Journal of the American Heart Association最新文献

{"title":"Blood Pressure Variability and Risk of Cardiovascular Events and Mortality in Real-World Clinical Settings.","authors":"Hsin-Lun Li, Hung-Ju Lin, Chih-Hsin Muo, Chung-Yen Lu, Chin-Chi Kuo, Pei-Chun Chen","doi":"10.1161/JAHA.124.037658","DOIUrl":"10.1161/JAHA.124.037658","url":null,"abstract":"<p><strong>Background: </strong>The real-world applicability of long-term blood pressure (BP) variability measurements remains underexplored. We evaluated the association between visit-to-visit BP variability and the risk of cardiovascular events and all-cause mortality using electronic health records.</p><p><strong>Methods: </strong>In this retrospective cohort study at a large academic medical center in Taiwan, we calculated the variability independent of the mean (VIM) and average real variability of BP using electronic health records of 16 945 adults with at least one outpatient BP measurement in any 3 consecutive years from 2012 to 2017. We used Cox proportional hazards models to assess associations between BP variability and cardiovascular events, including cardiovascular deaths, and all-cause mortality through 2020.</p><p><strong>Results: </strong>Over a median follow-up of 4 years, 317 patients experienced cardiovascular events, and 582 died. Adjusted hazard ratios (HRs) for cardiovascular events increased gradually across both VIM and average real variability quartiles of BP. The adjusted HRs (95% CIs) per interquartile range increase in systolic BP variability was 1.24 (1.09-1.41) for VIM and 1.11 (1.01-1.23) for average real variability. For diastolic BP, the HRs (95% CIs) were 1.22 (1.09-1.36) and 1.13 (1.02-1.24), respectively. Similar results were observed for all-cause mortality except a weaker association with average real variability of diastolic BP (HR, 1.08 [95% CI, 0.99-1.17]). The association between VIM of BP and risk of cardiovascular events was consistent across patient subgroups.</p><p><strong>Conclusions: </strong>In the electronic health records analysis, visit-to-visit BP variability was independently associated with the risk of cardiovascular events and all-cause mortality. Our findings indicate the applicability of BP variability indices in real-world health care settings.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037658"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144370","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":"Climate Vulnerability and Cardiovascular-Kidney-Metabolic Disease in the United States.","authors":"Pedro Rafael Vieira de Oliveira Salerno, P Grace Tee Lewis, Zhuo Chen, Jean-Eudes Dazard, Sarju Ganatra, Eman Nayaz Ahmed, Khurram Nasir, Salil V Deo, Sanjay Rajagopalan, Sadeer Al-Kindi","doi":"10.1161/JAHA.124.038251","DOIUrl":"10.1161/JAHA.124.038251","url":null,"abstract":"<p><strong>Background: </strong>There is an incomplete understanding of the impact of climate change on cardiovascular-kidney-metabolic (CKM) syndrome. Although climate change affects all Americans, certain communities and individuals may suffer a disproportionate burden. Therefore, this study's objective was to explore the relationship between the Climate Vulnerability Index domains and the prevalence of CKM components in the United States.</p><p><strong>Methods: </strong>This cross-sectional study obtained health outcomes from Centers for Disease Control and Prevention Population Level Analysis and Community Estimates (2021) and assessed the census tract-level prevalence of coronary heart disease, chronic kidney disease, obesity, diabetes, dyslipidemia, and hypertension. ANOVA was used to assess statistically significant differences in the means of CKM components between quartiles of each climate change domain. Linear regression models assessed the association between each domain and outcome, followed by models adjusted by baseline Climate Vulnerability Index components. Fully adjusted models included all 3 climate change domains and the baseline Climate Vulnerability Index components.</p><p><strong>Results: </strong>Data for 70 300 census tracts, covering 299.8 million individuals, were included. Statistically significant differences (<i>P</i><0.001) in CKM prevalence were found between quartiles of all climate change domains. These associations persisted after adjusting for baseline domains (environment, social/economic, and infrastructure) and in the full model including all domains.</p><p><strong>Conclusions: </strong>The Climate Vulnerability Index's climate change component was associated with the prevalence of CKM components (coronary heart disease, chronic kidney disease, obesity, diabetes, dyslipidemia, and hypertension). These findings suggest that populations with CKM may be associated with increased climate vulnerability, underscoring the need for a deeper understanding of climate change as a determinant of health.