Circulation最新文献

{"title":"Cardiac Biomarkers in Patients with Asymptomatic Severe Aortic Stenosis: Analysis from the EARLY TAVR Trial.","authors":"Brian R Lindman, Philippe Pibarot, Allan Schwartz, J Bradley Oldemeyer, Yan Ru Su, Kashish Goel, David J Cohen, William F Fearon, Vasilis Babaliaros, David Daniels, Adnan Chhatriwalla, Hussam S Suradi, Pinak Shah, Molly Szerlip, Michael J Mack, Thom Dahle, William W O'Neill, Charles J Davidson, Raj Makkar, Tej Sheth, Jeremiah Depta, James T DeVries, Jeffrey Southard, Andrei Pop, Paul Sorajja, Rebecca T Hahn, Yanglu Zhao, Martin B Leon, Philippe Généreux","doi":"10.1161/CIRCULATIONAHA.125.074425","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.125.074425","url":null,"abstract":"<p><strong>Background: </strong>The EARLY TAVR trial demonstrated that early transcatheter aortic valve replacement (TAVR) intervention was superior to clinical surveillance (CS) with delayed TAVR in patients with asymptomatic, severe aortic stenosis (AS). Cardiac biomarkers are associated with maladaptive remodeling, symptom onset, and worse outcomes after TAVR. Whether elevated biomarkers identify asymptomatic patients more likely to benefit from early intervention is unknown.</p><p><strong>Methods: </strong>A core laboratory measured N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitivity cardiac troponin T (hs-cTnT). Associations between biomarker levels and risk of the trial primary endpoint (death, stroke, or unplanned cardiovascular hospitalization) and other secondary endpoints were examined with Kaplan-Meier curves and Cox proportional hazard models. Interaction tests were performed to assess whether the treatment effect of early TAVR, compared with CS, differed according to biomarker levels.</p><p><strong>Results: </strong>Among 901 patients randomized in EARLY TAVR, 798 (89%) had biospecimens measured (median NT-proBNP 287 [145, 601]; median hs-cTnT 14.6 [10.5, 21.0]). Higher levels of NT-proBNP and hs-cTnT were broadly associated with higher event rates for multiple endpoints. In general, there was no significant interaction between baseline biomarkers and treatment group with respect to any composite or individual endpoint examined, although trends broadly demonstrated a greater relative benefit of early TAVR at lower biomarker levels. There was a significant interaction between hs-cTnT and treatment group with respect to death or heart failure hospitalization (HFH) (interaction p=0.04) and HFH alone (interaction p=0.03) such that the relative benefit of early TAVR was greater for patients with normal, rather than elevated, levels of hs-cTnT at baseline. For some endpoints, higher baseline NT-proBNP was associated with numerically greater absolute risk reduction with early TAVR than lower NT-proBNP levels.</p><p><strong>Conclusions: </strong>In patients with asymptomatic severe high gradient AS, higher NT-proBNP and hs-cTnT levels were broadly associated with higher event rates as expected. However, the relative benefit of an early TAVR strategy was consistent regardless of baseline biomarker levels and, contrary to our hypothesis, tended to be more pronounced in those with the lowest biomarker levels. These findings suggest limited value for single measurements of these biomarkers to guide the timing of TAVR in asymptomatic patients.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":35.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751425","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":"Two-year Outcomes of Transcatheter Edge-to-edge Repair for Severe Tricuspid Regurgitation: The TRILUMINATE Pivotal Randomized Trial.","authors":"Saibal Kar, Raj R Makkar, Brian K Whisenant, Nadira Hamid, Hursh Naik, Peter Tadros, Matthew J Price, Gagan Singh, Jonathan G Schwartz, Samir Kapadia, Oluseun Alli, Samuel Horr, Puvi Seshiah, Wayne Batchelor, Brandon M Jones, Mustafa I Ahmed, Raymond Benza, Ulrich Jorde, Vinod H Thourani, Andrew A Ghobrial, Gilbert H L Tang, Phillip M Trusty, Dina Huang, Rebecca T Hahn, David H Adams, Paul Sorajja","doi":"10.1161/CIRCULATIONAHA.125.074536","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.125.074536","url":null,"abstract":"<p><strong>Background: </strong>One-year outcomes of the TRILUMINATE Pivotal trial found that transcatheter edge-to-edge repair (TEER) for the treatment of severe, symptomatic tricuspid regurgitation (TR) improved quality-of-life compared with medical therapy alone with similar rates of mortality and heart failure hospitalization (HFH). However, additional follow-up is necessary to determine prolonged benefits of tricuspid TEER.