Journal of the American Heart Association最新文献

{"title":"Return to Work After Ischemic Stroke in Young Adults: A Multicenter Cohort Study, Systematic Review, and Meta-Analysis.","authors":"Gabriel Yi Ren Kwok, Nicole Yeong, Michelle Law, Zi Lun Kang, Arjun Achar, Xin Yuan Lim, Megan B J Ng, Yao-Hao Teo, Sarah M L Tan, Jamie S Y Ho, Maznah Marmin, Fadhlina Hassan, Magdalene L J Chia, Lily Y H Wong, Ching-Hui Sia, Vijay K Sharma, Leonard L L Yeo, Aftab Ahmad, Benjamin Y Q Tan","doi":"10.1161/JAHA.124.036427","DOIUrl":"https://doi.org/10.1161/JAHA.124.036427","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke incidence in young adults is increasing globally, with return to work (RTW) a key rehabilitation goal. We aimed to assess the overall proportions of and factors associated with RTW following young adult ischemic stroke.</p><p><strong>Methods and results: </strong>We performed a retrospective cohort study of all patients with ischemic stroke aged 18 to 50 years at 2 tertiary hospitals in Singapore from 2020 to 2022. We evaluated associations between patient characteristics and 3-month RTW status, augmenting these findings with a systematic review and meta-analysis of PubMed, Embase, Scopus, and Cochrane databases from January 2000 to November 2023. We pooled proportions for RTW and functional recovery (defined as a 90-day modified Rankin Scale score of 0-2) and meta-analyzed associations between patient characteristics and RTW using random-effects models. In this multicenter cohort, 68.8% (249/362) of young patients with ischemic stroke returned to work, while 87.8% (318/362) achieved functional recovery. Multivariable logistic regression showed that patients with large-artery atherosclerosis pathogenesis, diabetes, higher admission National Institutes of Health Stroke Scale scores, and higher 90-day modified Rankin Scale had significantly lower odds of RTW. The systematic review and meta-analyses of 1914 patients across 6 cohort studies identified significantly lower odds of RTW in patients with large-artery atherosclerosis, diabetes, and admission National Institutes of Health Stroke Scale SCORE >15. The pooled proportion of RTW was 63.2% (984/1574 [95% CI, 56.0-69.9]) and functional recovery 84.7% (719/846 [95% CI, 81.1-87.8]).</p><p><strong>Conclusions: </strong>Patients with large-artery atherosclerosis, diabetes, and higher admission National Institutes of Health Stroke Scale score at baseline are less likely to RTW. While lower 90-day modified Rankin Scale is significantly associated with RTW, many patients achieving functional recovery do not RTW. Well-designed cohort studies are warranted to explore this disparity.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036427"},"PeriodicalIF":5.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774759","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 Imaging-Free Myocardial Fibrosis Prediction Models, Association with Outcomes, and Sample Size Estimation for Phase 3 Trials.","authors":"Nicholas Black, Joshua Bradley, Gavin Lewis, Jakub Lagan, Christopher Orsborne, Fardad Soltani, John P Farrant, Theresa McDonagh, Matthias Schmitt, João L Cavalcante, Martin Ugander, Javed Butler, Mark C Petrie, Christopher A Miller, Erik B Schelbert","doi":"10.1161/JAHA.124.037254","DOIUrl":"https://doi.org/10.1161/JAHA.124.037254","url":null,"abstract":"<p><strong>Background: </strong>Phase 3 trials testing whether pharmacologic interventions targeting myocardial fibrosis improve outcomes require myocardial fibrosis measurement that does not rely on tomographic imaging with intravenous contrast.</p><p><strong>Methods: </strong>We developed and externally validated extracellular volume (ECV) prediction models incorporating readily available data (comorbidity and natriuretic peptide variables), excluding tomographic imaging variables. Associations between predicted ECV and incident outcomes (death or hospitalization for heart failure) were tested in survival analysis. We created various sample size estimates for a hypothetical therapeutic clinical trial testing an antifibrotic therapy using (1) predicted ECV, (2) measured ECV, or (3) no ECV.