JACC advances最新文献

{"title":"Automated Real-Time Percutaneous Coronary Intervention Risk Model Leveraging Electronic Health Records","authors":"Mandeep Singh MD, MPH ,&nbsp;Adelaide M. Arruda-Olson MD, PhD ,&nbsp;Bradley R. Lewis MS ,&nbsp;Bradley K. Johnson BS ,&nbsp;Rajeev Chaudhry MD, MPH ,&nbsp;Arman Arghami MD, MPH ,&nbsp;Mohamad Alkhouli MD, MBA ,&nbsp;Charanjit S. Rihal MD, MBA","doi":"10.1016/j.jacadv.2025.101865","DOIUrl":"10.1016/j.jacadv.2025.101865","url":null,"abstract":"<div><h3>Background</h3><div>Automated individualized risk prediction tools linked to electronic health records (EHRs) are not available for patients undergoing percutaneous coronary interventions (PCIs).</div></div><div><h3>Objectives</h3><div>Our goal was to automatically extract data elements used in the Mayo Clinic PCI models from EHR to enable point of care risk assessment.</div></div><div><h3>Methods</h3><div>Using the Mayo Clinic PCI registry, variables in the Mayo Clinic PCI risk score were trained and tested in an EHR to identify in-hospital death, stroke, bleeding, acute kidney injury (AKI) in patients who underwent PCI from 2016 to 2024. Least absolute shrinkage and selection operator regression was utilized to train (data building) and test (assessing performance) prediction models and to estimate effect sizes that were weighted and integrated into a scoring system.</div></div><div><h3>Results</h3><div>Death, stroke, bleeding, AKI occurred in 157 (1.8%), 43 (0.5%), 157 (1.8%), and 682 (7.6%), respectively. The C-statistics (95% CI) from the training and testing data sets were 0.83 (95% CI: 0.80-0.86) and 0.84 (95% CI: 0.78-0.89); 0.76 (95% CI: 0.65-0.84) and 0.77 (95% CI: 0.65-0.86); 0.80 (95% CI: 0.75-0.83) and 0.75 (95% CI: 0.68-0.81); and 0.82 (95% CI: 0.80-0.84) and 0.80 (95% CI: 0.77-0.84) for in-hospital death, stroke, bleeding, and AKI, respectively. Bootstrap analysis indicated that the models were not overfit to the available data set. The probabilities estimated from the models matched the observed data well, as indicated by the calibration curve slope and intercept and across subgroups, including women, acute coronary syndrome, cardiogenic shock, and diabetes mellitus.</div></div><div><h3>Conclusions</h3><div>Real-time, automated, point of care PCI risk assessment is feasible in an EHR environment.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101865"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144472332","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 Pharmacist Telehealth Comanagement for Heart Failure","authors":"D. Steven Fox MD ,&nbsp;Nadine Zawadski PhD ,&nbsp;Kimberly Buss MD ,&nbsp;Angela Leahy PhamD ,&nbsp;Q. Laura Zhang PharmD ,&nbsp;Yu Christine Chan BS Pharm","doi":"10.1016/j.jacadv.2025.101906","DOIUrl":"10.1016/j.jacadv.2025.101906","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure with reduced ejection fraction (HFrEF) imposes high morbidity and mortality burdens. Outcomes improve significantly with guideline-directed medical therapy (GDMT), but patients infrequently achieve target regimens in practice.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to determine the effectiveness of telehealth-delivered pharmacist comanagement for patients with HFrEF vs usual care to: 1) achieve goal GDMT therapy; and 2) reduce health care utilization.</div></div><div><h3>Methods</h3><div>This nonrandomized controlled study, spanning 2022 to 2023, analyzed a health care delivery improvement project at an integrated health care network. In-network Medicare recipients with a HFrEF diagnosis (based on chart review) were divided into those covered by the network’s risk-sharing agreement (intervention group) vs otherwise similar (comparison group) patients. A difference-in-difference analysis with inverse propensity weighting adjusted for observable risk factors. Intervention patients received medication reconciliation, new drug initiation, dose adjustments, and safety monitoring by program pharmacists via telehealth. Main outcome measures were hospitalizations and achievement of target GDMT therapy.