JACC advances最新文献

{"title":"Characteristics of Hemorrhagic Myocardial Infarction After ST-Segment Elevation Myocardial Infarction in the United States","authors":"Ankur Kalra MD, MSc , Keyur Vora MD, MS , Vivek Bhat MBBS , Ashish Kumar MD , Khurram Nasir MD, MPH, MSc , Saeed R. Shaikh MD, MBA , Samir R. Kapadia MD , Rishi Puri MD, PhD , Grant W. Reed MD, MSc , Rohan Dharmakumar PhD","doi":"10.1016/j.jacadv.2025.102194","DOIUrl":"10.1016/j.jacadv.2025.102194","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11","pages":"Article 102194"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159688","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":"Randomized Controlled Trials Evaluating Artificial Intelligence in Cardiovascular Care","authors":"Dor Hadida Barzilai MD ,&nbsp;Karin Sudri MA ,&nbsp;Gal Goshen PhD ,&nbsp;Eyal Klang MD ,&nbsp;Eyal Zimlichman MD ,&nbsp;Israel Barbash MD ,&nbsp;Michal Cohen Shelly BSc, MBA","doi":"10.1016/j.jacadv.2025.102152","DOIUrl":"10.1016/j.jacadv.2025.102152","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) has shown promise in transforming health care, particularly in cardiology. However, there is a lack of high-quality evidence demonstrating its impact on crucial clinical outcomes.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to synthesize existing evidence from randomized controlled trials (RCTs) on the application of AI in cardiology, evaluating its impact on key clinical outcomes.</div></div><div><h3>Methods</h3><div>We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching MEDLINE, Web of Science, and the Cochrane Library from inception to November 2024. We included RCTs evaluating machine learning models compared to traditional methods in cardiovascular care. Primary outcomes focused on patient-important metrics, while secondary outcomes covered time and resource savings.</div></div><div><h3>Results</h3><div>Eleven RCTs met the inclusion criteria. Studies were conducted between 2021 and 2024, with 81.2% being multicenter trials. Five studies (45.5%) reported improvements in clinical events, 6 (54.5%) showed enhanced diagnostic accuracy and early detection, and 3 (27.3%) demonstrated improved resource utilization.</div></div><div><h3>Conclusions</h3><div>This review highlights AI's potential to enhance cardiovascular care through improved early detection, diagnostic accuracy, and resource efficiency. However, the limited number of RCTs indicates a need for more high-quality studies to validate AI’s effectiveness across various clinical domains.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11","pages":"Article 102152"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152134","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":"Postoperative Pericarditis After Cardiac Surgery in Adult Congenital Heart Disease","authors":"Sinan Khor MD, PhD ,&nbsp;Adam Small MD ,&nbsp;Jodi Feinberg NP ,&nbsp;Ralph S. Mosca MD ,&nbsp;TK Susheel Kumar MD ,&nbsp;Brittany N. Weber MD, PhD ,&nbsp;Dan Halpern MD ,&nbsp;Michael Garshick MD","doi":"10.1016/j.jacadv.2025.102144","DOIUrl":"10.1016/j.jacadv.2025.102144","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac surgery is associated with postsurgical inflammatory conditions, including postoperative pericarditis, that confer morbidity and are understudied in the adult congenital heart disease (ACHD) population.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to evaluate the incidence and risk factors for developing postoperative pericarditis in ACHD surgical operations.</div></div><div><h3>Methods</h3><div>Retrospective study of ACHD patients who underwent cardiac surgery between 2015 and 2023 at a major New York medical center. Pericarditis diagnosis required: 1) no prior history of pericarditis; 2) at least 2/4 criteria for acute pericarditis (chest pain, friction rub, nonlocalizing ST-segment elevations or PR depressions, new/worsening pericardial effusion); and 3) treatment of pericarditis (nonsteroidal anti-inflammatory drugs, colchicine, steroids, interleukin 1 inhibition). Surgical data and patient characteristics were collected. Logistic regression was used to determine baseline variables associated with pericarditis after atrial septal defect (ASD) repair.