Journal of the American Heart Association最新文献

{"title":"Neurovascular Decoupling Is Associated With Lobar Intracerebral Hemorrhages and White Matter Hyperintensities.","authors":"Suzanne E van Dijk, Nadieh Drenth, Anne Hafkemeijer, Gerda Labadie, Marie-Noëlle W Witjes-Ané, Frank Baas, Jeroen P Vreijling, Gerard J Blauw, Serge A R B Rombouts, Jeroen van der Grond, Sanneke van Rooden","doi":"10.1161/JAHA.124.038819","DOIUrl":"10.1161/JAHA.124.038819","url":null,"abstract":"<p><strong>Background: </strong>Neurovascular coupling is a fundamental aspect of brain function by regulating cerebral blood flow in response to regional neuronal activity. Increasing evidence suggest neurovascular decoupling occurs early in the progression of Alzheimer disease (AD), potentially reflecting early vascular damage. Therefore, understanding the relationship between neurovascular coupling and established vascular risk factors for AD is essential to gain deeper insights into the vascular mechanisms underlying AD.</p><p><strong>Methods: </strong>This cross-sectional observational study investigated the association between neurovascular coupling and vascular risk factors for AD, specifically small vessel disease magnetic resonance imaging markers, cardiovascular risk factors, and the apolipoprotein E genotype. The cohort included 119 participants diagnosed with subjective cognitive impairment, mild cognitive impairment, and AD-related dementia, as well as individuals without cognitive complaints. Neurovascular coupling was measured by blood-oxygen-level-dependent functional magnetic resonance imaging amplitude in response to visual stimulation.</p><p><strong>Results: </strong>Our findings revealed that decreased neurovascular coupling is linked to structural brain changes typically seen in small vessel disease; specifically we found an association between neurovascular coupling and white matter hyperintensities load (<i>β</i>=-0.199, <i>P</i>=0.030) and presence of lobar intracerebral hemorrhage (<i>β</i>=-0.228, <i>P</i>=0.011).</p><p><strong>Conclusions: </strong>This raises the suggestion that a decreased neurovascular coupling in the disease process of AD is related to comorbid small vessel disease.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038819"},"PeriodicalIF":5.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416280","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":"Which Matters More for Out-of-Hospital Cardiac Arrest Survival: Witnessed Arrest or Bystander Cardiopulmonary Resuscitation?","authors":"Cheng-Yi Fan, Ya-Ting Liang, Edward Pei-Chuan Huang, Jiun-Wei Chen, Wen-Chu Chiang, Charlotte Wang, Chih-Wei Sung","doi":"10.1161/JAHA.124.038427","DOIUrl":"10.1161/JAHA.124.038427","url":null,"abstract":"<p><strong>Background: </strong>Despite the well-known importance of witnessed arrest and bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest outcomes, previous studies have shown significant statistical inconsistencies. We hypothesized an interaction effect and conducted stratified analyses to investigate whether witnessed arrest is more important than bystander CPR.</p><p><strong>Methods: </strong>This study enrolled patients with out-of-hospital cardiac arrest between January 2010 and December 2022 in 3 emergency medical service (systems in Taiwan). Data were extracted from emergency medical service dispatch reports, including patient characteristics, witnessed arrest, bystander CPR, time for each dispatch, and prehospital interventions. The outcome measure was prehospital return of spontaneous circulation (ROSC). Patients were categorized into 4 groups: witnessed and bystander CPR present (W+B+), witnessed present but bystander CPR absent (W+B-), witnessed absent but bystander CPR present (W-B+), and witnessed and bystander CPR absent (W-B-). Multiple logistic regression on prehospital ROSC were performed in the 4 subgroups separately.</p><p><strong>Results: </strong>A total of 14 737 patients with out-of-hospital cardiac arrest were identified, of whom 977 (6.6%) achieved prehospital ROSC. The W+B+ group exhibited the highest prehospital ROSC rate (14.0%). Stratification confirmed a statistically significant interaction between witnessed arrest and bystander CPR. Defibrillation, endotracheal intubation, and epinephrine administration were significantly associated with prehospital ROSC in all subgroups. Most explanatory variables significant in the witnessed arrest group were adjusted for in the nonwitnessed arrest group. Younger age was associated with prehospital ROSC only in the W+B+ group.