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Article History

Received: 17 July 2025

Revised: 6 October 2025

Accepted: 15 October 2025

First Online: 5 January 2026

Compliance with ethical standards

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: This work was supported by the Japan Cardiovascular Research Foundation based on a contract with Bayer Yakuhin, Ltd., which had no role in the study design, data collection or analysis, results interpretation, or manuscript writing. TN reports Grants-in-Aid for Scientific Research (22K08092) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan and personal fees from Bayer Yakuhin, Medtronic Japan, and Biotronik Japan. KN reports grants from the Japan. Agency for Medical Research and Development (AMED; 21ek0210136h0003). KK reports trust research/joint research funds from Bayer Yakuhin, and Daiichi-Sankyo; scholarship funds from Abbott; and personal fees from Bayer Yakuhin, Daiichi-Sankyo, Novartis Pharma AG, and Otsuka Pharmaceutical Co. MA reports grants from the Japan AMED, personal fees from Bristol Myers Squibb and Nippon Boehringer Ingelheim, and grants and personal fees from Bayer Yakuhin and Daiichi-Sankyo. JA reports personal fees from Bayer Yakuhin and Sanofi and grants and personal fees from Daiichi-Sankyo. TM reports grants from the Japan Cardiovascular Research Foundation and personal fees from Nippon Boehringer Ingelheim, Daiichi-Sankyo, AstraZeneca, and Bayer Yakuhin. MN reports grants and personal fees from Bayer Yakuhin, Daiichi-Sankyo, and Sanofi and personal fees from Bristol Myers Squibb and Nippon Boehringer Ingelheim. KM reports personal fees from Amgen Astellas BioPharma, Astellas Pharma, MSD, Bayer Yakuhin, Sanofi, Takeda Pharmaceutical, Daiichi-Sankyo, Nippon Boehringer Ingelheim, and Bristol Myers Squibb. NH reports grants and personal fees from Bayer Yakuhin, grants from Nippon Boehringer Ingelheim, and personal fees from Bristol Myers Squibb. KK reports grants from the Japan Cardiovascular Research Foundation, grants and personal fees from Bayer Yakuhin, Daiichi-Sankyo, Sanofi, MSD, and AstraZeneca, and personal fees from Bristol Myers Squibb and Nippon Boehringer Ingelheim. HO reports personal fees from Abbott Medical Japan, Bayer Yakuhin, Daiichi-Sankyo, Eisai, Kowa, Takeda Pharmaceutical, and Teijin. SY reports on grants from Takeda Pharmaceutical, Abbott, and Boston Scientific and personal fees from Daiichi-Sankyo and Bristol Myers Squibb. The other authors declare no conflicts of interest for this study.