Journal of the American College of Cardiology最新文献

{"title":"Clinical Signs of Congestion in Younger Patients With Decompensated Heart Failure","authors":"Jaimie Coburn, Pieter A. Neef, Simon Hobson, Jonathan R. Dalzell","doi":"10.1016/j.jacc.2024.08.079","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.08.079","url":null,"abstract":"No Abstract","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"8 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665370","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":"Tirzepatide Reduces LV Mass and Paracardiac Adipose Tissue in Obesity-Related Heart Failure: SUMMIT CMR Substudy","authors":"Christopher M. Kramer, Barry A. Borlaug, Michael R. Zile, Dustin Ruff, Joseph M. DiMaria, Venu Menon, Yang Ou, Angela M. Zarante, Karla C. Hurt, Masahiro Murakami, Milton Packer","doi":"10.1016/j.jacc.2024.11.001","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.11.001","url":null,"abstract":"<h3>Background</h3>Obesity is a known risk factor for heart failure with preserved ejection fraction (HFpEF) and is considered a distinct phenotype with more concentric remodeling. Epicardial adipose tissue (EAT) is also increased in obesity-related HFpEF and is associated with adverse events.<h3>Objectives</h3>The cardiac magnetic resonance (CMR) substudy of the SUMMIT trial aimed to examine the effects of tirzepatide on cardiac structure and function with the underlying hypothesis that it would reduce left ventricular (LV) mass and EAT in obesity-related HFpEF.<h3>Methods</h3>A total of 175 patients with obesity-related HFpEF from the parent study of tirzepatide (2.5 mg subcutaneously weekly, increasing to a maximum of 15 mg weekly) or matching placebo underwent CMR at baseline, which consisted of multiplanar cine imaging. A total of 106 patients completed the CMR and had adequate image quality for analysis of LV and left atrial structure and function and paracardiac (epicardial plus pericardial) adipose tissue at both baseline and 52 weeks. The prespecified primary endpoint of this substudy was between-group changes in LV mass.<h3>Results</h3>LV mass decreased by 11 g (95% CI: −19 to −4 g) in the treated group (n = 50) when corrected for placebo (n = 56) (<em>P =</em> 0.004). Paracardiac adipose tissue decreased in the treated group by 45 mL (95% CI: −69 to −22 mL) when corrected for placebo (<em>P &lt;</em> 0.001). The change in LV mass in the treated group correlated with changes in body weight (<em>P &lt;</em> 0.02) and tended to correlate with changes in waist circumference and blood pressure (<em>P =</em> 0.06 for both). The LV mass change also correlated with changes in LV end-diastolic volume and left atrial end-diastolic and end-systolic volumes (<em>P &lt;</em> 0.03 for all).<h3>Conclusions</h3>The CMR substudy of the SUMMIT trial demonstrated that tirzepatide therapy in obesity-related HFpEF led to reduced LV mass and paracardiac adipose tissue as compared with placebo, and the change in LV mass paralleled weight loss. These physiologic changes may contribute to the reduction in heart failure events seen in the main SUMMIT trial. (A Study of Tirzepatide [LY3298176] in Participants With Heart Failure With Preserved Ejection Fraction [HFpEF] and Obesity: The SUMMIT Trial; <span><span>NCT04847557</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>)","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"13 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670675","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":"Revealing the Hidden Layers: Focus on Social and Psychological Determinants in Congenital Heart Surgery Prognosis","authors":"Zhangxin Wen, Sihan Duan, Hong Liu","doi":"10.1016/j.jacc.2024.07.060","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.07.060","url":null,"abstract":"No Abstract","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"64 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665360","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":"Glycemic Control and Coronary Stent Failure in Patients With Type 2 Diabetes Mellitus","authors":"Chao Liu, Ximing Li, Hongliang Cong","doi":"10.1016/j.jacc.2024.07.062","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.07.062","url":null,"abstract":"No Abstract","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"18 