Journal of the American Heart Association最新文献

{"title":"Impact of Transcatheter Edge-to-Edge Repair in Patients With Cardiac Sarcoidosis: Insights From the OCEAN-Mitral Registry.","authors":"Takashi Hiruma, Mike Saji, Mamoru Nanasato, Itaru Takamisawa, Ryosuke Higuchi, Yuki Izumi, Ryo Abe, Mitsuaki Isobe, Masanori Yamamoto, Shunsuke Kubo, Masahiko Asami, Yusuke Enta, Shinichi Shirai, Masaki Izumo, Shingo Mizuno, Yusuke Watanabe, Makoto Amaki, Kazuhisa Kodama, Junichi Yamaguchi, Toru Naganuma, Hiroki Bota, Yohei Ohno, Daisuke Hachinohe, Masahiro Yamawaki, Hiroshi Ueno, Kazuki Mizutani, Toshiaki Otsuka, Kentaro Hayashida","doi":"10.1161/JAHA.124.039243","DOIUrl":"10.1161/JAHA.124.039243","url":null,"abstract":"<p><strong>Background: </strong>In patients with sarcoidosis, cardiac involvement is a crucial prognostic factor leading to severe cardiovascular events. Mitral regurgitation (MR) predisposes patients to drug-refractory heart failure; however, MR in patients with cardiac sarcoidosis (CS) has been scarcely investigated and its therapeutic approach remains unclear. This study aimed to investigate the clinical impact of transcatheter edge-to-edge repair in patients with CS.</p><p><strong>Methods: </strong>Patients with CS-related ventricular functional MR were compared with those with other nonischemic cardiomyopathies in the OCEAN (Optimized Catheter Valvular Intervention)-Mitral registry in Japan.</p><p><strong>Results: </strong>Among 1240 patients with nonischemic cardiomyopathy-related ventricular functional MR, 40 (3.2%) had CS. Of these, 18 patients (45.0%) had immunosuppressive therapy. Twenty-seven patients (67.5%) were New York Heart Association function class III/IV. Patients with CS were more likely to be younger and female, had a higher prevalence of ventricular tachyarrhythmia and cardiac resynchronization therapy, and had a larger left ventricle with more severe MR than the others. At the procedure, 38 patients (95.0%) had devices placed at the central lesion. All patients with CS were successfully treated, leading to immediate improvement of cardiac output. At 1-year follow-up, 89.3% had MR ≤2+ and 40.0% had New York Heart Association function class I. Despite similar outcomes between groups, greater remnant MR and fatal arrhythmic events in those with CS may be due to inadequate reverse remodeling and ongoing left ventricle damage caused by inflammation.</p><p><strong>Conclusions: </strong>Transcatheter edge-to-edge repair is an effective heart failure treatment for patients with CS-related MR; however, the drug- and cardiac device-refractory cardiomyopathy in this population warrants careful management.</p><p><strong>Registration: </strong>URL: www.umin.ac.jp/english/; Unique Identifier: UMIN000023653.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039243"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722569","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":"Atherogenic Effects of Acute Electronic Cigarette Compared With Tobacco Cigarette Smoking in People Living With HIV: A Randomized Crossover Trial.","authors":"Theodoros Kelesidis, Leila Fotooh Abadi, Isabelle Ruedisueli, Zoee U D'Costa, Holly R Middlekauff","doi":"10.1161/JAHA.124.038258","DOIUrl":"10.1161/JAHA.124.038258","url":null,"abstract":"<p><strong>Background: </strong>People living with HIV (PLWH) are disproportionately affected by tobacco-related health disparities. Concurrent recreational drug use is also more prevalent. Switching to electronic cigarettes (ECs) has been proposed as a harm reduction strategy. However, it remains unproven whether ECs are less atherogenic than tobacco cigarettes (TCs).</p><p><strong>Methods and results: </strong>PLWH who smoke TCs and met eligibility criteria were invited to enroll in our acute crossover trial (NCT04568395) comparing the effects of using an EC, a TC, and a straw control on different days on monocyte transendothelial migration and monocyte-derived foam cell formation in our novel ex vivo atherogenesis assay. Twenty-eight PLWH (aged 41.8±9.8 years; 27 men and 1 woman, 18 with a positive urine toxicology screen) completed all 3 sessions. The acute rise in plasma nicotine was similar after acute TC and EC use (7.32±0.86 ng/mL versus 6.30±0.92 ng/mL, <i>P</i>=0.69). The monocyte transendothelial migration after acutely smoking a TC increased by a mean of 0.65-fold difference compared with the straw control (<i>P</i><0.01). The monocyte transendothelial migration after using an EC was not significantly increased compared with the straw control. The monocyte-derived foam cell formation after acutely smoking a TC was increased by a mean of 0.65-fold difference compared with the straw control (<i>P</i><0.001). The monocyte-derived foam cell formation after acutely using an EC was not significantly increased compared with the straw control. These findings were present in PLWH with and without concurrent recreational drug use.