JAMA cardiology最新文献

{"title":"Temporary Mechanical Cardiac Support Outcomes and Cardiogenic Shock.","authors":"Federico Pappalardo,Nicoletta D'Ettore,Andrea Montisci","doi":"10.1001/jamacardio.2025.0486","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0486","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"28 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846374","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":"Temporary Mechanical Cardiac Support Outcomes and Cardiogenic Shock-Reply.","authors":"Jacob Eifer Møller,Nanna Louise Junker Udesen,Christian Hassager","doi":"10.1001/jamacardio.2025.0489","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0489","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"75 2 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846373","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":"Periconceptional Glucagon-Like Peptide-1 Receptor Agonist Use and Discontinuation","authors":"Sadiya S. Khan, William A. Grobman, Dhruv S. Kazi","doi":"10.1001/jamacardio.2025.0637","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0637","url":null,"abstract":"This Viewpoint describes the need for more studies on the best timing for dicontinuation of glucagon-like peptide-1 receptor agonists before pregnancy.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"120 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836913","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":"Automated Deep Learning Phenotyping of Tricuspid Regurgitation in Echocardiography","authors":"Amey Vrudhula, Milos Vukadinovic, Christiane Haeffele, Alan C. Kwan, Daniel Berman, David Liang, Robert Siegel, Susan Cheng, David Ouyang","doi":"10.1001/jamacardio.2025.0498","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0498","url":null,"abstract":"ImportanceAccurate assessment of tricuspid regurgitation (TR) is necessary for identification and risk stratification.ObjectiveTo design a deep learning computer vision workflow for identifying color Doppler echocardiogram videos and characterizing TR severity.Design, Setting, and ParticipantsAn automated deep learning workflow was developed using 47 312 studies (2 079 898 videos) from Cedars-Sinai Medical Center (CSMC) between 2011 and 2021. Data analysis was performed in 2024. The pipeline was tested on a temporally distinct test set of 2462 studies (108 138 videos) obtained in 2022 at CSMC and a geographically distinct cohort of 5549 studies (278 377 videos) from Stanford Healthcare (SHC). Training and validation cohorts contained data from 31 708 patients at CSMC receiving care between 2011 and 2021. Patients were chosen for parity across TR severity classes, with no exclusion criteria based on other clinical or demographic characteristics. The 2022 CSMC test cohort and SHC test cohorts contained studies from 2170 patients and 5014 patients, respectively.ExposureDeep learning computer vision model.Main Outcomes and MeasuresThe main outcomes were area under the receiver operating characteristic curve (AUC), sensitivity, and specificity in identifying apical 4-chamber (A4C) videos with color Doppler across the tricuspid valve and AUC in identifying studies with moderate to severe or severe TR.ResultsIn the CSMC test dataset, the view classifier demonstrated an AUC of 1.000 (95% CI, 0.999-1.000) and identified at least 1 A4C video with color Doppler across the tricuspid valve in 2410 of 2462 studies with a sensitivity of 0.975 (95% CI, 0.968-0.982) and a specificity of 1.000 (95% CI, 1.000-1.000). In the CSMC test cohort, moderate or severe TR was detected with an AUC of 0.928 (95% CI, 0.913-0.943), and severe TR was detected with an AUC of 0.956 (95% CI, 0.940-0.969). In the SHC cohort, the view classifier correctly identified at least 1 TR color Doppler video in 5268 of the 5549 studies, resulting in an AUC of 0.999 (95% CI, 0.998-0.999), a sensitivity of 0.949 (95% CI, 0.944-0.955), and a specificity of 0.999 (95% CI, 0.999-0.999). The artificial intelligence model detected moderate or severe TR with an AUC of 0.951 (95% CI, 0.938-0.962) and severe TR with an AUC of 0.980 (95% CI, 0.966-0.988).Conclusions and RelevanceIn this study, an automated pipeline was developed to identify clinically significant TR with excellent performance. With open-source code and weights, this project can serve as the foundation for future prospective evaluation of artificial intelligence–assisted workflows in echocardiography.