JACC advances最新文献

{"title":"Sodium-Glucose Cotransporter 2 Inhibitors Preceding ST-Segment Elevation Myocardial Infarction","authors":"Jay S. Shavadia MD ,&nbsp;Megan Tomilin MSc ,&nbsp;Paulos Chumala PhD ,&nbsp;Rama Mangipudi MSc ,&nbsp;Jacob Udell MD ,&nbsp;Haissam Haddad MD ,&nbsp;George S. Katselis PhD","doi":"10.1016/j.jacadv.2025.101887","DOIUrl":"10.1016/j.jacadv.2025.101887","url":null,"abstract":"<div><h3>Background</h3><div>While sodium-glucose cotransport 2 receptor inhibitors (SGLT2i) improve post infarction cardiovascular outcomes, limited understanding exists on how these agents influence pathophysiology preceding myocardial infarction.</div></div><div><h3>Objectives</h3><div>The objective of this study was to explore how proteins are differentially regulated in patients on and not on an SGLT2i preceding ST-segment elevation myocardial infarction (STEMI).</div></div><div><h3>Methods</h3><div>Between June 2021 and October 2023, blood was collected at the time of arterial sheath insertion from consecutive STEMI patients. We then identified patients with diabetes and created propensity-matched pairs of patients on and not on SGLT2i prior to STEMI (SGLT2i+ and SGLT2i−). Serum was separated, and following immunodepletion and enzymatic digestion, liquid chromatography-tandem mass spectrometry was performed to identify differentially regulated proteins between the 2 SGLT2i groups.</div></div><div><h3>Results</h3><div>Of the 560 STEMI patients, 149 eligible patients had diabetes distributed by pre-existing SGLT2i use as: SGLT2i+ (n = 35) and SGLT2i− (n = 114). Both SGLT2i groups were comparable in their presenting demographics and reperfusion strategies, except for higher proportion of insulin use in SGLT2i+ patients. Thirty-three SGLT2i+/SGLT2i− propensity-matched pairs were created from which 21 differentially expressed proteins were identified; dominantly noted was up-regulation of proteins involved in heme-scavenging and nitric oxide transport in patients on SGLT2i+ compared with SGLT2i preceding STEMI.</div></div><div><h3>Conclusions</h3><div>SGLT2i appears to predominantly associate with up-regulation of heme-scavenging and nitric oxide, and plausibly through a related reduction in infarct size also associates with the observed related improvement in post infarction heart failure.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101887"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313750","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":"Multisite Validation of a Strategy to Identify Very Low Risk Emergency Department Patients Without Troponin","authors":"Nicklaus P. Ashburn MD, MS ,&nbsp;Anna C. Snavely PhD ,&nbsp;Akalya Villenthi MS ,&nbsp;Tara Hashemian MS ,&nbsp;Michael W. Supples MD, MPH ,&nbsp;Simon A. Mahler MD, MS","doi":"10.1016/j.jacadv.2025.101913","DOIUrl":"10.1016/j.jacadv.2025.101913","url":null,"abstract":"<div><h3>Background</h3><div>Patients with chest pain who are very low risk, defined by a History, Electrocardiogram, Age, and Risk factors (HEAR) score ≤1, may not require troponin testing.</div></div><div><h3>Objectives</h3><div>The aim of this study was to determine whether troponin testing is needed in patients with HEAR scores ≤1 in a multisite U.S. cohort.</div></div><div><h3>Methods</h3><div>We conducted an observational cohort study using the Wake Forest Chest Pain Registry. Patients ≥18 years old with HEART Pathway assessments and high-sensitivity troponin testing were accrued from 5 U.S. emergency departments (November 1, 2020-July 7, 2022). HEAR scores were prospectively completed by the treating clinician for patients with no known coronary artery disease and a nonischemic electrocardiogram. The outcome was 30-day major adverse cardiovascular events (MACE) (death, myocardial infarction [MI], and revascularization). The proportion of patients with HEAR scores ≤1 with MACE within 30 days was determined, and test characteristics were calculated. The net reclassification improvement index for troponin testing among patients with HEAR scores ≤1 was determined.</div></div><div><h3>Results</h3><div>Among 9,105 patients, 17.2% (1,565/9,105) had a HEAR score ≤1. At 30 days, MACE occurred in 0.7% (11/1,565; 95% CI: 0.4-1.3), with 3 deaths, 8 MIs, and 1 revascularization. The sensitivity and negative predictive value for 30-day MACE in patients with a HEAR score ≤1 were 97.9% (95% CI: 96.2-98.9) and 99.3% (95% CI: 98.7-99.6). Troponin testing correctly reclassified 8 with death, MI, or revascularization. Troponin was elevated among 74 without MACE, yielding a nonsignificant net reclassification improvement index of 0.7% (95% CI: −0.4 to 1.8).