Circulation最新文献

{"title":"Response by Szczeklik et al to Letter Regarding Article, \"Ivabradine in Patients Undergoing Noncardiac Surgery: A Randomized Controlled Trial\".","authors":"Wojciech Szczeklik, Zbigniew Putowski, P J Devereaux","doi":"10.1161/CIRCULATIONAHA.126.079809","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.079809","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"153 18","pages":"e1283-e1284"},"PeriodicalIF":38.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Affordability in the United States, From Crisis to Action: A Presidential Advisory From the American Heart Association.","authors":"Dhruv S Kazi, Joshua A Beckman, Regina M Benjamin, Grace Firestone, Janay C Johnson, Mark B McClellan, Neil Meltzer, Anne Oxrider, Stacey E Rosen, Bertram L Scott, Kevin G Volpp, John J Warner","doi":"10.1161/CIR.0000000000001442","DOIUrl":"https://doi.org/10.1161/CIR.0000000000001442","url":null,"abstract":"<p><p>The United States is facing a growing health care affordability crisis. In 2024, national health expenditures totalled $5.3 trillion, or $15 474 per person, accounting for 18.0% of the U.S. economy. Spending on health care continues to rise, propelled by high prices for services, drugs, and devices; growing administrative complexity; chronic underinvestment in prevention, primary care, and public health; and the mounting burden of chronic conditions such as cardiovascular disease. Patients, even those with insurance, frequently face financial hardship, delayed or foregone care, and medical debt because of gaps in coverage and inadequate consumer protections. Addressing this crisis will require coordinated action across the health care system, guided by evidence and a commitment to shared responsibility among key stakeholders. This Presidential Advisory from the American Heart Association draws on interviews and listening sessions with patients, clinicians, payers, employers, health system leaders, and public health experts to examine the many dimensions of affordability and offer a practical framework for action. The Advisory presents 5 core principles to guide efforts to address the affordability crisis: ensuring access to high-quality care without financial hardship; minimizing cost sharing for high-value services; creating shared accountability across the health care system; investing in the workforce, infrastructure, and data systems needed to support progress; and addressing the social and structural factors that make care less affordable for many communities. The evidence, tools, and expertise to combat the health care affordability crisis already exist. What is needed now is the collective will to act.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":38.6,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular-Kidney-Metabolic Syndrome Stages, Echocardiographic Characteristics, and Heart Failure Risk: The Atherosclerosis Risk in Communities Study.","authors":"Mats C Højbjerg Lassen, John W Ostrominski, Brian L Claggett, Chiadi E Ndumele, Tor Biering-Sørensen, Kunihiro Matsushita, Elizabeth Selvin, Josef Coresh, Amil Shah, Scott D Solomon, Muthiah Vaduganathan","doi":"10.1161/CIRCULATIONAHA.125.077894","DOIUrl":"10.1161/CIRCULATIONAHA.125.077894","url":null,"abstract":"<p><strong>Background: </strong>Suboptimal cardiovascular-kidney-metabolic (CKM) health is highly prevalent in the United States, especially among older adults, but whether the CKM syndrome staging framework is predictive of incident heart failure (HF) in this population remains uncertain.</p><p><strong>Methods: </strong>Participants from the ARIC Study (Atherosclerosis Risk in Communities; visit 5, 2011-2013) who underwent echocardiography were categorized according to the American Heart Association CKM syndrome staging framework, which is based on excess or dysfunctional adiposity, metabolic risk factors, kidney disease, subclinical cardiovascular disease (CVD), and clinical CVD. We evaluated the association between CKM stage and prevalence and progression of cardiac remodeling and longitudinal risk of incident HF.