</p><p><strong>Conclusions: </strong>Witnessed arrest and bystander CPR may interact to predict prehospital ROSC in out-of-hospital cardiac arrest, with witnessed arrest likely having more significant impact on outcomes.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038427"},"PeriodicalIF":5.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374990","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":"Race and Resuscitation: Taking the Next Steps.","authors":"Jenny Shin, Thomas Rea","doi":"10.1161/JAHA.124.039353","DOIUrl":"10.1161/JAHA.124.039353","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039353"},"PeriodicalIF":5.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985300","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":"From Spoke to Hub: The \"Golden Hours\" in Cardiogenic Shock.","authors":"Miguel Alvarez Villela, Gerin R Stevens","doi":"10.1161/JAHA.124.039100","DOIUrl":"10.1161/JAHA.124.039100","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039100"},"PeriodicalIF":5.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416271","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":"Novel CT Image-Based Intracerebral Bleeding Risk Score for Patients With Acute Ischemic Stroke Undergoing Thrombolysis.","authors":"Shuangfang Fang, Hanhan Lei, Gareth Ambler, David J Werring, Huapin Huang, Huiying Lin, Xiaomin Wu, Qinli Zhang, Xiuyan Han, Genshan Gao, Ronghua Chen, Jie Chen, Hangfeng Li, Jin Wei, Guangliang Chen, Jianhua Chen, Nan Liu, Hou-Wei Du","doi":"10.1161/JAHA.124.037256","DOIUrl":"10.1161/JAHA.124.037256","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic intracerebral hemorrhage (sICH) after intravenous recombinant tissue plasminogen activator in patients with acute ischemic stroke (AIS) remains a feared yet unpredictable complication. We aimed to develop and validate a new predictive model incorporating clinical variables and noncontrast head computed tomography imaging features to predict sICH in patients with AIS receiving intravenous recombinant tissue plasminogen activator.</p><p><strong>Methods and results: </strong>The predictive model was derived from 808 patients with AIS in the derivation cohort in Southeast China, based on multivariable logistic regression analysis. External validation was conducted in a validation cohort from Central China. Discrimination, calibration, and clinical usefulness of the predictive model were assessed. We observed 32 sICH events among 808 patients with AIS in the derivation cohort, and 21 sICH events out of 612 participants in the validation cohort. The variables in the predictive model included cerebral small vessel disease burden and early infarct signs on head computed tomography scan, atrial fibrillation, age, systolic blood pressure, and initial National Institutes of Health Stroke Scale score. The fitted model showed promising discrimination (optimism-corrected C statistic of 0.80) and acceptable calibration (Hosmer and Lemeshow goodness of fit <i>P</i>=0.816) in the derivation cohort. External validation showed similar discrimination (C statistic 0.82 [95% CI, 0.72-0.91]) and calibration (Hosmer and Lemeshow goodness of fit <i>P</i>=0.866).</p><p><strong>Conclusions: </strong>Our internally and externally validated prediction model for sICH in patients with AIS who received intravenous thrombolysis may facilitate individualized prediction for intracerebral bleeding risk after intravenous thrombolysis for acute ischemic stroke.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037256"},"PeriodicalIF":5.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375039","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":"Skeletal Muscle Pathology in Pulmonary Arterial Hypertension and Its Contribution to Exercise Intolerance.","authors":"Thaís C F Menezes, Michael H Lee, Dara C Fonseca Balladares, Kevin Nolan, Sankalp Sharma, Rahul Kumar, Eloara V M Ferreira, Brian B Graham, Rudolf K F Oliveira","doi":"10.1161/JAHA.124.036952","DOIUrl":"10.1161/JAHA.124.036952","url":null,"abstract":"<p><p>Pulmonary arterial hypertension is a disease of the pulmonary vasculature, resulting in elevated pressure in the pulmonary arteries and disrupting the physiological coordination between the right heart and the pulmonary circulation. Exercise intolerance is one of the primary symptons of pulmonary arterial hypertension, significantly impacting the quality of life. The pathophysiology of exercise intolerance in pulmonary arterial hypertension is complex and likely multifactorial. Although the significance of right ventricle impairment and perfusion/ventilation mismatch is widely acknowledged, recent studies suggest pathophysiology of the skeletal muscle contributes to reduced exercise capacity in pulmonary arterial hypertension, a concept explored herein.