</div></div><div><h3>Results</h3><div>There were 190 intervention and 277 comparison group patients. The relative risk of cardiac hospitalization in the intervention group (vs comparison group) was 0.26 (95% CI: 0.08-0.86; <em>P</em> = 0.026), with an adjusted absolute risk reduction of 14.2 hospitalizations per 100 patient-years. In the intervention group, the ORs for achieving 3+ and 4 GDMT classes (vs comparison) were 2.73 (95% CI: 1.91-3.87; <em>P</em> &lt; 0.001) and 2.27 (95% CI: 1.29-4.01; <em>P</em> = 0.005), respectively. The adjusted absolute increase in patients on 3+ and 4 GDMT classes were 23% and 21%, respectively.</div></div><div><h3>Conclusions</h3><div>A dedicated pharmacist comanagement telehealth program for patients with HFrEF proved effective at improving GDMT use and reducing cardiac hospitalizations.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144472333","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":"Predictors of Length-of-Stay Among Transcatheter Aortic Valve Replacement Patients Using a Supervised Machine Learning Algorithm","authors":"Gregory L. Judson MD ,&nbsp;Jeff Luck PhD ,&nbsp;Skye Lawrence BA ,&nbsp;Rakan Khaki MPH ,&nbsp;Harsh Agrawal MD ,&nbsp;Krishan Soni MD ,&nbsp;Kirsten Tolstrup MD ,&nbsp;Vijayadithyan Jaganathan MD ,&nbsp;Vaikom S. Mahadevan MD","doi":"10.1016/j.jacadv.2025.101902","DOIUrl":"10.1016/j.jacadv.2025.101902","url":null,"abstract":"<div><h3>Background</h3><div>Length of stay following transcatheter aortic valve replacement (TAVR) continues to improve, but significant gaps remain in predicting the length of stay following TAVR.</div></div><div><h3>Objectives</h3><div>This study aimed to develop a novel machine learning (ML) algorithm that would facilitate the understanding of the predictors of early and late hospital discharge in patients who have undergone TAVR.</div></div><div><h3>Methods</h3><div>Using the Biome data set, 9,172 outpatient TAVR procedures were analyzed from 21 centers between 2017 and 2021 across the United States. Supervised random forest ML algorithms were developed to identify variables involved in short length of stay (SLOS) (length of stay &lt;36 hours) and long length of stay (LLOS) (length of stay ≥72 hours) in a 70% sample of the Biome data set. The models were then tested on the remaining 30% of the data set and results compared to standard multivariable models in predicting LOS.</div></div><div><h3>Results</h3><div>Twenty and 22 variables were identified and included as important predictors for the SLOS and LLOS multivariable models, respectively. The predictive power of both the SLOS (sensitivity 0.81, specificity 0.70, area under the curve [AUC] 0.82) and LLOS (sensitivity 0.45, specificity 0.94, AUC 0.85) ML models were more robust than the standard multivariable model (SLOS AUC 0.65, LLOS AUC 0.65). Our study uncovered several previously unreported predictors for length of stay following TAVR, such as procedural duration, postprocedure physical therapy, and procedure day of the week.</div></div><div><h3>Conclusions</h3><div>ML algorithms may have an important role in identifying novel predictors of short and prolonged length of stay following TAVR. These efforts may facilitate targeted quality improvement programs to decrease length of stay post-TAVR.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 8","pages":"Article 101902"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366426","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 for Detection of Prognostically Significant Left Ventricular Dysfunction From Echocardiography","authors":"David Playford MBBS, PhD ,&nbsp;Simon Stewart PhD, DMSc ,&nbsp;Andrew Watts PhD ,&nbsp;Dean Kezurer BPhil(Hons) ,&nbsp;Yih-Kai Chan PhD ,&nbsp;Geoff Strange PhD","doi":"10.1016/j.jacadv.2025.101891","DOIUrl":"10.1016/j.jacadv.2025.101891","url":null,"abstract":"<div><h3>Background</h3><div>Identification of left ventricular (LV) dysfunction following echocardiographic investigations remains problematic, particularly when the ejection fraction (EF) is preserved.