JACC advances最新文献

{"title":"LLMonFHIR","authors":"Paul Schmiedmayer PhD ,&nbsp;Adrit Rao ,&nbsp;Philipp Zagar MS ,&nbsp;Lauren Aalami MS ,&nbsp;Vishnu Ravi MD ,&nbsp;Aydin Zahedivash MD, MBA ,&nbsp;Dong-han Yao MD ,&nbsp;Arash Fereydooni MD ,&nbsp;Oliver Aalami MD","doi":"10.1016/j.jacadv.2025.101780","DOIUrl":"10.1016/j.jacadv.2025.101780","url":null,"abstract":"<div><h3>Background</h3><div>To improve healthcare quality and empower patients, federal legislation requires nationwide interoperability of electronic health records (EHRs) through Fast Healthcare Interoperability Resources (FHIR) application programming interfaces. Nevertheless, key barriers to patient EHR access—limited functionality, English, and health literacy—persist, impeding equitable access to these benefits.</div></div><div><h3>Objectives</h3><div>This study aimed to develop and evaluate a digital health solution to address barriers preventing patient engagement with personal health information, focusing on individuals managing chronic cardiovascular conditions.</div></div><div><h3>Methods</h3><div>We present LLMonFHIR, an open-source mobile application that uses large language models (LLMs) to allow users to “interact” with their health records at any degree of complexity, in various languages, and with bidirectional text-to-speech functionality. In a pilot evaluation, physicians assessed LLMonFHIR responses to queries on 6 SyntheticMass FHIR patient datasets, rating accuracy, understandability, and relevance on a 5-point Likert scale.</div></div><div><h3>Results</h3><div>A total of 210 LLMonFHIR responses were evaluated by physicians, receiving high median scores for accuracy (5/5), understandability (5/5), and relevance (5/5). Challenges summarizing health conditions and retrieving lab results were noted, with variability in responses and occasional omissions underscoring the need for precise preprocessing of data.</div></div><div><h3>Conclusions</h3><div>LLMonFHIR's ability to generate responses in multiple languages and at varying levels of complexity, along with its bidirectional text-to-speech functionality, give it the potential to empower individuals with limited functionality, English, and health literacy to access the benefits of patient-accessible EHRs.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 6","pages":"Article 101780"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of Diastolic Dysfunction in Adults With Failing Fontan Circulation","authors":"Ibrahim M. Khayyat MD ,&nbsp;Maria Victoria Ordonez MD ,&nbsp;Ariane Marelli MD ,&nbsp;Judith Therrien MD","doi":"10.1016/j.jacadv.2025.101758","DOIUrl":"10.1016/j.jacadv.2025.101758","url":null,"abstract":"<div><div>Since the initial Fontan procedure introduced in 1968 for tricuspid atresia, significant advancements have expanded its application to various congenital cardiac anomalies where a biventricular circulation is unattainable. Despite improved survival rates, Fontan circulation tends to fail over time leading to late morbidity and mortality. Diastolic dysfunction is increasingly recognized as a significant contributor to circulatory insufficiency and failure in Fontan patients. This review aims to assess the current evidence for diagnosing diastolic dysfunction in adults with failing Fontan circulation, including biomarkers, echocardiography, cardiac magnetic resonance imaging, and catheterization. While advancements have been made in understanding diastolic dysfunction in single ventricles, challenges remain due to the unique anatomy and physiology of Fontan patients. Future research should focus on refining diagnostic parameters and exploring potential therapies tailored to the distinct needs of this population.