JACC advances最新文献

{"title":"Enhancement of Stress ECG Performance with Machine Learning","authors":"Ayan Banerjee PhD ,&nbsp;Riya Sudhakar Salian PhD ,&nbsp;Hema Srikanth Vemulapalli MBBS ,&nbsp;Anil Kumar Sriramoju MBBS ,&nbsp;Poojan Prajapati MBBS ,&nbsp;Juan F. Rodriguez-Riascos MD ,&nbsp;Padmapriya Muthu MBBS ,&nbsp;Shruti Krishna Iyengar MBBS ,&nbsp;Win Shen MD ,&nbsp;Sandeep K.S. Gupta PhD ,&nbsp;Komandoor Srivathsan MD","doi":"10.1016/j.jacadv.2025.102141","DOIUrl":"10.1016/j.jacadv.2025.102141","url":null,"abstract":"<div><h3>Background</h3><div>Exercise stress electrocardiogram (ECG) (ESE) is a widely used, noninvasive diagnostic tool for detecting coronary artery disease (CAD). Despite its widespread use, the diagnostic accuracy of ESE remains suboptimal.</div></div><div><h3>Objectives</h3><div>This study aimed to develop and evaluate an artificial intelligence (AI) model, using a transformer-based architecture, to enhance the diagnostic performance ofESEs.</div></div><div><h3>Methods</h3><div>Patients who underwent coronary angiography within 2 months of the ESE were eligible for inclusion. An AI model processed exercise stress ECG images into time-series data. A transformer-based architecture was employed to integrate temporal ECG features and predict CAD. Model performance in predicting severe CAD was first evaluated using 5-fold cross-validation on a test subset from the original cohort, and subsequently on a second validation cohort.</div></div><div><h3>Results</h3><div>We developed a model using a total of 1,200 ECGs. An additional validation cohort of 91 patients was also analyzed. On the initial test subset, the AI model demonstrated a sensitivity of 93.6%, specificity of 93.2%, and overall accuracy of 93.4%. Notably, the model improved sensitivity with an absolute increase of 40.9% in women and 44.6% in men. In the second validation cohort, the model achieved an accuracy of 78%, with a sensitivity of 64.6% and a specificity of 93%.</div></div><div><h3>Conclusions</h3><div>This study presents a proof of concept demonstrating that an AI-based model for stress ECG interpretation is feasible and shows acceptable performance.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102141"},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049138","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":"Targeted Geriatric Assessment to Predict Outcomes in Older Adults With Heart Failure.","authors":"Caio A M Tavares, João Otávio Ferreira Meyer, Scott L Hummel, Silvia de Fátima Takahashi, Felipe Vecchi Moreira, Lucca Moreira Lopes, Vagner Madrini-Junior, Marcelo Eidi Ochiai, Silvia Moreira Ayub-Ferreira, Fabio Fernandes, Fernando Bacal, Wilson Jacob-Filho, Márlon Juliano Romero Aliberti","doi":"10.1016/j.jacadv.2025.102128","DOIUrl":"https://doi.org/10.1016/j.jacadv.2025.102128","url":null,"abstract":"<p><strong>Background: </strong>Health care for older adults with heart failure (HF) has primarily focused on cardiovascular assessment, with limited attention to geriatric conditions that might affect meaningful clinical outcomes.</p><p><strong>Objectives: </strong>The purpose of this study was to evaluate whether the 10-minute Targeted Geriatric Assessment (10-TaGA) enhances the prediction of clinical outcomes in older adults with HF.</p><p><strong>Methods: </strong>Prospective cohort study of HF patients consecutively admitted to a geriatric day hospital in Brazil. Cox proportional hazard models assessed 1-year all-cause mortality, hospitalization, HF hospitalization, and days of health lost among 10-TaGA score tertiles (low-, intermediate-, and high-risk groups), adjusted for clinical variables and the Cardiac and Comorbid Conditions Heart Failure risk score.</p><p><strong>Results: </strong>Among the 326 patients included (mean age 80.9 ± 7.7 years; 37.7% female; 59.8% identified as White), 76 died within 1 year. We observed a graded association between 10-TaGA risk categories and the primary outcome of all-cause mortality or hospitalization (low-risk, reference; intermediate-risk, adjusted HR: 1.41 [95% CI: 0.96-2.05]; high-risk, adjusted HR: 1.97 [95% CI: 1.30-2.99]). Similar trend was found for days of health lost (mean difference of +22 days [95% CI: -2 to +45] and +49 days [95% CI: +9 to +88] for the intermediate- and high-risk groups). Adding the 10-TaGA to clinical variables and the Cardiac and Comorbid Conditions Heart Failure improved discrimination for all-cause mortality/hospitalization (time-specific difference in area under the curve at 1 year: 0.04 [95% CI: 0.01-0.08]; P = 0.025).