</div></div><div><h3>Objectives</h3><div>The authors examined the operational characteristics of artificial intelligence LV dysfunction (AI-LVD) identification from routinely obtained echocardiographic measurements.</div></div><div><h3>Methods</h3><div>Following initial training in 126,136 (imputation cohort) and 254,735 (training cohort) cases from the National Echo Database of Australia, the AI-LVD was tested in 81,509 cases (last echo January 1, 2000-May 21, 2019) with no mitral valve intervention or pacemaker. This cohort comprised 41,796 men (51.3%) aged 62.3 ± 17.1 years and 39,713 women aged 63.2 ± 18.4 years, in whom 4,490 (5.5%), 3,734 (4.6%), and 59,297 (72.7%) had reduced, mildly reduced, and preserved EF, while 13,988 (17.2%) had no recorded EF and 39,940 (45.2%) had “indeterminate” filling pressures.</div></div><div><h3>Results</h3><div>Overall, the AI-LVD generated a (sex-specific) output in decile distributions consistent with increasingly higher levels of LV dysfunction and mortality—actual 5-year mortality rising from 5.7% to 66.3% and 2.3% to 64.2% in men and women, respectively. The prognostic capacity of the AI-LVD persisted in preserved EF, when adjusting for age, year of echo, and missing echo parameters—with adjusted hazard for all-cause mortality during 1,541 (812-2,682) days follow-up 4.93-fold (95% CI: 4.35-5.59) and 7.11-fold (95% CI: 5.85-8.64) higher in the highest vs lowest decile group in men and women, respectively.</div></div><div><h3>Conclusions</h3><div>A new AI-LVD algorithm using only echocardiographic measurements can reliably identify prognostically important LV dysfunction, including in preserved EF, even when key reporting parameters are missing. The AI-LVD can be used in real-time during routine echocardiography reporting.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101891"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365032","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":"Effect of Frailty on Cardiovascular Clinical Trials","authors":"Haowen Jiang MBBS ,&nbsp;Jie Jun Wong MBBS ,&nbsp;Ru-San Tan MBBS ,&nbsp;Fei Gao PhD ,&nbsp;Louis LY. Teo MBBS ,&nbsp;Jordan B. Strom MD, MSc ,&nbsp;Chim C. Lang MD, PhD ,&nbsp;Angela S. Koh MBBS, MPH, PhD","doi":"10.1016/j.jacadv.2025.101889","DOIUrl":"10.1016/j.jacadv.2025.101889","url":null,"abstract":"<div><h3>Background</h3><div>Patients with cardiovascular (CV) diseases are increasingly frail but rarely represented in trials. Understanding effect modification by frailty on CV trials is critical as it could help define treatment strategies in frail patients.</div></div><div><h3>Objectives</h3><div>This meta-analysis aims to assess the implications of frailty on CV outcomes in clinical trials.</div></div><div><h3>Methods</h3><div>Randomized controlled trials examining the effects of frailty in the context of CV trials were included (<span><span>CRD42024528279</span><svg><path></path></svg></span>). Outcomes included a composite of major adverse cardiac events (MACE), all-cause mortality, CV mortality, hospitalizations, and frailty-specific outcomes (physical, quality of life, and frailty scores). HRs and 95% CIs were pooled for clinical endpoints, and standardized mean differences (SMDs) were calculated for frailty-specific outcomes.</div></div><div><h3>Results</h3><div>Thirty unique randomized controlled trials were included with a pooled total of 87,711 participants. Frail patients had a significantly increased risk of MACE (HR: 2.33 [95% CI: 1.87-2.91], <em>P</em> &lt; 0.001, I² = 83%), all-cause mortality (HR: 2.34 [95% CI: 1.80-3.05], <em>P</em> &lt; 0.01, I² = 75%), CV mortality (HR: 1.76 [95% CI: 1.60-1.93], <em>P</em> &lt; 0.001, I² = 0%), and hospitalizations (HR: 2.38 [95% CI: 1.65-3.43], <em>P</em> &lt; 0.001, I² = 92%) compared to nonfrail patients. In the frailest group, trial interventions decreased MACE (HR: 0.81 [95% CI: 0.74-0.88], <em>P</em> &lt; 0.001, I² = 0%) and hospitalization (HR: 0.81 [95% CI: 0.72-0.90], <em>P</em> &lt; 0.001, I² = 0%) risks with no significant difference in mortality risk (<em>P</em> &gt; 0.05) compared with the control group. Trial interventions significantly improved physical (SMD: 0.15, 0.04-0.26) and quality of life (SMD: 0.15, 0.09-0.21) but not frailty scores (<em>P</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>While frailty prognosticated a higher risk of CV events and mortality, frailty did not reduce treatment efficacy. CV trial interventions appear beneficial even in the frailest group.