</p><p><strong>Methods: </strong>A total of 572 patients with severe, symptomatic TR were randomized to either tricuspid TEER+medical therapy (Device) or medical therapy alone (Control). Two-year prespecified endpoints were (1) recurrent HFH and (2) freedom from all-cause mortality, tricuspid valve surgery and tricuspid valve intervention post treatment visit, assessed in the intention-to-treat population.</p><p><strong>Results: </strong>The annualized rate of recurrent heart failure hospitalizations through 2 years was significantly lower with tricuspid TEER compared with Control (0.19 vs 0.26 events/patient-year, p=0.02; joint frailty model hazard ratio 0.72, one-sided upper confidence limit of 0.93, p=0.02). Freedom from all-cause mortality, tricuspid valve surgery, and tricuspid valve intervention through 2 years was significantly higher with tricuspid TEER compared with Control (77.6% vs 29.3%, p<0.0001) driven by more tricuspid valve intervention in control patients crossing over to device treatment (3.8% vs. 61.5%). Rates of all-cause mortality (17.9% vs. 17.1%) and tricuspid valve surgery (2.3% vs. 4.3%) were similar between groups. Moderate-or-less TR was present in 84% at 2 years in the Device group.</p><p><strong>Conclusions: </strong>At 2-year follow-up, tricuspid TEER appears safe, significantly reduced TR severity, and decreased rates of HFH compared with medical therapy alone.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":35.5,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751369","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":"Electronic Provider Notification to Facilitate the Recognition and Management of Severe Aortic Stenosis: a Randomized Clinical Trial.","authors":"Varsha Keelara Tanguturi, Roukoz Abou-Karam, Fangzhou Cheng, Rong Duan, Ignacio Inglessis, Nathaniel Langer, Evin Yucel, Jonathan Passeri, Judy Hung, Sammy Elmariah","doi":"10.1161/CIRCULATIONAHA.125.074470","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.125.074470","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic severe aortic stenosis (AS) remains undertreated with high resultant mortality despite increased growth and availability of aortic valve replacement (AVR) since the advent of transcatheter therapies. We evaluate the impact of electronic provider notifications (EPN) on rates of AVR at 1-year.</p><p><strong>Methods: </strong>In a pragmatic cluster randomized clinical trial conducted within multicenter academic health system from March 2022 through November 2023, 285 providers who had ordered a transthoracic echocardiogram (TTE) with findings potentially indicative of severe AS with aortic valve area ≤ 1.0 cm² were enrolled. Providers were randomly assigned to receive EPN for each of their patients with severe AS on TTE or to usual care. Notifications highlighted the detection of severe AS and included patient-specific clinical guideline recommendations for its management. The primary endpoint was the proportion of patients with severe AS receiving AVR within 1-year of the index TTE.</p><p><strong>Results: </strong>A total of 144 providers were randomized to intervention and 141 to control, resulting in 496 and 443 patients assigned to each group, respectively. The patient cohort had mean age of 77±11 years, was 47% female, and had mean aortic valve area 0.8±0.1 cm². Rates of AVR within 1-year were 48.2% with EPN versus 37.2% with usual care (OR 1.62; 95% CI 1.13-2.32; p=0.009) and 60.7% and 46.5%, respectively, amongst symptomatic patients (OR 1.77; 95% CI 1.17-2.65; p=0.006). Notification treatment effect was highest with EPN in patients >80 years of age (OR 2.00; 95% CI 1.17-3.41; p=0.01), in women (OR 2.78; 95% CI 1.69-4.57; p<0.001), and when index TTE was performed within the inpatient setting (OR 2.49, 95% CI 1.44-4.31; p<0.001). Within 1-year, restricted mean survival time was longer with EPN in all (12 days; p=0.04) and symptomatic patients (23 days; p=0.01).