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038251"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144371","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":"Burden of High Systolic Blood Pressure in the Eastern Mediterranean Region, 1990 to 2021: Results From the Global Burden of Disease Study 2021.","authors":"Malihe Rezaee, Mohammad-Mahdi Bastan, Alireza Yaghoobi, Amir Hossein Behnoush, Kaveh Hosseini","doi":"10.1161/JAHA.124.039158","DOIUrl":"10.1161/JAHA.124.039158","url":null,"abstract":"<p><strong>Background: </strong>High systolic blood pressure (HSBP) is a significant public health issue, increasing the risk of various chronic and acute diseases. This study comprehensively analyzes the HSBP-attributed burden in the Eastern Mediterranean Region (EMR).</p><p><strong>Methods: </strong>We extracted and analyzed data on deaths, disability-adjusted life-years (DALYs), years of life lost, years lived with disability, and summary exposure values (SEVs) related to HSBP from the Global Burden of Disease (GBD) 2021 study for the EMR countries from 1990 to 2021.</p><p><strong>Results: </strong>In 2021, HSBP accounted for an estimated age-standardized death rate of 228.4 (95% UI: 189.6 to 266) and DALYs rate of 4554.9 (3719.7 to 5279.6) per 100,000 population in the EMR. From 1990 to 2021, there was a 12.7% and 14.1% decline in age-standardized death and DALYs rates linked to HSBP, respectively, with greater reduction among women. During this period, all countries except Pakistan and Libya experienced a decrease in age-standardized death and DALYs rates, and also countries with higher socio-demographic index (SDI) reported a lower burden attributable to HSBP in 2021. Despite the overall reduction in burden, age-standardized SEVs of HSBP increased by 21.3% (12.2% to 31.7%) from 1990 to 2021, with a more significant rise in men than in women.</p><p><strong>Conclusion: </strong>While the HSBP-attributed burden has decreased in the EMR from 1990 to 2021, the increasing trend in age-standardized SEVs indicates a rising exposure. Therefore, implementing effective strategies aimed at further reducing the burden and exposure values of HSBP in this region is essential.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039158"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175775","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":"Fitness First: How High-Intensity Interval Training Responses Shape Clinical Outcomes During a 15-Year Follow-Up Among Patients With Heart Failure.","authors":"Thomas G Bissen, Joseph D Vondrasek","doi":"10.1161/JAHA.125.042535","DOIUrl":"10.1161/JAHA.125.042535","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042535"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175781","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":"Safety and Efficacy of Dapagliflozin in Patients With Systemic Right Ventricular Dysfunction: DAPA-SRV Trial.","authors":"Mathieu Albertini, Victor Waldmann, Pauline David, Alexis Barat, Antoine Legendre, Anne-Solene Chaussade, Laurence Iserin, Magalie Ladouceur","doi":"10.1161/JAHA.124.040302","DOIUrl":"10.1161/JAHA.124.040302","url":null,"abstract":"<p><strong>Background: </strong>Heart failure is the leading cause of death in adults with a systemic right ventricle (sRV). While dapagliflozin has proven benefits in patients with acquired heart diseases and heart failure with reduced ejection fraction, its impact remains unknown in patients with an sRV. We aimed to evaluate the safety and efficacy of dapagliflozin in this population.</p><p><strong>Methods: </strong>We conducted a prospective, observational, single-center study including symptomatic patients (New York Health Association [NYHA] functional class ≥2) with sRV dysfunction despite medical treatment, enrolled from February 2023 to February 2024. Patients were assessed at baseline and 3 and 6 months after dapagliflozin introduction. The primary end point was 6-Minute Walk Distance (6MWD). Secondary end points included N-terminal pro-B-type natriuretic peptide, quality of life (according to the Kansas City Cardiomyopathy Questionnaire-12-item version [KCCQ-12]), NYHA class, systemic and subpulmonary ventricular systolic function, and treatment-related side effects.</p><p><strong>Results: </strong>A total of 32 patients were included. The mean age of the participants was 48 years (range, 19-79 years), 20 (62%) patients were men, 12 (38%) had congenitally corrected transposition of the great arteries, and 20 (62%) had transposition of the great arteries with atrial switch. At 6 months, 6MWD significantly improved (585 m versus 558 m, <i>P</i>=0.04). Quality of life (91.5 versus 80.5, <i>P</i><0.001), sRV function (fractional area change: 33% versus 28% [<i>P</i>=0.02]; global longitudinal strain: -13.1% versus -11.2% [<i>P</i>=0.04]) also improved. No significant side effects were observed.