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 6","pages":"Article 101758"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in the Impact of Exercise Volume on Subclinical Coronary Atherosclerosis","authors":"Ahmed Abdelaziz MD ,&nbsp;Ahmed Elshahat MD ,&nbsp;Ahmed Farid Gadelmawla MD ,&nbsp;Muhammad Desouky MD ,&nbsp;Abdelrahman H. Hafez MD ,&nbsp;Mohamed Abdelaziz MD ,&nbsp;Noha Hammad MD ,&nbsp;Dua Eldosoky MD ,&nbsp;Kirtipal Bhatia MD ,&nbsp;Annalisa Filtz MD ,&nbsp;Daniel Lorenzatti MD ,&nbsp;Toshiki Kuno MD, PhD ,&nbsp;Salim S. Virani MD, PhD ,&nbsp;Martha Gulati MD, MS ,&nbsp;Michel D. Shapiro DO, MCR ,&nbsp;Carl J. Lavie MD ,&nbsp;Leandro Slipczuk MD, PhD","doi":"10.1016/j.jacadv.2025.101786","DOIUrl":"10.1016/j.jacadv.2025.101786","url":null,"abstract":"<div><h3>Background</h3><div>The effects of high-volume exercise on coronary atherosclerosis remain controversial.</div></div><div><h3>Objectives</h3><div>The authors aimed to evaluate the impact of endurance exercise on coronary atherosclerosis assessed by cardiac computed tomography (CT) in athletes and nonathletes, and analyze differences based on sex.</div></div><div><h3>Methods</h3><div>We searched PubMed, Scopus, Web of Science, and Cochrane Central for relevant studies from inception to September 2024, assessing the impact of different exercise volumes on subclinical coronary artery atherosclerosis assessed by coronary artery calcification (CAC) scoring or CT angiography (CCTA). The control group comprised nonathletes. The primary outcome was the difference in CAC scores between athletes and nonathletes and the secondary outcome was the differences in calcified plaque by CCTA. The analysis was stratified by sex and exercise volume assessed using metabolic equivalents of task (MET)-min/wk.</div></div><div><h3>Results</h3><div>Nine observational studies including 61,150 participants were included in the analysis. Male athletes with an exercise volume of &gt;3,000 MET-min/wk showed higher mean CAC scores than nonathlete males (mean difference = 31.62; 95% CI: 10.66-52.58; <em>P</em> &lt; 0.001), while no difference in CAC was found for male athletes with 1,500 to 3,000 MET-min/wk (<em>P</em> = 0.93) or female athletes with an exercise volume of 1,500 MET-min/wk or greater (<em>P</em> = 0.39 and <em>P</em> = 0.07). Our secondary endpoint showed significant sex-specific differences on the association of exercise volume and calcified plaque number and volume by CCTA.</div></div><div><h3>Conclusions</h3><div>Males with high-volume exercise training (&gt;3,000 MET-min/wk) exhibited a higher burden of calcified plaque by CAC score than male nonathletes, while no such difference was observed in female athletes.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 6","pages":"Article 101786"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Plaque, Inflammation, Subclinical Myocardial Injury, and Major Adverse Cardiovascular Events in the REPRIEVE Substudy","authors":"Michael T. Lu MD, MPH ,&nbsp;Heather J. Ribaudo PhD ,&nbsp;Sara McCallum MPH ,&nbsp;Markella V. Zanni MD ,&nbsp;Christopher deFilippi MD ,&nbsp;Jana Taron MD ,&nbsp;Julia Karady MD, PhD, MPH ,&nbsp;Borek Foldyna MD, PhD ,&nbsp;Kayla Paradis MBA ,&nbsp;Sarah M. Chu MSN ,&nbsp;Marissa R. Diggs BA ,&nbsp;Tricia H. Burdo PhD ,&nbsp;Judith S. Currier MD ,&nbsp;Gerald S. Bloomfield MD, MPH ,&nbsp;Carl J. Fichtenbaum MD ,&nbsp;Carlos D. Malvestutto MD, MPH ,&nbsp;Judith A. Aberg MD ,&nbsp;Thomas Mayrhofer PhD ,&nbsp;Pamela S. Douglas MD ,&nbsp;Steven K. Grinspoon MD","doi":"10.1016/j.jacadv.2025.101781","DOIUrl":"10.1016/j.jacadv.2025.101781","url":null,"abstract":"<div><h3>Background</h3><div>In REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV), pitavastatin prevented major adverse cardiovascular events (MACE) and reduced noncalcified coronary plaque (NCP) among people with HIV and low-to-moderate traditional cardiovascular disease (CVD) risk.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to assess the relationship of coronary plaque, inflammation, and subclinical myocardial injury with MACE.