Journal of the American Heart Association最新文献

{"title":"Outcomes in Early Postoperative Versus Late New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting.","authors":"Florian E M Herrmann, Amar Taha, Mary Rezk, Susanne J Nielsen, Andreas Martinsson, Emma C Hansson, Gerd Juchem, Christian Hagl, Anders Jeppsson","doi":"10.1161/JAHA.125.043026","DOIUrl":"10.1161/JAHA.125.043026","url":null,"abstract":"<p><strong>Background: </strong>It is unclear whether new-onset postoperative atrial fibrillation (POAF) early after coronary artery bypass grafting (CABG) is associated with a similar risk of adverse outcomes as new-onset atrial fibrillation occurring later after CABG.</p><p><strong>Methods: </strong>All patients treated with CABG in Sweden from 2007 to 2020 were investigated. Individual patient data from SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry and 3 other prospective national registries were merged. The adjusted incidences of all-cause mortality, ischemic stroke, any thromboembolism, heart failure hospitalization, and major bleeding within 12 months after debut of POAF (AF occurring before hospital discharge) or Late AF (new-onset AF occurring between 3 months and 3 years after CABG) were compared by multivariable Poisson regression analysis, adjusted for time-updated patient characteristics and comorbidities.</p><p><strong>Results: </strong>Out of 35 329 patients, 10 609 (30.0%) developed POAF and 628 (2.5%) developed Late AF. The crude mortality rate was lower in patients with POAF than in patients with Late AF (1.88 [95% CI, 1.63-2.17] versus 9.08 [95% CI, 6.92-11.82] per 100 patient-years). The adjusted incidence rate ratios for all-cause mortality (2.91 [95% CI, 2.10-3.95]); ischemic stroke (1.70 [95% CI, 1.15-2.44]); any thromboembolism (1.59 [95% CI, 1.11-2.22]), heart failure hospitalization (1.61 [95% CI, 1.19-2.12]); and major bleeding (1.73 [95% CI, 1.24-2.36]) were higher in patients with Late AF.</p><p><strong>Conclusions: </strong>POAF was associated with a markedly lower risk for morbidity and mortality than late new-onset AF after CABG. POAF and late new-onset AF after CABG are 2 different clinical entities of AF that may require different treatment strategies.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043026"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193960","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":"High-Profile Cardiac Arrests Correlate With Online Searches and Public Interest: A Call for Action.","authors":"Kirsten E Shaw, Larissa Stanberry, Kevin M Harris","doi":"10.1161/JAHA.125.042184","DOIUrl":"10.1161/JAHA.125.042184","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042184"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088164","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":"Anterior T-Wave Inversion Pattern in Female Athletes: Is It Time to Rewrite the Playbook?","authors":"Samantha L Weller, Bradley J Petek","doi":"10.1161/JAHA.125.045828","DOIUrl":"10.1161/JAHA.125.045828","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e045828"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193853","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":"Unequal Hearts: Racial Disparities Persist in Heart Transplant Outcomes.","authors":"Juan Carlos Batlle, Katherine A A Clark","doi":"10.1161/JAHA.125.045280","DOIUrl":"10.1161/JAHA.125.045280","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e045280"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139357","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":"Arterial Stiffness in Cancer Survivors: The Prognostic Value of Estimated Pulse Wave Velocity in US Cancer Population From the National Health and Nutrition Examination Survey 2009 to 2018.","authors":"Mustafa Al-Jarshawi, Akhmetzhan Galimzhanov, Marco Zimarino, Islam Y Elgendy, Carlos Diaz-Arocutipa, Ofer Kobo, Mamas A Mamas","doi":"10.1161/JAHA.125.041645","DOIUrl":"10.1161/JAHA.125.041645","url":null,"abstract":"<p><strong>Background: </strong>Estimated pulse wave velocity (ePWV), a marker of arterial stiffness, is strongly associated with cardiovascular events and all-cause death in the general population. This study evaluates the association of arterial stiffness, defined by the ePWV equation, with all-cause and cardiovascular death and identifies an optimal ePWV threshold for risk stratification in cancer survivors.</p><p><strong>Methods: </strong>Using data from the National Health and Nutrition Examination Survey (2009-2018), we analyzed a cohort representing more than 105 million US cancer survivors. Multivariable Cox regression and Kaplan-Meier analyses assessed the association between ePWV and outcomes. Dose-dependent relationships were explored, and an optimal ePWV threshold was determined through maximally selected rank statistics.