Journal of the American Heart Association最新文献

{"title":"Comparative Evaluation of Resting and Hyperemic Angiography-Derived Index of Microcirculatory Resistance in Chronic Coronary Syndrome.","authors":"Yang Zhang, Quan Li, Yicong Ye, Xiliang Zhao, Liang Zhang, Zhennan Li, Tianyi Wang, Yaodong Ding, Li Lin, Yi Ye, Jiayi Han, Guosheng Fu, Jiancheng Xiu, Yongde Wang, Guipeng An, Ning Guo, Chao Zhang, Chunliang Wang, Qinghua Zhao, Huay-Cheem Tan, Yong Zeng","doi":"10.1161/JAHA.124.040173","DOIUrl":"https://doi.org/10.1161/JAHA.124.040173","url":null,"abstract":"<p><strong>Background: </strong>Angiography-derived index of microcirculatory resistance (IMR) has emerged as a feasible alternative to wire-based IMR, due to the elimination of specialized wire and simplifying of the procedure. However, the differences in diagnostic accuracy between hyperemic and resting angiography with this technology remain underexplored.</p><p><strong>Methods: </strong>This prospective, multicenter study was conducted to evaluate the feasibility and diagnostic accuracy of x-ray angiography-derived IMR (xaIMR) in patients with chronic coronary syndrome using wire-based functional indices as the reference. Angiography-derived functional indices were calculated using a computational fluid dynamics model. The xaIMR indices were derived from hyperemic and resting angiography, respectively.</p><p><strong>Results: </strong>A total of 139 vessels were included in the analysis of the present study. Both hyperemic xaIMR (<i>r</i>=0.82; <i>P</i><0.001) and resting xaIMR (R-xaIMR) (<i>r</i>=0.25; <i>P</i>=0.003) exhibited positive linear correlations with wire-based IMR. Notably, hyperemic xaIMR was associated with a higher diagnostic yield (area under the receiver operating characteristic curve) than resting xaIMR (area under the receiver operating characteristics curve, 0.95 versus 0.72; <i>P</i><0.001). Significant differences in diagnostic yield between these modalities were observed in vessels with compromised coronary flow reserve (<2.0). In contrast, such differences were not observed in vessels with normal coronary flow reserve (≥2.0).</p><p><strong>Conclusions: </strong>xaIMR, especially derived from hyperemic angiography, is a reliable, noninvasive alternative to wire-based IMR for assessing coronary microcirculatory resistance in chronic coronary syndrome. However, resting angiography-derived xaIMR may have limited diagnostic accuracy in patients with reduced coronary flow reserve. Further studies are warranted to validate these findings in broader populations.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040173"},"PeriodicalIF":5.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676528","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":"Sleep Duration Irregularity and Risk for Incident Cardiovascular Disease in the UK Biobank.","authors":"Tianyi Huang, Sina Kianersi, Heming Wang, Kaitlin S Potts, Raymond Noordam, Tamar Sofer, Martin K Rutter, Susan Redline","doi":"10.1161/JAHA.124.040027","DOIUrl":"https://doi.org/10.1161/JAHA.124.040027","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence supports a link between circadian disruption as measured by higher night-to-night variation in sleep duration and increased risk of cardiovascular disease (CVD). It remains unclear whether this association varies by CVD types or may be modified by average sleep duration and genetic risk for CVD.</p><p><strong>Methods: </strong>Our prospective analysis included 86 219 UK Biobank participants who were free from CVD when completing 7 days of accelerometer measurement from 2013 to 2015. Sleep irregularity was evaluated by the SD of accelerometer-measured sleep duration over 7 days. Incident major CVD events, defined as fatal or nonfatal myocardial infarction and stroke, were identified through linkage to Hospital Episode Statistics data until May 31, 2022. Multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs for associations of sleep duration SD with risk for major CVD events overall and for myocardial infarction and stroke separately.