Circulation最新文献

{"title":"Ablation Strategies for Repeat Procedures in Atrial Fibrillation Recurrences Despite Durable Pulmonary Vein Isolation: The Prospective Randomized ASTRO AF Multicenter Trial.","authors":"Boris Schmidt, Stefano Bordignon, Andreas Metzner, Philipp Sommer, Daniel Steven, Tilmann Dahme, Matthias Busch, Roland Richard Tilz, David Schaack, Andreas Rillig, Christian Sohns, Arian Sultan, Karolina Weinmann-Emhardt, Astrid Hummel, Julia Vogler, Thomas Fink, Jakob Lueker, Alexander Pott, Christian Heeger, K R Julian Chun","doi":"10.1161/CIRCULATIONAHA.124.069993","DOIUrl":"10.1161/CIRCULATIONAHA.124.069993","url":null,"abstract":"<p><strong>Background: </strong>Ablation strategies for patients with symptomatic atrial fibrillation and isolated pulmonary veins vary and their effects on arrhythmia recurrence remain unclear. A prospective randomized German multicenter trial sought to compare 2 ablation strategies in this patient cohort.</p><p><strong>Methods: </strong>Patients with atrial fibrillation despite durable pulmonary vein isolation were randomly assigned at 7 centers to undergo low-voltage area ablation using 3-dimensional mapping and irrigated radiofrequency current ablation (group A) or empirical left atrial appendage isolation (LAAI) using the cryoballoon followed by staged interventional left atrial appendage closure (group B). The primary end point was freedom from atrial tachyarrhythmias between 91 and 365 days after index ablation. The study was powered for superiority of LAAI compared with low-voltage area.</p><p><strong>Results: </strong>Patients (40% women; mean age, 68.8±8 years) with paroxysmal (32%) or persistent atrial fibrillation (68%) were randomized to undergo low-voltage area ablation (n=79) or cryoballoon-guided LAAI (n=82). After a planned interim analysis, enrollment was halted for futility on January 10, 2023. In the LAAI group, 77 of 82 left atrial appendages were successfully isolated with subsequent left atrial appendage closure in 57 patients. Procedure-related complications occurred in 4 (5%) and 11 (13.5%) patients in group A and B, respectively (<i>P</i>=0.10). The median follow-up was 367 days (interquartile range, 359-378). The Kaplan-Meier point estimate for freedom from atrial tachyarrhythmias was 51.7% (CI, 40.9%-65.4%) for group A and 55.5% (CI, 44.4%-69.2%; <i>P</i>=0.8069) for group B.</p><p><strong>Conclusions: </strong>The current study did not detect superiority of cryoballoon-guided LAAI over low-voltage area ablation in patients with atrial fibrillation despite durable PVI.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04056390.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"2007-2018"},"PeriodicalIF":35.5,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380145","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":"Aortic Stenosis and Coronary Artery Disease: Decision-Making Between Surgical and Transcatheter Management.","authors":"Daijiro Tomii, Thomas Pilgrim, Michael A Borger, Ole De Backer, Jonas Lanz, David Reineke, Matthias Siepe, Stephan Windecker","doi":"10.1161/CIRCULATIONAHA.124.070502","DOIUrl":"10.1161/CIRCULATIONAHA.124.070502","url":null,"abstract":"<p><p>Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist and share pathophysiological mechanisms. The proportion of patients with AS and CAD requiring revascularization varies widely because of uncertainty about best clinical practices. Although combined surgical aortic valve replacement and coronary artery bypass grafting has been the standard of care, management options in patients with AS and CAD requiring revascularization have expanded with the advent of transcatheter aortic valve replacement (TAVR). Potential alternative treatment pathways include revascularization before TAVR, concomitant TAVR and percutaneous coronary intervention, percutaneous coronary intervention after TAVR and deferred percutaneous coronary intervention or hybrid procedures. Selection depends on underlying disease severity, antithrombotic treatment strategies, clinical presentation, and symptom evolution after TAVR. In patients