</p><p><strong>Results: </strong>Multivariable models predicting ECV had reasonable discrimination (optimism corrected C-statistic for predicted ECV ≥27%, 0.78 [95% CI, 0.75-0.80] in the derivation cohort [n=1663] and 0.74 [95% CI, 0.71-0.76] in the validation cohort [n=1578]) and reasonable calibration. Predicted ECV associated with adverse outcomes in Cox regression models: ECV ≥27% (binary variable) hazard ratio 2.21 (95% CI, 1.84-2.66). For a hypothetical clinical trial with an inclusion criterion of ECV ≥27%, use of predicted ECV (with probability threshold of 0.69 and 80% specificity) compared with measured ECV would obviate the need to perform 3940 cardiac magnetic resonance scans, at the cost of an additional 3052 participants screened and 705 participants enrolled.</p><p><strong>Conclusions: </strong>Predicted ECV (derived without tomographic imaging) associates with outcomes and efficiently identifies vulnerable patients who might benefit from treatment. Predicted ECV may foster the design of phase 3 trials targeting myocardial fibrosis with higher numbers of screened and enrolled participants, but with simplified eligibility criteria, avoiding the complexity of tomographic imaging.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037254"},"PeriodicalIF":5.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775015","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":"Neighborhood Safety and Hypertension Risk: A Systematic Review.","authors":"Yeonwoo Kim, Soeun Jang, Shaikh Ullahansari, Jimmy Vo, Kate Hyun, Paul J Fadel","doi":"10.1161/JAHA.124.035381","DOIUrl":"https://doi.org/10.1161/JAHA.124.035381","url":null,"abstract":"<p><strong>Background: </strong>Responding to the increasing focus on residential environments, our systematic review aimed to consolidate existing empirical evidence regarding the impact of neighborhood safety on blood pressure. We also summarized the mediating and moderating mechanisms through which neighborhood safety influences blood pressure, alongside their direct effects, to offer insights for future research.</p><p><strong>Methods: </strong>We searched 5 electronic databases (PubMed, Ovid MEDLINE, CINAHL Complete, ProQuest Dissertations and Theses Global, and Web of Science) for the period up to and including December 27, 2022. The initial search yielded 4944 studies reviewed, of which 19 met our criteria and were reviewed.</p><p><strong>Results: </strong>Our findings consistently show that living in a safe neighborhood is associated with lower blood pressure outcomes. While most cross-sectional studies found that the association was not statistically significant (7/10 studies showed insignificant results), longitudinal studies that tracked changes in neighborhood safety over time (4/5 studies) showed significant negative associations between neighborhood safety and blood pressure. Additionally, some studies identified sex (n=3), age (n=2), and neighborhood characteristics (n=4) as significant moderators, with the strength of the association between neighborhood safety and blood pressure varying across different demographic groups and neighborhood contexts.</p><p><strong>Conclusions: </strong>Our findings suggest that unsafe neighborhoods may increase blood pressure and hypertension risk, warranting further research and interventions. This review also highlights the importance of adopting longitudinal designs, especially those using time-varying measures of neighborhood environments.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e035381"},"PeriodicalIF":5.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774571","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 of Accelerometer-Derived Physical Activity Pattern With the Risks of All-Cause, Cardiovascular Disease, and Cancer Death.","authors":"Dan-Qing Liao, Hong-Min Li, Hao-Jie Chen, Shu-Min Lai, Xu-Lian Tang, Cheng-Shen Qiu, Li-Ying Du, Hong-Xuan Huang, Zhi-Yuan Xiong, Ling Kuang, Bing-Yun Zhang, Pei-Dong Zhang, Jian Gao, Wen-Fang Zhong, Pei-Liang Chen, Dan Liu, Jin Yang, Qing-Mei Huang, Chen Mao, Zhi-Hao Li","doi":"10.1161/JAHA.124.039225","DOIUrl":"https://doi.org/10.1161/JAHA.124.039225","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines suggest engaging in a minimum of 150 minutes of moderate to vigorous physical activity (MVPA) each week to support overall health. However, the effect of concentrated versus evenly distributed physical activity (PA) on health outcomes remains uncertain. This study aims to investigate the associations of \"weekend warrior\" pattern, where most MVPA is completed in 1 to 2 days, and a more evenly spread MVPA pattern with mortality risk.