</p><p><strong>Conclusions: </strong>In older adults with HF referred to the geriatric day hospital, the 10-TaGA provided clinically relevant information beyond standard cardiac assessments and may support effective patient-centered care.</p>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":" ","pages":"102128"},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082600","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":"Development of an Electronic Medical Record–Based Score for Heart Failure Prediction in Cancer Survivors","authors":"Cheng Hwee Soh PhD ,&nbsp;Lena Nguyen MSc ,&nbsp;Anna Chu MHSc ,&nbsp;Agus Salim PhD ,&nbsp;Husam Abdel-Qadir MD, PhD ,&nbsp;Thomas H. Marwick MBBS, PhD, MPH","doi":"10.1016/j.jacadv.2025.102129","DOIUrl":"10.1016/j.jacadv.2025.102129","url":null,"abstract":"<div><h3>Background</h3><div>Awareness of heart failure (HF) as a long-term complication of cancer has led to an interest in HF surveillance among survivors. However, existing HF risk scores are not tailored for survivors and not designed for the use in electronic medical records (EMRs) or administrative data sets where clinical data such as blood pressure and pathology results are often unavailable.</div></div><div><h3>Objectives</h3><div>The objective of the study is to develop a cancer-specific incident HF risk score suitable for screening in EMR or administrative data sets.</div></div><div><h3>Methods</h3><div>The cancer-specific HF prediction from EMRs in survivor health care (CHERISH) risk score was developed from risk variables identified in 16,191 cancer survivors (mean 61 years; 59.5% female) derived from the UK Biobank. External validation was conducted in a population-based Ontario cohort (n = 446,096; mean 67 years; 53.9% female). HF risk classification with CHERISH was compared against the ARIC (Atherosclerotic Risk In Community)-HF score using area under the curve (AUC).</div></div><div><h3>Results</h3><div>The CHERISH score incorporates 11 clinical variables—age, years since cancer diagnosis, coronary heart disease, arrhythmia, myocardial infarct, diabetes, hypertension, leukemia, non-Hodgkin lymphoma, lung cancer, and breast cancer. CHERISH demonstrated strong prediction of 10-year HF incidence during internal validation (AUC: 0.829), exceeding ARIC-HF (AUC: 0.697; <em>P</em> &lt; 0.001). In external validation, CHERISH showed an AUC of 0.721 in predicting 10-year HF incidence, compared to an AUC of 0.751 (<em>P</em> &lt; 0.001) with ARIC-HF.</div></div><div><h3>Conclusions</h3><div>The integration of the CHERISH score into EMR systems may provide large-scale, automated HF risk assessment in cancer survivors, using routinely collected clinical data.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102129"},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049135","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":"Balancing Exercise Benefits Against Heartbeat Consumption in Elite Cyclists","authors":"Tim Van Puyvelde MD ,&nbsp;Kristel Janssens BN ,&nbsp;Luke Spencer BbioMed(Hons) ,&nbsp;Paolo D’Ambrosio MD ,&nbsp;Max Ray MD ,&nbsp;Stephen J. Foulkes PhD ,&nbsp;Mark J. Haykowsky PhD ,&nbsp;Guido Claessen MD, PhD ,&nbsp;Rik Willems MD, PhD ,&nbsp;Andre La Gerche MD, PhD","doi":"10.1016/j.jacadv.2025.102140","DOIUrl":"10.1016/j.jacadv.2025.102140","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102140"},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049140","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":"Prevalence of Obesity, Excess Central Adiposity, and Cardiovascular Risk Among Older Adults","authors":"Michael E. Ernst PharmD ,&nbsp;Michelle A. Fravel PharmD ,&nbsp;Robyn L. Woods PhD ,&nbsp;Suzanne G. Orchard PhD ,&nbsp;Alice Owen PhD ,&nbsp;Rory Wolfe PhD ,&nbsp;Zhen Zhou PhD","doi":"10.1016/j.jacadv.2025.102150","DOIUrl":"10.1016/j.jacadv.2025.102150","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102150"},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049141","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":"10-TaGA: