Journal of the American Heart Association最新文献

{"title":"Percutaneous Mechanical Aspiration in Patients With Right-Sided Infective Endocarditis: A Science Advisory From the American Heart Association.","authors":"Abdallah El Sabbagh, Evin Yucel, Sanjum S Sethi, Mikhael F El-Chami, Sandra S Mattos, Bailey Ann Estes, Brittany A Zwischenberger, John M Moriarty, Andrew Sp Sharp, Larry M Baddour","doi":"10.1161/JAHA.126.050115","DOIUrl":"https://doi.org/10.1161/JAHA.126.050115","url":null,"abstract":"<p><p>Percutaneous mechanical aspiration has emerged as a novel, catheter-based strategy for the management of right-sided infective endocarditis, particularly in patients with a suboptimal response to antimicrobials or in those considered high risk for surgery. Initially developed for thrombus extraction, percutaneous mechanical aspiration has been increasingly used to achieve source control by debulking large vegetations. Despite growing clinical adoption and support from societal statements and guidelines, there have been no randomized controlled trials evaluating its safety or efficacy in right-sided infective endocarditis. Current evidence is derived from retrospective case series, registries, and administrative data sets, all limited by heterogeneity in patient populations, procedural techniques, and outcome definitions. Nevertheless, recent data from multicenter registries demonstrate promising procedural success and feasibility in select patients. In response to expanding use and persistent knowledge gaps, this American Heart Association Science Advisory aimed to (1) define the rationale and evolving indications for percutaneous mechanical aspiration in right-sided infective endocarditis, (2) summarize the available clinical evidence and technical considerations, (3) provide expert consensus on patient selection and procedural planning, and (4) identify priorities for future prospective investigation.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e050115"},"PeriodicalIF":5.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845796","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":"Worsening Renal Function at 1 Year After Acute Heart Failure: A Report From the WET-HF2 Registry.","authors":"Shinsuke Takeuchi, Takashi Kohno, Ayumi Goda, Yasuyuki Shiraishi, Ryo Nakamaru, Yuji Nagatomo, Mitsunobu Kitamura, Michiru Nomoto, Masatake Kobayashi, Satoshi Higuchi, Munehisa Sakamoto, Kazutaka Miyamoto, Kyoko Soejima, Shun Kohsaka, Tsutomu Yoshikawa","doi":"10.1161/JAHA.125.046776","DOIUrl":"https://doi.org/10.1161/JAHA.125.046776","url":null,"abstract":"<p><strong>Background: </strong>The prognostic impact of worsening renal function (WRF) during the vulnerable phase following discharge after hospitalization for acute decompensated heart failure (HF) remains unclear. This study investigated the determinants of WRF 1 year after discharge (1Y-WRF) and its association with clinical outcomes in patients with acute decompensated HF.</p><p><strong>Methods: </strong>Data were analyzed for 1753 patients hospitalized with acute decompensated HF from WET-HF2 (West Tokyo Heart Failure 2), a multicenter registry. 1Y-WRF was defined as a ≥25% decrease in estimated glomerular filtration rate (eGFR). The primary end point was a composite of all-cause mortality and HF rehospitalization beyond 1 year after discharge. Exploratory subgroup analyses were conducted based on age, sex, left ventricular ejection fraction, diabetes, eGFR, HF rehospitalization, and loop diuretic intensification within 1 year after discharge, anemia, and renin-angiotensin-aldosterone system inhibitors use.</p><p><strong>Results: </strong>Of the 1753 patients (median age 76 years, 39.9% female, median eGFR 50.7 mL/min per 1.73 m² at discharge), 285 (16.3%) developed 1Y-WRF. Female sex, anemia, higher New York Heart Association class, and higher eGFR at discharge were associated with 1Y-WRF. Over a median follow-up of 1 year, 1Y-WRF was associated with an increased risk of the composite end point (adjusted hazard ratio, 1.34 [95% CI, 1.02-1.75], <i>P</i>=0.035), primarily driven by HF rehospitalization. The adverse prognostic impact was notable in young patients and those with high eGFR and no HF rehospitalization within 1 year after discharge.</p><p><strong>Conclusions: </strong>In a contemporary cohort of acute decompensated heart failure 1Y-WRF was relatively common and associated with subsequent worse clinical outcomes.