</p><p><strong>Results: </strong>During a median follow-up of 59 months, a total of 105 869 670 weighted cancer survivors (2234 unweighted) were analyzed, recording 435 all-cause and 91 cardiovascular deaths. Early vascular aging (ePWV ≥9.4 m/s) was present in 54.6% of participants. Each 1 m/s increase in ePWV was associated with higher risks of all-cause death (29%) and cardiovascular death (46%) (hazard ratio [HR], 1.29 [95% CI, 1.19-1.40] and 1.46 [95% CI, 1.20-1.76], respectively, both <i>P</i><0.001). Those with ePWV ≥12.05 m/s demonstrated higher risks of all-cause and cardiovascular death (HR, 1.70 [95% CI, 1.35-2.13] and 2.53 [95% CI, 1.56-4.12], respectively, both <i>P</i><0.001).</p><p><strong>Conclusions: </strong>Arterial stiffness, assessed by ePWV, demonstrates prognostic utility in cancer survivors, showing a nonlinear association with all-cause and cardiovascular death, independent of demographic, socioeconomic, traditional cardiovascular risk factors not included in the ePWV equation, and baseline cardiovascular disease.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041645"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088093","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":"Dynamic Increase of the C₂HEST Score in Relation to the Development of Incident Atrial Fibrillation: A Longitudinal Cohort Study.","authors":"Yan-Guang Li, Yi-Jie Liu, Li-Li Wang, Qiao-Yuan Li, Tao Zhang, Xu Liu, Qin-Chao Wu, Yan Yin, Shao-Min Chen, Jin Bai, Daniele Pastori, Gregory Y H Lip, Yun-Long Wang","doi":"10.1161/JAHA.124.039231","DOIUrl":"10.1161/JAHA.124.039231","url":null,"abstract":"<p><strong>Background: </strong>The risk of incident atrial fibrillation (AF) increases with accumulating risk factors. Baseline-only risk assessment may not reflect the real risk of incident AF. We aimed to evaluate the performance of the dynamic change of the C₂HEST score (C2: coronary artery disease/chronic obstructive pulmonary disease (1 point each); H: hypertension (1 point); E: elderly (age ≥75 years, 2 points); S: systolic/diastolic heart failure (2 points); and T: thyroid disease (hyperthyroidism, 1 point) C₂HEST) score to assess the risk of incident AF during follow-up.</p><p><strong>Methods: </strong>The present study data were retrieved from the Information Management and Big Data Center of Peking University Hospital Group. Patients without AF at baseline were enrolled. New-onset comorbidities were recorded during follow-up. The change in the C₂HEST score was analyzed. The baseline and the change in C₂HEST scores were compared for the prediction of incident AF.</p><p><strong>Results: </strong>A total of 120 133 patients were included in the final analysis. During 346 400 patient-years of follow-up, 2304 developed incident AF (0.67 per 100 patient-years). The mean C₂HEST score increased significantly from 1.62 to 2.96 (<i>P</i><0.05). A significant proportion of patients had newly diagnosed comorbidities (61.9% with ∆C₂HEST ≥1 in AF and 14.6% with C₂HEST ≥1 in non-AF). The change in C₂HEST scores showed better performance compared with the baseline score, as assessed by area under curve analyses (∆C₂HEST 0.821 [0.811-0.830], baseline 0.758 [0.747-0.769]), decision curve analysis, and positive net reclassification index.</p><p><strong>Conclusions: </strong>The risk for incident AF is not static and increases with the accumulation of new comorbidities. The change in C₂HEST score had better prediction in assessing individual risk of incident AF compared with the baseline score.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039231"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088144","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":"Role of Lipids and Lipid Management Therapy Among Patients With Peripheral Artery Disease: A Reappraisal of the Current Evidence and Future Directions.","authors":"McCall Walker, Kayla A Riggs, Anand Rohatgi, Joshua Beckman, Tayo Addo, Saket Girotra, Marc P Bonaca, Ehrin Armstrong, Dharam J Kumbhani","doi":"10.1161/JAHA.124.039734","DOIUrl":"10.1161/JAHA.124.039734","url":null,"abstract":"<p><p>Peripheral artery disease (PAD), defined by stenosis or occlusion of the extremities (particularly the lower extremities), affects 200 million individuals worldwide, including an estimated 7% of adults in the United States alone. It is the third leading cause of atherosclerotic morbidity after coronary artery disease and stroke. Regardless of symptoms, individuals with PAD are known to be at a significantly increased risk for development of a major adverse cardiovascular event and have a higher all-cause mortality than those without disease. Despite PAD underdiagnosis, higher atherosclerotic cardiovascular disease burden, and evidence of decreased atherosclerotic cardiovascular disease risk with lipid modification, lipid undertreatment and nontreatment remain common among patients with PAD. This review addresses (1) the role of lipids in the pathophysiology of incident PAD and in adverse outcomes in those with PAD, (2) the role of lipid-modifying therapies in primary and secondary prevention of PAD, and (3) insights regarding future directions of the study of lipids as it relates to PAD.