Circulation最新文献

{"title":"Effect of APOC3 Inhibition with Olezarsen on Coronary Atherosclerosis: Essence-TIMI 73b Imaging Study.","authors":"Nicholas A Marston,Brian A Bergmark,Thomas A Prohaska,Filipe A Moura,Andre Zimerman,Veronica J Alexander,Yu Mi Kang,Julia Weinland,Xinhui Ran,Sabina A Murphy,Shuanglu Zhang,Dan Li,Maciej Banach,Erik S G Stroes,Robert Kiss,Daniel Gaudet,Michal Vrablik,Assen Goudev,Jeroen J Bax,Matthew J Budoff,Borek Foldyna,Michael T Lu,Sotirios Tsimikas,Robert P Giugliano,Marc S Sabatine","doi":"10.1161/circulationaha.126.080012","DOIUrl":"https://doi.org/10.1161/circulationaha.126.080012","url":null,"abstract":"BACKGROUNDWhether lowering triglyceride-rich lipoproteins and remnant cholesterol favorably modifies coronary atherosclerosis is unclear. Olezarsen, an antisense oligonucleotide that targets apolipoprotein C-III, reduces triglycerides by ~60% and remnant cholesterol by ~70%, has a neutral effect on LDL cholesterol (LDL-C), and reduces apolipoprotein B (apoB) by ~15% in moderate hypertriglyceridemia. We investigated the effect of olezarsen on coronary plaque in adults with largely moderate hypertriglyceridemia.METHODSWe conducted a coronary computed tomography angiography (CCTA) study within Essence-TIMI 73b, a randomized, placebo-controlled trial of olezarsen vs. placebo that enrolled patients between November 2022 and February 2024. Inclusion criteria were triglycerides ≥150 mg/dL (2.26 mmol/L), presence or high risk for cardiovascular disease, and non-calcified plaque on baseline CCTA. The primary endpoint was percent change from baseline to 12 months in non-calcified plaque volume (NCPV).RESULTSOf 468 participants (349 olezarsen, 119 placebo), the median age was 63 years (IQR 56-70); 31% were women, and 97% received lipid-lowering therapy. Median baseline triglycerides were 249 mg/dL (IQR 197-331), and remnant cholesterol was 53 mg/dL (IQR 38-76). Median baseline NCPV was 125.3 mm³ (IQR 63.2-213.3). At 6 months, olezarsen reduced triglycerides by 63.9%, remnant cholesterol by 71.9%, and apolipoprotein B by 16.0% over placebo, with no difference in LDL-C. The percent change in NCPV with olezarsen from baseline to month 12 did not differ between olezarsen and placebo (placebo-adjusted least-squares mean difference 2.98%; 95% CI -3.4 to 9.3; p=0.36). No significant differences between olezarsen and placebo were observed for changes in low-attenuation, calcified, or total plaque volumes at 12 months.CONCLUSIONSDespite substantial triglyceride and remnant cholesterol lowering, treatment with olezarsen for 12 months on top of standard-of-care lipid-lowering therapy in patients with largely moderate hypertriglyceridemia did not affect noncalcified coronary plaque volume.","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"3 1","pages":""},"PeriodicalIF":37.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147536244","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":"Prehospital Heparin Administration in Patients With STEMI Undergoing Primary PCI: HEPARIN STEMI Randomized Controlled Trial.","authors":"Misa Fister,Marko Noc,Peter Radsel,Matjaz Bunc,Danilo Franco,Tomaz Goslar, ","doi":"10.1161/circulationaha.126.079839","DOIUrl":"https://doi.org/10.1161/circulationaha.126.079839","url":null,"abstract":"BACKGROUNDPrimary PCI is the preferred reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI). We investigated benefits and safety of pretreatment with unfractioned heparin (UFH) in STEMI referred to primary PCI.METHODSOur single-center, open-label, randomized controlled trial assigned STEMI with ≤6 hours of symptom duration either to 70-100 IE/kg bolus of UFH at first prehospital medical contact (FMC) plus supplemental dose before PCI adjusted to activated clothing time ≥250 seconds or to control group undergoing standard UFH at the time of PCI. Primary efficacy endpoint was TIMI 2-3 flow in infarct related artery (IRA) at initial coronary angiography. Primary safety endpoint was BARC 3-5 bleeding during the index hospital stay.RESULTSFrom March 2022 to February 2025, 298 patients were randomized to UFH pretreatment and 295 to the control group. Both groups were comparable in age, gender, risk factors, previous cardiovascular events and median delay from symptoms to coronary angiography (145 min vs 150 min; p=0.814). Median time from UFH pretreatment to coronary angiography was 60 min (25th and 75th IQR 47 - 55 min). TIMI 2-3 in IRA was documented in 43% in UFH pretreatment and 27% in control groups (RR 1.59 [95% CI 1.27-1.98]; p<0.001) without significant difference in BARC 3-5 bleeding (2.4% vs 2.0%; RR 1.16 [95% CI 0.39-3.45]; p=0.789).CONCLUSIONSIn patients with STEMI undergoing primary PCI in a mature STEMI network, pretreatment with UFH at FMC was associated with an absolute 16% increase in IRA patency without causing excessive bleeding.","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"16 1","pages":""},"PeriodicalIF":37.