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"74 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841340","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–Enabled Prediction of Heart Failure Risk From Single-Lead Electrocardiograms","authors":"Lovedeep S. Dhingra, Arya Aminorroaya, Aline F. Pedroso, Akshay Khunte, Veer Sangha, Daniel McIntyre, Clara K. Chow, Folkert W. Asselbergs, Luisa C. C. Brant, Sandhi M. Barreto, Antonio Luiz P. Ribeiro, Harlan M. Krumholz, Evangelos K. Oikonomou, Rohan Khera","doi":"10.1001/jamacardio.2025.0492","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0492","url":null,"abstract":"ImportanceDespite the availability of disease-modifying therapies, scalable strategies for heart failure (HF) risk stratification remain elusive. Portable devices capable of recording single-lead electrocardiograms (ECGs) may enable large-scale community-based risk assessment.ObjectiveTo evaluate whether an artificial intelligence (AI) algorithm can predict HF risk from noisy single-lead ECGs.Design, Setting, and ParticipantsA retrospective cohort study of individuals without HF at baseline was conducted among individuals with conventionally obtained outpatient ECGs in the integrated Yale New Haven Health System (YNHHS) and prospective population-based cohorts of the UK Biobank (UKB) and the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Data analysis was performed from September 2023 to February 2025.ExposureAI-ECG–defined risk of left ventricular systolic dysfunction (LVSD).Main Outcomes and MeasuresAmong individuals with ECGs, lead I ECGs were isolated and a noise-adapted AI-ECG model (to simulate ECG signals from wearable devices) trained to identify LVSD was deployed. The association of the model probability with new-onset HF, defined as the first HF hospitalization, was evaluated. The discrimination of AI-ECG was compared against 2 risk scores for new-onset HF (Pooled Cohort Equations to Prevent Heart Failure [PCP-HF] and Predicting Risk of Cardiovascular Disease Events [PREVENT] equations) using the Harrel C statistic, integrated discrimination improvement, and net reclassification improvement.ResultsThere were 192 667 YNHHS patients (median [IQR] age, 56 [41-69] years; 111 181 women [57.7%]), 42 141 UKB participants (median [IQR] age, 65 [59-71] years; 21 795 women [51.7%]), and 13 454 ELSA-Brasil participants (median [IQR] age, 51 [45-58] years; 7348 women [54.6%]) with baseline ECGs. A total of 3697 (1.9%) developed HF in YNHHS over a median (IQR) of 4.6 (2.8-6.6) years, 46 (0.1%) in UKB over a median (IQR) of 3.1 (2.1-4.5) years, and 31 (0.2%) in ELSA-Brasil over a median (IQR) of 4.2 (3.7-4.5) years. A positive AI-ECG screening result for LVSD was associated with a 3- to 7-fold higher risk for HF, and each 0.1 increment in the model probability was associated with a 27% to 65% higher hazard across cohorts, independent of age, sex, comorbidities, and competing risk of death. AI-ECG’s discrimination for new-onset HF was 0.723 (95% CI, 0.694-0.752) in YNHHS, 0.736 (95% CI, 0.606-0.867) in UKB, and 0.828 (95% CI, 0.692-0.964) in ELSA-Brasil. Across cohorts, incorporating AI-ECG predictions alongside PCP-HF and PREVENT equations was associated with a higher Harrel C statistic (difference in addition to PCP-HF, 0.080-0.107; difference in addition to PREVENT, 0.069-0.094). AI-ECG had an integrated discrimination improvement of 0.091 to 0.205 vs PCP-HF and 0.068 to 0.192 vs PREVENT; it had a net reclassification improvement of 18.2% to 47.2% vs PCP-HF and 11.8% to 47.5% vs PREVENT.Conclusions and RelevanceAcross multinational coh","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"17 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841110","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":"Progressive Kidney Dysfunction After Left Atrial Appendage Closure.","authors":"Shuaishuai Yuan, Chao Tao, Peijun