Journal of the American College of Cardiology最新文献

{"title":"FLAVOUR: Just a Difference in Taste?","authors":"Allen Jeremias, Rick H J A Volleberg, Ziad A Ali","doi":"10.1016/j.jacc.2025.07.004","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.07.004","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 8","pages":"607-609"},"PeriodicalIF":22.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958777","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":"Effect of RSV Vaccine on Heart Failure Hospitalizations: A Prespecified Analysis of the DAN-RSV Trial.","authors":"Kristoffer Grundtvig Skaarup, Mats C Højbjerg Lassen, Niklas Dyrby Johansen, Sine H Christensen, Negar Aliabadi, Daniel Modin, Brian L Claggett, Carsten S Larsen, Lykke Larsen, Lothar Wiese, Michael Dalager-Pedersen, Matias G Lindholm, Anne Marie R Jensen, Maria Dons, Katrine F Bernholm, Filip S Davidovski, Lisa S Duus, Camilla I Ottosen, Anne B Nielsen, Julie H Borchsenius, Caroline Espersen, Güldas Köse, Frederik H Fussing, Lars Køber, Scott D Solomon, Jens Ulrik Stæhr Jensen, Cyril Jean-Marie Martel, Alexandre Mebazaa, Bradford D Gessner, Claudia Schwarz, Elisa Gonzalez, Mette Skovdal, Pingping Zhang, Elizabeth Begier, Tor Biering-Sørensen","doi":"10.1016/j.jacc.2025.08.023","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.08.023","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958765","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 Outcomes of Conduction System Pacing vs Right Ventricular Septal Pacing in Atrioventricular Block: The CSPACE Randomized Controlled Trial.","authors":"Chee Loong Dominic Chow, Chiew Wong, Nigel Sutherland, Manoj Niranjan Obeyesekere, Geoffrey R Wong, Charles M Eastwood, Julie Abduloska, Christian M Davey, Amandeep Singh Bhutani, Victoria Tran, Fari Asari, Aakaash D Patel, Muhtasim Rahman Zahin, Amarpal Karamjit Singh, Mark A Tacey, William J van Gaal, Pugazhendhi Vijayaraman, Han S Lim, Uwais Mohamed","doi":"10.1016/j.jacc.2025.06.043","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.06.043","url":null,"abstract":"<p><strong>Background: </strong>Patients with atrioventricular (AV) block receiving right ventricular (RV) pacing are at risk of pacing-induced cardiomyopathy (PICM), need for upgrade to biventricular cardiac resynchronization therapy (CRT), heart failure hospitalization (HFH), and mortality. Conduction system pacing (CSP) is a promising pacing strategy to mitigate these adverse outcomes.</p><p><strong>Objectives: </strong>The aim of this study was to compare the clinical outcomes between RV septal pacing (RVsP) and CSP.</p><p><strong>Methods: </strong>A randomized controlled trial (RCT) was performed in 202 consecutive patients with pacing indication for AV block without CRT indication, with a 1:1 randomization allocation ratio between RVsP and CSP. The primary outcome was a composite endpoint of PICM, upgrade to biventricular CRT, HFH, and all-cause mortality. This trial was registered with the Australian New Zealand Clinical Trials Registry.</p><p><strong>Results: </strong>CSP was successful in 89 of 101 patients (88.1%). After a mean follow-up period of 25.2 ± 11.8 months, CSP was associated with lower composite endpoint (7.17 vs 20.69 events per 100 person-years; HR: 0.35; 95% CI: 0.19-0.64; P < 0.001) primarily driven by lower PICM (CSP 4.58 vs RVsP 14.69 events per 100-person-years; HR: 0.31; 95% CI: 0.15-0.67; P = 0.002) and need for CRT upgrade (0 vs 1.92 events per 100-person-years; HR: 1.65e^-9; 95% CI: 0-∞; P = 0.043). There was no difference in HFH (CSP 0.48 vs RVsP 2.92 events per 100-person years; HR: 0.16; 95% CI: 0.02-1.37, P = 0.057) or all-cause mortality (CSP 2.86 vs RVsP 4.72 events per 100-person-years; HR: 0.61; 95% CI: 0.22-1.69; P = 0.337). Lead revision occurred more with CSP (8 patients [7.9%] vs 1 patient [1.0%]; P = 0.017).</p><p><strong>Conclusions: </strong>This RCT demonstrates the superiority of CSP over RVsP in achieving improved clinical outcomes and supports the indication of CSP as an upfront pacing technique for patients with AV block. (CSPACE: A Randomised Controlled Trial Comparing Right Ventricular Pacing with Conduction System Pacing; ACTRN12619001613190).</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 8","pages":"563-573"},"PeriodicalIF":22.