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Scarring of the left atrial (LA) wall from atrial ablation (AF) leads to the development of stiff LA syndrome. Multiple ablation treatments have been considered to be associated with the development of LA calcification (LAC). We report a case of wild-type transthyretin cardiac amyloidosis (CA) who presented with worsening heart failure due to stiff LA syndrome despite the condition after initial ablation for AF. The case had LAC along the ablation point, a reduced LA reservoir strain by echocardiography, and a characteristic pulmonary artery wedge pressure waveform with markedly elevated v wave by right cardiac catheter examination consistent with stiff LA syndrome. Notably, in patients with CA, there may be a causal relationship between ablation for AF and LAC and development of stiff LA syndrome. When we encounter patients with worsening heart failure with CA after AF ablation, we should pay additional attention to stiff LA syndrome. • In the case of worsening heart failure in patients who have undergone left atrial (LA) catheter ablation, the possibility of stiff LA syndrome due to calcification of the LA should be considered. • A detailed assessment of hemodynamics by echocardiography and right heart catheterization is useful for diagnosis of stiff LA syndrome. • In patients with cardiac amyloidosis treated with radiofrequency catheter ablation for atrial fibrillation, additional attention should be given to calcification of the LA and stiff LA syndrome. [ABSTRACT FROM AUTHOR]

Aims: A fourth heart sound (S4) was reported to be almost never present in patients with amyloid light‐chain cardiomyopathy. There have been no reports on S4 in patients with wild‐type transthyretin amyloid cardiomyopathy (ATTRwt‐CM). This study aimed to clarify the clinical implications of S4 in patients with ATTRwt‐CM. Methods and results: Seventy‐six patients with ATTRwt‐CM (mean age: 80.4 ± 5.4 years, 68 males) who had undergone phonocardiography (PCG) were retrospectively assessed. We measured S4 amplitude on digitally recorded PCG. S4 was considered to be present when its amplitude was 1.0 mm or greater on the PCG. Distinct S4 was defined as S4 with an amplitude of 2.0 mm or greater, which is usually recognizable by auscultation. According to the rhythm and presence or absence of S4, the patients were divided into three groups, namely, sinus rhythm (SR) with S4, SR without S4, and non‐SR. Non‐SR consisted of atrial fibrillation, atrial flutter, and atrial tachycardia. Thirty‐six patients were in SR and the remaining 40 patients were in non‐SR. In the 36 patients in SR, S4 was shown by PCG to be present in 17 patients (47%), and distinct S4 was recognized in 7 patients (19%) by auscultation. In patients who were in SR, those with S4 had higher systolic blood pressure (124 ± 15 vs. 99 ± 8 mmHg, P < 0.001), lower level of plasma B‐type natriuretic peptide (308 [interquartile range (IQR): 165, 354] vs. 508 [389, 765] pg/mL, P = 0.034) and lower level of high‐sensitivity cardiac troponin T (0.068 [0.046, 0.089] vs. 0.109 [0.063, 0.148] ng/mL, P = 0.042) than those without S4. There was no significant difference in left atrium (LA) volume index or LA reservoir strain between patients with S4 and without S4. Patients with S4 had more preserved LA systolic function than those without S4 (peak atrial filling velocity: 53 ± 25 vs. 34 ± 9 cm/s, P = 0.033; LA contractile strain: 4.1 ± 2.1 vs. 1.6 ± 2.0%, P = 0.012). Patients in SR without S4 had worse short‐term prognosis compared with the other two groups (generalized Wilcoxon test, P = 0.033). Conclusions: S4 was present in 47% of the patients in SR with ATTRwt‐CM. Patients in SR without S4 had more impaired LA systolic function than those in SR with S4. The absence of S4 portends a poor short‐term prognosis in patients with ATTRwt‐CM. [ABSTRACT FROM AUTHOR]

This article discusses the use of allogenic haematopoietic stem cell transplantation (HSCT) as a potential treatment for subcutaneous panniculitis-like T-cell lymphoma (SPTCL) with a specific genetic mutation. SPTCL is a rare disease with no agreed-upon treatment. The study focuses on one patient who did not respond to other treatments and received HSCT from a sibling donor. The patient achieved complete remission, suggesting that HSCT could be an effective therapy for SPTCL patients with this genetic mutation. The article also includes a table summarizing the characteristics and treatment outcomes of 13 SPTCL patients from diverse ethnic backgrounds. The study was funded by the Japan Society for the Promotion of Science and declares no conflicts of interest. [Extracted from the article]

Aims: This study aimed to evaluate the impact of frailty and living function domains based on the Kihon Checklist (KCL), a questionnaire for a comprehensive frailty assessment, on prognosis in patients with acute heart failure (AHF). Methods and results: The Kochi Registry of Subjects with Acute Decompensated Heart Failure (Kochi YOSACOI) study was a prospective multicentre cohort study enrolling 1061 patients hospitalized for AHF from May 2017 to December 2019 in Japan. We divided patients into three groups according to the severity of frailty using the KCL and compared clinical outcomes after discharge. The primary endpoint was all‐cause death, and the secondary outcomes were cardiovascular death, heart failure (HF) rehospitalization, and the composite event of cardiovascular death and HF rehospitalization. Of 936 patients (median age, 81 years; 48.9% women) who could be assessed for frailty, we identified frailty in 501 patients (53.5%), prefrailty in 290 patients (31.0%), and non‐frailty in 145 patients (15.5%). Compared with prefrail and non‐frail patients, frail patients were older (83 vs. 79 and 72 years, P < 0.001), were more likely to be women (53.9% vs. 43.1% and 43.4%, P = 0.005), and were more likely to have a history of previous HF hospitalization (35.4% vs. 25.3% and 19.6%, P < 0.001) and multimorbidity (90.8% vs. 81.0% and 73.8%, P < 0.001). Frail patients had a lower rate of discharge to home (79.7% vs. 94.8% and 96.5%, P < 0.001). During the 2 year follow‐up period, frail patients had a higher incidence rate of all‐cause death, cardiovascular death, and HF rehospitalization (log‐rank P < 0.001, P < 0.001, and P = 0.003, respectively). After adjusting for other prognostic factors, multivariate analysis showed that frailty was associated with all‐cause death [adjusted hazard ratio (HR): 2.917, 95% confidence interval (CI): 1.326–6.417, P = 0.008] and cardiovascular death (adjusted HR: 7.026, 95% CI: 1.700–29.030, P = 0.007). Among all domains of the KCL, the cognitive function domain was associated with a higher risk of all‐cause death (P = 0.004) and cardiovascular death (P < 0.001). The depression domain remained associated with a higher risk of HF rehospitalization (P = 0.045). The risk for all‐cause death increased with an increase in total KCL score (adjusted HR: 1.819, 95% CI: 1.300–2.547, P < 0.001). Conclusions: The KCL is a useful tool for risk stratification of adverse outcomes in patients with AHF. Functional declines in psycho‐emotional domains including cognitive function and depressed mood contribute to adverse outcomes. [ABSTRACT FROM AUTHOR]