Journal of the American Heart Association最新文献

{"title":"Enhancing Societal Participation for Stroke Survivors With Cognitive Impairments: A Randomized Controlled Trial.","authors":"Shih-Pin Hsu, Te-Hsun Hung, Yen-Nung Lin, Jiunn-Horng Kang, Der-Sheng Han, Valeria Chiu, Tsan-Hon Liou, Yi-Hsuan Wu, Peng-Sheng Ni, Elizabeth R Skidmore, Feng-Hang Chang","doi":"10.1161/JAHA.125.042295","DOIUrl":"10.1161/JAHA.125.042295","url":null,"abstract":"<p><strong>Background: </strong>Returning to societal participation is an important goal for stroke survivors, but evidence for effective rehabilitation remains inconclusive. This study evaluated the efficacy of participation-focused strategy training in improving poststroke participation among community-dwelling survivors with cognitive impairments.</p><p><strong>Methods: </strong>This multicenter, randomized trial enrolled stroke survivors with executive function impairments between January 2019 and March 2023. Participants received either strategy training (n=96) or an attention-control intervention (n=99) in 12 to 15 sessions over 8 weeks. The primary outcome was the postintervention change in participation across productivity, social, and community domains from the baseline, measured by the Participation Measure-3 Domains, 4 Dimensions. Secondary outcomes included changes in activity performance, self-efficacy, and global cognition from baseline.</p><p><strong>Results: </strong>Eligible 195 participants were included in the intention-to-treat analysis (64 women, 32.8%; median [interquartile range] age: 62 [52-68] years). After adjusting for baseline primary outcome, stroke severity, and dose of regular rehabilitation, the strategy training group showed greater improvements in productivity and social participation compared with the control group (adjusted mean difference between groups [95% CI]: 7.89 [2.61-13.16] (<i>P</i>=0.004) and 0.29 [0.08-0.51] (<i>P</i>=0.009), respectively) from baseline to postintervention. These effects remained without adjustment, but did not persist at 3-month follow-up. No significant between-group differences were observed for any other outcomes.</p><p><strong>Conclusions: </strong>Participation-focused strategy training significantly improved productivity and social participation among enrolled stroke survivors compared with the control intervention postintervention. Further research is warranted to confirm these findings in the oldest survivors and to explore approaches for enhancing the long-term benefits of strategy training.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03792061.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042295"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088159","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":"Racial Disparities in Heart Transplantation: Long-Term Graft Survival and Nonmortality Outcomes.","authors":"Steven Anthony Hamilton, Brian Wayda, Yingjie Weng, Shiqi Zhang, Kiran K Khush","doi":"10.1161/JAHA.124.038892","DOIUrl":"10.1161/JAHA.124.038892","url":null,"abstract":"<p><strong>Background: </strong>Prior studies have reported conflicting evidence on racial disparities in heart transplant outcomes, often focusing only on short-term mortality rates. We assessed longer-term survival and a broader range of post-heart transplant outcomes by race.</p><p><strong>Methods: </strong>We analyzed adult heart transplant recipients from 2017 to 2022 in the SRTR (Scientific Registry for Transplant Recipients), categorizing race as Black, non-Hispanic White, or Other. The primary outcome was graft failure at 1 and 3 years. Secondary outcomes included acute rejection, renal dysfunction, and posttransplant diabetes. χ² tests and Kaplan-Meier/logistic regression analyses were used.</p><p><strong>Results: </strong>Among 15 873 recipients (63% White, 23% Black, 14% Other), Black recipients were more likely female, publicly insured, and less likely to be college educated. They also had higher use of durable ventricular assist devices and intra-aortic balloon pump at transplant. One-year graft survival was similar across groups (91.8% Black versus 91.1% non-Black), but 3-year survival was lower among Black individuals (83.4% versus 85.7%, <i>P</i>=0.006). After adjusting for socioeconomic and clinical factors, Black recipients had a higher risk of graft failure at 3 years (odds ratio, 1.22 [95% CI, 1.07-1.39]). Black patients also experienced higher rates of acute rejection (12.4% versus 10.2%), diabetes (10.8% versus 7.1%), and renal dysfunction progression (40.9% versus 37.1%) at 3 years (<i>P</i><0.05 for all).