</p><p><strong>Methods: </strong>Data from the UK Biobank were used, with participants having a full week of device-measured PA data from 2013 to 2015. Three MVPA patterns were defined: inactive, active weekend warrior, and active regular. The relationships between PA patterns and mortality risk were investigated using the Cox proportional hazards model.</p><p><strong>Results: </strong>During an 8.1-year median follow-up, 3965 adults died from all causes, including 667 from cardiovascular disease and 1780 from cancer. Both the active weekend warrior group (all-cause death: hazard ratio [HR], 0.68 [95% CI, 0.64-0.74]; cardiovascular disease death: HR, 0.69 [95% CI, 0.58-0.83]; cancer death: HR, 0.79 [95% CI, 0.71-0.89]) and the active regular group (all-cause death: HR, 0.74 [95% CI, 0.68-0.81]; cardiovascular disease death: HR, 0.76 [95% CI, 0.61-0.94]; cancer death: HR, 0.87 [95% CI, 0.76-0.99]) demonstrated a lower mortality risk compared with the inactive group after following the recommended 150 minutes of MVPA per week. Furthermore, there was no discernible difference in the mortality risk between the active regular group and the active weekend warrior group.</p><p><strong>Conclusions: </strong>Engaging in PA concentrated within 1 to 2 days was related with a similar reduction in mortality risk as more evenly spread activity. Our findings are particularly significant for individuals who find it challenging to engage in regular PA due to time constraints.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039225"},"PeriodicalIF":5.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765925","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":"Resource Efficient Screening for Primary Prevention of Coronary Heart Disease: A Proof-of-Concept Test in the MESA Cohort.","authors":"Eva Hagberg, Elias Björnson, Martin Adiels, Anders Gummesson, Matthew Allison, Bledar Daka, Göran Bergström","doi":"10.1161/JAHA.124.038504","DOIUrl":"10.1161/JAHA.124.038504","url":null,"abstract":"<p><strong>Background: </strong>The best use of cardiac imaging to guide preventive coronary heart disease (CHD) treatment is debated. Current guidelines recommend the pooled cohort equation, followed by computed tomography for coronary artery calcification (CAC) assessment. We evaluated if this approach could be simplified using a self-report risk algorithm instead of the pooled cohort equation.</p><p><strong>Methods: </strong>A gradient boosting machine model was trained on self-reported factors to calculate the probability of a high CAC score (≥100). This model was part of a self-report-based CHD preventive strategy with 3 steps: (1) calculate the probability of having a high CAC; (2) perform computed tomography for high-risk individuals; and (3) assign treatment eligibility with lipid-lowering therapy if CAC score exceeds a designated threshold. This strategy was tested using data from the MESA (Multi-Ethnic Study of Atherosclerosis) cohort (n=4564) and compared with guidelines recommending CAC scanning for intermediate-risk individuals (pooled cohort equation, 7.5% to <20%) by evaluating CHD events over 10-year follow-up in the group defined as treatment eligible by either strategy.</p><p><strong>Results: </strong>The pooled cohort equation identified 33% of the MESA population as eligible for a CAC scan and 19% as treatment eligible, capturing 48% of all CHD events (103 of 216). The self-report strategy identified 56% of CHD events (120 of 216; <i>P</i>=0.02) with the same number of CAC scans and treatments but required health care visits for only 33% of the population.