JAMA cardiology最新文献

{"title":"Sex-Based Patterns and Trends in Transcatheter Aortic Valve Implantation.","authors":"Johny Nicolas, Annetine C Gelijns, Alan J Moskowitz, Martin B Leon, Roxana Mehran, Joanna Chikwe, Michael J Mack, Mayra E Guerrero, Raj R Makkar, Mariell Jessup, Patrick T O'Gara, Natalia Egorova","doi":"10.1001/jamacardio.2026.0941","DOIUrl":"10.1001/jamacardio.2026.0941","url":null,"abstract":"<p><strong>Importance: </strong>Sex-related disparities affect diagnosis, referral, and prognosis of aortic valvular diseases. Contemporary US data on transcatheter aortic valve implantation (TAVI) by sex are limited.</p><p><strong>Objective: </strong>To characterize 10-year trends in TAVI use, periprocedural complications, and long-term outcomes among Medicare beneficiaries, stratified by sex.</p><p><strong>Design, setting, and participants: </strong>This nationwide, retrospective, population-based cohort study used US Medicare claims data from fee-for-service beneficiaries discharged after TAVI from January 1, 2013, to December 31, 2022. The median follow-up time was 2.19 (IQR, 0.94-3.79) years. Exclusions included patients who had concomitant valve surgery, infective endocarditis, valve-in-valve TAVI, transapical TAVI, TAVI for pure aortic insufficiency, or later conversion to Medicare Advantage. Analyses were conducted between October 1, 2024, and April 1, 2025.</p><p><strong>Exposure: </strong>TAVI.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was all-cause mortality. Secondary outcomes included periprocedural mortality, vascular complications, acute kidney injury, major or life-threatening bleeding, stroke, acute myocardial infarction (AMI), permanent pacemaker implantation (PPI), and hospitalization for heart failure (HF). Adjusted odds ratios (AORs) and hazard ratios (AHRs) with 95% CIs were estimated.</p><p><strong>Results: </strong>The study included 314 123 patients (141 233 women [45.0%] and 172 890 men [55.0%]). Women were older than men (mean [SD] age, female: 80.3 [7.8] years; male: 79.4 [7.7] years; standardized mean difference, 12%). The proportion of female patients who underwent TAVI declined from 47.6% in 2013 to 43.6% in 2022 (P < .001). Compared with men, women had higher periprocedural mortality (2.5% vs 2.2%; AOR, 1.20 [95% CI, 1.14-1.26]), vascular complications (5.8% vs 3.6%; AOR, 1.65 [95% CI, 1.60-1.71]), and bleeding (10.4% vs 6.8%; AOR, 1.67 [95% CI, 1.62-1.71]) but less PPI (16.9% vs 20.0%; AOR, 0.81 [95% CI, 0.79-0.82]). Long-term mortality was lower in female patients (AHR, 0.92; 95% CI, 0.91-0.93), although their risks of HF hospitalization, AMI, stroke, and bleeding were higher.</p><p><strong>Conclusions and relevance: </strong>Among Medicare beneficiaries, women constituted a progressively declining proportion of patients treated with TAVI, experienced more periprocedural complications, and demonstrated modestly better long-term survival compared with men. Further work is needed to understand factors influencing these trends and to refine sex-specific strategies for optimal outcomes.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837924","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":"Competitive Native Flow and Coronary Bypass Graft Patency in AAOCA-Reply.","authors":"Haihang Xu, Beifang Li, Zhaolong Xu","doi":"10.1001/jamacardio.2026.0711","DOIUrl":"https://doi.org/10.1001/jamacardio.2026.0711","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837758","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":"Artificial Intelligence Electrocardiogram and Left Ventricular Systolic Dysfunction in Kenya.","authors":"Ambarish Pandey, Neil Keshvani, Matthew W Segar, Joon-Myoung Kwon, Hak Seung Lee, Charit Bhograj, Khomotso Itumeleng Mashilane, Nipun Jain, William Mwiti, Edwin Wambari, Hellen Nguchu, Lois N Wagana-Muriithi, Erick Anyira, Philemon Namasaka, Lilian Mbau, Anne Wairagu, Beatrice Muthui-Mutua, Maureen Bikoro, M C Riro Mwita, Irene Njeri, Bernard Gituma, David Mbogo, Amanda Ngolobe, Hilda Nabiswa, Bernard Samia","doi":"10.1001/jamacardio.2026.0908","DOIUrl":"10.1001/jamacardio.2026.0908","url":null,"abstract":"<p><strong>Importance: </strong>Early detection of risk of heart failure with reduced ejection fraction remains challenging in resource-limited settings due to limited access to echocardiography. Artificial intelligence electrocardiogram (AI-ECG) algorithms have demonstrated promise for identifying left ventricular systolic dysfunction (LVSD), but their feasibility in resource-constrained settings remains unknown.</p><p><strong>Objective: </strong>To determine the frequency of patients in Kenya with a high probability of LVSD by AI-ECG and assess AI-ECG algorithm performance against the gold standard of echocardiography.