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036952"},"PeriodicalIF":5.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375049","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":"Spatial Correlates of Dementia and Disability After Intracerebral Hemorrhage.","authors":"Yutong Chen, Cyprien A Rivier, Samantha A Mora, Victor Torres Lopez, Sam Payabvash, Kevin Sheth, Andreas Harloff, Guido J Falcone, Jonathan Rosand, Ernst Mayerhofer, Christopher D Anderson","doi":"10.1161/JAHA.124.037930","DOIUrl":"10.1161/JAHA.124.037930","url":null,"abstract":"<p><strong>Background: </strong>Dementia and disability are highly prevalent after spontaneous intracerebral hemorrhage (ICH). Previous studies categorizing ICH by large anatomic boundaries have demonstrated that lobar ICH is associated with dementia, while ICH in the basal ganglia is associated with disability. This study aims to refine our understanding of the association between ICH location and post-ICH dementia and disability at a voxel level, which could improve the prognostic accuracy of these outcomes and provide mechanistic insights into post-ICH functional outcomes.</p><p><strong>Methods and results: </strong>In this cohort study, we segmented the ICH lesions from the noncontrast computed tomography scans from 882 patients from the MGH-ICH (Massachusetts General Hospital ICH Study) as the discovery data set and from 146 patients from the Yale-ICH cohort as the validation data set. Using electronic health records and follow-up telephone interviews, incident dementia (<i>International Classification of Diseases</i>, <i>Ninth Revision</i> [<i>ICD-9</i>] codes of dementia or modified telephone interview for cognitive status <20) and disability (modified Rankin Scale score >2) were identified. The median follow-up times of the MGH-ICH and Yale-ICH cohorts were 2.9 (interquartile range, 1.0-5.8) years and 1.0 (interquartile range, 0.6-1.0) years, respectively. Two techniques of lesion symptom mapping were applied on the ICH lesions: sparse canonical correlation analysis for neuroimaging and voxel-based lesion symptom mappings. Dementia conversion after ICH was associated with ICH in the left temporo-occipital region (mean hazard ratio [HR], 3.62 [95% CI, 2.71-4.63]) and left superior longitudinal fasciculus (mean HR, 2.91 [95% CI, 2.40-3.52]). Development of disability after ICH was linked to the right cerebral peduncle (mean HR, 3.10 [95% CI, 2.44-3.94]), right pallidum (mean HR, 2.96 [95% CI, 1.99-4.25]), and right posterior limb of the internal capsule (mean HR, 2.54 [95% CI, 1.88-3.96]).</p><p><strong>Conclusions: </strong>Specific distribution of ICH lesions is linked to development of dementia and disability after ICH. These insights have the potential to enhance clinical prognostic models for patients with ICH, facilitating more precise predictions of outcomes based on hemorrhage location.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037930"},"PeriodicalIF":5.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375050","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":"Unveiling the Genetic Landscape of Coronary Artery Disease Through Common and Rare Structural Variants.","authors":"Kruthika R Iyer, Shoa L Clarke, Rodrigo Guarischi-Sousa, Ketrin Gjoni, Adam S Heath, Erica P Young, Nathan O Stitziel, Cecelia Laurie, Jai G Broome, Alyna T Khan, Joshua P Lewis, Huichun Xu, May E Montasser, Kellan E Ashley, Natalie R Hasbani, Eric Boerwinkle, Alanna C Morrison, Nathalie Chami, Ron Do, Ghislain Rocheleau, Donald M Lloyd-Jones, Rozenn N Lemaitre, Joshua C Bis, James S Floyd, Gregory L Kinney, Donald W Bowden, Nicholette D Palmer, Emelia J Benjamin, Matthew Nayor, Lisa R Yanek, Brian G Kral, Lewis C Becker, Sharon L R Kardia, Jennifer A Smith, Lawrence F Bielak, Arnita F Norwood, Yuan-I Min, April P Carson, Wendy S Post, Stephen S Rich, David Herrington, Xiuqing Guo, Kent D Taylor, JoAnn E Manson, Nora Franceschini, Katherine S Pollard, Braxton D Mitchell, Ruth J F Loos, Myriam Fornage, Lifang Hou, Bruce M Psaty, Kendra A Young, Elizabeth A Regan, Barry I Freedman, Ramachandran S Vasan, Daniel Levy, Rasika A Mathias, Patricia A Peyser, Laura M Raffield, Charles Kooperberg, Alex P Reiner, Jerome I Rotter, Goo Jun, Paul S de Vries, Themistocles L Assimes","doi":"10.1161/JAHA.124.036499","DOIUrl":"10.1161/JAHA.124.036499","url":null,"abstract":"<p><strong>Background: </strong>Genome-wide association studies have identified several hundred susceptibility single nucleotide variants for coronary artery disease (CAD). Despite single nucleotide variant-based genome-wide association studies improving our understanding of the genetics of CAD, the contribution of structural variants (SVs) to the risk of CAD remains largely unclear.