Li","doi":"10.1001/jamacardio.2025.0258","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0258","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811347","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":"Self-Administered Etripamil and Emergency Department Visits in Supraventricular Tachycardia","authors":"Sean D. Pokorney, A. John Camm, Paul Dorian, James E. Ip, Bruce S. Stambler, David B. Bharucha, Jonathan P. Piccini","doi":"10.1001/jamacardio.2025.0417","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0417","url":null,"abstract":"This secondary analysis of a randomized clinical trial describes the use of emergency care after self-administration of etripamil by patients experiencing paroxysmal supraventricular tachycardia episodes at home.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"1 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143806179","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":"Hypertensive Disorders of Pregnancy and Long-Term Risk of Dilated Cardiomyopathy.","authors":"Upasana Tayal, Constantinos Kallis, Georgie M Massen, Nora Rossberg, Emily L Graul, Jennifer K Quint","doi":"10.1001/jamacardio.2025.0328","DOIUrl":"10.1001/jamacardio.2025.0328","url":null,"abstract":"<p><strong>Importance: </strong>The impact of hypertensive disorders of pregnancy on developing dilated cardiomyopathy is unknown.</p><p><strong>Objective: </strong>To determine whether hypertensive disorders of pregnancy are associated with long-term risk of dilated cardiomyopathy.</p><p><strong>Design, setting, and participants: </strong>This population-based cohort study performed in England used the following linked electronic health records databases: Clinical Practice Research Datalink (CPRD) Pregnancy Register, CPRD Aurum (primary care), Hospital Episode Statistics Admitted Patient Care, and Office for National Statistics mortality data. Participants included an exposed cohort of 14 083 patients in their first pregnancy with hypertensive disorders of pregnancy (index date observed: January 1997 to December 2018; followed up until July 2023) and unexposed cohort of 70 415 with normotensive pregnancies randomly sampled from the Pregnancy Register (5:1 ratio).</p><p><strong>Exposure: </strong>Hypertensive disorder of pregnancy (preeclampsia, gestational hypertension).</p><p><strong>Main outcomes and measures: </strong>Cox proportional hazards models were fitted to estimate hazard ratios (HRs) of developing dilated cardiomyopathy.</p><p><strong>Results: </strong>The cohort included 14 083 individuals with a hypertensive disease of pregnancy during their first pregnancy and 70 415 individuals with normotensive first pregnancies. A first-time pregnancy complicated by a hypertensive disorder of pregnancy, compared with a normotensive first-time pregnancy, was associated with a 93% higher risk of developing dilated cardiomyopathy (adjusted HR, 1.93 [95% CI, 1.33-2.81]; P = .001; adjusted for maternal age). Dilated cardiomyopathy developed a median (IQR) of 5.1 (0.7-10.6) years post partum in those with HDP and 10.6 (4.2-15.8) years post partum in those with normotensive first pregnancies. The association remained significant after adjusting for maternal age, birth year, gestational diabetes, postpregnancy diabetes, postpregnancy hypertension, total parity, ethnicity, and socioeconomic status (adjusted HR, 1.55 [95% CI, 1.04-2.31]; P = .03). There was a dose response; there was a higher risk of DCM in those with preeclampsia (adjusted HR, 1.85 [95% CI, 1.24-2.76]; P = .002) and severe preeclampsia (adjusted HR, 4.29 [95% CI, 2.32-7.96]; P < .001). Maternal age (adjusted HR per year of age, 1.06 [95% CI, 1.03-1.08]; P < .001) and postpartum incident hypertension (adjusted HR, 1.68 [95% CI, 1.16-2.42]; P = .006) were independently associated with the development of DCM.