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e046776"},"PeriodicalIF":5.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846070","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":"Association of Polygenic Risk Scores With Aortic Valve Calcium: The Multi-Ethnic Study of Atherosclerosis.","authors":"Seamus P Whelton, Jie Yao, Clary Clish, Alexis C Wood, Kent D Taylor, Michael J Blaha, Matthew Budoff, Natalie Marrero, George Thanassoulis, Wendy S Post, Xiuqing Guo, Jerome I Rotter","doi":"10.1161/JAHA.124.040064","DOIUrl":"https://doi.org/10.1161/JAHA.124.040064","url":null,"abstract":"<p><strong>Background: </strong>Aortic valve calcification (AVC) is the primary process leading to aortic stenosis. We examined whether polygenic risk scores (PRS) are associated with AVC beyond traditional atherosclerotic cardiovascular disease risk factors.</p><p><strong>Methods: </strong>We included 6812 participants in MESA (Multi-Ethnic Study of Atherosclerosis) with computed tomography-measured AVC at Visit 1. Using previously published PRS we calculated weighted PRS, standardized within each ancestry group. The cross-sectional association per 1 SD higher PRS with AVC >0 was examined using multivariable logistic regression modeling with Bonferroni correction. The mean age was 62 years old, 53% were female, and 913 (13.4%) had AVC >0 at baseline.</p><p><strong>Results: </strong>The PRS for coronary artery disease (hazard ratio [HR], 1.16 [95% CI, 1.07-1.26]), systolic blood pressure (HR, 1.1 [95% CI, 1.020-1.2]), low-density lipoprotein cholesterol (HR, 1.16 [95% CI, 1.06-1.25]), and lipoprotein(a) (HR, 1.11 [95% CI, 1.02-1.20]) were significantly associated with AVC, whereas the other PRS including coronary artery calcium (HR, 1.02 [95% CI, 0.94-1.10]) and C-reactive protein (HR, 0.97 [95% CI, 0.89-1.05]) were not. In sex-stratified analyses, the PRS for coronary artery disease, low-density lipoprotein cholesterol, and lipoprotein(a) were significantly associated with AVC >0 for both sexes (<i>P</i><0.05), whereas the systolic blood pressure PRS was borderline significant for women (HR, 1.10 [95% CI, 0.97-1.25]) and significant for men (HR, 1.11 [95% CI 1.00-1.24]).</p><p><strong>Conclusions: </strong>Our results confirm the role of atherogenic lipids in the pathogenesis of AVC and suggest that systolic blood pressure and the genetic risk factors for CAD are also important risk factors. The lack of association for the coronary artery calcium PRS with AVC >0 strongly suggests significant differences exist in the calcification pathways for AVC and coronary artery calcium.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040064"},"PeriodicalIF":5.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846073","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":"Hemorrhage Pattern and Amyloid Burden in Cerebral Amyloid Angiopathy.","authors":"Elif Gokcal, J Alex Becker, Mitchell J Horn, Ofer Rotschild, Alvin S Das, Avia Abramovitz Fouks, Jonathan Rosand, Anand Viswanathan, Keith A Johnson, M Edip Gurol, Steven M Greenberg","doi":"10.1161/JAHA.125.048858","DOIUrl":"https://doi.org/10.1161/JAHA.125.048858","url":null,"abstract":"<p><strong>Background: </strong>Cerebral amyloid angiopathy (CAA), a cerebral small vessel disease characterized by vascular amyloid deposition, presents with heterogeneous imaging features, but the biological mechanisms underlying hemorrhagic markers remain unclear. We assessed hemorrhage patterns in CAA to determine their associations with amyloid burden and related imaging markers.</p><p><strong>Methods: </strong>Sixty-two patients with probable CAA underwent Pittsburgh compound B-positron emission tomography and structural magnetic resonance imaging. Participants were classified by dominant hemorrhagic pattern: lobar cerebral microbleed-dominant (n=31), cortical superficial siderosis-dominant (n=17), and nondominant (n=14). Global cortical amyloid burden was quantified as Pittsburgh compound B distribution volume ratio. White matter hyperintensity volume and high-degree centrum semiovale-enlarged perivascular spaces were assessed. Associations were tested using age- and sex-adjusted regression models.