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039734"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088326","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":"Design of Black Impact: A Randomized Controlled Trial Evaluating the Mechanisms Underlying Psychosocial Stress Reduction in a Cardiovascular Health Intervention.","authors":"Timiya S Nolan, Amaris Williams, Shannon L Gillespie, Tamar Gur, Daniel Walker, Jennifer A Garner, Jeff Galley, Luiza Reopell, Amani Wilson, Kwame Lartey, Nnanna Ojembe, Aryn Hubbard, Joseph Ballas, Bhavya Appana, Emmanuella Aboagye-Mensah, Shabrya Smith, Madison Griffin, Songzhu Zhao, Guy N Brock, Carrie Baker, Jenelle Hoseus, Diana Briggs, John Gregory, Mysheika W Roberts, Makeda Porter, Joshua J Joseph","doi":"10.1161/JAHA.124.039380","DOIUrl":"10.1161/JAHA.124.039380","url":null,"abstract":"<p><strong>Background: </strong>Lower attainment of cardiovascular health (CVH), indicated by lower scores on the American Heart Association's Life's Essential 8 metrics, is a major contributor to Black men having the shortest life expectancy of any nonindigenous race/sex group. Evidence-based community interventions to improve CVH in Black men are sparse; thus, an academic-community-government-industry partnership was developed to cocreate and test a 24-week CVH intervention for Black men, Black Impact, in line with best practices for community-based participatory research.</p><p><strong>Methods and results: </strong>The Black Impact intervention is delivered by health coaches, fitness trainers, and community health workers and emphasizes weekly physical activity, health education, and addressing social needs. Together, academic-community-government-industry partners will conduct a randomized, waitlist-controlled trial among 340 Black men with suboptimal CVH to determine intervention: (1) efficacy on CVH and psychosocial stress; (2) effect on individual and interpersonal outcomes; (3) effect on biological mechanisms responsive to psychosocial stress; and (4) organizational contexts and resources necessary for sustainability of the academic-community-government-industry partnership. An intervention working group of academic-community-government-industry partner representatives will guide implementation and evaluation. Upon trial completion, findings (eg, change in CVH at 24 weeks [primary], change in perceived stress at 24 weeks [coprimary], biological mechanisms, psychosocial process mediators [stress, social and interpersonal processes]) will be disseminated in scientific and lay settings.</p><p><strong>Conclusions: </strong>Robust clinical trials are needed to test novel interventions focused on CVH equity. Black Impact will determine intervention efficacy, evaluate biological and psychosocial mediators of impact, and lay a framework for sustainability and scalability.</p><p><strong>Registration: </strong>URL: https://clinicaltrials.gov/; Unique Identifier: NCT06055036.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039380"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139534","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":"Transcriptome Analysis Identified <i>SPP1</i>-Positive Monocytes as a Key in Extracellular Matrix Formation in Thrombi.","authors":"Takaya Kitano, Tsutomu Sasaki, Takahiro Matsui, Masaharu Kohara, Kotaro Ogawa, Kenichi Todo, Hajime Nakamura, Yuri Sugiura, Yuki Shimada, Shuhei Okazaki, Junichi Iida, Kohki Shimazu, Eiichi Morii, Manabu Sakaguchi, Masami Nishio, Masaru Yokoe, Haruhiko Kishima, Hideki Mochizuki","doi":"10.1161/JAHA.125.044299","DOIUrl":"10.1161/JAHA.125.044299","url":null,"abstract":"<p><strong>Background: </strong>Thrombi follow various natural courses. They are known to become harder over time and may persist long term; some of them can also undergo early spontaneous dissolution and disappearance. Hindering thrombus stability may contribute to the treatment of thrombosis and the prevention of embolisms. However, the detailed mechanisms underlying thrombus maturation remain unclear.