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101889"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366957","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":"Stent-Retriever Thrombectomy in STEMI With Large Thrombus Burden","authors":"Rafail A. Kotronias MBChB, MSc ,&nbsp;Jason L. Walsh MBChB ,&nbsp;Stefano Andreaggi MD ,&nbsp;Leonardo Portolan MD ,&nbsp;Alessandro Maino MD ,&nbsp;Federico Marin MD ,&nbsp;Jason Chai MBBCh ,&nbsp;Ikboljon Sobirov MSc ,&nbsp;Muhammad Sheikh MD ,&nbsp;Thomas J. Cahill MBBS, DPhil ,&nbsp;Andrew J. Lucking MBChB, PhD ,&nbsp;Max Costello BSc ,&nbsp;Eva Fraile Moreno MScNurs ,&nbsp;Vrinda Haridas BNurs ,&nbsp;Anisha Shaji BNurs ,&nbsp;Hector M. Garcia-Garcia MD, PhD ,&nbsp;Keith M. Channon MBChB, MD ,&nbsp;Adrian P. Banning MBChB, MD ,&nbsp;Jeremy P. Langrish MBBCh, PhD ,&nbsp;Giovanni Luigi De Maria MD, PhD","doi":"10.1016/j.jacadv.2025.101893","DOIUrl":"10.1016/j.jacadv.2025.101893","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous coronary intervention (PCI) restores epicardial flow in ST-segment elevation myocardial infarction (STEMI), but large thrombus burden (LTB) can impair myocardial perfusion due to embolization. While manual aspiration (MA) devices have limited efficacy in STEMI, the success of stent-retriever thrombectomy (SRT) in stroke suggests it as a promising option for STEMI.</div></div><div><h3>Objectives</h3><div>The RETRIEVE AMI (stent-retriever thrombectomy for thrombus burden reduction in patients with acute myocardial infarction) trial assessed the safety and efficacy of Solitaire X SRT vs Export MA in STEMI patients with LTB.</div></div><div><h3>Methods</h3><div>This single-center study enrolled 81 STEMI patients with LTB (TIMI thrombus grade ≥4) and randomized them to PCI, MA-assisted, or SRT-assisted PCI. The primary endpoint was difference in prestent thrombus volume by optical coherence tomography between SRT and either comparator; coprimary endpoints included device-related target vessel complications and major adverse cardiac and cerebrovascular events through 6 months.</div></div><div><h3>Results</h3><div>SRT was performed in 26 cases (one crossover), and MA in 27. No device-related arterial complications or cerebrovascular events occurred in the SRT arm. Baseline thrombus volume was significantly higher in the SRT group (18.3 mm³) compared to MA (7.7 mm³) and no modification (9.8 mm³; <em>P</em> = 0.04). Prestent thrombus volume was not significantly different between SRT (7.7; IQR: 2.3-18.6) and either MA (4.8; IQR: 1.8-8.4; <em>P</em> = 0.17) or no thrombus modification (9.8; IQR: 4.5-18.1; <em>P</em> = 1.00). Both techniques significantly reduced prestent thrombus burden (SRT: 12.8%; IQR: 4.4%-21.5%; <em>P</em> = 0.016 and MA: 13.0%; IQR: 3.8%-19.4%; <em>P</em> = 0.003) compared to no modification (22.8%; IQR: 10.4%-27.7%). No device-related clinically relevant arterial injury was detected and in-hospital and 6-month major adverse cardiac and cerebrovascular events did not differ between arms.</div></div><div><h3>Conclusions</h3><div>RETRIEVE AMI demonstrates the feasibility of Solitaire X SRT in STEMI with LTB. Prestent thrombus volume was not different between SRT, MA, or no thrombus modification, although SRT extracted larger thrombus volume than MA. Larger multicenter studies using optical coherence tomography-based criteria are needed to minimize variability and enhance comparative assessments.