Journal of the American Heart Association最新文献

{"title":"New Echocardiographic Algorithm for Estimating Right Atrial Pressure in Severe Tricuspid Regurgitation: Insights From Simultaneous Cardiac Catheterization.","authors":"Onyou Kim, Jihoon Kim, Ki H Choi, Eun K Kim, Sung-A Chang, Sang-C Lee, Seung W Park, Sung-J Park, Jeong H Yang","doi":"10.1161/JAHA.125.041981","DOIUrl":"https://doi.org/10.1161/JAHA.125.041981","url":null,"abstract":"<p><strong>Background: </strong>The accuracy of echocardiographic estimation of pulmonary artery pressure has been questioned in patients with severe tricuspid regurgitation (TR). This study aimed to evaluate the accuracy of echocardiographic estimates of pulmonary artery pressure compared with simultaneous right heart catheterization (RHC) in patients with severe TR.</p><p><strong>Methods: </strong>In this prospective observational study, a total of 48 patients with severe TR were enrolled between September 2021 and August 2024 at an experienced RHC center. Data were obtained by simultaneously measuring echocardiography and RHC parameters. The correlation between pulmonary arterial systolic pressure (PASP) measured by echocardiography and RHC was analyzed using Pearson correlation and Bland-Altman analysis.</p><p><strong>Results: </strong>The median age was 71.5 years, and 26 (54.2%) of the patients were women. Forty-three (89.6%) patients had secondary TR as the underlying pathogenesis. There was a good correlation (<i>r</i>=0.85 as Pearson correlation, <i>P</i><0.001) between PASP measurements obtained via echocardiography and RHC, with a bias of +1.3 mm Hg and 95% limits of agreement ranging from -12.8 to 15.5 mm Hg. Incorporating parameters such as inferior vena cava collapsibility of ≤20%, hepatic vein systolic flow reversal, and the V-wave cutoff sign further stratified the estimated right atrial pressure to 10, 15, or 20 mm Hg in patients initially estimated to have a right atrial pressure of 15 mm Hg (<i>P</i><0.001). The use of these new criteria improved the correlation for PASP estimation by echocardiography compared with RHC (<i>r</i>=0.90, <i>P</i><0.001).</p><p><strong>Conclusions: </strong>Echocardiography demonstrated good agreement with invasively measured PASP. Incorporating additional echocardiographic parameters significantly enhanced the accuracy of PASP estimation, suggesting a refined noninvasive diagnostic approach in severe TR.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041981"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651131","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":"Digital Therapeutic Based Randomized Investigation to Improve Glycemic Control in Patients With Type 2 Diabetes and Residual Hyperglycemia on Stable Medical Therapy: Rationale, Design, and Baseline Characteristics of the BRIGHT Trial.","authors":"Mario Enrico Canonico, Judith Hsia, Frederick A Masoudi, Hayden B Bosworth, Stacy Greene, Bryan C Batch, Natia Hamilton, Thiago B de Araujo, Matthew Jackson, Marsha Broussard, Zonda Gooden, Nicole L Guthrie, Bjorn Hansell, Laura Matteliano-Madu, Kara Mosesso, Mark A Berman, Marc P Bonaca","doi":"10.1161/JAHA.124.038737","DOIUrl":"https://doi.org/10.1161/JAHA.124.038737","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of type 2 diabetes continues to rise in the United States and worldwide. Although novel pharmacotherapies have shown benefits, not all patients have access to these medications and of those who do, some are unable to tolerate treatment. Behavior change is long known to be foundational for patients with cardiometabolic disease due to its direct positive impact on health outcomes. Cognitive behavioral therapy delivered by a digital therapeutic has the potential to address access to behavioral therapy for patients with type 2 diabetes.</p><p><strong>Methods: </strong>The BRIGHT (Digital Therapeutic Based Investigation to Improve Glycemic Control in Patients With Type 2 Diabetes and Residual Hyperglycemia on Stable Medical Therapy) Trial (NCT05266625) is a randomized, controlled, multicenter, pragmatic, pivotal trial with open-label extension evaluating the hypothesis that AspyreRx improves glycemic control and cardiometabolic measures in patients with type 2 diabetes compared with a control application added to usual care across a broad range of patients in a real-world setting. The current study objectives are to evaluate the efficacy and safety of AspyreRx at 90 and 180 days compared with a control group and to assess the long-term effectiveness, safety, and impact on health care and medication use over long-term follow up.