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147536246","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":"Myocardial Infarction, Precision-Engineered T Regulatory Cells to the Rescue.","authors":"Liwu Li","doi":"10.1161/circulationaha.126.078800","DOIUrl":"https://doi.org/10.1161/circulationaha.126.078800","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"89 1","pages":"998-1000"},"PeriodicalIF":37.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578067","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":"Competing Risks in Cardiovascular Research: A Practical Perspective.","authors":"Andrea Bellavia,Sabina A Murphy","doi":"10.1161/circulationaha.126.078513","DOIUrl":"https://doi.org/10.1161/circulationaha.126.078513","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"104 1","pages":"945-947"},"PeriodicalIF":37.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578011","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":"Transient Sprr1a Expression Defines a Population of Border Zone Cardiomyocytes That Survive Ischemic Injury.","authors":"Emily H Marshall,Daniel A Zuppo,Kimberly N Burgos Villar,Adwiteeya Misra,Deanne M Mickelsen,Ronald A Dirkx,Eric M Small","doi":"10.1161/circulationaha.125.075192","DOIUrl":"https://doi.org/10.1161/circulationaha.125.075192","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"1 1","pages":"1001-1004"},"PeriodicalIF":37.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Dawn for Pre-hospital Heparin in STEMI? Insights from the HEPARIN STEMI Trial.","authors":"Diana A Gorog,Antonio Landi","doi":"10.1161/circulationaha.126.080190","DOIUrl":"https://doi.org/10.1161/circulationaha.126.080190","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"1 1","pages":""},"PeriodicalIF":37.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147536245","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":"Adaptive AI for Cardiovascular Event Adjudication: Cardiovascular Event Adjudication Across Different Definitions in the ODYSSEY OUTCOMES and EUCLID Trials.","authors":"Sreekanth Vemulapalli,Karla Pena Guerra,Daniel Wojdyla,W Schuyler Jones,Kenneth W Mahaffey,Robert A Harrington,Philippe Gabriel Steg,Gregory G Schwartz,Manesh R Patel,Renato D Lopes,Ricardo Henao","doi":"10.1161/circulationaha.126.080072","DOIUrl":"https://doi.org/10.1161/circulationaha.126.080072","url":null,"abstract":"BACKGROUNDClinical endpoint classification (CEC) is the gold standard for cardiovascular endpoint measurement in clinical trials, but adds time and cost. We developed and validated an artificial intelligence (AI) algorithm (ADAPT-CEC) that adjudicates multiple cardiovascular endpoints and adapts to new definitions.METHODSADAPT-CEC was derived on myocardial infarction (MI), stroke, and heart failure from the ODYSSEY OUTCOMES trial and externally validated on MI, stroke, bleeding and CV death from the EUCLID trial after adaptation with 20 EUCLID suspected events per endpoint. ADAPT-CEC was compared via F1 score with direct generative pretrained transformer (GPT) 4.0 adjudication and a hybrid approach where the 30% of suspected events with the lowest AI prediction certainty used human adjudication. The EUCLID primary endpoint of CV death, MI, or stroke was re-estimated for all three adjudication strategies.RESULTSAmongst 13,885 suspected EUCLID primary endpoint events, ADAPT CEC, hybrid, and GPT 4.0 strategies correctly classified 86.4%, 95.6%, and 76.3% of all endpoints and 99.4%, 99.6%, and 99.8% of all non-endpoints compared with human adjudication, respectively. Hybrid adjudication F1 metrics were the highest [CV death (0.94, 95% CI 0.92 - 0.96), MI (0.80, 95% CI 0.77 - 0.82), stroke (0.82; 95% CI 0.78 - 0.86), bleeding (0.83, 95% CI 0.82 - 0.85)]. ADAPT-CEC F1 metrics were lower for CV death, MI, and stroke but similar to GPT 4.0 while bleeding (0.78, 95% CI 0.77 - 0.79) was superior to GPT 4.0. The EUCLID primary treatment effect was similar by human adjudication (HR 1.02, 95% CI 0.93 - 1.13), hybrid (HR 1.04; 95% CI 0.94 - 1.15) ADAPT-CEC (HR 0.98, 95% CI 0.88 - 1.09) and GPT 4.0 (1.06, 95% CI 0.95 - 1.19) adjudication.CONCLUSIONSAfter brief adaptation, a single trial derived AI algorithm can adjudicate similar (MI and stroke) and new endpoints (CV death and bleeding) in a second trial and replicate the EUCLID primary outcome treatment effect. A hybrid approach with humans adjudicating those suspected events with the lowest 30% of ADAPT-CEC prediction certainty was superior to ADAPT-CEC alone or GPT 4.0 alone and replicated the EUCLID primary outcome treatment effect. Prospective studies of adaptive AI adjudication are needed to determine future trial implementation.","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"62 1","pages":""},"PeriodicalIF":37.