Journal of the American Heart Association最新文献

{"title":"Influence of Sex and Race or Ethnicity on Major Adverse Cardiovascular Outcomes Following Coronary Artery Bypass Surgery in a Large Integrated Health Care System.","authors":"Janine Y Yang, Douglas Stram, John Doan, Alix P Fairman, Maqdooda Merchant, Cynthia Triplett, Ahmad Y Sheikh, Richard V Ha, Seema K Pursnani","doi":"10.1161/JAHA.125.042071","DOIUrl":"10.1161/JAHA.125.042071","url":null,"abstract":"<p><strong>Background: </strong>We aimed to evaluate the influence of sex and race or ethnicity on major adverse cardiovascular events (MACEs) following coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>This was a retrospective study of Kaiser Permanente Northern California members who underwent CABG from 2008 to 2019, evaluating odds of MACEs (myocardial infarction, stroke, serial percutaneous intervention, repeat CABG, death) at 30 days, 1 year, and up to 12 years follow-up using multivariable logistic and proportional hazards regression analyses. We adjusted for demographic, clinical/surgical, and socioeconomic characteristics.</p><p><strong>Results: </strong>Cohort included n=7405 with mean age 65.2 years. There were n=6082 men and n=1323 women with 2179 (35.8%) and 639 (48.3%) MACEs, respectively. Older age, higher glycated hemoglobin, diabetes, end-stage renal disease, lower hemoglobin, higher creatinine, smoking, lack of cardiopulmonary bypass, and use of nonarterial graft were significant predictors of long-term MACEs. Female sex was associated with an increased odds of MACE at 30 days (odds ratio, 1.62 [95% CI, 1.19-2.21]) and 1 year (hazard ratio, 1.24 [95% CI, 1.02-1.51]).</p><p><strong>Conclusion: </strong>Female, Black, and Other (Native American, multiethnic or missing) race or ethnicity groups had the greatest incidence of MACEs at up to 12 years follow-up post CABG, with differences largely driven by increased risk factor burden. Black and Other race or ethnicity were not significantly associated with long-term CABG risk in multivariable modeling. Further understanding is required to improve upstream preventive efforts.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042071"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088150","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":"New-Onset Atrial Fibrillation During ST-Segment-Elevation Myocardial Infarction: Risk of Recurrence and Its Clinical Impact During 10 Years of Follow-Up.","authors":"Marina M Demidova, Maria A Baturova, David Erlinge, Pyotr G Platonov","doi":"10.1161/JAHA.124.040478","DOIUrl":"10.1161/JAHA.124.040478","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) often complicates ST-segment-elevation myocardial infarction (STEMI), but data on AF recurrence after first-ever AF during STEMI are scarce. We aimed at assessing the risk of AF recurrence after first-ever transient AF during admission for STEMI.</p><p><strong>Methods: </strong>We performed a single-center, register-based cohort study. Patients with STEMI discharged alive after primary percutaneous coronary intervention during 2007 to 2010 were followed until 2018. Clinical characteristics, date of AF diagnosis, and mortality status were retrieved from Swedish national registries. All ECGs recorded before, during, or after STEMI were reviewed. The primary end point was the first documented AF episode after discharge, and the secondary end point was mortality. The risk of AF during follow-up was calculated using the Fine-Gray subdistributional hazard model for AF and total mortality, regressed on prespecified clinical and demographic covariates. In patients with first-ever transient AF during STEMI, we looked for the factors associated with AF recurrence.</p><p><strong>Results: </strong>Of 2120 patients discharged alive, 127 (5.9%) had AF during admission for STEMI. Patients with AF during STEMI were more likely to develop AF during follow-up (hazard ratio [HR], 4.82 [95% CI, 3.86-6.02]; <i>P</i><0.001), with 28% AF recurrence by 1 year. Compared with no AF, patients with AF during STEMI had a higher risk of death (HR, 1.17 [95% CI, 1.01-1.35]; <i>P</i>=0.033). No clinical or demographic characteristics predicted recurrent AF during follow-up. Low P-wave voltage in lead I at predischarge electrocardiography was independently associated with recurrent AF during follow-up (HR, 2.39 [95% CI, 1.23-4.62]; <i>P</i>=0.010).