</p><p><strong>Conclusions: </strong>In this first study of EPN in valvular heart disease, EPN increased rates of AVR for severe AS, lessened gender and age disparities in AVR utilization, and improved survival time. EPN may provide a simple, scalable intervention to raise awareness of critical TTE findings and improve the quality of care for severe AS.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":35.5,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751366","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":"Oral Semaglutide and Cardiovascular Outcomes in Persons With Type 2 Diabetes, According to SGLT2i Use: Prespecified Analyses of the SOUL Randomized Trial.","authors":"Nikolaus Marx, John E Deanfield, Johannes F E Mann, Rosario Arechavaleta, Stephen C Bain, Harpreet S Bajaj, Katrine Bayer Tanggaard, Andreas L Birkenfeld, John B Buse, Zaklina Davicevic-Elez, Cyrus Desouza, Scott S Emerson, Mads D M Engelmann, G Kees Hovingh, Silvio E Inzucchi, Pardeep S Jhund, Sharon L Mulvagh, Rodica Pop-Busui, Neil R Poulter, Søren Rasmussen, Shih-Te Tu, Darren K McGuire","doi":"10.1161/CIRCULATIONAHA.125.074545","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.125.074545","url":null,"abstract":"<p><strong>Background: </strong>Both glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose co-transporter-2 inhibitors (SGLT2i) improve cardiovascular (CV) outcomes in people with type 2 diabetes (T2D) and CV or chronic kidney disease (CKD). However, there are limited data about the effect of combining these agents on CV and safety outcomes.</p><p><strong>Methods: </strong>The SOUL trial (NCT03914326) randomised 9650 participants with T2D and atherosclerotic CV disease and/or CKD to oral semaglutide or placebo. As prespecified, participants were analysed according to baseline use of SGLT2i (Yes: n=2596, No: n=7054) and, subsequently for any use of SGLT2i during the trial (Yes: n=4718, No: n=4932). The primary outcome was time to first major adverse cardiovascular event (MACE), defined as cardiovascular death, non-fatal myocardial infarction or non-fatal stroke. Safety was evaluated by comparing the incidence of serious adverse events.</p><p><strong>Results: </strong>Over a mean follow-up of 47.5±10.9 months, the risk of the primary outcome in the overall trial population was 14% lower for oral semaglutide vs placebo (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.77; 0.96). In those taking SGLT2i at baseline, there were 143/1296 (semaglutide) versus 158/1300 (placebo) primary outcome events (HR 0.89; 95% CI 0.71; 1.11); and 436/3529 versus 510/3525, respectively, in participants not taking SGLT2i at baseline (HR 0.84; 95% CI 0.74; 0.95; <i>P</i>-interaction 0.66). An analysis of MACE by any in-trial SGLT2i use versus no use also showed no evidence of heterogeneity in the effects of oral semaglutide. The adverse event profiles of oral semaglutide with or without concomitant SGLT2i were similar.</p><p><strong>Conclusions: </strong>Oral semaglutide reduced MACE outcomes independently of concomitant SGLT2i treatment and this combination appeared to be safe.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":35.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742412","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":"Role of Cardiovascular Disease Journals in Reporting Sex and Gender in Research.","authors":"C Noel Bairey Merz, Robert O Bonow, Mercedes Carnethon, Filippo Crea, Joseph A Hill, Harlan M Krumholz, Roxana Mehran, Erica S Spatz","doi":"10.1161/CIRCULATIONAHA.125.074517","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.125.074517","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":35.