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958748","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-Term Outcomes After Fractional Flow Reserve vs Intravascular Ultrasound to Guide PCI: The FLAVOUR Trial Extended Follow-Up.","authors":"Seokhun Yang, Xinyang Hu, Jinlong Zhang, Jun Jiang, Joo-Yong Hahn, Joon-Hyung Doh, Bong-Ki Lee, Weon Kim, Jinyu Huang, Fan Jiang, Hao Zhou, Peng Chen, Lijiang Tang, Wenbing Jiang, Hao Chen, Xiaomin Chen, Wenming He, Sung Gyun Ahn, Seung-Jea Tahk, Ung Kim, Doyeon Hwang, Jeehoon Kang, You-Jeong Ki, Eun-Seok Shin, Chang-Wook Nam, Jian'an Wang, Bon-Kwon Koo","doi":"10.1016/j.jacc.2025.06.042","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.06.042","url":null,"abstract":"<p><strong>Background: </strong>The optimal treatment strategy for patients with intermediate coronary stenosis remains uncertain.</p><p><strong>Objectives: </strong>The aim of this study was to investigate the long-term outcomes of a randomized, open-label, multinational trial comparing fractional flow reserve (FFR)-guided vs intravascular ultrasound (IVUS)-guided treatment strategies.</p><p><strong>Methods: </strong>Patients aged ≥19 years with de novo intermediate coronary stenosis (40%-70%) and target vessel diameters ≥2.5 mm were randomized 1:1 to FFR- or IVUS-guided treatment across 18 sites in Korea and China. The primary endpoint was a composite of all-cause death, myocardial infarction, and any revascularization occurring after the index procedure. Secondary endpoints included individual components of the primary outcome and per vessel outcomes according to treatment type. Extended follow-up continued through September 2024.</p><p><strong>Results: </strong>Between July 2016 and August 2019, 1,682 patients were assigned to the FFR-guided (n = 838) and IVUS-guided (n = 844) groups. Over a median follow-up period of 6.3 years (Q1-Q3: 5.6-6.9 years), the primary outcome occurred in 339 patients (22.0%), with no statistically significant difference between groups (179 [23.1%] for FFR vs 160 [20.9%] for IVUS; HR: 1.15; 95% CI: 0.93-1.42; P = 0.208). The revascularization rate after the index procedure was higher in the FFR group (113 [14.9%] vs 87 [11.8%]; HR: 1.32; 95% CI: 1.00-1.75; P = 0.049), particularly for target vessel revascularization (72 [9.6%] vs 44 [6.2%]; HR: 1.67; 95% CI: 1.15-2.43; P = 0.007). Landmark analysis at 2 years and per vessel analyses indicated that the higher revascularization rate after the index procedure was driven primarily by late (2-7 years) revascularizations in vessels in which percutaneous coronary intervention (PCI) was initially deferred. Nevertheless, the overall rate of target vessel PCI, including procedures at index and during follow-up, was significantly lower in the FFR group (38.8% vs 60.5%; P < 0.001), with no statistically significant differences in the annual cumulative incidence of death or myocardial infarction between groups.</p><p><strong>Conclusions: </strong>FFR-guided and IVUS-guided treatment strategies resulted in comparable long-term outcomes, with no significant difference in patient-oriented composite outcomes. Although FFR-guided treatment was associated with a higher incidence of late target vessel revascularization, the overall target vessel PCI rate, accounting for both the index procedure and revascularization during follow-up, remained significantly lower in the FFR-guided treatment group, with comparable rates of hard outcomes between the 2 groups.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 8","pages":"593-606"},"PeriodicalIF":22.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958786","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":"Pharmacological Treatment of Heart Failure with Reduced Ejection Fraction: An Updated Systematic Review and Network Meta-Analysis.","authors":"Bart J van Essen, Daan C H Ceelen, Wouter Ouwerkerk, Tiew-Hwa K Teng, Ganash N Tharshana, Fook Ming Hew, Javed Butler, Faiez Zannad, Carolyn S Lam, Justin Ezekowitz, Adriaan A Voors, Jasper Tromp","doi":"10.1016/j.jacc.2025.08.054","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.08.054","url":null,"abstract":"<p><strong>Background: </strong>In 2022, our network meta-analysis showed that a combination of β-blockers, angiotensin receptor-neprilysin inhibitors (ARNi), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter 2 inhibitors (SGLT2i) was most effective in reducing all-cause mortality in heart failure with reduced ejection fraction (HFrEF). This study updates the treatment benefit by including additional large randomized controlled trials (RCTs) since 2022, including the Vericiguat Global Study in Participants with Chronic Heart Failure (VICTOR) trial.