Journal of the American College of Cardiology最新文献

{"title":"Effect of Empagliflozin on the Mechanisms Driving Erythropoiesis and Iron Mobilization in Patients With Heart Failure","authors":"João Pedro Ferreira MD, PhD ,&nbsp;Stefan D. Anker MD, PhD ,&nbsp;Javed Butler MD, MPH ,&nbsp;Gerasimos Filippatos MD, PhD ,&nbsp;James L. Januzzi Jr. MD ,&nbsp;Elke Schueler PhD ,&nbsp;Marina Panova-Noeva PhD ,&nbsp;Kristiane Wetzel PhD ,&nbsp;Juergen Prochaska MD, PhD ,&nbsp;Stuart J. Pocock PhD ,&nbsp;Naveed Sattar MD, PhD ,&nbsp;Mikhail Sumin MD, PhD ,&nbsp;Faiez Zannad MD, PhD ,&nbsp;Milton Packer MD","doi":"10.1016/j.jacc.2025.03.503","DOIUrl":"10.1016/j.jacc.2025.03.503","url":null,"abstract":"<div><h3>Background</h3><div>Sodium-glucose cotransporter 2 (SGLT2) inhibitors stimulate erythropoiesis, but the mechanisms and clinical relevance of the effect of SGLT2 inhibitors on systemic iron metabolism in patients with heart failure is not well understood.</div></div><div><h3>Objectives</h3><div>The authors sought to characterize a comprehensive suite of iron metabolism biomarkers—particularly the erythroblast signaling molecule, erythroferrone—in patients with heart failure before and after short- and long-term treatment with empagliflozin in patients with heart failure and a reduced or preserved ejection fraction.</div></div><div><h3>Methods</h3><div>We measured serum iron metabolism biomarkers at baseline, 12 weeks, and 52 weeks in 1,139 patients who were treated with placebo or empagliflozin in the EMPEROR (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure) program, and we characterized the inter-relationships of these biomarkers with clinical status and with the effect of empagliflozin on erythropoiesis and heart failure outcomes.</div></div><div><h3>Results</h3><div>Correlations among iron biomarkers indicated the presence of a functional erythropoietin-erythroferrone–transferrin-receptor-protein-1 (TfR1)–hepcidin axis. As heart failure advanced, patients showed higher levels of erythropoietin, erythroferrone, and TfR1 (<em>P</em> trend &lt;0.01), and levels of these proteins predicted a heightened risk of cardiovascular death or heart failure hospitalization (all <em>P</em> &lt; 0.01). Compared with placebo, at 12 weeks, empagliflozin increased hemoglobin by 0.6 to 0.9 g/dL (<em>P</em> &lt; 0.001), an effect that was accompanied by further activation of the erythropoietin-erythroferrone-TfR1 axis and increased iron use. Empagliflozin increased serum levels of erythroferrone by &gt;40% (along with increases in erythropoietin and TfR1), while simultaneously decreasing hepcidin levels and reducing serum iron concentrations and transferrin saturation (all <em>P</em> &lt; 0.01). When treated with empagliflozin, patients with evidence of iron deficiency at baseline showed attenuation of the erythrocytic response (<em>P</em> trend = 0.04) but no diminution of the heart failure benefits.</div></div><div><h3>Conclusions</h3><div>The erythropoietin-erythroferrone-TfR1-hepcidin axis is activated in patients with heart failure as the disease advances and is further heightened by SGLT2 inhibitors, in parallel with their effect to enhance erythropoiesis and iron mobilization and use. These changes have important implications for understanding the mechanism of action of SGLT2 inhibitors and for monitoring the response to treatment.</div></div>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 18","pages":"Pages 1757-1770"},"PeriodicalIF":21.