Journal of the American Heart Association最新文献

{"title":"Role of Cardiovascular Health in the Bidirectional Progression Trajectories Between Cardiovascular Disease, Type 2 Diabetes, and Cancer.","authors":"Yu Peng, Peng Wang, Fubin Liu, Xixuan Wang, Changyu Si, Jianxiao Gong, Huijun Zhou, Fangfang Song","doi":"10.1161/JAHA.124.038180","DOIUrl":"https://doi.org/10.1161/JAHA.124.038180","url":null,"abstract":"<p><strong>Background: </strong>There existed bidirectional associations of cardiovascular disease (CVD) and type 2 diabetes (T2D) with cancer, partly attributed to their shared risk factors. We aimed to explore the role of cardiovascular health (CVH) in bidirectional transitions between CVD, T2D, and cancer.</p><p><strong>Methods: </strong>Based on the UK Biobank, we used 2 subcohorts: a disease-free cohort of 277 997 individuals without cancer, CVD, and T2D; and a disease survivor cohort consisting of 61 971 cases with cancer, CVD, and T2D at baseline. The CVH was assessed on the basis of Life's Essential 8 score. We conducted the multistate model and Cox proportional hazards model to explore the role of CVH in bidirectional transitions between CVD, T2D, and cancer in disease-free and disease survivor cohorts, respectively.</p><p><strong>Results: </strong>High CVH was significantly associated with a lower transition risk from CVD to cancer (hazard ratio, 0.822 [95% CI, 0.693-0.975]). On the other hand, increased CVH was related to reduced risks of progression from cancer to CVD and T2D (both <i>P</i> for trend<0.001), particularly in the high CVH group. For disease survivor cohorts, per 10-point increase in CVH was associated with >10% lower cancer risk in CVD and T2D cases, and a 16% and 42% reduction in the risk of incident CVD and T2D among cancer survivors, respectively.</p><p><strong>Conclusions: </strong>High CVH was related to a decreased risk of bidirectional transitions between CVD, T2D, and cancer. This highlighted the significance of maintaining high CVH throughout the life span for the primary prevention of CVD, T2D, and cancer.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038180"},"PeriodicalIF":5.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506059","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 No-Flow Time, Prehospital Low-Flow Time, and Conversion to Nonshockable Rhythm in Patients With Out-of-Hospital Cardiac Arrest Presenting With Initial Shockable Rhythm: A Nationwide Prospective Study in Japan.","authors":"Kenji Kandori, Satoshi Nakajima, Tasuku Matsuyama, Tetsuhisa Kitamura, Hiromichi Narumiya, Masahito Hitosugi, Yohei Okada","doi":"10.1161/JAHA.124.038725","DOIUrl":"https://doi.org/10.1161/JAHA.124.038725","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrest (OHCA) with initial shockable rhythm generally has a favorable prognosis. However, the prognosis worsens when this rhythm transitions to nonshockable rhythm on hospital arrival. This study aimed to investigate the association between no-flow time (NFT), prehospital low-flow time (LFT), and the conversion to nonshockable rhythm on hospital arrival in patients with OHCA initially exhibiting shockable rhythm.</p><p><strong>Methods: </strong>We analyzed adult patients with OHCA from the JAAM-OHCA (Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest) registry (June 2014-December 2020) with initial shockable rhythm. The primary outcome was rhythm conversion to nonshockable on hospital arrival. Adjusted odds ratios (aORs) with 95% CIs were calculated using a logistic model to examine the associations between NFT, prehospital LFT, and rhythm conversion.</p><p><strong>Results: </strong>Of 68 110 patients, 3720 patients were included in our analysis. On hospital arrival, 27.9% patients achieved return of spontaneous circulation, 32.8% maintained shockable rhythm, and 39.3% transitioned to nonshockable rhythm (718 to pulseless electrical activity, 744 to asystole). Median NFT was 4 minutes (interquartile range [IQR], 1-9 minutes), and median prehospital LFT was 22 minutes (IQR, 14-31 minutes). Longer NFT and prehospital LFT were associated with higher aORs of rhythm conversion: NFT (5-9 minutes: aOR, 1.38 [95% CI, 1.14-1.67]; ≥10 minutes: aOR, 1.75 [95% CI, 1.44-2.14]); and prehospital LFT (15-19 minutes: aOR, 2.56 [95% CI, 2.00-3.27]; 20-29 minutes, aOR, 4.73 [95% CI, 3.83-5.85]; ≥30 minutes, aOR, 6.85 [95% CI, 5.49-8.56]).