</p><p><strong>Conclusion: </strong>These data suggest smaller proatherogenic effects following EC versus TC use in PLWH and justify a larger study looking at cardiovascular risks of ECs in PLWH who smoke, including those who use recreational drugs, populations disproportionately affected by tobacco-related health disparities.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038258"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658982","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":"An International Longitudinal Natural History Study of Patients With Danon Disease: Unique Cardiac Trajectories Identified Based on Sex and Heart Failure Outcomes.","authors":"Kimberly N Hong, Emily Eshraghian, Tarek Khedro, Alessia Argirò, Jennifer Attias, Garrett Storm, Melina Tsotras, Tanner Bloks, Isaiah Jackson, Elijah Ahmad, Sharon Graw, Luisa Mestroni, Quan M Bui, Jonathan Schwartz, Stuart Turner, Eric D Adler, Matthew Taylor","doi":"10.1161/JAHA.124.038394","DOIUrl":"10.1161/JAHA.124.038394","url":null,"abstract":"<p><strong>Background: </strong>Danon disease is a rare X-linked dominant cardioskeletal myopathy caused by mutations in the lysosome-associated membrane protein-2 gene. Though the severe morbidity of disease in men is well established, longitudinal studies describing the trajectory of cardiovascular disease in both sexes are lacking.</p><p><strong>Methods and results: </strong>Data were from the International Danon Disease Registry and includes retrospective data on 116 patients who provided informed consent between 2005 and 2022. The analysis included 116 patients with Danon disease with a median age of diagnosis of 15.2 years (10.0-25.2 years). Trends in echocardiographic parameters over time indicate decreased left ventricular ejection fraction and increased left ventricular end diastolic dimension regardless of sex and heart failure (HF) outcome; however, rate of change was increased in patients who experienced a HF outcome in both sexes. Left ventricular wall hypertrophy continues in men who have not yet experienced a HF outcome and stabilizes before HF outcome, while females have progressive left ventricular thinning regardless of HF outcome. Stratified analysis demonstrated 2 distinct groups of females: one who experienced HF outcome before 26 years of age and another group with this HF outcome after.</p><p><strong>Conclusions: </strong>In this largest longitudinal natural history study of Danon disease to date, we confirmed that males present on average a decade earlier and demonstrate more progressive cardiac hypertrophy and HF than females. Notably, there may be a subset of females who are phenotypically similar to males with profound left ventricular hypertrophy that appears to stabilize or regress before HF outcome. Correlations between structural cardiac dysfunction and disease progression may permit risk stratification, refinement of treatment algorithms, and inform therapeutic trial design.</p><p><strong>Registration: </strong>URL: https://clinicaltrials.gov/; Unique Identifier: NCT03766386.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038394"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674826","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":"Global Trends and Cross-Country Inequalities in Stroke and Subtypes Attributable to High Body Mass Index From 1990 to 2021.","authors":"Yuhang Zhu, Wanguo Liu, Kangding Liu, Ying Gao, Sibo Wang","doi":"10.1161/JAHA.124.039135","DOIUrl":"10.1161/JAHA.124.039135","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a major global cause of death and disability, with high body mass index (HBMI) as a key modifiable risk factor. Understanding HBMI-attributable stroke burden is crucial for effective prevention.