</div></div><div><h3>Methods</h3><div>804 REPRIEVE Mechanistic Substudy participants enrolled from April 2015 to February 2018 at 31 U.S. sites, randomized to pitavastatin 4 mg/day or placebo, and followed for incident MACE (median 6.2 years [Q1-Q3 5.4-7.1]), were assessed for relationships of baseline NCP, markers of inflammation (high-sensitivity C-reactive protein [hs-CRP], interleukin (IL)-6, oxidized low-density lipoprotein, and lipoproprotein-associated phospholipase A2), and subclinical myocardial injury (high-sensitivity cardiac troponin T [hs-cTnT]) with MACE.</div></div><div><h3>Results</h3><div>Among enrolled participants (17% female [139/804], 47% non-White [379/804], median age 51 years, median low-density lipoprotein 105 mg/dL, 10-year atherosclerotic CVD [ASCVD] risk 4.6%, 40% [299/755] with noncalcified plaque), MACE incidence was 7.26/1,000 (95% CI: 4.51-11.7) person-years (17 events) for pitavastatin and 9.15/1,000 person-years (95% CI: 5.97-14.0) (21 events) for placebo. The hazard of MACE was greater in those with (vs without) noncalcified plaque (HR: 2.5; [95% CI: 1.3-4.8]; <em>P</em> = 0.008), with higher levels of hs-CRP (<em>P</em> = 0.049), IL-6 (<em>P</em> = 0.033), and hs-cTnT (<em>P</em> = 0.003) at study entry, persisting after ASCVD risk adjustment. In exploratory prediction modeling, adding hs-CRP, IL-6, and hs-cTnT to ASCVD risk increased the integrated area under the curve to 0.72 and C-statistic to 0.73 (0.62-0.84) vs 0.58 and 0.56 (0.45-0.67) compared to ASCVD risk alone.</div></div><div><h3>Conclusions</h3><div>NCP and higher hs-CRP, IL-6, and hs-cTnT were associated with MACE and improved risk prediction over traditional risk factors in people with HIV without cardiac symptoms and low-to-moderate ASCVD risk. (Evaluating the Use of Pitavastatin to Reduce the Risk of Cardiovascular Disease in HIV-Infected Adults [REPRIEVE]; <span><span>NCT02344290</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 6","pages":"Article 101781"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoring System-Based Approach for Positive Intracoronary Acetylcholine Provocation Tests","authors":"Yoshiyuki Ohnaga MD ,&nbsp;Yuichi Saito MD ,&nbsp;Yuichiro Mori MD ,&nbsp;Ken Kato MD ,&nbsp;Kazuya Tateishi MD ,&nbsp;Hideki Kitahara MD ,&nbsp;Yoshio Kobayashi MD","doi":"10.1016/j.jacadv.2025.101790","DOIUrl":"10.1016/j.jacadv.2025.101790","url":null,"abstract":"<div><h3>Background</h3><div>Although intracoronary acetylcholine (ACh) provocation testing is a guideline-recommended invasive standard for the diagnosis of vasospastic angina (VSA), ACh tests are largely underused in clinical practice globally. Recently, the ABCD score, consisting of clinical presentation, myocardial bridge, C-reactive protein, and dyslipidemia, was developed to predict positive ACh test results.</div></div><div><h3>Objectives</h3><div>The authors aimed to externally validate the diagnostic ability of the score and attempted to improve the predictivity for identifying patients with VSA.</div></div><div><h3>Methods</h3><div>From May 2012 to September 2023, a total of 723 patients undergoing ACh provocation tests for diagnosing VSA were included. The original ABCD score was calculated according to the predefined criteria, and the modified ABCD score was internally developed to improve the diagnostic accuracy. The positive ACh provocation test (ie, VSA) was defined as a significant angiographic vasospasm accompanied by chest pain and/or ischemic electrocardiographic changes.</div></div><div><h3>Results</h3><div>Of the 723 patients, 383 (53.0%) had positive ACh provocation test results. The receiver-operating characteristics curve analysis indicated that the original ABCD score was significantly predictive of positive ACh tests. Using best cutoff values on receiver-operating characteristics curve analyses, we developed the modified ABCD score, which was simpler than the original score. The modified rather than original ABCD score had better diagnostic ability for positive ACh test results (area under the curve 0.65 vs 0.55; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The original ABCD score was predictive of VSA in this external validation study with modest diagnostic accuracy, while the modified ABCD score achieved better predictivity for identifying patients with VSA.