Journal of the American Heart Association最新文献

{"title":"Cerebral Hemodynamic Impairment and Cognitive Dysfunction in <i>APOE4</i> Carriers With Asymptomatic Carotid Artery Stenosis/Occlusion.","authors":"Yoshinori Kakino, Yorito Hattori, Soshiro Ogata, Yuriko Nakaoku, Kunihiro Nishimura, Hidehiro Iida, Masafumi Ihara","doi":"10.1161/JAHA.124.039210","DOIUrl":"10.1161/JAHA.124.039210","url":null,"abstract":"<p><strong>Background: </strong>Our previous preclinical study demonstrated that <i>APOE4</i>-targeted replacement mice exhibit more severe cerebral hypoperfusion and cognitive impairment than <i>APOE3</i>-targeted replacement mice with carotid artery stenosis due to neurovascular dysfunction. Therefore, we clinically investigate whether <i>APOE4</i> contributes to cerebral hemodynamic and cognitive impairment in subjects with asymptomatic carotid artery stenosis or occlusion.</p><p><strong>Methods and results: </strong>A cross-sectional observational study was conducted between January 2017 and March 2022. In a primary analysis, 91 subjects (114 affected cerebral hemispheres) with asymptomatic carotid artery stenosis or occlusion who underwent neuropsychological examinations and ¹⁵O-gas positron emission tomography were included to examine associations of <i>APOE4</i> with cognitive impairment and cerebral hemodynamic impairment. A sensitivity analysis was performed with 161 subjects (201 affected cerebral hemispheres) who underwent ¹⁵O-gas positron emission tomography scan. In the primary analysis, 20 (22.0%) subjects were <i>APOE4</i> carriers. <i>APOE4</i> was an independent risk factor of lower cerebral blood flow in the anterior circulation territory (β=-0.058 [95% CI, -0.098 to -0.018], <i>P</i>=0.005) and short-term memory impairment in Alzheimer's Disease Assessment Scale-Cognitive Subscale 13 (β=1.16 [95% CI, 0.009-2.30], <i>P</i>=0.048) in a multivariable linear regression analysis. In the sensitivity analysis, 31 (19.3%) subjects carried <i>APOE4</i>, which was an independent risk factor of lower cerebral blood flow (β=-0.048 [95% CI, -0.079 to -0.012], <i>P</i>=0.003) in the anterior circulation territory.</p><p><strong>Conclusions: </strong><i>APOE4</i> may confer an increased risk of decreased cerebral blood flow accompanied by memory impairment in asymptomatic carotid artery stenosis or occlusion consistent with our experimental study. <i>APOE</i> genotyping in such subjects may be useful for early detection of disease severity.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039210"},"PeriodicalIF":5.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626765","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":"Volunteer Responder Recruitment, Voluntary Deployment of Automated External Defibrillators, and Coverage of Out-of-Hospital Cardiac Arrest in Denmark.","authors":"Nanna Bo, Anne Juul Grabmayr, Fredrik Folke, Louise Kollander Jakobsen, Julie Samsøe Kjølbye, Shaun Theodor Florentz Sødergren, Kristian Bundgaard Ringgren, Linn Andelius, Christian Torp-Pedersen, Mads C Tofte Gregers, Carolina Malta Hansen","doi":"10.1161/JAHA.124.036363","DOIUrl":"10.1161/JAHA.124.036363","url":null,"abstract":"<p><strong>Background: </strong>A volunteer responder program to out-of-hospital cardiac arrest (OHCA) was implemented stepwise in Denmark (2017-2020). This study assessed automated external defibrillator (AED) and volunteer responder coverage of historical OHCAs in Denmark.</p><p><strong>Methods: </strong>Non-emergency medical services witnessed OHCAs (2016-2020) from the Danish Cardiac Arrest Registry with known location and AEDs from the Danish AED network were included. Volunteer responders with an exact location were identified using the volunteer responder server. A historical OHCA was defined as covered when ≥4 volunteer responders and ≥1 AED were <500 m range. Coverage was examined according to location (public or home), time of day (noon or midnight), and volunteer responder background (lay people or health care professionals).