Circulation最新文献

{"title":"Response by Park and Kang to Letter Regarding Article, \"Ertugliflozin for Functional Mitral Regurgitation Associated With Heart Failure: EFFORT Trial\".","authors":"Sung-Ji Park, Duk-Hyun Kang","doi":"10.1161/CIRCULATIONAHA.124.072232","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.072232","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 3","pages":"e28"},"PeriodicalIF":35.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001010","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":"An Advocacy Agenda for the Human Brain: Moving From Brain Health to Brain Capital.","authors":"Mitchell S V Elkind, Harris Eyre, Cheryl Pegus","doi":"10.1161/CIRCULATIONAHA.124.073077","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.073077","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 3","pages":"e24-e26"},"PeriodicalIF":35.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000741","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":"Driving Restrictions and Incapacitation Vulnerability Evaluation After ST-Segment-Elevation Myocardial Infarction: DRIVE-STEMI Study.","authors":"Zachary Singer, Harindra C Wijeysundera, Feng Qiu, Jiming Fang, Ragavie Manoragavan, Christopher S Simpson, Luiz F Ybarra","doi":"10.1161/CIRCULATIONAHA.124.071649","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.071649","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 3","pages":"282-284"},"PeriodicalIF":35.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000819","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":"Association Between Delay to First Shock and Successful First-Shock Ventricular Fibrillation Termination in Patients With Witnessed Out-of-Hospital Cardiac Arrest.","authors":"Remy Stieglis, Bas J Verkaik, Hanno L Tan, Rudolph W Koster, Hans van Schuppen, Christian van der Werf","doi":"10.1161/CIRCULATIONAHA.124.069834","DOIUrl":"10.1161/CIRCULATIONAHA.124.069834","url":null,"abstract":"<p><strong>Background: </strong>In patients with out-of-hospital cardiac arrest who present with an initial shockable rhythm, a longer delay to the first shock decreases the probability of survival, often attributed to cerebral damage. The mechanisms of this decreased survival have not yet been elucidated. Estimating the probability of successful defibrillation and other factors in relation to the time to first shock may guide prehospital care systems to implement policies that improve patient survival by decreasing time to first shock.</p><p><strong>Methods: </strong>Patients with a witnessed out-of-hospital cardiac arrest and ventricular fibrillation (VF) as an initial rhythm were included using the prospective ARREST registry (Amsterdam Resuscitation Studies). Patient and resuscitation data, including time-synchronized automated external defibrillator and manual defibrillator data, were analyzed to determine VF termination at 5 seconds after the first shock. Delay to first shock was defined as the time from initial emergency call until the first shock by any defibrillator. Outcomes were the proportion of VF termination, return of organized rhythm, and survival to discharge, all in relation to the delay to first shock. A Poisson regression model with robust standard errors was used to estimate the association between delay to first shock and outcomes.</p><p><strong>Results: </strong>Among 3723 patients, the proportion of VF termination declined from 93% when the delay to first shock was <6 minutes to 75% when that delay was >16 minutes (<i>P</i>_trend<0.001). Every additional minute in VF from emergency call was associated with 6% higher probability of failure to terminate VF (adjusted relative risk, 1.06 [95% CI, 1.04-1.07]), 4% lower probability of return of organized rhythm (adjusted relative risk, 0.96 [95% CI, 0.95-0.98]), and 6% lower probability of surviving to discharge (adjusted relative risk, 0.94 [95% CI, 0.93-0.95]).</p><p><strong>Conclusions: </strong>Every minute of delay to first shock was associated with a significantly lower proportion of VF termination and return of organized rhythm. This may explain the worse outcomes in patients with a long delay to defibrillation. Reducing the time interval from emergency call to first shock to ≤6 minutes could be considered a key performance indicator of the chain of survival.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"235-244"},"PeriodicalIF":35.