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 6","pages":"Article 101790"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Sudden Cardiac Arrest and Implantable Cardiac Defibrillator Shocks on Mental Health","authors":"Estelle Torbey MD ,&nbsp;Carlos Mena-Hurtado MD ,&nbsp;Jamie L. Jackson PhD ,&nbsp;Zainab Samaan MBChB, MSc, PhD ,&nbsp;Samuel F. Sears PhD ,&nbsp;Susanne S. Pedersen PhD ,&nbsp;Anurada Lala MD ,&nbsp;Rosy Thachil MD ,&nbsp;Jill Steiner MD, MS ,&nbsp;Onyedika J. Ilonze MD, MPH ,&nbsp;Davis Jones MD ,&nbsp;Karol Watson MD, PhD ,&nbsp;Andrea Price MS ,&nbsp;Christopher Knoepke PhD ,&nbsp;Jim W. Cheung MD ,&nbsp;Kim Smolderen PhD ,&nbsp;ACC Cardiopsychology Work Group","doi":"10.1016/j.jacadv.2025.101797","DOIUrl":"10.1016/j.jacadv.2025.101797","url":null,"abstract":"<div><div>Survivors of sudden cardiac arrest (SCA) and those who experience shocks from an implantable cardiac defibrillator (ICD-S) are at risk of developing unrecognized and untreated mental health (MH) symptoms. MH sequelae can include anxiety, depression, or post-traumatic stress symptoms which hinder one's ability to return to usual life and activity, impeding follow-up, health care seeking, and adherence to care plans. Addressing MH as part of a whole person care in such scenarios could lead to improved wellness and recovery. This review examines the MH sequelae of SCA and ICD-S, explores potential therapies for managing these issues, proposes strategies to improve MH post-SCA or defibrillator shock, and identifies areas for future research.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 6","pages":"Article 101797"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Prevalence, Treatment, and Relationship of Metabolic Syndrome and Individual Components by Race/Ethnicity, 1999-2018","authors":"Yuan Lu ScD ,&nbsp;Xumin Li MS ,&nbsp;Yuntian Liu MPH ,&nbsp;César Caraballo MD ,&nbsp;Daisy Massey BA ,&nbsp;Shiwani Mahajan MD, MHS ,&nbsp;Erica Spatz MD, MHS ,&nbsp;Jeph Herrin PhD ,&nbsp;Harlan M. Krumholz MD, SM","doi":"10.1016/j.jacadv.2025.101785","DOIUrl":"10.1016/j.jacadv.2025.101785","url":null,"abstract":"<div><h3>Background</h3><div>Nationally representative data on recent trends in racial/ethnic differences in metabolic syndrome (MetS) prevalence and treatment are sparse.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to examine 20-year trends in the prevalence, treatment, and interrelationships of MetS and its individual components among U.S. adults, overall and by race/ethnicity.</div></div><div><h3>Methods</h3><div>We evaluated trends from 1999 to 2018 in 20,397 adults using data from the National Health and Nutrition Examination Survey. Age-standardized prevalence estimates were calculated for MetS, its components, and related prescription drug use. Trends were assessed using weighted linear regression, and racial/ethnic disparities were examined using <em>t</em>-tests.</div></div><div><h3>Results</h3><div>The mean age was 47.5 (47.4-47.6) years; 51.3% were female; 77.9%, 12.8%, and 9.4% were White, Black, and Hispanic, respectively. MetS prevalence increased significantly from 1999 to 2018 across all groups (<em>P</em> &lt; 0.001). Among MetS components, waist circumference and fasting glucose increased across all groups, while triglycerides increased only among Black individuals. Lipid-lowering medication use increased (<em>P</em> &lt; 0.001), but racial/ethnic disparities persisted. Compared to White individuals, Hispanic individuals had lower antihypertensive and lipid-lowering medication use (<em>P</em> &lt; 0.01). Despite increased prescriptions, &lt;65% of eligible individuals received lipid-lowering therapy, and &lt;35% received antihyperglycemic therapy, highlighting substantial treatment gaps. Racial/ethnic differences in MetS component relationships were observed: blood pressure played a larger role in Black individuals, while fasting glucose was more prominent in Hispanic individuals.