Circulation最新文献

{"title":"From Hippocrates to Biologics, The Evolving History of Pericarditis: A Review.","authors":"Astefanos Al-Dalakta, Chadi Tabaja, Mohammad Alqahtani, Tom Kai Ming Wang, Massimo Imazio, Paul C Cremer, Sushil Allen Luis, George Lazaros, Allan L Klein","doi":"10.1161/CIRCULATIONAHA.126.079230","DOIUrl":"10.1161/CIRCULATIONAHA.126.079230","url":null,"abstract":"<p><p>Pericarditis remains a common and clinically relevant cardiovascular condition whose diagnosis and management have evolved substantially over time. Understanding this historical progression provides important context for contemporary practice and emerging therapeutic strategies. Early descriptions, dating back to Hippocrates, framed pericarditis as a clinical observation, with more precise diagnostic characterization emerging in the 19th century through the work of Laennec and later refined by clinicians such as Spodick and Hatle. Initial treatment approaches were largely symptomatic or surgical, including pericardiectomy for advanced constrictive disease. The mid-twentieth century marked a shift toward medical therapy with the introduction of nonsteroidal anti-inflammatory drugs and corticosteroids, which improved symptom control but were limited by high recurrence rates. The advent of echocardiography transformed pericardial disease evaluation by enabling noninvasive diagnosis, hemodynamic assessment, and safer pericardiocentesis. More recently, cardiac magnetic resonance imaging has further advanced care by allowing detailed tissue characterization and improved risk stratification. Randomized trials established colchicine as a cornerstone therapy for both acute and recurrent pericarditis. A major paradigm shift has occurred with the recognition of autoinflammatory mechanisms underlying recurrent disease and the introduction of targeted interleukin-1 inhibition, including anakinra and rilonacept, particularly for refractory cases. Together, these advances reflect a transition from empirical management toward mechanism-based, personalized care. Ongoing progress in imaging, biomarker integration, and targeted immunomodulation is expected to further refine diagnosis, treatment, and long-term outcomes for patients with pericardial disease.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"154 13","pages":"1265-1275"},"PeriodicalIF":41.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073694","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":"Risk of Stroke and TIA With Pulsed Field Compared With Radiofrequency Ablation for Atrial Fibrillation.","authors":"Enrico G Ferro, Andre d'Avila, Matthew J Reynolds, Daniel Villarreal, Jason Nelson, Jason Yoon, Stephanie Vu, Anusha Nallaparaju, Andrew H Locke, Timothy Maher, Shu Yang, Patricia Tung, Robert W Yeh, Peter J Zimetbaum, Jonathan W Waks, Daniel B Kramer","doi":"10.1161/CIRCULATIONAHA.126.081092","DOIUrl":"10.1161/CIRCULATIONAHA.126.081092","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) of atrial fibrillation has been rapidly adopted, partly because of safety expectations compared with thermal ablation. Comparative safety data between the 2 modalities remain limited.</p><p><strong>Methods: </strong>We conducted a prospective registry analyzing consecutive atrial fibrillation ablations at a high-volume US academic center between 2022 and 2026. The primary end point was stroke or transient ischemic attack (TIA) within 30 days, independently adjudicated by blinded neurologists. Secondary end points included death and other procedural complications. Propensity score methods with inverse probability of treatment weighting were used to balance differences in patient characteristics. Differences in the procedural workflow of PFA versus radiofrequency ablation (RFA) were evaluated with exploratory mediation analyses.</p><p><strong>Results: </strong>A total of 4221 ablation procedures (2077 RFA and 2144 PFA: 68.7% Farawave, 23.3% Sphere 9, 6.9% Varipulse, 0.7% PulseSelect) was performed by 12 operators. Patients receiving PFA and RFA had similar baseline characteristics (mean age, 67 years; 31% female; 47% persistent atrial fibrillation; 7% previous stroke/TIA), which were balanced after inverse probability of treatment weighting. Compared with RFA, PFA procedures were shorter (108 versus 144 minutes) and included more frequent posterior wall isolation (57% versus 31%). The 30-day rate of stroke/TIA was significantly higher for PFA cases (10 events; 0.47%) compared with RFA (2 events; 0.10%) in both unweighted and propensity score-weighted analyses (weighted risk difference, 0.36% [95% CI, 0.03%-0.70%]; <i>P</i>=0.03). Stroke/TIA events were evenly distributed throughout the study period with no clustering around the time of PFA adoption or operators (with no operator associated with ≥2 events). Exploratory mediation models were limited by the low event rates and did not identify more extensive ablation as an independent risk factor for stroke. Weighted rates of other procedural complications were low (<1%) and similar between PFA and RFA groups.