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665364","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":"Semaglutide Improves Cardiovascular Outcomes in Patients With History of Coronary Artery Bypass Graft and Obesity","authors":"Subodh Verma, Scott Emerson, Jorge Plutzky, Steven E. Kahn, Signe Stensen, Peter E. Weeke, Derrick Musinga, Paul Poirier, Ildiko Lingvay, A. Michael Lincoff","doi":"10.1016/j.jacc.2024.11.008","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.11.008","url":null,"abstract":"No Abstract","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"11 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670674","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":"Oxidized Phospholipids and Calcific Aortic Valvular Disease","authors":"Harpreet S. Bhatia, Marc R. Dweck, Neil Craig, Romain Capoulade, Philippe Pibarot, Patrick J. Trainor, Seamus P. Whelton, Rishi Rikhi, Karita C.F. Lidani, Wendy S. Post, Michael Y. Tsai, Michael H. Criqui, Michael D. Shapiro, Matthew J. Budoff, Andrew P. DeFilippis, George Thanassoulis, Sotirios Tsimikas","doi":"10.1016/j.jacc.2024.08.070","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.08.070","url":null,"abstract":"<h3>Background</h3>Oxidized phospholipids (OxPLs) are carried by apolipoprotein B-100–containing lipoproteins (OxPL-apoB) including lipoprotein(a) (Lp[a]). Both OxPL-apoB and Lp(a) have been associated with calcific aortic valve disease (CAVD).<h3>Objectives</h3>This study aimed to evaluate the associations between OxPL-apoB, Lp(a) and the prevalence, incidence, and progression of CAVD.<h3>Methods</h3>OxPL-apoB and Lp(a) were evaluated in MESA (Multi-Ethnic Study of Atherosclerosis) and a participant-level meta-analysis of 4 randomized trials of participants with established aortic stenosis (AS). In MESA, the association of OxPL-apoB and Lp(a) with aortic valve calcium (AVC) at baseline and 9.5 years was evaluated using multivariable ordinal regression models. In the meta-analysis, the association between OxPL-apoB and Lp(a) with AS progression (annualized change in peak aortic valve jet velocity) was evaluated using multivariable linear regression models.<h3>Results</h3>In MESA, both OxPL-apoB and Lp(a) were associated with prevalent AVC (OR per SD: 1.19 [95% CI: 1.07-1.32] and 1.13 [95% CI: 1.01-1.27], respectively) with a significant interaction between the two (<em>P</em> &lt; 0.01). Both OxPL-apoB and Lp(a) were associated with incident AVC at 9.5 years when evaluated individually (interaction <em>P</em> &lt; 0.01). The OxPL-apoB∗Lp(a) interaction demonstrated higher odds of prevalent and incident AVC for OxPL-apoB with increasing Lp(a) levels. In the meta-analysis, when analyzed separately, both OxPL-apoB and Lp(a) were associated with faster increase in peak aortic valve jet velocity, but when evaluated together, only OxPL-apoB remained significant (ß: 0.07; 95% CI: 0.01-0.12).<h3>Conclusions</h3>OxPL-apoB is a predictor of the presence, incidence, and progression of AVC and established AS, particularly in the setting of elevated Lp(a) levels, and may represent a novel therapeutic target for CAVD.","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"7 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637622","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":"Treating Older Patients in Cardiogenic Shock with a Microaxial Flow Pump: Is it DANGERous?","authors":"Anika Klein, Rasmus P. Beske, Christian Hassager, Lisette O. Jensen, Hans Eiskjær, Norman Mangner, Axel Linke, Amin Polzin, P. Christian Schulze, Carsten Skurk, Peter Nordbeck, Peter Clemmensen, Vasileios Panoulas, Sebastian Zimmer, Andreas Schäfer, Nikos Werner, Thomas Engstøm, Lene Holmvang, Anders Junker, Henrik Schmidt, Jacob E. Møller","doi":"10.1016/j.jacc.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.11.003","url":null,"abstract":"<h3>Background</h3>Whether age impacts the recently demonstrated survival benefit of microaxial flow pump (mAFP) treatment in patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (CS) is unknown.<h3>Objectives</h3>The purpose of this study was to assess the impact of age on mortality and complication rates in patients with STEMI-related CS randomized to standard care or mAFP on top of standard care.