</p><p><strong>Conclusions: </strong>The AspyreRx digital therapeutic is a Food and Drug Administration approved therapy for patients with type 2 diabetes. Although its efficacy for lowering hemoglobin A1C at 90 days was demonstrated, opportunities remain to better understand the long-term effects and the effectiveness and safety in a broader and more diverse real-world environment. BRIGHT is designed to evaluate these questions using a virtual, decentralized, model and include a diverse site mix designed to better understand real-world effectiveness and generalizability.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038737"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651188","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":"Ventricular Repolarization in Healthy Young Adults Who Use Combusted Cannabis: A Cross-Sectional Parallel Group Comparison Study.","authors":"Katherine Hampilos, Reece Fong, Joshua Sanchez, Isabelle Ruedisueli, Samuel Lopez, Kevin Zhao, Jeff Gornbein, Ziva D Cooper, Holly Middlekauff","doi":"10.1161/JAHA.125.041460","DOIUrl":"https://doi.org/10.1161/JAHA.125.041460","url":null,"abstract":"<p><strong>Background: </strong>Inhaled combusted cannabis and co-use of combusted cannabis and nicotine electronic cigarettes (ECIGs) are emerging trends among young adults, yet the potential cardiovascular disease risks associated with these substances remain unclear. This study examined whether cannabis use increases cardiovascular disease risk, specifically, arrhythmia risk, as estimated by ventricular repolarization, and whether ECIG co-use further amplifies this risk.</p><p><strong>Methods: </strong>A cross-sectional parallel group comparison study was conducted with 3 groups: healthy adults (21-30 years) who (1) chronically use combusted cannabis but no tobacco, (2) chronically co-use both nicotine ECIGs and combusted cannabis, and (3) are nonusers (controls). The primary outcomes, Tpeak-Tend (Tp-e) interval, Tp-e/QT, and Tp-e/QTc, were assessed using 5-minute ECG recordings during supine rest and abrupt standing. Secondary outcomes included resting hemodynamic parameters and heart rate variability.</p><p><strong>Results: </strong>The study enrolled 134 participants (cannabis use=59, cannabis/ECIG co-use=26, control=49). The demographics among the groups did not differ. At supine rest, the Tp-e interval was not different between the combusted cannabis users (88±18 milliseconds) and controls (91±20 milliseconds; <i>P</i>=0.68). In contrast, the Tp-e was significantly shorter in the cannabis/ECIG co-use group (77±15 milliseconds) compared with the cannabis (<i>P</i>=0.017) and control (<i>P</i>=0.003) groups. These findings were confirmed upon abrupt standing. Hemodynamic and heart rate variability parameters did not differ among groups.</p><p><strong>Conclusions: </strong>In healthy young adults, chronic co-use of inhaled combusted cannabis and nicotine ECIGs, but not exclusive cannabis use, is associated with alterations in ventricular repolarization as estimated by Tp-e. The implications of short ventricular repolarization in people who co-use nicotine ECIGs and inhaled combusted cannabis warrant further investigation.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041460"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651237","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":"Mavacamten in Symptomatic Patients Resistant to Previous Advanced Therapy for Obstructive Hypertrophic Cardiomyopathy.","authors":"Daniele Massera, Elizabeth Adlestein, Sumar Frejat, Woon Y Wu, Maria C Reuter, Yuhe Xia, Isabel C Alvarez, Mark V Sherrid","doi":"10.1161/JAHA.125.041565","DOIUrl":"https://doi.org/10.1161/JAHA.125.041565","url":null,"abstract":"<p><strong>Background: </strong>The clinical benefits of mavacamten in patients with obstructive hypertrophic cardiomyopathy previously treated with advanced therapies are not established.</p><p><strong>Methods: </strong>Clinical and echocardiographic outcomes of patients treated with mavacamten for left ventricular outflow obstruction for at least 8 weeks were assessed based on prior treatment with one or more advanced therapies: disopyramide, septal myectomy, alcohol septal ablation, dual-chamber ventricular pacing with short atrioventricular delay; we also evaluated patients with left ventricular outflow obstruction that emerged as major driver of symptoms after aortic valve replacement.