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496237","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":"Fractional Flow Reserve and Instantaneous Wave-Free Ratio as Predictors of the Placebo-Controlled Response to Percutaneous Coronary Intervention in Stable Coronary Artery Disease.","authors":"Michael J Foley, Christopher A Rajkumar, Fiyyaz Ahmed-Jushuf, Florentina Simader, Shayna Chotai, Henry Seligman, Krzysztof Macierzanka, John R Davies, Thomas R Keeble, Peter O'Kane, Peter Haworth, Helen Routledge, Tushar Kotecha, Gerald Clesham, Rupert Williams, Jehangir Din, Sukhjinder S Nijjer, Nick Curzen, Manas Sinha, Ricardo Petraco, James Spratt, Sayan Sen, Graham D Cole, Frank E Harrell, James P Howard, Darrel P Francis, Matthew J Shun-Shin, Rasha Al-Lamee","doi":"10.1161/CIRCULATIONAHA.124.072281","DOIUrl":"10.1161/CIRCULATIONAHA.124.072281","url":null,"abstract":"<p><strong>Background: </strong>ORBITA-2 (the Placebo-Controlled Trial of Percutaneous Coronary Intervention for the Relief of Stable Angina) provided evidence for the role of percutaneous coronary intervention (PCI) for angina relief in stable coronary artery disease. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are often used to guide PCI; however, their ability to predict placebo-controlled angina improvement is unknown.</p><p><strong>Methods: </strong>Participants with angina, ischemia, and stable coronary artery disease were enrolled, and anti-anginal medications were stopped. Participants reported angina episodes daily for 2 weeks using the ORBITA smartphone symptom application (ORBITA-app). At the research angiogram, FFR and iFR were measured. After sedation and auditory isolation, participants were randomized to PCI or placebo before entering a 12-week blinded follow-up phase with daily angina reporting. The ability of FFR and iFR, analyzed as continuous variables, to predict the placebo-controlled effect of PCI was tested using Bayesian proportional odds modeling.</p><p><strong>Results: </strong>Invasive physiology data were available for 279 patients (140 PCI and 139 placebo). The median (interquartile range) age was 65 years (59.0-70.5), and 223 (79.9%) were male. Median FFR was 0.60 (0.46-0.73), and median iFR was 0.76 (0.50-0.86). The lower the FFR or iFR, the greater the placebo-controlled improvement with PCI across all end points. There was strong evidence that a patient with an FFR at the lower quartile would have a greater placebo-controlled improvement in angina symptom score with PCI than a patient at the upper quartile (FFR, 0.46 versus 0.73: odds ratio, 2.01; 95% credible interval, 1.79-2.26; probability of interaction, >99.9%). Similarly, there was strong evidence that a patient with an iFR at the lower quartile would have greater placebo-controlled improvement in angina symptom score with PCI than a patient with an iFR at the upper quartile (iFR, 0.50 versus 0.86: odds ratio, 2.13; 95% credible interval, 1.87-2.45; probability of interaction, >99.9%). The relationship between benefit and physiology was seen in both Rose angina and Rose nonangina.</p><p><strong>Conclusions: </strong>Physiological stenosis severity, as measured by FFR and iFR, predicts placebo-controlled angina relief from PCI. Invasive coronary physiology can be used to target PCI to those patients who are most likely to experience benefit.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03742050.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"202-214"},"PeriodicalIF":35.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496240","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":"Exploring Integrin α5β1 as a Potential Therapeutic Target for Pulmonary Arterial Hypertension: Insights From Comprehensive Multicenter Preclinical Studies.","authors":"Sarah-Eve Lemay, Mónica S Montesinos, Yann Grobs, Tetsuro Yokokawa, Tsukasa Shimauchi, Manon Mougin, Charlotte Romanet, Mélanie Sauvaget, Sandra Breuils-Bonnet, Alice Bourgeois, Charlie Théberge, Andréanne Pelletier, Reem El Kabbout, Sandra Martineau, Keiko Yamamoto, Muzaffar Akram, Adrian S Ray, Blaise Lippa, Bryan Goodwin, Fu-Yang Lin, Hua Wang, James E Dowling, Min Lu, Qi Qiao, T Andrew McTeague, Terence I Moy, François Potus, Steeve Provencher, Olivier Boucherat, Sébastien Bonnet","doi":"10.1161/CIRCULATIONAHA.124.070693","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.070693","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary arterial hypertension (PAH) is characterized by obliterative vascular remodeling of the small pulmonary arteries (PAs) and progressive increase in pulmonary vascular resistance leading to right ventricular failure. Although several drugs are approved for the treatment of PAH, mortality rates remain high. Accumulating evidence supports a pathological function of integrins in vessel remodeling, which are gaining renewed interest as drug targets. However, their role in PAH remains largely unexplored.