JAMA cardiology最新文献

{"title":"First-in-Human Real-Time MR-Guided Ventricular Ablation for Idiopathic Outflow Tract Premature Ventricular Complexes.","authors":"Marco J W Götte,Luuk H G A Hopman,Pranav Bhagirath,Michiel J B Kemme,Jules L Nelissen,Katherine Lindborg,Axel J Krafft,Marieke E S Sprengers,Steven A J Chamuleau,Cornelis P Allaart","doi":"10.1001/jamacardio.2025.3000","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3000","url":null,"abstract":"ImportanceCatheter ablation is a cornerstone therapy for symptomatic ventricular arrhythmias, yet current techniques rely on fluoroscopy and electroanatomic mapping, which provide limited soft-tissue detail and expose patients and staff to ionizing radiation. Real-time magnetic resonance (MR)-guided ablation may overcome these limitations by enabling direct visualization of cardiac anatomy, substrate, and lesion formation, all within a radiation-free environment.ObjectiveTo demonstrate the technical feasibility and safety of the first-in-human real-time MR-guided radiofrequency ventricular ablation procedure.Design, Setting, and ParticipantThis was a prospective, worldwide-first roll-in case from the ongoing VISABL-VT nonrandomized clinical trial assessing MR-guided radiofrequency ablation of ventricular tachycardia. The procedure and analysis were performed in April 2025 at an academic tertiary care center equipped with a standard 1.5-T MR imaging (MRI) suite and dedicated MR-compatible electrophysiology platform, MR-compatible 12-lead electrocardiographic monitoring and recording system, MR-conditional defibrillator, and real-time catheter tracking integrated with the MRI scanner for synchronized imaging and ablation. The patient was a 73-year-old man with symptomatic, drug-refractory outflow tract premature ventricular complexes (PVCs).InterventionThe ablation was performed under general anesthesia inside the MRI scanner. Intraprocedurally acquired noncontrast 3-dimensional MR angiographic imaging was used to create an anatomical roadmap for the procedure. Real-time catheter tracking and activation mapping were performed using actively tracked diagnostic and ablation catheters. Mapping identified earliest activation first in the posterior septal right ventricular outflow tract, where ablation transiently suppressed PVCs. Ectopy recurred but was ultimately resolved by ablation performed via a retrograde aortic approach in the left coronary cusp. Lesion formation was confirmed via postprocedural MRI.Main Outcomes and MeasuresSuppression of PVCs and presence or absence of procedural complications.ResultsThe procedure was performed under real-time MRI guidance without complications. PVCs were completely suppressed, with no recurrence during 30-minute observation or at 2-month follow-up.ConclusionsThis first-in-human case demonstrates that ventricular ablation can be safely and effectively performed entirely under real-time MR guidance. Further evidence from the VISABL-VT trial will clarify clinical utility and long-term outcomes.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"4658 3 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071734","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":"Subclinical Coronary Atherosclerosis and Retinal Optical Coherence Tomography Angiography.","authors":"Jee Myung Yang,Dong Hyun Yang,Seung-Whan Lee,Jiehoon Kwak,Yunhan Lee,Yoon Jeon Kim,Joo Yong Lee,Kyung Rim Sung,Young Hee Yoon","doi":"10.1001/jamacardio.2025.3036","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3036","url":null,"abstract":"ImportanceSystemic disease burden is well reflected in the retinal microvasculature, but it is not established whether optical coherence tomography angiography (OCTA) parameters can reliably reflect coronary atherosclerosis.ObjectiveTo assess the association of reduced retinal vascular density and subclinical coronary atherosclerosis in asymptomatic individuals.Design, Setting, and ParticipantsThis cross-sectional cohort study included asymptomatic individuals with elevated cardiovascular risk who self-referred for a health screening program involving coronary computed tomography angiography (CTA) at Asan Medical Center in Seoul, South Korea, and subsequently underwent OCTA as part of ophthalmic evaluations. This study was conducted from October 2015 to December 2020, and data analysis was conducted from January 2021 to May 2025.Main Outcomes and MeasuresThe primary outcome was the association between OCTA parameters and coronary CTA parameters.ResultsA total of 1286 eyes from 1286 participants were analyzed (mean [SD] age, 64.2 [9.9] years; 482 female participants [37.5%]). Coronary artery calcium score (CACS), presence of plaque and its subtypes, obstructive coronary artery disease (CAD), severe CAD, segment stenosis score (SSS), and segment involvement score (SIS) were significantly increased across