undergoing surgical aortic valve replacement, the addition of coronary artery bypass grafting has been associated with improved long-term mortality, especially if CAD is complex. although it is associated with higher periprocedural risk. The therapeutic impact of percutaneous coronary intervention in patients with TAVR is less well-established. The multitude of clinical permutations and remaining uncertainties do not support a uniform treatment strategy for patients with AS and CAD. Therefore, to provide the best possible care for each individual patient, heart teams need to be familiar with the available data on AS and CAD. Herein, we provide an in-depth review of the evidence supporting the decision-making process between transcatheter and surgical approaches and the key elements of treatment selection in patients with AS and CAD.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"150 25","pages":"2046-2069"},"PeriodicalIF":35.5,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834248","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 Wang and Huang Regarding Article, \"Targeting NPM1 Epigenetically Promotes Postinfarction Cardiac Repair by Reprogramming Reparative Macrophage Metabolism\".","authors":"Hai-Yan Wang, Feng Huang","doi":"10.1161/CIRCULATIONAHA.124.071181","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.071181","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"150 25","pages":"e688"},"PeriodicalIF":35.5,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834323","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":"ASCVD Risk Refinement With NT-proBNP for Statin Allocation Among Low- and Intermediate-Risk Individuals.","authors":"Jelena Pavlović, Maryam Kavousi, M Kamran Ikram, M Arfan Ikram, Daniel Bos, Maarten J G Leening","doi":"10.1161/CIRCULATIONAHA.124.071071","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.071071","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"150 25","pages":"2070-2072"},"PeriodicalIF":35.5,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834252","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":"Cardiac Reprogramming and Gata4 Overexpression Reduce Fibrosis and Improve Diastolic Dysfunction in Heart Failure With Preserved Ejection Fraction.","authors":"Yu Yamada, Taketaro Sadahiro, Koji Nakano, Seiichiro Honda, Yuto Abe, Tatsuya Akiyama, Ryo Fujita, Masashi Nakamura, Takashi Maeda, Yuta Kuze, Masaya Onishi, Masahide Seki, Yutaka Suzuki, Chikara Takeuchi, Yuka W Iwasaki, Kensaku Murano, Mamiko Sakata-Yanagimoto, Shigeru Chiba, Hideyuki Kato, Hiroaki Sakamoto, Yuji Hiramatsu, Masaki Ieda","doi":"10.1161/CIRCULATIONAHA.123.067504","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.123.067504","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) is a major health concern. Pathological stimuli and interactions between cardiac fibroblasts (CFs) and other cell types may lead to cardiac fibrosis and diastolic dysfunction, which are hallmarks of HFpEF. Interstitial and perivascular cardiac fibrosis correlates with poor prognosis in HFpEF; however, mechanisms of fibrosis remain poorly elucidated, and targeted therapies are lacking. Cardiac reprogramming is a promising therapeutic approach for myocardial infarction that facilitates cardiac regeneration and antifibrosis action through <i>Mef2c/Gata4/Tbx5/Hand2</i> (MGTH) overexpression in resident CFs. However, the efficacy of this approach on HFpEF is yet to be established.</p><p><strong>Methods: </strong>Herein, we examined the effects of cardiac reprogramming in HFpEF using Tcf21^iCre/Tomato/MGTH2A transgenic mice, which expressed both MGTH and reporter expression in CFs for cardiac reprogramming and lineage tracing upon tamoxifen administration. To establish HFpEF model mice, we used a combination of a high-fat diet and nitric oxide synthase inhibition. Bulk RNA-sequencing, single-cell RNA-sequencing, and spatial transcriptomics were conducted to determine fibrotic mechanisms and the efficacy of cardiac reprogramming in HFpEF. We generated new tamoxifen-inducible transgenic mice overexpressing each reprogramming factor in CFs to investigate the effect of single factors. Last, we analyzed the effect of reprogramming factors in human CFs.