</p><p><strong>Results: </strong>We documented 2310 incident cases of major CVD events (myocardial infarction: 1183, stroke: 1175) over 636 258 person-years of follow-up. After adjusting for sociodemographic factors and family history of CVD, the HR associated with a 1-hour increase in sleep duration SD was 1.19 (95% CI, 1.10-1.27) for CVD (<i>P</i>-trend<0.0001), 1.23 (95% CI, 1.11-1.35) for myocardial infarction (<i>P</i>-trend<0.0001), and 1.17 (95% CI, 1.05-1.29) for stroke (<i>P</i>-trend=0.003). Additional adjustment for lifestyle factors, comorbidities, and sleep-related factors modestly attenuated these associations. Higher sleep irregularity was associated with higher CVD risk irrespective of genetic risk (<i>P</i>-interaction=0.43), but this association was stronger among individuals with longer average sleep duration >8 hours (<i>P</i>-interaction=0.006).</p><p><strong>Conclusions: </strong>Higher night-to-night variation in accelerometer-measured sleep duration was associated with consistently higher risks for major CVD events. The association did not seem to be modified by genetic risk for CVD and was more pronounced in long sleepers.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040027"},"PeriodicalIF":5.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676533","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":"Management and Outcomes of Patients Undergoing Cardiovascular Evaluation Across Health Care Systems: Comparison of Community Care and Integrated Veterans Affairs Health Care.","authors":"Stephen W Waldo, Thomas J Glorioso, Neel Butala, Paul Varosy, Claire S Duvernoy, Mary E Plomondon, Joseph Francis","doi":"10.1161/JAHA.125.041930","DOIUrl":"https://doi.org/10.1161/JAHA.125.041930","url":null,"abstract":"<p><strong>Background: </strong>The Veterans Affairs (VA) Healthcare System maintains the largest integrated health system in the United States but also supports fee-for-service insurance for veterans receiving care in community facilities outside the VA. We sought to evaluate the management and outcomes of patients referred for consultation in either venue, using cardiovascular evaluation as a model.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study identifying patients enrolled in the VA Healthcare System referred for cardiovascular evaluation from October 2020 through September 2024 and stratified the population based on the venue in which evaluation was completed. The primary outcome was major adverse cardiovascular events (acute coronary syndromes/stroke/mortality) in a matched population.</p><p><strong>Results: </strong>Among 235 197 consultations for cardiovascular evaluation, 201 453 were completed in the chosen venue within 6 months. The time between consultation and evaluation was similar across venues (community, 35 days [95% CI, 17-65] versus VA, 33 days [95% CI, 19-53]), with comparable delays to diagnostic testing or therapeutic interventions. Patients receiving care in the community were more likely to undergo stress testing (43.2% versus 36.4%, <i>P</i>=1.5×10^-46) and coronary angiography (23.1% versus 17.4%, <i>P</i>=2.1×10^-51) within 2 years compared with those treated in the VA Healthcare System. Despite this, patients treated in the community had a significantly higher rate of major adverse events at 2 years (17.6% versus 15.3%, <i>P</i>=5.9×10^-10) compared with those treated in the VA Healthcare System.</p><p><strong>Conclusions: </strong>Patients undergoing cardiovascular evaluation in community practices were not evaluated more rapidly than those seen in the VA, though they were more likely to receive initial and repeat diagnostic testing. Adverse events were more common among community-treated patients than those in the VA, suggesting an opportunity to optimize access to care while improving clinical outcomes.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041930"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661005","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 in Stroke Frequency and Severity Following Transcatheter Aortic Valve Replacement.","authors":"Vijay A Joshi, Emily M Bucholz, Marshall Roll, Natalia Rahman, Dhaval Kolte, Carlos Davila, Robert W Yeh, David J Cohen, Stephen W Waldo, Neel M Butala","doi":"10.1161/JAHA.125.041943","DOIUrl":"https://doi.org/10.1161/JAHA.125.041943","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a recognized complication following transcatheter aortic valve replacement (TAVR). Although women have historically had a higher rate of bleeding and vascular complications after TAVR, contemporary data on sex differences in post-TAVR stroke and stroke severity are lacking. Disabling strokes significantly affect quality of life and outcomes, underscoring the need to explore sex-specific variations in post-TAVR stroke risk.