</p><p><strong>Conclusions: </strong>Transient AF during STEMI is associated with an increased risk of AF after discharge and long-term mortality.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040478"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088299","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":"Population-Based Study on the Coexistence of Metabolic Dysfunction-Associated Steatotic Liver Disease and Chronic Kidney Disease.","authors":"Rachel Sze Jen Goh, Jaycie Koh, Made Ayu Utami Intaran, Yiphan Chin, Gwyneth Kong, Bryan Chong, Jobelle Chia, Mark Y Chan, Anurag Mehta, Mark Muthiah, Muhammad Shahzeb Khan, Nicholas Ws Chew","doi":"10.1161/JAHA.125.041834","DOIUrl":"10.1161/JAHA.125.041834","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) and chronic kidney disease (CKD) are important cardiovascular risk factors. However, the prognostic impact of coexisting MASLD and CKD remains understudied.</p><p><strong>Methods: </strong>This study cohort used the NHANES (National Health and Nutrition Examination Survey) 2007 to 2018 database, examining outcomes in adults with varying MASLD and CKD statuses. The primary outcome was all-cause mortality. Secondary outcomes included coronary heart disease, heart failure, stroke, and cancer. Cox regression model was constructed to investigate the relationship between MASLD/CKD and all-cause mortality, adjusted for age, prior coronary heart disease, body mass index, smoking, poverty-to-income ratio, lipid-lowering and glucose-lowering medications. Sensitivity analysis was performed with hepatic fibrosis and CKD.</p><p><strong>Results: </strong>Among 14 818 participants (mean follow-up: 6.9 ± 3.4 years), a majority of participants had MASLD(-)/CKD(-) (50.8%), followed by MASLD(+)/CKD(-) (34.8%), MASLD(+)/CKD(+) (7.7%), and MASLD(-)/CKD(+) (6.7%). MASLD(+)/CKD(+) (n = 1142) had the highest rates of obesity (77.6%), hypertension (77.5%), dyslipidemia (67.0%), and diabetes (49.7%), with the highest risk of coronary heart disease (risk ratio [RR], 1.79 [95% CI, 1.13-2.82],<i>P</i> = 0.013) and heart failure (RR 2.33 [95% CI, 1.07-5.08], <i>P</i> = 0.033). Socioeconomic disparities were observed, with lower-income individuals predominantly in the group with MASLD(+)/CKD(+) (<i>P</i> < 0.001). MASLD(+)/CKD(+) (adjusted hazard ratio [aHR], 3.28 [95% CI, 1.89-5.70], <i>P</i> < 0.001) and MASLD(-)/CKD(+) (aHR, 2.18 [95% CI, 1.33-3.66], <i>P</i> = 0.002) phenotypes were independent mortality predictors. Although MASLD(-)/CKD(+) and MASLD(+)/CKD(+) had unfavorable 10-year prognoses, survival was worse in those with both hepatic fibrosis and CKD (<i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>MASLD(+)/CKD(+) phenotype increases the risk of cardiometabolic multimorbidity and independently predicts mortality. Mortality risk increased progressively in individuals with both advanced hepatic fibrosis and CKD.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041834"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088347","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":"Methadone Blockade of Inward Rectifier Potassium Current Promotes Both Early and Delayed Repolarization Arrhythmias: Mechanistic Insights From Computational Modeling.","authors":"Zhaoyang Zhang, J T Green, Mark C Haigney, Patrick Walker, Kalyanam Shivkumar, Alan Garfinkel, Zhilin Qu","doi":"10.1161/JAHA.125.042201","DOIUrl":"10.1161/JAHA.125.042201","url":null,"abstract":"<p><strong>Background: </strong>Methadone blocks several ionic currents with different half-maximal inhibitory concentrations, including the rapid component of the delayed and inward (I_K1) rectifier potassium current, the L-type calcium current, and the late sodium current. Despite the well-known proarrhythmic effect of methadone, the underlying mechanisms remain less well understood.</p><p><strong>Methods: </strong>Computer simulations were used to explore the proarrhythmic effects of methadone by investigating how its blocking effects on ionic currents act alone or together in arrhythmogenesis.