</p><p><strong>Methods: </strong>The expression of the RGD (arginylglycylaspartic acid)-binding integrin α5β1 was assessed in PAs, PA smooth muscle cells, and PA endothelial cells from patients with PAH and controls using NanoString, immunoblotting, and Mesoscale Discovery assays. RNA sequencing was conducted to identify gene networks regulated by α5β1 inhibition in PAH PA smooth muscle cells. The therapeutic efficacy of α5β1 inhibition was evaluated using a novel small molecule inhibitor and selective neutralizing antibodies in Sugen/hypoxia and monocrotaline rat models, with validation by an external contract research organization. Comparisons were made against standard-of-care therapies (ie, macitentan, tadalafil) and sotatercept and efficacy was assessed using echocardiographic, hemodynamic, and histological assessments. Ex vivo studies using human precision-cut lung slices were performed to further assess the effects of α5β1 inhibition on pulmonary vascular remodeling.</p><p><strong>Results: </strong>We found that the arginine-glycine-aspartate RGD-binding integrin α5β1 is upregulated in PA endothelial cells and PA smooth muscle cells from patients with PAH and remodeled PAs from animal models. Blockade of the integrin α5β1 or depletion of the α5 subunit downregulated FOXM1 (forkhead box protein M1)-regulated gene networks, resulting in mitotic defects and inhibition of the pro-proliferative and apoptosis-resistant phenotype of PAH cells. We demonstrated that α5β1 integrin blockade safely attenuates pulmonary vascular remodeling and improves hemodynamics and right ventricular function and matched or exceeded the efficacy of standard of care and sotatercept in multiple preclinical models. Ex vivo studies further validated its potential in reversing advanced remodeling in human precision-cut lung slices.</p><p><strong>Conclusions: </strong>These findings establish α5β1 integrin as a pivotal driver of PAH pathology and we propose its inhibition as a novel, safe, and effective therapeutic strategy for PAH.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":35.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001272","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":"Assessing and Addressing Cardiovascular and Obstetric Risks in Patients Undergoing Assisted Reproductive Technology: A Scientific Statement From the American Heart Association.","authors":"Rina Mauricio, Garima Sharma, Jennifer Lewey, Rose Tompkins, Torie Plowden, Kathryn Rexrode, Mary Canobbio, Jenna Skowronski, Afshan Hameed, Candice Silversides, Harmony Reynolds, Arthur Vaught","doi":"10.1161/CIR.0000000000001292","DOIUrl":"https://doi.org/10.1161/CIR.0000000000001292","url":null,"abstract":"<p><p>The use of assisted reproductive technology (ART) is growing, both to assist individuals with infertility and for fertility preservation. Individuals with cardiovascular disease (CVD), or risk factors for CVD, are increasingly using ART. Thus, knowing how to care for patients undergoing ART is important for the cardiovascular clinician. In this scientific statement, we review the ART process and known short-term and long-term risks associated with ART that can adversely affect patients with CVD. We review current knowledge on risks from ART for specific cardiac conditions and provide a suggested approach to evaluating and counseling patients with CVD contemplating ART as well as suggested management before and during the ART process. Individuals with CVD are at increased risk for pregnancy complications, and management of this unique population has been discussed previously. The focus of this scientific statement is on ART. Therefore, discussions on risk assessment, counseling, and management of individuals with CVD during pregnancy are limited, and established guidelines are referenced.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":35.