</div></div><div><h3>Results</h3><div>Among 214 ACHD patients undergoing cardiac surgery (median age 36 years [Q1-Q3: 26-53 years], 48.5% male), 47 patients (22.0%) developed postoperative pericarditis and were more commonly Asian or Black. The majority (37/47, 78.7%) of cases occurred within the first 7 days, with clinical resolution within 2 to 4 weeks, except for 4 patients (8.5%) who developed recurrent pericarditis. None developed tamponade or required pericardial drainage. Pericarditis occurred most frequently with shunt repair operations (27/47, 57.4%), in particular after ASD repair (24/29, 82.7%) using autologous pericardium (15/33, 45.4%) and aortic valve replacements (10/29, 34.4%). Logistic regression analysis of ASD repairs identified younger age, male sex, and Asian race as independent risk factors for pericarditis.</div></div><div><h3>Conclusions</h3><div>Roughly one in five ACHD cardiac surgical cases develop postoperative pericarditis, most frequently after ASD repairs using autologous pericardium or aortic valve replacement, yet only rarely had long-lasting complications.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11","pages":"Article 102144"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152081","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 Among Cardiovascular Disease Program Directors in the United States","authors":"Shreya Arvind MD ,&nbsp;Sriram Sunil Kumar MD ,&nbsp;Sharanya Kaushik MD ,&nbsp;Maisha Maliha MD ,&nbsp;Vikyath Satish MD ,&nbsp;Amrin Kharawala MD ,&nbsp;Sanjana Nagraj MD ,&nbsp;Sumant Pargaonkar MD ,&nbsp;Rosy Thachil MD","doi":"10.1016/j.jacadv.2025.102197","DOIUrl":"10.1016/j.jacadv.2025.102197","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11","pages":"Article 102197"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121073","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":"Lipoprotein(a) Testing Trends in the United States 2015-2024","authors":"Mattheus Ramsis MD,&nbsp;Mustafa Naguib BS,&nbsp;Marissa Dzotsi BS, MPH,&nbsp;Michael Wilkinson MD,&nbsp;Ehtisham Mahmud MD,&nbsp;Pam Taub MD,&nbsp;Harpreet S. Bhatia MD, MAS","doi":"10.1016/j.jacadv.2025.102205","DOIUrl":"10.1016/j.jacadv.2025.102205","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11","pages":"Article 102205"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121170","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":"Prognostic Implications of Preoperative hs-cTnT in Elective Coronary Artery Bypass Grafting","authors":"Leo Pölzl MD, PhD ,&nbsp;Joseph Kletzer MD ,&nbsp;Ronja Lohmann MD ,&nbsp;Christian Sutter MD ,&nbsp;Maria Ioannou-Nikolaidou MD ,&nbsp;Clemens Engler MD ,&nbsp;Michael Graber MD, PhD ,&nbsp;Felix Nägele MD ,&nbsp;Jakob Hirsch MD ,&nbsp;Samuel Heuts MD ,&nbsp;Martin Czerny MD ,&nbsp;Sebastian J. Reinstadler MD, PhD ,&nbsp;Johannes Holfeld MD ,&nbsp;Michael Grimm MD ,&nbsp;Albi Fagu MD ,&nbsp;Maximilian Kreibich MD ,&nbsp;Tau Hartikainen MD ,&nbsp;Nikolaos Bonaros MD ,&nbsp;Tim Berger MD ,&nbsp;Can Gollmann-Tepeköylü MD, PhD","doi":"10.1016/j.jacadv.2025.102180","DOIUrl":"10.1016/j.jacadv.2025.102180","url":null,"abstract":"<div><h3>Background</h3><div>Elevated preoperative hs-cTnT may reflect underlying myocardial vulnerability, potentially influencing surgical timing and perioperative strategies in patients undergoing elective coronary artery bypass grafting (CABG).</div></div><div><h3>Objectives</h3><div>This study investigates the association between preoperative hs-cTnT levels, perioperative outcomes, and long-term mortality, aiming to improve risk stratification and guide clinical decision-making.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed a consecutive series of 5,450 patients undergoing CABG at 2 tertiary centers between 2010 and 2023. Patients were categorized into 3 groups based on preoperative hs-cTnT levels: 1) nonelevated (&lt;1x upper reference limit [URL]); 2) mildly elevated (1–3x URL); and 3) significantly elevated (&gt;3x URL). A propensity score weighting method was performed before evaluating the association of hs-cTnT with perioperative outcomes, 30-day mortality and 5-year mortality.