Journal of the American College of Cardiology最新文献

{"title":"Trajectories of Angina After Initial Invasive vs Conservative Strategy for Chronic Coronary Disease.","authors":"Nobuhiro Ikemura, Philip G Jones, Zhuxuan Fu, Paul S Chan, Charles F Sherrod, Suzanne V Arnold, David J Cohen, Daniel B Mark, David J Maron, Judith S Hochman, John A Spertus","doi":"10.1016/j.jacc.2025.06.044","DOIUrl":"10.1016/j.jacc.2025.06.044","url":null,"abstract":"<p><strong>Background: </strong>Clinical trials typically report average health status outcomes by treatment at single points in time, as opposed to participants' trajectories (or journeys) over time. Although ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated better mean health status at discrete times with an invasive treatment among those with baseline angina, the patterns of individual participants' angina over time are unknown.</p><p><strong>Objectives: </strong>The purpose of this study was to identify patterns of individual participants' angina over time after invasive or conservative management strategies for chronic coronary disease.</p><p><strong>Methods: </strong>In this secondary analysis of the ISCHEMIA trial, which enrolled participants with chronic coronary disease and moderate to severe ischemia from July 2012 to January 2018, we used ordinal latent trajectory analysis to assess angina frequency over a 2-year period, separately for participants assigned to the initial invasive and initial conservative arms. Angina frequency was defined using the SAQ-AF (Seattle Angina Questionnaire Angina Frequency) score, recategorized as daily/weekly (0-60 points), monthly (61-99 points), and no angina (100 points). Participants without baseline angina were excluded.</p><p><strong>Results: </strong>Among 2,977 participants with baseline angina, 1,505 (50.6%) were randomized to initial invasive and 1,472 (49.4%) to initial conservative management; baseline characteristics were well balanced between groups. Six distinct patterns of angina trajectories were identified in each arm and were qualitatively similar: 1) rapid resolution; 2) gradual resolution; 3) early improvement with persistent infrequent angina; 4) severe angina with improvement; 5) modest angina with minimal change; and 6) severe angina without improvement. In the invasive group, the most common patterns included rapid resolution (27.1%) and early improvement with persistent infrequent angina (32.1%), whereas the conservative group more often showed modest angina with minimal change (42.1%) and fewer cases of rapid resolution (12.8%) or early improvement with persistent infrequent angina (10.2%).</p><p><strong>Conclusions: </strong>Patients with chronic coronary disease and angina experienced diverse symptom trajectories, ranging from rapid resolution to severe or persistent angina. A greater proportion of conservatively managed patients experienced unfavorable angina patterns over 2 years compared with those treated invasively. When health status is monitored over time, such patterns may help identify patients with persistent symptoms who could benefit from additional therapy. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 11","pages":"782-793"},"PeriodicalIF":22.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033534","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":"Moderate Secondary Mitral Regurgitation: Evolving Evidence and Management Strategies.","authors":"Mauro Riccardi, Matteo Pagnesi, Carlo M Lombardi, Stefan D Anker, Francesco Maisano, Javed Butler, Marianna Adamo, Gregg W Stone, Marco Metra","doi":"10.1016/j.jacc.2025.07.019","DOIUrl":"10.1016/j.jacc.2025.07.019","url":null,"abstract":"<p><p>Secondary mitral regurgitation (SMR) is common in patients with heart failure (HF). Although randomized clinical trials have been focused on the treatment of severe SMR, the prognostic role and potential for treatment of moderate SMR cannot be overlooked. The randomized RESHAPE-HF2 trial included patients with moderate and severe SMR with consistent findings in both groups, raising the hypothesis that transcatheter correction of moderate SMR could have beneficial effects, although this needs further investigation. The aim of this review is to describe the prevalence of moderate SMR in patients with HF, its prognostic impact, and discuss current evidence for pharmacologic and interventional management of patients with moderate SMR.