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982924","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":"Exercise Training in Patients With Hypertrophic Cardiomyopathy Without Left Ventricular Outflow Tract Obstruction: A Randomized Clinical Trial.","authors":"Helga Lillian Gudmundsdottir, Anna Axelsson Raja, Kasper Rossing, Hanne Rasmusen, Martin Snoer, Lars Juel Andersen, Rikke Gottlieb, Alex Hørby Christensen, Henning Bundgaard, Finn Gustafsson, Jens Jakob Thune","doi":"10.1161/CIRCULATIONAHA.124.070064","DOIUrl":"10.1161/CIRCULATIONAHA.124.070064","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction commonly experience reduced exercise capacity. Physical training improves exercise capacity in these patients, but whether the underlying effects of exercise are a result of central hemodynamic or peripheral improvement is unclear. This study assessed whether exercise training reduces left ventricular filling pressure measured during exercise in patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Between March 2019 and June 2022, patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction were randomly assigned (1:1) to a 12-week (3 h/wk) supervised, moderate-intensity exercise training program or continued usual activity. The primary outcome was the change in invasively measured pulmonary capillary wedge pressure during mild exercise (25 W) from baseline to week 12. Pressure tracings were analyzed offline by a blinded investigator. Secondary outcomes included changes in peak oxygen consumption, cardiac index, quality of life, echocardiographic indices of diastolic function, and natriuretic peptides.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 59 patients randomized (mean age, 58.1 [12.2] years; 27% women), 51 (86%) completed all follow-up assessments. At week 12, the change in 25-W pulmonary capillary wedge pressure was -2.8 (6.8) mm Hg in the exercise group, compared with +1.2 (4.9) mm Hg in the usual-activity group (between-group difference, 4.0 mm Hg [95% CI, 0.7-7.3]; &lt;i&gt;P&lt;/i&gt;=0.018). Peak oxygen consumption improved by +1.8 (2.0) mL·kg⁻¹·min⁻¹ in the exercise group versus -0.3 (3.1) mL·kg⁻¹·min⁻¹ in the usual-activity group (&lt;i&gt;P&lt;/i&gt;=0.005). Exercise training improved the ventilatory efficiency (V&lt;sub&gt;E&lt;/sub&gt;/VCO&lt;sub&gt;2&lt;/sub&gt;) slope compared with usual activity (between-group difference, 2.0 [95% CI, 0.6-3.5]; &lt;i&gt;P&lt;/i&gt;=0.006). Peak cardiac index improved by +0.38 (1.38) L·min⁻¹·m⁻² in exercise versus -0.85 (1.20) L·min⁻¹·m⁻² in the usual-activity group (&lt;i&gt;P&lt;/i&gt;=0.002). Change in overall Kansas City Cardiomyopathy Questionnaire score was similar between groups. However, the change in physical limitation scores (+8.4 [12.0] points in exercise versus +0.7 [6.8] points in usual-activity group; &lt;i&gt;P&lt;/i&gt;=0.034) and quality-of-life scores (+8.7 [18.0] points in exercise versus 0.7 [4.0] points in usual-activity group; &lt;i&gt;P&lt;/i&gt;=0.01) differed significantly. There were no significant changes in diastolic function assessed by echocardiography or in natriuretic peptides.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction, a 12-week moderate-intensity exercise training program resulted in reduced left ventricular filling pressures at mild exertion and improved exercise performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Registration: &lt;/strong&gt;URL: https://www.clinicaltrials.gov;","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"132-144"},"PeriodicalIF":35.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603498","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":"Swinging Pendulum Between Risks and Benefits of Antiplatelet Agents: A Call for Consistency in the Interpretation of Evidence and Guideline Recommendations.","authors":"Antonio Landi, Diana A Gorog, Marco Valgimigli","doi":"10.1161/CIRCULATIONAHA.124.070797","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.070797","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 2","pages":"126-128"},"PeriodicalIF":35.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977933","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 Sun et al to Letter Regarding Article, \"Piezo1-Mediated Neurogenic Inflammatory Cascade Exacerbates Ventricular Remodeling After Myocardial Infarction\".","authors":"Meiyan Sun, Shufang He, Ji Hu, Ye Zhang","doi":"10.1161/CIRCULATIONAHA.124.071536","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.071536","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 2","pages":"e23"},"PeriodicalIF":35.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977929","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}