Journal of the American Heart Association最新文献

{"title":"Evaluating the Science of Diversity in Clinical Trials: Design and Goals of an American Heart Association Strategic Focused Research Network.","authors":"Erin D Michos, Cheryl R Himmelfarb, Eldrin F Lewis, Tzung Hsiai, Keith C Norris, Joseph Keawe'aimoku Kaholokula, Rema Raman, Jevay Grooms, Scott D Halpern, Priscilla Pemu, Fatima Rodriguez, Hannah Valantine","doi":"10.1161/JAHA.125.041831","DOIUrl":"10.1161/JAHA.125.041831","url":null,"abstract":"<p><strong>Background: </strong>Clinical trials serve as the key evidence that shapes guideline recommendations and clinical practice. Despite long-standing recommendations by regulatory and funding organizations for representative trial enrollment, the underinclusion of women and individuals from diverse racial and ethnic populations in cardiovascular and dementia clinical trials persists. This undermines trust in research, threatens basic principles of fairness, and may limit the generalizability of trial results to broad patient populations.</p><p><strong>Methods: </strong>To better understand how to foster more inclusive cardiovascular trial participation, the American Heart Association launched a Strategically Focused Research Network (SFRN) to study the Science of Diversity in Clinical Trials in 2022. The SFRN includes 5 Network Centers operating from Johns Hopkins University (\"IMPACT\"), Stanford University (\"DIVERSE\"), University of California Los Angeles (\"iDIVERSE\"), University of Southern California/Howard University (\"ATRIL\"), and the University of Pennsylvania (\"BETTER\"). Each Center is a partnership that includes an institution focused on the education of Black, Hispanic, American Indian, Native Hawaiian/Pacific Islander, and/or non-White students. Each Center has multiple projects with actionable results and is training at least 3 dedicated postdoctoral fellows. Additionally, a 6th Center (\"TRAIN\") led by faculty at Stanford and Morehouse Universities is facilitating formal fellowship training across the Centers.</p><p><strong>Conclusions: </strong>Projects are ongoing and all 6 Centers are working on collaborative initiatives. These Centers are expected to provide valuable insights into clinical trial participation, including innovative conceptual frameworks to inform the diversification of clinical trial participation and novel recruitment and retention strategies that can be broadly disseminated.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041831"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139531","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":"Remnant Cholesterol and Prognostic Outcomes in Patients With Atrial Fibrillation on Oral Anticoagulants.","authors":"Linhao Liu, Geru Aa, Hangkuan Liu, Pengfei Sun, Yuanyuan Liu, Zhiqiang Zhang, Xiaozhi Chen, Qing Yang, Xin Zhou","doi":"10.1161/JAHA.125.042389","DOIUrl":"10.1161/JAHA.125.042389","url":null,"abstract":"<p><strong>Background: </strong>The relationship between dyslipidemia, a significant contributor to atherosclerotic cardiovascular disease, and atrial fibrillation remains unclear. This study aims to investigate the impact of remnant cholesterol (RC) on the prognosis of patients with atrial fibrillation on oral anticoagulants.</p><p><strong>Methods: </strong>A total of 23 267 patients with atrial fibrillation on oral anticoagulants from the Tianjin Health Medical Data Platform in China were identified for the analysis. We categorized participants into RC tertiles and used a multivariate Cox model to evaluate outcomes. Subgroup and sensitivity analyses were used to evaluate the association between RC tertiles and all-cause death. The study analyzed the combined effect of RC and low-density lipoprotein cholesterol on outcomes on the basis of the median levels of both lipids.</p><p><strong>Results: </strong>The top RC tertile (tertile 3) was associated with a 24% increased risk of all-cause death (hazard ratio [HR], 1.24 [95% CI, 1.11-1.38]), 18% increased risk of ischemic stroke (HR, 1.18 [95% CI, 1.00-1.38]), and 35% increased risk of acute myocardial infarction (HR, 1.35 [95% CI, 1.07-1.71]) compared with the bottom RC tertile (tertile 1). A sex-specific interaction was noted for RC and death, with the association appearing more evidently in men. The results remained consistent throughout various sensitivity analyses. This association with RC appeared to persist even when low-density lipoprotein cholesterol levels were relatively low (below the median of 102 mg/dL), showing a 17% increased risk of composite ischemic outcomes (HR, 1.17 [95% CI, 1.01-1.37]).