</p><p><strong>Objectives: </strong>To evaluate and compare regimens of pharmacotherapy in patients with HFrEF.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, and Cochrane CENTRAL for RCTs in patients with HFrEF through April 2025. Using frequentist network meta-analysis, we estimated hazard ratios (HRs) for all-cause mortality (primary outcome), cardiovascular death, and the composite of cardiovascular death or heart failure hospitalization (secondary outcomes). Absolute benefits were quantified as life-years gained using BIOSTAT-CHF and ASIAN-HF cohort data.</p><p><strong>Results: </strong>The analysis included 103,754 patients across 89 randomized controlled trials. Relative to placebo, quintuple therapy with ARNi, β-blockers, MRA, SGLT2i, and vericiguat most effectively reduced all-cause mortality (HR 0.35, 95% confidence interval [CI]: 0.27-0.45), followed by quadruple therapy with ARNi, β-blockers, MRA and SGLT2i (0.39, 95% CI: 0.32-0.49). For a representative 70-year-old patient, quadruple therapy (ARNi/β-blockers/MRA/SGLT2i) provided 5.3 additional life-years (95% CI: 2.8-7.7 years) versus no treatment, while quintuple therapy (ARNi/β-blockers/MRA/SGLT2i/vericiguat) provided 6.0 additional life-years (95% CI: 3.7-8.4).</p><p><strong>Conclusions: </strong>This analysis reinforces the substantial mortality and morbidity benefit associated with the currently recommended quadruple therapy regimen-angiotensin receptor-neprilysin inhibitors (ARNi), β-blockers, mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT2i)-in patients with HFrEF. The addition of vericiguat may provide an incremental survival gain of approximately 0.7 years beyond that achieved with quadruple therapy. However, these results should be regarded as exploratory, as they are derived from a secondary endpoint of a single trial.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958666","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":"Evidentiary Landscape of Heart Failure Therapies, Regulatory Decisions, and Translation Into Guidelines.","authors":"Sanjay Kaul","doi":"10.1016/j.jacc.2025.06.036","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.06.036","url":null,"abstract":"<p><p>In the last decade, the U.S. Food and Drug Administration has approved 6 drugs to reduce morbidity or mortality and improve functional capacity in patients with heart failure with reduced ejection fraction (HFrEF) and 3 drugs to reduce morbidity or mortality in patients with heart failure with preserved ejection fraction (HFpEF). Of the drugs approved for HFrEF, only 2 reduced mortality (sacubitril/valsartan in the PARADIGM-HF trial and dapagliflozin in the DAPA-HF trial). None of the drugs approved for HFpEF reduced mortality. Four trials, 1 with finerenone (FINEARTS-HF trial), 2 with semaglutide (STEP-HFpEF/DM trial), and 1 with tirzepatide (SUMMIT trial) met their primary endpoint in patients with HFpEF and are currently under review for approval. In contrast, before 2015, the U.S. Food and Drug Administration approved 11 drugs (captopril, enalapril, valsartan, candesartan, long-acting metoprolol succinate, bisoprolol, carvedilol, digoxin, isosorbide dinitrate-hydralazine, spironolactone, and epleronone) for patients with chronic stable HFrEF but none for HFpEF. All 11 drugs reduced mortality and morbidity except for digoxin, which only reduced hospitalization for heart failure. This state-of-the-art review examines the evidentiary support for regulatory actions and incorporation into guidelines of heart therapies approved since 2015.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 8","pages":"610-624"},"PeriodicalIF":22.