</p><p><strong>Results: </strong>Global Pittsburgh compound B distribution volume ratio was significantly higher in the cerebral microbleed-dominant (1.40±0.23) and cortical superficial siderosis-dominant (1.45±0.27) groups than nondominant group (1.20±0.17; <i>P</i>=0.007 and <i>P</i>=0.006, respectively), and these associations remained independent after adjustment (odds ratio [OR], 1.8 [95% CI, 1.1-2.8]; <i>P</i>=0.009 and OR, 1.6 [95% CI, 1.1-2.5]; <i>P</i>=0.020). Compared with the nondominant group, high-degree centrum semiovale-enlarged perivascular spaces were independently associated with both cerebral microbleed-dominant (OR, 9.3 [95% CI, 1.6-52]; <i>P</i>=0.011) and cortical superficial siderosis-dominant (OR, 10 [95% CI, 1.6-62]; <i>P</i>=0.013). In the full cohort, Pittsburgh compound B distribution volume ratio was independently associated with high-degree centrum semiovale-enlarged perivascular spaces (<i>P</i>=0.016) and white matter hyperintensity volume (<i>P</i>=0.049). Findings were unchanged in sensitivity analyses, adjusting for intracerebral hemorrhage.</p><p><strong>Conclusions: </strong>Amyloid burden in CAA is associated with hemorrhage-dominant patterns, high-degree centrum semiovale-enlarged perivascular spaces, and greater WMH volume. These findings support a close link between vascular amyloid deposition and downstream vascular brain injury, underscoring its relevance as a therapeutic target in CAA.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e048858"},"PeriodicalIF":5.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846151","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":"Glucose Disposal Rate: A Novel Measure of Insulin Resistance Associated With Myocardial Fibrosis and Incident Heart Failure.","authors":"Syed Bukhari, Yaa A Kwapong, Lisa R Yanek, Erin D Michos, Joao A C Lima, Wendy S Post, Cynthia C Taub, Kavita Sharma, Monica Mukherjee, Benjamin H Freed, Anum S Minhas, Elnaz Ebrahimihoor, Justin B Echouffo-Tcheugui, Allison G Hays","doi":"10.1161/JAHA.125.047908","DOIUrl":"https://doi.org/10.1161/JAHA.125.047908","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is increasingly driven by cardiometabolic risk factors such as obesity and insulin resistance. The estimated glucose disposal rate (eGDR) is a validated surrogate marker of insulin resistance. Reduced eGDR, reflecting higher insulin resistance, has been linked to cardiovascular disease, but its associations with myocardial fibrosis and HF remain unclear.</p><p><strong>Methods: </strong>The study included 6025 participants in MESA (Multi-Ethnic Study of Atherosclerosis) free of HF at exam 2 (2002-2004). eGDR was calculated using body mass index, hypertension, and hemoglobin A1c. Cardiac magnetic resonance imaging (2010-2012) assessed left ventricular ejection fraction and myocardial fibrosis by late gadolinium enhancement. Associations of baseline eGDR with incident HF were evaluated using Cox models, stratified by diabetes.</p><p><strong>Results: </strong>Over a mean follow-up of 14±5 years, 404 participants developed HF. eGDR was inversely associated with incident HF (adjusted hazard ratio [HR] per unit decrease, 1.28 [95% CI, 1.22-1.35]), a relationship that persisted regardless of diabetes status and was more pronounced for HF with preserved ejection fraction (n=200; adjusted HR per unit decrease, 1.36 [95% CI, 1.27-1.45]) than HF with reduced ejection fraction (n=168; HR, 1.19 [95% CI, 1.11-1.27]). Lower eGDR was also associated with higher left ventricular ejection fraction (n=2899; β=0.16, [95% CI, 0.03-0.28]) and higher odds of myocardial fibrosis (n=1780; adjusted odds ratio, 1.27 [95% CI, 1.16-1.41]).</p><p><strong>Conclusions: </strong>Lower eGDR is independently associated with subclinical myocardial damage and incident HF, highlighting insulin resistance as a key driver of adverse remodeling and a potential marker for early HF risk stratification and prevention.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e047908"},"PeriodicalIF":5.