</p><p><strong>Methods: </strong>In this retrospective cohort study, we included all patients who underwent TAVR in the National Inpatient Sample from 2016 to 2021. Stroke and stroke severity were ascertained using validated claims-based algorithms. Disabling strokes were defined as those resulting in death or discharge to a nonhome location. We used multivariable logistic regression to evaluate the association between sex and stroke while adjusting for covariates, including cerebral embolic protection use, and accounting for survey weights.</p><p><strong>Results: </strong>Among our weighted sample of 379 410 patients (43.9% female), women demonstrated higher overall in-hospital stroke incidence compared with men (2.31% versus 1.69%; adjusted odds ratio [aOR], 1.208 [95% CI, 1.082-1.350]). This difference was driven primarily by disabling strokes, which were more common in women (1.61% versus 1.01%; aOR, 1.327 [95% CI, 1.158-1.520]). Conversely, the incidence of nondisabling stroke was not statistically different between sexes (0.70% versus 0.67%;( aOR, 1.013 [95% CI, 0.844-1.215]).</p><p><strong>Conclusions: </strong>Among patients undergoing TAVR in contemporary practice, women had a higher rate of any stroke and disabling strokes compared with men. These findings emphasize the need for tailored strategies to mitigate stroke risk and improve outcomes for female TAVR patients.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041943"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651147","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":"Targeting <i>Mettl14</i> Using an RNA-Targeting Clustered Regularly Interspaced Short Palindromic Repeat-<i>High-Fidelity</i> Cas13x System Attenuates Doxorubicin-Induced Cardiotoxicity.","authors":"Wensi Wan, Caiyue Cui, Yi Zhou, Jiaqi Wang, Xuan Zhao, Xinxin Cui, Jiangpeng Sun, Pujiao Yu, Jingyi Feng, Tianhui Wang, Lijun Wang, Jiahong Xu","doi":"10.1161/JAHA.124.040700","DOIUrl":"https://doi.org/10.1161/JAHA.124.040700","url":null,"abstract":"<p><strong>Background: </strong>Doxorubicin is an effective chemotherapy drug used to treat various types of cancer. However, doxorubicin treatment is associated with cardiotoxicity, which limits its clinical use. Exercise can benefit both cancer and cardiovascular disease. Clustered regularly interspaced short palindromic repeat (CRISPR)-Cas13 (CRISPR-associated protein 13) platforms have emerged as effective technologies for targeting the expression of RNA in transcript levels. To develop exercise mimetics that can mimic the beneficial effects of exercise training to attenuate doxorubicin-induced cardiotoxicity, we are using the CRISPR-<i>hf</i> (<i>high-fidelity</i>)Cas13x system.</p><p><strong>Methods: </strong>Adult male mice were swim-trained twice a day for 4 weeks to induce exercise-induced physiological cardiac hypertrophy. Adeno-associated virus 9-mediated METTL14 (methyltransferase-like 14) overexpression under the cardiac-specific <i>ctnt</i> promoter was used to overexpression METTL14 in vivo. RNA N⁶-methyladenosine inhibitor STM2457 was used to modulate global total RNA m⁶A levels in vivo. CRISPR-cr3-4/<i>hf</i>Cas13x system was generated by <i>hf</i>Cas13x guided crRNA3 and crRNA4 targeting the <i>Mettl14</i> expressed under <i>ctnt</i> promoter and packaged in an adeno-associated virus 9.</p><p><strong>Results: </strong>Swimming exercise alleviated doxorubicin-induced cardiotoxicity. METTL14 was increased in doxorubicin-treated hearts but decreased in exercised hearts. METTL14 overexpression inhibited exercise-induced physiological cardiac hypertrophy. Conversely, STM2457 treatment reversed the suppressive effects of METTL14 overexpression on the physiological cardiac hypertrophy induced by exercise. Treatment with CRISPR-cr3-4/<i>hf</i>Cas13x effectively inhibiting the expression of METTL14 in the heart, alleviating doxorubicin treatment-induced cardiac dysfunction and cardiac fibrosis.</p><p><strong>Conclusions: </strong>Our results suggest that the CRISPR-<i>hf</i>Cas13x system has the potential for generating exercise mimetics. Mimicking exercise by RNA-targeting <i>Mettl14</i> suppression could be a therapeutic strategy for doxorubicin-induced cardiotoxicity.