</p><p><strong>Methods: </strong>We compared the RNA expression in 3 thrombi retrieved from cerebral vessels via thrombectomy with that in simultaneously sampled blood. The results were validated using immunohistochemistry on 66 thrombi retrieved from patients with cerebral embolism. Single-cell RNA sequencing data of thrombi from pulmonary arteries were used to uncover the molecular mechanisms.</p><p><strong>Results: </strong>A total of 1121 genes were upregulated in thrombi. Pathway enrichment and protein-protein interaction analyses revealed upregulation of extracellular matrix formation and identified <i>SPP1</i> as a hub gene. Immunohistochemistry revealed that expression level of osteopontin (the transcript of <i>SPP1</i>) positively correlated to that of collagen type VI in thrombi. Osteopontin was expressed primarily by monocytes/macrophages in the thrombi, particularly in older ones. Among these 66 patients, the presence of collagen type VI in the thrombus was marginally associated with longer puncture-to-reperfusion time and more passes before reperfusion, indicating that those thrombi were resistant to thrombectomy. Single-cell RNA sequencing of thrombi identified a subpopulation of monocytes/macrophages that highly express <i>SPP1</i>. These <i>SPP1</i>-high monocytes/macrophages highly expressed genes related to the extracellular matrix and communicated closely with fibroblasts.</p><p><strong>Conclusions: </strong>Collectively, our findings indicate that <i>SPP1</i>-high monocytes/macrophages play a crucial role in thrombus maturation.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e044299"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193495","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":"Different Metabolic Phenotypes of Obesity and 2 Decades Risk of Cardio-Renal-Metabolic Multimorbidity: Tehran Lipid and Glucose Study.","authors":"Danial Molavizadeh, Soroush Masrouri, Farzad Esmaeili, Fereidoun Azizi, Farzad Hadaegh","doi":"10.1161/JAHA.124.040930","DOIUrl":"10.1161/JAHA.124.040930","url":null,"abstract":"<p><strong>Background: </strong>Less is known regarding the association between metabolic phenotypes of general and abdominal obesity and incident cardio-renal-metabolic (CRM) multimorbidity, defined as coexistence of at least 2 of the following: diabetes, chronic kidney disease, and cardiovascular diseases (hypertension or stroke or coronary heart disease).</p><p><strong>Methods: </strong>Among 6343 participants (3555 women), with a mean age of 37.06 years, metabolically healthy status was defined as absence of any metabolic syndrome components. Participants were classified as metabolically healthy/unhealthy normal weight, overweight, and obese on the basis of body mass index; and metabolically healthy/unhealthy nonabdominal obese and abdominal obese according to waist circumference. Multivariable Cox hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs, adjusted for age, sex, smoking status, education level, marital status, pulse rate, estimated glomerular filtration rate, family history of premature cardiovascular disease, and family history of diabetes.</p><p><strong>Results: </strong>During a median follow-up of 14.3 years, CRM multimorbidity occurred in 4.8, 13.4, 15.0, 10.8, 17.4, and 29.9% of participants with metabolically healthy normal weight, metabolically healthy overweight, metabolically healthy obese, metabolically unhealthy normal weight, metabolically unhealthy overweight, and metabolically unhealthy obese phenotypes, respectively. In multivariable analyses, compared with the metabolically healthy normal weight, participants with metabolically healthy overweight (HR, 2.08 [95% CI, 1.35-3.20]), metabolically healthy obese (HR, 2.04 [95% CI, 1.11-3.75]), metabolically unhealthy normal weight (HR, 2.29 [95% CI, 1.61-3.27]), metabolically unhealthy overweight (HR, 2.83 [95% CI, 2.01-3.99]), and metabolically unhealthy obese (HR, 5.16 [95% CI, 3.64-7.32]) phenotypes had higher risk of developing CRM multimorbidity. Compared with the metabolically healthy abdominal obese phenotype, participants with metabolically healthy nonabdominal obese (HR, 1.77 [95% CI, 1.19-2.64)], metabolically unhealthy nonabdominal obese (HR, 1.95 [95% CI, 1.48-2.57]), and metabolically unhealthy abdominal obese (HR, 3.26 [95% CI, 2.49-4.28]) exhibited elevated risk. Generally, we found no statistically significant effect modification by sex and age; however, these associations were more pronounced among women and younger individuals.</p><p><strong>Conclusions: </strong>Our results indicate that there is no benign phenotype of obesity beyond metabolically healthy normal weight regarding the incidence of CRM multimorbidity.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040930"},"PeriodicalIF":5.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978435","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}