<h3>Methods</h3>This is a secondary analysis of the Danish-German Cardiogenic Shock (DanGer Shock) trial, an international, multicenter, open-label trial, in which 355 adult patients with STEMI-related CS were randomized to receive a mAFP (Impella CP) plus standard care or standard care alone. The primary outcome of 180-day all-cause mortality is analysed according to age and intervention.<h3>Results</h3>From lowest to highest age quartile, the median ages (range) were: 54 (31-59), 65 (60-69), 73 (70-76), and 81 (77-92) years. There were no differences in blood pressure, lactate level, left ventricular ejection fraction or shock severity at randomization across age groups.Mortality increased from lowest to highest quartile (31%, 47%, 61%, and 73%, respectively; log-rank p&lt;0.001), with an adjusted odds ratio (OR) for death at 180 days of 7.85 (95% CI, 3.37-19.2; p&lt;0.001) in the highest quartile compared to the lowest. The predicted risk of mortality was higher in the standard-care group until approximately 77 years, after which the predicted risk became higher in the mAFP group (p-interaction=0.2). In patients younger than 77 years, a reduced 180-day mortality was observed in patients randomized to the mAFP (OR, 0.45; 95% CI, 0.28-0.73; p=0.001), opposed to patients aged 77 years or older (OR, 1.52; 95% CI, 0.57–4.08; p=0.40), p=0.028 for interaction. Complications were more frequent in the mAFP group, but there were no apparent differences in incidence of complications across all ages.<h3>Conclusions</h3>This exploratory secondary analysis of the DanGer Shock trial demonstrates that elderly patients with STEMI-related CS experience high mortality and may not attain the same benefit from routine treatment with a mAFP as younger patients. Incorporating age as a factor in patient selection may enhance the overall benefit of this therapy. (DanGer Shock, NCT01633502)","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"19 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637583","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":"Systolic Blood Pressure and Pulse Pressure in Heart Failure: Pooled Participant-Level Analysis of Four Trials","authors":"Henri Lu, Toru Kondo, Brian L. Claggett, Muthiah Vaduganathan, Brendon L. Neuen, Iris E. Beldhuis, Pardeep S. Jhund, Finnian R. Mc Causland, Inder S. Anand, Marc A. Pfeffer, Bertram Pitt, Faiez Zannad, Michael R. Zile, John J.V. McMurray, Scott D. Solomon, Akshay S. Desai","doi":"10.1016/j.jacc.2024.11.007","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.11.007","url":null,"abstract":"<h3>Background</h3>Hypertension is common in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), and current guidelines recommend treating systolic blood pressure (SBP) to a target below 130 mmHg. However, data supporting treatment to this target is limited. Additionally, pulse pressure (PP), a marker of aortic stiffness, has been associated with increased risk of cardiovascular events, but its prognostic impact in HFpEF has not been extensively studied.<h3>Objectives</h3>This study aimed to explore the impact of baseline SBP and PP on cardiovascular outcomes in patients with HFmrEF or HFpEF.<h3>Methods</h3>I-PRESERVE, TOPCAT-Americas, PARAGON-HF and DELIVER were global, randomized clinical trials testing irbesartan, spironolactone, sacubitril/valsartan and dapagliflozin respectively, against either a placebo or an active comparator (valsartan, in PARAGON-HF), in patients with HF and a left ventricular ejection fraction ≥40% (in DELIVER) or ≥45% (in the other trials). The relationship between continuous baseline SBP and PP, and the primary endpoint (first HF hospitalization or cardiovascular death) was analyzed with restricted cubic splines. We further evaluated the prognostic impact of SBP categories (&lt;120, 120-129, 130-139, ≥140 mmHg) and PP quartiles on the primary endpoint.<h3>Results</h3>A total of 16,950 patients (mean age 71±9 years, 49% male, mean SBP 131±15 mmHg, mean PP 55±14 mmHg) were included. The relationship between SBP and the primary endpoint was J-shaped, with the lowest risk at 120-130 mmHg. A similar pattern was found for PP, with the lowest risk at 50-60 mmHg. The highest SBP category (reference: 120-129 mmHg) and PP quartile (reference: 46-54 mmHg) were associated with a higher risk of the primary outcome (HR: 1.22; 95% CI: 1.10-1.34; HR: 1.22; 95% CI: 1.11-1.34, respectively). Higher PP was associated with greater cardiovascular risk, regardless of SBP.