</p><p><strong>Conclusions: </strong>A self-report screening strategy, combined with CAC scoring, is more resource efficient and better discriminates high-risk individuals suitable for lipid-lowering therapy compared with current guidelines.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038504"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674864","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":"Serum Vasoactive Intestinal Peptide as a Novel Biomarker for Low-Voltage Areas in Patients With Atrial Fibrillation.","authors":"Kotaro Nishino, Taro Temma, Hiroyuki Natsui, Masaya Watanabe, Motoki Nakao, Masahiro Kawasaki, Kintaro Shimano, Kei Kawakami, Shota Saito, Jiro Koya, Daishiro Tatsuta, Takuya Koizumi, Takahide Kadosaka, Taro Koya, Satonori Tsuneta, Kiwamu Kamiya, Toshiyuki Nagai, Toshihisa Anzai","doi":"10.1161/JAHA.124.039192","DOIUrl":"10.1161/JAHA.124.039192","url":null,"abstract":"<p><strong>Background: </strong>Low-voltage areas in the left atrium predict atrial fibrillation recurrence after catheter ablation and are associated with adverse outcomes like death, heart failure, and stroke. Detecting low-voltage areas (LVAs) typically requires invasive procedures, highlighting the need for a simple, minimally invasive marker. Vasoactive intestinal peptide (VIP), a neuropeptide released during parasympathetic stimulation, affects electrophysiological remodeling in atrial fibrillation. We hypothesized that serum VIP could serve as a biomarker for detecting LVAs in these patients.</p><p><strong>Methods and results: </strong>This prospective, cross-sectional study was conducted at Hokkaido University Hospital between August 2021 and September 2023. We included 108 patients with atrial fibrillation scheduled for catheter ablation. Blood samples were collected during ablation to measure VIP using an ELISA. Electroanatomical mapping identified LVAs, defined as regions with bipolar voltage ≤0.5 mV and occupying >5% of the left atrial surface. Statistical analyses evaluated the relationship between VIP and LVAs. Fifty-one patients (47%) had LVAs, with significantly higher serum VIP levels than those without (335.1 versus 247.7 pg/mL, <i>P</i><0.001). VIP levels and female sex were statistically significant factors of LVAs. Adding VIP to the existing score significantly improved its discrimination (area under the curve: 0.784 versus 0.707, <i>P</i><0.001).</p><p><strong>Conclusions: </strong>Serum VIP levels are higher in patients with atrial fibrillation with LVAs, suggesting its potential as a noninvasive biomarker for detecting these areas and improving clinical management.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039192"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674883","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":"Longitudinal Association of Remnant Cholesterol With Cognitive Decline Varies by Lipid-Lowering Drugs: A Population-Based Cohort Study.","authors":"Jianian Hua, Jianye Dong, Ying Chen, Haibin Li, Qingmei Chen","doi":"10.1161/JAHA.124.040211","DOIUrl":"10.1161/JAHA.124.040211","url":null,"abstract":"<p><strong>Background: </strong>Although the association between remnant cholesterol (RC) and cognitive impairment has been reported, the association of RC with cognitive decline remains scarce. Also, the role of lipid-lowering therapy in the association is unclear. The study aimed to examine the longitudinal associations of RC with cognitive decline by lipid-lowering drug use during follow-up.</p><p><strong>Methods and results: </strong>The study used data from Wave 2 (2004-2005) to Wave 8 (2016-2017) of the ELSA (English Longitudinal Study of Ageing). Global cognitive functions at baseline (Wave 2) and during the follow-up (Waves 3-8) were assessed by integrating 3 cognitive domains: memory capacity, semantic fluency, and orientation. Multivariate-adjusted linear mixed models were employed to examine the longitudinal associations, with results presented as <i>β</i> (95% CI) in SD/year. Of the 5053 participants ultimately included, 55.4% were female and the mean age (SD) was 65.7 (9.3) years. Per 1 mmol/L increment in RC was significantly associated with a faster rate of cognitive decline (<i>β</i>=-0.010 SD/year [95% CI -0.019 to -0.001]). Furthermore, we observed that association pattern between RC and cognitive decline only in the non-lipid-lowering drug group (<i>β</i>=-0.019 SD/year [95% CI, -0.031 to -0.007]) but not in the lipid-lowering drug group (<i>β</i>=0.007 SD/year [95% CI, -0.006 to 0.020]), with a significant interaction (<i>P</i>=0.015). Similar findings were observed for the 3 cognitive domains.