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729039","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":"Impact of Heart Transplant Allocation Changes on Waitlist Mortality and Clinical Practice in Pediatric and Adult Patients With Congenital Heart Disease and Cardiomyopathy.","authors":"Luke Wooster, Matthew J O'Connor, Xuemei Zhang, Constantine D Mavroudis, Katsuhide Maeda, Humera Ahmed, Jonathan Edwards, Kimberly Y Lin, Carol Wittlieb-Weber, Joseph W Rossano, Jonathan B Edelson","doi":"10.1161/CIRCULATIONAHA.124.072335","DOIUrl":"10.1161/CIRCULATIONAHA.124.072335","url":null,"abstract":"<p><strong>Background: </strong>The United Network of Organ Sharing made changes to the priority for allocation of hearts for transplantation in 2016 for pediatric patients and 2018 for adult patients. Although recent work has evaluated the impact of the revised allocation systems on mechanical circulatory support practices and waitlist outcomes, there are limited data that focus more specifically on the impact of the allocation changes on patients with congenital heart disease (CHD) or cardiomyopathy and how these relationships might differ in pediatric and adult patients.</p><p><strong>Methods: </strong>The United Network of Organ Sharing database was queried for pediatric (<18 years of age) and adult (18-50 years of age) patients with a CHD or cardiomyopathy diagnosis listed for heart transplantation. Cohorts were grouped into preallocation and postallocation change eras: pediatric patients from January 1, 2011, to March 21, 2016, and January 1, 2017, to December 31, 2021; and adult patients from January 1, 2015, to October 17, 2018, and January 1, 2019, to December 31, 2021. Differences in era for survival or waitlist removal because of clinical deterioration from the time of heart transplantation listing were compared using competing risk models.</p><p><strong>Results: </strong>We identified 11 637 patients listed for heart transplantation during the study period, including 2882 pediatric patients with CHD, 594 adults with CHD, 2348 pediatric patients with cardiomyopathy, and 5813 adults with cardiomyopathy. In a competing risk model adjusting for demographic and clinical factors, allocation changes were significantly associated with lower death or waitlist removal within 1 year of heart transplantation listing in infants with CHD (hazard ratio, 0.75 [95% CI, 0.57-0.99]; <i>P</i>=0.04), children with CHD (hazard ratio, 0.61 [95% CI, 0.43-0.86]; <i>P</i>=0.005), and adults with cardiomyopathy (hazard ratio, 0.60 [95% CI, 0.44-0.81]; <i>P</i>=0.001), but not in infants with cardiomyopathy, children with cardiomyopathy, or adults with CHD.</p><p><strong>Conclusions: </strong>The recent allocation changes of the Organ Procurement and Transplantation Network associations with waitlist duration and outcome were not uniform across pediatric and adult cohorts with CHD or those with cardiomyopathy. Children with cardiomyopathy and adults with CHD did not experience the mortality benefits experienced by adults with cardiomyopathy and children with CHD. Future iterations of the allocation systems should consider differential access to mechanical circulatory support options for children and adults, patient sensitization status, and whether having separate systems for adults and children is the most appropriate method to allocate organs.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"814-824"},"PeriodicalIF":35.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945759","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":"Highlights From the <i>Circulation</i> Family of Journals.","authors":"","doi":"10.1161/CIRCULATIONAHA.125.074426","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.125.074426","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 12","pages":"878-883"},"PeriodicalIF":35.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699799","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 Disease in Anabolic Androgenic Steroid Users.","authors":"Josefine Windfeld-Mathiasen, Ida M Heerfordt, Kim Peder Dalhoff, Jon Trærup Andersen, Michael Asger Andersen, Karl Sebastian Johansson, Tor Biering-Sørensen, Flemming Javier Olsen, Henrik Horwitz","doi":"10.1161/CIRCULATIONAHA.124.071117","DOIUrl":"10.1161/CIRCULATIONAHA.124.071117","url":null,"abstract":"<p><strong>Background: </strong>Use of anabolic androgenic steroids (AASs) is associated with increased mortality, and case reports have suggested that some of these deaths are due to cardiovascular disease. However, the epidemiology of cardiovascular disease in AAS users is still relatively unexplored. This study aimed to measure the incidence of cardiovascular disease in male AAS users and to compare these rates with those of a cohort from the general population matched by age and sex.