</div></div><div><h3>Conclusions</h3><div>MetS prevalence has increased over 2 decades. Persistent racial/ethnic disparities exist in antihypertensive, antihyperglycemic, and lipid-lowering medication use. Across all racial/ethnic subgroups, large opportunities remain for improving treatment strategies among individuals with medication indications.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 6","pages":"Article 101785"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence–Derived Electrocardiographic Age Predicts Mortality in Adults With Congenital Heart Disease","authors":"Scott Anjewierden MD ,&nbsp;Donnchadh O'Sullivan MB, BCh, BAO ,&nbsp;Kathryn E. Mangold PhD ,&nbsp;Itzhak Zachi Attia PhD ,&nbsp;Francisco Lopez-Jimenez MD ,&nbsp;Paul A. Friedman MD ,&nbsp;Alexander C. Egbe MBBS, MPH ,&nbsp;Heidi M. Connolly MD ,&nbsp;William R. Miranda MD ,&nbsp;Samuel J. Asirvatham MD ,&nbsp;Jennifer Dugan ,&nbsp;Katia Bravo-Jaimes MD ,&nbsp;Talha Niaz MBBS ,&nbsp;Malini Madhavan MBBS ,&nbsp;Luke J. Burchill MBBS, PhD","doi":"10.1016/j.jacadv.2025.101777","DOIUrl":"10.1016/j.jacadv.2025.101777","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) can be used to estimate age from the electrocardiogram (AI-ECG age). The difference between AI-ECG age and chronological age (delta-age) is an independent predictor of mortality in the general population.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to assess the relationship between delta-age and mortality among adults with congenital heart disease (ACHD).</div></div><div><h3>Methods</h3><div>A previously validated neural network was used to analyze standard digital 12-lead ECGs in a cohort of ACHD (age &gt;18 years) between 1992 and 2023. A single ECG from each patient, collected during the first visit to the ACHD clinic, was analyzed to compute the delta-age. The relationship between the delta-age and mortality was evaluated using Cox proportional hazard models adjusting for influential clinical factors.</div></div><div><h3>Results</h3><div>Of 5,780 subjects tested (50% females), the mean chronological age was 39.1 ± 15.0 years. AI-ECG age was 52.3 ± 16.6 years. CHD complexity was classified as mild, moderate, and severe in 7.4%, 73.9%, and 18.7% of patients, respectively. Patients with severe CHD had the highest median delta-age of 15.8 (IQR: 3.5-31.2) years followed by moderate 11.5 (IQR: 3.5-21.3) years and simple 6.7 (IQR: 0.3-14.2) years. During a median follow-up of 6.4 years (IQR: 1.58-13.7 years), 839 (14.5%) patients died. After adjusting for chronologic age, CHD complexity, and other clinical variables, delta-age was associated with increased mortality risk (HR: 1.06 [1.03-1.09] per 5-year increment in delta-age, <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Delta-age, the difference between AI-ECG and chronological age, is an independent predictor of all-cause mortality in ACHD.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 6","pages":"Article 101777"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Perspectives of Female Pediatric Cardiology Division Chiefs","authors":"Dana B. Gal MD ,&nbsp;Sujatha Buddhe MD, MS, MBA ,&nbsp;Arghavan Salles MD, PhD ,&nbsp;Jennifer G. Co-Vu MD ,&nbsp;Alaina K. Kipps MD, MS","doi":"10.1016/j.jacadv.2025.101805","DOIUrl":"10.1016/j.jacadv.2025.101805","url":null,"abstract":"<div><h3>Background</h3><div>Representation of women at successive career stages decreases within academic pediatric cardiology. Despite equal gender representation among pediatric cardiology trainees and board-eligible pediatric cardiologists, only 13% of U.S. programs have female division chiefs. There is little insight into what drives success among women who, despite these odds, attain the highest levels of academic success and leadership.</div></div><div><h3>Objectives</h3><div>The aim of this study was to describe perspectives of women pediatric cardiology chiefs.