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 11","pages":"813-828"},"PeriodicalIF":22.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033622","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 Disquieting Plateau.","authors":"Harlan M Krumholz","doi":"10.1016/j.jacc.2025.07.025","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.07.025","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 9","pages":"637-639"},"PeriodicalIF":22.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958703","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":"Impact of LDL-Cholesterol When the Coronary Artery Calcium Score Is 0: Long-Term Cardiovascular Events.","authors":"Allison W Peng, Alexander C Razavi, John T Wilkins, Norrina B Allen, Laurence S Sperling, Jamal S Rana, Tia Bimal, Seamus P Whelton, Michael J Blaha, Roger S Blumenthal, Eugenia Gianos","doi":"10.1016/j.jacc.2025.06.053","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.06.053","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 9","pages":"676-680"},"PeriodicalIF":22.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958734","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":"Dietary and Lifestyle Habits of Cardiologists: Perception vs Practice.","authors":"Kim Allan Williams, Mashaal Ikram, Beth Frates, Paul Theriot","doi":"10.1016/j.jacc.2025.06.021","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.06.021","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 9","pages":"673-675"},"PeriodicalIF":22.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958764","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":"Prevalence and Predictors of Neurocognitive Dysfunction in Adults With Congenital Heart Disease: Results From MINDS-ACHD.","authors":"Scott Cohen, Michelle Gurvitz, Kristin M Burns, Olivia Wheaton, Laura G Umfleet, Nicole Brown, Candice K Silversides, Lauryn Dugan, Mary E Stumpf, Timothy B Cotts, Peter R Ermis, Susan M Jameson, Stephanie Gaydos, Arvind Hoskoppal, Ian Lindsay, Larry W Markham, Stephanie Fuller, Fred H Rodriguez, Gayatri Ranganathan, Felicia Trachtenberg, Ali N Zaidi","doi":"10.1016/j.jacc.2025.06.051","DOIUrl":"10.1016/j.jacc.2025.06.051","url":null,"abstract":"<p><strong>Background: </strong>Adults with congenital heart disease (ACHD) undergo repeated cardiac interventions, develop cardiac complications including atrial fibrillation, heart failure, and stroke, and may have genetic vulnerabilities for neurocognitive deficits (NCDs). However, NCDs have not been well studied in this population.</p><p><strong>Objectives: </strong>The aim of this study was to examine the prevalence and risk factors associated with NCDs in young adults with moderate and severe complex congenital heart disease (CHD).</p><p><strong>Methods: </strong>This was a prospective study of objective (cognitive battery of the National Institutes of Health [NIH] Toolbox) and subjective (NeuroQOL Item Bank v2) measures of neurocognitive function in ACHD patients (ages 18-30 years) from 14 North American ACHD centers. Multivariable regression was used to examine predictors of neurocognitive function.</p><p><strong>Results: </strong>Overall, 467 ACHD participants were enrolled (82 dextro-transposition of the great arteries, 123 tetralogy of Fallot, 132 single ventricle, and 130 other CHD). The mean age was 24.5 years, 44% were male, 81% were White, and 78% had NYHA functional class I. For the total cohort, 34% scored at least 1 standard deviation below the normative mean on the NIH Toolbox Total Composite Score and 22% scored at least 1 standard deviation below the normative mean on the NeuroQOL. Education and NYHA functional class were independently associated with NIH Toolbox scores. Education, body mass index, atrial arrhythmias, depression, and anxiety were independently associated with NeuroQOL scores.</p><p><strong>Conclusions: </strong>NCDs are prevalent in young adults with moderate and severely complex CHD, with approximately one-third having objective NCDs and one-fifth subjective NCDs. These findings emphasize the importance of integrating neurocognitive assessments into routine ACHD care.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 9","pages":"640-655"},"PeriodicalIF":22.