</p><p><strong>Methods: </strong>Men sanctioned in an antidoping program for AAS use in Danish fitness centers between 2006 and 2018 were included and matched for age and sex with 50 times as many controls from the general Danish population. The cohort was followed until June 30, 2023. Using the nationwide registries, we obtained information on admissions, prescriptions, educational length, and occupational status for both the AAS users and controls. This study investigated the incidence of acute myocardial infarction, percutaneous coronary intervention, or coronary artery bypass graft, venous thromboembolism, ischemic stroke, arrhythmia, cardiomyopathy, heart failure, and cardiac arrest during the follow-up period.</p><p><strong>Results: </strong>During an average of 11 years of follow-up, AAS users (n=1189) demonstrated a significantly higher incidence of several cardiovascular events compared with controls (n=59 450). Correspondingly, AASs were associated with an increased risk of acute myocardial infarction (adjusted hazard ratio [aHR] 3.00 [95% CI, 1.67-5.39]), percutaneous coronary intervention or coronary artery bypass graft (aHR 2.95 [95% CI, 1.68-5.18]), venous thromboembolism (aHR 2.42 [95% CI, 1.54-3.80]), arrhythmias (aHR 2.26 [95% CI, 1.53-3.32]), cardiomyopathy (aHR 8.90 [95% CI, 4.99-15.88]), and heart failure (aHR 3.63 [95% CI, 2.01-6.55]). Due to the limited number of ischemic stroke and cardiac arrest cases among AAS users, these outcomes were not reportable.</p><p><strong>Conclusions: </strong>AAS use is associated with a substantially increased risk of cardiovascular disease in a large cohort with a long follow-up period.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"828-834"},"PeriodicalIF":35.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406103","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":"Hypertension and Atrial Fibrillation: A Frontier Review From the AF-SCREEN International Collaboration.","authors":"Teemu J Niiranen, Renate B Schnabel, Aletta E Schutte, Yitschak Biton, Giuseppe Boriani, Claire Buckley, Alan C Cameron, Albertino Damasceno, Søren Z Diederichsen, Wolfram Doehner, Yutao Guo, F D Richard Hobbs, Boyoung Joung, Graeme J Hankey, Gregory Y H Lip, Trudie Lobban, Maja-Lisa Løchen, Georges Mairesse, Amam Mbakwem, Peter A Noseworthy, George Ntaios, Steven Steinhubl, George Stergiou, Jesper Hastrup Svendsen, Robert G Tieleman, Jiguang Wang, Neil R Poulter, Jeff S Healey, Ben Freedman","doi":"10.1161/CIRCULATIONAHA.124.071047","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.071047","url":null,"abstract":"<p><p>Hypertension is the leading modifiable risk factor for atrial fibrillation (AF) and is estimated to be present in >70% of AF patients. This Frontiers Review was prepared by 29 expert members of the AF-SCREEN International Collaboration to summarize existing evidence and knowledge gaps on links between hypertension, AF, and their cardiovascular sequelae; simultaneous screening for hypertension and AF; and the prevention of AF through antihypertensive therapy. Hypertension and AF are inextricably connected. Both are easily diagnosed, often silent, and frequently treated inadequately. Together, they additively increase the risk of ischemic stroke, heart failure, and many types of dementia, resulting in greater all-cause mortality, considerable disease burden, and increased health care expenditures. Automated upper arm cuff blood pressure devices with implemented technology can be used to simultaneously detect both hypertension and AF. However, positive screening for AF with an oscillometric blood pressure monitor still requires ECG confirmation. The current evidence suggests that high-risk individuals aged ≥65 years or with treatment-resistant hypertension could benefit from AF screening. Since antihypertensive therapy effectively lowers AF risk, particularly in individuals with left ventricular dysfunction, hypertension should be the key target for AF prediction and prevention rather than merely a comorbidity of AF. Nevertheless, several important gaps in knowledge need to be filled over the next years, including the ideal method and selection of patients for simultaneous screening of hypertension and AF and the optimal antihypertensive drug class and blood pressure targets for AF prevention.