</p><p><strong>Conclusions: </strong>Prolonged NFT and prehospital LFT were significantly associated with rhythm conversion to nonshockable on hospital arrival in patients with OHCA with initial shockable rhythm at the scene.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038725"},"PeriodicalIF":5.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505579","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":"OPTILOW: A Low-Profile Approach for Implanting Optimus-L Stents in Infants and Children.","authors":"Katarzyna Gendera, James R Bentham, Stanimir Georgiev, Mohamed Kasem, Peter Ewert, Jörg Michel, Raymond N Haddad","doi":"10.1161/JAHA.124.038301","DOIUrl":"https://doi.org/10.1161/JAHA.124.038301","url":null,"abstract":"<p><strong>Background: </strong>Stent implantation poses challenges in small children due to their limited vessel size and rapid growth. This multicenter study evaluates in vivo efficacy of implanting Optimus-L stents in small patients using a low-profile approach.</p><p><strong>Methods: </strong>We retrospectively reviewed data from children weighing ≤20 kg with congenital heart stenotic lesions who received Optimus-L stents manually mounted on small-sized balloon catheters (diameter ≤12 mm) using a hand-actuated compression tool and implanted through small-sized sheaths (≤8 Fr) at our institutions between May 2022 and January 2024. Stent performance was assessed.</p><p><strong>Results: </strong>We identified 28 patients (67.8% male) with median age and weight of 3.4 years (interquartile range [IQR], 1.5-5.5) and 12.9 kg (IQR, 9.1-16.4). Six (21.4%) were infants, 11 (39.3%) ≤10 kg. Stenotic lesions included 16 branch pulmonary arteries, 9 aortic isthmus, 2 right ventricular outflow tracts, and 1 Glenn anastomosis. Percentage of stenosis was 50% (IQR, 36%-58%). All implantations were successful without complications. The procedures mostly used 7 Fr sheaths for stents on 6, 7, and 8 mm balloons and 8 Fr sheaths for 9, 10, 12 mm balloons. Median stent expansion percentage was 95% (IQR, 90%-96%). Median vessel diameters increased from 4.6 mm (IQR, 3.8-5.1) to 8.8 mm (IQR, 7.5-9.5) (<i>P</i><0.001), with median stenosis expansion at 103% (IQR, 51%-146%). Median stent shortening was 1.9% (IQR, 0%-3.9%). Two patients required redo stent balloon dilation after 18 and 20 months. Median follow-up was 8 months (IQR, 3.2-13.2). Median last recorded Doppler velocity on implanted stents was 1.6 m/s (IQR, 1.2-2).</p><p><strong>Conclusions: </strong>Optimus-L stents can safely treat arterial and venous stenosis in infants and small children via a low-profile approach with good outcomes.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038301"},"PeriodicalIF":5.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506003","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":"Synthetic Data for the Get With The Guidelines-Stroke Registry.","authors":"Lanjing Wang, Vihaan Manchanda, Holly Picotte, Chandler Beon, Jennifer L Hall, Juan Zhao, Xue Feng","doi":"10.1161/JAHA.124.039667","DOIUrl":"https://doi.org/10.1161/JAHA.124.039667","url":null,"abstract":"<p><p>The American Heart Association's Get With The Guidelines-Quality Improvement registry is a vital resource for real-world cardiovascular and stroke data and research, containing >14 million records from >2800 participating hospitals. To facilitate and streamline research, we aim to generate a synthetic data set that increases access to real-world data and facilitates data exploration of the Get With The Guidelines-Stroke registry. We first randomly sampled 1000 records from the entire registry data set from 2005 to 2021 containing 7.8 million records. To preserve privacy and break the links from the original data, we shifted all data time variables and replaced all patient identifiers. To evaluate the generated synthetic data, we compared the distributions of patient demographics (eg, age, race, sex) and other key stroke-related measures. The generated synthetic data exhibited similar distributions in age, race, sex, and time-sensitive metrics such as door-to-needle time and time to intravenous thrombolytic therapy, demonstrating that this open access data set can provide all researchers the opportunity to explore real-world cardiovascular and stroke data.