</p><p><strong>Conclusions: </strong>Higher baseline RC levels were associated with steeper cognitive decline. The use of lipid-lowering drugs might mitigate this decline. These findings underscore the importance of early RC monitoring and proactive management with lipid-lowering drugs in clinical practice.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040211"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711982","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":"Progression of Carotid Intima-Media Thickness in Children of the Cardiovascular Comorbidity in Children With Chronic Kidney Disease Study: Risk Factors and Impact of Blood Pressure Dynamics.","authors":"Anke Doyon, Jonas Hofstetter, Aysun Karabay Bayazit, Karolis Azukaitis, Ana Niemirska, Mahmut Civilibal, Ipek Kaplan Bulut, Ali Duzova, Berna Oguz, Bruno Ranchin, Rukshana Shroff, Yelda Bilginer, Salim Caliskan, Dusan Paripovic, Cengiz Candan, Alev Yilmaz, Jerome Harambat, Zeynep Birsin Özçakar, Francesca Lugani, Harika Alpay, Sibylle Tschumi, Ebru Yilmaz, Dorota Drozdz, Yilmaz Tabel, Gül Özcelik, Alberto Caldas Afonso, Onder Yavascan, Anette Melk, Uwe Querfeld, Franz Schaefer","doi":"10.1161/JAHA.124.037563","DOIUrl":"10.1161/JAHA.124.037563","url":null,"abstract":"<p><strong>Background: </strong>Carotid intima-media thickness (cIMT) may identify early alterations in the vascular phenotype in children with chronic kidney disease (CKD).</p><p><strong>Methods and results: </strong>Investigation of longitudinal changes in cIMT SD scores (SDS) in 670 patients from the 4C Study (Cardiovascular Comorbidity in Children With CKD Study), aged 6 to 17 years, with CKD stage 3 to 5 at baseline. The longitudinal trajectory of cIMT SDS over up to 8 years was examined using a longitudinal mixed-effects model. The yearly progression rate in cIMT SDS (β=0.20 [95% CI, 0.13-0.28]) remained positive during the initial 4.5-year follow-up period but slowed down quadratically with increasing observation time (β=-0.02 [95% CI, -0.03 to -0.01]). Risk factors for increased cIMT SDS included time since baseline, younger age, higher height SDS, female sex, elevated diastolic blood pressure, and lower serum albumin, but not estimated glomerular filtration rate. In patients with progressive CKD, higher albuminuria was additionally associated with an increase in cIMT SDS. In patients with stable CKD, serum phosphate and time were the only risk factors identified for elevated cIMT SDS. Annual rates of change in blood pressure were positively correlated with the rate of change in cIMT SDS within the first 4.5 years (for systolic: β=0.42 [95% CI, 0.22-0.62]; for diastolic: β=1.56 [95% CI, 1.01-2.11]).</p><p><strong>Conclusions: </strong>The results show a significant longitudinal increase in cIMT SDS in children with CKD. Changes in blood pressure are associated with the progression of cIMT SDS, suggesting a relevant impact of blood pressure modulation on cIMT SDS.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037563"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712145","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":"Additive Value of Right Ventricular Global Longitudinal Strain to a Conventional Echocardiographic Parameter to Improve Prognostic Value in Intermediate-Risk Pulmonary Embolism.","authors":"Shunsuke Eguchi, Yoshiyuki Orihara, Ayumi Eguchi, Michael Pfeiffer, Brandon Peterson, Mohammed Ruzieh, Zhaohui Gao, John Boehmer, John Gorcsan, Ryan Wilson","doi":"10.1161/JAHA.124.036294","DOIUrl":"10.1161/JAHA.124.036294","url":null,"abstract":"<p><strong>Background: </strong>Right ventricular (RV) dysfunction has been identified as a prognostic marker for adverse events in patients with intermediate-risk pulmonary embolism. We hypothesized that right-sided strain parameters have additive value to conventional echocardiographic parameters to further risk-stratify patients for mortality.