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143904223","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":"Safety and Lipid-Lowering Efficacy of Inclisiran Monotherapy in Patients without ASCVD: The VICTORION-Mono Randomized Clinical Trial","authors":"","doi":"10.1016/j.jacc.2025.04.049","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.04.049","url":null,"abstract":"Inclisiran administration twice-yearly (after initial and 3-month doses) effectively reduces low-density lipoprotein cholesterol (LDL-C) in patients o…","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"1 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143905548","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":"Medicine’s Responsibility in Divided Times","authors":"Harlan M. Krumholz MD, SM (Editor-in-Chief, JACC; Harold H. Hines, Jr Professor, Yale School of Medicine, New Haven, Connecticut, USA)","doi":"10.1016/j.jacc.2025.03.531","DOIUrl":"10.1016/j.jacc.2025.03.531","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 18","pages":"Pages 1796-1797"},"PeriodicalIF":21.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903900","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: Relationship Between the Aorta and the Pulmonary Valve","authors":"Kalyanam Shivkumar MD, PhD","doi":"10.1016/j.jacc.2025.03.533","DOIUrl":"10.1016/j.jacc.2025.03.533","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 18","pages":"Pages 1798-1799"},"PeriodicalIF":21.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903901","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":"Trends and Physician-Level Variation in Contrast Volume During Percutaneous Coronary Intervention","authors":"Nobuhiro Ikemura MD, PhD ,&nbsp;Paul S. Chan MD, MSc ,&nbsp;David J. Cohen MD, MS ,&nbsp;Kevin F. Kennedy MS ,&nbsp;Anezi Uzendu MD ,&nbsp;Shun Kohsaka MD ,&nbsp;John A. Spertus MD, MPH","doi":"10.1016/j.jacc.2025.03.528","DOIUrl":"10.1016/j.jacc.2025.03.528","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 18","pages":"Pages 1792-1795"},"PeriodicalIF":21.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903899","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":"Insulin Resistance and Diabetes in HFpEF","authors":"Jennifer E. Ho MD ,&nbsp;Zsu-Zsu Chen MD, MPH ,&nbsp;Emily S. Lau MD, MPH","doi":"10.1016/j.jacc.2025.03.529","DOIUrl":"10.1016/j.jacc.2025.03.529","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 18","pages":"Pages 1789-1791"},"PeriodicalIF":21.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143904132","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":"SGLT2 Inhibitors in Heart Failure","authors":"Kieran F. Docherty MBChB(Hons), PhD","doi":"10.1016/j.jacc.2025.03.532","DOIUrl":"10.1016/j.jacc.2025.03.532","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 18","pages":"Pages 1771-1773"},"PeriodicalIF":21.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143904224","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":"2025 AHA/ACC Clinical Performance and Quality Measures for Patients With Chronic Coronary Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures","authors":"Marlene S. Williams, Glenn N. Levine, Dinesh Kalra, Anandita Agarwala, Diana Baptiste, Joaquin E. Cigarroa, Rebecca L. Diekemper, Marva V. Foster, Martha Gulati, Timothy D. Henry, Dipti Itchhaporia, Jennifer S. Lawton, L. Kristin Newby, Kelly C. Rogers, Krishan Soni, Jacqueline E. Tamis-Holland","doi":"10.1016/j.jacc.2025.02.001","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.02.001","url":null,"abstract":"Chronic coronary disease (CCD) is the leading cause of death in the United States. There is an ongoing imperative to disseminate evidence-based and patient-centered care recommendations that further align the management of patients with CCD to updated evidence-based guidelines. The writing committee developed a comprehensive CCD measure set comprising 10 performance measures and 3 quality measures, the focus of which is to include practical steps to specifically advance care in the CCD population. The measure set begins with an assessment of tobacco use and evidence-based cessation interventions. Also included are topics such as antiplatelet therapy, lipid assessment and low-density lipoprotein cholesterol goals, and guideline-directed management and therapy for hypertension and reduced left ventricular dysfunction in patients with CCD. The measure