</p><p><strong>Conclusions: </strong>This is the first study, to our knowledge, demonstrating the functional benefits and safety of dapagliflozin in symptomatic patients with sRV dysfunction under medical treatment with sacubitril/valsartan. These results support the need for larger randomized trials to further evaluate this therapeutic option in this population.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040302"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175798","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":"Fasting Before Cardiac Catheterization: Still Necessary? A Systematic Review and Meta-Analysis of Randomized Clinical Trials.","authors":"Adil Salihu, Stephane Fournier, Sarah Hugelshofer, Quentin Liabot, Victor Weerts, Georgios Tzimas, Valentina Rancati, Clemence Ferlay, Aurelia Zimmerli, Olivier Muller, Henri Lu, Panagiotis Antiochos, Orestis Efthimiou, David Meier","doi":"10.1161/JAHA.124.040445","DOIUrl":"10.1161/JAHA.124.040445","url":null,"abstract":"<p><strong>Background: </strong>Fasting before elective or nonurgent coronary angiography is commonly recommended to reduce the risk of adverse events, such as aspiration pneumonia. This systematic review and meta-analysis aimed to evaluate the impact of fasting versus nonfasting protocols on patient outcomes and satisfaction.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and Cochrane Library databases for randomized clinical trials comparing fasting and nonfasting states before cardiac catheterization. The primary outcome was a composite of adverse events including pneumonia, hypoglycemia, and nausea/vomiting. Secondary outcomes included individual adverse events and patient satisfaction. For each binary outcome we estimated crude event probabilities for each treatment arm. Next, we pooled study-specific results in meta-analyses using odds ratio (OR) and risk difference as effect measures for binary outcomes and standardized mean difference for satisfaction.</p><p><strong>Results: </strong>We identified 8 randomized clinical trials, including a total of 3147 patients. Our meta-analysis showed no evidence of a difference in the incidence of composite adverse events between fasting and nonfasting groups in ORs (OR, 1.08, [95% CI, 0.78-1.51], where OR<1 favors fasting). The crude event probabilities were 4.9% and 4.4% for fasting and nonfasting groups respectively, with an estimated risk difference =0.4% (-1.1% to 1.8%), where risk difference <0 favors fasting. Patient satisfaction was found higher in nonfasting protocols, standardized mean difference 0.62 (0.11-1.13).</p><p><strong>Conclusion: </strong>Our meta-analysis found no evidence that fasting before elective coronary angiography reduces adverse events. However, we found evidence that fasting reduces patient satisfaction. These findings question the necessity of fasting protocols in this context.</p><p><strong>Registration: </strong>URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024595465; Unique identifier: CRD42024595465.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040445"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121288","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":"Impact of Vestibular Rehabilitation and Dual-Task Training on Balance and Gait in Survivors of Stroke: A Systematic Review and Meta-Analysis.","authors":"Brooke Nairn, Nehzat Koohi, Diego Kaski, Doris-Eva Bamiou, Marousa Pavlou","doi":"10.1161/JAHA.124.040663","DOIUrl":"10.1161/JAHA.124.040663","url":null,"abstract":"<p><strong>Background: </strong>Evidence supports that vestibular rehabilitation therapy (VRT) improves the static and dynamic balance of survivors of stroke, yet VRT is rarely included in stroke rehabilitation guidelines. We aim to answer the question: What are the effects of VRT or dual-task training (DTT) on balance and gait for reducing the risk of falls among survivors of late subacute and chronic stroke?</p><p><strong>Methods: </strong>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement guidelines, electronic databases PubMed, EMBASE, MEDLINE, Web of Science, and Scopus for English were searched to identify randomized controlled trials published within the past 10 years in the English language, investigating VRT for patients with late subacute and chronic stroke.</p><p><strong>Results: </strong>Eleven studies (n=509 participants) were included in the systematic review, and 10 studies (n=413 participants) were included in a meta-analysis. The average participant age was 60.9 years, with 62.11% male. On average, 36 months had passed since stroke onset. The pooled effect standardized mean difference suggests that VRT has a significantly large effect for improving balance (standardized mean difference, 0.64 [95% CI, 0.44-0.85], <i>P</i><0.00001), particularly from balance-specific training (standardized mean difference, 1.07 [95% CI, 0.70-1.45], <i>P</i>=0.002). Dual-task training (DTT) moderately improved gait (standardized mean difference, 0.46 [95% CI, 0.18-0.74], <i>P</i>=0.001), with greater benefits from DTT compared with single-task training.