</p><p><strong>Results: </strong>A total of 22 330 OHCAs and 22 418 AEDs (387 AEDs/100 000 inhabitants) were included. At noon, 34 180 volunteer responders (589 volunteer responders/100 000 inhabitants) were identified as available. During daytime, OHCA coverage was 56% (95% CI, 55.9-57.2, n=12 625) decreasing to 30% (95% CI, 29.8-31.0, n=6793) when including only volunteer responders with a health care background. There was no significant difference in coverage according to time of day or location of arrest. OHCA coverage was 85% (95% CI, 84.2-86.0, n=6153) 4 years after implementation (first area included).</p><p><strong>Conclusion: </strong>Regardless of time of day, more than half of all OHCAs were covered by volunteer responders and AEDs in Denmark. Excluding lay volunteers would almost halve the coverage. Our results indicate successful recruitment of volunteer responders and deployment of AEDs with great potential for improving bystander defibrillation.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036363"},"PeriodicalIF":5.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626769","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":"Correction to: Mortality Patterns in Pediatric Pulmonary Vein Stenosis: Insights Into Right Ventricular Systolic Pressure Associations.","authors":"","doi":"10.1161/JAHA.124.035037","DOIUrl":"10.1161/JAHA.124.035037","url":null,"abstract":"<p><p>In the article by <b>Takajo</b> et al, \"<b>Mortality Patterns in Pediatric Pulmonary Vein Stenosis: Insights Into Right Ventricular Systolic Pressure Associations</b>,\" which published online on January 17, 2025 (<i>J Am Heart Assoc</i>. <b>2025;</b> 2025;14:e037908. DOI: 10.1161/JAHA.124.035037) and was included in the <b>January 21, 2025</b> issue of the journal, corrections were needed. Throughout the manuscript, the term <b>\"ECG\"</b> was mistakenly used instead of <b>\"echocardiographic\"</b> or <b>\"echocardiography.\"</b> This error occurred during the copyediting process, where \"echo\" was inadvertently converted to \"ECG.\" The specific corrections are as follows: In the <b>Methods</b> section, third paragraph, <i>\"At our institution, suspicion of PVS typically arises from ECG findings.\" has been corrected to \"At our institution, suspicion of PVS typically arises from echocardiographic findings.\"</i> In the <b>Methods</b> section, third paragraph, <i>\"The ECG performed closest to the last catheterization was used for subsequent analysis.\" has been changed to \"The echocardiography performed closest to the last catheterization was used for subsequent analysis.</i> In the footnotes of <b>Table 3</b>, \"<i>RV systolic function assessed by ECG closest to the last catheterization\" has been corrected to</i> \"<i>RV systolic function assessed by echocardiography closest to the last catheterization.\"</i> The <b>authors and publisher</b> regret the errors. The online version of the article has been updated and is available at https://www.ahajournals.org/doi/full/10.1161/JAHA.124.035037.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e035037"},"PeriodicalIF":5.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626789","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":"Harnessing Electronic Health Records and Artificial Intelligence for Enhanced Cardiovascular Risk Prediction: A Comprehensive Review.","authors":"Ming-Lung Tsai, Kuan-Fu Chen, Pei-Chun Chen","doi":"10.1161/JAHA.124.036946","DOIUrl":"10.1161/JAHA.124.036946","url":null,"abstract":"<p><p>Electronic health records (EHR) have revolutionized cardiovascular disease (CVD) research by enabling comprehensive, large-scale, and dynamic data collection. Integrating EHR data with advanced analytical methods, including artificial intelligence (AI), transforms CVD risk prediction and management methodologies. This review examines the advancements and challenges of using EHR in developing CVD prediction models, covering traditional and AI-based approaches. While EHR-based CVD risk prediction has greatly improved, moving from models that integrate real-world data on medication use and imaging, challenges persist regarding data quality, standardization across health care systems, and geographic variability. The