</p><p><strong>Results: </strong>The major findings are (1) blocking I_K1 potentiates QT prolongation-related arrhythmogenesis by enhancing a tissue-scale dynamical instability for the spontaneous genesis of ectopic excitations; blocking I_K1 and the rapid component of the delayed rectifier potassium current together results in a synergistic effect, greatly increasing the arrhythmia propensity, much larger than that of blocking either one alone; (2) blocking I_K1 in combination with lowering L-type calcium current potentiates phase 2 reentry caused by spike-and-dome action potential morphology, an arrhythmia mechanism of early repolarization or Brugada syndrome, whereas blocking the rapid component of the delayed rectifier potassium current exhibits little effect for this mechanism of arrhythmias; and (3) hypoxia, often comorbid in methadone populations, can potentiate QT prolongation-related arrhythmias at high sympathetic activity and phase 2 reentry at low sympathetic activity, mainly via its effect on the L-type calcium current.</p><p><strong>Conclusions: </strong>Methadone promotes both early and delayed repolarization arrhythmias. Early repolarization may be responsible for methadone-related deaths occurring mainly during sleep and occurring more often in men. Blocking I_K1 can work synergistically with other channel blockers to disproportionately increase arrhythmia propensity, greatly increasing methadone's risk when it is combined with other proarrhythmic drugs or under disease conditions.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042201"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138986","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":"Interventional Partial Cavopulmonary Connection: Initial Clinical Experience With Acute Procedural up to Midterm Results.","authors":"Katarzyna Gendera, Peter Ewert, Stanimir Georgiev, Andreas Eicken, Daniel Tanase, Kristina Borgmann, Paul Philipp Heinisch, Nicole Nagdyman, Julie Cleuziou, Dunja Renner, Pinar Bambul Heck","doi":"10.1161/JAHA.125.043042","DOIUrl":"10.1161/JAHA.125.043042","url":null,"abstract":"<p><strong>Background: </strong>Creation of a partial cavopulmonary anasthomosis in patients with isolated right-sided heart failure or patients with cyanosis and intracardial right-to-left shunt and reduced blood flow in the pulmonary circulation may provide a significant improvement in exercise capacity and also facilitate the performance of activities of daily living in patients with a deteriorated clinical condition. However, surgical partial cavopulmonary connection creation may be a high-risk procedure in this patient group. An interventional partial cavopulmonary connection may provide a less invasive treatment modality for these patients. The aim of the study was a retrospective evaluation of patients who underwent the creation of an interventional partial cavopulmonary connection.</p><p><strong>Methods: </strong>Each patient who was qualified for treatment underwent a preinterventional computed tomography scan with 3-dimensional reconstruction for improved procedure planning. As a preparation preceding the interventional partial cavopulmonary connection, a prestent (bare metal stent) was implanted into the superior vena cava during cardiac catheterization in most cases. The perforation was performed with the use of needle punctures as a straightforward method in all cases. Thereafter, a covered stent was implanted, connecting the superior vena cava and the right pulmonary artery.</p><p><strong>Results: </strong>Between July 2019 and July 2024, 14 patients (male n=6, 43%) underwent an interventional partial cavopulmonary connection. The indication for treatment was deteriorated clinical condition (n=12, 86%) or significant cyanosis (n=2, 14%). The procedure was performed successfully in all cases. The median follow-up time was 19.8 months (minimum 2.7; maximum 65.6).</p><p><strong>Conclusions: </strong>Our study shows that transcatheter creation of partial cavopulmonary connection provides a promising treatment modality for selected adult patients with right-sided heart failure and may lead to clinical improvement in this patient group.