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12422717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958781","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":"The Pathophysiologic Basis and Management of Calcific Aortic Valve Stenosis: JACC State-of-the-Art Review.","authors":"Milind Y Desai, Eugene Braunwald","doi":"10.1016/j.jacc.2025.06.049","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.06.049","url":null,"abstract":"<p><p>Calcific aortic valve stenosis (CAVS) is the most frequent valve disorder in adults, with a steadily increasing incidence with age. Currently, no effective treatments are available to prevent or delay disease progression. In addition to progressive calcification, there is increasing recognition of the underlying roles of oxidative stress, chronic inflammation, lipoprotein deposition, and induction of osteogenic signaling in driving progression of CAVS. Although traditional markers of CAVS progression, such as increased valve gradients and reduced areas, are currently used to guide clinical decisions regarding valve replacement, these measures may not capture progression of early, potentially modifiable disease. Hence, there is a need for more sensitive markers, such as aortic valve calcification, to monitor disease progression in CAVS. This JACC State-of-the-Art Review provides a comprehensive discussion of the pathogenesis and progression of CAVS and emphasizes the unmet need for innovative medical treatments. Additionally, it explores emerging therapeutic approaches, advanced methods for evaluating disease progression, and cutting-edge techniques to measure therapeutic efficacy.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 9","pages":"659-672"},"PeriodicalIF":22.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958745","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":"Neurocognitive Outcomes in Adults With Congenital Heart Disease: MIND the Gap.","authors":"Shabnam Peyvandi, Roberta G Williams","doi":"10.1016/j.jacc.2025.07.005","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.07.005","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 9","pages":"656-658"},"PeriodicalIF":22.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958752","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":"Sex Differences in Effectiveness of Semaglutide in Patients With Peripheral Artery Disease: The STRIDE Trial.","authors":"Subodh Verma, Andrei-Mircea Catarig, Kim Houlind, Bernhard Ludvik, Joakim Nordanstig, Neda Rasouli, Harald Sourij, Sebastian Thomas, Sidse K Nørgaard, Marc P Bonaca","doi":"10.1016/j.jacc.2025.08.046","DOIUrl":"10.1016/j.jacc.2025.08.046","url":null,"abstract":"<p><strong>Background: </strong>Peripheral artery disease (PAD) is prevalent in women and men with type 2 diabetes (T2D). Sex-based differences exist in its epidemiology, clinical presentation, functional impact, outcomes, and potentially in responses to treatments. Recently, semaglutide 1.0 mg has been shown to improve functional outcomes and health-related quality of life in individuals with early symptomatic PAD and T2D in the STRIDE trial.</p><p><strong>Objectives: </strong>The objective of this study was to describe baseline characteristics, functional status, and therapeutic efficacy of once-weekly semaglutide 1.0 mg between females and males with PAD and T2D as a post hoc analysis from the STRIDE trial.</p><p><strong>Methods: </strong>The primary endpoint in STRIDE was the ratio to baseline in maximum walking distance (MWD) at week 52 on a constant load treadmill. Confirmatory secondary endpoints included change in MWD at week 57, change in pain-free walking distance at week 52, and change in PAD-specific Vascular Quality of Life Questionnaire-6 total score from baseline to week 52. Herein, we report the outcomes analyzed by sex.</p><p><strong>Results: </strong>Of 792 participants, 195 (24.6%) were female and 597 (75.4%) were male. Females were younger, had lower rates of smoking, lower prevalence of concomitant coronary artery disease and heart failure, and less frequent use of antiplatelet therapies compared with males. Geometric mean MWD at baseline was 187.3 m (coefficient of variation: 0.6) and 191.5 m (coefficient of variation: 0.6) in females and males, respectively. At week 52, there was a consistent improvement in MWD across sexes, which favored semaglutide treatment (P-interaction value = 0.65). At week 57, there was a consistent trend for improved MWD that favored semaglutide treatment for both females and males (P interaction = 0.53). Improvement in pain-free walking distance was consistent across sexes at week 52 in favor of semaglutide (P interaction = 0.80). Likewise, PAD-specific quality of life (assessed using Vascular Quality of Life Questionnaire-6) improvements with semaglutide in both sexes were consistent with the overall trial.