J-ACCESS investigation and nuclear cardiology in Japan: implications for heart failure

Area of Science:

• Cardiology
• Nuclear Cardiology
• Public Health

Background:

• Coronary heart disease is a global mortality cause, but heart failure (HF) prevalence is increasing in developed nations, notably Japan.
• Japan's HF demographic features an aging population and lower incidence of ischemic origins.
• Multicenter J-ACCESS investigations have provided extensive data on nuclear cardiology practice and prognosis over two decades in Japan.

Purpose of the Study:

• To clarify the background and reasons for the high proportion of severe HF events in Japan.
• To identify predictors of major adverse cardiac events in patients undergoing nuclear cardiology examinations.
• To emphasize risk-based approaches for optimal medical therapy and coronary revascularization.

Main Methods:

• Analysis of data from the multicenter prognostic J-ACCESS investigations (Series 1-4).
• Identification of predictors for major adverse cardiac events and severe HF requiring hospitalization.
• Review of clinical guidelines regarding non-invasive imaging for chronic coronary artery disease.

Main Results:

• While hard cardiac events are less frequent in Japan than in the USA/Europe, similar predictors for major adverse cardiac events were identified.
• Severe heart failure requiring hospitalization constituted the largest proportion (50-75%) of major events in J-ACCESS registries.
• Age, myocardial perfusion defects, left ventricular dysfunction, diabetes, and chronic kidney disease are key predictors of cardiovascular events, including severe HF.

Conclusions:

• The high incidence of severe HF events in Japan warrants further investigation into underlying factors.
• Risk stratification incorporating age, cardiac function, perfusion defects, and comorbidities is crucial for managing cardiovascular events.
• Updated clinical guidelines highlight the importance of non-invasive imaging and risk-based strategies for chronic coronary artery disease management.