Korean Circulation Journal 대한심장학회지 순환기 Bak M, et al. Korean Circ J. 2023 Feb;53:e14. https://doi.org/10.4070/kcj.2022.0252

BACKGROUND: Moderate aortic stenosis (AS) poses a substantial risk for adverse outcomes, yet its prognostic determinants and cardiac remodeling markers remain underexplored. This study aimed to evaluate prognostic factors, including left atrial strain, and their predictive value for adverse cardiac events in patients with moderate AS. METHODS: A retrospective cohort study included 1125 patients diagnosed with moderate AS between 2008 and 2019. Cardiac remodeling indices, including left atrial reservoir strain (LARS) and left ventricular global longitudinal strain, were assessed using speckle-tracking echocardiography. The primary outcome was cardiac death, while the secondary outcome was a composite of cardiac death or heart failure hospitalization. RESULTS: Among the study population (median age, 74 years; 47.2% women), the Kaplan-Meier–estimated 5-year rates of cardiac mortality and the composite outcome were 16.7% and 33.9%, respectively, during a median follow-up of 42.8 months. Of the cardiac remodeling indices evaluated, LARS emerged as the most sensitive and independent predictor of cardiac death (adjusted hazard ratio, 0.948 per 1% increase; P =0.003) and the composite outcome (adjusted hazard ratio, 0.940 per 1% increase; P <0.001). Notably, the prognostic significance of reduced LARS persisted even after aortic valve replacement (hazard ratio, 2.177 for LARS <20.6% versus ≥20.6%; P =0.024). Furthermore, among all cardiac remodeling parameters analyzed, LARS showed the highest predictive performance for the composite outcome (C-index, 0.586 [95% CI, 0.541–0.632]) compared with other parameters. CONCLUSIONS: LARS is a sensitive and independent prognostic marker in moderate AS, reflecting cardiac remodeling. Regular assessment of left atrial strain could enhance risk stratification and guide clinical management strategies in patients with moderate AS.

Hyun J, et al. Korean Circ J. 2024 Dec;55:e29. https://doi.org/10.4070/kcj.2024.0229

Hong D, et al. Korean Circ J. 2025 May;55:e87. https://doi.org/10.4070/kcj.2024.0445

Background and Objectives: Optimal pharmacological treatment following left ventricular ejection fraction (LVEF) improvement remains largely unknown. This study compared the clinical outcomes of patients with heart failure (HF) with improved EF (HFimpEF) based on the maintenance of sacubitril/valsartan (S/V) or transition to a renin–angiotensin system blocker (RASB). Material and Method: A total of 354 patients with recovered LVEF of at least 40% after S/V treatment from a single center were retrospectively analyzed. Patients were categorized into three groups: those who continued S/V (n = 294), those who switched to RASB (n = 47), and those who discontinued both S/V and RASB (n = 13). The primary endpoint was HF relapse, defined as a two-fold increase in baseline serum N-terminal-pro hormone B-type natriuretic peptide (NT-proBNP) concentration exceeding 400 pg/dL. Secondary endpoints included the ratio and difference between baseline and peak NT-proBNP levels. Result: Baseline clinical characteristics were well balanced among groups. Over a median follow-up of 399 (252–589) days, HF relapse occurred more frequently in patients who discontinued both S/V and RASB compared to those who maintained either treatment (53.8% vs. 16.3% vs. 10.6%; p = 0.001). NT-proBNP levels also showed a more pronounced increase in this group. However, there were no significant differences in primary or secondary outcomes between the S/V and RASB groups. Conclusions: Our findings suggest that replacing S/V with another RASB does not worsen outcomes in patients with HFimpEF after S/V treatment, whereas discontinuation of both therapies is associated with a significantly higher risk of HF relapse. A prospective trial is warranted to confirm the safety and effectiveness of this approach in maintaining remission.

Background: Transthoracic echocardiography (TTE) requires time-intensive integration of quantitative measurements and qualitative visual assessment. Fully automated artificial intelligence (AI)-based analysis may reduce total analysis time while preserving accuracy, but systematic real-world validation remains limited. Methods: This prospective, single-center pilot study enrolled 40 TTE examinations. Identical deidentified DICOM datasets were independently provided to a trained cardiac sonographer and a fully automated AI system comprising quantitative and qualitative visual interpretation modules. All outputs were compared with a cardiologist-adjudicated reference standard. Primary endpoints were total analysis time and noninferiority of AI-derived left ventricular ejection fraction (LVEF) versus the reference standard, with a prespecified margin of 3 percentage points (one-sided α = 0.025). Results: Median analysis time was 94 s (interquartile range [IQR], 82–106 s) for the AI workflow versus 490 s (IQR, 438–626 s) for the human workflow (P < 0.001). AI-derived LVEF met the noninferiority criterion (mean difference, 0.00 percentage points; upper one-sided 95% confidence bound, 1.41 percentage points; P < 0.001), with an intraclass correlation coefficient (ICC) of 0.902 (95% confidence interval, 0.822–0.947). ICCs for secondary quantitative indices ranged from 0.625 to 0.989. For aortic regurgitation severity grading, AI’s overall accuracy was 75.0% (quadratic weighted κ = 0.762), compared with 82.5% for human interpretation (κ = 0.812, McNemar P = 0.579). Conclusions: Fully automated AI-assisted TTE analysis substantially reduced total analysis time while maintaining noninferior LVEF accuracy and acceptable performance across secondary quantitative and qualitative indices. These findings support the use of AI as a practical workflow accelerator in routine echocardiography.