</p><p><strong>Conclusions: </strong>Higher RC levels in patients with atrial fibrillation receiving oral anticoagulation therapy were associated with an increased risk of death, acute myocardial infarction, and ischemic stroke.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042389"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192997","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":"Evolving Perspectives in Surgery for Mitral Regurgitation: Why Sex Matters.","authors":"Edouard Long, Minji Ho, Sarah Guo, Tanisha Rajah, Sara Volpi, Narain Moorjani, Jason Ali, Francis C Wells, Antonio Bivona, Vassilios Avlonitis, Gianluca Lucchese, Rajdeep Bilkhu, Alessia Rossi, Paolo Bosco","doi":"10.1161/JAHA.125.044639","DOIUrl":"10.1161/JAHA.125.044639","url":null,"abstract":"<p><p>There is a growing body of evidence investigating sex differences in the presentation, assessment, and outcomes of patients with mitral regurgitation (MR) undergoing mitral valve surgery. It has been shown that women present at older ages, with more comorbidities and more severe symptoms. Compared with male patients, female patients have longer intervals to surgery, lower rates of surgery, and receive fewer mitral valve repairs (as opposed to replacements). On imaging, left ventricular cavity sizes and many quantitative measures of MR severity differ significantly by sex, and current guidelines do not account for this. While sex differences in surgical outcomes have been documented, these are largely limited to primary MR and are based on older studies, underscoring the need for further research. Data on sex differences in transcatheter interventions for MR are inconclusive and heterogeneous, complicating comparisons to surgery. To address these disparities, sex-specific thresholds for intervention in primary MR, standardization of the quantification of MR severity by sex, and further prospective studies are required. As we move into an era of precision medicine, it is critical to recognize sex as a key determinant of cardiovascular care. In patients undergoing surgery for MR, further research should evaluate whether current intervention thresholds and management pathways are appropriately tailored to female patients.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e044639"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193806","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":"Prehospital Prediction of Cardiogenic Shock Among Patients With ST-Segment-Elevation Myocardial Infarction: The EARLY SHOCK Score.","authors":"Cathevine Yang, Terry Lee, Andrew Kochan, Madeleine Barker, Thomas M Roston, John A Cairns, Joel Singer, Brian Grunau, Jennie Helmer, David D Berg, Graham C Wong, Christopher B Fordyce","doi":"10.1161/JAHA.124.040681","DOIUrl":"10.1161/JAHA.124.040681","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock (CS) develops in up to 10% of patients with ST-segment-elevation myocardial infarction and is associated with high mortality and morbidity rates. The objective of the current study was to generate a clinical scoring system that can be easily applied in the prehospital setting to predict the development of in-hospital CS among patients undergoing primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction.</p><p><strong>Methods: </strong>The authors conducted a retrospective cohort study using prospective data from a dual hub-and-spoke health system. Logistic regression was used to assess the relationship between prespecified clinical predictors and the occurrence of in-hospital CS. Internal validation was conducted to assess the C statistic and calibration curve of the prediction model. The prediction model was converted to a risk score by scaling of the regression coefficients.