</p><p><strong>Results: </strong>We included 115 consecutive patients (mean age 66±12 years, 57% women, wall thickness 17±4 mm) on mavacamten for a median 45 (interquartile range, 22-61) weeks, of whom 53 (46%) patients were previously on disopyramide (n=45); underwent septal myectomy (n=8), alcohol septal ablation (n=6), or forced ventricular pacing (n=11); and 5 had previous aortic valve replacement. New York Heart Association class improved from 2.6±0.5 to 1.8±0.6 (<i>P</i><0.0001) in those with and without prior advanced therapy. Left ventricular systolic dysfunction (ejection fraction <50%) occurred in 12 (10%) patients, 8 (15%) in the advanced treatment group and 4 (7%) in those without (<i>P</i>=0.13). Maximal provoked peak left ventricular outflow gradients decreased from 103 (77-130) mm Hg to 11 (8-21) mm Hg in patients with prior advanced therapy and from 101 (81-130) mm Hg to 13 (8-25) mm Hg in those without (<i>P</i>=0.31).</p><p><strong>Conclusions: </strong>Mavacamten is a safe and effective treatment for symptomatic left ventricular outflow obstruction in patients with obstructive hypertrophic cardiomyopathy resistant to previous advanced pharmacologic therapy, surgery, or alcohol septal ablation or who develop manifest left ventricular outflow obstruction after aortic valve replacement.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041565"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651129","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":"Heterogeneity of Cardiovascular Effects of Second-Line Glucose-Lowering Therapies in Adults With Type 2 Diabetes Across the Range of Moderate Baseline Cardiovascular Risk.","authors":"Yihong Deng, Eric C Polley, Jeph Herrin, Kavya S Swarna, David M Kent, Joseph S Ross, Bradley A Maron, Mindy M Mickelson, Rozalina G McCoy","doi":"10.1161/JAHA.124.040217","DOIUrl":"https://doi.org/10.1161/JAHA.124.040217","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) have favorable cardiovascular outcomes compared with dipeptidyl peptidase-4 inhibitors (DPP4is) and sulfonylureas in adults with type 2 diabetes and high cardiovascular risk. How these benefits vary across lower levels of cardiovascular risk is unknown.</p><p><strong>Methods: </strong>We used nationwide claims data to emulate a comparative effectiveness trial and examine the heterogeneity of treatment effects of GLP-1RAs, SGLT2is, DPP4is, and sulfonylureas on major adverse cardiovascular events (MACEs) among adults with type 2 diabetes and moderate cardiovascular risk (annualized MACE risk 1%-5%, estimated using the annualized claims-based MACE estimator).</p><p><strong>Results: </strong>Among 386 276 included adults with type 2 diabetes, 25.2% had baseline ACME-predicted MACE risk >1% to ≤2% (lower-risk patients) and 13.3% had ACME-predicted risk >4% to ≤5% (higher-risk patients). By year 3 of treatment, higher-risk patients derived greater absolute benefit than lower-risk patients when treated with GLP-1RAs versus sulfonylureas (absolute reduction in the estimated rate of MACE of 3.1% in higher-risk patients and 1.6% in lower-risk patients), SGLT2is versus sulfonylureas (absolute reduction, 3.9% in higher-risk patients and 1.3% in lower-risk patients), and GLP-1RAs versus DPP4is (absolute reduction, 1.6% in higher-risk patients and 0.5% in lower-risk patients). The relative benefits for MACE were also greater in higher-risk than lower-risk patients with SGLT2is versus DPP4is (hazard ratio [HR], 0.78 [95% CI, 0.70-0.87] in higher-risk patients; HR, 0.99 [95% CI, 0.88-1.12] in lower-risk patients). Conversely, the relative benefits of DPP4is and GLP-1RAs versus sulfonylureas were greater in lower-risk patients: HR 0.76 (95% CI, 0.71-0.81) in lower-risk and HR 0.91 (95% CI, 0.97-0.96) in higher-risk patients for DPP4is versus sulfonylureas; HR 0.67 (95% CI, 0.58-0.78) in lower-risk and HR 0.80 (95% CI, 0.70-0.93) in higher-risk patients for GLP-1RAs versus sulfonylurea. Benefits of SGLT2is and GLP-1RAs were comparable across all risk levels.</p><p><strong>Conclusions: </strong>Cardiovascular benefits of SGLT2is and GLP-1RAs exist across all levels of moderate cardiovascular risk, reinforcing the importance of choosing glucose-lowering therapies that can prevent MACE in all people with type 2 diabetes.