set concludes with an emphasis on the importance of cardiac rehabilitation referral and patient education, including symptom management and lifestyle modification.","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"35 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893335","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":"Pulse Field Ablation for Persistent Atrial Fibrillation","authors":"Amier Ahmad MD,&nbsp;Rahul N. Doshi MD","doi":"10.1016/j.jacc.2025.03.522","DOIUrl":"10.1016/j.jacc.2025.03.522","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 17","pages":"Pages 1679-1681"},"PeriodicalIF":21.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878540","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":"Pulsed Field Ablation for Persistent Atrial Fibrillation","authors":"Vivek Y. Reddy MD ,&nbsp;Edward P. Gerstenfeld MD ,&nbsp;Boris Schmidt MD ,&nbsp;Devi Nair MD ,&nbsp;Andrea Natale MD ,&nbsp;Walid Saliba MD ,&nbsp;Atul Verma MD ,&nbsp;Philipp Sommer MD ,&nbsp;Andreas Metzner MD ,&nbsp;Mohit Turagam MD ,&nbsp;Stanislav Weiner MD ,&nbsp;Jean Champagne MD ,&nbsp;Ignacio Garcio-Bolao MD, PhD ,&nbsp;Hugh Calkins MD ,&nbsp;Jeffrey Olson MD ,&nbsp;Ziad Issa MD ,&nbsp;Marshall Winner MD ,&nbsp;Wilber Su MD ,&nbsp;Gery Tomassoni MD ,&nbsp;Jamie Kim MD ,&nbsp;Kapil Kumar","doi":"10.1016/j.jacc.2025.03.515","DOIUrl":"10.1016/j.jacc.2025.03.515","url":null,"abstract":"<div><h3>Background</h3><div>Pulsed field ablation (PFA) has gained prominence for pulmonary vein isolation (PVI) to treat atrial fibrillation, but there are limited outcome data on PFA to treat persistent atrial fibrillation (PerAF).</div></div><div><h3>Objectives</h3><div>This study sought to determine the safety and efficacy of PVI + posterior wall ablation (PWA) with PFA in PerAF.</div></div><div><h3>Methods</h3><div>ADVANTAGE AF (A Prospective Single Arm Open Label Study of the FARAPULSE Pulsed Field Ablation System in Subjects with Persistent Atrial Fibrillation) is a prospective, single-arm, multicenter pivotal investigational device exemption study of PerAF patients undergoing PVI+PWA with the pentaspline PFA catheter. One-year follow-up included 24-hour Holter monitoring at 6 and 12 months and twice monthly and symptomatic transtelephonic monitoring. The primary safety endpoint was incidence of predefined adverse events. The primary effectiveness endpoint included acute success and postblanking 1-year freedom from atrial tachyarrhythmia recurrence (&gt;30 seconds), redo ablation, cardioversion, or antiarrhythmic drug escalation. Endpoint analysis used Kaplan-Meier methodology with 97.5% 1-sided confidence limits compared with a 12% safety and 40% effectiveness goals, with 85% power.</div></div><div><h3>Results</h3><div>PFA in 339 patients (260 treatment and 79 roll-in) resulted in 99.7% success for both PVI and PWA. The primary safety endpoint was 2.3% (5.1% upper confidence limit), including 1 with pericarditis, 1 with myocardial infarction, and 4 with pulmonary edema; no tamponade, stroke, pulmonary vein stenosis, or esophageal fistula occurred. Primary effectiveness was 63.5% (57.3% lower confidence limit) at 1 year, with 8.5% patients having a single, isolated atrial fibrillation recurrence. Freedom from symptomatic atrial fibrillation was 85.3%; efficacy varied by operator experience.</div></div><div><h3>Conclusions</h3><div>ADVANTAGE AF, the first large prospective study of PFA to treat PerAF using a strategy of PVI and posterior wall isolation, revealed favorable safety and effectiveness outcomes. (A Prospective Single Arm Open Label Study of the FARAPULSE Pulsed Field Ablation System in Subjects with Persistent Atrial Fibrillation [ADVANTAGE AF]; <span><span>NCT05443594</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"85 17","pages":"Pages 1664-1678"},"PeriodicalIF":21.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878539","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}