</div></div><div><h3>Methods</h3><div>This was a qualitative study using semistructured virtually conducted interviews. All current and former female chiefs of North American academic pediatric cardiology divisions were invited to participate. We completed inductive thematic analysis of transcribed interviews.</div></div><div><h3>Results</h3><div>Among eligible individuals, 16 of 20 agreed to participate. While 9 (56%) had worked under female chairs of pediatrics, only 4 (25%) previously had a female division chief. All held formal leadership roles before being chief. All participated in leadership training. Most were married (94%) and had children (81%). Three major findings were identified: “I didn't set out to be chief,” which included minor findings of the need for external validation, self-doubt, and late achievement of chief-level leadership; leveraging and discarding stereotypically feminine qualities; and solutions.</div></div><div><h3>Conclusions</h3><div>Women who rise to the highest leadership ranks in pediatric cardiology have shared perspectives. These perspectives are influenced by gender norms and inform ideas to address attrition of women in academic pediatric cardiology. Participants emphasized a need for increased awareness of this issue in pediatric cardiology, the importance of sponsorship, access to leadership training/coaching, and workplace and schedule flexibility as potential solutions.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 6","pages":"Article 101805"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Amyloidosis in Older Adults With a Focus on Frailty","authors":"Nicole K. Bart MBBS, DPhil ,&nbsp;Giada Bianchi MD ,&nbsp;Sarah A.M. Cuddy MD ,&nbsp;Parag Goyal MD, MSc ,&nbsp;Jan M. Griffin MD ,&nbsp;Scott L. Hummel MD, MS ,&nbsp;Peter Macdonald MBBS, PhD ,&nbsp;Mathew Maurer MD ,&nbsp;Elyn Montgomery RN, PhD ,&nbsp;Michael G. Nanne MD, MHS ,&nbsp;Ariela R. Orkaby MD, MPH ,&nbsp;Vaishali Sanchorawala MD ,&nbsp;Abdulla A. Damluji MD, PhD, MBA ,&nbsp;ACC Geriatric Cardiology Leadership Council","doi":"10.1016/j.jacadv.2025.101784","DOIUrl":"10.1016/j.jacadv.2025.101784","url":null,"abstract":"<div><div>Amyloidosis, which is caused by misfolded proteins that form amyloid fibrils, is predominantly diagnosed in older adults. Although previously considered a rare disease, increased awareness and noninvasive diagnostic methods have resulted in a rise in diagnoses. As a multisystem disease that affects multiple organ systems (cardiac, gastrointestinal, renal, and neurological), there is significant overlap with both geriatric conditions and common conditions in heart failure. Frailty is recognized as a distinct biological syndrome of declines across multiple physiological systems, which prevents maintenance of homeostasis and limits the ability to respond to stressors. Frailty was initially characterized as physical frailty alone; however, it is increasingly recognized that it is multidimensional with components including nutrition, cognitive, psychological, and social. Frailty in cardiovascular disease has become an important risk factor, indicator for disease severity, and can help guide decisions around intervention. In certain patients, frailty may be reversible. Given the lack of consensus definitions, tools, and implementation of frailty in both clinical and research settings in the field of amyloidosis, we convened a group of experts from cardiology, geriatric cardiology, geriatrics, hematology, and allied health to form this state-of-the-art review. There are many points of intersectionality between amyloidosis, aging, and frailty which herald a need for multidisciplinary care. This review document aims to provide guidance in how to understand and address frailty in older patients with a specific focus on cardiac amyloidosis.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 6","pages":"Article 101784"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}