complexity of EHR data requires sophisticated computational methods and multidisciplinary approaches for effective CVD risk modeling. AI's deep learning enhances prediction performance but faces limitations in interpretability and the need for validation and recalibration for diverse populations. The future of CVD risk prediction and management increasingly depends on using EHR and AI technologies effectively. Addressing data quality issues and overcoming limitations from retrospective data analysis are critical for improving the reliability and applicability of risk prediction models. Integrating multidimensional data, including environmental, lifestyle, social, and genomic factors, could significantly enhance risk assessment. These models require continuous validation and recalibration to ensure their adaptability to diverse populations and evolving health care environments, providing reassurance about their reliability.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036946"},"PeriodicalIF":5.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626812","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":"Intensive Blood Pressure Strategy on Cardiovascular Diseases in Patients With Metabolic Syndrome: Post Hoc Analysis of a Clinical Trial.","authors":"Guozhe Sun, Xiaofan Guo, Guangxiao Li, Pengyu Zhang, Yangzhi Yin, Lixia Qiao, Ning Ye, Chang Wang, Songyue Liu, Danxi Geng, Wei Miao, Ziyi Xie, Yao Yu, Zhi Li, Xiaoqiong Jiang, Xiangyu Tan, Yingxian Sun","doi":"10.1161/JAHA.124.036820","DOIUrl":"10.1161/JAHA.124.036820","url":null,"abstract":"<p><strong>Background: </strong>Blood pressure (BP) management in patients with metabolic syndrome is complex, and optimal targets remain debated. The CRHCP (China Rural Hypertension Control Project) trial demonstrated that intensive BP control reduces cardiovascular events. This secondary analysis assessed its efficacy in patients with hypertension and metabolic syndrome.</p><p><strong>Methods and results: </strong>This a post hoc analysis of a cluster randomized trial (NCT03527719) across 3 Chinese provinces; 18 076 hypertensive patients with metabolic syndrome were followed up for 3 years. Intervention groups received multifaceted BP management by nonphysician health care professionals aiming for <130/80 mm Hg BP under physician supervision. The primary outcome of major adverse cardiovascular events included stroke, myocardial infarction, heart failure, and death from cardiovascular causes, during a 3-year follow-up. A total of 18 076 participants (median [range] age, 63 [54-72] years; 13 056 [72.2%] women) were enrolled in 2 clusters and were adjudicated for the primary outcome (control, 9337; intervention, 8739). At the end of the 3-year follow-up, the mean systolic/diastolic BP was 126.3/73.0 mm Hg in the intervention group versus 147.3/82.0 mm Hg in the usual care group. Compared with the usual care group, the intervention group had a lower rate of major adverse cardiovascular events (1.58% versus 2.42% per year; hazard ratio [HR], 0.65 [95% CI, 0.57-0.74]; <i>P</i><0.001), as well as stroke (HR, 0.68 [95% CI, 0.55-0.83]; <i>P</i>=0.015), myocardial infarction (HR, 0.70 [95% CI, 0.51-0.97]; <i>P</i>=0.034), death from cardiovascular causes (HR, 0.67 [95% CI, 0.47-0.96]; <i>P</i>=0.029), and death from all causes (HR, 0.82 [95% CI, 0.71-0.94]; <i>P</i>=0.005).</p><p><strong>Conclusions: </strong>Intensive BP control (<130/80 mm Hg) by trained nonphysician community health care professionals effectively reduces cardiovascular events in patients with hypertension and metabolic syndrome.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03527719.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036820"},"PeriodicalIF":5.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626816","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":"Mediating Role of Blood Metabolites in the Relationship Between Immune Cell Traits and Heart Failure: A Mendelian Randomization and Mediation Analysis.","authors":"Yi Liu, Chenfu Shen, Yu Cao","doi":"10.1161/JAHA.124.037265","DOIUrl":"10.1161/JAHA.124.037265","url":null,"abstract":"<p><strong>Background: </strong>Observational studies have shown a significant association between immune cells and heart failure (HF). Nevertheless, the precise biological mechanisms underlying this association remain unclear.