</p><p><strong>Methods and results: </strong>Using Global Burden of Disease 2021 data, we analyzed disability-adjusted life years and mortality from stroke and its subtypes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) attributable to HBMI at global, regional, and national levels from 1990 to 2021. We conducted decomposition, frontier, inequality, and predictive analyses to assess epidemiological trends and future projections up to 2035. Despite country-specific variations in disability-adjusted life years and mortality, the global burden of stroke and its subtypes attributable to HBMI has increased from 1990 to 2021. Frontier analysis indicated that countries with higher sociodemographic index were expected to own lower age-standardized rates for stroke and its subtypes attributable to HBMI. Decomposition analysis revealed that population growth and aging were the primary contributors to the rise. Significant cross-country disparities remained, although inequality analysis showed a decline in SDI-related differences over time. The projected annual rise in disability-adjusted life years and mortality from 2021 to 2035 suggested ongoing significant challenges in stroke control and management in the coming decades.</p><p><strong>Conclusion: </strong>The global health challenge posed by the increasing burden of stroke and its subtypes attributable to HBMI remains significant, especially in low- and middle-sociodemographic index regions. Targeted lifestyle modifications and policy interventions are crucial for reducing HBMI and mitigating stroke burden, warranting special attention from policymakers in high-burden regions.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039135"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711978","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":"The Quantitative Flow Ratio Uncertainty-Zone: Finding Certainty Within Uncertainty.","authors":"Warren Tai, Samit M Shah, Rushi V Parikh","doi":"10.1161/JAHA.124.038843","DOIUrl":"10.1161/JAHA.124.038843","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038843"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674904","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 CREATE Trial: A Multicenter, Randomized Comparison of Continuation or Cessation of Single Antithrombotic Therapy at 1 Year After Transcatheter Aortic Valve Replacement.","authors":"Ran Liu, Yang Li, Lihua Zhang, Zhinan Lu, Zhaolin Fu, Thomas Modine, Hasan Jilahawi, Stuart Pocock, Yongjian Wu, Guangyuan Song","doi":"10.1161/JAHA.124.039350","DOIUrl":"10.1161/JAHA.124.039350","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines and expert consensus recommend lifelong single antiplatelet therapy for patients undergoing transcatheter aortic valve replacement who have no indication for anticoagulation or dual antiplatelet therapy. However, there is no direct evidence from randomized controlled trials supporting this practice. Furthermore, the optimal duration of antiplatelet therapy in this population has not been adequately investigated.</p><p><strong>Methods and results: </strong>CREATE (A Multicenter Randomized Controlled Study to Evaluate Cessation of Antithrombotic Therapy at 1 Year in TAVR Patients-The CREATE Study) is a prospective, multicenter, open-label, randomized controlled trial for patients who have undergone successful transcatheter aortic valve replacement and have no indication for long-term oral anticoagulation or antiplatelet therapy. Eligible patients are free from major bleeding and ischemic events for 1 year postprocedure before being randomized 1:1 to single antiplatelet therapy (control group) or no antiplatelet therapy (experimental group). The primary efficacy end point is the incidence of bleeding events, defined by the VARC-3 (Valve Academic Research Consortium-3) criteria, at 1-year postrandomization. The primary safety end point is a composite of cardiac death, myocardial infarction, and ischemic stroke at 1 year. The trial is powered for both superiority in efficiency and noninferiority in safety. Accordingly, a total of 3380 patients will be enrolled.</p><p><strong>Conclusions: </strong>The CREATE trial aims to assess if stopping antiplatelet therapy at 1-year after transcatheter aortic valve replacement reduces bleeding risk without increasing ischemic events in patients not requiring chronic antithrombotic therapy.</p><p><strong>Registration: </strong>URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2400087454.