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039667"},"PeriodicalIF":5.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505578","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":"Growth Rate Assessed by Vascular Deformation Mapping Predicts Type B Aortic Dissection in Marfan Syndrome.","authors":"Carlos Alberto Campello Jorge, Prabhvir Singh Marway, Nicasius S Tjahjadi, Heather A Knauer, Himanshu J Patel, Marion Hofmann Bowman, Kim Eagle, Nicholas S Burris","doi":"10.1161/JAHA.124.039179","DOIUrl":"https://doi.org/10.1161/JAHA.124.039179","url":null,"abstract":"<p><strong>Background: </strong>Patients with Marfan syndrome (MFS) are at a high risk of type B aortic dissection (TBAD). Aortic growth and elongation have been suggested as risk factors for TBAD. Vascular deformation mapping is an image analysis technique for mapping 3-dimensional aortic growth on routine computed tomography angiography (CTA) scans. We aimed to use vascular deformation mapping to examine the value of aortic growth rate in the descending thoracic aorta, among other imaging biomarkers, to identify the factors associated with risk of TBAD in MFS.</p><p><strong>Methods: </strong>Computed tomography angiography scans spanning 2004 to 2023 from adult patients with MFS with native descending thoracic aorta were analyzed by vascular deformation mapping. Other measurements included multilevel thoracoabdominal aortic diameters and the length of the descending thoracic aorta by centerline analysis.</p><p><strong>Results: </strong>Among the 105 patients with MFS analyzed, 63.8% were men, with median age of 40 (range, 18-73) years and a median surveillance interval of 5.3 (range, 2.0-18.3) years. During surveillance, 12 (11.4%) patients developed TBAD. Patients with TBAD had a higher radial growth rate (0.63 versus 0.23 mm/year; <i>P</i><0.001) and elongation rate (2.4 versus 0.5 mm/year; <i>P</i><0.001), on univariate and multivariable analysis, but predissection descending aortic diameter was not significantly different. Predictors of growth rate included younger age, higher baseline maximal diameter of the descending thoracic aorta, smoking history, and warfarin use.</p><p><strong>Conclusions: </strong>Radial growth and elongation rates of the descending thoracic aorta were independent predictors of TBAD occurrence in MFS. TBAD often occurred at nonaneurysmal diameters (<4.0 cm). These findings emphasize the role of growth over absolute diameter in risk stratification for TBAD in MFS.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039179"},"PeriodicalIF":5.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505961","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":"Multimorbidity Is Associated With Symptom Severity and Disease Progression in Patients with Paroxysmal Atrial Fibrillation-Data From the RACE V Study.","authors":"Colinda van Deutekom, Martijn E van de Lande, Rajiv Rama, Bao-Oanh Nguyen, Robert G Tieleman, Vanessa Weberndörfer, Martin E W Hemels, Mirko de Melis, Ulrich Schotten, Dominik Linz, Harry J G M Crijns, Isabelle C van Gelder, Michiel Rienstra","doi":"10.1161/JAHA.123.034514","DOIUrl":"https://doi.org/10.1161/JAHA.123.034514","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity is common among patients with atrial fibrillation (AF) and is associated with worse outcomes. We aimed to investigate the association between multimorbidity, AF progression and AF symptom severity in patients with paroxysmal AF.