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101893"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366958","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":"Subclinical Myocardial Injury and Global Cognitive Performance","authors":"Shubham Tomar MBBS, MPH ,&nbsp;Karita C.F. Lidani MD, MSc, PhD ,&nbsp;Aline A.I. Moraes MD, PhD ,&nbsp;Shi Huang PhD ,&nbsp;Christian Oakley BS ,&nbsp;Khurram Nasir MD, MPH ,&nbsp;Michael J. Blaha MD, MPH ,&nbsp;Susan R. Heckbert MD, PhD ,&nbsp;Timothy M. Hughes PhD ,&nbsp;Christopher R. deFilippi MD ,&nbsp;Yader Sandoval MD ,&nbsp;Allan S. Jaffe MD ,&nbsp;Andrew P. DeFilippis MD, MSc","doi":"10.1016/j.jacadv.2025.101894","DOIUrl":"10.1016/j.jacadv.2025.101894","url":null,"abstract":"<div><h3>Background</h3><div>Cognitive impairment is common in cardiovascular disease (CVD) patients.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to evaluate the relationship of myocardial injury, measured by high-sensitivity cardiac troponin T (hs-cTnT), with global cognitive performance and its decline over time.</div></div><div><h3>Methods</h3><div>Hs-cTnT assessed at baseline (2000-2002) and exam 5 (2010-2012) in 4,445 participants. Cognitive function evaluated using the Cognitive Abilities Screening Instrument (CASI) at exams 5 and 6 (2016-2018). Subclinical myocardial injury defined as hs-cTnT above limits of detection but below 19 ng/L, while clinical myocardial injury &gt;19 ng/L. Cognitive decline was a &gt;5 point decrease in CASI scores from exam 5 to 6. Regression analysis assessed the association of hs-cTnT levels with CASI scores and their decline.</div></div><div><h3>Results</h3><div>Mean age at baseline was 60 years with 53% females. At baseline and exam 5, 63% and 87% had subclinical myocardial injury, respectively. Higher Log₁₀(hs-cTnT) at baseline (β = −1.45 [95% CI: −2.5 to −0.41]), exam 5 (β = −1.63 [95% CI: −2.7 to −0.59]), and greater baseline to exam 5 increase (β = −1.42 [95% CI: −2.8 to −0.06]) were associated with lower CASI scores at exam 5, after adjusting for demographics, education, language, and apolipoprotein E status. These estimate lost significance after CVD risk factor adjustment. Higher Log₁₀(hs-cTnT) at baseline (OR: 2.02 [95% CI: 1.29-3.12]), exam 5 (OR: 2.52 [95% CI: 1.56-4.05]), or greater baseline to exam 5 increase (OR: 2.22 [95% CI: 1.18-4.15]) were associated with higher odds of cognitive decline in fully adjusted models.</div></div><div><h3>Conclusions</h3><div>In community-based cohort, higher or increasing hs-cTnT was associated with greater odds of future cognitive decline over 6 years of follow-up.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 8","pages":"Article 101894"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338958","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":"Benefits of Patisiran on Functional Capacity in ATTR Cardiac Amyloidosis","authors":"John L. Berk MD ,&nbsp;Olivier Lairez MD, PhD ,&nbsp;Pedro Schwartzmann MD, PhD ,&nbsp;Shaun Bender PhD ,&nbsp;Matthew T. White PhD ,&nbsp;Patrick Y. Jay MD, PhD ,&nbsp;David Danese MBA ,&nbsp;Ronald Witteles MD","doi":"10.1016/j.jacadv.2025.101876","DOIUrl":"10.1016/j.jacadv.2025.101876","url":null,"abstract":"<div><h3>Background</h3><div>Patients with transthyretin amyloidosis with cardiomyopathy (ATTR-CM) suffer substantial morbidity and mortality. The meaningful preservation of functional capacity and quality of life are important priorities.</div></div><div><h3>Objectives</h3><div>The 6-minute walk test (6MWT), a measure of functional capacity, was the primary outcome in the APOLLO-B study of patisiran in patients with ATTR-CM; the treatment benefit vs placebo was +15 m over 12 months. We estimated the minimal clinically important difference for change in 6MWT performance.</div></div><div><h3>Methods</h3><div>Change from baseline in 6MWT performance was anchored to established categories of clinically important change in the Kansas City Cardiomyopathy Questionnaire-Overall Summary score. To relate changes in 6MWT performance to activities of daily living, we fit a proportional-odds cumulative logit model for items in the Kansas City Cardiomyopathy Questionnaire Physical Limitation domain.