</p><p><strong>Conclusions: </strong>Racial disparities in heart transplant outcomes persist, particularly in longer-term survival. These disparities may be partially mediated by differences in posttransplant complications such as rejection, renal dysfunction, and diabetes.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038892"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139244","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":"Subgroups With Metabolic Syndrome Show Different Association With Ischemic Heart Disease and Stroke; Findings of Iran STEPS Survey 2021.","authors":"Sogol Koolaji, Sina Azadnajafabad, Moein Yoosefi, Naser Ahmadi, Ali Golestani, Erfan Ghasemi, Arezou Dilmaghani-Marand, Negar Rezaei, Ameneh Kazemi, Nazila Rezaei, Yosef Farzi, Kamyar Rezaee, Arefeh Alipour Derouei, Maryam Nasserinejad, Elham Abdolhamidi, Mohammad-Mahdi Rashidi, Rosa Haghshenas, Azadeh Momen Nia Rankohi, Shirin Djalalinia, Farideh Razi, Bagher Larijani, Farshad Farzdafar","doi":"10.1161/JAHA.124.039240","DOIUrl":"10.1161/JAHA.124.039240","url":null,"abstract":"<p><strong>Background: </strong>Metabolic syndrome (MetS) is defined as clustering of 3 or more of 5 metabolic risk factors in an individual. It has been greatly using in clinical practice; although some research illustrated that it might not act as a homogenous disorder in association with cardiovascular diseases. Therefore, we aimed to investigate its prevalence and association with ischemic heart disease (IHD) and stroke.</p><p><strong>Methods: </strong>Using Iran STEPS (STEPwise Approach to NCD [Noncommunicable Diseases] Risk Factor Surveillance) Survey 2021, the prevalence and association of MetS, with prevalence of IHD and stroke was assessed. Given the definition of MetS, it includes 16 combinations (clusters) of 5 risk factors; we aggregated them into 6 groups and evaluated their association with prevalence of IHD and stroke.</p><p><strong>Results: </strong>Overall, 54.19% of total population had MetS, where the most prevalent criterion was elevated waist circumference. MetS was associated with 1.70 times greater adjusted odds ratio (OR) of IHD prevalence (95% CI, 1.40-2.07). A closer look reveals that the greatest OR of IHD prevalence was observed in individuals with all 5 risk factors or 4 risk factors including both elevated blood pressure and fasting plasma glucose with ORs of 6.69 (3.52-12.68) and 6.38 (3.38-12.03), respectively, compared with individuals with none of the risk factors (0 components).</p><p><strong>Conclusions: </strong>The association of MetS cluster with IHD and stroke prevalence varied. In addition to the dose-response relationship, the clusters characterized by both elevated BP and FPG are the most critical for targeting preventive and therapeutic measures.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039240"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139268","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":"Afterload Mismatch Is Associated With Higher Cardiac Mortality After Heart Transplantation.","authors":"Mattia Corianò, Nicola Pradegan, Andrea Golfetto, Vincenzo Tarzia, Annalisa Angelini, Chiara Tessari, Marny Fedrigo, Giuseppe Toscano, Gino Gerosa, Francesco Tona","doi":"10.1161/JAHA.124.040636","DOIUrl":"10.1161/JAHA.124.040636","url":null,"abstract":"<p><strong>Background: </strong>Heart transplant (HT) recipients tend to develop unfavorable ventricular-arterial interactions, yet the prognostic implications of this altered physiology remain unclear. We aimed to identify the presence of afterload mismatch (AM) after heart transplantation, its determinants, and its impact on long-term cardiac mortality.</p><p><strong>Methods: </strong>An observational, single-center study was conducted on the historical cohort of patients who received HT at our institution. Patients survived the first year after HT with a LVEF ≥50%, cardiac allograft vasculopathy grades 0 to 1, and acute cellular rejection grades 0 to 1R. Arterial elastance and ventricular elastance were calculated noninvasively using blood pressure, end-systolic volume, and end-diastolic volume. Patients were grouped as follows: low afterload (LA- arterial elastance <median), matched high afterload (MHA- arterial elastance ≥median, ventricular elastance ≥median), and AM (arterial elastance ≥median, ventricular elastance <median).