</div></div><div><h3>Results</h3><div>Among elective CABG patients, 26.6% had hs-cTnT levels &gt;1x URL, and 12.4% had levels &gt;3x URL. Patients with significantly elevated hs-cTnT (&gt;3x URL) demonstrated increased risks of extracorporeal membrane oxygenation use (HR: 2.96 [95% CI: 1.81-4.84]), hemofiltration (HR: 2.99 [95% CI: 2.27-3.94]), and 5-year mortality (HR: 1.55 [95% CI: 1.28-1.86]) (all <em>P</em> &lt; 0.001). Even mild elevations (1–3x URL) were linked to higher rates of hemofiltration (HR: 2.25 [1.75-2.90]; <em>P</em> &lt; 0.001), extracorporeal membrane oxygenation use (HR: 1.65 [95% CI: 1.01-2.69]; <em>P</em> = 0.046), and 5-year mortality (HR: 1.37 [95% CI: 1.14-1.34]; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Preoperative hs-cTnT is an independent predictor of adverse outcomes in elective CABG. Integrating hs-cTnT into routine preoperative assessment could identify high-risk patients, optimize surgical timing, and determine whether patients may benefit more from CABG or percutaneous coronary intervention, ultimately improving clinical outcomes.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11","pages":"Article 102180"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121072","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":"Evaluating Racial Disparities in Access to Common Pediatric/Congenital Transcatheter Interventions","authors":"Michael L. O’Byrne MD, MSCE ,&nbsp;Kevin F. Kennedy MS ,&nbsp;Ryan Callahan MD ,&nbsp;Yoav Dori MD, PhD ,&nbsp;Jonathan J. Rome MD ,&nbsp;Christopher L. Smith MD, PhD ,&nbsp;Jie Tang MD ,&nbsp;Matthew J. Gillespie MD ,&nbsp;Christopher M. Janson MD","doi":"10.1016/j.jacadv.2025.102158","DOIUrl":"10.1016/j.jacadv.2025.102158","url":null,"abstract":"<div><h3>Background</h3><div>Disparities in outcomes for congenital heart surgery patients have been observed. To our knowledge, these disparities have not been studied in pediatric/congenital interventional cardiology.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to determine whether Black race or Hispanic ethnicity is associated with disparities in diagnosis, referral, and/or access to catheterization.</div></div><div><h3>Methods</h3><div>A multicenter cohort study of patients ≤18 years who underwent: 1) device closure of atrial septal defect (ASD); 2) device closure of patent ductus arteriosus; 3) balloon pulmonary valvuloplasty (BPV); and 4) balloon aortic valvuloplasty (BAV) at centers contributing to the IMPACT registry 6/1/2016-12/31/2022. The associations between race-ethnicity and age at procedure and other procedure-specific markers of disease severity were evaluated. Also, the associations between race-ethnicity and the risk of adverse events and the proportion of patients treated at high-, medium-, and low-volume centers for each procedure were evaluated.</div></div><div><h3>Results</h3><div>In total, 20,632 subjects were studied (34% ASD, 48% patent ductus arteriosus, 14% BPV, and 5% BAV). Race-ethnicity was associated with older age for ASD and BPV (<em>P</em> &lt; 0.05) and more severe disease for BPV and BAV (<em>P</em> &lt; 0.05). The proportion of Black and Hispanic patients was higher in low-volume than in high-volume centers (<em>P</em> &lt; 0.05 for all procedures).</div></div><div><h3>Conclusions</h3><div>Minority race-ethnicity was associated with older age at referral and more severe disease, implying disparities in referral and/or access and higher likelihood of treatment at low-volume centers. Efforts to understand and mitigate disparities in this population should focus on screening, diagnosis, and access.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 11","pages":"Article 102158"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121074","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":"Cardiorespiratory Fitness, Multimorbidity Risk, and 15-Year Trajectories in Chronic Disease Accumulation: A Prospective Longitudinal Study.","authors":"Liyao Xu, Shuqi Wang, Maiwulamujiang Maimaitiyiming, Wenzhe Yang, Sakura Sakakibara, Xiuying Qi, Yaogang Wang, Abigail Dove","doi":"10.1016/j.jacadv.2025.102198","DOIUrl":"https://doi.org/10.1016/j.jacadv.2025.102198","url":null,"abstract":"<p><strong>Background: </strong>Cardiorespiratory fitness (CRF) has been linked to lower risk of individual chronic diseases, but little is known about the CRF in relation to multimorbidity.</p><p><strong>Objectives: </strong>The authors investigated the association between CRF and multimorbidity risk and explored differences in the trajectories of chronic disease accumulation at varying levels of CRF.