</p><p><strong>Results: </strong>Of the 5646 participants who had data available for CKM staging (age range, 66 to 90 years; 3271 women [57.9%]), 24 (0.4%) were stage 0 (optimal CKM health), 104 (1.8%) stage 1, 460 (8.1%) stage 2, 3197 (56.0%) stage 3, 1842 (32.3%) stage 4a, and 19 (0.3%) stage 4b. Higher CKM stage was incrementally associated with adverse left ventricular remodeling, worse left ventricular systolic and diastolic function, and greater progression of adverse remodeling by visit 7 (2018-2019). Among participants without prevalent HF at visit 5 (n=4827), the risk of incident HF during follow-up (656 events; median follow-up time, 9.0 years) increased with higher CKM syndrome stage: stage 0/1, 0 events per 1000 person-years; stage 2, 2.9 events/1000 person-years (referent due to no events in stage 0/1); stage 3, 15.1 events/1000 person-years (adjusted hazard ratio, 3.6 [95% CI, 2.1-6.0]); stage 4, 37.4 events/1000 person-years (adjusted hazard ratio, 8.3 [95% CI, 4.9-14.2]; <i>P</i>_trend<0.001).</p><p><strong>Conclusions: </strong>Poor CKM health was widespread among community-dwelling older adults, with higher CKM stage associated with adverse myocardial remodeling and increased risk of incident HF.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"1268-1280"},"PeriodicalIF":38.6,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter by Rose Regarding Article, \"Long-Term Outcomes of Early Surgery Versus Conventional Treatment for Asymptomatic Severe Mitral Regurgitation: A Propensity Analysis\".","authors":"David Rose","doi":"10.1161/circulationaha.125.078363","DOIUrl":"https://doi.org/10.1161/circulationaha.125.078363","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"21 1","pages":"e1151-e1152"},"PeriodicalIF":37.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response by Kang to Letter Regarding Article, \"Long-Term Outcomes of Early Surgery versus Conventional Treatment for Asymptomatic Severe Mitral Regurgitation: A Propensity Analysis\".","authors":"Duk-Hyun Kang","doi":"10.1161/circulationaha.126.079910","DOIUrl":"https://doi.org/10.1161/circulationaha.126.079910","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"5 1","pages":"e1153"},"PeriodicalIF":37.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Narrow Window in a Wide Complex Rhythm.","authors":"Ashwin A Pillai,Gautham Kalahasty,Kenneth A Ellenbogen","doi":"10.1161/circulationaha.126.080236","DOIUrl":"https://doi.org/10.1161/circulationaha.126.080236","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"4 1","pages":"1337-1339"},"PeriodicalIF":37.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Empagliflozin on Device-Measured Thoracic Impedance in Patients With Type 2 Diabetes Treated With an Implantable Cardioverter Defibrillator.","authors":"Takayuki Sumiyoshi,Kenichi Iijima,Shinya Fujiki,Koji Hirabayashi,Hiroki Matsumoto,Shunsuke Kuroda,Hidemori Hayashi,Yoshihisa Nakagawa,Kazuyoshi Takahashi,Masaaki Okabe,Kengo Kusano,Shingen Owada,Yusuke Kondo,Kenichi Tsujita,Yoshiaki Kubota,Hirofumi Tomita,Toshihisa Anzai,Morio Shoda,Masafumi Watanabe,Takashi Tokano,Toyoaki Murohara,Takashi Kaneshiro,Takeshi Kato,Hidehira Fukaya,Koji Maemura,Tomio Umemoto,Ritsushi Katou,Takashi Saigawa,Shigeto Naito,Kenji Ando,Masafumi Yano,Junichi Nitta,Tetsuji Miura,Yugo Yamashita,Kazuomi Kario,Miyako Igarashi,Hisako Yoshida,Takahiro Tanaka,Koichi Node,Tohru Minamino","doi":"10.1161/circulationaha.125.077634","DOIUrl":"https://doi.org/10.1161/circulationaha.125.077634","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"69 1","pages":"1343-1346"},"PeriodicalIF":37.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Women's Health Through Public Policy.","authors":"Stacey E Rosen,Amit Khera,Janay C Johnson","doi":"10.1161/circulationaha.126.080040","DOIUrl":"https://doi.org/10.1161/circulationaha.126.080040","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"25 1","pages":"1340-1342"},"PeriodicalIF":37.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subcutaneous Defibrillator Implantation With or Without Defibrillation Test: The Primary Results of the Randomized PRAETORIAN-DFT Trial.","authors":"Reinoud E Knops,Christelle Marquie,Peter Nordbeck,Roland Tilz,Leonard A Dijkshoorn,Anne-Floor B E Quast,Tom F Brouwer,Pier D Lambiase,Christopher Cassidy,Lucas V A Boersma,Martin C Burke,Tim R Betts,Vincent Probst,Harish Manyam,Frank A L E Bracke,Hendrik Bonnemeier,Jürgen Kuschyk,Gregory Golovchiner,Anouk de Weger,Marc A Miller,Jonas S S G de Jong,Abdul Ghani,Nigel Lewis,Eloi Marijon,Nick R Bijsterveld,Pascal Defaye,Claire Martin,Duncan C Field,Jan Elders,Naushad A Shaik,Serge Boveda,Willeke van der Stuijt,Jolien A de Veld,Kirsten M Kooiman,Shari Pepplinkhuizen,Lukas Kaiser,Anita Arya,Raymond Tukkie,Léon J P M van Woerkens,Margriet W Feenema-Aardema,Michael Glikson,Alexander H Maass,Amir Zaidi,Arthur A M Wilde,Louise R A Olde Nordkamp,Lonneke Smeding,Mikhael F