the quartiles of superficial and deep parafoveal vascular density (PFVD). When modeled as continuous variables, superficial capillary plexus (SCP) and deep capillary plexus (DCP) PFVD were the most significant metrics and correlated with CACS, number of coronary vessels involved, SSS, and SIS. The lowest quartile of SCP PFVD was associated with significantly higher odds of obstructive CAD (adjusted odds ratio [aOR], 2.91; 95% CI, 1.83-4.73), severe CAD (aOR, 3.30; 95% CI, 1.55-7.91), and elevated SSS and SIS scores compared to the highest quartile. Similar but attenuated associations were observed for DCP PFVD. Continuous variable analysis for ORs for unit increase supported a linear inverse association between PFVD and CAD burden. Incorporating PFVD into models with cardiovascular risk factors improved area under the curve (AUC) for identifying severe CAD (AUC, 0.79; 95% CI, 0.75-0.82), obstructive CAD (AUC, 0.78; 95% CI, 0.76-0.81), and SSS of 10 or higher (AUC, 0.77; 95% CI, 0.74-0.80), with SCP yielding superior performance over DCP.Conclusions and RelevanceIn this cross-sectional cohort study, reduced retinal PFVD was independently associated with subclinical coronary atherosclerosis in a population with elevated vascular risk. In this context, decreased PFVD may reflect greater subclinical coronary atherosclerotic burden and help identify individuals who could benefit from further coronary evaluation, beyond traditional risk factors.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"83 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071771","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":"Prevention of Adverse Cardiovascular Events Using the 23-Valent Pneumococcal Polysaccharide Vaccine: A Randomized Clinical Trial.","authors":"Alexis Hure,Roseanne Peel,Catherine D'Este,Walter P Abhayaratna,Andrew Tonkin,Ingrid Hopper,Amanda G Thrift,Christopher Levi,Jonathan Sturm,David Durrheim,Joseph Hung,Tom Briffa,Derek P Chew,Shu Ren,Mark McEvoy,Philip Hansbro,David Newby,Stuart Szwec,Simon Chiu,John Attia","doi":"10.1001/jamacardio.2025.3043","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3043","url":null,"abstract":"ImportanceAnimal studies and meta-analysis of human observational data suggest that pneumococcal polysaccharide vaccination (PPV) could be protective against atherosclerosis; however, to the authors' knowledge, no randomized clinical trial has been conducted.ObjectiveTo determine whether pneumococcal vaccination (Pneumovax [Merck Sharp & Dohme Corp]) decreases the composite primary outcome of fatal and nonfatal acute coronary syndrome and ischemic stroke in people at increased risk, with an average follow-up of 7 years after immunization.Design, Setting, and ParticipantsThis was a double-blind, placebo-controlled, parallel-arm randomized clinical trial conducted at 6 centers across Australia. Participants were community-dwelling adults 55 to 60 years of age at baseline in 2016 to 2017, with at least 2 risk factors (obesity, hypertension, or hypercholesterolemia) for cardiovascular disease (CVD) but no prior CVD event or indication for early pneumococcal vaccination. Data were analyzed from February 2023 to December 2024 using competing risk proportional hazards regression models, stratified by sex and center.InterventionsParticipants received either 23-valent PPV (PPV23) or placebo (saline).Main Outcomes and MeasuresThe primary outcome was a composite of fatal and nonfatal myocardial infarction or ischemic stroke, ascertained via electronic medical records from emergency department, admitted patient, and mortality data collections using International Statistical Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes.ResultsA total of 4725 participants (mean [SD] age, 58.0 [1.7] years; 2433 male [52%]) were included in this study. There was no significant difference in the primary outcome (58 of 2366 events in the active PPV23 group compared with 64 of 2357 events in the control group, hazard ratio, 0.90; 95% CI, 0.63-1.28; P = .57). Similarly, no significant differences occurred in the exploratory outcomes of all-cause mortality, all-cause hospital presentations, and CVD-related hospital procedures. These results are tempered by the lower than expected event rate leading to low power.Conclusions and RelevanceResults of this randomized clinical trial found that PPV23 did not reduce the rates of fatal and nonfatal acute coronary syndrome and ischemic stroke, although the study was underpowered.Trial RegistrationANZCTR Identifier: ACTRN12615000536561.