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043042"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139548","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":"Trimetazidine Is Associated With Ameliorated Stroke Risk in Patients With Both Ischemic Heart Disease and Atrial Fibrillation.","authors":"Yuen-Ting Cheng, Gregory Y H Lip, Bernard M Y Cheung, Kai-Hang Yiu, Hung-Fat Tse, Yap-Hang Chan","doi":"10.1161/JAHA.125.041629","DOIUrl":"10.1161/JAHA.125.041629","url":null,"abstract":"<p><strong>Background: </strong>Myocardial ischemia is closely associated with arrhythmogenesis and prognostication in patients with atrial fibrillation (AF). Trimetazidine ameliorates myocardial ischemia through prioritizing cardiomyocyte metabolism to glucose oxidation. Whether trimetazidine clinically reduces stroke risk in patients with ischemic heart disease and AF was unknown.</p><p><strong>Methods: </strong>We recruited patients with ischemic heart disease from the Hong Kong Clinical Data Analysis and Reporting System between January 1, 1999 and December 31, 2020. Patients with comorbid AF were identified, and those with a history of prior stroke were excluded. Trimetazidine users and nonusers (with long-acting nitrates as the control) were compared for the primary end point of incident ischemic stroke using Cox proportional regression, with and without propensity matching.</p><p><strong>Results: </strong>The primary analysis included 12 527 patients with ischemic heart disease and preexisting AF (mean age, 77.5±10.3 years; 44.6% men), who were further categorized as trimetazidine users (n=960) versus nonusers (n=11 567). Over a follow-up period of 1133 (interquartile range, 442-2454) days, 2160 patients (17.2%) developed new-onset ischemic stroke. Trimetazidine use was independently associated with a lower risk of new-onset ischemic stroke (hazard ratio [HR], 0.55 [95% CI, 0.44-0.68]; <i>P</i><0.001). Propensity score-matched analyses revealed similar findings (adjusted HR, 0.65 [95% CI, 0.52-0.80]; <i>P</i><0.001). Furthermore, trimetazidine was also independently associated with a lower risk of recurrent ischemic stroke (HR, 0.51 [95% CI, 0.37-0.69]; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>Treatment with trimetazidine is associated with a lower risk of incident and recurrent stroke in patients with both ischemic heart disease and AF. These findings will need to be confirmed in randomized controlled trials.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041629"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193572","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":"Blood Pressure and Cardiovascular Outcomes in Adults With Diabetes and Chronic Kidney Disease.","authors":"Hyeok-Hee Lee, Jong Hyun Jhee, Eun-Jin Kim, Dasom Son, Hyeon Chang Kim, Daichi Shimbo, Hokyou Lee","doi":"10.1161/JAHA.125.042966","DOIUrl":"10.1161/JAHA.125.042966","url":null,"abstract":"<p><strong>Background: </strong>Current hypertension guidelines recommend intensive blood pressure (BP) targets (eg, <130/80 mm Hg) for patients with diabetes and chronic kidney disease. However, data supporting these recommendations are limited.</p><p><strong>Methods: </strong>From Korean nationwide health screening and claims data, we identified 373 966 adults with both diabetes and chronic kidney disease who (1) underwent a baseline health examination in 2009 to 2013; (2) had ≥3 BP-measuring visits during a 5-year look-back period; and (3) did not have prior cardiovascular disease (CVD). The mean of all BPs measured throughout the look-back period was used for the analysis. The primary outcome was CVD event, defined as a composite of myocardial infarction, stroke, heart failure, or death from CVD.</p><p><strong>Results: </strong>Over a median follow-up of 10.2 years, 40 781 CVD events occurred. When using systolic BP 130 to <140 mm Hg as the reference, multivariable-adjusted hazard ratios (HRs) for CVD event in the systolic BP ≥150, 140 to <150, 120 to <130, and <120 mm Hg groups were 1.34 (95% CI, 1.29-1.39), 1.11 (95% CI, 1.08-1.14), 0.89 (95% CI, 0.87-0.91), and 0.77 (95% CI, 0.74-0.80), respectively. When using diastolic BP 80 to <90 mm Hg as the reference, HRs in the diastolic BP ≥100, 90 to <100, 70 to <80, and <70 mm Hg groups were 1.70 (95% CI, 1.56-1.85), 1.19 (95% CI, 1.15-1.24), 0.88 (95% CI, 0.86-0.90), and 0.83 (95% CI, 0.80-0.87), respectively. Systolic BP <130 mm Hg and diastolic BP <80 mm Hg were each associated with reduced CVD risk in a log-linear pattern.