</div></div><div><h3>Conclusions</h3><div>Patients with no known coronary artery disease, a nonischemic electrocardiogram, and a HEAR score ≤1 had a missed MACE rate &lt;1%. Troponin testing identified additional patients with MACE but did not significantly improve risk stratification accuracy.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101913"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313751","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":"Incidence of Stroke in Adults With Congenital Heart Disease","authors":"Amanda E. Bilski MD, MPH ,&nbsp;Jonathan Kochav MD, MS ,&nbsp;Greer Waldrop MD, ScM ,&nbsp;Gular Mammadli MD ,&nbsp;Mehriban Sariyeva MD ,&nbsp;Melissa Argenio MSN ,&nbsp;Joshua Z. Willey MD, MS ,&nbsp;Chinwe Ibeh MD ,&nbsp;Marlon Rosenbaum MD ,&nbsp;Matthew Lewis MD, MPH ,&nbsp;Eliza C. Miller MD, MS","doi":"10.1016/j.jacadv.2025.101898","DOIUrl":"10.1016/j.jacadv.2025.101898","url":null,"abstract":"<div><h3>Background</h3><div>Congenital heart disease is associated with an increased risk of cerebrovascular events.</div></div><div><h3>Objectives</h3><div>The authors investigated the incidence of stroke and transient ischemic attack (TIA) in adults with congenital heart disease (ACHD).</div></div><div><h3>Methods</h3><div>A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all studies reporting the incidence of stroke and TIA in ACHD. Two independent reviewers screened studies, which were included if patients were of age 16 years or older with congenital heart disease and if the outcome was stroke or TIA. Random-effects meta-analysis was conducted to estimate the pooled incidence rate of stroke and TIA with 95% CIs. The Newcastle-Ottawa Scale for Risk of Bias was applied. This systematic review is registered (<span><span>CRD42022322144</span><svg><path></path></svg></span>).</div></div><div><h3>Results</h3><div>Of 11,028 identified abstracts, 27 studies met inclusion criteria. Twenty-one studies reported mean or median age, which was &lt;60 years in 19 studies. Thirty-nine estimates of incidence rates from 24 studies were entered in the meta-analysis. The pooled incidence rate estimate of stroke and TIA was 0.58 per 100 person-years, with significant heterogeneity between studies (95% CI: 0.39-0.86; I²: 97.8%; <em>P</em> &lt; 0.001). Secondary analyses were performed stratified by outcome subtype. The pooled incidence rate of ischemic stroke was estimated at 0.59 per 100 person-years (95% CI: 0.36-0.95; I²: 98%; <em>P</em> = 0.01).</div></div><div><h3>Conclusions</h3><div>This meta-analysis describes the incidence rate of stroke and TIA in the ACHD population. High-quality studies are needed to identify which ACHD patients are at the highest risk and to develop effective strategies for primary stroke prevention in this population.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101898"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314129","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":"Simple Renal Cysts in Marfan Syndrome","authors":"Claire Bouleti MD, PhD ,&nbsp;Noemie Tence MD ,&nbsp;Raphael Thuillier MD, PhD ,&nbsp;Florence Nicot MD ,&nbsp;Nicoletta Pasi MD ,&nbsp;Benjamin Alos MD ,&nbsp;Gaspard Suc MD ,&nbsp;Olivier Milleron MD ,&nbsp;Florence Arnoult MD ,&nbsp;Maria Tchitchinadze MD ,&nbsp;Maud Langeois ,&nbsp;Catherine Boileau MD, PhD ,&nbsp;Laurent Gouya MD, PhD ,&nbsp;Phalla Ou MD, PhD ,&nbsp;Guillaume Jondeau MD, PhD","doi":"10.1016/j.jacadv.2025.101870","DOIUrl":"10.1016/j.jacadv.2025.101870","url":null,"abstract":"<div><h3>Background</h3><div>A link between simple renal cysts (SRCs) and aortic aneurysms or dissection has been reported in the general population. Marfan syndrome (MFS) is associated with severe aortic disease, but very few data on SRCs exist in this population.</div></div><div><h3>Objectives</h3><div>The objectives were to evaluate: 1) the prevalence of SRCs in patients with MFS, compared to matched controls; and 2) the association between SRCs and aortic events in patients with MFS.