American Journal of Cardiology最新文献

{"title":"Natural History of Atrial versus Ventricular Secondary Tricuspid Regurgitation: Insights from the Bronx-Valve Registry.","authors":"Julio Echarte-Morales, Juan Torrado, Andrea Scotti, Matteo Sturla, Pier Pasquale Leone, Guillaume Bonnet, Augustin Coisne, Sebastian Ludwig, Diego Barzallo, Elie Flatow, Manaf Assafin, Tadahisa Sugiura, Juan F Granada, Ulrich P Jorde, Carlos J Rodriguez, Leandro Slipczuk, Mario J Garcia, Rodrigo Estevez Loureiro, Edwin C Ho, Azeem Latib","doi":"10.1016/j.amjcard.2025.10.007","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.10.007","url":null,"abstract":"<p><p>Atrial secondary tricuspid regurgitation (A-STR) and ventricular secondary tricuspid regurgitation (V-STR) have unique physiological and anatomical differences, but long-term outcomes based on TR etiology remain poorly understood. This study aimed to assess the characteristics and outcomes of severe A-S and V-STR. Adults diagnosed with severe secondary TR between January 2017 and December 2019 in a quaternary-care health system were included. TR was classified into left-sided V-STR (left-sided cardiac diseases), right-sided V-STR (pulmonary/vascular diseases), and A-STR (atrial pathology). The primary endpoint was to assess survival at follow-up. Incidence of heart failure (HF) hospitalizations and cardiovascular mortality were secondary endpoints. Among 1,037 patients with STR, 125 (12%) had A-STR, 737 (71.1%) left-sided V-STR, and 175 (16.9%) right-sided V-STR. Survival was significantly higher for A-STR compared to left and right-sided V-STR (46.9% vs. 30.6% vs. 22.0%, log-rank p=0.042, respectively). At multivariable Cox regression analysis, left and right-sided V-STR were independently associated with worse survival compared to A-STR (HR: 1.439, p=0.039 and HR: 1.816, p=0.001, respectively). A-STR patients also experienced lower rates of HF hospitalizations and cardiovascular mortality. A-STR was associated with better survival and fewer HF hospitalizations than V-STR groups, with right-sided V-STR being the strongest independent predictor of all-cause mortality.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Prognostic Implications of Precipitating Factors in Patients with Spontaneous Coronary Artery Dissection.","authors":"Alexander Marschall, Marcos García-Guimarães, Ricardo Sanz-Ruiz, Manel Sabaté, Maite Velazquez-Martín, Gabriela Veiga, Ainhoa Pérez-Guerrero, Pablo Avanzas, Carlos Cortés, Fernando Macaya, Soledad Ojeda, Marcelo Jimenez-Kockar, Gerard Roura, Belen Cid, Teresa Bastante, David Del Val, Fernando Alfonso","doi":"10.1016/j.amjcard.2025.10.012","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.10.012","url":null,"abstract":"<p><p>Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), historically linked to pregnancy but increasingly associated with emotional and physical stressors. The prognostic impact of these precipitating factors remains unclear. This study aimed to evaluate their clinical and prognostic relevance in a large, nationwide prospective SCAD cohort. The prospective Spanish SCAD Registry (RN-DCE) included 388 patients from 34 centers since 2015. Coronary angiograms were centrally reviewed, and patients were categorized based on the presence and type of precipitating factor (emotional or physical). Major adverse cardiovascular and cerebrovascular events (MACCE) including all-cause death, reinfarction, unplanned revascularization, recurrent SCAD, and stroke, were centrally adjudicated. Cox regression models were used to assess associations with in-hospital and long-term outcomes. Precipitating factors were identified in 40% of patients, with emotional triggers more common than physical (26% vs. 15%). Patients with triggers were younger (52 (±11.3) vs 55 (±11.8) years, p=0.046) and had higher rates of depression and anxiety (24% vs 18%, p=0.078 and 25% vs 13%, p<0.004). Emotional triggers were more frequent among women and strongly associated with psychiatric history. The overall presence of a trigger was not associated with increased MACCE risk (Adjusted HR: 0.90 (0.39-2.10), p=0.794). However, SCAD events related to the peripartum period or to Valsalva maneuvers were associated with worse short- and long-term outcomes. In conclusion, in this large national cohort, most precipitating factors were not linked to worse prognosis. However, peripartum-related SCAD and events triggered by Valsalva-like maneuvers may indicate higher-risk presentations and warrant closer clinical attention.