Journal of the American College of Cardiology最新文献

{"title":"Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension","authors":"Irene M. Lang MD ,&nbsp;Philippe Brenot MD ,&nbsp;Hélène Bouvaist MD ,&nbsp;Elie Fadel MD ,&nbsp;Xavier Jaïs MD ,&nbsp;Michael M. Madani MD ,&nbsp;Stefan Guth MD ,&nbsp;Marcin Kurzyna MD ,&nbsp;Gérald Simonneau MD ,&nbsp;Christoph B. Wiedenroth MD ,&nbsp;Ehtisham Mahmud MD ,&nbsp;Hiroto Shimokawahara MD ,&nbsp;Riyaz Bashir MD ,&nbsp;Marion Delcroix MD ,&nbsp;Robert Frantz MD ,&nbsp;Christian Gerges MD ,&nbsp;Laurent Godinas MD ,&nbsp;Gustavo A. Heresi MD ,&nbsp;Pavel Jansa MD ,&nbsp;David P. Jenkins MD ,&nbsp;Hiromi Matsubara MD","doi":"10.1016/j.jacc.2025.04.021","DOIUrl":"10.1016/j.jacc.2025.04.021","url":null,"abstract":"<div><h3>Background</h3><div>Chronic thromboembolic pulmonary hypertension results from mechanical obstruction of major pulmonary artery lumina with fibrotic tissue. Main treatment has been pulmonary endarterectomy, a complex surgical procedure removing vascular obstruction. However, at least 40% of patients are not candidates for pulmonary endarterectomy because of technical inoperability, comorbidities, or limited access to surgery. Balloon pulmonary angioplasty (BPA) has emerged as an interventional treatment for these patients.</div></div><div><h3>Objectives</h3><div>The International BPA Registry (<span><span>NCT03245268</span><svg><path></path></svg></span>) was designed to investigate BPA practice across 18 established centers in the United States, Europe, and Japan.</div></div><div><h3>Methods</h3><div>A total of 500 patients were prospectively and consecutively enrolled between March 2018 and March 2020, with follow-up until March 2022. Of these, 484 patients were included in the analysis set.</div></div><div><h3>Results</h3><div>Regional differences were seen in patient characteristics (fewer patients with prior pulmonary endarterectomy and more elderly women in Japan) and procedural details (less medical pretreatment, more jugular access, more segments and more occlusive lesions treated per session and patient, less conscious sedation, less contrast and less radiation, shorter intervals between BPA sessions in Japan). Female sex, procedure in Europe/United States, pulmonary hypertension medications at any time, and higher baseline pulmonary vascular resistance (PVR), calculated as transpulmonary pressure gradient divided by cardiac output, emerged as independent predictors of complications during BPA. After a median of 5 (Q1-Q3: 3-6) BPA sessions per patient within a median time of 4.9 months (Q1-Q3: 1.7-11.0 months), a 15-mm Hg (38%) decrease in mPAP, a 332 dynes/s/cm⁻⁵ (57%) decrease in PVR, and a 3.2% increase in arterial saturation (medians; <em>P</em> &lt; 0.001) were observed, and there were significant improvements in functional class, 6-minute walk distance, serum levels of N-terminal probrain natriuretic peptide, and Borg dyspnea index. BPA complications occurred in 11.3% of sessions and 33.9% of patients and were mostly hemoptyses. No patient died within 30 days of BPA.</div></div><div><h3>Conclusions</h3><div>Our data are in line with previous reports on changes of clinical and hemodynamic parameters and complication rates of BPA. Centers with more experience providing BPAs were more likely to achieve a higher percentage decrease in PVR.</div></div>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 23","pages":"Pages 2270-2284"},"PeriodicalIF":21.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237869","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":"Embracing Uncertainty, Elevating Insight","authors":"Harlan M. Krumholz MD, SM (Editor-in-Chief, JACC; Harold H. Hines, Jr Professor)","doi":"10.1016/j.jacc.2025.05.005","DOIUrl":"10.1016/j.jacc.2025.05.005","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 23","pages":"Pages 2324-2325"},"PeriodicalIF":21.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237811","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":"The 4 Longest Days","authors":"Michelle M. Kittleson MD, PhD","doi":"10.1016/j.jacc.2025.03.534","DOIUrl":"10.1016/j.jacc.2025.03.534","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 23","pages":"Pages 2337-2338"},"PeriodicalIF":21.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237865","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":"Clinical Trial Perspective","authors":"John A. Spertus MD, MPH,&nbsp;Andrew J. Sauer MD,&nbsp;Suzanne V. Arnold MD, MHA,&nbsp;Philip G. Jones MS","doi":"10.1016/j.jacc.2025.04.064","DOIUrl":"10.1016/j.jacc.2025.04.064","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 23","pages":"Pages 2329-2332"},"PeriodicalIF":21.