</p><p><strong>Results: </strong>Cardiac reprogramming with MGTH overexpression improved diastolic dysfunction, cardiac hypertrophy, fibrosis, inflammation, and capillary loss in HFpEF. Cardiac reprogramming converted approximately 1% of resident CFs into induced cardiomyocytes. Bulk RNA-seq indicated that MGTH overexpression upregulated genes related to heart contraction and suppressed the fetal gene program (<i>Nppa</i> and <i>Nppb</i>) and proinflammatory and fibrotic signatures. Single-cell RNA-sequencing and spatial transcriptomics revealed that multiple CF clusters upregulated fibrotic genes to induce diffuse interstitial fibrosis, whereas distinct CF clusters generated focal perivascular fibrosis in HFpEF. MGTH overexpression reversed these profibrotic changes. Among 4 reprogramming factors, only Gata4 overexpression in CFs reduced fibrosis and improved diastolic dysfunction in HFpEF by suppressing CF activation without generating new induced cardiomyocytes. Gata4 overexpression also suppressed profibrotic signatures in human CFs.</p><p><strong>Conclusions: </strong>Overexpressing Gata4 in CFs may be a promising therapeutic approach for HFpEF by suppressing fibrosis and improving diastolic dysfunction.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":35.5,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823621","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":"2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.","authors":"Robert Greif, Janet E Bray, Therese Djärv, Ian R Drennan, Helen G Liley, Kee-Chong Ng, Adam Cheng, Matthew J Douma, Barnaby R Scholefield, Michael Smyth, Gary Weiner, Cristian Abelairas-Gómez, Jason Acworth, Natalie Anderson, Dianne L Atkins, David C Berry, Farhan Bhanji, Bernd W Böttiger, Richard N Bradley, Jan Breckwoldt, Jestin N Carlson, Pascal Cassan, Wei-Tien Chang, Nathan P Charlton, Sung Phil Chung, Julie Considine, Andrea Cortegiani, Daniela T Costa-Nobre, Keith Couper, Thomaz Bittencourt Couto, Katie N Dainty, Vihara Dassanayake, Peter G Davis, Jennifer A Dawson, Allan R de Caen, Charles D Deakin, Guillaume Debaty, Jimena Del Castillo, Maya Dewan, Bridget Dicker, Jana Djakow, Aaron J Donoghue, Kathryn Eastwood, Walid El-Naggar, Raffo Escalante-Kanashiro, Jorge Fabres, Barbara Farquharson, Joe Fawke, Maria Fernanda de Almeida, Shannon M Fernando, Emer Finan, Judith Finn, Gustavo E Flores, Elizabeth E Foglia, Fredrik Folke, Craig A Goolsby, Asger Granfeldt, Anne-Marie Guerguerian, Ruth Guinsburg, Carolina Malta Hansen, Tetsuo Hatanaka, Karen G Hirsch, Mathias J Holmberg, Stuart Hooper, Amber V Hoover, Ming-Ju Hsieh, Takanari Ikeyama, Tetsuya Isayama, Nicholas J Johnson, Justin Josephsen, Anup Katheria, Mandira D Kawakami, Monica Kleinman, David Kloeck, Ying-Chih Ko, Peter Kudenchuk, Amy Kule, Hiroshi Kurosawa, Jorien Laermans, Anthony Lagina, Kasper G Lauridsen, Eric J Lavonas, Henry C Lee, Swee Han Lim, Yiqun Lin, Andrew S Lockey, Jesus Lopez-Herce, George Lukas, Finlay Macneil, Ian K Maconochie, John Madar, Abel Martinez-Mejas, Siobhan Masterson, Tasuku Matsuyama, Richard Mausling, Christopher J D McKinlay, Daniel Meyran, William Montgomery, Peter T Morley, Laurie J Morrison, Ari L Moskowitz, Michelle Myburgh, Sabine Nabecker, Vinay Nadkarni, Firdose Nakwa, Kevin J Nation, Ziad Nehme, Tonia Nicholson, Nikolaos Nikolaou, Chika Nishiyama, Tatsuya Norii, Gabrielle Nuthall, Shinichiro Ohshimo, Theresa Olasveengen, Alexander Olaussen, Gene Ong, Aaron Orkin, Michael J Parr, Gavin D Perkins, Helen Pocock, Yacov Rabi, Violetta Raffay, James Raitt, Tia Raymond, Giuseppe Ristagno, Antonio Rodriguez-Nunez, Joseph Rossano, Mario Rüdiger, Claudio Sandroni, Taylor L Sawyer, Stephen M Schexnayder, Georg Schmölzer, Sebastian Schnaubelt, Anna Lene Seidler, Federico Semeraro, Eunice M Singletary, Markus B Skrifvars, Christopher M Smith, Jasmeet Soar, Anne Lee Solevåg, Roger Soll, Willem Stassen, Takahiro Sugiura, Kaushila Thilakasiri, Janice Tijssen, Lokesh Kumar Tiwari, Alexis Topjian, Daniele Trevisanuto, Christian Vaillancourt, Michelle Welsford, Myra H Wyckoff, Chih-Wei Yang, Joyce Yeung, Carolyn M Zelop, David A Zideman, Jerry P Nolan, Katherine M Berg","doi":"10.1161/CIR.0000000000001288","DOIUrl":"10.1161/CIR.0000000000001288","url":null,"abstract":"<p><p>This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"e580-e687"},"PeriodicalIF":35.