</p><p><strong>Results: </strong>From April 1, 2012, to December 31, 2020, there were 2736 consecutive patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Of these, 415 (15.2%) developed CS. Eight strong predictors were independently associated with CS by multivariable analysis and used to develop a prediction model. The model achieved a C statistic of 0.87. The EARLY SHOCK risk scoring algorithm incorporates Emergency Medical Services Heart Rate and Systolic Blood Pressure, Age, Renal Replacement, Location of Infarction, Sugar (diabetes), Heart Failure, and Cardiac Arrest.</p><p><strong>Conclusions: </strong>The authors identified 8 clinical variables that strongly predict CS among patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. This has been developed into the EARLY SHOCK score, which can be easily applied in the prehospital setting to rapidly identify CS and enable shock team activation. External validation for the scoring system is pending for broader application.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040681"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823256","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":"Multicenter Stroke Preclinical Assessment Network Analysis of Cardiovascular Risk Factor Subgroups Treated With the Poly(ADP-Ribose) Polymerase Inhibitor Veliparib.","authors":"Raymond C Koehler, Karni Bedirian, Mu-Hsun Chen, Yanrong Shi, Suyi Cao, Brooklyn D Avery, Senthilkumar S Karuppagounder, Kazi Akhter, Adnan Bibic, Valina L Dawson, Ted M Dawson, Márcio A Diniz, Jessica Lamb, Karisma A Nagarkatti, Anjali Chauhan, Jaroslaw Aronowski, Louise D McCullough, Andreia Lopes de Morais, Xuyan Jin, Cenk Ayata, Mariia Kumskova, Rakesh B Patel, Anil K Chauhan, Enrique C Leira, Pradip K Kamat, Mohammad B Khan, Krishnan M Dhandapani, David C Hess, Ligia S B Boisserand, Basavaraju G Sanganahalli, Lauren H Sansing, Patrick D Lyden","doi":"10.1161/JAHA.124.040914","DOIUrl":"10.1161/JAHA.124.040914","url":null,"abstract":"<p><strong>Background: </strong>The Stroke Preclinical Assessment Network tested 6 therapeutic interventions initiated at the time of reperfusion after focal ischemic stroke in young mice, aging mice, obese mice, and spontaneously hypertensive rats. This randomized, controlled trial was conducted across 6 sites with concealed treatment and blinded neurobehavior assessments. The trial had an adaptive design with preset levels of efficacy and futility interrogated after each of 4 stages. The primary outcome was turning preference on the corner test at 1 month. The PARP (poly(ADP-ribose) polymerase) inhibitor, veliparib, was considered futile after the second stage when pooling all animal models (<i>n</i>=231 veliparib; <i>n</i>=344 placebo).</p><p><strong>Methods: </strong>A secondary analysis was performed to evaluate veliparib treatment on primary and secondary outcomes in individual subgroup models.</p><p><strong>Results: </strong>Intravenous injection of veliparib at reperfusion failed to show a benefit on the corner test at 7 or 30 days of recovery in young mice, obese mice, or spontaneously hypertensive rats. However, in aging mice (15-18 months old), veliparib significantly improved performance on the corner test at 7 (<i>P</i>=0.007) and 30 (<i>P</i>=0.03) days and reduced foot-faults on the grid walk test at 7 (<i>P</i>=0.024) and 30 (<i>P</i>=0.008) days. These effects were independent of sex. Treatment had no effect on magnetic resonance imaging-determined lesion volume. The survival was similar with placebo and veliparib treatments across subgroups, although mortality was high in aging mice.</p><p><strong>Conclusions: </strong>Veliparib improved functional outcome in aging mice. Because ischemic stroke predominantly occurs in the aging population, further research into the benefit of PARP inhibitors in aged animal models of stroke is warranted.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040914"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139271","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":"Identifying High-Risk Cardiac Arrest Neighborhoods Using Social Vulnerability Index and Geospatial Analysis.","authors":"Ryan A Coute, Ariann F Nassel, Jolanda L Hudson, Joseph D Richardson, William C Ferguson, Brian H Nathanson, Elizabeth A Jackson","doi":"10.1161/JAHA.125.043469","DOIUrl":"10.1161/JAHA.125.043469","url":null,"abstract":"<p><strong>Background: </strong>Identifying high-risk locations for out-of-hospital cardiac arrest (OHCA) is essential for targeted community interventions. We aimed to use the Social Vulnerability Index (SVI) and geospatial mapping of OHCA data to locate high-risk neighborhoods in Birmingham, Alabama, for community training programs.