</p><p><strong>Methods: </strong>To investigate the causative relationships and underlying mechanisms between immune cell traits and adult HF, 3 main methods of Mendelian randomization were used: 2-sample Mendelian randomization, multivariable Mendelian randomization with controlling for several factors affecting HF, and mediation analysis. Results from the inverse variance-weighted model indicated that genetic predispositions for human leukocyte antigen-type DR (HLA DR) on CD33dim HLA DR+ CD11b+ (odds ratio, 0.967 [95% CI, 0.939-0.996]; <i>P</i>=0.028) may be associated with a reduced risk of HF. Although the association between HF and HLA DR on CD33 dim HLA DR+ CD11b+ did not withstand multiple-testing correction, the Mendelian randomization results (<i>P</i>_IVW <0.05) decrease the likelihood that the observational results are due to chance.</p><p><strong>Results: </strong>Our 2-step mediation analysis demonstrated that genetic predispositions for HLA DR on CD33dim HLA DR+ CD11b+ (odds ratio,1.085 [95% CI, 1.020-1.155]; <i>P</i>=0.010) was associated with increased levels of the metabolite Octadecanedioate, while genetic predispositions for Octadecanedioate levels (odds ratio, 0.917 [95% CI, 0.849-0.991]; <i>P</i>=0.028) was associated with a reduced risk of HF. Moreover, our results also demonstrated that the association between HLA DR on CD33dim HLA DR+ CD11b+ and HF was possibly mediated by Octadecanedioate levels, with a mediation proportion of 21.4% [95% CI, 43.7 -0.998].</p><p><strong>Conclusions: </strong>These findings underscore the importance of HLA DR on CD33dim HLA DR+ CD11b+ in the development of HF, with Octadecanedioate levels acting as a possible mediator in this pathway.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037265"},"PeriodicalIF":5.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626889","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":"P2Y₁₂ Inhibitor-Based Single Antiplatelet Therapy Versus Conventional Dual Antiplatelet Therapy After Newer-Generation Drug-Eluting Stent Implantation in Chronic and Acute Coronary Syndromes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.","authors":"Juan F Iglesias, Benjamin Assouline, Quentin Chatelain, Yazan Musayeb, Sophie Degrauwe, Marco Roffi","doi":"10.1161/JAHA.124.036642","DOIUrl":"10.1161/JAHA.124.036642","url":null,"abstract":"<p><strong>Background: </strong>P2Y₁₂ inhibitor-based single antiplatelet therapy (SAPT) after drug-eluting stent implantation reduces major bleeding without increasing the risk of major adverse cardiovascular and cerebral events compared with 12-month dual antiplatelet therapy (DAPT). The differential effects of P2Y₁₂ inhibitor monotherapy compared with conventional DAPT in patients with chronic coronary syndromes versus acute coronary syndromes (ACS) remain uncertain.</p><p><strong>Methods and results: </strong>PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials comparing oral P2Y₁₂ inhibitor-based SAPT after ≤3 months DAPT versus 12-month DAPT after newer-generation drug-eluting stent implantation. Patients were categorized based on baseline presentation (chronic coronary syndromes versus ACS). The co-primary end points were major bleeding and major adverse cardiovascular and cerebral events, a composite of all-cause death, myocardial infarction, or ischemic stroke. A total of 43 945 (ACS, 28 360, 65%) patients from 7 randomized controlled trials were included. At a median follow-up of 12 months, P2Y₁₂ inhibitor-based SAPT was associated with a lower risk of major bleeding (risk ratio [RR], 0.63 [95% CI, 0.48-0.82]; <i>P</i><0.001) compared with 12-month DAPT. The risk of major bleeding was significantly lower among patients with ACS (RR, 0.55 [95% CI, 0.40-0.75]; <i>P</i><0.001). Compared with standard DAPT, P2Y₁₂ inhibitor-based SAPT was associated with a similar risk of major adverse cardiovascular and cerebral events (RR, 0.98 [95%CI, 0.87-1.11]; <i>P</i>=0.74) among patients with chronic coronary syndromes and ACS. There was no significant interaction between treatment effect and baseline presentation.