</p><p><strong>Conclusions: </strong>In a high-volume, single-center registry with high clinical granularity and systematic patient follow-up, PFA was associated with a significantly higher risk of stroke/TIA at 30 days compared with RFA. These results call for enhanced postmarket surveillance and dedicated prospective evaluation as the PFA procedural volume continues to exponentially increase.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"1170-1183"},"PeriodicalIF":41.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812377","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":"Primary and Secondary Raynaud: A Scientific Statement From the American Heart Association.","authors":"Francisco Ujueta, Guillaume Goudot, Maurizio Cutolo, Roisin Dolan, Cane Hoffman, Mihir Desai, Marie Gerhard-Herman","doi":"10.1161/CIR.0000000000001464","DOIUrl":"10.1161/CIR.0000000000001464","url":null,"abstract":"<p><p>Raynaud phenomenon (RP), a vascular disorder affecting the small arteries and arterioles of the extremities, is characterized by episodic vasospastic attacks. In primary RP (PRP), these episodes cause changes in skin color, ranging from white (pallor) to blue (cyanosis) due to reduced tissue perfusion, followed by red (hyperemia) upon reperfusion, often triggered by environmental factors or emotional stress. RP is classified into 2 major types: PRP and secondary RP (SRP). PRP and SRP share similar symptoms, but differ in pathogenesis, severity, duration, and potential complications. PRP usually affects women in the second decade of life and typically follows a benign course. SRP usually occurs later in life, secondary to an underlying systemic condition. Unlike PRP, SRP may result in digit ischemia or tissue loss in severe cases. There is a scarcity of clinical trials evaluating treatment options for patients with RP. Management involves both lifestyle modifications and pharmacologic therapies. Although much remains unknown about the pathophysiology, management, and quality of life in RP, emerging evidence suggests that advanced imaging modalities may facilitate earlier detection of SRP. Treating the underlying disease is essential to improving vascular symptoms and preventing complications in SRP. This scientific statement reviews current evidence on quality of life measures for individuals with RP and on medical management, botulinum toxin therapy, and surgical intervention for severe cases.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"e505-e517"},"PeriodicalIF":41.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812388","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":"Optimizing Safety of Pulsed Field Ablation for Atrial Fibrillation: Much Accomplished, Still More to Do.","authors":"Sana M Al-Khatib, Mark S Link, Andrea M Russo","doi":"10.1161/CIRCULATIONAHA.126.082070","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.082070","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"154 13","pages":"1184-1186"},"PeriodicalIF":41.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073671","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":"Hemorrhage Within Atherosclerotic Plaques: From Binary Marker to Dynamic Process.","authors":"Luca Saba, Peter Libby","doi":"10.1161/CIRCULATIONAHA.126.082116","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.082116","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"154 13","pages":"1165-1167"},"PeriodicalIF":41.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073685","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":"CD8 T Cells Derived Granzyme B Mediated Heart Failure After Checkpoint Blockade.","authors":"Daniela Čiháková, Robin A Welsh","doi":"10.1161/CIRCULATIONAHA.126.079961","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.079961","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"154 13","pages":"1258-1260"},"PeriodicalIF":41.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073706","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":"2026 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.","authors":"Annemarie Thompson, Kirsten E Fleischmann, Nathaniel R Smilowitz, Lisa de Las Fuentes, Debabrata Mukherjee, Niti R Aggarwal, Faraz S Ahmad, Robert B Allen, S Elissa Altin, Andrew Auerbach, Jeffrey S Berger, Benjamin Chow, Habib A Dakik, Eric L Eisenstein, Marie Gerhard-Herman, Kamrouz Ghadimi, Bessie Kachulis, Jacinthe Leclerc, Christopher S Lee, Tracy E Macaulay, Gail Mates, Geno J Merli, Purvi Parwani, Jeanne E Poole, Michael W Rich, Kurt Ruetzler, Steven C Stain, BobbieJean Sweitzer, Amy W Talbot, Saraschandra Vallabhajosyula, John Whittle, Kim Allan Williams","doi":"10.1161/CIR.0000000000001472","DOIUrl":"10.1161/CIR.0000000000001472","url":null,"abstract":"<p><strong>Aim: </strong>The \"2026 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery\" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.