Journal of Cardiovascular Medicine最新文献

{"title":"Arrhythmias in patients with transthyretin cardiac amyloidosis and the impact of contemporary disease-modifying therapies.","authors":"Ioannis Ntalas, Panagiotis Korantzopoulos, Christos Goudis, Emmanouil Chourdakis, Christos S Katsouras","doi":"10.2459/JCM.0000000000001944","DOIUrl":"https://doi.org/10.2459/JCM.0000000000001944","url":null,"abstract":"<p><p>Transthyretin cardiac amyloidosis (ATTR-CM) is an increasingly recognized infiltrative cardiomyopathy characterized by extracellular deposition of misfolded transthyretin fibrils, leading to progressive myocardial stiffening, electrical remodeling, and conduction-system disease. These pathophysiological changes create a complex arrhythmic substrate, resulting in a high burden of atrial, bradyarrhythmia, and ventricular arrhythmias that significantly contribute to morbidity and mortality. Despite advances in disease recognition, the optimal management of arrhythmias in ATTR-CM remains challenging, with limited evidence guiding antiarrhythmic strategies and device therapy. In particular, the prognostic significance of ventricular arrhythmias and the role of implantable cardioverter-defibrillators (ICDs) remain controversial. Recent disease-modifying therapies (DMTs), including transthyretin stabilizers (tafamidis, diflunisal) and gene-silencing agents (patisiran, vutrisiran), have transformed the therapeutic landscape and may modify disease progression and arrhythmic burden, although their direct antiarrhythmic impact is not yet fully defined. This narrative review provides a structured overview of the mechanisms, epidemiology, and clinical management of arrhythmias in ATTR-CM, with a focus on clinically relevant decision-making and the potential influence of contemporary DMTs. Finally, it highlights key unresolved questions and areas requiring further prospective research.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 10","pages":"786-797"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highlights from the issue.","authors":"Ciro Indolfi","doi":"10.2459/JCM.0000000000001950","DOIUrl":"https://doi.org/10.2459/JCM.0000000000001950","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 10","pages":"741-744"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the letter to the editor regarding 'Conscious sedation versus general anesthesia for transesophageal echocardiography guidance of percutaneous left atrial appendage occlusion'.","authors":"Giulia Laterra","doi":"10.2459/JCM.0000000000001942","DOIUrl":"10.2459/JCM.0000000000001942","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 10","pages":"805-806"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and prognostic role of left atrial reverse remodeling in patients undergoing mitral transcatheter edge-to-edge repair: insights from the Multicenter Echocardiographic Registry of patients undergoing mitral Transcatheter Edge-to-Edge Repair.","authors":"Elisa Pezzola, Laura Lupi, Antonio Popolo Rubbio, Edoardo Sciatti, Cristina Giannini, Marta Barletta, Antonio De Luca, Davide Stolfo, Lisa Serafini, Alessandra Ricci, Luigi Fiocca, Matteo Mazzola, Luca Branca, Mauro Massussi, Michele Senni, Gianfranco Sinagra, Francesco Bedogni, Marco De Carlo, Marco Metra, Marianna Adamo","doi":"10.2459/JCM.0000000000001943","DOIUrl":"10.2459/JCM.0000000000001943","url":null,"abstract":"<p><strong>Aims: </strong>Atrial enlargement is a complex maladaptive process related to pressure and volume overload. Left atrial reverse remodeling (LARR) has been described as a result of medical and interventional therapies. We sought to explore LARR prevalence and its prognostic implications following mitral transcatheter edge-to-edge repair (M-TEER).</p><p><strong>Methods and results: </strong>Four-hundred and twenty-five patients from the MERIT-TEER (Multicenter Echocardiographic Registry of patients undergoing M-TEER) who received a successful procedure from 2012 to 2024 with available left atrial volume (LAV) have been analyzed. LARR was defined as a reduction in LAV of at least 15%. LARR prevalence and its association with the risk of heart failure hospitalization and all-cause mortality at 4 years' follow-up were evaluated in the overall population and according to mitral regurgitation etiology.At short-term follow-up, LARR was observed in 124 patients (29.20%). LARR was more prevalent among primary mitral regurgitation (PMR) patients compared with those with ventricular secondary (vSMR) and atrial secondary mitral regurgitation (aSMR) (37.23, 27.19, and 18.33%; P = 0.017). At long-term follow-up, the composite outcome occurred in 153 patients (36.2%). LARR was independently associated with lower risk of events in the overall population [adjusted hazard ratio 0.59, 95% confidence interval (CI) 0.43-0.85, P = 0.005] and among vSMR patients (adjusted hazard ratio 0.43, 95% CI 0.26-0.71, P = 0.001), but not in aSMR or PMR.</p><p><strong>Conclusion: </strong>LARR was observed in less than one-third of patients undergoing M-TEER (29.2%), occurring more frequently in PMR. LARR was independently associated with lower risk of all-cause mortality and heart failure hospitalization in the overall population and particularly in patients with vSMR.