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040217"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651209","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":"When Is the Broken Heart Most Dangerous? Assessing Risk Factors to Predict Inpatient Death in Takotsubo Cardiomyopathy: Analysis of the National Inpatient Sample for 2021.","authors":"Kayode Emmanuel Ogunniyi, Olumide Damilola Akinmoju, Gbolahan Olatunji, Emmanuel Kokori, Nicholas Aderinto, Ikponmwosa Jude Ogieuhi, Adewunmi Akingbola, Muhammadul-Awwal Irodatullah Bisola, Oluwafemi Isaiah Ajimotokan, Peace Ajala, Inderbir Padda, Arun U Mahtani, Toluwalase Awoyemi, Jay Nfonoyim","doi":"10.1161/JAHA.124.040167","DOIUrl":"https://doi.org/10.1161/JAHA.124.040167","url":null,"abstract":"<p><strong>Background: </strong>Takotsubo cardiomyopathy (TC) has a similar clinical presentation to acute coronary syndromes (ACS). As the prevalence and influence on clinical decisions of this condition are being increasingly recognized, prognostic factors have yet to be established. We applied known near-term acute coronary syndrome mortality risk factors to determine their prognostic value in TC. This study aimed to assess the patient characteristics and comorbidities predicting inpatient death from TC. Understanding these risk factors is essential for clinical decision making and improving prognostic assessments.</p><p><strong>Methods: </strong>We analyzed the National Inpatient Sample database for 2021. Inclusion criteria were principal diagnosis of TC (<i>International Classification of Diseases</i>, <i>Tenth Revision</i> [<i>ICD-10</i>] code I51.81) and age ≥18 years. Different comorbidities, age, and sex were analyzed, and the primary outcome was inpatient death. Univariate logistic regression was used to test the association of each factor with death, and multivariate logistic regression was then used to test for independent predictive value.</p><p><strong>Results: </strong>A total of 9109 admissions for TC were identified (10.3% men and 89.7% women) with a mean age of 67 years and an inpatient mortality rate of 2.31%. On univariate regression, age (odds ratio [OR], 1.04; <i>P</i>=0.013), heart failure (OR, 3.2; <i>P</i><0.001), atrial fibrillation (OR, 3.12; <i>P</i><0.001), and chronic kidney disease (OR, 3.54; <i>P</i><0.001) were significant predictors of inpatient death. On multivariate regression, only heart failure (OR, 2.8; <i>P</i>=0.007) and chronic kidney disease (OR, 2.34; <i>P</i>=0.032) were independently associated with inpatient death.</p><p><strong>Conclusions: </strong>Preexisting heart failure and a history of chronic kidney disease are poor prognostic factors in patients presenting with TC. Further large-scale studies are required to validate our findings.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040167"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651238","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 Care and Outcomes: A National Stroke Registry Study.","authors":"Min Xu, Youssef Hbid, Kaili Stanley, Charles Wolfe, Matthew D L O'Connell, Abdel Douiri","doi":"10.1161/JAHA.124.040926","DOIUrl":"https://doi.org/10.1161/JAHA.124.040926","url":null,"abstract":"<p><strong>Background: </strong>Previous evidence on sex differences in stroke care and outcomes was limited in sample representativeness and coverage of care indicators. We aim to investigate various indicators of stroke care quality, survival, and functional outcome at discharge between men and women, using a national stroke registry.</p><p><strong>Methods: </strong>Ten key indicators, representative from across stroke care pathway, were compared between men and women using the Sentinel Stroke National Audit Programme, a national quality register for England, Wales, and Northern Ireland (2013-2023, n=844 970). Multivariable Poisson regression models with robust variance were constructed to estimated adjusted relative risks (ARR). The 1-year adjusted hazard ratios (AHR) of mortality were conducted using adjusted restricted mean survival time. Favorable functional outcomes at discharge were measured using modified Rankin Scale (0-2).