</p><p><strong>Methods: </strong>A retrospective observational analysis was conducted using nontraumatic OHCA cases in adults (≥18 years) in Birmingham from January 1, 2020 to December 31, 2023. Census tracts served as proxies for neighborhoods. A 5-step process identified high-risk tracts: (1) OHCA incidents were geocoded in ArcGIS and assigned a geographic identifier by census tract; (2) SVI data were merged with each record; (3) the Getis-Ord GI* statistic identified a hot spot with 99% confidence; (4) tracts with an SVI >90th percentile within the hot spot were flagged; and (5) excess relative risk rates were calculated and stratified by quintiles. The primary outcome was high-risk census tracts defined by hot spot location, high SVI, and high relative risk.</p><p><strong>Results: </strong>A total of 966 OHCA cases from 115 census tracts were included. Hot spot analysis identified 30 tracts (26.1%) with high-risk characteristics. Within these, 17 tracts had an SVI >90th percentile, and 10 tracts had an excess relative risk in the top quintile. Hot spot tracts had a higher proportion of Black residents and lower cardiopulmonary resuscitation rates. No significant difference in survival outcomes were observed; however, the overall neurologically intact survival was 1.2%.</p><p><strong>Conclusions: </strong>Multiple neighborhoods in Birmingham exhibit extreme levels of social vulnerability and excess relative risk of OHCA, making them ideal candidates for community training initiatives.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043469"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139540","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":"Left Atrial Appendage Closure in Patients Refusing Oral Anticoagulation: The LAAC-REFUSAL Study.","authors":"Roberto Galea, Tommaso Bini, Kasper Korsholm, Alexander Sedaghat, Adel Aminian, Vivian Vij, Juan Perich Krsnik, Konstantina Chalkou, Georgios Siontis, Laurent Roten, Jens Erik Nielsen-Kudsk, Lorenz Räber","doi":"10.1161/JAHA.124.040404","DOIUrl":"10.1161/JAHA.124.040404","url":null,"abstract":"<p><strong>Background: </strong>The benefit of left atrial appendage closure (LAAC) in patients refusing oral anticoagulation (OAC) despite medical recommendations is unknown. We aim to assess the efficacy and the safety of LAAC in patients refusing OAC.</p><p><strong>Methods: </strong>Data on consecutive patients with atrial fibrillation undergoing percutaneous LAAC between 2009 and 2022 in 4 European centers were collected and patients undergoing LAAC due to refusal of OAC (refusal group) were compared with patients receiving LAAC for more established indications (control group). The primary end point of the study was the composite of cardiovascular death, stroke, or systemic embolism. The secondary end points included technical success and procedural complications. Events during follow-up were compared with those predicted by CHA2DS2VASC and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile International Normalized Ratio, elderly, drugs/alcohol concomitantly (HASBLED) score risks.</p><p><strong>Results: </strong>Of the 2649 patients submitted to LAAC, 119 were performed due to OAC refusal (4.5%). Two-hundred-thirty-eight (8.9%) control patients were identified. Refusal as compared with the control group included younger and lower-risk patients. At 3 years, the primary end point was significantly lower (4.2% versus 17.2%; adjusted hazard ratio: 0.37; 95% CI: 0.14-0.99; <i>P</i>=0.048) in the refusal in respect to the control group. Technical success and procedural complications were similar between groups. In the refusal group, the annual rate of thromboembolic events and major bleedings were 2.3% and 1.9%, respectively, corresponding to 62% and 47% risk reductions as compared with the rates expected by risk scores.