</p><p><strong>Results: </strong>Overall, 345 patients who received HT were enrolled. Left ventricular ejection fraction was lower in AM (57%) than in LA and MHA (63% and 64%, respectively; <i>P</i><0.0001); stroke volume was lower in AM than in LA but comparable between AM and MHA (27, 35, and 26 mL/m² for AM, LA, and MHA, respectively; <i>P</i>=0.0001). Predictors of AM were male recipient/male donor (β=0.15, <i>P</i>=0.0067) and male recipient/female donor (β=0.6, <i>P</i>=0.0078). After a median of 11.3 years, 59 recipients had died. Cardiac mortality was higher in the group with AM (AM median survival: 17.2, 27.8, and 24.1 years for AM, LA, and MHA, respectively; log-rank <i>P</i>=0.005). After adjusting for confounding variables, AM was associated with cardiac mortality (hazard ratio [HR], 2.26 [95% CI, 1.18-4.35]; <i>P</i>=0.0143)as were male recipient/female donor (HR, 2.94 [95% CI], 1.18-4.35; <i>P</i>=0.0358).</p><p><strong>Conclusion: </strong>Three phenotypes of patients who received HT were identified, and AM resulted as an independent predictor of cardiac mortality.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040636"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139570","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":"Validation of a 0-/2-Hour High-Sensitivity Cardiac Troponin Algorithm for Suspected Acute Coronary Syndrome in the Emergency Department.","authors":"Dustin G Mark, Jie Huang, Keane K Lee, Dana R Sax, Dustin W Ballard, David R Vinson, Mary E Reed","doi":"10.1161/JAHA.125.043756","DOIUrl":"10.1161/JAHA.125.043756","url":null,"abstract":"<p><strong>Background: </strong>We implemented a hs-cTnI (high-sensitivity cardiac troponin I)-based algorithm for emergency department (ED) evaluation of possible non-ST-segment-elevation acute coronary syndrome within an integrated health system (Kaiser Permanente Northern California).</p><p><strong>Methods: </strong>Retrospective study of adult (18+ years) ED encounters for chest pain/discomfort with hs-cTnI testing (Access hsTnI, Beckman) at 21 medical centers between January 1, 2023 and June 30, 2024, excluding ST-segment-elevation myocardial infarction. The primary outcome was 30-day myocardial infarction or death. Sensitivity, specificity, negative predictive value, positive predictive value, and likelihood ratios were reported, with subgroup analyses by age, sex, coronary artery disease, chronic kidney disease, and ED disposition.</p><p><strong>Results: </strong>There were 104 025 encounters in the final cohort (median age 59 years, 45% male, 18% coronary artery disease, and 13% chronic kidney disease). The primary outcome occurred in 5.5% encounters. Rule-out criteria were present in 70% of encounters (sensitivity, 95.4% [95% CI, 94.8%-96.0%]; negative predictive value, 99.7% [95% CI, 99.6%-99.7%]; likelihood ratio, -0.05) and 7% of encounters met rule-in criteria (specificity, 96.7% [95% CI, 96.6-96.8%]; positive predictive value, 60.2% [95% CI, 59.3%-61.1%]; likelihood ratio, +24.4). In subgroup analyses, rule-out criteria negative predictive value was below 99% in stage 4+ chronic kidney disease (96.1% [95% CI, 94.6%-97.6%]) and ischemic coronary artery disease (98.6% [95% CI 98.3-98.9%]), though not among those selected for ED discharge (98.4% [95% CI, 96.7%-99.2%] and 99.1% [95% CI, 98.8%-99.4%], respectively).</p><p><strong>Conclusions: </strong>The Kaiser Permanente Northern California non-ST-elevation acute coronary syndrome evaluation algorithm demonstrated excellent overall performance. Negative predictive value was modestly diminished in ischemic coronary artery disease or advanced chronic kidney disease, but risk was largely mitigated by ED discharge disposition decisions.