</p><p><strong>Results: </strong>Women comprised 48% of the study population, mean age 77 years (SD: 13.4) compared with 72 years (13.3) for men. Compared with men, women tend to have severe strokes (19% versus 12%), lower prevalence of diabetes (20% versus 24%), and higher prevalence of atrial fibrillation (21% versus 18%) but similar stroke types (ischemic: 87% versus 88%). Women were less likely to have thrombolysis of arrival <1 hour, brain scan <1 hour, thrombolysis of stroke onset <4 hours, swallowing screen <4 hours, admission to stroke unit <4 hours, assessed by trained nurses <24 hours, assessed by occupational therapist <72 hours, and communication speech and language therapy <72 hours. Women tended to have poorer functional outcome at discharge (ARR, 1.06 [95% CI, 1.05-1.06]) but better 1-year survival (AHR, 0.99 [95% CI, 0.98-0.99]).</p><p><strong>Conclusions: </strong>Women were less likely to receive several indicators of evidence-based stroke care compared with men. Although they had better survival, functional outcome was poorer in women.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040926"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651146","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":"Clinical Impact of Early Changes in Serum Albumin on Patient Prognosis After Mitral-Transcatheter Edge-to-Edge Repair.","authors":"Kenichi Shibata, Masanori Yamamoto, Ai Kagase, Takahiro Tokuda, Hiroshi Tsunamoto, Tetsuro Shimura, Azusa Kurita, Ryo Yamaguchi, Mike Saji, Yuki Izumi, Masahiko Asami, Yusuke Enta, Shinichi Shirai, Masaki Izumo, Shingo Mizuno, Yusuke Watanabe, Makoto Amaki, Kazuhisa Kodama, Junichi Yamaguchi, Toru Naganuma, Hiroki Bota, Yohei Ohno, Masahiro Yamawaki, Daisuke Hachinohe, Hiroshi Ueno, Gaku Nakazawa, Toshiaki Otsuka, Shunsuke Kubo, Kentaro Hayashida","doi":"10.1161/JAHA.125.041961","DOIUrl":"https://doi.org/10.1161/JAHA.125.041961","url":null,"abstract":"<p><strong>Background: </strong>Low serum albumin levels indicate frailty and are strong predictors of poor prognosis after mitral transcatheter edge-to-edge repair (M-TEER); however, albumin levels are expected to improve in response to treatment for mitral regurgitation. No reports have elucidated the clinical effects of albumin changes after M-TEER. Thus, we aimed to explore the association between early albumin changes and clinical outcomes after M-TEER and to identify the associated factors.</p><p><strong>Methods: </strong>Data from 2695 patients enrolled in a Japanese multicenter registry whose serum albumin levels were measured before and 1 month after undergoing M-TEER were retrospectively reviewed. Changes in albumin (Δ-albumin) were calculated and divided into 2 groups, namely improved albumin (Δ-albumin >0) and worsening albumin (Δ-albumin ≤0) groups. The incidence, predictors, and clinical outcomes associated with early albumin changes were investigated.</p><p><strong>Results: </strong>After M-TEER, albumin levels improved in 56.1% of the patients (n=1512). The independent predictors of worsening Δ-albumin comprised old age, acute procedure success not achieved, higher Clinical Frailty Scale, higher hemoglobin, impaired renal function, and preprocedural higher albumin levels (all <i>P</i><0.05). Improved Δ-albumin was independently associated with reduced all-cause mortality after M-TEER (hazard ratio [HR], 0.62 [95% CI, 0.52-0.75], <i>P</i><0.001). Additionally, improved Δ-albumin was associated with a lower competing risk of heart failure hospitalization (HR, 0.78 [95% CI, 0.64-0.94], <i>P</i>=0.01).</p><p><strong>Conclusions: </strong>Early improvement in Δ-albumin may serve as a measure of procedural benefits and a surrogate marker for predicting clinical outcomes after M-TEER.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041961"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651184","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":"Comparison of Valve Academic Research Consortium (VARC)-2 and VARC-3 Criteria for Bleeding Complications After Transcatheter Aortic Valve Replacement.","authors":"Stephan Nienaber, Janosch Himken, Max Meertens, Victor Mauri, Samuel Lee, Jonathan Curio, Elmar Kuhn, Richard Nies, Kaveh Eghbalzadeh, Johannes Dohr, Stephan Baldus, Hendrik Wienemann, Matti Adam","doi":"10.1161/JAHA.124.039342","DOIUrl":"https://doi.org/10.1161/JAHA.124.039342","url":null,"abstract":"<p><strong>Background: </strong>The Valve Academic Research Consortium (VARC) has updated criteria for periprocedural bleeding after transcatheter aortic valve replacement. However, clinical validation of the VARC-3 bleeding definition is scarce. The aim of this study was to evaluate incidence, associated variables, and clinical impact of VARC-3 bleeding.