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615874","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":"Clinical Use of Bedside Portable Ultra-Low-Field Brain Magnetic Resonance Imaging in Patients on Extracorporeal Membrane Oxygenation: Results From the Multicenter SAFE MRI ECMO Study.","authors":"Sung-Min Cho, Shivalika Khanduja, Christopher Wilcox, Kha Dinh, Jiah Kim, Jin Kook Kang, Ifeanyi David Chinedozi, Zachary Darby, Matthew Acton, Hannah Rando, Jessica Briscoe, Errol L Bush, Haris I Sair, John Pitts, Lori R Arlinghaus, Audrey-Carelle N Wandji, Elena Moreno, Glenda Torres, Bindu Akkanti, Jose Gavito-Higuera, Steven Keller, HuiMahn A Choi, Bo Soo Kim, Aaron Gusdon, Glenn J Whitman","doi":"10.1161/CIRCULATIONAHA.124.069187","DOIUrl":"10.1161/CIRCULATIONAHA.124.069187","url":null,"abstract":"<p><strong>Background: </strong>Early detection of acute brain injury (ABI) at the bedside is critical in improving survival for patients with extracorporeal membrane oxygenation (ECMO) support. We aimed to examine the safety of ultra-low-field (ULF; 0.064-T) portable magnetic resonance imaging (pMRI) in patients undergoing ECMO and to investigate the ABI frequency and types with ULF-pMRI.</p><p><strong>Methods: </strong>This was a multicenter prospective observational study (SAFE MRI ECMO study [Assessing the Safety and Feasibility of Bedside Portable Low-Field Brain Magnetic Resonance Imaging in Patients on ECMO]; NCT05469139) from 2 tertiary centers (Johns Hopkins, Baltimore, MD and University of Texas-Houston) with specially trained intensive care units. Primary outcomes were safety of ULF-pMRI during ECMO support, defined as completion of ULF-pMRI without significant adverse events.</p><p><strong>Results: </strong>Of 53 eligible patients, 3 were not scanned because of a large head size that did not fit within the head coil. ULF-pMRI was performed in 50 patients (median age, 58 years; 52% male), with 34 patients (68%) on venoarterial ECMO and 16 patients (32%) on venovenous ECMO. Of 34 patients on venoarterial ECMO, 11 (22%) were centrally cannulated and 23 (46%) were peripherally cannulated. In venovenous ECMO, 9 (18%) had single-lumen cannulation and 7 (14%) had double-lumen cannulation. Of 50 patients, adverse events occurred in 3 patients (6%), with 2 minor adverse events (ECMO suction event; transient low ECMO flow) and one serious adverse event (intra-aortic balloon pump malfunction attributable to electrocardiographic artifacts). All images demonstrated discernible intracranial pathologies with good quality. ABI was observed in 22 patients (44%). Ischemic stroke (36%) was the most common type of ABI, followed by intracranial hemorrhage (6%) and hypoxic-ischemic brain injury (4%). Of 18 patients (36%) with both ULF-pMRI and head computed tomography within 24 hours, ABI was observed in 9 patients with a total of 10 events (8 ischemic, 2 hemorrhagic events). Of the 8 ischemic events, pMRI observed all 8, and head computed tomography observed only 4 events. For intracranial hemorrhage, pMRI observed only 1 of them, and head computed tomography observed both (2 events).</p><p><strong>Conclusions: </strong>Our study demonstrates that ULF-pMRI can be performed in patients on ECMO across different ECMO cannulation strategies in specially trained intensive care units. The incidence of ABI was high, seen in 44% of ULF-pMRI studies. ULF-pMRI imaging appears to be more sensitive to ABI, particularly ischemic stroke, compared with head computed tomography.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"1955-1965"},"PeriodicalIF":35.