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846200","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":"Real-World Outcomes of FFRangio-Guided Treatment for Coronary Artery Disease in Acute Versus Chronic Coronary Syndromes.","authors":"Guy Witberg, Yuetsu Kikuta, Kazuhiro Dan, Hiroyoshi Yokoi, Yutaka Hikichi, Mamoru Nanasato, Toru Tanigaki, Yeela Talmor-Barkan, Amos Levi, Ran Kornowski, Hitoshi Matsuo","doi":"10.1161/JAHA.125.044105","DOIUrl":"https://doi.org/10.1161/JAHA.125.044105","url":null,"abstract":"<p><strong>Background: </strong>The use of angiogram-based fractional flow reserve technologies in routine clinical practice is increasing steadily. Available data suggest that it is associated with comparable clinical outcomes compared with wire-based fractional flow reserve (FFR), but evidence is still limited, especially in patients with acute coronary syndromes (ACSs). The aim of this study was to examine the real-world clinical outcomes of an angiogram based fractional flow reserve technology (FFRangio; CathWorks, Kfar-Saba, Israel) to guide treatment for coronary artery disease in patients presenting with acute versus chronic coronary syndromes (CCSs).</p><p><strong>Methods: </strong>This is a retrospective, observational study. Our cohort included consecutive patients undergoing coronary angiography in 7 centers (Japan, 6; Israel, 1), whose treatment was guided by FFRangio between January 2021 and December 2023. The primary end point was 2-year cumulative incidence of major adverse cardiac events, stratified by presentation (ACS/CCS) and treatment strategy (revascularization/deferral).</p><p><strong>Results: </strong>Overall, 2245 patients (ACS, 756; CCS, 1489) were included. Patients with ACS were younger and more likely to be diabetic. At 2 years, ACS presentation resulted in higher risk of major adverse cardiac events (9.8% versus 5.6%; HR, 1.80; <i>P</i><0.001). Stratified by presentation and treatment, deferred patients had similar risk of major adverse cardiac events (ACS, 5.4%; CCS, 4.7%; HR, 1.08; <i>P</i>=0.672) for treated patients, ACS presentation associated with increased risk for major adverse cardiac events (11.7% versus 7.3%; HR, 1.64; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>In a real-world setting, FFRangio-guided treatment yields 2-year outcomes comparable with current data for wire-based fractional flow reserve for both patients with ACS and patients with CCS. ACS presentation is associated with increased risk for major adverse cardiac events in patients undergoing FFRangio-guided revascularization but not deferral. These results demonstrate the clinical utility of FFRangio-guided treatment across the spectrum of coronary artery disease presentation excluding ST-segment-elevation myocardial infarction.</p><p><strong>Registration: </strong>URL: https://clinicaltrials.gov/study/NCT05648396?term=FFRangio%20&viewType=Card&rank=3; Unique Identifier: NCT05648396.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e044105"},"PeriodicalIF":5.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845786","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":"Reduced Posterior Occlusal Contacts Are Associated With an Increased Risk of Stroke: A Retrospective Study Based on a Japanese Claims Database.","authors":"Takashi Miyano, Taro Kusama, Manami Hoshi-Harada, Ken Osaka, Kenji Takeuchi","doi":"10.1161/JAHA.125.047074","DOIUrl":"https://doi.org/10.1161/JAHA.125.047074","url":null,"abstract":"<p><strong>Background: </strong>Stroke remains a leading cause of mortality and disability worldwide, requiring modifiable risk factors for prevention. Oral health, particularly posterior occlusal contact that supports mastication, may influence systemic vascular outcomes; however, its role in stroke remains unclear. This study investigated whether reduced posterior occlusal contact independently predicts stroke in Japanese adults.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data collected from April 2016 to March 2022 from a nationwide health insurance database in Japan. Adults aged 40 to 74 years without a history of stroke were included. Posterior occlusal status was categorized as Eichner A (full posterior occlusal contact), B (partial contact), or C (no contact). The primary outcome was stroke incidence, identified using validated insurance claims. Cox proportional hazards models were used to estimate hazard ratios (HRs), adjusting for demographics, health behaviors, comorbidities, and tooth counts.</p><p><strong>Results: </strong>Among 981 543 participants (mean age 49.6±7.0 years; 57.5% male) followed for 2 712 815 person-years, 7086 strokes occurred. In adjusted Cox models, Eichner B was significantly associated with higher stroke risk than Eichner A (HR, 1.26 [95% CI, 1.10-1.44], <i>P</i><0.001). Eichner C showed elevated risk, although not statistically significant (HR, 1.17 [95% CI, 0.91-1.50], <i>P</i>=0.229). Associations were observed in both sexes and across age groups.