</p><p><strong>Methods and results: </strong>The RACE V (Reappraisal of AF: Interaction Between Hypercoagulability, Electrical Remodeling, and Vascular Destabilization in the Progression of AF) study included patients with paroxysmal AF and continuous rhythm monitoring. Multimorbidity was defined as ≥2 comorbidities (heart failure, hypertension, diabetes, coronary heart disease, kidney dysfunction, moderate or severe mitral valve regurgitation, or obesity). AF symptom severity was assessed via the University of Toronto AF Severity Scale questionnaire. The associations between multimorbidity, AF progression, and AF symptom severity were determined using logistic regression analyses. Median age was 65 (58-71) years and 179 of 417 patients (43%) were women, with a median of 1 (1-2) comorbidities. Median follow-up was 2.2 (1.6-2.8) years. Multimorbidity was associated with AF progression (odds ratio [OR], 2.02 [95% CI, 1.10-3.72], <i>P</i>=0.024) and increased AF symptom severity (OR, 2.67 [95% CI, 1.79-3.99], <i>P</i><0.001). There was a positive dose-response relation between the number of comorbidities and AF progression (OR, 1.40 [95% CI, 1.09-1.79], <i>P</i>=0.008), as well as AF symptom severity (OR, 1.64 [95% CI, 1.35-1.99], <i>P</i><0.001). These results remained significant after adjusting for age.</p><p><strong>Conclusions: </strong>In patients with paroxysmal AF, multimorbidity was associated with AF progression and AF symptom severity. The risk of AF progression and AF symptom severity increased with every additional comorbidity.</p><p><strong>Registration: </strong>URL: clinicaltrials.gov. Unique Identifier: NCT02726698.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e034514"},"PeriodicalIF":5.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506023","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 Maternal Vitamin D₃ Levels in Shaping Adolescent Vascular Health: Evidence From a Spanish Population-Based Birth Cohort.","authors":"Júlia Sangüesa, Sandra Márquez, Parisa Montazeri, Silvia Fochs, Nuria Pey, Augusto Anguita-Ruiz, Charline Warembourg, Elke Rouxel, Tim Nawrot, Patrick De Boever, Bart Elen, Diana B P Clemente, Maribel Casas, Martine Vrijheid","doi":"10.1161/JAHA.124.035273","DOIUrl":"https://doi.org/10.1161/JAHA.124.035273","url":null,"abstract":"<p><strong>Background: </strong>Low gestational vitamin D levels may increase offspring risk of cardiovascular disease from an early age. Studies investigating the impact on offspring macrovascular function have been inconsistent. Few included pulse wave velocity as an arterial stiffness indicator, and none included measures of microvascularization as an early marker of cardiovascular health. This study explored the association between gestational vitamin D levels and macro- and microvascular health across early adolescence.</p><p><strong>Methods and results: </strong>We analyzed data from 430 mother-child pairs from a Spanish birth cohort. 25-hydroxyvitamin D₃ (vitamin D₃) levels were measured in serum at 13 weeks of pregnancy. At 11 and 15 years we assessed macrovascular parameters, including systolic and diastolic blood pressure (mm Hg) and pulse wave velocity (m/s), and microvascular parameters (central retinal artery/vein equivalent (μm)). We used continuous (in ng/mL) and categorical (deficient <20 ng/mL versus adequate >20 ng/mL) deseasonalized 25(OH)D₃ levels as exposure. Mixed effect and linear regression models were conducted. During their pregnancies, nearly 23% of the mothers had deficient vitamin D₃ levels. We did not find statistically significant associations between pregnancy vitamin D₃ levels and macro- and microvascular function markers across adolescence. However, subjects exposed to deficient vitamin D₃ levels showed a nonstatistically significant decrease in pulse wave velocity (<i>β</i>=-0.09 [95% CI, -0.19 to 0.01]) compared with those exposed to adequate levels. There was no evidence of a sex interaction.</p><p><strong>Conclusions: </strong>Our findings show little evidence to support associations between low vitamin D levels during pregnancy and macro- or microvascular health parameters through early adolescence.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e035273"},"PeriodicalIF":5.