</p><p><strong>Conclusions: </strong>Among patients with diabetes and chronic kidney disease, SBP <130 mm Hg and diastolic BP <80 mm Hg were associated with reduced risk of CVD.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042966"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193807","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":"Long-Term Prognostic Value of the Prognostic Nutritional Index in Patients Undergoing Coronary Artery Bypass Grafting.","authors":"Dong Hyun Gim, Seung Hun Lee, Ji Hyun Cha, Ki Hong Choi, Young Bin Song, Joo Myung Lee, Taek Kyu Park, Joo-Yong Hahn, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Dong Seop Jeong, Su Ryeun Chung, Yang Hyun Cho, Kiick Sung, Wook Sung Kim, Jeong Hoon Yang","doi":"10.1161/JAHA.125.043597","DOIUrl":"10.1161/JAHA.125.043597","url":null,"abstract":"<p><strong>Background: </strong>The Prognostic Nutritional Index (PNI) as an indicator of nutritional and immunological status has been widely applied in various medical conditions. However, its prognostic role in postoperative outcomes after coronary artery bypass grafting has not been fully elucidated. This study investigated the long-term prognostic impact of PNI for patients undergoing coronary artery bypass grafting.</p><p><strong>Methods: </strong>A total of 6626 patients who underwent coronary artery bypass grafting from 2001 to 2017 were analyzed. PNI was calculated as 10×serum albumin (g/dL)+0.005×total lymphocyte count (per mm³).</p><p><strong>Results: </strong>PNI is negatively correlated with age (<i>r</i>=-0.24, <i>P</i><0.001) and positively correlated with body mass index (<i>r</i>=0.13, <i>P</i><0.001). PNI was significantly associated with all-cause mortality during a median follow-up of 10.0 years (hazard ratio [HR], 0.96 [per 1 increase] [95% CI, 0.96-0.97]; <i>P</i><0.001). The low-PNI group (≤47, n=3956) showed a higher incidence of all-cause mortality than those with high PNI (>47, n=2670) (64.8% versus 45.5%; adjusted HR, 1.19 [95% CI, 1.09-1.30]; <i>P</i><0.001). The model including PNI showed better prognostic discrimination for predicting all-cause mortality during long-term follow-up compared with the model with only clinical variables (C index, 0.733 [95% CI, 0.721-0.745] versus 0.763 [95% CI, 0.751-0.774]; integrated discrimination improvement, 0.037 [95% CI, 0.032-0.042]; net reclassification index, 0.334 [95% CI, 0.286-0.383]; <i>P</i><0.001 for each comparison).</p><p><strong>Conclusions: </strong>Perioperative PNI was significantly associated with long-term mortality after coronary artery bypass grafting, and addition of PNI improved risk discrimination beyond conventional clinical models. Further prospective studies are warranted to validate these findings.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043597"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193953","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":"Disparities in Access to Vascular Stroke Imaging and Carotid Revascularization: A Population Study.","authors":"Harshil Shah, Tina He, Naomi Dyck, Jillian Stang, Dana Nicol, Christiane J McIntosh, Stephen B Wilton, Shelagh B Coutts, Nishita Singh, Michael D Hill, Aravind Ganesh","doi":"10.1161/JAHA.125.043715","DOIUrl":"10.1161/JAHA.125.043715","url":null,"abstract":"<p><strong>Background: </strong>Decisions on imaging with computed tomography angiography, magnetic resonance angiography, and ultrasound in stroke or transient ischemic attack (TIA) may be influenced by factors ranging from location-based resource considerations to patient characteristics. We investigated disparities in vascular imaging utilization and carotid revascularization over 7 years in a Canadian province (Alberta, population: 4.4 million).