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237857","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":"Predicting Heart Failure Outcomes Using Patient-Reported Health Status","authors":"Bassim R. El-Sabawi MD ,&nbsp;Mohammed A. Al-Garadi PhD ,&nbsp;Bryan D. Steitz PhD ,&nbsp;Amy M. Perkins MS ,&nbsp;Allison B. McCoy PhD ,&nbsp;Donald G. Sengstack MS ,&nbsp;Robert A. Greevy Jr. PhD ,&nbsp;Emily H. Burnell BA ,&nbsp;Kelly H. Schlendorf MD ,&nbsp;JoAnn Lindenfeld MD ,&nbsp;Lynne W. Stevenson MD ,&nbsp;Deepak K. Gupta MD, MSCI ,&nbsp;John A. Spertus MD, MPH ,&nbsp;Sean P. Collins MD ,&nbsp;Michael E. Matheny MD, MPH, MS ,&nbsp;Justin M. Bachmann MD, MPH","doi":"10.1016/j.jacc.2025.03.545","DOIUrl":"10.1016/j.jacc.2025.03.545","url":null,"abstract":"<div><h3>Background</h3><div>The Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12), a patient-reported outcome measure for adults with heart failure, is associated with hospitalizations and mortality in clinical trials. Curated data sets from controlled trials differ substantially from pragmatic data collected from real-world settings, however, and few data exist on the KCCQ-12's predictive utility in clinical practice.</div></div><div><h3>Objectives</h3><div>This study sought to evaluate the predictive utility of the KCCQ-12 for hospitalizations and mortality when administered during outpatient heart failure care.</div></div><div><h3>Methods</h3><div>We conducted a cohort study of patients assigned the KCCQ-12 in heart failure clinics from July 2019 through March 2024. The primary exposure was KCCQ-12 Overall Summary (KCCQ-OS) score. The primary outcomes were 90-day hospitalization and cumulative mortality. Multivariable-adjusted associations were assessed using logistic regression and Cox proportional hazards models. Gradient boosting (XGBoost) and random survival forest machine learning models were used to evaluate KCCQ-OS feature importance in predicting 90-day hospitalizations and cumulative mortality, respectively.</div></div><div><h3>Results</h3><div>Among 4,406 patients assigned the KCCQ-12, 2,888 (66%) completed at least 1 questionnaire. The median KCCQ-OS score was 59.4 (Q1-Q3: 35.4-81.8). Patients with KCCQ-OS scores &lt;25 had higher adjusted risks of 90-day hospitalization (OR: 3.49; 95% CI: 2.50-4.90) and cumulative mortality (HR: 3.09; 95% CI: 2.29-4.17) compared with those with scores ≥75. The KCCQ-OS score was the most important feature for predicting 90-day hospitalizations in the XGBoost model (area under the receiver-operating characteristic curve: 0.760; 95% CI: 0.706-0.811) and the most important feature for predicting cumulative mortality in the random survival forest model (C-index 0.783; 95% CI: 0.742-0.824) compared with other clinical, demographic, and laboratory variables. KCCQ-12 noncompletion was independently associated with increased 90-day hospitalization (OR: 1.72; 95% CI: 1.46-2.02) and 1-year mortality (HR: 1.52; 95% CI: 1.25-1.84) after adjusting for all variables in the primary analysis.</div></div><div><h3>Conclusions</h3><div>In outpatient heart failure care, lower KCCQ-OS scores were strongly associated with increased hospitalizations and mortality, with the greatest risk among patients with scores &lt;25. Noncompletion of the KCCQ-12 was itself associated with worse outcomes. The KCCQ-OS score was the dominant predictor of 90-day hospitalizations and cumulative mortality in machine learning models, supporting the KCCQ-12 as a prognostic tool in routine clinical practice.</div></div>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 23","pages":"Pages 2253-2266"},"PeriodicalIF":21.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237907","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":"The Effect of Aircraft Noise on Left Ventricular Remodeling","authors":"Mi Zhou MMed, PhD ,&nbsp;Ming-jiao Liao MMed ,&nbsp;Li-xue Yin MD","doi":"10.1016/j.jacc.2025.02.036","DOIUrl":"10.1016/j.jacc.2025.02.036","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 23","pages":"Page e201"},"PeriodicalIF":21.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237860","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":"Kansas City Cardiomyopathy Questionnaire","authors":"Suzanne V. Arnold MD, MHA","doi":"10.1016/j.jacc.2025.04.017","DOIUrl":"10.1016/j.jacc.2025.04.017","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 23","pages":"Pages 2267-2269"},"PeriodicalIF":21.