El-Chami, ","doi":"10.1161/circulationaha.126.080638","DOIUrl":"https://doi.org/10.1161/circulationaha.126.080638","url":null,"abstract":"BACKGROUNDTo improve survival in patients at risk of sudden cardiac death, subcutaneous ICDs (S-ICDs) require optimal implant positioning for effective shocks. Defibrillation (DF) testing is recommended but carries serious risks. The PRAETORIAN score predicts defibrillation outcomes based on chest X-rays. The PRAETORIAN-DFT trial evaluated whether omission of DF testing guided by the PRAETORIAN score is non-inferior for first-shock efficacy.METHODSIn this multinational trial, S-ICD patients from 37 centers were randomized to DF testing or no DF testing. In the No-DF testing group, the PRAETORIAN score was evaluated before discharge. The primary endpoint was failed first shock for spontaneous ventricular arrhythmias, as a surrogate for defibrillation success, tested for non-inferiority with a 3% absolute risk margin. Secondary endpoints included mortality, potential DF testing-related complications, and S-ICD revisions.RESULTSThe included 965 patients (No-DF testing, n=483;DF testing, n=482) were followed for a median of 41 months. Failed first shock for spontaneous ventricular arrhythmia occurred in 1.7% of the No-DF testing group versus 2.3% of the DF testing group (-0.6%, 95% CI [ -2.6 to 1.4]; p<0.001). There were no significant differences in all-cause mortality (HR 0.9 [95% CI 0.6-1.4]) or arrhythmic death (HR 0.4 [95% CI 0.04-3.4]). Potential DF testing-related complications occurred in 1.7% in the DF testing group. Postoperative S-ICD revisions due to inadequate positioning were identical between groups (n=2 each).CONCLUSIONSPRAETORIAN score-guided omission of DF testing- after S-ICD implantation did not increase the risk of failed first shocks for spontaneous ventricular arrhythmias and reduced procedural risk without increasing S-ICD revisions. (Funded by Boston Scientific; PRAETORIAN-DFT).","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"22 1","pages":""},"PeriodicalIF":37.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147743794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Activity in Pediatric Cardiomyopathies: Moving for Health: A Scientific Statement From the American Heart Association.","authors":"Jonathan B Edelson,Carissa M Baker-Smith,Barbara Cifra,Melissa Cousino,Sharlene M Day,Jonathan A Drezner,Anne M Dubin,Corey Gates,David A White,Jennifer Conway, ","doi":"10.1161/cir.0000000000001431","DOIUrl":"https://doi.org/10.1161/cir.0000000000001431","url":null,"abstract":"Physical activity (PA) is essential for the cardiovascular, emotional, and social health of all children and adolescents. However, for pediatric patients with cardiomyopathy, decades of risk-averse clinical guidance have resulted in widespread PA restriction due to fears of sudden cardiac death and disease progression. This has contributed to sedentary behavior, poor cardiorespiratory fitness, and increased risk of secondary cardiometabolic conditions in this population. However, emerging data challenge this restrictive paradigm, showing that the risk of sudden cardiac death may not be higher in some patients with cardiomyopathy who exercise than in those who are less active, and that participation in PA may also have a positive effect on reverse remodeling. This American Heart Association scientific statement provides an evidence-based framework for the promotion of PA in pediatric patients with hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy, or arrhythmogenic cardiomyopathy, as well as those with implantable cardioverter defibrillators; outlines the physical, social, and emotional benefits of PA for these children and adolescents; and provides updated risk stratification strategies, including the use of advanced imaging, exercise testing, and genotype-specific data. This scientific statement underscores the importance of shared decision-making tailored to developmental maturity and family goals and emphasizes the need for longitudinal surveillance as clinical phenotypes evolve. With individualized assessment and informed shared decision-making, most children and adolescents with cardiomyopathy can safely engage in PA, with important implications for long-term cardiometabolic and psychologic health.","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"66 1","pages":""},"PeriodicalIF":37.8,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147733968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}