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Predictors of Atrial Fibrillation After Cavotricuspid Isthmus Ablation for Typical Atrial Flutter.","authors":"Paulomi Gohel, William White, Karim Jandali Rifai, Malek Moumne, Samir Saba, Haitham Hreibe","doi":"10.1016/j.amjcard.2025.10.009","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.10.009","url":null,"abstract":"<p><p>Cavotricuspid isthmus (CTI) ablation is a highly effective treatment of typical atrial flutter (AFL). The emergence of new-onset atrial fibrillation (AF) following CTI ablation is clinically relevant but limited data exist regarding its predictors. The goal of this study is to investigate predictors of new-onset AF following CTI ablation. Patients who underwent CTI ablation between 2016 and 2022 were included. Baseline variables including left atrial volume index (LAVI), cardiac comorbidities, CHA₂DS₂-VASc score, and medications were collected. The primary outcome was the occurrence of new-onset AF after the index CTI ablation. New AF occurred in 44 (29%) of 153 patients at a median of 264 days. Patients who developed AF were more likely men (p=0.046), had hypertension (p=0.014), and higher LAVI (40.6 ± 12.2 vs. 34.2 ± 9.5 mL/m², p<0.001). After adjusting for unbalanced covariates in a Cox multivariable model, protective predictors against developing new AF included female sex (HR 0.31, 95% CI 0.12-0.76, p=0.011) and prior cardiac surgery (HR 0.22, 95% CI 0.07-0.72, p=0.013) while increased LAVI (HR 1.02, 95% CI 1.00-1.05, p=0.08) showed a trend towards higher risk of new AF. In conclusion, in this cohort of AF-naive patients undergoing CTI ablation for typical AFL, nearly one-third developed new-onset AF. Independent predictors of developing AF include male sex and no-prior cardiac surgery. These findings have clinical implications to the management of AFL patients, including for the decision to consider performing concomitant AF ablation in patients with higher risk features.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes Following Percutaneous Coronary Intervention with Drug-Eluting Stents and Drug-Coated Balloons in Lesion with Eruptive Calcified Nodules.","authors":"Masahiro Koide, Kan Zen, Tomotsugu Seki, Kento Fukui, Kazuaki Takamatsu, Jun Shiraishi, Satoaki Matoba","doi":"10.1016/j.amjcard.2025.10.010","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.10.010","url":null,"abstract":"<p><p>Eruptive calcified nodules (ECN) represent a distinct and high-risk plaque morphology implicated in the pathogenesis of acute coronary syndrome. While prior studies have reported poor clinical outcomes following percutaneous coronary intervention (PCI) with drug-eluting stents (DES) or drug-coated balloons (DCB) for these lesions, comparative data evaluating the efficacy of DES versus DCB therapy remains unavailable. Among 1,975 patients who underwent optical coherence tomography (OCT)-guided PCI for de novo coronary lesions, 68 patients (75 lesions) were identified with OCT-confirmed ECN. These lesions were retrospectively analyzed and stratified into either the DES group (45 lesions in 41 patients) or the DCB group (30 lesions in 27 patients). The primary endpoint was clinically driven target lesion revascularization (CD-TLR) and cardiac death. Over a median follow-up of 2.1 years, no significant differences were observed between the two groups in CD-TLR (hazard ratio [HR] 1.2; 95% confidence interval [CI] 0.5-3.2; p = 0.6) and cardiac death (HR 0.7; 95% CI 0.3-1.9; p = 0.5). These findings remained consistent after adjustment for baseline clinical characteristics. In conclusion, this study demonstrated that PCI with either DES or DCB for OCT-identified ECN results in similarly poor clinical outcomes, highlighting the limitations of current PCI devices for these rare, unstable lesions and emphasizing the need for alternative therapies.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Dive Rendezvous as a Novel Alternative Technique for Conventional Externalization in Retrograde Chronic Total Occlusion Interventions.","authors":"Mihajlo Kovacic, Gregor Leibundgut, Mihai Cocoi, Nenad Bozinovic, Giuseppe Colletti, Josip Andelo Borovac, Claudiu Ungureanu","doi":"10.1016/j.amjcard.2025.10.011","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.10.011","url":null,"abstract":"<p><p>Chronic total occlusion percutaneous coronary intervention (CTO-PCI) has made significant progress with the retrograde approach, particularly when antegrade techniques are insufficient or not clinically indicated. Despite its advantages, the conventional externalization process carries some notable challenges, including procedural complexity, increased equipment requirements, and elevated risk of rupture of fragile collateral vessels. This article examines the \"Deep Dive Rendezvous\" or DDR technique that we propose in great detail. This novel interventional solution builds on the previously elaborated rendezvous approaches, however, with the added value of offering an enhanced guidewire support through deep intubation into the retrograde system. By refining the rendezvous technique, we propose DDR as a streamlined and effective alternative to conventional externalization. This technique has the potential to reduce risks of procedural complications, preserve collateral vessel integrity, and diminish the need for additional equipment or introduction of complex procedural steps. In conclusion, the versatility of this technique extends to serving as both a primary strategy and a bailout solution, making it a valuable option in cases where conventional externalization is either impractical or unsafe during the retrograde CTO-PCI.