1: Clinical Utility of the H2FPEF Score in Patients with Early Atrial Fibrillation

J Am Coll Cardiol HF.

Feb 14, 2024. Epublished DOI: 10.1016/j.jchf.2023.12.011

Reina Hirano, Nobuhiro Ikemura, Dan Nguyen, Philip G Jones, Takehiro Kimur, Yoshinori Katsumata, Ikuko Ueda, Seiji Takatsuki, John A. Spertus, and Shun Kohsaka

Atrial fibrillation is the most common arrhythmia in adults, but the subsequent development of heart failure is a major problem. In particular, heart failure with preserved ejection fraction (HFpEF)—a type where the ejection fraction is preserved (i.e., the echocardiogram appears normal)—is difficult to diagnose and is often overlooked or its treatment delayed. The H ₂ FPEF score has traditionally been recommended to aid in the diagnosis of HFpEF (and is also adopted in Japan's clinical practice guidelines). This H ₂ FPEF score is calculated using a combination of symptoms and test results, but it has primarily targeted only cases of dyspnea, and unfortunately, its effectiveness in patients with atrial fibrillation had not been studied. Therefore, with the help of Keio University Hospital and 10 affiliated institutions, we collected data from approximately 1,800 patients newly diagnosed with atrial fibrillation, followed them for two years, and analyzed the association between the H ₂ FPEF score and prognosis (we are truly grateful to the doctors at each institution for their immense support). The results showed that a high H ₂ FPEF score was associated with a risk of hospitalization for heart failure. Additionally, it was demonstrated that for these patients, conventional atrial fibrillation treatment alone resulted in poor improvement in symptoms and QOL. Regarding the treatment of HFpEF, effective specific therapies (such as SGLT2 inhibitors) have recently been introduced. We believe that the findings of our study can contribute to the early identification of patients at high risk for heart failure and the implementation of these treatments at the appropriate time.

Finally, for the publication of this research, the first author received guidance from many mentors since her student days. We would like to take this opportunity to express our deepest gratitude.

(Shun Kohsaka [76th graduating class], Reina Hirano [102nd graduating class], and Nobuhiro Ikemura, Department of Cardiology)

Journal of Thoracic Oncology.

2024;19(1):52-70.

Fang WT, Girard N, Cilento V, Goren E, Dibaba D, Ruffini E, Ahmad U, Appel S, Bille A, Boubia S, Brambilla C, Cangir AK, Detterbeck F, Falkson C, Filosso PL, Giaccone G, Guerrera F, Huang JM, Infante M, Kim DK, Lucchi M, Marino M, Marom EM, Nicholson AG, Okumura M, Rami-Porta R, Rimner A, Simone CB, II, Asamura H.

This paper, published by the International Association for the Study of Lung Cancer (IASLC) in the Journal of Thoracic Oncology (JTO), presents the proposed revisions for the 9th edition of the TNM classification for thymic epithelial tumors, which will take effect in 2024. The TNM classification is a system defined by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) that describes the anatomical extent of a tumor as a stage, based on three components: the primary tumor (T), lymph node metastasis (N), and distant metastasis (M). It is established for malignant tumors in almost all organs. In modern cancer treatment, determining the stage classification is a crucial step in the initial phase of treatment planning, and treatment is administered accordingly. The classification is revised every seven years, and 2024 is the year the 9th edition takes effect. This paper is the IASLC's publication of these revisions. Incidentally, for the three thoracic malignancies—lung cancer, thymic tumors, and malignant pleural mesothelioma—the actual revision work is handled by the IASLC's Staging and Prognostic Factors Committee. As the committee chair, I oversaw this work, and this paper is one of a total of 28 papers planned by the committee. For thymic tumors, the N and M classifications have been redefined in this revision, which has led to a better separation of survival curves for each stage of thymic carcinoma in particular (see figure). The revision work for the 10th edition at the IASLC has already begun, and the introduction of non-anatomical factors is being considered.

(Hisao Asamura, Department of Thoracic Surgery, Tokyo Dental College Ichikawa General Hospital)