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506062","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":"Heart Failure Is Associated With Increased Stroke Severity, In-Hospital Mortality, Major Adverse Cardiovascular Events, and Complications: Insights From the Chinese Stroke Center Alliance.","authors":"Guoliang Hu, Hongqiu Gu, Yingyu Jiang, Chunjuan Wang, Yong Jiang, Zixiao Li, Yongjun Wang, Yilong Wang","doi":"10.1161/JAHA.124.036707","DOIUrl":"https://doi.org/10.1161/JAHA.124.036707","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) constitutes the source of various damaging pathophysiological mechanisms in acute ischemic stroke (AIS). The effect of a previous HF on the in-hospital outcomes for patients with AIS still lacks effective research. We aimed to evaluate the severity of stroke, in-hospital mortality, major adverse cardiovascular events, and complications associated with a previous HF in these patients.</p><p><strong>Methods and results: </strong>This cross-sectional study was conducted at 1476 hospitals in the Chinese Stroke Center Alliance. Multivariable logistic regression and propensity score-matched analyses were used to evaluate the association between a history of HF and in-hospital outcomes. Of 836 885 patients with AIS, 1.1% (n=8950) patients had a history of HF. Patients with a history of HF had a higher National Institutes of Health Stroke Scale score at admission (6.0 versus 3.0) than those without a history of HF. Multivariable analysis revealed that a history of HF was associated with an 80% higher risk of all-cause mortality (odds ratio [OR], 1.80 [95% CI, 1.54-2.10]), a 34% higher risk of major adverse cardiovascular events (OR, 1.34 [95% CI, 1.26-1.43]), and a 92% higher risk of complications (OR, 1.92 [95% CI, 1.83-2.02]). Further propensity score matching showed that patients with a history of HF had higher risks of adverse in-hospital outcomes (all-cause mortality: OR, 1.62 [95% CI, 1.30-2.02]; major adverse cardiovascular events: OR, 1.39 [95% CI, 1.26-1.53]; complications: OR, 1.70 [95% CI, 1.58-1.82]).</p><p><strong>Conclusions: </strong>Patients with AIS and a history of HF have increased risks of severe stroke, in-hospital mortality, major adverse cardiovascular events, and complications. Systematic cardiovascular evaluation and integrated multidisciplinary care for patients with AIS in clinical practice are warranted.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036707"},"PeriodicalIF":5.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506016","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":"Protective Effect on Spinal Cord Injury of Prophylactic Cerebrospinal Fluid Drainage in Extensive Aortic Arch Repair for Type A Aortic Dissection: A Retrospective Cohort Study.","authors":"Chenyu Zhou, Bin Hou, Kai Zhang, Shiqi Gao, Fangfang Cao, Yumeng Ji, Enzehua Xie, Jiawei Qiu, Juntao Qiu, Cuntao Yu","doi":"10.1161/JAHA.124.039427","DOIUrl":"https://doi.org/10.1161/JAHA.124.039427","url":null,"abstract":"<p><strong>Background: </strong>Cerebrospinal fluid drainage (CSFD) is commonly used to manage spinal cord injury (SCI) after aortic surgery. However, there is still limited evidence regarding its effectiveness in patients with type A aortic dissection undergoing total arch replacement plus frozen elephant trunk procedure.</p><p><strong>Methods: </strong>A total of 1931 patients were retrospectively enrolled between 2010 and 2023. Patients with high-risk postoperative SCI (N=445) were divided into 2 groups: with or without prophylactic CSFD to evaluate the protective effect of prophylactic CSFD. Patients with postoperative SCI (N=119) were divided into 3 groups, without CSFD, therapeutic CSFD, and prophylactic CSFD, and analyzed to compare the treatment effect of different CSFD strategies.</p><p><strong>Results: </strong>Prophylactic CSFD significantly reduced the incidence of postoperative SCI in high-risk patients (26.9% versus 17.7%, <i>P</i>=0.029), further supported by matching weights analysis of propensity score and conditional logistic regression. Analyses of the SCI population revealed less severe SCI symptoms in patients with prophylactic CSFD, as assessed by the American Spinal Injury Association Impairment Scale (adjusted <i>P</i><0.05). Multivariable ordinal logistic regression showed that compared with those without CSFD, prophylactic CSFD (<i>P</i>=0.003) but not therapeutic CSFD (<i>P</i>=0.981) was beneficial to the in-hospital recovery of postoperative SCI. Long-term SCI outcomes did not differ among groups.