</p><p><strong>Conclusions: </strong>Compared with 12-month DAPT, P2Y₁₂ inhibitor-based SAPT after newer-generation drug-eluting stent implantation is associated with a lower risk of major bleeding without increasing the risk of major adverse cardiovascular and cerebral events, a difference primarily driven by patients with ACS.</p><p><strong>Registration: </strong>URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42023239341.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036642"},"PeriodicalIF":5.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626925","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":"Signal-Averaged ECG in the Diagnostic Workup for Arrhythmogenic Cardiomyopathy: Insights From the Nordic ARVC Registry.","authors":"Aleksei A Savelev, Eivind W Aabel, Anneli Svensson, Pia Dahlberg, Alex Hørby Christensen, Trine Madsen, Henning Bundgaard, Tiina Heliö, Aevar Ulfarsson, Thor Edvardsen, Jesper H Svendsen, Henrik K Jensen, Kristina H Haugaa, Pyotr G Platonov","doi":"10.1161/JAHA.124.037544","DOIUrl":"10.1161/JAHA.124.037544","url":null,"abstract":"<p><strong>Background: </strong>The diagnostic role of signal-averaged ECG (SAECG) in arrhythmogenic right ventricular cardiomyopathy (ARVC) has lately been questioned. We assessed the value of SAECG-derived late ventricular potentials (LP) in ARVC diagnosis and its association with disease manifestations.</p><p><strong>Methods and results: </strong>Patients with definite ARVC diagnosis or genotype-positive family members who underwent SAECG were included in register-based observational study (n=357, mean age 41 years, 47% female, 43% probands). LP and terminal activation duration (TAD) were defined by Task Force Criteria 2010. We assessed the association of TAD and LP with structural RV abnormalities and ventricular tachycardia (VT), defined as sustained VT, appropriate implantable cardioverter-defibrillator shock, aborted cardiac arrest, or sudden cardiac death, at diagnosis. LP were documented in 210 patients (59%) and abnormal TAD in 66 patients (18%). Each of the SAECG parameters was significantly associated with definite ARVC diagnosis in receiver-operator characteristics curve analysis with area under the curve between 0.67 and 0.74. Exclusion of SAECG from diagnostic workup led to reclassification of 37 patients (16%) from definite to borderline ARVC (13 probands, 9 of whom had prevalent VT). Ninety patients (25%) had history of VT. LP, but not TAD, were associated with VT (adjusted odds ratio [OR_adj], 2.42 [95%CI, 1.07-5.48]). LP had lower specificity (72% versus 97%) but higher sensitivity (71% versus 25%) for association with RV structural abnormalities than TAD.</p><p><strong>Conclusions: </strong>In the Nordic ARVC cohort SAECG-derived LP are associated with VT and structural RV abnormalities and were critical for ascertainment of ARVC diagnosis in 16% of patients with narrow QRS complexes, including 8% of all probands.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037544"},"PeriodicalIF":5.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588212","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":"Multicenter Experience With a Novel Real-Time 3-Dimensional Intracardiac Echocardiography Catheter to Guide Interventional Cardiac Procedures.","authors":"Mohamad Adnan Alkhouli, John D Carroll, Aken A Desai, Yu-Rong Gao, Tomnema Xiong, Andrea Natale, Ignacio Inglessis-Azuaje, Bradley P Knight","doi":"10.1161/JAHA.124.037019","DOIUrl":"10.1161/JAHA.124.037019","url":null,"abstract":"<p><strong>Background: </strong>Recent technologies enable real-time 3-dimensional intracardiac echocardiography (ICE) with the advantages of 2-dimensional ICE and imaging capabilities of transesophageal echocardiography. The purpose of this study is to evaluate the real-world, multicenter safety and performance of a novel 3-dimensional ICE system in a variety of cardiac interventions used in standard clinical practice.