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"64 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071759","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":"Transthyretin Cardiac Amyloidosis in Older Black and Hispanic Individuals With Heart Failure.","authors":"Frederick L Ruberg,Sergio Teruya,Stephen Helmke,Dia A Smiley,Denise Fine,Damian Kurian,Farbod Raiszadeh,Tatiana Prokaeva,Brian Spencer,Sherry Wong,Shivda Pandey,William S Blaner,Albert DeLuca,Lynne L Johnson,Mona P Kinkhabwala,Jay Leb,Akiva Mintz,Michael P LaValley,Andrew J Einstein,Elizabeth Cohn,Cesia Gallegos,Gillian Murtagh,Jeffery W Kelly,Edward J Miller,Mathew S Maurer","doi":"10.1001/jamacardio.2025.2948","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2948","url":null,"abstract":"ImportanceTransthyretin cardiac amyloidosis (ATTR-CA) is an underdiagnosed but treatable cause of heart failure (HF) in older individuals that occurs in the context of normal wild-type (ATTRwt-CA) or an abnormal inherited (ATTRv-CA) TTR gene variant. While the most common inherited TTR variant, V142I, occurs in 3% to 4% of self-identified Black Americans and is associated with excess morbidity and mortality, the prevalence of ATTR-CA in this at-risk population is unknown.ObjectiveTo define the prevalence of ATTR-CA and proportions attributable to ATTRwt-CA or ATTRv-CA among older Black and Caribbean Hispanic individuals with HF.Design, Setting, and ParticipantsThis prospective, multicenter, cross-sectional study was conducted in several major US cities (Boston, Massachusetts; New York, New York; and New Haven, Connecticut) among individuals who self-identified as Black or Caribbean Hispanic older than 60 years with HF. Participants were enrolled between May 2019 and June 2024, and data analysis was conducted from June 2024 to May 2025.Main Outcomes and MeasuresATTR-CA was determined by radionuclide imaging, with blood testing to exclude light-chain amyloidosis and genotyping to determine TTR gene variant. Echocardiographic, biochemical, physical performance, and quality-of-life data were collected.ResultsAmong 646 participants, median (IQR) participant age was 73 (66-80) years, 329 (50.6%) were women, 550 (85.1%) identified as Black, and 186 (28.8%) identified as Caribbean Hispanic. Median (IQR) left ventricular wall thickness was 13 (12-14) mm, and median (IQR) left ventricular ejection fraction was 61% (55%-66%). Overall prevalence of ATTR-CA was 6.66% (95% CI, 4.73%-8.58%), of whom 24 (55.8%) had ATTRwt-CA and 19 (44.2%) had ATTRv-CA owing to V142I. Overall prevalence of V142I allele was 5.6%, and of those, 19 (52.8%) had ATTRv-CA. Prevalence of ATTR-CA was 8.15% (95% CI, 5.15%-11.15%) in men and 5.20% (95% CI, 2.79%-7.61%) in women (P = .13). Prevalence of ATTR-CA was 7.82% (95% CI, 5.57%-10.06%) in Black participants and 2.15% (95% CI, 0.07%-4.24%) in Hispanic participants (P = .004). Among Black participants aged 75 years or younger, ATTR-CA was observed in 3.42% of participants (95% CI, 1.43%-5.40%) compared to 14.04% (95% CI, 9.53%-18.54%) of those older than 75 years (P < .001). Among Black male participants older than 75 years, prevalence of ATTR-CA was 17.17% (95% CI, 9.74%-24.60%).Conclusions and RelevanceIn this cross-sectional study, ATTR-CA was an important cause of HF in older Black individuals with HF, particularly in men older than 75 years. Approximately half of V142I carriers with HF had ATTR-CA, while 55.8% of all ATTR-CA cases had normal TTR genotype.Trial RegistrationClinicalTrials.gov Identifier: NCT03812172.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"64 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025442","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":"Noninvasive Anatomical and Functional Imaging for Hemodynamic Relevance in Right Coronary Artery Anomalies.","authors":"Marius R Bigler,Anselm W Stark,Federico Caobelli,Axel Rominger,Ryota Kakizaki,Flavio G Biccirè,Saddam M A Al-Sabri,Isaac Shiri,Matthias Siepe,Stephan Windecker,Lorenz Räber,Christoph Gräni","doi":"10.1001/jamacardio.2025.2993","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2993","url":null,"abstract":"ImportanceRight anomalous aortic origin of a coronary artery (R-AAOCA) is a rare congenital condition increasingly diagnosed with the growing use of cardiac imaging. Due to dynamic compression of the anomalous vessel, invasive fractional flow reserve (FFR) during a dobutamine-atropine volume challenge (FFR-dobutamine) is considered the reference standard. A reliable alternative method is needed to reduce extensive invasive testing, but it remains uncertain whether noninvasive imaging can accurately assess the hemodynamic relevance of R-AAOCA.ObjectiveTo evaluate the diagnostic performance of noninvasive anatomical and functional cardiac imaging to determine the hemodynamic relevance of R-AAOCA compared with the FFR-dobutamine reference standard.Design, Setting, and ParticipantsThis was a prospective, single-center cohort study performed between June 2020 and January 2025. The study was conducted at a specialized coronary artery anomaly clinic in Bern, Switzerland. Consecutive adult patients with R-AAOCA with an interarterial/intramural