</p><p><strong>Design, setting, and participants: </strong>This was a cross-sectional study with enrollment from June to December 2024. Participants underwent baseline assessment and 12-lead ECG, and a subset completed echocardiography within 7 days. The echocardiography subset included participants from 3 prespecified risk strata: those with prior cardiovascular disease, those at high cardiovascular risk (Framingham Risk Score [FRS] ≥10%), and those at low risk (FRS <10%). The study took place at 8 outpatient health care facilities across Kenya. A total of 1444 patients 18 years and older seeking routine care were enrolled and completed paired echocardiogram. Exclusion criteria included inability to provide informed consent.</p><p><strong>Exposure: </strong>Risk of LVSD was identified using a validated convolutional neural network AI-ECG algorithm (AiTiALVSD).</p><p><strong>Main outcomes and measures: </strong>Key outcomes were the diagnostic performance (sensitivity, specificity, and positive and negative predictive values) of the AI-ECG algorithm for detecting LVSD (LVEF <40%) when confirmed on echocardiography.</p><p><strong>Results: </strong>Among 1444 participants (mean [SD] age, 59.0 [16.7] years; 907 [62.8%] female; 1118 [77.4%] at high risk), LVSD was identified in 204 (14.1%). The AI-ECG algorithm had a sensitivity of 95.6% (95% CI, 91.8-97.7), specificity of 79.4% (95% CI, 77.0-81.5), positive predictive value of 43.2% (95% CI, 38.7-47.9), negative predictive value of 99.1% (95% CI, 98.3-99.5), and area under the receiver operating characteristic curve (AUC) of 0.96 (95% CI, 0.95-0.97). Performance remained consistent across cardiovascular risk strata (AUC, 0.96-0.98).</p><p><strong>Conclusions and relevance: </strong>In this study, the AI-ECG algorithm demonstrated the potential clinical utility for screening of LVSD risk with high sensitivity and negative predictive value and may be particularly scalable in a resource-limited setting.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837785","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":"Error in Open Access Status.","authors":"","doi":"10.1001/jamacardio.2026.1518","DOIUrl":"10.1001/jamacardio.2026.1518","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837750","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":"Competitive Native Flow and Coronary Bypass Graft Patency in AAOCA.","authors":"Christoph Gräni, Matthias Siepe","doi":"10.1001/jamacardio.2026.1300","DOIUrl":"https://doi.org/10.1001/jamacardio.2026.1300","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837823","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":"Interpreting AI-Enhanced ECG Performance in High-Risk, Resource-Limited Settings.","authors":"Fu Siong Ng, Anoop Shah, Barbara Casadei","doi":"10.1001/jamacardio.2026.0709","DOIUrl":"https://doi.org/10.1001/jamacardio.2026.0709","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837776","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":"Error in Byline.","authors":"","doi":"10.1001/jamacardio.2026.1459","DOIUrl":"10.1001/jamacardio.2026.1459","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771700","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":"Response to PCSK9 Inhibition Based on LDL Receptor Function in Familial Hypercholesterolemia: A Nonrandomized Clinical Trial.","authors":"Frederick J Raal,Nyda Fourie,Russell Scott,Dirk J Blom,Matthys M De Vries Basson,Meral Kayikcioglu,Mendel Roth,Jeffrey Vest,David Kallend,Evan A Stein","doi":"10.1001/jamacardio.2026.0879","DOIUrl":"https://doi.org/10.1001/jamacardio.2026.0879","url":null,"abstract":"ImportanceIn individuals with heterozygous familial hypercholesterolemia (HeFH), it is uncertain whether and to what extent the reduction in low-density lipoprotein cholesterol (LDL-C) with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor therapy is dependent on the residual functional activity of the LDLR gene carrying the pathogenic variant.ObjectiveTo evaluate the reduction in LDL-C achieved with PCSK9 inhibition according to FH genotype in a large cohort of patients with HeFH.Design, Setting, and ParticipantsThis nonrandomized clinical trial reports on a predefined, pooled subanalysis of participants with HeFH requiring additional lipid-lowering therapy in the open-label worldwide phase 3 study of the PSCK9 inhibitor lerodalcibep. This study included participants randomized to 5 phase 3 studies with the plasma PSCK9 inhibitor lerodalcibep and who participated in the open-label extension study from December 2020 to May 2025. Data were analyzed from March 2025 to February 2026.InterventionAll participants received lerodalcibep 300 mg subcutaneously monthly for 72 weeks.Main Outcome and MeasuresThe co-primary efficacy end points were LDL-C reduction at weeks 48 and 72. Secondary and exploratory end points included LDL-C response according to FH genotype and the achievement of currently recommended LDL-C goals.ResultsAmong 703 included participants (mean [range] age, 53.8 [18-80] years; 372 male [52.9%]), 86 (12.2%) were Black, South Asian, or multiracial and 617 (87.8%) were White; 217 participants (72.3%) had atherosclerotic cardiovascular disease (ASCVD) or were at very high risk for ASCVD and 195 participants (27.7%) were at high risk for