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040700"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651150","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 Between Size of Left Ventricle and Long-Term Cardiovascular Events.","authors":"Yun-Jiu Cheng, Zi-Li Liao, Li-Juan Liu, Yue-Dong Ma, Xu-Miao Chen, Ze-Xuan Wu, Hui-Qiang Wei, Wei-Dong Lin, Yi-Jian Liao, Su-Hua Wu, Yu-Mei Xue, Li-Chun Wang, Yang Wu","doi":"10.1161/JAHA.124.040490","DOIUrl":"https://doi.org/10.1161/JAHA.124.040490","url":null,"abstract":"<p><strong>Background: </strong>The prognostic significance of small left ventricle (LV) in the general population and its association with cardiovascular disease remain elusive.</p><p><strong>Methods: </strong>Using data from the UK Biobank, 39 363 participants underwent baseline cardiovascular magnetic resonance imaging and were categorized into 3 groups based on left ventricular end-diastolic volume index: small, normal, and large LV. Cox proportional hazards models were applied to evaluate the association between LV size and composite cardiovascular outcomes.</p><p><strong>Results: </strong>An elevated prevalence of small LV was observed among the 4305 participants, with a notable trend toward increased occurrence in older individuals. Over a median follow-up of 5.21 years, 1500 cases of major adverse cardiovascular events, 1096 coronary heart disease, 288 ischemic stroke, and 722 deaths from any cause occurred. After adjusting for multiple confounders, hazard ratios (HRs) of small LV comparing the normal LV were 1.24 (95% CI, 1.07-1.44) for major adverse cardiovascular events, 1.29 (95% CI, 1.09-1.53) for coronary heart disease, 1.53 (95% CI, 1.11-2.09) for ischemic stroke, and 1.33 (95% CI, 1.08-1.64) for death from all causes. Notably, a U-shaped relationship was identified between left ventricular end-diastolic volume index and cardiovascular outcomes. Subgroup analysis revealed that, compared with women, the presence of a small LV in men exhibited a significant correlation with adverse cardiovascular events, thereby demonstrating potential value in disease prediction and risk stratification.</p><p><strong>Conclusions: </strong>These findings highlight the importance of considering small LV as a prognostic marker for cardiovascular disease and underscore the need for further research to elucidate the underlying mechanisms and develop targeted interventions.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040490"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651200","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":"Effects of Intracoronary SuperSaturated Oxygen Therapy on Myocardial Blood Flow, Microvascular Obstruction, and Myocardial Salvage in ST-Segment-Elevation Myocardial Infarction in Swine Ischemia/Reperfusion Model.","authors":"Pedro H C Melo, Mateusz Kachel, Kacper Nowak, Yanping Cheng, Paul Wilburn, Donald Blum, Ramu Perumal, Jeffrey L Creech, Gilles Barone-Rochette, Robert A Kloner, Juan F Granada, Daniel Burkhoff, Grzegorz L Kaluza","doi":"10.1161/JAHA.124.038891","DOIUrl":"https://doi.org/10.1161/JAHA.124.038891","url":null,"abstract":"<p><strong>Background: </strong>Early reperfusion after ST-segment-elevation myocardial infarction is essential for limiting infarct size. However, reperfusion injury can lead to progressive microvascular obstruction (MVO), reducing myocardial blood flow (MBF), aggravating ischemia and myocardial necrosis. We hypothesized that SuperSaturated Oxygen (SSO₂) Therapy may reduce infarct size by alleviating MVO, so we evaluated the effects of SSO₂ on the time course of MBF and MVO in a preclinical ischemia/reperfusion model.</p><p><strong>Methods: </strong>Twelve swine surviving 90 minutes of balloon-induced anterior ST-segment-elevation myocardial infarction and 15-minute auto-reperfusion, were assigned to 120 minutes of SSO₂ (n=6) or further 120 minutes of auto-reperfusion (control, n=6). Microspheres were injected into the left ventricle at multiple time points to assess MBF, calculated as the total blood flow within areas at risk normalized to the total flow within remote zones. An angiography-derived index of microcirculatory resistance was analyzed. MVO and infarct zones were identified using thioflavin-S and 2,3,5-triphenyl tetrazolium chloride staining and quantified with ImageJ software.