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 10","pages":"745-755"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of patients with obesity presenting with cardiac arrest and the potential role of cardioverter-defibrillator therapy: an analysis using the National Inpatient Sample database.","authors":"Maisha Maliha, Jose Rodriguez Szasdi, Jiyoung Seo, Vishakha Modak, Sharanya Kaushik, Eric Stecker, Peter M Jessel","doi":"10.2459/JCM.0000000000001906","DOIUrl":"https://doi.org/10.2459/JCM.0000000000001906","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a well established risk factor for cardiovascular disease and has been associated with an increased incidence of cardiac arrest. This study utilizes the National Inpatient Sample (NIS) database to analyze the characteristics of obese patients presenting with cardiac arrest and explores the potential role of implantable cardioverter-defibrillator (ICD) therapy in this population.</p><p><strong>Methods: </strong>We analyzed data from the NIS database between 2016 and 2020, including obese (body mass index ≥30) adult patients with and without cardiac arrest. Baseline characteristics and comorbidities were identified using relevant ICD-10 codes. Differences in outcomes and comorbidities between the two groups, as well as factors associated with ICD placement, were evaluated using multivariable logistic regression.</p><p><strong>Results: </strong>We analyzed 4 445 524 obese patients, including 88 770 individuals who presented with cardiac arrest (mean age: 63.2 ± 12.6 years) and 4 356 754 without cardiac arrest (mean age: 59.0 ± 15.2 years). Obese patients with cardiac arrest were more likely to be White men with a greater burden of comorbidities, such as hypertension, chronic ischemic heart disease, smoking, alcohol use, hyperthyroidism, congestive heart failure, and atrial and ventricular arrhythmias, with atrial fibrillation being a particularly dominant association with cardiac arrest (odds ratio: 7.80, P < 0.001). In addition, individuals with private insurance and those treated at large, urban teaching hospitals were more likely to be diagnosed with cardiac arrest, with longer hospital stays, higher costs, and increased mortality. In the setting of cardiac arrest associated with ventricular tachycardia and fibrillation, males with private insurance, higher median household incomes (> $35 000), and treatment at large, urban teaching hospitals had higher odds of ICD placement. Furthermore, obese individuals with advancing age and comorbidities - including diabetes, obstructive lung disease, peripheral vascular disease, and renal and liver disease - faced higher odds of mortality without an ICD. Compared with White patients, Asian, Pacific Islander, and Native American individuals without an ICD also had higher odds of mortality.</p><p><strong>Conclusion: </strong>Obese individuals, particularly White males with comorbidities, were more likely to experience cardiac arrest, with atrial fibrillation being a strong independent risk factor even after adjustment for heart failure. Disparities in healthcare access were evident, with individuals of higher socioeconomic status more likely to receive ICDs, while certain racial groups had worse outcomes.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 10","pages":"772-785"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal cell carcinoma: a silent ascent to the right atrium.","authors":"Raffaella Mistrulli, Eleonora Zuppini, Sara Cangianiello, Pasquale Paolisso, Emanuele Barbato","doi":"10.2459/JCM.0000000000001949","DOIUrl":"https://doi.org/10.2459/JCM.0000000000001949","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 10","pages":"807-808"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten years of concomitant aortic and mitral replacement: trends, outcomes and the role of patient-prosthesis mismatch.","authors":"Nicolò Azzola Guicciardi, Roberto Lorusso, Sofia Pavan, Benedetto Del Forno, Davide Margonato, Vincenzo Rizza, Andrea Mariani, Matteo Mazzola, Alessandro Castiglioni, Ottavio Alfieri, Eustachio Agricola, Francesco Maisano, Michele De Bonis","doi":"10.2459/JCM.0000000000001948","DOIUrl":"https://doi.org/10.2459/JCM.0000000000001948","url":null,"abstract":"<p><strong>Background: </strong>Contemporary data comparing double mechanical prostheses (DMP) vs. double biological prostheses (DBP) for concomitant aortic and mitral valve replacement are scarce, and the cumulative hemodynamic burden of simultaneous prosthesis-patient mismatch (PPM) at both positions has never been systematically assessed.</p><p><strong>Results: </strong>DMP recipients had lower in-hospital mortality (1.9% vs. 15.2%; P = 0.010) and superior 7-year survival (91.3% vs. 67.7%; P = 0.003), but significantly higher stroke rates (32.2% vs. 5.0%; P = 0.023). Combined PPM occurred in 64.6% of DBP vs. 14.8% of DMP (P < 0.001).</p><p><strong>Major findings: </strong>Concomitant double valve replacement confirmed its high-risk profile, with an overall in-hospital mortality of 10.5%. DMP demonstrated superior unadjusted survival (7-year: 91.3% vs. 67.7%; P = 0.003) but significantly higher stroke risk (32.2% vs. 5.0%; P = 0.023), without differences in major bleeding rates at follow-up (8.2% vs. 11.3%; P = 0.478), although baseline differences precluded definitive prosthesis-type recommendations after multivariable adjustment. Combined PPM is highly prevalent after DBP (64.6%) and emerged as a univariable mortality predictor (hazard ratio 1.97; P = 0.046); given the exploratory nature of the cPPM definition and its collinearity with prosthesis type, this should be regarded as hypothesis-generating and warrants validation in larger, ideally multicenter, cohorts.