</p><p><strong>Methods and results: </strong>This is a retrospective cohort study of patients with intermediate-risk pulmonary embolism between 2010 and 2018. All-cause 30-day mortality was evaluated. Echocardiographic strain parameters and conventional RV measurements were compared between survivors and nonsurvivors. Two hundred fifty-one patients were analyzed. Mortality at 30 days was 12.4%. Image quality was sufficient for RV strain analysis in 230 patients (91.6%). Right to left ventricular end-diastolic diameter ratio (RV/LV ratio) (odds ratio [OR], 1.490 [95% CI, 1.120-1.990]) and RV global longitudinal strain (RVGLS) (OR, 0.742 [95% CI, 0.605-0.910]) were independently associated with 30-day mortality. Using RVGLS and RV/LV ratio in an additive fashion, we found that 99 patients with a high RVGLS (>17.7%) and low RV/LV ratio (<1.03) had a 30-day mortality of 1.0%. Conversely, 39 patients with a low RVGLS (≤17.7%) and high RV/LV ratio (≥1.03) had a 30-day mortality of 46.2%. Kaplan-Meier analysis depicted the significantly different prognosis among the groups (<i>P</i><0.001).</p><p><strong>Conclusions: </strong>The combined evaluation of RVGLS and RV/LV ratio is a practical method of evaluating RV dysfunction. Using both parameters in patients with intermediate-risk pulmonary embolism identifies those at highest and lowest risk of short-term mortality. This approach offers promise for improved risk stratification and guidance of treatment pathways.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036294"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712173","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 Outcomes for Heart-Alone and Multiorgan Transplant Under the New Heart Allocation Policy Era.","authors":"Keshvi Chauhan, Timothy Hess, Didier Mandelbrot, Takushi Kohmoto, Ravi Dhingra","doi":"10.1161/JAHA.124.036687","DOIUrl":"10.1161/JAHA.124.036687","url":null,"abstract":"<p><strong>Background: </strong>In October 2018, a new heart transplant allocation policy was implemented in the United States to address inequalities. Under the new policy, some patient outcomes for patients with heart transplant have improved; however, outcomes of multiorgan transplants combined with heart remain unclear.</p><p><strong>Methods: </strong>We examined the waitlist mortality, time to transplant, and posttransplant survival for all patients listed between 2013 and 2022 for multiorgan transplants with heart (n=3798) and compared the old policy era to the new policy era using cumulative incident curves and multivariable Cox regression models. Cumulative incidence curves also compared multiorgan transplants to patients listed for heart alone (n=31 840) under the new policy era.</p><p><strong>Results: </strong>Patients awaiting multiorgan transplants had higher use of intra-aortic balloon pumps (4.7% versus 11%) and extracorporeal membrane oxygenation support (2.4% versus 4.9%) in the new policy era. Under the new policy, despite receiving transplants sooner (n=2200 transplants, hazard ratio [HR], 1.74 [95% CI, 1.59-1.91]), patients who received multiorgan transplants had no change in waitlist mortality (n=340 deaths, HR, 1.06 [95% CI, 0.84-1.34]) compared with the old policy era. The rate of death post-multiorgan transplant was significantly higher in incidence curves under the new policy compared with the old policy era (log-rank <i>P</i>=0.02). However, in multivariable Cox models, the risk of death post-multiorgan transplant was similar under the new policy (n=287 deaths, HR, 1.11 [95% CI, 0.87-1.41]) compared with the old policy era.</p><p><strong>Conclusions: </strong>Under the new policy, waitlist deaths have decreased for patients awaiting heart alone, but not for those awaiting multiorgan transplants. Post-transplant survival remains lower for patients who underwent multiorgan transplant (compared with heart-alone transplant), with no change under the new policy.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036687"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722545","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}