</p><p><strong>Results: </strong>SSO₂ Therapy significantly reduced MVO compared with controls (4.64% versus 13.00% of left ventricular area; <i>P</i><0.001) and improved myocardial salvage index (MSI, 64.76% versus 43.11%; <i>P</i>=0.03). MBF was significantly higher in the SSO₂ group compared with controls at the end of therapy (1.1 versus 0.59; <i>P</i>=0.03). In the controls, following initial hyperemia, flow decreased significantly at 165, 195, and 225 minutes (<i>P</i>=0.01). Conversely, the SSO₂ group showed no significant decrease in MBF in the same interval (<i>P</i>=0.38). Median angiography-derived index of microcirculatory resistance values showed a nonsignificant trend of reduced final microvascular resistance in the SSO₂ group only.</p><p><strong>Conclusions: </strong>In a translational ST-segment-elevation myocardial infarction model, SSO₂ prevented a reduction in MBF during the 120-minute reperfusion period, with significantly increased MBF at the end of the experiment. MBF improvement was translated to a 64% relative reduction in the extent of MVO, and a 50% relative increase in the myocardial salvage index.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038891"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651202","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":"Effects of Warfarin on the Risks of Mortality, Acute Heart Failure, and Infection Resolution in Patients With Infective Endocarditis: A Target Trial Emulation.","authors":"Teddy Tai Loy Lee, Chengsheng Ju, Sunny Ching Long Chan, Oscar Hou In Chou, Jeffrey Shi Kai Chan, Sharen Lee, Tong Liu, Shuk Han Cheng, Yuhui Zhang, Bernard Man Yung Cheung, Abraham Ka-Chung Wai, Li Wei, Gary Tse","doi":"10.1161/JAHA.125.041965","DOIUrl":"https://doi.org/10.1161/JAHA.125.041965","url":null,"abstract":"<p><strong>Background: </strong>Infective endocarditis (IE) can be complicated by acute heart failure and bacteremia, which can account for increased mortality. The role of anticoagulation with warfarin in IE is controversial. This study aimed to study the effects of anticoagulation with warfarin on survival in patients with IE, through reducing the risks of thromboembolism and possibly shortening infection time.</p><p><strong>Methods: </strong>This was a retrospective population-based cohort study using the Clinical Data Analysis and Reporting System from Hong Kong. Patients diagnosed with IE between January 1, 1997 and August 31, 2020 were identified using <i>International Classification of Diseases, Ninth Revision</i> (<i>ICD-9</i>) codes. A target pragmatic trial was emulated using the observational data with cloning-censoring-weighting approach, comparing the treatment effect of initiation warfarin within 14 days versus no warfarin on the risk of all-cause mortality, acute heart failure, and achieving negative blood culture in patients with IE. Pooled logistic regression was applied to estimate 12-week survival or cumulative incidence differences and risk ratios (RRs).</p><p><strong>Results: </strong>A total of 5121 patients with IE with an average age of 55.7 years (SD:18.9) were included. Warfarin use was associated with lower risks of all-cause mortality with 12-week survival difference of 6.5% (95% CI, 2.6%-9.9%) and RR of 0.72 (95% CI, 0.57-0.88) and a greater benefit of achieving negative blood cultures with 12-week cumulative incidence difference of 11.4% (95% CI, 5.4%-16.5%) and RR of 1.13 (95% CI, 1.06-1.20) but similar risks of acute heart failure (RR, 1.07 [95% CI, 0.87-1.30]).</p><p><strong>Conclusions: </strong>Patients with IE initiating warfarin had significantly lower risk of mortality with potential benefits on achieving negative blood cultures, suggesting benefit in infection resolution but a similar risk of acute heart failure.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041965"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651204","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":"Endothelial Activation and Stress Index Is Associated With Adverse Maternal and Perinatal Outcomes in Preeclampsia.","authors":"Anna S Scholz, Annabel Kussner, Michael Elsässer, Thomas Luft, Stephanie Wallwiener, Alexandra von Au","doi":"10.1161/JAHA.125.041059","DOIUrl":"https://doi.org/10.1161/JAHA.125.041059","url":null,"abstract":"<p><strong>Background: </strong>Endothelial dysfunction represents a key driver in the development of preeclampsia. The Endothelial Activation and Stress Index (EASIX) is a validated predictor of endothelial-related complications in diverse clinical settings beyond obstetrics. Therefore, we aimed to assess the predictive performance of EASIX for adverse maternal and perinatal outcomes in pregnancies with preeclampsia.