</p><p><strong>Structure: </strong>Recommendations from the \"2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery\" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"154 13","pages":"e413-e504"},"PeriodicalIF":41.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073732","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 Yang et al to Letter Regarding Article, \"Association of Pre-Fontan Hemodynamics With Long-Term Outcomes After Fontan Palliation: A Study From the Pediatric Cardiac Care Consortium\".","authors":"Yanxu Yang, Jessica H Knight, Xiao Song, Kathy J Jenkins, Jeffrey P Jacobs, Yijian Huang, Matthew E Oster, Lazaros K Kochilas","doi":"10.1161/CIRCULATIONAHA.126.081221","DOIUrl":"10.1161/CIRCULATIONAHA.126.081221","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"154 13","pages":"e411-e412"},"PeriodicalIF":41.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073659","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":"Imaging Features of Hereditary Transthyretin Cardiac Amyloidosis.","authors":"Dominic E Fullenkamp, Ike S Okwuosa, Marissa A Clifford, Lisa M Dellefave-Castillo","doi":"10.1161/CIRCULATIONAHA.126.081419","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.081419","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"154 13","pages":"1276"},"PeriodicalIF":41.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073688","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":"Tocilizumab Is Associated With a Lower Incidence of Major Adverse Cardiovascular Events in Giant Cell Arteritis.","authors":"Alexis F Guedon, Patrice Cacoub, Fabrice Carrat, Olivier Espitia, Adrien Mirouse, Etienne Ghrenassia, Olivier Fain, Arsène Mekinian, David Saadoun","doi":"10.1161/CIRCULATIONAHA.126.080365","DOIUrl":"10.1161/CIRCULATIONAHA.126.080365","url":null,"abstract":"<p><strong>Background: </strong>Giant cell arteritis is associated with increased cardiovascular risk, potentially related to systemic inflammation, vascular injury, and glucocorticoid exposure. Whether steroid-sparing therapies differentially influence cardiovascular outcomes in giant cell arteritis remains uncertain.</p><p><strong>Methods: </strong>We conducted a nationwide observational cohort study emulating a target trial using the French National Health Data System from January 1, 2012, to December 31, 2024. We included patients hospitalized for incident giant cell arteritis who initiated tocilizumab or methotrexate within 6 months after discharge. The primary outcome was the first major adverse cardiovascular event, defined as any coronary event, ischemic stroke, or all-cause death. Treatment effects were estimated with a clone-censor-weight approach with inverse probability of censoring weighting. We estimated 2-year cumulative incidences, absolute risk differences, and hazard ratios with 95% CIs.</p><p><strong>Results: </strong>In 1997 patients with incident giant cell arteritis (mean age, 73.1±8.3 years; 70.4% women), 1095 initiated tocilizumab and 902 initiated methotrexate within 6 months after discharge. At 2 years, the cumulative incidence of major adverse cardiovascular events was 6.4% (95% CI, 4.9%-7.9%) with tocilizumab and 10.7% (95% CI, 8.4%-12.9%) with methotrexate (risk difference, -4.3% [95% CI, -6.6% to -1.7%]). Tocilizumab initiation was associated with a lower risk of major adverse cardiovascular events (hazard ratio, 0.60 [95% CI, 0.48-0.75]), driven by fewer coronary events (hazard ratio, 0.55 [95% CI, 0.37-0.84]) and all-cause deaths (hazard ratio, 0.53 [95% CI, 0.36-0.74]). Results were consistent in sensitivity analyses using alternative grace periods, corticosteroid dose thresholds, restriction to the 2017 to 2024 period, and a per-protocol-analogous approach. Negative control outcomes did not differ meaningfully between treatment strategies.</p><p><strong>Conclusions: </strong>In this nationwide target trial emulation of incident giant cell arteritis, initiation of tocilizumab was associated with a lower risk of major adverse cardiovascular events compared with methotrexate, primarily through a reduction in coronary events and all-cause deaths.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT07459335.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"1187-1199"},"PeriodicalIF":41.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849866","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}