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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]

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]

Aims: Guideline‐directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF) is recommended in clinical guidelines, but elderly patients have not fully received GDMT in the clinical situation. The aim of this study was to determine the clinical characteristics of patients who have not received GDMT and the association between implementation of GDMT at discharge and physical frailty in patients with HFrEF who were hospitalized for acute decompensated heart failure (ADHF). Methods and results: This study was a cross‐sectional study with a retrospective analysis of the Kochi YOSACOI study, a prospective multicentre observational study that enrolled 1061 patients hospitalized for ADHF from May 2017 to December 2019 in Japan. Of 339 patients (32.0%) with HFrEF, 268 patients who were assessed for physical frailty by the Japanese version of the Cardiovascular Health Study criteria were divided into two groups: those with GDMT (135 patients, 50.4%) and those without GDMT (133 patients, 49.6%). GDMT was defined as the prescription of a combination of renin‐angiotensin system (RAS) inhibitors (angiotensin‐converting inhibitors or angiotensin receptor blockers) and beta‐blockers. The median age of patients with HFrEF was 76 years (interquartile range, 67–83 years). Patients without GDMT were older than patients with GDMT (73 years vs. 78 years, P < 0.001). Patients without GDMT tended to have more prior HF admission than did patients with GDMT (P = 0.004), and patients without GDMT had lower levels of estimated glomerular filtration rate (P < 0.001) than those in patients with GDMT. Physical frailty was observed in 54.1% of the patients without GDMT and in 38.5% of the patients with GDMT (P = 0.014). Patients without GDMT had a higher rate of cognitive impairment than that in patients with GDMT (P = 0.009). RAS inhibitors only, beta‐blockers only, and both RAS inhibitors and beta‐blockers were less frequently prescribed in patients with physical frailty than in patients with physical non‐frailty (52.0% vs. 86.7%, P < 0.05; 70.1% vs. 100.0%, P < 0.05; 42.5% vs. 86.7%, P < 0.01, respectively). In logistic regression analysis, compared with physical non‐frailty, physical frailty was significantly associated with no implementation of GDMT (odds ratio: 6.900, 95% confidence interval: 1.420–33.600; P = 0.017), independent of older age and severe renal dysfunction. Conclusions: The results of this study suggest that physical frailty is one of the factors that may withhold GDMT in patients with HFrEF. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to elucidate the clinical characteristics, including frailty status, of patients with heart failure with preserved ejection fraction (HFpEF) in comparison with those in patients with heart failure with reduced ejection fraction (HFrEF) in a super-aged region of Japan. Methods and results Of the 1061 Japanese patients enrolled in the Kochi YOSACOI study, a multicentre registry, we divided 645 patients (median age of 81 years [interquartile range, 72–87 years]; women, 49.1%) into two groups, HFpEF patients (61.2%) and HFrEF patients (38.8%). Physical frailty was diagnosed on the basis of the Japanese version of Cardiovascular Health (J-CHS) Study criteria. Patients for whom left ventricular ejection fraction data were not available (n = 19), patients with heart failure with mildly reduced ejection fraction (n = 172), and patients who were not assessed by the J-CHS criteria (n = 225) were excluded. The median ages of the HFpEF and HFrEF patients were 84 and 76 years, respectively. The proportion of patients with HFpEF gradually increased with advance of age. The proportion of patients with three or more comorbidities was larger in HFpEF patients than in HFrEF patients (77.9% vs. 65.6%, P = 0.003). Handgrip strength was significantly lower in HFpEF patients than in HFrEF patients for both men (P < 0.001) and women (P = 0.041). Comfortable 5 m walking speed was significantly slower in HFpEF patients than in HFrEF patients (P < 0.001). The proportions of patients with physical frailty were 55.2% in HFpEF patients and 46.8% in HFrEF patients, and the proportion was significantly higher in HFpEF patients (P = 0.043). In multivariate analysis, physical frailty was associated with advanced age [odds ratio (OR), 1.030; 95% confidence interval (CI), 1.010–1.050; P = 0.023] and low albumin level (OR, 0.334; 95% CI, 0.192–0.582; P < 0.001) in HFpEF patients, and physical frailty was associated with women (OR, 2.150; 95% CI, 1.030–4.500; P = 0.042) and anaemia (OR, 2.840; 95% CI, 1.300–6.230; P = 0.003) in HFrEF patients. Conclusions In a super-aged population of HF patients in Japan, HFpEF patients are more likely to be frail/have a high frailty status compared with HFrEF patients. The results suggested that physical frailty is associated with extracardiac factors in both HFpEF patients and HFrEF patients. [ABSTRACT FROM AUTHOR]