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578014","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":"The Role of Atrial Pacing Support in Cardiac Resynchronization Therapy: A Non-Inferiority Randomized Trial.","authors":"Mauro Biffi,Giovanni Rovaris,Ennio Carmine Luigi Pisanò,Valeria Calvi,Antonio Rapacciuolo,Matteo Santamaria,Giampiero Maglia,Gabriele Zanotto,Emanuele Bertaglia,Gerardo Nigro,Andrea Giomi,Francesca Notarangelo,Patrizia Pepi,Giuliano D'Alterio,Davide Castagno,Antonio Dello Russo,Antonino Nicosia,Massimo Zecchin,Matteo Bertini,Antonio Duca,Daniele Giacopelli,Alessio Gargaro,Giovanni Luca Botto, ","doi":"10.1161/circulationaha.126.079859","DOIUrl":"https://doi.org/10.1161/circulationaha.126.079859","url":null,"abstract":"BACKGROUNDThe role of atrial pacing support is unclear in cardiac resynchronization therapy-defibrillator (CRT-D) patients without sinus node dysfunction.METHODSWe conducted a randomized, parallel-group, non-inferiority trial to evaluate whether a two-lead CRT-DX system capable of atrial sensing (but no pacing) via a floating dipole on the right ventricular lead is not inferior to a three-lead CRT-D with conventional atrial lead. Between October 17, 2018, and March 5, 2024, 636 patients (68 ± 10 years old, 28.6% females) with standard CRT-D indication, optimized medical therapy, and resting sinus rate ≥45 beats/min were randomized 1:1 to CRT-DX (VDD 35 beats/min) or CRT-D (DDD 50 beats/min) at 23 Italian sites. A centralized block randomization procedure stratified by site was used, with patients and primary outcome assessors blinded to treatment assignment. The primary endpoint was a 1-year composite of all-cause mortality, cardiovascular hospitalization, and lead-related complications (loss of functionality not correctable by device reprogramming). Key secondary endpoints were each component, echocardiographic reverse remodeling, and 6-minute walk test distance at 12 months.RESULTSThe primary endpoint occurred in 41 (13.1%) patients in the CRT-DX group and 47 (15.6%) patients in the CRT-D group, corresponding to a hazard ratio of 0.82 (95% CI, 0.54-1.25). This confirmed non-inferiority (pre-specified relative margin of 1.20) in both the per-protocol (p=0.039) and intention-to-treat (p=0.044) analyses. Individual components showed no significant differences, except for lead complications related to right atrial functionality (4 [1.3% ] patients in the CRT-DX group vs. 13 [4.2%] patients in the CRT-D group; p=0.040). Reverse remodeling responders were 203 (77.5% of 262) CRT-DX patients and 190 (76.3% of 249) CRT-D patients (p=0.83). Walking distance did not differ between two study arms (404 vs. 398 m; p=0.62). After median follow-up of 2.4 years, only one CRT-DX patient required implantation of a standard atrial lead.CONCLUSIONSTwo-lead CRT-DX system without atrial pacing is non-inferior to conventional three-lead CRT-D, with fewer atrial lead-related complications.","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"117 1","pages":""},"PeriodicalIF":37.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147536247","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":"Group 1 Pulmonary Hypertension With Elevated Pulmonary Artery Wedge Pressure: Characterizing A Complex Phenotype.","authors":"Lindsay M Forbes,William K Cornwell","doi":"10.1161/circulationaha.126.078855","DOIUrl":"https://doi.org/10.1161/circulationaha.126.078855","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"18 1","pages":"963-966"},"PeriodicalIF":37.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578068","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 Meng et al Regarding Article, \"An Aberrant Resurgence of Endogenous Retroviruses Prompts Myocarditis and Heart Failure\".","authors":"Chang Meng,Yintang Wang,Guobin Miao","doi":"10.1161/circulationaha.125.077923","DOIUrl":"https://doi.org/10.1161/circulationaha.125.077923","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"14 1","pages":"e1058"},"PeriodicalIF":37.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578013","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}