</p><p><strong>Conclusions: </strong>Despite substantial heterogeneity across studies, the evidence supports that VRT, can probably improve balance, and DTT may improve gait outcomes among survivors of late subacute and chronic stroke. An optimal program for this population should focus on balance and DTT with subcomponents of gait and strength training. Further research is required to determine the optimal number of weeks, sessions/week, and duration (minutes) of VRT sessions.</p><p><strong>Registration: </strong>URL:  https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023450254.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040663"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129510","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":"Impact of Statin Nonacceptance on Cardiovascular Outcomes in Patients With Diabetes.","authors":"Nisarg Shah, Zhou Lan, C Justin Brown, Seth S Martin, Alexander Turchin","doi":"10.1161/JAHA.124.040464","DOIUrl":"10.1161/JAHA.124.040464","url":null,"abstract":"<p><strong>Background: </strong>Many patients with diabetes do not accept statin therapy despite being at increased risk for cardiovascular events compared with the general population. The effects of delaying statin therapy are not well-understood.</p><p><strong>Methods: </strong>This is a retrospective cohort study that followed adults with diabetes and no preexisting atherosclerotic cardiovascular disease at the Mass General Brigham integrated health system between 2000 and 2018. The exposure was immediate versus delayed statin acceptance by patients who were recommended statin therapy. The primary outcome was the composite incidence of myocardial infarction and ischemic stroke.</p><p><strong>Results: </strong>Among the 7239 study patients, the median age was 55.0 years, and 52.0% were women. Within this cohort, 1280 (17.7%) delayed statin therapy by a mean±SD of 2.7±3.1 years. Patients who delayed statin therapy had higher mean low-density lipoprotein cholesterol levels while they were not prescribed a statin (126.4 versus 99.2 mg/dL, <i>P</i><0.001). The cumulative 10-year rate of myocardial infarctions and ischemic strokes was 6.4% for patients who initiated statins immediately versus 8.5% for patients who delayed statin therapy (<i>P</i>=0.001). In a multivariable analysis adjusted for demographic characteristics and comorbidities, statin nonacceptance was an independent risk factor for myocardial infarction and ischemic stroke (hazard ratio [HR], 1.49 [95% CI, 1.16-1.90]; <i>P</i>=0.002). Mediation analysis showed that greater low-density lipoprotein cholesterol exposure induced a higher incidence of adverse cardiovascular events (HR, 1.62 [95% CI, 1.46-1.80]; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>Among patients with diabetes, patients who delayed statin therapy had a significantly higher cardiovascular risk; this relationship was mediated by higher low-density lipoprotein cholesterol levels. These findings underscore the importance of timely lipid-lowering for this high-risk patient population and can help guide decision-making by patients and clinicians.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040464"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057729","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":"Development and Validation of Models to Estimate the Incident Risk of Cognitive Impairment and Atherosclerotic Cardiovascular Disease in Older Adults.","authors":"Michael G Nanna, Daniel Wojdyla, Eric D Peterson, Ann Marie Navar, Jeff D Williamson, Lisandro D Colantonio, Stephen Y Wang, Yasser Jamil, Alain G Bertoni, Musarrat Nahid, Abdulla A Damluji, Parag Goyal, Sarwat I Chaudhry, Thomas M Gill, Karen P Alexander","doi":"10.1161/JAHA.124.038949","DOIUrl":"10.1161/JAHA.124.038949","url":null,"abstract":"<p><strong>Background: </strong>Guidelines emphasize using atherosclerotic cardiovascular disease (ASCVD) risk prediction models for treatment decisions, but risk of cognitive impairment is an equally important concern in older adults. Current ASCVD risk prediction models were derived in younger adults and do not include holistic measures of health or predict cognitive impairment.