</p><p><strong>Methods: </strong>The study included 38,348 adults from the UK Biobank (mean age 55.21 ± 8.15 years; 51.95% female) who were followed for up to 15 years to detect the incidence of 59 common chronic diseases. CRF was estimated using a 6-minute submaximal exercise test and tertiled as low, moderate, and high (after standardization by age and sex). Multimorbidity was defined as the presence of 2 or more chronic diseases. Data were analyzed using Cox regression, Laplace regression, and linear mixed-effects models.</p><p><strong>Results: </strong>During the follow-up (median [IQR]: 11.57 [7.39-11.76] years), 15,368 (40.08%) participants developed multimorbidity. The risk of multimorbidity was 21% lower in participants with high compared to low CRF (HR: 0.79 [95% CI: 0.76-0.83]). The median time to multimorbidity onset was 1.27 (95% CI: 1.01-1.54) years later for those with high compared to low CRF. Moreover, participants with high CRF experienced a significantly slower annual rate of chronic disease accumulation (β = -0.043 [-0.050 to -0.036]).</p><p><strong>Conclusions: </strong>High CRF is associated with lower multimorbidity risk, delayed onset of multimorbidity, and significantly slower accumulation of chronic diseases. The findings highlight the importance of CRF for healthy longevity.</p>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":" ","pages":"102198"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253984","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":"Risk of Major Adverse Cardiovascular Events During Acute Streptococcus pneumoniae Infection in COPD Patients","authors":"Nicoline Meyer Riisberg MD ,&nbsp;Daniel Modin MD ,&nbsp;Barbara Bonnesen Bertelsen MD, PhD ,&nbsp;Anna K. Vognsen MSc ,&nbsp;Josefin Eklöf MD, PhD ,&nbsp;Jonas Bredtoft Boel MSc, PhD ,&nbsp;Christian Østergaard MD ,&nbsp;Ram Benny Dessau MD, PhD ,&nbsp;Tor Biering-Sørensen MD, PhD ,&nbsp;Jens-Ulrik Stæhr Jensen MD, PhD ,&nbsp;Pradeesh Sivapalan MD, PhD","doi":"10.1016/j.jacadv.2025.102172","DOIUrl":"10.1016/j.jacadv.2025.102172","url":null,"abstract":"<div><h3>Background</h3><div>Patients with chronic obstructive pulmonary disease (COPD) are at an increased risk of severe complications and death from community-acquired pneumonia such as <em>Streptococcus pneumoniae.</em> Previous studies suggest that acute infection heightens the short-term risk of cardiovascular events.</div></div><div><h3>Objectives</h3><div>This study investigates the risk of major adverse cardiovascular events (MACE) during the acute phase of <em>S pneumoniae</em> infection in patients with COPD.</div></div><div><h3>Methods</h3><div>We conducted a self-controlled case series study in patients with COPD and a positive lower respiratory tract or blood culture for <em>S pneumoniae</em> between 2010 and 2017 using Danish Nationwide register data. The primary outcome was incidence of MACE and the risk interval was defined as the first 14 days after an airway or blood culture positive for <em>S. pneumonia</em>. The control interval was defined as 180 days before and 180 days after the risk interval. Statistical analysis involved conditional Poisson regression models to calculate incidence rate ratios.</div></div><div><h3>Results</h3><div>We identified 327 patients with a positive culture for <em>S pneumoniae</em>, who experienced a MACE during the study period. Sixty patients died during the study period leaving 267 patients for analysis. Pneumococcal infection was associated with a 4.6-fold increased incidence of MACE (<em>P</em> &lt; 0.001) within 14 days after the infection and a 9.1-fold increased incidence of acute myocardial infarction (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Pneumococcal infection in patients with COPD was associated with an increased risk of MACE within 14 days postinfection. Further studies should address whether preventative interventions could mitigate risks in patients with COPD and pneumococcal infections.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102172"},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121273","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":"Fit Is it for Longevity and Prevention of Multimorbidity.","authors":"Carl J Lavie, Charles Faselis, Peter Kokkinos","doi":"10.1016/j.jacadv.2025.102199","DOIUrl":"https://doi.org/10.1016/j.jacadv.2025.102199","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":" ","pages":"102199"},"PeriodicalIF":0.0,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253906","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}