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 12","pages":"863-877"},"PeriodicalIF":35.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699803","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":"Aspirin Plus Rivaroxaban Versus Rivaroxaban Alone for the Prevention of Venous Stent Thrombosis Among Patients With Post-Thrombotic Syndrome: The Multicenter, Multinational, Randomized, Open-Label ARIVA Trial.","authors":"Stefano Barco, Houman Jalaie, Tim Sebastian, Simon Wolf, Riccardo M Fumagalli, Michael Lichtenberg, Thomas Zeller, Christian Erbel, Oliver Schlager, Nils Kucher","doi":"10.1161/CIRCULATIONAHA.124.073050","DOIUrl":"10.1161/CIRCULATIONAHA.124.073050","url":null,"abstract":"<p><strong>Background: </strong>In patients with post-thrombotic syndrome, stent recanalization of iliofemoral veins or the inferior vena cava can restore venous patency and improve functional outcomes. The risk of stent thrombosis is particularly increased during the first 6 months after intervention. The ARIVA trial (Aspirin Plus Rivaroxaban Versus Rivaroxaban Alone for the Prevention of Venous Stent Thrombosis in Patients With PTS) tested whether 100 mg of daily aspirin plus 20 mg of rivaroxaban is superior to 20 mg of rivaroxaban alone to prevent stent thrombosis within 6 months after stent placement for post-thrombotic syndrome.</p><p><strong>Methods: </strong>In this multinational, academic, open-label, independently adjudicated trial, patients with a Villalta score >4 points and a stenosis or occlusion of the inferior vena cava, iliac veins, or common femoral vein successfully treated with venous stent placement were randomized in a 1:1 fashion to the study groups. Key exclusion criteria included <18 or >75 years of age, contraindications to anticoagulant use, or acute venous thrombosis <3 months. The primary efficacy outcome was the composite of no occlusion in the treated segment assessed at serial duplex ultrasound examinations or no reintervention needed to maintain patency within 6 months. Secondary outcomes, including Villalta score, quality of life, and safety outcomes, were also assessed. The study was registered at ClinicalTrials.gov (NCT04128956).</p><p><strong>Results: </strong>From 2020 through 2022, 172 patients were screened, 169 were randomized, and 162 were included in the full analysis set, receiving either aspirin plus rivaroxaban (n=80) or rivaroxaban alone (n=82) for 6 months. Mean±SD age was 42.8±14.7 years; 103 patients (60.9%) were women; 154 patients (97.5%) were White; and leg ulcers were present in 7% of patients. The primary patency rate at 6 months was 94.8% versus 92.4% (absolute risk difference, 2.4% [95% CI, -13.6 to 18.0]), respectively. The mean±SD decrease in the Villalta score for the affected leg (without ulcer) from baseline to 6 months was -6.7±4.4 and -7.0±5.2 points (<i>P</i>=0.36), respectively. There were no differences in other outcomes or quality of life at 6 months. No major bleeding occurred.</p><p><strong>Conclusions: </strong>The overall primary patency rate during the first 6 months after endovascular intervention for post-thrombotic syndrome was higher than expected and comparable between patients receiving aspirin combined with rivaroxaban and those receiving rivaroxaban alone.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04128956.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"835-846"},"PeriodicalIF":35.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051867","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}