</p><p><strong>Methods: </strong>This retrospective study analyzed data from 986 patients with preeclampsia who delivered at Heidelberg University Hospital between 2017 and 2022. The primary end points were adverse maternal (death; kidney failure; pulmonary edema; eclampsia; disseminated intravascular coagulation; hemorrhage; cerebrovascular event; and hemolysis, elevated liver enzymes, low platelets syndrome); and perinatal events (death, stillbirth, preterm delivery, placental abruption, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis). EASIX was calculated as a product of lactate dehydrogenase and creatinine, both divided by platelet counts.</p><p><strong>Results: </strong>Five hundred forty-two patients were eligible for the analysis. EASIX was significantly elevated in patients with a maternal adverse event (1.41±0.86 versus 0.87±0.5, <i>P</i><0.0001) or perinatal adverse event (1.05±0.65 versus 0.93±0.59, <i>P</i>=0.046) compared with patients without an adverse event. EASIX was independently associated with adverse maternal (adjusted odds ratio [aOR], 2.90 [2.00-4.19]) and perinatal events (aOR, 2.02 [1.21-3.39]). These associations were emphasized when stratifying for early-onset preeclampsia. EASIX levels of the highest tertile were associated with the shortest remaining time to delivery (adjusted hazard ratio, 2.10 [1.66-2.66]).</p><p><strong>Conclusions: </strong>Our findings underline EASIX as an easily available predictive marker of the risk of maternal and perinatal adverse outcomes in patients with preeclampsia. We propose that EASIX may be useful to stratify the individual risk of adverse events, especially in patients with early-onset preeclampsia.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041059"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651205","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":"Fetal Cerebrovascular Response to Maternal Hyperoxia Testing and Association With Brain Growth and Postnatal Brain Injury in Congenital Heart Disease.","authors":"Mariam Taleb, Jing Liu, Duan Xu, Yii Zhao, Anita J Moon-Grady, Patrick S McQuillen, Shabnam Peyvandi","doi":"10.1161/JAHA.125.042014","DOIUrl":"https://doi.org/10.1161/JAHA.125.042014","url":null,"abstract":"<p><strong>Background: </strong>Neurodevelopmental outcomes are impaired in significant congenital heart disease (CHD) with prenatal origins. The cerebrovascular response to maternal hyperoxia (MH) varies in fetuses with CHD, which may reflect brain health in utero. We investigated the association between lack of cerebrovascular reactivity with MH and adverse neurologic outcomes in CHD measured as brain growth and risk of postnatal white matter injury.</p><p><strong>Methods: </strong>This is a prospective cohort study of pregnant participants whose fetuses had CHD requiring a neonatal operation. We performed fetal echocardiograms with MH, fetal brain magnetic resonance imaging (MRI), and postnatal preoperative brain MRI. A ≥5% change in middle cerebral artery pulsatility index with MH defined reactivity. Total brain volume was measured on MRIs. The neonatal MRI was assessed for white matter injury. Regression analyses compared responders versus nonresponders, then stratified by hypoplastic left heart syndrome and d-transposition of the great arteries groups.</p><p><strong>Results: </strong>Fifty-five participants underwent fetal imaging. Forty-nine neonates underwent brain MRI. Among subjects with hypoplastic left heart syndrome, at each gestational week, total brain volume was 17.8 mL greater in responders (95% CI, 3.3-32.3; <i>P</i>=0.02). This pattern was not seen in d-transposition of the great arteries. Postnatal white matter injury was less common in responders.</p><p><strong>Conclusions: </strong>Lack of fetal cerebrovascular response to MH is associated with smaller total brain volume beginning in utero in hypoplastic left heart syndrome. Postnatal white matter injury is more common among nonresponders. MH testing can help identify individual fetuses with CHD at highest risk for adverse neurologic outcomes, particularly those with hypoplastic left heart syndrome.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042014"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651207","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}