JAMA cardiology最新文献_第4页

JAMA Cardiology Peer Reviewers in 2024.

IF 14.8 1区医学

JAMA cardiology Pub Date : 2025-03-19 DOI: 10.1001/jamacardio.2025.0242

引用次数: 0

Concomitant Mechanical Aspiration and Appendage Closure for Recalcitrant Left Atrial Appendage Thrombi

IF 24 1区医学

JAMA cardiology Pub Date : 2025-03-19 DOI: 10.1001/jamacardio.2025.0203

Maryam Saleem, Abhishek Maan, Daniel R. Musikantow, Chi Zhang, Yury Malyshev, Marc A. Miller, Srinivas R. Dukkipati, Parasuram M. Krishnamoorthy, Martin Goldman, Prakash Krishnan, Vivek Y. Reddy

{"title":"Concomitant Mechanical Aspiration and Appendage Closure for Recalcitrant Left Atrial Appendage Thrombi","authors":"Maryam Saleem, Abhishek Maan, Daniel R. Musikantow, Chi Zhang, Yury Malyshev, Marc A. Miller, Srinivas R. Dukkipati, Parasuram M. Krishnamoorthy, Martin Goldman, Prakash Krishnan, Vivek Y. Reddy","doi":"10.1001/jamacardio.2025.0203","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0203","url":null,"abstract":"ImportanceIt is well appreciated that a small yet high-risk subset of patients with atrial fibrillation (AF) develops persistent left atrial appendage (LAA) thrombus despite optimal oral anticoagulation (OAC). In patients with either a heightened risk of bleeding precluding enhanced doses of OAC to dissolve the thrombus, or thromboembolism despite optimal OAC, there are limited nonsurgical options.ObjectivesTo introduce a novel management strategy for resistant LAA thrombus: percutaneous mechanical thrombus aspiration with cerebral protection, followed by LAA closure (LAAC).Design, Setting, and ParticipantsThis descriptive, prospective case series of 9 consecutive patients with persistent LAA thrombus was conducted between August 2023 and July 2024 at Mount Sinai Hospital. After placing a cerebral protection device (CPD) when anatomically feasible, balloon atrial septostomy was performed as needed to enhance transeptal access. A 20F mechanical aspiration device with a 15-mm funneled ostium was advanced to the LAA ostium, and manual vacuum aspiration of thrombus was performed. After ultrasonic confirmation of thrombectomy, an LAAC device was implanted.Main Outcomes and MeasuresPatient demographic, clinical, and intervention data were collected.ResultsNine patients (mean [SD] age, 74.7 [13.6] years; median [IQR] CHA2DS2-VASc [congestive heart failure, hypertension, age 75 years or older, diabetes, stroke, vascular disease, age 65-74 years, and female sex] score, 5 [2-8] points) presented with LAA thrombus in the context of contraindications to OAC. CPD was placed in 8 patients; one had prohibitive aortic arch anatomy. Given the patient’s high thrombotic burden and limited alternatives, the decision was to proceed without CPD, based on a risk-benefit assessment. Balloon atrial septostomy was performed in 8 patients. In 8 patients, complete thrombus removal was achieved, followed by successful LAAC device placement. One patient had a small residual distal thrombus, presumably organized, which was strongly adherent to the LAA myocardium; this was compressed against the wall with the LAAC device. One patient had a small thrombus fragment recovered from the CPD postprocedure. During both the index procedure and during follow-up (range, 4-15 months), there were no complications.Conclusions and RelevanceThis cases series found that temporary cerebral protection, percutaneous mechanical vacuum thrombectomy, and mechanical LAA closure was feasible in patients with persistent LAA thrombus despite optimal OAC. Larger studies will be needed to fully assess the efficacy and safety of this approach.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"25 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653587","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}

引用次数: 0

Peak Oxygen Uptake vs Ventilatory Efficiency.

IF 14.8 1区医学

JAMA cardiology Pub Date : 2025-03-19 DOI: 10.1001/jamacardio.2025.0216

Jiawei Du, Jinghua Hou

引用次数: 0

A Man in His 30s With Ponytail Coronary Artery Anomaly.

IF 14.8 1区医学

JAMA cardiology Pub Date : 2025-03-19 DOI: 10.1001/jamacardio.2025.0124

Leizhi Ku, Xiaojing Ma

引用次数: 0

JAMA Cardiology-The Year in Review 2024.

IF 14.8 1区医学

JAMA cardiology Pub Date : 2025-03-19 DOI: 10.1001/jamacardio.2025.0478

Robert O Bonow

引用次数: 0

Peak Oxygen Uptake Vs Ventilatory Efficiency-In Reply.

IF 14.8 1区医学

JAMA cardiology Pub Date : 2025-03-19 DOI: 10.1001/jamacardio.2025.0219

Matthew M Y Lee, Gregory D Lewis

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Exercise-Induced Dyspnea in an Older Woman With a History of Coronary Artery Disease

IF 24 1区医学

JAMA cardiology Pub Date : 2025-03-12 DOI: 10.1001/jamacardio.2025.0115

Soundous M’Rabet, Jean-Christophe Eicher, Charles Guenancia

引用次数: 0

FFR-Guided Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Diabetes.