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 10","pages":"798-803"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polyvascular disease by systematic vascular screening and adverse outcomes in patients with acute myocardial infarction.","authors":"Hikaru Hayakawa, Akihito Tanaka, Shuji Morikawa","doi":"10.2459/JCM.0000000000001945","DOIUrl":"10.2459/JCM.0000000000001945","url":null,"abstract":"<p><strong>Aims: </strong>The prognostic significance of systematically screened extra-coronary vascular disease in patients with acute myocardial infarction (AMI) remains incompletely understood. We investigated the prevalence and prognostic impact of polyvascular disease (PVD) identified using a routine vascular screening strategy in patients with AMI.</p><p><strong>Methods: </strong>This retrospective single-center observational study included consecutive patients with AMI who underwent percutaneous coronary intervention. Ankle-brachial index (ABI) measurement and carotid ultrasonography were routinely performed during index hospitalization. PVD was defined as the presence of peripheral artery disease (ABI ≤ 0.90) and/or carotid artery disease, defined as carotid plaque according to the Mannheim consensus (maximal wall thickness ≥ 1.5 mm) or ≥50% carotid stenosis. The primary endpoint was a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and unplanned coronary revascularization after discharge.</p><p><strong>Results: </strong>Among 233 eligible patients, PVD was identified in 73 patients (31.3%), including 55 (23.6%) with single-territory PVD and 18 (7.7%) with multiterritory PVD. During a median follow-up of 419 days, the primary endpoint occurred in 43 patients. Kaplan-Meier analysis demonstrated a graded decrease in event-free survival according to increasing PVD burden (log-rank P = 0.014; P for trend = 0.007). In Cox proportional hazards analysis, the presence of PVD was significantly associated with adverse cardiovascular outcomes, and this association remained significant after adjustment for age, sex, diabetes mellitus, and renal dysfunction.</p><p><strong>Conclusions: </strong>PVD is common in patients with AMI and is associated with poor long-term clinical outcomes. Routine systematic assessment of extra-coronary vascular disease may improve cardiovascular risk stratification.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 10","pages":"756-763"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beta-blocker therapy and aortic growth in nonsyndromic ascending thoracic aortic aneurysms: a serial CT analysis.","authors":"Aydin İşletme, Sercan Deveci, Semih Eren, Elif Hatipoğlu, Ayça Gümüşdağ, Mehmet Baran Karataş, Gündüz Durmuş","doi":"10.2459/JCM.0000000000001947","DOIUrl":"https://doi.org/10.2459/JCM.0000000000001947","url":null,"abstract":"<p><strong>Background: </strong>The role of beta blockers in slowing aneurysm progression in patients with nonsyndromic ascending thoracic aortic aneurysms (aTAA) remains uncertain. We investigated the association between beta blocker therapy and longitudinal ascending aortic growth measured by serial computed tomography (CT).</p><p><strong>Methods: </strong>This retrospective single-center cohort study included 390 adults with nonsyndromic aTAA who underwent at least two contrast-enhanced CT examinations separated by a minimum of 2 years. Patients were classified according to beta blocker therapy (311 users and 79 nonusers). The primary outcome was the annual ascending aortic growth rate. Secondary outcomes included changes in the ascending aortic size index (ASI) and ascending aortic height index (AHI). Univariate and multivariable linear regression analyses were performed to identify independent predictors of annual aortic growth.</p><p><strong>Results: </strong>Baseline ascending aortic diameter was comparable between beta blocker users and nonusers (45.1 ± 3.5 vs. 45.2 ± 3.6 mm, P = 0.73). During a mean CT follow-up of 73.2 ± 39.1 months, annual ascending aortic growth rates were similar between groups (0.40 ± 0.54 vs. 0.45 ± 0.65 mm/year, P = 0.49). Likewise, changes in ASI and AHI did not differ according to beta blocker therapy. In multivariable linear regression analysis, beta blocker use was not independently associated with annual ascending aortic growth (standardized β = -0.031, P = 0.548). Exploratory subgroup analyses demonstrated numerically lower annual growth rates among beta blocker users with baseline ascending aortic diameters ≥48 mm and bicuspid aortic valves; however, neither comparison reached statistical significance.</p><p><strong>Conclusions: </strong>In this long-term CT-based cohort of patients with nonsyndromic aTAA, beta blocker therapy was not independently associated with slower ascending aortic growth or changes in indexed aortic dimensions. Larger prospective studies are needed to further clarify the role of beta blockers in limiting aneurysm progression.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 10","pages":"764-771"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding: 'Conscious sedation versus general anesthesia for transesophageal echocardiography guidance of percutaneous left atrial appendage occlusion'.","authors":"Aysha Hashmi","doi":"10.2459/JCM.0000000000001941","DOIUrl":"10.2459/JCM.0000000000001941","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 10","pages":"804-805"},"PeriodicalIF":2.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}