</div></div><div><h3>Results</h3><div>The APOLLO-B trial randomized 360 patients to receive placebo (n = 179) or patisiran (n = 181). The estimated minimal clinically important difference in 6MWT was 6.9 to 7.8 m. When comparing the change from baseline in 6MWT at month 12 between 2 patients, 15 m greater preservation was associated with approximately 10% to 16% lower odds of deterioration in walking 1 block (OR: 0.88 [95% CI: 0.83-0.93]), climbing stairs (OR: 0.84 [95% CI: 0.80-0.89]), hurrying/jogging (OR: 0.88 [95% CI: 0.83-0.93]), dressing oneself (OR: 0.85 [95% CI: 0.81-0.90]), and performing yard/housework or carrying groceries (OR: 0.89 [95% CI: 0.84-0.93]).</div></div><div><h3>Conclusions</h3><div>In patients with ATTR-CM treated with patisiran, mean population-level differences of 7 to 8 m in 6MWT have practical relevance. The magnitude of the impact of patisiran on 6MWT performance over 12 months in APOLLO-B was associated with preserving the ability to perform activities of daily living.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 8","pages":"Article 101876"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338325","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":"Gender Disparities Are Not Binary","authors":"Stephen C. Cook MD ,&nbsp;Caroline Ong MD, MS ,&nbsp;Matthew Carazo MD","doi":"10.1016/j.jacadv.2025.101920","DOIUrl":"10.1016/j.jacadv.2025.101920","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101920"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329871","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":"Raising the Alarm","authors":"Ghazaleh Goldar MD ,&nbsp;Aaron A. Sifuentes MD ,&nbsp;Kaushik Gokul BS ,&nbsp;Usamah M. ElBakkush MD ,&nbsp;Mohammed Mhanna MD ,&nbsp;Peter Farjo MD ,&nbsp;Paari Dominic MBBS","doi":"10.1016/j.jacadv.2025.101890","DOIUrl":"10.1016/j.jacadv.2025.101890","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac abnormalities are often the first or only sign of sarcoidosis. Current guidelines recommend evaluating for cardiac sarcoidosis (CS) in patients below 60 years with unexplained complete heart block (CHB).</div></div><div><h3>Objectives</h3><div>The aim of the study was to assess the proportion of patients with unexplained CHB who receive guideline-recommended testing for CS and to compare subsequent diagnosis rates with expected prevalence.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using TriNetX data, identifying patients aged 18 to 60 years with unexplained CHB requiring device placement over the past 5 years. We assessed the use of cardiac diagnostic tests—cardiac magnetic resonance imaging, positron emission tomography, chest computed tomography, and myocardial biopsy—and tracked CS diagnoses over 5 years.</div></div><div><h3>Results</h3><div>Among 1,279 patients meeting criteria across 55 health care organizations, 75% were treated at academic centers. The mean age was 48 ± 11 years; 53% were male, and 73% were White. Over a median follow-up of 724 days (Q1-Q3: 0-1,117), advanced cardiac testing was performed in 256 patients (20.0%; 95% CI: 17.8%-22.2%). Specific test utilization included cardiac magnetic resonance imaging in 131 patients (10.2%; 95% CI: 8.6%-11.9%), chest computed tomography in 141 (11.0%; 95% CI: 9.3%-12.7%), cardiac positron emission tomography in ≤10 (0.7%; 95% CI: 0.3%-1.3%), and myocardial biopsy in ≤10 (0.7%; 95% CI: 0.3%-1.3%). Fewer than 10 patients (&lt;1%; 95% CI: 0.3%-1.3%) were diagnosed with CS, far below the expected prevalence of 19% to 34%.</div></div><div><h3>Conclusions</h3><div>Despite guideline recommendations, diagnostic testing for CS in younger patients with unexplained CHB remains low. This gap likely contributes to significant underdiagnosis and highlights the need for improved adherence to evaluation protocols.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101890"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144329870","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}