</p><p><strong>Conclusions: </strong>Reduced posterior occlusal support was associated with higher stroke risk independent of tooth count and conventional vascular risk. These findings highlight that posterior occlusal support may represent a potential marker of cerebrovascular risk and warrant further investigation into its clinical relevance.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e047074"},"PeriodicalIF":5.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845952","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":"Revisiting Glycemic Control Targets: Survival Outcomes by Glycated Hemoglobin Levels Among Patients With Diabetes Under Contemporary Antidiabetic Therapy.","authors":"Donna Shu-Han Lin, Hao-Yun Lo, Jen-Kuang Lee","doi":"10.1161/JAHA.125.046125","DOIUrl":"https://doi.org/10.1161/JAHA.125.046125","url":null,"abstract":"<p><strong>Background: </strong>Optimal glycated hemoglobin (HbA1c) targets for type 2 diabetes remain controversial. Given the evolution of modern antidiabetic therapies, this study aims to reevaluate optimal glycemic targets among patients receiving contemporary glucose-lowering treatments.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the National Taiwan University Hospital Integrated Medical Database, including 16 604 patients with type 2 diabetes who initiated dipeptidyl peptidase-4 inhibitors between 2009 and 2019, with follow-up through December 2021. Patients were categorized by long-term mean HbA1c quintiles. Outcomes included major adverse cardiovascular events (including ischemic stroke, myocardial infarction, cardiovascular death), renal outcomes (progression to dialysis, ≥50% estimated glomerular filtration rate decline, or doubling serum creatinine), hospitalization for heart failure, and safety outcomes. Associations were assessed using Cox proportional hazards models and restricted cubic spline analyses.</p><p><strong>Results: </strong>Compared with the third quintile as reference, the fourth (hazard ratio [HR], 1.22 [95% CI, 1.01-1.47]) and fifth quintiles (HR, 1.36 [95% CI, 1.12-1.64]) were associated with a significantly higher risk of major adverse cardiovascular events. Restricted cubic spline modeling identified significant J-shaped relationships for both major adverse cardiovascular events and renal outcomes, with the lowest risk observed around an HbA1c of 7%. In contrast, hospitalization for heart failure risk increased linearly with rising HbA1c levels. Notably, sex differences were identified: men showed a linear decrease in cardiovascular risk with lower HbA1c, whereas women exhibited a J-shaped relationship, indicating increased risks at both glycemic extremes.</p><p><strong>Conclusion: </strong>Optimal glycemic targets among patients receiving contemporary therapies differ by outcome and sex. Individualized HbA1c management strategies are essential to balance cardiovascular and renal benefits against potential risks.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e046125"},"PeriodicalIF":5.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846007","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 Among Young Patients With ST-Segment-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis.","authors":"Giordano Maria Pugliesi, Paul Onyeji, Giuseppe Verolino, Sonise MomplaisirOnyeji, Luca Fazzini, Paweł Łajczak, Meyof Sabeth Mbiih Toukam, Davide Sala, Eduardo Araujo Quartieri, Miguel Chaves Lenzi, Giovanni Battista Perego, Dario Calderone","doi":"10.1161/JAHA.125.046648","DOIUrl":"https://doi.org/10.1161/JAHA.125.046648","url":null,"abstract":"<p><strong>Background: </strong>Female sex is associated with lower incidence of myocardial infarction, especially at younger ages. However, sex differences in mortality and coronary artery disease patterns among young patients with ST-segment-elevation myocardial infarction are not well established. This study evaluated sex differences in in-hospital and 1-year all-cause death and in the extent of coronary artery disease in patients aged ≤45 years with ST-segment-elevation myocardial infarction.