IF 14.8 1区医学

JAMA cardiology Pub Date : 2025-03-12 DOI: 10.1001/jamacardio.2025.0095

Kuniaki Takahashi, Hisao Otsuki, Frederik M Zimmermann, Victoria Y Ding, Thomas Engstrøm, Hans Gustav Hørsted Thyregod, Branko Beleslin, Svetozar Putnik, Luke Tapp, Thomas Barker, Simon Redwood, Christopher Young, G Jan-Willem Bech, Gerard J F Hoohenkerk, Bernard De Bruyne, Nico H J Pijls, William F Fearon

{"title":"FFR-Guided Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Diabetes.","authors":"Kuniaki Takahashi, Hisao Otsuki, Frederik M Zimmermann, Victoria Y Ding, Thomas Engstrøm, Hans Gustav Hørsted Thyregod, Branko Beleslin, Svetozar Putnik, Luke Tapp, Thomas Barker, Simon Redwood, Christopher Young, G Jan-Willem Bech, Gerard J F Hoohenkerk, Bernard De Bruyne, Nico H J Pijls, William F Fearon","doi":"10.1001/jamacardio.2025.0095","DOIUrl":"10.1001/jamacardio.2025.0095","url":null,"abstract":"Importance: Outcomes in patients with diabetes after fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) using current-generation drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) are unknown.Objectives: To investigate the relative treatment effect of PCI vs CABG according to diabetes status with respect to major adverse cardiac and cerebrovascular events (MACCE) at 3 years and to evaluate the impact of the SYNTAX score.Design, setting, and participants: This is a prespecified subgroup analysis of the FAME (Fractional Flow Reserve vs Angiography for Multivessel Evaluation) 3 trial, an investigator-initiated, randomized clinical trial conducted at 48 centers worldwide. The FAME 3 trial enrolled patients with 3-vessel coronary artery disease not involving the left main undergoing coronary revascularization between August 2014 and December 2019. Data analysis was conducted in August 2023. Clinical follow-up was performed at hospital discharge and at 1 month, 6 months, 1 year, 2 years, and 3 years after randomization.Intervention: Either FFR-guided PCI with current-generation DES or CABG.Main outcomes and measures: The primary end point was MACCE, defined as the composite of all-cause death, myocardial infarction, stroke, or repeat revascularization at 3 years.Results: Of 1500 total patients enrolled, mean (SD) patient age was 65.1 (8.4) years, and 265 patients (17.7%) were female. The FAME 3 trial included 428 patients with diabetes (28.5%). Patients with diabetes, especially those receiving insulin, had a higher risk of MACCE at 3 years compared with those without diabetes. Regarding relative treatment effect, the risk of MACCE was higher after FFR-guided PCI compared with CABG in both patients with diabetes (hazard ratio [HR], 1.44; 95% CI, 0.91-2.28; P = .12) and those without diabetes (HR, 1.50; 95% CI, 1.08-2.07; P = .02), with no significant interaction (P for interaction = .94). In patients with a low SYNTAX score (<23), there was no significant difference in MACCE between PCI and CABG, while in patients with an intermediate to high SYNTAX score (≥23), PCI had a higher risk of MACCE than CABG, regardless of diabetes status.Conclusions and relevance: In this subgroup analysis of the FAME 3 randomized clinical trial, the relative benefit of CABG compared with FFR-guided PCI was similar among patients with and without diabetes.Trial registration: ClinicalTrials.gov Identifier: NCT02100722.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604742","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}

引用次数: 0

Novel Controlled Metabolic Accelerator for Obesity-Related HFpEF

IF 24 1区医学

JAMA cardiology Pub Date : 2025-03-12 DOI: 10.1001/jamacardio.2025.0103

Ambarish Pandey, Gregory D. Lewis, Barry A. Borlaug, Sanjiv J. Shah, Andrew J. Sauer, Sheldon Litwin, Kavita Sharma, Diane K. Jorkasky, Elizabeth A. Tarka, Shaharyar M. Khan, Dalane W. Kitzman

