JAMA cardiology最新文献

{"title":"Patent Foramen Ovale and Dysarthria in a Man in His 60s.","authors":"Alpana Senapati, Yehia Saleh, Su Min Chang","doi":"10.1001/jamacardio.2025.1679","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.1679","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266185","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":"Temporal and Geographic Trends in the Treatment of Peripheral Arterial Disease Stratified by Race Among Medicare Beneficiaries.","authors":"Birgit Vogel, Katerina Dangas, Francesca Maria Di Muro, Samantha Sartori, Angelo Oliva, George Dangas, Prakash Krishnan, Harrison Yoon, Katherine Etter, Daniel Erim, Yuriy Pylypchuk, Rachel Keever, Roxana Mehran","doi":"10.1001/jamacardio.2025.1714","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.1714","url":null,"abstract":"<p><strong>Importance: </strong>Racial disparities in the management of peripheral arterial disease (PAD) are well established. Analysis of the temporal trends and geographic variation in racial differences in the use of revascularization and major amputation may identify areas for targeted intervention.</p><p><strong>Objective: </strong>To investigate differences in the treatment of PAD between Black and White patients over time and by US state.</p><p><strong>Design, setting, and participants: </strong>This cohort study examined data for Medicare fee-for-service beneficiaries with a PAD diagnosis between 2018 and 2022. Data were analyzed from November 14, 2023, to February 13, 2025.</p><p><strong>Exposures: </strong>Black and White race.</p><p><strong>Main outcomes and measures: </strong>The proportions of Black and White patients with PAD undergoing revascularization and major amputation were compared over time and by state. Data were adjusted for age, sex, hypertension, diabetes, tobacco use, chronic kidney disease, and county-level Social Vulnerability Index (SVI).</p><p><strong>Results: </strong>The total sample size was 2 376 300 beneficiaries (1 224 537 men [51.5%]). Black patients (219 338 [9.2%]) were slightly younger than White patients (2 156 962 [90.8%]; mean [SD] age, 75.8 [7.9] years vs 76.9 [7.8] years; P < .001) and had a higher prevalence of comorbidities. A higher proportion of Black patients (8.9%) than White patients (7.6%) underwent revascularization (odds ratio, 1.19 [95% CI, 1.18-1.21]; P < .001), and a higher proportion of Black patients (2.8%) than White patients (1.0%) underwent major amputation (odds ratio, 2.91 [95% CI, 2.83-2.99]; P < .001). Higher proportions of Black patients than White patients underwent revascularization and major amputation in the majority of states, although with marked variation in these proportional differences across states. The proportions of Black and White patients who underwent revascularization decreased over time (from 8.0% to 7.4% for Black patients and from 6.8% to 6.2% for White patients). The proportion of Black patients who underwent major amputation decreased (from 2.9% to 2.5%; P < .001), but there was no change among White patients (from 0.7% to 0.7%; P = .53). Revascularization correlated weakly (ρ = 0.10), and amputation correlated moderately with SVI (ρ = 0.46).</p><p><strong>Conclusions and relevance: </strong>These findings suggest that higher proportions of Black patients than White patients undergo invasive procedures for PAD, with considerable variation across states. Although the proportional difference in major amputations has narrowed over time, the persistent proportional excess of major amputations among Black patients requires further study to investigate whether this difference reflects remediable disparities in care.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266187","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":"Aortic Valve Replacement in Patients With Asymptomatic Severe Aortic Stenosis: The Devil Is in the Detail.","authors":"Graham S Hillis, Gerry P McCann, David E Newby","doi":"10.1001/jamacardio.2025.1676","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.1676","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266240","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":"Institutional Variability in Processes of Care and Outcomes Among Patients With STEMI in the US.","authors":"Yasser M Sammour, Safi U Khan, Haoyun Hong, Jingyuan Wu, Alexander C Fanaroff, Grant W Reed, Remy Poudel, Kathie Thomas, Zhao Ni, Abhinav Goyal, Ajay J Kirtane, Robert W Yeh, W Schuyler Jones, Sachin S Goel, Wissam A Jaber, Neal S Kleiman","doi":"10.1001/jamacardio.2025.1411","DOIUrl":"10.1001/jamacardio.2025.1411","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Percutaneous coronary intervention (PCI) is the criterion standard for acute ST-elevation myocardial infarction (STEMI). Achieving target first medical contact (FMC)-to-device time is a quality metric in STEMI care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To describe site-level variability in achieving target FMC-to-device time (≤90 minutes for primary presentations to PCI-capable hospitals and ≤120 minutes for transfers), compare treatment times according to hospital performance, location, and primary PCI volume, and assess whether these aspects are associated with clinical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This was a retrospective cross-sectional study from the American Heart Association Get With the Guidelines-Coronary Artery Disease registry from 2020 to 2022. Patients were recruited from a multicenter quality-improvement registry across 503 US hospitals. Patients with STEMI or STEMI equivalent who underwent primary PCI were included in this analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;FMC-to-device time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Hospital performance was determined by the proportion of patients meeting target FMC-to-device time at each site. Treatment times and outcomes were compared by hospital performance, location, and primary PCI volume.