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11627327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating Autoantibodies Targeting TREK-1 in Patients With Short-Coupled Ventricular Fibrillation.","authors":"Jin Li, Alexandre Janin, Mona Patoughi, Nathalie Gaudreault, Lenke Kis, Hamid Moha Ou Maati, Yohan Bossé, Christian Steinberg","doi":"10.1161/CIRCULATIONAHA.124.070284","DOIUrl":"10.1161/CIRCULATIONAHA.124.070284","url":null,"abstract":"<p><strong>Background: </strong>Short-coupled ventricular fibrillation (SCVF) is increasingly being recognized as a distinct primary electrical disorder and cause of otherwise unexplained cardiac arrest. However, the pathophysiology of SCVF remains largely elusive. Despite extensive genetic screening, there is no convincing evidence of a robust monogenic disease gene, thus raising the speculations for alternative pathogeneses. The role of autoimmune mechanisms in SCVF has not been investigated so far. The objective of this study was to screen for circulating autoantibodies in patients with SCVF and assess their role in arrhythmogenesis.</p><p><strong>Methods: </strong>This is a prospective, single-center, case-control study enrolling cardiac arrest survivors diagnosed with SCVF or idiopathic ventricular fibrillation (IVF) between 2019 and 2023 at the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval Inherited Arrhythmia Clinic in Canada. Plasma samples were screened for autoantibodies targeting cardiac ion channels using peptide microarray technology. Identified target autoantibodies were then purified from pooled plasma samples for subsequent cellular electrophysiological studies.</p><p><strong>Results: </strong>Fourteen patients with SCVF (n=4 [29% of patients] female patients; median age, 45 years [interquartile range: 36, 59]; n=14 [100% of patients] non-Hispanic White) and 19 patients with idiopathic ventricular fibrillation (n=8 [42%] female patients; median age, 49 years [38, 57]; n=19 [100%] non-Hispanic White) were enrolled in the study and compared with 38 (n=20 [53%] female subjects; median age, 45 years [29, 66]; n=36 [95%] non-Hispanic White) sex-, age- and ethnicity-matched healthy controls. During the study period, 11 (79%) SCVF probands experienced ventricular fibrillation recurrence after a median of 4.3 months (interquartile range, 0.3-20.7). Autoantibodies targeting cardiac TREK-1 (TWIK [tandem of pore-domains in a weakly inward rectifying potassium channel]-related potassium channel 1 were identified in 7 (50%) patients with SCVF (<i>P</i>=0.049). Patch clamp experiments demonstrated channel-activating properties of anti-TREK-1 autoantibodies that are antagonized by quinidine in both HEK293 cells and human induced pluripotent stem cell-derived cardiomyocytes.</p><p><strong>Conclusions: </strong>Patients with SCVF harbor circulating autoantibodies against the cardiac TREK-1 channel. Anti-TREK-1 autoantibodies not only present the first reported biomarker for SCVF, but our functional studies also suggest a direct implication in the arrhythmogenesis of SCVF.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"1944-1954"},"PeriodicalIF":35.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307189","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":"Clinical Correlates and Prognostic Impact of Cognitive Dysfunction in Patients With Heart Failure and Preserved Ejection Fraction: Insights From PARAGON-HF.","authors":"Li Shen, Pooja Dewan, João Pedro Ferreira, Jonathan W Cunningham, Pardeep S Jhund, Inder S Anand, Alvin Chandra, Lu-May Chiang, Brian Claggett, Akshay S Desai, Jianjian Gong, Carolyn S P Lam, Martin P Lefkowitz, Aldo P Maggioni, Felipe Martinez, Milton Packer, Margaret M Redfield, Jean L Rouleau, Dirk J van Veldhuisen, Faiez Zannad, Michael R Zile, Scott D Solomon, John J V McMurray","doi":"10.1161/CIRCULATIONAHA.124.070553","DOIUrl":"10.1161/CIRCULATIONAHA.124.070553","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment is common in patients with heart failure and preserved ejection fraction but its clinical correlates and prognostic associations are poorly understood.