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039350"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674928","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":"American Heart Association Automated External Defibrillator Symposium: Summary and Recommendations.","authors":"José G Cabañas, Comilla Sasson, Benjamin S Abella, Tom P Aufderheide, Lance B Becker, Katie N Dainty, Carolina Malta-Hansen, Rudolph W Koster, Michael C Kurz, Keith A Marill, Maureen O'Connor, Ashish R Panchal, Jon C Rittenberger, David D Salcido, Michael R Sayre, Paul Snobelen, Monique A Starks, Dianne L Atkins","doi":"10.1161/JAHA.124.039291","DOIUrl":"10.1161/JAHA.124.039291","url":null,"abstract":"<p><p>The American Heart Association (AHA) introduced public access defibrillation more than 30 years ago. Since then, we have seen the growth of public access defibrillation programs across many settings within communities. However, despite high expectations that the availability of automated external defibrillators (AEDs) and more integrated public access defibrillation programs would dramatically increase cardiac arrest survival, AEDs are used in the United States in only 4% of out-of-hospital cardiac arrests and survival rates have remained disappointingly low. In follow-up to a recent International Liaison Committee on Resuscitation report, an AED Symposium was organized by members of the AHA Emergency Cardiovascular Care Committee to establish a strategic roadmap for AED technology, education and training, and real-world use of these devices, including integration with public access defibrillation programs to meet the AHA's goal of doubling out-of-hospital cardiac arrests survival by 2030. The meeting brought together a diverse group of subject matter experts including representatives from the US Food and Drug Administration, the defibrillator industry, clinicians, and scientists. This paper summarizes the proceedings of the AED symposium and suggests a set of strategic recommendations to ultimately improve survival from cardiac arrest.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039291"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658777","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":"α Protein Kinase 3 Is Essential for Neonatal and Adult Cardiac Function.","authors":"Wei Feng, Li Wang, Julius Bogomolovas, Zengming Zhang, Titania Huang, Chien-Wei Chang, Abraham Shain, Yusu Gu, Yoshitake Cho, Xiaohai Zhou, Ju Chen","doi":"10.1161/JAHA.124.039464","DOIUrl":"10.1161/JAHA.124.039464","url":null,"abstract":"<p><strong>Background: </strong>ALPK3 (α protein kinase 3) is an atypical kinase highly expressed in human and murine hearts. Biallelic loss-of-function mutations in ALPK3 lead to pediatric cardiomyopathy. The specific stages at which ALPK3 is essential for cardiac function and the mechanisms by which it regulates cardiac function require further exploration.</p><p><strong>Methods and results: </strong>We generated ALPK3 global knockout and inducible cardiac-specific knockout mice. We performed time-course physiological and morphological assessments to determine ALPK3's role in neonatal and adult hearts. We also generated an <i>Alpk3</i>-3xFLAG-HA knock-in mouse model to determine endogenous ALPK3 localization. To investigate mechanisms of ALPK3 regulation, we performed biochemical assays and RNA sequencing experiments in global knockout mice. ALPK3 is critical for both neonatal and adult cardiac function. Loss of ALPK3 at germline and adult stages leads to dilated cardiomyopathy. Approximately 75% of germline ALPK3 mice die within 1 month, while surviving mutant mice develop dilated cardiomyopathy that transitions to left ventricular hypertrophy, mirroring clinical manifestations in human patients with biallelic ALPK3 mutations. We found that ALPK3 localizes to the M-band in both neonatal and adult cardiomyocytes and interacts with muscle RING-finger proteins, which may regulate thick filament protein turnover.</p><p><strong>Conclusions: </strong>Our study highlights the necessity of ALPK3 in neonatal and adult cardiac function. Our data support a model in which ALPK3 serves as a scaffold protein to recruit machineries essential for regulating thick filament protein turnover.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039464"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712151","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":"Model for End Stage Liver Disease Excluding International Normalized Ratio Predicts Severe Right Ventricular Failure After HeartMate 3 Implantation in a Contemporary Cohort.","authors":"David S Lambert, Ana María Picó, Justin D Vincent, Elena Deych, Erin Coglianese, Joel D Schilling, Justin M Vader, Bin Q Yang","doi":"10.1161/JAHA.124.037553","DOIUrl":"10.1161/JAHA.124.037553","url":null,"abstract":"<p><strong>Background: </strong>Right ventricular failure (RVF) after left ventricular assist devices is associated with significant morbidity and mortality. Therefore, identifying patients at risk for severe RVF is important for clinical decision-making. Current risk prediction models were not developed in contemporary populations with left ventricular assist devices and have limited clinical applicability. In this study, we sought to evaluate whether the Model for End Stage Liver Disease Excluding International Normalized Ratio (MELD-XI) can predict severe RVF after HeartMate 3 implantation.