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043756"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193485","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":"Improving American Indian Adolescent and Young Adult Cardiovascular Health: The Importance of the Strong Heart Family Study.","authors":"Joseph Burns, Whitney R Lloyd, Keila N Lopez, Jessica A Reese, Jason F Deen","doi":"10.1161/JAHA.125.042895","DOIUrl":"10.1161/JAHA.125.042895","url":null,"abstract":"<p><p>American Indian (AI) people have among the highest rates of cardiovascular morbidity and mortality in the United States. Fortunately, since its inception in 1988, the SHS (Strong Heart Study) and its expansion, the SHFS (Strong Heart Family Study), have provided the most robust data on AI cardiovascular health in adults and children. This article aims to highlight key SHFS publications related to AI and adolescent cardiovascular health, identify ongoing investigations, and promote community-based participatory research and advocacy efforts addressing the needs of AI people. The success of SHFS is rooted in community-based participatory research and presents a model for academic, clinical, tribal, and community partnerships. Furthermore, the findings of SHFS highlight the importance of early identification of cardiovascular disease risk factors and the unique social drivers of health that affect this population, to promote health equity in AI communities.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042895"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193886","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":"Nothing Is Wrong With My Heart: Patient-Reported Understanding of Heart Failure With Preserved Ejection Fraction.","authors":"Yulia Khodneva, Megan Nordberg, Larry R Hearld, Pankaj Arora, Andrea L Cherrington","doi":"10.1161/JAHA.124.041191","DOIUrl":"10.1161/JAHA.124.041191","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) represents the fastest growing subtype of heart failure, and one-half of patients with HFpEF are unaware of a heart failure diagnosis. The purpose of this study was to explore patient-reported barriers to understanding HFpEF.</p><p><strong>Methods: </strong>Adult patients with HFpEF, recruited from a local health care system, participated in a qualitative study. Participants were asked to describe their heart condition and what they want to learn more. Interviews were transcribed and analyzed using thematic analysis.</p><p><strong>Results: </strong>Twenty-one participants with HFpEF, aged 60 years, 62% Black, and 67% women, were included. Most participants had at least a high school degree (72%). Mean duration of heart failure was 4 years; 95% had hypertension, 43% had diabetes, and mean body mass index was 38.4 kg/m². All participants were unaware they had HFpEF, with 60% reporting they had congestive heart failure. Thematic analysis identified 4 themes: (1) disease uncertainty, (2) impact of initial diagnosis, (3) scramble to learn about HF, and (4) opportunities to improve care. Barriers to understanding HFpEF included lack of information from providers, limited provider availability, ineffective provider communication and using complex medical terminology, short duration of clinic visits, and fatigue during the clinic visit. Participants expressed multiple needs in health information, mental health support, and counseling on the management and prognosis of HFpEF. Finally, participants desired improved communication with their health care team.</p><p><strong>Conclusions: </strong>Participants were not aware they had HFpEF and expressed multiple suggestions for future interventions.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"eJAHA2025041191T"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193943","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":"Beyond Rejection: Long-Term Survival Following Heart Transplant.","authors":"Justin C Y Chan, Randal I Goldberg","doi":"10.1161/JAHA.125.045281","DOIUrl":"10.1161/JAHA.125.045281","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e045281"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139518","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":"Thermoneutrality Does Not Affect Angiotensin II-Induced Aortic Aneurysms in Hypercholesterolemic Mice.","authors":"Liyuan Zhu, Bowen Li, Michael K Franklin, Deborah A Howatt, Yuriko Katsumata, Alan Daugherty, Hong S Lu","doi":"10.1161/JAHA.125.043689","DOIUrl":"10.1161/JAHA.125.043689","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043689"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193250","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":"Obesity Adversely Affects Dietary Metabolism: Time to Inform Guidelines?","authors":"Rajeev Gupta, Anshul Yadav","doi":"10.1161/JAHA.125.045359","DOIUrl":"10.1161/JAHA.125.045359","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e045359"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193977","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}