</p><p><strong>Methods: </strong>We analyzed cognitive function, using the Mini-Mental State Examination (MMSE), in patients with heart failure and preserved ejection fraction enrolled in a prespecified substudy of the PARAGON-HF trial (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in Heart Failure With Preserved Ejection Fraction). Logistic regression analyses were performed to determine the variables associated with lower MMSE scores at baseline and postbaseline decline in MMSE scores at 48 weeks. Cox proportional hazards regression and semiparametric proportional rates models were used to examine the risk of clinical outcomes related to baseline MMSE scores, and decline in MMSE scores during follow-up, adjusted for prognostic variables including NT-proBNP (N-terminal pro-B-type natriuretic peptide).</p><p><strong>Results: </strong>At baseline, cognitive function was normal (MMSE score 28-30) in 1809 of 2895 patients (62.5%), borderline (score 24-27) in 794 (27.4%), and impaired (score <24) in 292 (10.1%). Variables associated with both a lower MMSE score at baseline and a decline in score from baseline included older age, a history of stroke or transient ischemic attack, and lower serum albumin. Compared with those with baseline MMSE scores of 28 to 30, patients in the lower MMSE score categories had a stepwise increase in the risk of the composite of time to first heart failure hospitalization or cardiovascular death, with an adjusted hazard ratio of 1.27 (95% CI, 1.06-1.53) for those with scores of 24 to 27 and 1.58 (95% CI, 1.21-2.06) for those with scores <24, respectively. These associations were also found for the individual components of the composite and all-cause death. Likewise, cognitive impairment was associated with a 50% higher risk of total (first and repeat) heart failure hospitalizations and cardiovascular deaths. Examining the change in MMSE score from baseline, a decrease in MMSE score during follow-up was associated with a higher risk of death.</p><p><strong>Conclusions: </strong>In patients with heart failure and preserved ejection fraction, even modest baseline impairment of cognitive function was associated with worse outcomes, including death. A decline in MMSE score during follow-up was a strong predictor of mortality, independent of other prognostic variables.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"1913-1927"},"PeriodicalIF":35.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459503","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":"2024 American Heart Association and American Red Cross Guidelines for First Aid.","authors":"Elizabeth K Hewett Brumberg, Matthew J Douma, Kostas Alibertis, Nathan P Charlton, Michael P Goldman, Katrina Harper-Kirksey, Seth C Hawkins, Amber V Hoover, Amy Kule, Stefan Leichtle, Sarah Frances McClure, George Sam Wang, Mark Whelchel, Lynn White, Eric J Lavonas","doi":"10.1161/CIR.0000000000001281","DOIUrl":"10.1161/CIR.0000000000001281","url":null,"abstract":"<p><p>Codeveloped by the American Heart Association and the American Red Cross, these guidelines represent the first comprehensive update of first aid treatment recommendations since 2010. Incorporating the results of structured evidence reviews from the International Liaison Committee on Resuscitation, these guidelines cover first aid treatment for critical and common medical, traumatic, environmental, and toxicological conditions. This update emphasizes the continuous evolution of evidence evaluation and the necessity of adapting educational strategies to local needs and diverse community demographics. Existing guidelines remain relevant unless specifically updated in this publication. Key topics that are new, are substantially revised, or have significant new literature include opioid overdose, bleeding control, open chest wounds, spinal motion restriction, hypothermia, frostbite, presyncope, anaphylaxis, snakebite, oxygen administration, and the use of pulse oximetry in first aid, with the inclusion of pediatric-specific guidance as warranted.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"e519-e579"},"PeriodicalIF":35.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615858","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}