A Triaging Tool for Geriatric-Informed Heart Failure Care.","authors":"Eiran Z Gorodeski, Vincent D Salvador","doi":"10.1016/j.jacadv.2025.102126","DOIUrl":"https://doi.org/10.1016/j.jacadv.2025.102126","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":" ","pages":"102126"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082627","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":"Speaking the Language of Inclusion","authors":"Narayan Schütz PhD ,&nbsp;Ritu Doijad BS ,&nbsp;Ahmed A. Eltahir BS ,&nbsp;Ashish Sarraju MD ,&nbsp;Fatima Rodriguez MD, MPH ,&nbsp;Daniel Seung Kim MD, PhD, MPH","doi":"10.1016/j.jacadv.2025.102123","DOIUrl":"10.1016/j.jacadv.2025.102123","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102123"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027544","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":"Efficacy of Coronary Sinus Aspiration in Reducing Contrast-Induced Nephropathy in High-Risk Patients","authors":"Somil Verma MD ,&nbsp;Anwar Hussain Ansari MD, DM ,&nbsp;Rajesh Kumar MD, DM ,&nbsp;Ankit Jain MD, DM ,&nbsp;Abhinav Aggarwal MD ,&nbsp;Sandeep Bansal MD, DM ,&nbsp;Hermohinder Singh Isser MD, DM","doi":"10.1016/j.jacadv.2025.102132","DOIUrl":"10.1016/j.jacadv.2025.102132","url":null,"abstract":"<div><h3>Background</h3><div>Contrast-induced nephropathy (CIN) is a complication of angiographic procedures. Coronary sinus aspiration (CSA) is a novel technique aimed at reducing renal exposure to contrast and mitigating the risk of CIN.</div></div><div><h3>Objectives</h3><div>The aim of the study was to evaluate the rates of CIN in high-risk patients with and without CSA at the time of coronary angioplasty.</div></div><div><h3>Methods</h3><div>In this single-center, prospective, single-blind randomized controlled trial, 70 high-risk patients undergoing coronary angioplasty were randomized into 2 groups: the intervention group (coronary angioplasty with CSA) and the control group (coronary angioplasty). The primary outcome was the proportion of patients developing CIN (defined as an increase in serum creatinine of at least 25% or 0.5 mg/dL within 3 days following the procedure).</div></div><div><h3>Results</h3><div>In total, 70 patients with diabetes and chronic kidney disease 3 (mean age 60.6 ± 8.7 years) were included. Of the 37 participants initially allocated to CSA, 4 were excluded (3 due to difficulties in coronary sinus cannulation and 1 due to a procedural complication). The mean volume of injected contrast was 65.2 ± 23 mL and the estimated volume of aspirated contrast was 18.7 ± 7.1 mL. Among the 66 remaining patients, the rate of CIN was lower in the intervention group (5/33, 15.2%) compared to the control group (13/33, 39.4%) (<em>P</em> = 0.027). There were no differences in postprocedural serum creatinine and estimated glomerular filtration rate.</div></div><div><h3>Conclusions</h3><div>While CSA was associated with lower rates of CIN in high-risk patients undergoing coronary angioplasty, procedural complications can occur. Larger studies are needed to understand the role of CSA for high-risk patients undergoing coronary angioplasty.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102132"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027543","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":"Early Access to Tafamidis for Patients With Transthyretin Amyloid Cardiomyopathy","authors":"Maria G. Crespo-Leiro MD ,&nbsp;Mazen Hanna MD ,&nbsp;Thibaud Damy MD ,&nbsp;Diego Delgado MD ,&nbsp;Ben Ebede MS ,&nbsp;Valentina Marino MD ,&nbsp;Ronnie Wang MPH ,&nbsp;Mathew S. Maurer MD ,&nbsp;Pablo Garcia-Pavia MD ,&nbsp;Brian M. Drachman MD","doi":"10.1016/j.jacadv.2025.102122","DOIUrl":"10.1016/j.jacadv.2025.102122","url":null,"abstract":"<div><h3>Background</h3><div>Tafamidis is a standard of care treatment for patients with transthyretin amyloid cardiomyopathy (ATTR-CM). While evidence was being assessed by regulatory authorities, a new, independent, and inclusive cohort of the phase 3 long-term extension study offered early access to tafamidis.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to present safety, mortality, and hospitalization findings for patients who received early access tafamidis.