ASCVD. Despite most participants receiving treatment with statins or ezetimibe, the mean (SD) baseline LDL-C was 144.9 (61.9) mg/dL. Mean (SD) reductions in LDL-C associated with lerodalcibep were 50.3% (28.9%) and 50.3% (28.7%) (mean [SD] absolute change, -72.6 [50.5] mg/dL and -71.8 [48.0] mg/dL) at weeks 48 and 72, respectively. Of 740 participants (92.5%) who underwent genetic testing, monogenic FH-causing variants were found in 455 participants (61.5%), including 432 participants (95.7%) with the LDLR pathogenic variant. LDL-C reduction with lerodalcibep was independent of LDLR variant functional activity. More than 70% of participants achieved both a reduction in LDL-C of at least 50% and their ASCVD risk-based LDL-C goal.Conclusions and RelevanceThese findings suggest that lerodalcibep was associated with significantly and consistently reduced LDL-C in patients with HeFH, with response found to be independent of LDLR function of the pathogenic variant. These findings support that LDL-C reductions in patients with HeFH with PCSK9 inhibition are predominantly mediated by upregulation of the unaffected wild-type LDLR.Trial RegistrationClinicalTrials.gov Identifier: NCT04798430.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"29 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754897","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 Sodium Paradox in Decompensated Heart Failure.","authors":"Jan Biegus,Julio Núñez,Jeffrey Testani,Piotr Ponikowski","doi":"10.1001/jamacardio.2026.0938","DOIUrl":"https://doi.org/10.1001/jamacardio.2026.0938","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"25 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754896","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":"Timeliness of Transthyretin Cardiac Amyloidosis Diagnosis in the Medicare Population.","authors":"Gabriela Spencer-Bonilla,Jun Fan,Paul Cheng,Natasha Din,Fatima Rodriguez,Marie Davies,Mia A Papas,Joanna Huang,John Venditto,Ronald M Witteles,Paul Heidenreich,Kevin Alexander,Alexander T Sandhu","doi":"10.1001/jamacardio.2026.0833","DOIUrl":"https://doi.org/10.1001/jamacardio.2026.0833","url":null,"abstract":"ImportanceTimely diagnosis of transthyretin cardiac amyloidosis (ATTR-CM) is critical for early treatment to reduce morbidity and mortality, yet the timeliness of contemporary ATTR-CM diagnosis remains poorly understood.ObjectiveTo describe the time from incident heart failure (HF) diagnosis to ATTR-CM diagnosis and identify predictors of delayed diagnosis among Medicare beneficiaries.Design, Setting, and ParticipantsThis was a cohort study using US Medicare fee-for-service data from January 2016 to December 2022. Medicare fee-for-service beneficiaries with HF and ATTR-CM were included. Data were analyzed from November 2024 to July 2025.ExposuresHF diagnosis with ATTR-CM diagnosis following HF diagnosis or within 1 year prior.Main Outcomes and MeasuresThe primary outcome was time to ATTR-CM diagnosis, measured as the number of days between each patient's first HF diagnosis and first ATTR-CM diagnosis. Multivariable logistic regression assessed demographic, clinical, and socioeconomic factors associated with delayed ATTR-CM diagnosis (defined as >6 months from HF diagnosis to ATTR-CM diagnosis).ResultsA total of 7770 patients with HF and ATTR-CM were identified in the Medicare dataset. The median (IQR) age at the time of ATTR-CM diagnosis was 81 (76-86) years; 5995 enrollees (77%) were men. The median (IQR) time from HF diagnosis to ATTR-CM diagnosis was 494 (63-1340) days. For the 6175 patients with a loop diuretic prescription before ATTR-CM diagnosis, the median (IQR) time between initial loop prescription and ATTR-CM diagnosis was 840 (252-1768) days. After adjustment, older age (odds ratio [OR], 0.68; 95% CI, 0.63-0.74), history of atrial fibrillation (OR, 0.39; 95% CI, 0.33-0.49), and carpal tunnel syndrome (OR, 0.85; 95% CI, 0.74-0.97) were associated with lower odds of delayed diagnosis. Female sex (OR, 1.28; 95% CI, 1.13-1.45), a history of aortic stenosis (OR 1.39; 95% CI, 1.20-1.62), chronic obstructive pulmonary disease (OR, 1.18; 95% CI, 1.03-1.34), coronary artery disease (OR, 1.26; 95% CI, 1.13-1.40), diabetes (OR, 1.21; 95% CI, 1.07-1.37), and hypertension (OR, 1.28; 95% CI, 1.13-1.45) were associated with higher odds of delayed diagnosis.Conclusions and RelevanceThere were substantial delays between incident HF and diagnosis of ATTR-CM found in this study. Female sex and having a history of aortic stenosis, coronary artery disease, diabetes, hypertension, or chronic obstructive pulmonary disease, which are each associated with cardiomyopathy and breathlessness, were associated with delayed diagnosis. These findings highlight the need for a heightened index of suspicion for ATTR-CM in patients with other possible etiologies of cardiomyopathy or HF symptoms.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"1 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754895","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}