<h3>Conclusions</h3>Our analysis of a large pooled dataset from four clinical trials, including over 16,900 patients with HFmrEF/HFpEF, indicates a J-shaped relationship between both SBP and PP, and cardiovascular risk. The lowest risk was observed at SBP levels between 120 and 130 mmHg and PP values between 50 and 60 mmHg.","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"64 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637574","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":"Intensive lifestyle intervention, cardiac biomarkers, and cardiovascular outcomes in diabetes: LookAHEAD cardiac biomarker ancillary study","authors":"Kershaw V. Patel, Zainali Chunawala, Subodh Verma, Matthew W. Segar, Katelyn R. Garcia, Chiadi E. Ndumele, Thomas J. Wang, James L. Januzzi, Antoni Bayes-Genis, Javed Butler, Carolyn S.P. Lam, Christie M. Ballantyne, James A. de Lemos, Alain G. Bertoni, Mark Espeland, Ambarish Pandey","doi":"10.1016/j.jacc.2024.11.004","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.11.004","url":null,"abstract":"<h3>Background</h3>NT-proBNP and hs-cTnT are associated with cardiovascular outcomes and are recommended for measurement in type 2 diabetes (T2D). However, the effects of an intensive lifestyle intervention (ILI) targeting weight loss on cardiac biomarkers and the prognostic association of changes in these biomarkers with risk of adverse cardiovascular outcomes in T2D are not well-established.<h3>Objectives</h3>To evaluate the effects of an ILI on cardiac biomarkers and the association of changes in cardiac biomarkers with risk of cardiovascular outcomes in T2D.<h3>Methods</h3>Participants of the LookAHEAD trial underwent NT-proBNP and hs-cTnT measurement at baseline (N=3,984), 1- and 4-years. The effects of the ILI (vs. diabetes support and education [DSE]) on cardiac biomarkers were assessed using adjusted linear mixed-effect models and summarized as geometric mean ratios (GMR). Associations of longitudinal changes in cardiac biomarkers with risk of cardiovascular outcomes were assessed using adjusted Cox models.<h3>Results</h3>Average baseline NT-proBNP and hs-cTnT was 77 and 10.7 ng/L, respectively. The ILI (vs. DSE) led to an increase in NT-proBNP at 1-year (GMR[95% CI]: 1.14[1.08-1.20]), but this difference was attenuated by 4-years (GMR[95% CI]: 1.01[0.96-1.07]). The ILI (vs. DSE) led to lower hs-cTnT at 1-year (GMR[95% CI]: 0.94[0.91-0.97]) and 4-years (GMR[95% CI]: 0.93 [0.90-0.96]). Participants with meaningful weight loss by 1-year (≥5% vs. &lt;5%) had a significant increase in NT-proBNP in the short-term (year-1) which attenuated in the long-term follow-up (year-4). Meaningful 1-year weight loss was significantly associated with reduction in hs-cTnT in the long-term. In adjusted Cox-models, increase in NT-proBNP was significantly associated with higher risk of the composite ASCVD outcome and HF independent of baseline measure of the cardiac biomarker and changes in risk factors. In contrast, longitudinal increase in hs-cTnT was significantly associated with higher risk of the composite ASCVD outcome but not HF in the most adjusted model.<h3>Conclusions</h3>Among adults with T2D, an ILI led to a significant reduction in hs-cTnT on follow-up but a transient increase in NT-proBNP levels at 1-year that attenuated over time. Longitudinal assessment of NT-proBNP and hs-cTnT provide prognostic information for ASCVD risk while only changes in NT-proBNP predicted HF risk.","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"9 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637580","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":"Calcific Aortic Valve Disease: Lp(a) Takes the Heat, But Is OxPL Really Fanning the Flames?","authors":"Maxim E. Annink, S. Matthijs Boekholdt, Erik S.G. Stroes","doi":"10.1016/j.jacc.2024.09.1240","DOIUrl":"https://doi.org/10.1016/j.jacc.2024.09.1240","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>Funding Support and Author Disclosures</h2>Dr Stroes has received lecturing/Advisory Board fees from Amgen, Sanofi, Novo Nordisk, Novartis, Ionis, and AstraZeneca. The other authors have reported that they have no relationships relevant to the contents of this paper to disclose.</section></section>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"35 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637579","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}