</div></div><div><h3>Methods</h3><div>Consecutive patients with MFS ascertained by a pathogenic variant in the fibrillin-1 gene who underwent complete computed tomography scans at our institution were included and matched 1:1 for age and sex with controls.</div></div><div><h3>Results</h3><div>Between 2010 and 2016, 131 patients with MFS and 131 controls were included. The mean age was 40 ± 14 years, with 42% women. SRC prevalence was higher in patients with MFS: 41% vs 21% in controls (<em>P</em> &lt; 0.0001). SRC prevalence increased with aortic disease severity: 59% in patients with dissection, 43% in patients with aortic aneurysm surgery, and 19% in patients with MFS but without aortic events, similar to 21% in controls (<em>P</em> &lt; 0.009). In multivariable analysis, SRC presence in patients with MFS was independently associated with aortic dissection (adjusted OR: 2.30 [95% CI: 1.00-5.32]; <em>P</em> = 0.049).</div></div><div><h3>Conclusions</h3><div>The prevalence of SRCs was significantly higher in patients with MFS compared to matched controls. SRCs were independently associated with aortic dissection in MFS. Prospective studies are needed to further evaluate whether SRCs could represent a marker of aortic disease severity in patients with MFS.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101870"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297957","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":"Myocardial Work in Children With Hypertrophic Cardiomyopathy","authors":"Xander Jacquemyn BSc ,&nbsp;Rebbeca Dryer MD ,&nbsp;Kyla Cordrey MD ,&nbsp;Rita Long RDCS ,&nbsp;David A. Danford MD, MPH ,&nbsp;Shelby Kutty MD, PhD, MHCM ,&nbsp;Benjamin T. Barnes MD","doi":"10.1016/j.jacadv.2025.101885","DOIUrl":"10.1016/j.jacadv.2025.101885","url":null,"abstract":"<div><h3>Background</h3><div>Myocardial work (MW) predicts adverse outcomes in adults with hypertrophic cardiomyopathy (HCM), yet pediatric data are lacking.</div></div><div><h3>Objectives</h3><div>The aim of the study was to describe longitudinal changes in MW and evaluate associations with adverse outcomes in a pediatric population.</div></div><div><h3>Methods</h3><div>A total of 74 patients with HCM (11.9 years [7.7-14.5], 50% males) were included. MW indices—global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency (GWE)—were measured and compared with a family history group (FH) (n = 72) (defined as having a first-degree relative with HCM, a second-degree relative with sudden cardiac death (SCD), or a pathogenic mutation without positive phenotype) and healthy controls (n = 50). The primary outcome was a composite endpoint encompassing all-cause mortality, SCD, aborted SCD, appropriate implantable cardioverter-defibrillator discharge, and sustained ventricular tachycardia.</div></div><div><h3>Results</h3><div>MW indices differed significantly between groups at baseline. In HCM patients, GWI, GCW, and GWE were lower than in FH (pairwise <em>P</em> = 0.012, <em>P</em> &lt; 0.001, and <em>P</em> = 0.001, respectively), while only GCW and GWE were significantly lower in HCM compared to healthy control (both pairwise <em>P</em> &lt; 0.001). During follow-up (4.9 years [2.9-8.8]), patients with HCM showed significant decreases in GWI and GCW (<em>P</em> = 0.002 and <em>P</em> = 0.001), while global wasted work and GWE did not show significant changes (<em>P</em> = 0.665 and <em>P</em> = 0.126). In contrast, FH patients exhibited stable MW indices over time. Lower GWI and GCW were positively associated with the composite endpoint (both <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>In pediatric HCM, MW declines over time and is linked to adverse outcomes but remains primarily a research tool, with no superior risk stratification compared to global longitudinal strain.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101885"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307945","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":"Baseline Cardiac Biomarker Levels as Predictors of Cancer Risk in the MESA Cohort","authors":"Xinjiang Cai MD, PhD ,&nbsp;Quinn White BA ,&nbsp;W. Craig Johnson MS ,&nbsp;Spencer L. Hansen PhD ,&nbsp;Zeina A. Dardari PhD ,&nbsp;Michael Blaha MD ,&nbsp;Erin D. Michos MD, MHS ,&nbsp;Joao AC. Lima MD ,&nbsp;Christopher R. deFilippi MD ,&nbsp;Matthew J. Budoff MD ,&nbsp;Karol E. Watson MD, PhD ,&nbsp;Robyn L. McClelland PhD ,&nbsp;Eric H. Yang MD","doi":"10.1016/j.jacadv.2025.101884","DOIUrl":"10.1016/j.jacadv.2025.101884","url":null,"abstract":"<div><h3>Background</h3><div>Assessing the association between baseline levels of cardiac biomarkers and future cancer risk is critical to understand the cross talk between cardiovascular disease and cancer.