</p><p><strong>Methods: </strong>This prospective, multicenter, observational, single-arm study enrolled patients who were scheduled for an invasive cardiac procedure involving guidance with ICE and followed until discharge or ≤48 hours postprocedure. Intracardiac imaging was performed with the 3-dimensional ICE catheter, VeriSight Pro (Philips Inc.). Fluoroscopy was used in all cases and transesophageal echocardiography was used in some cases. The primary safety end point was device-related adverse events. The primary efficacy end point included technical success, imaging success, and clinical success.</p><p><strong>Results: </strong>Between October 2021 and November 2022, 155 patients were enrolled and screened. Percutaneous interventions performed included atrial septal defect/patent foramen ovale closures, left atrial appendage occlusion, catheter ablations, and valve procedures. No adverse events were related to the device or procedure. The technical, imaging, and clinical success rates were 98.7% (95% CI, 95.4%-99.8%), 96.1% (95% CI, 91.8%-98.6%), 94.8% (95% CI, 91.8%-98.6%), respectively. Overall, the VeriSight Pro ICE image quality was assessed to be \"acceptable\" or greater in relation to reference image modality among 96.2% (149 of 155) of procedures.</p><p><strong>Conclusions: </strong>VeriSight ICE imaging is safe and effective in the guidance of a wide variety of percutaneous cardiovascular procedures and has provided successful and high-quality imaging of cardiac structures.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037019"},"PeriodicalIF":5.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626900","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":"Evidence of Varicella Zoster Virus Reactivation in Children With Arterial Ischemic Stroke: Results of the VIPS II Study.","authors":"Heather J Fullerton, Nancy K Hills, Max Wintermark, Nomazulu Dlamini, Catherine Amlie-Lefond, Michael M Dowling, Lori C Jordan, Neil R Friedman, Mitchell S V Elkind, Charles Grose","doi":"10.1161/JAHA.124.039184","DOIUrl":"10.1161/JAHA.124.039184","url":null,"abstract":"<p><strong>Background: </strong>Varicella zoster virus (VZV) has historically been associated with focal cerebral arteriopathy and arterial ischemic stroke (AIS) in children, and risk of AIS and myocardial infarction in adults. The VIPS (Vascular Effects of Infection in Pediatric Stroke) II study aimed to determine whether VZV remains a pediatric stroke trigger in an era of routine VZV vaccination.</p><p><strong>Methods: </strong>This 22-center prospective cohort study enrolled 205 patients (28 days to 18 years; median, 11.6 years) with spontaneous AIS (December 2016 to January 2022) in North America and Australia, performed parental interviews, and collected baseline (hyperacute [≤72 hours; n=194] and acute [4-6 days; n=181]) and convalescent (1-6 weeks; n=74) serum samples. A virology research laboratory measured VZV IgM and IgG titers by an in-house ELISA in patients with AIS and 95 unmatched well control children.</p><p><strong>Results: </strong>Baseline serologies indicated prior VZV exposure in 198 patients (97%). Parents recalled prior VZV vaccination in 160 (78%) and remote chickenpox in 3 (1.4%). Twenty patients (9.8%) had serologic evidence of recent VZV reactivation at the time of their stroke; all were asymptomatic. All had remote VZV exposure with VZV vaccination (median) 6.1 years prior. We observed recent VZV reactivation in patients with focal cerebral arteriopathy (4/32 [12.5%]) but not with arterial dissection or moyamoya. All 95 controls had serologic evidence of prior VZV exposure and 3 (3.1%) had recent VZV reactivation.</p><p><strong>Conclusions: </strong>One in 10 patients with childhood AIS had recent, asymptomatic VZV reactivation. In a vaccinated population, VZV may continue to play a modest role in childhood stroke pathogenesis.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":"14 6","pages":"e039184"},"PeriodicalIF":5.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659305","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}