course and a right coronary dominance were included in the study.InterventionsAll patients underwent coronary computed tomography angiography (CCTA), nuclear cardiac imaging, and invasive FFR-dobutamine testing.Main Outcomes and MeasuresHemodynamic relevance of the anomalous vessel was defined as an FFR-dobutamine value less than or equal to 0.8. Patients with stenotic atherosclerotic plaques in the anomalous vessel at the time of functional testing were excluded.ResultsA total of 55 patients (mean [SD] age, 51 [12] years; 37 male [67%]) with newly detected R-AAOCA and combined interarterial/intramural course were included in the analysis. Median FFR-dobutamine was 0.87 (IQR, 0.80-0.91), and 15 cases (27%) were hemodynamically relevant (ie, FFR-dobutamine ≤0.8). Anatomical CCTA (ie, CCTA-ostial minor axis) assessment demonstrated both a 100% sensitivity and negative predictive value with a receiver operating characteristic curve of 0.82, as well as a specificity of 57%, leading to rule out 23 cases (42%; ie, 58% of the hemodynamic nonrelevant cases). Functional nuclear imaging detected ischemia in 4 patients (7%; ie, 27% of hemodynamically relevant cases, all true positive, none false positive), resulting in a sensitivity of 27%, both specificity and positive predictive value of 100%, and an accuracy of 80% in predicting FFR-dobutamine less than or equal to 0.8.Conclusions and RelevanceResults of this cohort study suggest that in adults with R-AAOCA, a multimodality diagnostic imaging approach applicable in a stepwise manner, starting with CCTA, which offers high diagnostic performance to exclude hemodynamic relevance-and optionally complemented by functional imaging with modest diagnostic performance to rule in hemodynamic relevance-may help to reduce the need for invasive testing to a subset of patients.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"35 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025444","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":"Approach to the Postmarket Evaluation of Consumer Wearable Technologies.","authors":"Krishna Pundi,Sanjeev Bhavnani,Clark Seninger,Bram Zuckerman,Jessica Paulsen,Felipe Aguel,Natasha Din,Ben Viggiano,Richard M Yoo,Nirav Dalal,Alan S Go,Christopher Granger,Harlan Krumholz,Kathleen Lacar,Ron Li,Steven Lin,Kenneth W Mahaffey,Megan Mahoney,Debbe McCall,Mellanie True Hills,Robert A Harrington,Tina Hernandez-Boussard,Anindita Saha,Nigam Shah,Mintu P Turakhia","doi":"10.1001/jamacardio.2025.3006","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3006","url":null,"abstract":"ImportanceConsumer wearable technologies have wide applications, including some that have US Food and Drug Administration clearance for health-related notifications. While wearable technologies may have premarket testing, validation, and safety evaluation as part of a regulatory authorization process, information on their postmarket use remains limited. The Stanford Center for Digital Health organized 2 pan-stakeholder think tank meetings to develop an organizing concept for empirical research on the postmarket evaluation of consumer-facing wearables.ObservationsThe postmarket evaluation of consumer wearables involves broad consideration of an individual consumer's journey from acquisition, intended and unintended use of the wearable, and access to health care resources on receipt of a notification. For individuals who do access the health care system, a wearable's downstream effects can be studied through appropriate clinical evaluation, delivery of guideline-directed treatments, shared decision-making in areas of clinical equipoise, and analysis of clinical end points and patient harms. Effective postmarket research draws from denominators appropriate to the clinical question, with clearly defined parameters for success and failure. Generalizability related to data completeness and reliability should also be considered. As patients increasingly integrate wearables into their health monitoring, cross-platform data sharing with a focus on privacy and data quality can drive patient-centered innovation and identify opportunities to bridge gaps in medical care.RelevanceThe think tank identified priorities in postmarket research, comprising the journey from consumer to patient and accounting for patient, clinician, health care delivery system, and societal impacts of consumer wearables. Overall, this approach serves not only to organize the study of consumer wearables but also to act as a guidepost for using real-world data in postmarket research.