</p><p><strong>Methods: </strong>A systematic review (December 9, 2025) was conducted using PubMed, Cochrane, Embase, major cardiology conference proceedings, and ClinicalTrials.gov. Studies comparing sexes for outcomes were included. Non-English publications, abstracts without full text, and studies published before 2010 were excluded. A random-effects meta-analysis was performed, with results presented as relative risks (RR) and 95% CIs. Heterogeneity was assessed using τ and <i>I</i>², risk of bias using the Risk of Bias in Nonrandomized Studies of Interventions tool. The study was registered on the International Prospective Register of Systematic Reviews.</p><p><strong>Results: </strong>Eleven studies including 738 029 patients with ST-segment-elevation myocardial infarction (22% women) were analyzed. Female sex was associated with higher unadjusted in-hospital (RR, 1.56 [95% CI, 1.40-1.74]; τ=0.04; <i>I</i>²=0%) and 1-year mortality rate (RR, 1.78 [95% CI, 1.50-2.12]; τ=0.00; <i>I</i>²=0%). Women more frequently had single-vessel disease (73% versus 60%; RR, 1.13 [95% CI, 1.03-1.23]; τ=0.07; <i>I</i>²=67%), while men had 2-vessel (23% versus 18%; RR, 0.76 [95% CI, 0.68-0.85]; τ=0.00; <i>I</i>²=0%;) and 3-vessel disease (16% versus 9%; RR, 0.49 [95% CI, 0.27-0.86]; τ=0.41; <i>I</i>²=33%).</p><p><strong>Conclusions: </strong>In young patients with ST-segment-elevation myocardial infarction, female sex is associated with higher unadjusted in-hospital and 1-year death despite less extensive CAD. Further studies adjusting for comorbidities and standardizing CAD definitions are needed.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e046648"},"PeriodicalIF":5.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846105","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":"Retinal and Choroidal Vascular Alterations in Carotid Dissection Versus Atherosclerosis: Insights Into Divergent Ischemic Mechanisms.","authors":"Le Cao, Hang Wang, Wenzuo Shang, William Robert Kwapong, Ruishan Liu, Tianxiang Lan, Guina Liu, Fayun Hu, Bo Wu","doi":"10.1161/JAHA.125.048079","DOIUrl":"https://doi.org/10.1161/JAHA.125.048079","url":null,"abstract":"<p><strong>Background: </strong>To contrast retinal and choroidal vascular alterations between carotid artery dissection (CAD) and carotid artery stenosis (CAS), and analyze their associations with cerebral infarction patterns and stenosis severity.</p><p><strong>Methods: </strong>This observational study included stenotic-degree-matched patients with CAD and patients with CAS. Retinal ischemic signs-cotton wool spots, retinal artery occlusion, and paracentral acute middle maculopathy-were evaluated using fovea-centered optical coherence tomography/angiography. Retinal vascular density and choroidal metrics (choriocapillaris density, thickness, vascular volume, and index) were analyzed.</p><p><strong>Results: </strong>The final analysis included 863 eyes from 467 participants (85 with CAD, 274 with CAS, 108 controls). Patients with CAD showed a significantly higher prevalence of paracentral acute middle maculopathy than Patients with CAS (6.4% versus 0.61%, <i>P</i><0.001). Although ipsilateral eyes in both groups showed reduced retinal vascular density (<i>P</i><0.017), a divergent pattern was observed in the choroid: CAD-affected eyes demonstrated significantly higher choriocapillaris density, choroidal vascular volume, and choroidal thickness relative to both control and CAS-affected eyes (<i>P</i><0.017). Clinically, retinal ischemic signs in CAD were significantly associated with cerebral infarction (<i>P</i>=0.022) and severe stenosis/occlusion (<i>P</i>=0.008). Notably, retinal signs correlated with cerebral infarction topography: subcortical infarctions were predominantly associated with paracentral acute middle maculopathy, whereas cortical infarctions were linked to cotton wool spots and retinal artery occlusion (<i>P</i>=0.004).</p><p><strong>Conclusions: </strong>Compared with atherosclerotic stenosis, CAD exhibits a distinct oculovascular phenotype characterized by a higher burden of acute retinal ischemia but compensatory choroidal hyperperfusion. Retinal imaging serves as a noninvasive window into CAD pathophysiology, offering biomarkers for assessing hemodynamic stability and thromboembolic risk.</p><p><strong>Registration: </strong>URL: www.chictr.org.cn; Unique identifier: ChiCTR2300074640.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e048079"},"PeriodicalIF":5.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846028","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}