</p><p><strong>Method and results: </strong>We leveraged SVs detected from high-coverage whole genome sequencing data in a diverse group of participants from the National Heart Lung and Blood Institute's Trans-Omics for Precision Medicine program. Single variant tests were performed on 58 706 SVs in a study sample of 11 556 CAD cases and 42 907 controls. Additionally, aggregate tests using sliding windows were performed to examine rare SVs. One genome-wide significant association was identified for a common biallelic intergenic duplication on chromosome 6q21 (<i>P</i>=1.54E-09, odds ratio=1.34). The sliding window-based aggregate tests found 1 region on chromosome 17q25.3, overlapping <i>USP36</i>, to be significantly associated with coronary artery disease (<i>P</i>=1.03E-10). <i>USP36</i> is highly expressed in arterial and adipose tissues while broadly affecting several cardiometabolic traits.</p><p><strong>Conclusions: </strong>Our results suggest that SVs, both common and rare, may influence the risk of coronary artery disease.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036499"},"PeriodicalIF":5.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416294","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":"Anticoagulation in Atrial Fibrillation With Valvular Heart Disease.","authors":"Ana Catarina Fonseca, Claúdia Jorge","doi":"10.1161/JAHA.124.038736","DOIUrl":"10.1161/JAHA.124.038736","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038736"},"PeriodicalIF":5.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416258","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":"Silent Myocardial Infarction and Risk of Stroke Recurrence: A Post Hoc Analysis of the IRIS Trial.","authors":"Mohamed Ridha, Cenai Zhang, Stephen McCullough, Catherine M Viscoli, Richa Sharma, Hooman Kamel, Alexander E Merkler","doi":"10.1161/JAHA.124.037663","DOIUrl":"10.1161/JAHA.124.037663","url":null,"abstract":"<p><strong>Background: </strong>Unrecognized or silent myocardial infarction (MI) detected on an ECG is associated with first-ever stroke, but the impact on stroke recurrence is unknown. We aimed to determine the association of silent MI with stroke recurrence in patients with a recent ischemic stroke.</p><p><strong>Methods and results: </strong>Subjects from the IRIS (Insulin Resistance Intervention After Stroke) trial with an available ECG were included. Clinical MI was defined as a history of hospitalization for MI. Silent MI was defined as ECG evidence of MI in the absence of clinical MI. The primary outcome was recurrent stroke. Ischemic stroke and subtype were assessed as secondary outcomes. Multivariable Cox regression analysis adjusted for demographics, pioglitazone, and vascular risk factors was used to examine the association between MI and stroke recurrence. A total of 2282 participants met the inclusion criteria. Clinical and silent MI were identified in 161 (7.1%) and 94 (4.1%) subjects, respectively. Over the study period, 209 recurrent strokes occurred, with 191 classified as ischemic. In the fully adjusted model, silent MI was significantly associated with any stroke (hazard ratio [HR], 2.29 [95% CI, 1.34-3.90]) and ischemic stroke (HR, 2.09 [95% CI, 1.18-3.70]) recurrence. Clinical MI was associated with stroke recurrence in the unadjusted analysis but not in the fully adjusted model (HR, 1.31 [95% CI, 0.81-2.11]). Silent MI was not associated with potential cardioembolic subtypes (HR, 1.50 [95% CI, 0.70-3.22]).</p><p><strong>Conclusions: </strong>Among patients with a recent ischemic stroke, silent MI was associated with stroke recurrence. Tailored prevention strategies in this population warrant future investigation.</p><p><strong>Registration: </strong>URL: https://clinicaltrials.gov. Unique Identifier: NCT00091949.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037663"},"PeriodicalIF":5.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375045","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}