</p><p><strong>Methods: </strong>We utilized data from the Framingham, Framingham Offspring, CHS (Cardiovascular Health Study), and ARIC (Atherosclerosis Risk in Communities) cohorts to derive and validate 2 Selective Functional Prediction models to estimate an older person's (aged ≥75 years) risk within 5 years of developing incident: (1) cognitive impairment; and (2) ASCVD, while accounting for the competing risk of death. Variable selection, including functional status, was based on the least absolute shrinkage and selection operator method. The cognitive impairment (N=3466) and ASCVD (N=4403) model populations were split into derivation and validation cohorts with external validation, then performed in MESA (Multi-Ethnic Study of Atherosclerosis).</p><p><strong>Results: </strong>In the derivation and external validation cohorts (median age, 79 years), 579 (16.7%) and 67 (15.3%) participants developed incident cognitive impairment, respectively; 748 (17.0%) and 80 (8.4%), respectively, experienced an ASCVD event. The cognitive impairment model (baseline Mini-Mental State Examination (MMSE), atrial fibrillation, antidepressant use, mobility impairment, and dependence for grocery shopping) had good discrimination in the internal and external validation cohorts (C index 0.75 and 0.73, respectively). The ASCVD model (employment status, MMSE, aspirin, lipid-lowering medications, blood pressure medications, systolic blood pressure, general health status, high-density lipoprotein cholesterol, triglycerides, creatinine, and mobility impairment) had satisfactory discrimination (C index 0.67) on internal validation and outperformed the pooled cohort equations, but had modest discrimination (C index 0.59) on external validation. Although both models were well calibrated in the internal validation cohorts, they overpredicted risk in the external validation cohort.</p><p><strong>Conclusions: </strong>Accurate prediction of an older person's risk of developing cognitive impairment is possible, but predicting future ASCVD events remains more challenging.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038949"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120384","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":"Cardiac Sympathetic Denervation Mitigated Ischemic Cardiomyopathy Progression in a Rat Model of Sleep Apnea.","authors":"Maximin Détrait, Jonathan Gaucher, Emma Billoir, Sophie Bouyon, Emeline Lemarié, Stéphanie Paradis, Guillaume Vial, Florent Chuffart, Côme Pasqualin, Fabien Hubert, Francesca Rochais, Stéphane Doutreleau, Jean-Louis Pépin, Diane Godin-Ribuot, Elise Belaidi, Claire Arnaud","doi":"10.1161/JAHA.124.038781","DOIUrl":"10.1161/JAHA.124.038781","url":null,"abstract":"<p><strong>Background: </strong>Ischemic cardiomyopathy with comorbid obstructive sleep apnea syndrome is associated with worse long-term outcomes. Intermittent hypoxia (IH), a key feature of obstructive sleep apnea, exacerbates sympathetic activity, hastening cardiac dysfunction and remodeling in ischemic cardiomyopathy rat models. This study explores whether targeted cardiac sympathetic denervation (CSD) can limit IH-induced progression of ischemic cardiomyopathy.</p><p><strong>Methods: </strong>Male Wistar rats underwent CSD, through ablation of the left middle cervical and stellate ganglions, and simultaneously myocardial infarction, via permanent left coronary artery ligation. Three days post surgery, rats were exposed to IH (21%-5% fraction of inspired O₂, 60-second cycle, 8 hours/day) or normoxia. At 6 weeks, calcium transient, sarcomere shortening, and adrenergic reserve in response to isoproterenol (100 nmol/L) were assessed in isolated cardiomyocytes. At 14 weeks, sympathovagal balance, cardiac function, and remodeling were evaluated.</p><p><strong>Results: </strong>Post myocardial infarction, CSD prevented IH-induced blunting of cardiomyocyte response to isoproterenol challenge and reduced cardiac sympathetic activity. In hypoxic animals, CSD reduced post-myocardial infarction alterations in long-term ejection fraction and mitigated cardiomyocyte hypertrophy and apoptosis. Transcriptomic analysis unveiled that CSD triggered biological processes related to cardiac repair and regeneration. Immunohistochemistry further supported these findings, demonstrating increased cardiomyocyte proliferation in the hypoxic group, as indicated by elevated Ki67 expression colocalized with MF20 markers.</p><p><strong>Conclusions: </strong>Our data demonstrate that CSD prevents IH-induced sympathetic hyperactivity, depletion of cardiac adrenergic reserve, and deterioration of cardiac function in a rat model of ischemic cardiomyopathy. This study highlights the intricate interplay between sympathetic activity and hypoxia in cardiac regeneration and underscores the importance of managing sympathetic hyperactivity in ischemic cardiomyopathy, particularly in the context of comorbid obstructive sleep apnea.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038781"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129508","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}