</p><p><strong>Conclusions: </strong>In this post hoc analysis from STRIDE, semaglutide 1.0 mg exhibited consistent improvements in functional outcomes in people with early symptomatic PAD and T2D regardless of sex. Females with PAD demonstrated differences in baseline demographics and treatment patterns compared with males, highlighting the importance of sex-specific evaluation in PAD trials.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958707","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":"Electromechanically Optimized Right Ventricular Pacing for Obstructive Hypertrophic Cardiomyopathy: The EMORI-HCM Trial.","authors":"Jagdeep S Mohal, Zachary I Whinnett, Saidi A Mohiddin, James Malcolmson, Perry Elliott, Julian O M Ormerod, Sanjay Prasad, James S Ware, Robert M Cooper, Mark A Tanner, Zohya Khalique, Jaymin S Shah, Daniel Keene, Pannathorn Tangkongpanich, Edward C Lewis, Chet Sharma, Rohin K Reddy, Akriti Naraen, Keenan Saleh, Jack W Samways, James P Howard, Jessica Artico, Prapa Kanagaratnam, Darrel P Francis, Rasha K Al-Lamee, Amanda Varnava, Matthew J Shun-Shin, Ahran D Arnold","doi":"10.1016/j.jacc.2025.08.050","DOIUrl":"10.1016/j.jacc.2025.08.050","url":null,"abstract":"<p><strong>Background: </strong>Many patients with symptomatic obstructive hypertrophic cardiomyopathy (oHCM) have devices capable of right ventricular pacing (RVP). Although pacing can reduce left ventricular outflow tract gradient (LVOTg), it can also reduce cardiac output, so its net effect is variable.</p><p><strong>Objective: </strong>We tested whether electromechanical optimization of the programmed atrio-ventricular delay (AVD) allows RVP to achieve a net benefit on symptoms.</p><p><strong>Methods: </strong>EMORI-HCM (Electromechanically Optimized Right Ventricular Pacing in Obstructive Hypertrophic Cardiomyopathy) is a multicenter, blinded, randomized, crossover trial of AVD-optimized RVP in patients with symptomatic oHCM with resting or provoked gradient of at least 30 mm Hg. Patients with existing dual-chamber devices were randomized to either 3 months of continuous AVD-optimized RVP (intervention) followed by 3 months of backup-only RVP (control), or vice versa. AVD was optimized using a high-precision multiple-alternation protocol assessing acute change in beat-by-beat blood pressure while varying AVD. The primary outcome was symptoms measured by the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score. Secondary outcomes include patient-reported daily symptom data collected using a dedicated smartphone application (ORBITA-app), dichotomous patient preference, EQ-5D, exercise capacity, and LVOTg. Patients were blinded to treatment allocation. Symptom assessments were self-administered. Outcome measures were recorded at baseline, crossover, and completion. Analysis was by Bayesian ordinal mixed modeling.</p><p><strong>Results: </strong>Between October 2021 and October 2024, 117 screened patients met the inclusion criteria, of whom 60 were randomized. AVD-optimized RVP improved Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (+4.5; 95% credible interval [CrI]: 1.3-8.1; probability of benefit [Pr_benefit] = 0.997) and daily symptom scores (OR: 1.29; 95% CrI: 0.98-1.68; Pr_benefit: 0.969) compared with backup-only pacing. AVD-optimized RVP improved exercise capacity (+1.0 mL/kg/min; 95% CrI: 0.1-2.0; Pr_benefit: 0.984) and LVOTg (-7.3 mm Hg; 95% CrI: -13.5 to -1.1; Pr_benefit: 0.010). It had no effect on B-type natriuretic peptide (Pr_benefit: 0.893) and ejection fraction was preserved (Pr_benefit: 0.409).</p><p><strong>Conclusions: </strong>In patients with oHCM, RVP delivered at electromechanically optimized AVD improves symptoms and exercise capacity. (Electromechanically Optimized Right Ventricular Pacing in Obstructive Hypertrophic Cardiomyopathy [EMORI-HCM], NCT05257772).</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958800","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}