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 73 826 patients were analyzed (median [IQR] age, 62 [54-71] years; 53 474 male [72.4%]). Of 60 109 patients who presented directly to PCI-capable hospitals (primary presentations), 35 783 (59.5%) achieved an FMC-to-device time of 90 minutes or less, whereas 6900 (50.3%) of 13 717 transfers had an FMC-to-device time of 120 minutes or less. There was substantial institutional variability in achieving target FMC-to-device time for both primary presentations (median [IQR], 60.8% [51.2%-68.8%]) and transfers (median [IQR], 50.0% [32.5%-66.9%]). High-performing centers met all target treatment times more frequently. Low-performing sites experienced prolonged emergency department stays, catheterization laboratory arrival-to-PCI times, and transfer delays, varying by mode of presentation. Compared with urban centers, presentation to rural hospitals did not affect the odds of meeting target FMC-to-device time for primary presentations (adjusted odds ratio [aOR], 1.20; 95% CI, 0.96-1.50) or transfers (aOR, 0.86; 95% CI, 0.50-1.47). Failure to achieve target FMC-to-device time was associated with increased in-hospital mortality risk for primary presentations (aOR, 2.21; 95% CI, 2.02-2.42) and transfers (aOR, 2.44; 95% CI, 1.90-3.12). Low hospital performance was associated with increased mortality risk compared with high performance in primary presentations (aOR, 1.16; 95% CI, 1.00-1.34). Outcomes were similar between rural vs urban and low vs high primary PCI volume centers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In this large cross-sectional study of patients with STEMI, there","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266184","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":"Finerenone in Heart Failure.","authors":"Sama Samankan, Taher Entezari-Maleki","doi":"10.1001/jamacardio.2025.1530","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.1530","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215840","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":"Finerenone in Heart Failure-Reply.","authors":"Muthiah Vaduganathan, John J V McMurray, Scott D Solomon","doi":"10.1001/jamacardio.2025.1533","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.1533","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215841","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":"AHA PREVENT Equations With Lipoprotein(a) and Risk Assessment for Primary Prevention.","authors":"Donald M Lloyd-Jones, Amit Khera","doi":"10.1001/jamacardio.2025.1591","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.1591","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215828","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":"PCSK9 in Familial Hypercholesterolemia and Beyond.","authors":"Marianne Abifadel","doi":"10.1001/jamacardio.2025.1408","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.1408","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215843","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":"Cellular Adhesion Molecules and Adverse Outcomes in Chronic Heart Failure: Findings From the DAPA-HF Randomized Clinical Trial.","authors":"Kirsty McDowell, Paul Welsh, Kieran F Docherty, David A Morrow, Pardeep S Jhund, Rudolf A De Boer, Eileen O'Meara, Silvio E Inzucchi, Lars Køber, Mikhail N Kosiborod, Felipe A Martinez, Piotr Ponikowski, Ann Hammarstedt, Anna Maria Langkilde, Scott D Solomon, Naveed Sattar, Marc S Sabatine, John J V McMurray","doi":"10.1001/jamacardio.2025.1592","DOIUrl":"10.1001/jamacardio.2025.1592","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Vascular cell adhesion molecule 1 (VCAM-1) and intracellular cell adhesion molecule 1 (ICAM-1) are responsible for immune cell-cell interactions. Systemic levels of VCAM-1 are associated with incident heart failure (HF).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine if VCAM-1 and ICAM-1 levels are associated with progression of established HF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;Participants enrolled in the biomarker substudy of the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) randomized clinical trial had VCAM-1 and ICAM-1 levels measured at baseline and 12 months. The DAPA-HF trial was conducted at 410 sites in 20 countries. Patients with HF and reduced ejection fraction (HFrEF) in New York Heart Association (NYHA) class II to IV with elevated natriuretic peptides were enrolled between February 15, 2017, and August 17, 2018, with final follow-up on June 6, 2019. Data were analyzed from January 2023 to January 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Dapagliflozin, 10 mg, once daily vs placebo.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was the composite of a worsening HF event or cardiovascular death. The associations between VCAM-1 and ICAM-1 levels at baseline and the primary outcome, its components, and all-cause death were analyzed using Cox proportional hazards regression models adjusted for known prognostic variables including estimated glomerular filtration rate (eGFR), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hs-TnT), as well as high-sensitivity C-reactive protein.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 3051 participants (mean [SD] age, 67.2 [10.5] years; 2386 male [78.2%]) were included in this study. Mean (SD) follow-up time was 17.6 (5.2) months. The median (IQR) baseline VCAM-1 level was 997 (816.7-1218.8) ng/mL. Compared with patients with lower concentrations of VCAM-1, those with higher concentrations of VCAM-1 were older (mean [SD] age T3 vs T1, 69.7 [9.7] years vs 64.1 [10.7] years; P &lt; .001), in worse NYHA class (T3 vs T1, NYHA class III/IV 35.6% [362 of 1017] vs 26.5% [269 of 1017]; P &lt; .001), and had higher NT-proBNP (median [IQR] T3 vs T1, 2018 [1126-3753] pg/mL vs 1118 [693-1830] pg/mL) and hs-TnT (median [IQR] T3 vs T1, 24.7 [17.1-37.5] ng/L vs 16.6 [11.6-24.9] ng/L) concentrations, and lower eGFR (mean [SD] T3 vs T1, 58.4 [17.6] mL/min/1.73 m2 vs 71.7 [18.0] mL/min/1.73 m2). Patients in tertile 3 of VCAM-1, compared with tertile 1, had the highest risk of each outcome (eg, adjusted hazard ratio [HR] for primary outcome 1.40; 95% CI, 1.11-1.77; P = .004). ICAM-1 level was not associated with an elevated risk of any outcome. The benefit of dapagliflozin vs placebo in reducing the risk of the primary outcome was consistent across VCAM-1 tertiles: HR, 0.76 (95% CI, 0.54-1.06), 0.82 (95% CI, 0.59-1.12), and 0.77 (95% CI, 0.61-0.98) for tertiles 1, 2 and 3, res","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215839","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":"Vascular Cell Adhesion Molecule 1 in Heart Failure-Stuck on You.","authors":"Ravi B Patel","doi":"10.1001/jamacardio.2025.1600","DOIUrl":"10.1001/jamacardio.2025.1600","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215844","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}