</p><p><strong>Methods: </strong>We used provincial administrative data encompassing patients presenting to hospital or emergency/urgent-care facilities with TIA or ischemic stroke from April 1, 2016 to March 31, 2023. We related the vascular imaging received to year, age, sex, event diagnosis, comorbidities, distance to a comprehensive stroke center, region, and stroke center type using mixed-effects logistic regressions. We similarly examined disparities in imaging for recurrent events and in receipt of carotid endarterectomy/stenting.</p><p><strong>Results: </strong>Among 47 963 patients (median age, 72, interquartile range, 61-82, 47.6% female) with stroke/TIA, patients who were female, older, and experienced minor stroke/TIA (versus major stroke) had lower odds of receiving computed tomography angiography or any neurovascular imaging, as did those presenting to nonstroke centers or rural sites (eg, 35.8% rural versus 75.3% urban, adjusted odds ratio [any imaging]:0.56, 95% CI, 0.34-0.94). Odds of receiving vascular imaging increased over time, including computed tomography angiography (2016:49.1% versus 2023:79.9%, adjusted odds ratio per-year since 2015 [computed tomography angiography], 1.18 [95% CI, 1.16-1.19]). Female sex and absent neurovascular imaging carried lower odds of carotid revascularization (2.4% female versus 4.4% male, adjusted odds ratio, 0.57 [95% CI, 0.52-0.63]).</p><p><strong>Conclusions: </strong>Despite increasing utilization of neurovascular imaging, patients who are female, older, rural, or with minor stroke/TIA remain less likely to receive neurovascular imaging, with expected implications for receiving carotid revascularization. Female patients are less likely to undergo carotid revascularization even after accounting for receipt of imaging.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"eJAHA2025043715T"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088104","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":"Rationale and Design of the EPISODE Trial: A Randomized Controlled Trial on the Effect of PCSK9 Inhibitors in Calcific Aortic Valve Stenosis.","authors":"Yang Zheng, Qiuxuan Li, Yuxiu Yang, Jingyao Yang, Zaiqiang Liu, Xiaoteng Ma, Zhijian Wang","doi":"10.1161/JAHA.125.042112","DOIUrl":"10.1161/JAHA.125.042112","url":null,"abstract":"<p><strong>Background: </strong>Calcific aortic valve stenosis (CAVS) can lead to cardiac adverse outcomes; however, currently, no effective pharmacological interventions are available to prevent or delay disease progression. Emerging evidence has identified significant associations between CAVS and key biomarkers, including Lp(a) (lipoprotein [a]), low-density lipoprotein cholesterol, and PCSK9 (proprotein convertase subtilisin/kexin type 9). However, robust evidence from randomized controlled trials is still lacking to substantiate these associations.</p><p><strong>Methods: </strong>The EPISODE (Effect of PCSK9 Inhibitors on Calcific Aortic Valve Stenosis) trial is a prospective, evaluator-blinded, randomized controlled trial designed to assess the therapeutic efficacy of PCSK9 inhibitors in patients with CAVS. A total of 160 patients with mild-to-moderate or asymptomatic severe CAVS will be randomly assigned to receive either statin monotherapy or a combination of statins and PCSK9 inhibitors. Participants will undergo follow-up assessments at 3-month intervals for 24 months, including transthoracic ultrasonic cardiogram, computed tomography, and quality-of-life evaluations using the EuroQol-5 Dimension-3 Level questionnaire. The primary end point is the annualized change in peak aortic jet velocity, whereas secondary end points encompass changes in aortic valve area, calcification score, incidence of heart valve surgery, and quality of life. Safety end points include all-cause mortality and cardiovascular events.</p><p><strong>Conclusions: </strong>The trial aims to evaluate the efficacy of PCSK9 inhibitors in modulating disease progression, reducing adverse cardiovascular events, and improving clinical outcomes in patients with CAVS. The anticipated findings are expected to provide critical insights for developing novel therapeutic strategies for early intervention in CAVS.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04968509.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042112"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088333","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}