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"49 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025437","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":"High-Risk Areas-The Trees in the Forest.","authors":"Charles Esenwa,Daniel Labovitz","doi":"10.1001/jamacardio.2025.2954","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2954","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"131 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025440","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":"High-Risk Areas-The Trees in the Forest-Reply.","authors":"Michael Liu,Rishi K Wadhera","doi":"10.1001/jamacardio.2025.2957","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2957","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"35 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025436","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":"Prevalence and Clinical Implications of Sleep Apnea in Hypertrophic Cardiomyopathy","authors":"Shahid Karim, Anwar Chahal, Shreyas Venkataraman, Abhishek J. Deshmukh, Konstantinos C. Siontis, Meghna Mansukhani, Thomas Konecny, Mohammed Y. Khanji, Steffen E. Petersen, Bernard J. Gersh, Jeffrey B. Geske, Virend K. Somers","doi":"10.1001/jamacardio.2025.2877","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2877","url":null,"abstract":"ImportanceSleep disordered breathing (SDB) is a well-established contributor to cardiovascular morbidity, mediated by intermittent hypoxemia, autonomic dysregulation, and endothelial dysfunction. Patients with hypertrophic cardiomyopathy (HCM) may be especially at risk for SDB, but the clinical impact of SDB in this population remains unclear.ObjectiveTo define the prevalence and subtypes of SDB in HCM and examine their association with echocardiographic parameters and cardiac biomarker expression.Design, Setting, and ParticipantsA prospective cohort study was conducted between April 18, 2018, and January 15, 2024, at a single tertiary referral center specializing in HCM care. Adults with HCM (left ventricular wall thickness ≥15 mm or pathogenic variants) were recruited from an institutional registry. Patients diagnosed with SDB or current pregnancy were excluded. Patients underwent polysomnography, with comparative assessment of echocardiographic, electrocardiographic, and biomarker indices. Observers were blinded to polysomnographic results. Data analysis was performed from April 11, 2024, to July 25, 2024.ExposuresSDB classified via polysomnography using apnea-hypopnea index thresholds, with subtypes including obstructive sleep apnea and central sleep apnea and with event severity, hypoxemia, and sleep architecture disruption quantified.Main Outcomes and MeasuresEchocardiographic indices, cardiac biomarker expression, functional status, apnea-hypopnea index, and overnight hypoxemia.ResultsAmong 154 patients (median [IQR] age, 60 [48-68] years; 102 [66.2%] male), 91 (59.1%) were diagnosed with SDB. Those with SDB, compared with those without SDB, had higher left ventricular mass index (median [IQR], 128 [107-161] vs 109 [96-134] g/m&lt;jats:sup&gt;2&lt;/jats:sup&gt;; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .03), E/e′ ratio (median [IQR], 12.5 [10.0-15.0] vs 10.0 [8.3-14.5]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .04), and baseline troponin-T level (median [IQR], 0.013 [0.009-0.022] vs 0.011 [0.007-0.015] ng/mL [to convert to micrograms per liter, multiply by 1]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .04) and greater overnight troponin-T level increases (change in median [IQR], 0.0021 [−0.0029 to 0.0062] vs 0.0002 [−0.0022 to 0.0026] ng/mL; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .02). New York Heart Association class II or III symptoms were more common in those with SDB (48 [52.7%] vs 17 [27.0%]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .005). Hypertension and diabetes were more prevalent among patients with SDB than without SDB (hypertension: 67 [73.6%] vs 36 [57.1%]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .03; diabetes: 14 [15.4%] vs 3 [4.8%]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .04), whereas rates of atrial fibrillation and prior myectomy did not differ significantly between groups.Conclusions and RelevanceThis study suggests that undiagnosed SDB is highly prevalent in patients with HCM and that SDB is associated with adverse myocardial remodeling, greater diastolic dysfunction, and elevated troponin-T level","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"58 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930634","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":"Chest Pain and Chest Wall Deformity","authors":"Kevin G. Tayon, William R. Miranda, Darrell B. Newman","doi":"10.1001/jamacardio.2025.2891","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2891","url":null,"abstract":"A man in his mid-30s with a history of Crohn disease presented with several years of intermittent, nonexertional chest pressure. What would you do next?","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"15 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930698","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}