</div></div><div><h3>Methods</h3><div>Patients with ATTR-CM and who had not taken part in the phase 3 study were able to receive tafamidis free acid 61 mg (the dose later approved) for up to 60 months or until commercial availability in their region. Enrollment criteria were minimal.</div></div><div><h3>Results</h3><div>Among the 1,476 patients initiating tafamidis in the study between 2018 and 2023, mean (SD) age at enrollment was 76.5 (7.8) years, 88.8% were male, 85.6% had wild-type ATTR-CM, and 52.9% had NYHA class II symptoms (I: 14.9%, III: 30.8%, IV: 1.3%). Median exposure and follow-up were 12 (range: 0-55) and 19 (95% CI: 18.4-20.7) months, respectively. Overall, 7.6% of patients reported treatment-related adverse events, with 0.6% considered serious and 0.6% leading to study discontinuation. No new safety signals were identified. In Kaplan-Meier analyses, all-cause and cardiovascular (CV)-related mortality occurred in 23.4% and 13.8% of patients over the study period. Furthermore, 43.3% and 26.5% of patients had all-cause and CV-related hospitalizations. The total annual CV-related hospitalization rate was 0.26.</div></div><div><h3>Conclusions</h3><div>In an inclusive patient cohort receiving early access to tafamidis, safety findings were consistent with those reported from other trials and real-world studies. (Long-term Safety of Tafamidis in Subjects With Transthyretin Cardiomyopathy; <span><span>NCT02791230</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102122"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042407","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":"Optical Coherence Tomography to Better Assess Chronic Total Occlusion Percutaneous Intervention Results","authors":"Sébastien Levesque MD ,&nbsp;Benjamin Faurie MD ,&nbsp;Benoit Lattuca MD, PhD ,&nbsp;Julien Lemoine MD ,&nbsp;Gael Pitchecanin MD ,&nbsp;Pascal Motreff MD, PhD ,&nbsp;Erwan Bressollette MD ,&nbsp;Stéphanie Ragot MD, PhD ,&nbsp;Claire Bouleti MD, PhD ,&nbsp;Luc-Philippe Christiaens MD, PhD","doi":"10.1016/j.jacadv.2025.102125","DOIUrl":"10.1016/j.jacadv.2025.102125","url":null,"abstract":"<div><h3>Background</h3><div>Angioplasty of coronary chronic total occlusions (CTOs) was a breakthrough, but there is a lack of data concerning stent healing after these complex procedures.</div></div><div><h3>Objectives</h3><div>The main aim of the PERFECTO (Post-stEnting assessment of Reendothelialization with optical Frequency domain imaging aftEr CTO procedure) study is to assess, for the first time, stent strut apposition at the index CTO procedure and at 3-month follow-up using frequency-domain optical coherence tomography (FD-OCT).</div></div><div><h3>Methods</h3><div>From March 2018 to January 2020, 114 consecutive patients who underwent successful CTO recanalization &gt;20 mm in length were prospectively included in 7 centers. FD-OCT was performed for ad hoc guidance during the index procedure and at 3-month follow-up. All patients received the same last-generation drug-eluting stent.</div></div><div><h3>Results</h3><div>Mean age was 63.2 years, and 87% were male. The rate of malapposed struts per patient was 7.84% at the end of the index procedure and 15.03% at 3-month follow-up (<em>P</em> &lt; 0.0001), highlighting the phenomenon of acquired malapposition. Malapposed struts occurred more often with dissection and re-entry techniques and subintimal stenting compared to intimal techniques (12.8% vs 5.3%, <em>P</em> = 0.02). At 3-month follow-up, distal vessel minimal lumen area increased from 69% (index 2.19 mm² vs 3.71 mm² at 3 months, <em>P</em> &lt; 0.0001). No complication occurred with FD-OCT.</div></div><div><h3>Conclusions</h3><div>CTO-percutaneous coronary intervention could affect stent healing with a high incidence of immediate and late-acquired malapposition. These results support the interest of using FD-OCT during follow-up to better assess CTO recanalization results. (Post-stenting Assessment of Reendothelialization With OFDI After CTO Procedure [PERFECTO]; <span><span>NCT03209843</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102125"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020347","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}