</div></div><div><h3>Objectives</h3><div>The authors aimed to determine the association between baseline levels of high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) with cancer risk in the prospective MESA (Multi-Ethnic Study of Atherosclerosis) cohort.</div></div><div><h3>Methods</h3><div>We analyzed data from 6,244 MESA participants free of self-reported cancer and cardiovascular disease at baseline. Incident cancer was identified using International Classification of Diseases-9th Revision codes from hospitalizations. Cox proportional hazards models were employed to evaluate the associations of hs-cTnT and NT-proBNP with cancer risk. Likelihood ratio tests assessed whether these associations differed by race/ethnicity or sex.</div></div><div><h3>Results</h3><div>The median age was 61.0 years, with 52.7% being female. Over a median follow-up period of 17.8 years, there were 820 incident cancer events, with an incidence rate of 91.2 cases per 10,000 person-years. Higher incidence rates for all cancers were generally associated with higher baseline hs-cTnT and NT-proBNP levels, especially in the highest quartiles. For all-cancer endpoints, the HRs of hs-cTnT and NT-proBNP, calculated based on the SDs for continuous covariates after standardization, were statistically significant in fully adjusted models (HR: 1.18; 95% CI: 1.09-1.27; <em>P</em> &lt; 0.001; and HR: 2.41; 95% CI: 1.30-4.49; <em>P</em> = 0.006, respectively). Sex and race/ethnicity did not significantly affect any of these associations.</div></div><div><h3>Conclusions</h3><div>In the MESA cohort, higher baseline levels of hs-cTnT and NT-proBNP predicted an increased risk of incident cancer, with no significant differences by race/ethnicity or sex.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101884"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144290999","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":"Venous Access and Patient Frailty in High-Risk Pulmonary Embolism","authors":"Louis-Marie Desroche MD ,&nbsp;Ilham Benzidia MD ,&nbsp;Brahim Harbaoui MD, PhD","doi":"10.1016/j.jacadv.2025.101880","DOIUrl":"10.1016/j.jacadv.2025.101880","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101880"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270931","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":"Lipid-Lowering Therapy in the U.S. Adults Before and After the COVID-19 Pandemic","authors":"Mohammed Essa MD, MPH ,&nbsp;Devesh Malik BS ,&nbsp;Yuan Lu ScD ,&nbsp;Huanhuan Yang PhD ,&nbsp;Erica S. Spatz MD, MHS ,&nbsp;Harlan M. Krumholz MD, SM ,&nbsp;Kamil F. Faridi MD, MSc","doi":"10.1016/j.jacadv.2025.101872","DOIUrl":"10.1016/j.jacadv.2025.101872","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101872"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270929","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":"Gaps in Knowledge and Confidence Among Cardiologists in Caring for Transgender and Gender Diverse Patients","authors":"Sarah Turecamo MD ,&nbsp;Lauren B. Beach JD, PhD ,&nbsp;Nosheen Reza MD ,&nbsp;Monika Sanghavi MD ,&nbsp;Michael G. Fradley MD ,&nbsp;Lauren Eberly MD, MPH","doi":"10.1016/j.jacadv.2025.101874","DOIUrl":"10.1016/j.jacadv.2025.101874","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101874"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270930","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":"Linkage of Parent-Infant Health Care Claims Reveals Prenatal Care Gaps and Facilitates Congenital Heart Outcomes Study","authors":"Joyce L. Woo MD, MS ,&nbsp;Kacie L. Dragan PhD, MPH ,&nbsp;Sarah Crook PhD ,&nbsp;Lynn M. Yee MD, MPH ,&nbsp;William A. Grobman MD, MBA ,&nbsp;Jane W. Newburger MD, MPH ,&nbsp;Kathleen E. Walsh-Spoonhower MD ,&nbsp;Erin A. Paul MD ,&nbsp;John Billings JD ,&nbsp;Brett R. Anderson MD, MBA, MS","doi":"10.1016/j.jacadv.2025.101871","DOIUrl":"10.1016/j.jacadv.2025.101871","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101871"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254665","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}