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237868","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":"Long-Acting Factor XI Inhibition and Periprocedural Bleeding","authors":"Siddharth M. Patel MD, MPH ,&nbsp;Robert P. Giugliano MD, SM ,&nbsp;David A. Morrow MD, MPH ,&nbsp;Sanobar Parkar MD ,&nbsp;Hannah Shapiro BS ,&nbsp;Bruce Hug MD, PhD ,&nbsp;Julia F. Kuder MA ,&nbsp;Erica L. Goodrich MS ,&nbsp;Shih-Ann Chen MD ,&nbsp;Shaun G. Goodman MD, MSc ,&nbsp;Boyoung Joung MD ,&nbsp;Robert G. Kiss MD ,&nbsp;Wojciech Wojakowski MD, PhD ,&nbsp;Jeffrey I. Weitz MD ,&nbsp;Sabina A. Murphy MPH ,&nbsp;Stephen D. Wiviott MD ,&nbsp;Daniel Bloomfield MD ,&nbsp;Marc S. Sabatine MD, MPH ,&nbsp;Christian T. Ruff MD, MPH","doi":"10.1016/j.jacc.2025.04.018","DOIUrl":"10.1016/j.jacc.2025.04.018","url":null,"abstract":"<div><h3>Background</h3><div>In AZALEA-TIMI 71 (A Multicenter, Randomized, Active-Controlled Study to Evaluate the Safety and Tolerability of Two Blinded Doses of Abelacimab Compared with Open-Label Rivaroxaban in Patients with Atrial Fibrillation–Thrombolysis In Myocardial Infarction 71), abelacimab, a novel factor XI inhibitor, significantly reduced the rate of major or clinically relevant nonmajor (CRNM) bleeding compared with rivaroxaban in patients with atrial fibrillation (AF). Abelacimab is long-acting with a half-life of ∼28 days.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to examine periprocedural bleeding among patients undergoing invasive procedures in the context of long-acting factor XI inhibition with abelacimab.</div></div><div><h3>Methods</h3><div>AZALEA-TIMI 71 was designed to assess the bleeding profile of abelacimab relative to rivaroxaban. Patients were randomized to either 1 of 2 abelacimab doses (90 or 150 mg subcutaneously monthly) or to rivaroxaban daily. Invasive procedures occurring during follow-up were categorized as low, intermediate, or high bleeding risk. Periprocedural bleeding events were identified as major/CRNM bleeds, as adjudicated by a clinical events committee blinded to treatment assignment, occurring within 30 days after a procedure, and related to the procedure on blinded review.</div></div><div><h3>Results</h3><div>A total of 920 procedures occurred in 441 patients, with approximately 1 in 3 patients in both rivaroxaban and abelacimab arms undergoing an invasive procedure over a median follow-up of 2.1 years. Most procedures were low bleeding risk (n = 696, 75.7%) and elective (n = 686, 74.6%). The median time to a procedure from the last dose of abelacimab was 29 days (Q1-Q3: 20-42 days), with 336 of the 602 (55.8%) procedures in the abelacimab arms occurring within the monthly dosing interval. Overall, the occurrence of periprocedural major or CRNM bleeding was low (&lt;2% of all procedures), representing 1.2% of all procedures in the abelacimab arms vs 2.2% of all procedures in the rivaroxaban arm (RR [risk ratio]: 0.54; 95% CI: 0.19-1.58), with consistent results in the individual abelacimab dosing arms. For procedures occurring within 30 days of an abelacimab dose, major or CRNM bleeds occurred in only 3 of the 336 (0.9%) procedures.</div></div><div><h3>Conclusions</h3><div>These data illustrate that patients with AF treated with abelacimab, a long-acting factor XI inhibitor, can undergo invasive procedures with low rates of bleeding. Moreover, these findings suggest that routine interruption of anticoagulation may not be necessary for all procedures in the context of factor XI inhibition, particularly for procedures that have low bleeding risk.</div></div>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 23","pages":"Pages 2288-2298"},"PeriodicalIF":21.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237904","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":"Amara Yad Image: The Relationship Between the Pulmonary Trunk, Aortic Root, and Atrial Appendages","authors":"Kalyanam Shivkumar MD, PhD","doi":"10.1016/j.jacc.2025.04.054","DOIUrl":"10.1016/j.jacc.2025.04.054","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 23","pages":"Pages 2339-2341"},"PeriodicalIF":21.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237859","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":"Reevaluating Beta-Blocker Recommendations Post-Myocardial Infarction","authors":"Sanjay Kaul MD","doi":"10.1016/j.jacc.2025.03.539","DOIUrl":"10.1016/j.jacc.2025.03.539","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 22","pages":"Pages 2096-2099"},"PeriodicalIF":21.7,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189825","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}