</p><p><strong>Methods: </strong>We retrospectively analyzed all adult patients who received HeartMate 3 left ventricular assist devices as initial implantation at 2 academic medical centers. We assessed whether MELD-XI is an independent risk factor for severe RVF in multivariate analysis and compared the predictive accuracy of MELD-XI with previously published risk scores. We also investigated the relationship between MELD-XI and markers of RV function and whether MELD-XI was associated with death or pump exchange at 1-year follow-up.</p><p><strong>Results: </strong>Our study included a total of 246 patients, of whom 74 (30%) experienced severe RVF. After adjusting for relevant covariables, MELD-XI was independently associated with severe RVF (odds ratio [OR], 1.18 [95% CI, 1.09-1.29]; <i>P</i><0.001) and performed similarly to the EUROMACS (European Registry for Patients with Mechanical Circulatory Support) and Michigan RVF risk scores. In addition, MELD-XI was not reflective of traditional echocardiographic or hemodynamic measures of right ventricular function. Finally, MELD-XI ≥14 predicted worse in-hospital mortality.</p><p><strong>Conclusions: </strong>Among patients undergoing HeartMate 3implantation, MELD-XI is independently associated with an increased risk of RVF and in-hospital mortality.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037553"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722599","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":"Angiographic Quantitative Flow Ratio-Guided Treatment of Patients With Physiologically Intermediate Coronary Lesions.","authors":"Jiannan Dai, Changdong Guan, Xueming Xu, Jingbo Hou, Haibo Jia, Huai Yu, Zening Jin, Guosheng Fu, Xiaofan Wu, Liansheng Wang, Rongchong Huang, Zhujun Shen, Yanyan Zhao, Yuanzhe Jin, Lei Song, Shengxian Tu, Shubin Qiao, Bo Yu, Bo Xu, Gregg W Stone","doi":"10.1161/JAHA.124.035756","DOIUrl":"10.1161/JAHA.124.035756","url":null,"abstract":"<p><strong>Background: </strong>The FAVOR III (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients With Coronary Artery Disease) China trial reported improved clinical outcomes with percutaneous coronary intervention guided by quantitative flow ratio (QFR) compared with angiography. Whether these benefits also apply for patients presenting with \"uncertainty-zone\" lesions of intermediate physiological significance is uncertain. This study aims to examine the impact of QFR guidance versus angiography guidance on the management and outcomes of percutaneous coronary intervention in uncertainty-zone lesions.</p><p><strong>Methods and results: </strong>In this prespecified subgroup analysis, offline QFR assessment categorized 873 patients (22.9%) into the uncertainty-zone subgroup, defined as having an offline QFR of 0.75 to 0.85 in all coronary arteries with a lesion causing ≥50% diameter stenosis. At 2 years, the rate of major adverse cardiac events, a composite of all-cause death, myocardial infarction, or ischemia-driven revascularization, occurred in 31 patients (7.0%) in the QFR-guided group and 35 patients (8.3%) in the angiography-guided group (hazard ratio [HR], 0.85 [95% CI, 0.52-1.37]). In landmark analysis, the relative treatment effect of QFR guidance versus angiography guidance on major adverse cardiac events differed before 1 year (4.7% versus 3.8%; HR, 1.25 [95% CI, 0.65-2.40]) and after 1 year (2.3% versus 5.5%; HR, 0.41 [95% CI, 0.20-0.87]) (<i>P</i>_interaction=0.03), driven by fewer nonprocedural myocardial infarctions and ischemia-driven revascularizations in the QFR-guided group after 1-year follow-up.</p><p><strong>Conclusions: </strong>In the modest-sized subgroup of patients with physiologically intermediate lesions randomized in the FAVOR III China trial, 2-year clinical outcomes were not significantly improved with a QFR-guided revascularization strategy compared with angiography guidance.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Identifier: NCT03656848.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e035756"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674832","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}