{"title":"Novel Controlled Metabolic Accelerator for Obesity-Related HFpEF","authors":"Ambarish Pandey, Gregory D. Lewis, Barry A. Borlaug, Sanjiv J. Shah, Andrew J. Sauer, Sheldon Litwin, Kavita Sharma, Diane K. Jorkasky, Elizabeth A. Tarka, Shaharyar M. Khan, Dalane W. Kitzman","doi":"10.1001/jamacardio.2025.0103","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0103","url":null,"abstract":"ImportanceExcess body fat plays a pivotal role in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). HU6 is a novel, controlled metabolic accelerator that enhances mitochondrial uncoupling resulting in increased metabolism and fat-specific weight loss.ObjectiveTo assess efficacy and safety of HU6 in reducing body weight, improving peak volume of oxygen consumption (VO2) and body composition among patients with obesity-related HFpEF.Design, Setting, and ParticipantsThe Exploratory Phase 2A, Double-Blind, Placebo-Controlled Dose Escalation Study of Safety, Tolerability, Pharmacodynamics, and Pharmacokinetics of HU6 for Subjects With Obese HFpEF (HuMAIN-HFpEF) trial was a multicenter, dose-escalation randomized clinical trial among patients with chronic stable HFpEF and obesity. Data were analyzed from July to October 2024.InterventionHU6 treatment for 19 weeks, starting at 150 mg per day and potentially up titrated to 450 mg per day based on safety and tolerability vs placebo.Main Outcomes and MeasuresThe primary end point was change in body weight.ResultsOf 66 participants randomized (mean [SD] age, 64.5 [12] years; 38 female [58%]; mean [SD] weight, 110.9 [22.4] kg), 56 completed the trial. HU6 (vs placebo) significantly decreased weight (between-group difference, −2.86 kg; 95% CI, −4.68 to −1.04 kg; P = .003), total fat mass (between-group difference, −2.96 kg; 95% CI, −4.50 to −1.42 kg; P &amp;lt; .001), and percentage visceral fat (between-group difference,−1.3%; 95% CI, −2.1 to −0.5%; P = .003), with no significant loss of muscle mass. There were no statistically significant changes in peak VO2, 6-minute walk distance, Kansas City Cardiomyopathy Questionnaire score, high-sensitivity C-reactive protein level, N-terminal pro–brain natriuretic peptide level, or diastolic function. Serious adverse events were noted in 5 participants (4 in the HU6 group; 1 in the placebo group), including 1 death, all judged unrelated to treatment.Conclusions and RelevanceAmong patients with obesity-related HFpEF, treatment with HU6 for 19 weeks led to modest but statistically significant weight loss without significant changes in peak VO2. Larger trials of longer duration are warranted to determine whether longer-term administration of HU6 can improve exercise function, quality of life, and cardiovascular outcomes in this increasingly common disorder.Trial RegistrationClinicalTrials.gov Identifier: NCT05284617","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"23 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599610","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}

引用次数: 0

Food Insecurity and Incident Cardiovascular Disease Among Black and White US Individuals, 2000-2020

IF 24 1区医学

JAMA cardiology Pub Date : 2025-03-12 DOI: 10.1001/jamacardio.2025.0109

Jenny Jia, Mercedes R. Carnethon, Mandy Wong, Cora E. Lewis, Pamela J. Schreiner, Namratha R. Kandula

{"title":"Food Insecurity and Incident Cardiovascular Disease Among Black and White US Individuals, 2000-2020","authors":"Jenny Jia, Mercedes R. Carnethon, Mandy Wong, Cora E. Lewis, Pamela J. Schreiner, Namratha R. Kandula","doi":"10.1001/jamacardio.2025.0109","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0109","url":null,"abstract":"ImportanceFood insecurity is associated with prevalent cardiovascular disease (CVD), but studies have been limited to cross-sectional data.ObjectivesTo study whether food insecurity is associated with incident CVD and to determine whether this association varies by sex, education, or race.Design, Setting, and ParticipantsThis prospective cohort study was conducted among US adults without preexisting CVD participating in the CARDIA (Coronary Artery Risk Development in Young Adults) study from 2000 to August 31, 2020. Data analysis was conducted from December 2022 to April 2024.ExposureFood insecurity, defined as endorsing limitations in household food variety and/or food quantity, assessed in the period 2000-2001.Main Outcomes and MeasuresThe primary outcome was CVD events, consisting of fatal and nonfatal coronary heart disease, heart failure, stroke, transient ischemic attack, or peripheral arterial disease, identified annually through August 31, 2020.ResultsOf 3616 total participating adults, mean (SD) age was 40.1 (3.6) years, and 2027 participants (56%) were female. Of 3616 participants, 1696 (47%) self-reported Black race and 529 participants (15%) had food insecurity at baseline. Individuals with food insecurity were more likely to self-identify as Black and report lower educational attainment. The mean (SD) follow-up period was 18.8 (3.4) years, during which 255 CVD events occurred: 57 events (11%) in food-insecure participants and 198 events (6%) in food-secure participants over the study period. After adjusting for age, sex, and field center, food insecurity was associated with incident CVD (adjusted hazard ratio [aHR], 1.90; 95% CI, 1.41-2.56). The association persisted (aHR, 1.47; 95% CI, 1.08-2.01) after further adjustment for the socioeconomic factors of education, marital status, and usual source of medical care.Conclusions and RelevanceIn this prospective cohort study among participants in the CARDIA study, food insecurity was associated with incident CVD even after adjustment for socioeconomic factors, suggesting that food insecurity may be an important social deprivation measure in clinical assessment of CVD risk. Whether interventions to reduce food insecurity programs can potentially alleviate CVD should be further studied.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"8 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599343","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}

引用次数: 0