</p><p><strong>Methods: </strong>The study included 2227 patients with severe aortic stenosis undergoing transcatheter aortic valve replacement between 2018 and 2023 at the University Hospital Cologne. VARC-3 bleeding during the index hospitalization were analyzed. Incidence, variables associated with bleeding, and impact on 30-day mortality were evaluated by comparison to the VARC-2 criteria. All data were prospectively collected.</p><p><strong>Results: </strong>VARC-3 bleeding was 2.5 times more prevalent than VARC-2 (13.9% versus 34.4%), as VARC-3 includes nonattributable blood loss >3 g/dL as a bleeding event. Chronic kidney disease, thoracotomy access, dual antiplatelet therapy (<i>P</i><0.001 for all), and female sex (<i>P</i>=0.023) were variables associated with VARC-3 bleedings. Type 3 bleeding (VARC-3) was associated with an increased 30-day mortality (hazard ratio [HR], 2.89 [95% CI, 1.35-6.19], <i>P</i>=0.006). VARC-2 major and life-threatening bleeding events were associated with increased 30-day mortality as well (HR, 2.74 [95% CI, 1.26-5.95], <i>P</i>=0.011 and HR, 29.60 [95% CI, 17.42-50.30], <i>P</i><0.001).</p><p><strong>Conclusions: </strong>The VARC-3 criteria present a refined classification for bleeding with prognostic relevance. However, the VARC-2 criteria demonstrate precision and clear correlation with increasing mortality risk proportional to the severity of bleeding too, showing even greater predictive accuracy in the transfemoral cohort. These findings require further validation with similar or even larger patient cohorts.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039342"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651186","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 Oxygen on Perioperative Vascular Function: A Randomized Clinical Trial.","authors":"Marcos G Lopez, Arvind K Pandey, Cassandra Hennessy, Christopher G Hughes, Tarek S Absi, Ashish S Shah, Matthew S Shotwell, David G Harrison, Frederic T Billings","doi":"10.1161/JAHA.125.041778","DOIUrl":"https://doi.org/10.1161/JAHA.125.041778","url":null,"abstract":"<p><strong>Background: </strong>Vascular dysfunction contributes to postoperative organ injury. Exposure to high concentrations of oxygen during surgery is common and may impair vascular function. We tested the hypothesis that hyperoxia during cardiac surgery impairs vascular function compared with normoxia.</p><p><strong>Methods: </strong>We recruited and randomly assigned patients having elective cardiac surgery to hyperoxia or normoxia during surgery, measured endothelium-mediated vasodilation via brachial artery flow-mediated dilation and fingertip pulse amplitude tonometry (reactive hyperemia index), assessed endothelium-dependent, endothelium-independent, and heme-independent soluble guanylyl cyclase activator-induced vasodilation ex vivo in mediastinal fat arterioles using wire myography, and quantified plasma markers of vascular function and oxidative stress.</p><p><strong>Results: </strong>Two hundred participants completed the study. Oxygen treatment did not affect flow-mediated dilation (primary outcome, <i>P</i>=0.377) or reactive hyperemia index (<i>P</i>=0.898). In isolated mediastinal fat arterioles, however, hyperoxia impaired endothelium-independent relaxation (<i>P</i><0.001) but not endothelium-dependent relaxation (<i>P</i>=0.759) or heme-independent soluble guanylyl cyclase activation (<i>P</i>=0.650). Hyperoxia also increased plasma plasminogen activator inhibitor-1 postoperatively but not e-selectin or syndecan-1. Hyperoxia increased intraoperative concentrations of F₂-isoprostanes and isofurans, which were associated with plasminogen activator inhibitor-1 but not other measurements of vascular function.</p><p><strong>Conclusions: </strong>Among adults receiving cardiac surgery, intraoperative hyperoxia did not affect endothelium-dependent vasodilation but impaired endothelium-independent vasodilation, likely via soluble guanylyl cyclase heme oxidation. Soluble guanylyl cyclase is a potential therapeutic target to enhance vascular function.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02361944.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041778"},"PeriodicalIF":5.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651203","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}