</p><p><strong>Conclusions: </strong>In this multicenter cohort of consecutive patients with atrial fibrillation submitted to LAAC, OAC refusal appeared as an infrequent indication. In this subgroup, LAAC was confirmed to be feasible and safe. The ischemic outcomes rates at 3 years are promising. Further studies are needed to better understand the potential effects of preferring LAAC over OAC.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040404"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139558","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":"Increased Mortality and Morbidity in Patients With Heart Failure With Sarcoidosis Compared With Other Causes: A Propensity-Matched Nationwide Cohort Study.","authors":"Entela Bollano, Michael Fu, Aldina Pivodic, Christian L Polte, Ulf Dahlström, Emanuele Bobbio","doi":"10.1161/JAHA.125.041944","DOIUrl":"10.1161/JAHA.125.041944","url":null,"abstract":"<p><strong>Background: </strong>The prognosis of heart failure (HF) from ischemic heart disease (IHD) is generally worse than from dilated cardiomyopathy (DCM). The impact of prior sarcoidosis on HF outcomes is unknown. We evaluated the prognostic impact of sarcoidosis in HF compared with IHD-HF and DCM-HF using SwedeHF (Swedish Heart Failure Registry).</p><p><strong>Methods: </strong>We identified patients with sarcoidosis before HF diagnosis (SC-HF) and propensity-matched them to patients with DCM-HF or IHD-HF between 2003 and 2020. The primary outcome was all-cause mortality; secondary outcomes were cardiovascular death and hospital readmission.</p><p><strong>Results: </strong>A total of 422 patients with SC-HF, 6913 with DCM-HF, and 47 164 with IHD-HF were eligible. After 1:2 matching, 365 patients with SC-HF (median follow-up 2.9 years) were compared with 730 with DCM-HF (3.6 years), and 418 with SC-HF (2.8 years) with 836 with IHD-HF (3.6 years). Baseline characteristics were well balanced. Patients with SC-HF had more comorbidities than DCM-HF but fewer than IHD-HF. One-year all-cause mortality was higher in patients with SC-HF than DCM-HF (12.9% versus 8.6%; hazard ratio [HR, 1.51] [95% CI, 1.04-2.21]; <i>P</i>=0.031), along with higher readmission rates. Compared patients with IHD-HF, those with SC-HF also showed higher 1-year mortality (14.8% versus 9.7%; HR, 1.58 [95% CI, 1.14-2.20]; <i>P</i>=0.006). Similar relative risks were observed across full follow-up.</p><p><strong>Conclusions: </strong>Sarcoidosis-associated HF is linked to significantly higher mortality than both DCM and IHD and to higher morbidity than DCM. These findings underscore the need for heightened clinical attention and may warrant tailored management strategies for this high-risk group.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041944"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193883","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":"Isolated Anterior T-Wave Inversion in Elite Athletes: Prevalence and Clinical Relevance by Sex and Sporting Discipline.","authors":"Jessica J Orchard, Jonathan A Drezner, Hariharan Raju, Rajesh Puranik, Belinda Gray, Maria Brosnan, Robert N Doughty, Bruce Hamilton, Tim Driscoll, Angus J Davis, Emma Buckthorpe, Simon Eggleton, Aaron Baggish, Andre La Gerche, John W Orchard","doi":"10.1161/JAHA.125.042435","DOIUrl":"10.1161/JAHA.125.042435","url":null,"abstract":"<p><strong>Background: </strong>Cardiac screening of elite athletes is common internationally. Female athletes are reported to have a higher proportion of abnormal screening ECGs compared with male athletes, despite lower rates of sudden cardiac death. T-wave inversion in leads V₂ and V₃ (TWI_V2-3) is considered abnormal for athletes aged ≥16 years, but there are knowledge gaps in prevalence and clinical outcomes.</p><p><strong>Methods: </strong>Data were obtained from the ARENA (Australasian Registry of ECGs of National Athletes) project and combined with previous athlete cohort studies from Australia and New Zealand. Sporting disciplines included Olympic sports (summer and winter), Australian football, cricket, football (soccer), and netball. Logistic regression calculated adjusted odds ratios with 95% CIs for the odds of isolated TWI_V2-3 adjusting for sex and sporting discipline.