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958701","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":"From the Hazards of Death to the Hazards of Indication Creep for TAVR.","authors":"Fabio Barili, Nabil Dib, Rita F Redberg, William E Boden, Sanjay Kaul, Alessandro Parolari, Amedeo Anselmi","doi":"10.1016/j.jacc.2025.06.026","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.06.026","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 8","pages":"e75-e76"},"PeriodicalIF":22.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958712","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":"Comparison of Fixed vs Age-Adjusted NT-proBNP Cutoffs to Define Pre-Heart Failure.","authors":"Anping Cai, Lin Liu, Yinqing Feng, Liwen Li, Biykem Bozkurt, James L Januzzi, Carolyn S P Lam, Gregg C Fonarow, Ambarish Pandey, Lin Yee Chen, Yunjiu Cheng, Antoni Bayes-Genis","doi":"10.1016/j.jacc.2025.06.041","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.06.041","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 8","pages":"625-629"},"PeriodicalIF":22.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958729","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":"Computed Tomography Angiography or Standard Care After Left Main PCI?","authors":"Fabrizio D'Ascenzo, Enrico Cerrato, Ovidio De Filippo, Luca Gaido, Alfonso Franzè, Mario Iannaccone, Wojciech Wańha, Andrea Santarelli, Vincenzo Guiducci, Umberto Barbero, Carlos Fernandez Pereira, Marco Gatti, Matteo Tebaldi, Massimo Giammaria, Giacomo Boccuzzi, Wojciech Wojakowski, Gianluca di Pietro, Roberto Placido, Sebastiano Gili, Alessandro Depaoli, Giuseppe Biondi Zoccai, Francesco Tomassini, Francesco Bruno, Daniela Zugna, Riccardo Faletti, Simone Biscaglia, Serena Caglioni, Ferdinando Varbella, Gaetano Maria de Ferrari, Gianluca Campo","doi":"10.1016/j.jacc.2025.07.060","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.07.060","url":null,"abstract":"<p><strong>Background: </strong>The clinical benefit of routine coronary computed tomography angiography (CCTA) after percutaneous coronary intervention (PCI) for unprotected left main (LM) disease is uncertain.</p><p><strong>Objectives: </strong>The authors evaluated whether CCTA-guided follow-up improves clinical outcomes vs symptoms- or ischemia-driven care after LM PCI.</p><p><strong>Methods: </strong>PULSE was a prospective, multicenter, open-label randomized trial. A total of 606 patients treated with second-generation drug-eluting stents were enrolled (October 2019 to September 2024) and randomized 1:1 to CCTA at 6 months (experimental) or standard care (control). The primary endpoint was a composite of all-cause death, spontaneous myocardial infarction (MI), unstable angina, or definite or probable stent thrombosis at 18 months. Secondary endpoints included target-lesion revascularization (TLR) and each primary endpoint component.</p><p><strong>Results: </strong>CCTA was completed in 272/303 experimental patients (89.8%) after a median of 200 days (IQR: 181-270 days). The primary endpoint occurred in 36/303 experimental patients vs 38/303 control patients (11.9% vs 12.5%; HR: 0.97; 95% CI: 0.76-1.23; P = 0.80). Compared with the control arm, the CCTA arm showed a reduced risk of spontaneous MI (0.9% vs 4.9%; HR: 0.26; 95% CI: 0.07-0.91; P = 0.004) and an increased risk of imaging-triggered TLR (4.9% vs 0.3%; HR: 7.7; 95% CI: 1.70-33.7; P = 0.001), whereas clinically driven TLR rates were similar (5.3% vs 7.2%; HR: 0.74; 95% CI: 0.38-1.41; P = 0.32).</p><p><strong>Conclusions: </strong>Routine CCTA after LM PCI did not reduce the composite primary endpoint, but was associated with fewer spontaneous MIs and more imaging-triggered revascularizations. Future trials to clarify its value in complex anatomic subsets appear to be warranted. (Angiographic Control vs Ischemia-Driven Management of Patients Treated With PCI on Left Main With Drug-Eluting Stents [PULSE; NCT04144881]).</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958686","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":"Mounting Evidence for Conduction System Pacing in Atrioventricular Block Ushers in a New Era.","authors":"Ratika Parkash, Kenneth A Ellenbogen","doi":"10.1016/j.jacc.2025.06.040","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.06.040","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 8","pages":"574-576"},"PeriodicalIF":22.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958789","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}