharge and the long-term prognosis formed a J-shaped curve, with the event rate being lowest in patients with SBP of 115-125 mmHg. This relationship was still significant after adjustment of multifaceted factors assessed in cardiac rehabilitation programs.

Low diastolic blood pressure was one of the independent predictors of ischemia-like findings of electrocardiogram in patients who underwent coronary angiography.

BACKGROUND: The underlying cause of a high cardiovascular event rate in the population with low diastolic blood pressure (DBP) has not been fully elucidated. METHODS AND RESULTS: The relationship between DBP and ischemia-like findings on electrocardiography (ECG) was investigated in 187 patients who underwent coronary angiography. Patients with conditions affecting ECG (e.g. patients taking digitalis or those with old myocardial infarction, complete right bundle branch block, or hypokalemia) were excluded from the analyses. Ischemia-like ECG was defined as having one or more of the following: borderline Q wave [Minnesota code (MC) I 3], ST depression (MC IV 1-3), negative T wave (MC V 1-3), and complete left bundle branch block (MC VII 1). Based on this definition, 70 of 187 patients (37%) had ischemia-like ECG. Compared with the group without it, the group with ischemia-like ECG included more females (p<0.01), and had lower values of body mass index (p = 0.01), DBP (p<0.01), estimated glomerular filtration rate (p<0.01), left ventricular ejection fraction (LVEF; p<0.01), and higher values of age (p<0.01) and left ventricular mass index (LVMI; p<0.01). The severity of coronary artery disease did not differ between the groups. Receiver operating characteristics curve analysis revealed that 74.5 mmHg was the optimal cut-off point of DBP to predict ischemia-like ECG (area under curve, 0.63; 95% confidence interval, 0.55-0.71, p = 0.003). There were no significant relationships between systolic blood pressure and ischemia-like ECG. A multivariate analysis showed that female sex, low DBP (≤ 74.5 mmHg), LVMI, and LVEF were the significant factors for the ischemia-like ECG. The odds ratio of low DBP was 2.53 (95% confidence interval, 1.19-5.40; p = 0.02). CONCLUSIONS: Low DBP was one of the significant predictors of the ischemia-like ECG in the present study. Myocardial ischemia may be a part of the cause of high cardiovascular morbidity in the population with low DBP.

Effects of intravenous nicorandil on the mid-term prognosis of patients with acute heart failure syndrome.

BACKGROUND: Acute heart failure syndrome (AHFS) remains a major clinical challenge because of its poor prognosis. Nicorandil, a hybrid compound of a potassium-channel opener and nitric oxide donor, has been reported to improve the prognosis of ischemic heart disease. We sought to evaluate the effect of intravenous nicorandil on the mid-term prognosis of AHFS. METHODS AND RESULTS: A total of 402 consecutive patients who were hospitalized for AHFS were divided into 2 groups according to the use of intravenous nicorandil: 78 patients in the Nicorandil group and 324 patients in the Control group. During the 180-day follow-up, death or rehospitalization for heart failure occurred in 7 patients in the Nicorandil group (9.0%) and in 75 patients (23.2%) in the Control group. Event-free survival rates were significantly higher in the Nicorandil group than in the Control group (P=0.006). Multivariate Cox hazard analysis revealed that age (hazard ratio (HR)=1.066, P<0.0001), systolic blood pressure (HR=0.983, P=0.0023), New York Heart Association class III/IV (HR=6.550, P<0.0001), log creatinine (HR=3.866, P=0.0106), and use of intravenous nicorandil (HR=0.179, P<0.0001) were significant predictive factors for the occurrence of death or rehospitalization for heart failure. CONCLUSIONS: Intravenous nicorandil treatment from the urgent phase of AHFS may improve the prognosis.