</p><p><strong>Results: </strong>Of 4423 athletes (40% female athletes; mean age, 19.7±4.5 years), isolated TWI_V2-3 was found in 36 athletes aged ≥16 years (27 [1.5%] female athletes, 9 [0.3%] male athletes). Isolated TWI_V2-3 was more common in female athletes compared with male athletes (adjusted odds ratio, 4.2 [95% CI, 2.0-9.5]) and endurance compared with nonendurance athletes (adjusted odds ratio, 4.8 [95% CI, 2.5-9.5]). Follow-up investigations were available in 34 of 36, including echocardiogram (n=30), magnetic resonance imaging (n=3), stress ECG (n=2), or subsequent normal ECG (n=13). After 6.4±2.6 years of follow-up, no athletes with isolated TWI_V2-3 were diagnosed with cardiac disease. Overall, female athletes had a higher proportion of abnormal ECGs compared with male athletes (4.2% versus 2.6%, <i>P</i>=0.004). If TWI_V2-3 was considered a normal finding in female athletes, female and male athletes would have similar proportions of abnormal ECGs (2.6% versus 2.6%, <i>P</i>=0.95).</p><p><strong>Conclusions: </strong>Isolated TWI_V2-3 was 4 times more common in female athletes and 5 times more common in endurance athletes. This finding was not associated with cardiac pathology.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042435"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193911","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":"Growth Differentiation Factor-15 is Associated With Acute Myocardial Infarction and Death at 30 and 90 Days in Emergency Department Patients With Suspected Acute Coronary Syndrome.","authors":"Bryn E Mumma, Nipun Bhandari, Nam K Tran, James S Ford, Robert Christenson, R Gentry Wilkerson, Troy Madsen, Michael T Weaver, Fan Yi, Xiaoxi Zhang, Brandon R Allen, Simon A Mahler","doi":"10.1161/JAHA.124.038675","DOIUrl":"10.1161/JAHA.124.038675","url":null,"abstract":"<p><strong>Background: </strong>Growth differentiation factor-15 (GDF-15) is a novel biomarker of cardiac stress. GDF-15 may be a stronger predictor of all-cause death in patients with acute chest pain than traditional biomarkers such as high-sensitivity troponin T and BNP (B-type natriuretic peptide). However, data from US populations are lacking. Our objective was to determine whether GDF-15 is an independent predictor of all-cause death or acute myocardial infarction (AMI) at index visit, 30 days, and 90 days.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the STOP-CP (High Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification) trial, which prospectively enrolled adults (aged ≥21 years) from 8 US emergency departments with suspected AMI in 2017 to 2018. High-sensitivity troponin T, BNP, and GDF-15 assays were performed at a central laboratory on samples from baseline and 3 hours later. The primary outcome was the composite of all-cause death or AMI at index visit, 30 days, and 90 days. Multiple logistic regression models assessed the association between GDF-15 and all-cause death or AMI at index visit, as well as at 30 and 90 days, while adjusting for age, sex, number of cardiac risk factors, ischemic ECG findings, high-sensitivity troponin T, and N-terminal pro-B-type natriuretic peptide.</p><p><strong>Results: </strong>We studied 1428 patients; median age was 58 (interquartile range, 49-66) years and 353 (25%) had a history of coronary artery disease. The composite outcome of all-cause death or AMI occurred in 169 (12%) patients at index visit, an additional 21 (1.5%) at 30 days, and an additional 27 (1.9%) at 90 days. In multiple logistic regression models, GDF-15 was independently associated with all-cause death or AMI at 30 days (adjusted odds ratio per SD, 1.27 [95% CI, 1.06-1.54]) and 90 days (adjusted odds ratio R per SD, 1.55 [95% CI, 1.26-1.94]), but not during the index visit (adjusted odds ratio per SD, 1.00 [95% CI, 0.83-1.16]).</p><p><strong>Conclusions: </strong>Among adult emergency department patients with suspected AMI, GDF-15 was independently associated with subsequent 30-day and 90-day all-cause death or AMI. These data suggest a potential role for GDF-15 in short-term cardiac risk stratification in emergency department patients without AMI at index visit.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038675"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193916","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}