</p><p><strong>Conclusions: </strong>Patients with hypertensive disorders of pregnancy had a greater risk of developing dilated cardiomyopathy. Older maternal age and postpartum hypertension were associated with higher risk of dilated cardiomyopathy after a hypertensive disorder of pregnancy. These findings support long-term clinical vigilance of patients with a history of hypertensive","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763620","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":"Adverse Pregnancy Outcomes and N-Terminal Pro-Brain Natriuretic Peptide Levels 2 to 7 Years After Delivery: The nuMoM2b Heart Health Study.","authors":"Priya M Freaney, Xiaoning Huang, Lucia C Petito, William A Grobman, Janet Catov, Alisse Hauspurg, C Noel Bairey Merz, Natalie Bello, Jin Kyung Kim, Abbi Lane, David M Haas, Lisa D Levine, Rebecca B McNeil, Eliza Miller, George Saade, Lauren Theilen, Lynn M Yee, Jasmina Varagic, Brian Mercer, Uma Reddy, Donald M Lloyd-Jones, Philip Greenland, Sadiya S Khan","doi":"10.1001/jamacardio.2025.0325","DOIUrl":"10.1001/jamacardio.2025.0325","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763500","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":"Accountable Care Organization Participation and Cardiovascular Care Quality.","authors":"Erica S Spatz, D August Oddleifson, Jehanzeb Kayani, Kensey L Gosch, Philip G Jones, Rushabh H Doshi, Thomas M Maddox, Nihar R Desai","doi":"10.1001/jamacardio.2025.0381","DOIUrl":"10.1001/jamacardio.2025.0381","url":null,"abstract":"<p><strong>Importance: </strong>The Medicare Shared Savings Program (MSSP) was introduced in 2012 to improve care quality and lower costs to Medicare. Under this program, accountable care organizations (ACOs) assumed responsibility for costs and care quality for a group of Medicare beneficiaries.</p><p><strong>Objective: </strong>To compare changes in quality measures for patients at outpatient cardiology practices before and after their participation in a Medicare Shared Savings Program ACO.</p><p><strong>Design, setting, and participants: </strong>This pre-post cohort study comparing quality prior to and after ACO participation evaluated the MSSP at 83 ACO outpatient cardiology practices compared with 332 non-ACO-participating cardiology practices, adjusted for secular trends, using 15 performance measures in the National Cardiovascular Data Registry PINNACLE (Practice Innovation and Clinical Excellence) Registry from January 1, 2013, through March 31, 2019. Data analysis was performed from 2022 to 2025.</p><p><strong>Exposures: </strong>Outpatient cardiology practice participation in the MSSP, which allows ACOs to share in the savings if predetermined cost targets are met, with payments adjusted based on a quality performance score.</p><p><strong>Main outcomes and measures: </strong>Primary end points included 15 quality measures for coronary artery disease, heart failure, atrial fibrillation, and hypertension.</p><p><strong>Results: </strong>During the study period, 2 390 244 patients (1 273 615 [53.3%] female; mean [SD] age, 58.5 [17.7] years) were cared for by 83 ACO practices, and 5 415 880 patients (2 810 204 [51.9%] female; mean [SD] age, 61.5 [16.3] years) were cared for by 332 non-ACO practices. Outpatient cardiology practice participation in an MSSP ACO was not associated with differential changes in various performance measures for coronary artery disease, heart failure, atrial fibrillation, and hypertension. There were no differential changes in the odds of β-blocker prescription, blood pressure control, antiplatelet prescription, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) prescription, low-density lipoprotein (LDL) profiles, or smoking cessation for coronary artery disease; left ventricular assessment, β-blocker prescription, ACEI or ARB prescription, or implantable cardioverter defibrillator use for heart failure; anticoagulation for atrial fibrillation; or blood pressure control for hypertension. Exploratory analyses extending follow-up to 24 months revealed an increase in β-blocker use for heart failure (adjusted odds ratio [aOR], 1.23; 95% CI, 1.02-1.49; P = .03) and a decline in LDL profiles less than 100 mg/dL (to convert to millimoles per liter, multiply by 0.0259; aOR, 0.71; 95% CI, 0.51-0.999; P = .049). Among a subset of traditional Medicare patients, there was an increase in implantable cardioverter defibrillator use by 12 months (aOR, 1.66; 95% CI, 1.12-2.45; P = .01) followi","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763458","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}