</p><p><strong>Conclusions: </strong>A prominent protective effect on SCI occurrence and recovery after the total arch replacement plus the frozen elephant trunk procedure was observed with prophylactic CSFD use in patients with type A aortic dissection. However, the effectiveness of therapeutic CSFD fell short of significance.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039427"},"PeriodicalIF":5.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506026","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":"Evaluation of Systemic Sclerosis Primary Heart Involvement and Chronic Heart Failure in the European Scleroderma Trials and Research Cohort.","authors":"Andrea-Hermina Györfi, Tim Filla, Amin Polzin, Koray Tascilar, Maya Buch, Monique Tröbs, Alexandru-Emil Matei, Paolo Airo, Alexandra Balbir-Gurman, Frederic Kuwert, Carina Mihai, Anna Kabala, Hanna Graßhoff, Julia Callaghan, Yohei Isomura, Jennifer Mansour, Julia Spierings, Anders Heiervang Tennoe, Enrico Selvi, Valeria Riccieri, Anna-Maria Hoffmann-Vold, Christina Bergmann, Georg Schett, Nicolas Hunzelmann, Jacob M van Laar, Lesley Ann Saketkoo, Masataka Kuwana, Elise Siegert, Gabriela Riemekasten, Oliver Distler, Tessa du Four, Vanessa Smith, Marie-Elise Truchetet, Jörg H W Distler","doi":"10.1161/JAHA.124.036730","DOIUrl":"https://doi.org/10.1161/JAHA.124.036730","url":null,"abstract":"<p><strong>Background: </strong>Systemic sclerosis (SSc) primary heart involvement (SSc-pHI) is one of the leading causes of mortality in SSc. We aimed to evaluate risk factors for SSc-pHI and its progression and the outcomes in the EUSTAR (European Scleroderma Trials and Research) cohort.</p><p><strong>Methods: </strong>SSc-pHI was defined according to the World Scleroderma Foundation/Heart Failure Association definition. Data from 5741 patients with SSc in the EUSTAR cohort were analyzed. Additional cardiovascular data were collected from a subcohort of 838 patients with SSc. Lasso regression was used for risk factor analyses. Kaplan-Meier estimator was used for survival analyses. Progression of SSc-pHI was evaluated by a study definition developed by rheumatology and cardiology experts.</p><p><strong>Results: </strong>Risk factors for the presence of SSc-pHI comprised skeletal muscle atrophy (odds ratio [OR], 2.00 [95% CI, 1.00-2.68]), age (OR, 1.91 [95% CI, 1.73-2.03]), male sex (OR, 1.77 [95% CI, 1.42-2.05]), swollen joints (OR, 1.70 [95% CI, 1.47-1.98]), skeletal muscle weakness (OR, 1.38 [95% CI, 1.00-1.85]), and tendon friction rubs (OR, 1.46 [95% CI, 1.00-1.77]) (n=3276). Telangiectasia (OR, 2.10 [95% CI, 1.38-2.72]), intestinal symptoms (OR, 1.70 [95% CI, 1.04-2.42]), age (OR, 1.47 [95% CI, 1.21-1.62]), and antitopoisomerase I antibodies (OR, 1.37 [95% CI, 1.00-1.77]) were associated with an increased risk for new onset of SSc-pHI (n=1000). Survival rate was significantly lower in patients with SSc-pHI than in those without (<i>P</i> value <0.0001, n=3768). Patients with SSc-pHI had a lower survival rate than patients with interstitial lung disease (n=3365). Swollen joints were associated with an increased risk of progressive SSc-pHI (OR, 2.49 [95% CI, 1.79-3.52]) (n=595). Tendon friction rubs (OR, 1.21 [95% CI, 0.94-1.90]) increased the risk of heart failure with preserved ejection fraction in patients with SSc-pHI.</p><p><strong>Conclusions: </strong>We defined progressive SSc-pHI and identified risk factors for new onset and progression of SSc-pHI and for SSc-pHI-associated heart failure with preserved ejection fraction in the largest cohort with SSc. These findings may guide patient stratification for diagnostic workup and therapy.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036730"},"PeriodicalIF":5.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505932","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}