The geometric structures and the static first- and second-order optical properties of 21 monosubstituted 8-hydroxyquinolines have been determined using the coupled perturbed Hartree-Fock ab inition extended basis set calculations. The halogen, nitro and amino substituent groups affect the alpha or beta polarizability of the 8-hydroxyquinoline samples. The basis set dependence of the calculated hyperpolarizabilities is consistent with the experimental and calculated results of standard samples. The method can be used in preparing aromatic heterocyclic compounds for nonlinear optical studies.

Aims: The aim of this study was to investigate clinical characteristics of frail patients based on a comprehensive frailty assessment in patients hospitalized for acute decompensated heart failure (HF) (ADHF) in super‐aged regional Japanese cohort. Methods and results: We established the Kochi Registry of Subjects with Acute Decompensated Heart Failure (Kochi YOSACOI) study, which was a prospective multicentre community‐based cohort study in six participating hospitals in Kochi Prefecture, Japan. We enrolled 1061 patients (median age, 81 years; 50.0% men) hospitalized for ADHF between June 2017 and December 2019 in this registry. Patients were classified into the three groups by the severity of frailty using the Kihon Checklist: we identified frailty in 510 patients (53.7%), prefrailty in 293 patients (30.9%), and non‐frailty in 146 patients (15.4%). Compared with prefrail and non‐frail patients, frail patients were older (84 years interquartile range [IQR, 77–88] vs. 79 years [IQR, 69–86] and 72 years [IQR 65–81], P < 0.001) and more often had prior HF hospitalization (29.6% vs. 21.8% and 16.4%, P < 0.05), chronic kidney disease (81.6% vs. 71.7% and 61.0%, P < 0.01), anaemia (75.3% vs. 61.4% and 50.0%, P < 0.001), cerebrovascular accident (19.0% vs. 9.9% and 4.1%, P < 0.01). The proportion of patients with three or more comorbidities was larger in the frailty group than in the other groups (78.0% vs. 67.2% and 63.0%, P < 0.01). The frequency of functional decline in all domains increased with frailty status. Approximately 70% of frail patients were identified as functional decline in physical function and socialization domains. Fifty to sixty per cent of frail patients had functional decline in instrumental activities of daily living, cognitive function, and depression domains. The percentage of worsening walking ability during hospitalization was increasing with the frailty status (frailty, 27.5%; prefrailty, 21.8%; non‐frailty, 8.9%). In multivariate logistic regression analysis, frailty was associated with age [odds ratio (OR) 1.031, 95% confidence interval (CI) 1.011–1.052, P = 0.003], prior HF hospitalization (OR 1.789, 95% CI 1.165–2.764, P = 0.008), brain natriuretic peptide level at discharge (OR 1.001, 95% CI 1.000–1.001, P = 0.020) and prior cerebrovascular accident (OR 2.549, 95% CI 1.484–4.501, P < 0.001). Conclusions: More than half of patients with ADHF were frail and had functional decline across multiple domains, not only physical function domain. The Kihon Checklist provided useful and valuable information for easily identifying frail patients and comprehensive management of HF. [ABSTRACT FROM AUTHOR]

The electronic structure and complex dielectric function of a model organic-inorganic superlattice (OISL) composed of organic tetracene and inorganic ZnSe were investigated at the atomic level by using a nonlocal density functional pseudopotential method and random phase approximation. It was found that the OISL has a two-dimensional electronic structure, similar to that of inorganic superlattices, and is a type II-misaligned superlattice confining electrons and holes in the ZnSe and tetracene layers, respectively. The misaligned magnitude of the OISL was estimated to be about 1.6 eV. Theoretical calculations clarified that the OISL is not a simple multilayered composite material composed of tetracene and ZnSe, but it is a material showing significant superlattice effects, in terms of its electronic structure and optical responses, owing to two-dimensionally delocalized electrons present in the ZnSe layers. [ABSTRACT FROM AUTHOR]