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 Receptor Agonists in Patients with Diabetes and Peripheral Artery Disease - In Pursuit of Excellence.","authors":"Stanislav Henkin, Gregory Piazza","doi":"10.1016/j.amjcard.2025.10.008","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.10.008","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Mechanical Aspiration Versus Surgical Management of Tricuspid Valve Endocarditis: A systematic review and updated meta-analysis.","authors":"Ricardo F O Suruagy-Motta, Luiz Guilherme Silva Almeida, Julia Tirelli-Rocha, Gabriel Rezende Neves, Rafael Batista Félix, Robert K White, Kalgi Modi, Gregg W Stone","doi":"10.1016/j.amjcard.2025.09.055","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.055","url":null,"abstract":"<p><strong>Background: </strong>Tricuspid valve infective endocarditis (TVIE) is increasingly prevalent, especially among intravenous drug users. Surgical intervention is the standard treatment for severe cases, but percutaneous mechanical aspiration (PMA) has emerged as a less invasive alternative in high-risk patients. Comparative data on both strategies remain limited.</p><p><strong>Objectives: </strong>To evaluate the safety and efficacy of PMA versus surgical management in patients with TVIE through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>A comprehensive search of five databases (PubMed, Embase, Cochrane, Web of Science, Scopus) through July 2025 identified studies comparing PMA and surgery for TVIE. Outcomes included all-cause mortality (30-day and 1-year), hospital length of stay, in-hospital mortality, and readmission for endocarditis. Risk ratios (RR) and mean differences (MD) were pooled using a random-effects model. Risk of bias was assessed using ROBINS-I.</p><p><strong>Results: </strong>Ten retrospective studies involving 6,035 patients were included (974 treated with PMA and 5,061 treated with surgery). The risk of in-hospital mortality was similar between PMA and surgery (RR=1.07; p=0.91). PMA was associated with a higher risk for 30-day mortality (RR=2.71; 95% CI: 1.53-4.82; p<0.001) but not for 1-year mortality (RR=1.13; 95% CI: 0.72-1.77; p=0.60) or readmission for endocarditis (RR=0.82; p=0.63) compared with surgery. PMA was also associated with a shorter hospital stay (MD=-7.0 days; 95% CI: -13.0 to -1.1; p=0.03). The risk of bias was moderate to serious in all studies.</p><p><strong>Conclusions: </strong>In conclusion, the present systematic review of ten retrospective studies, surgical management of TVIE was associated with better short-term survival compared with PMA although the risks of 1-year mortality and readmission were similar. Randomized trials are required to better define the risk benefit profile of these approaches to TVIE.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Drug Coated Balloon with Drug Eluting Stent for Isolated Ostial Side-Branch Coronary Artery Bifurcation Lesions.","authors":"Natasha Corballis, Ioannis Merinopoulos, U Bhalraam, Rajkumar Natarajan, Tharusha Gunawardena, Vassilios S Vassiliou, Simon Eccleshall","doi":"10.1016/j.amjcard.2025.09.059","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.059","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145306789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Right Atrial Aneurysm Associated With Tricuspid Valve Dysplasia.","authors":"Yu Wang, Shuhua Luo, Nan Guo","doi":"10.1016/j.amjcard.2025.09.064","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.064","url":null,"abstract":"<p><p>Congenital right atrial aneurysm (RAA) is a rare anomaly that may cause arrhythmias, thromboembolism, or heart failure. We report a prenatally diagnosed RAA with coexisting tricuspid valve (TV) dysplasia. Postnatally, the patient showed progressive atrial enlargement, and TV regurgitation. At 9 months, surgery was performed due to high thromboembolic and arrhythmic risk, including aneurysmal wall resection and TV repair. Postoperative recovery was uneventful. In conclusion, this case underscores the need for comprehensive imaging and individualized management in RAA, especially when coexisting valvular abnormalities are present.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145297951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiographic Predictors of Mortality in Cardiac Intensive Care Unit Patients with Pulmonary Hypertension.","authors":"Meir Tabi, Mitchell Padkins, Limor Ilan Bushari, Jeremy Thaden, Michael A Solomon, Garvan C Kane, Jacob C Jentzer","doi":"10.1016/j.amjcard.2025.09.060","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.060","url":null,"abstract":"<p><p>Pulmonary Hypertension (PH) is associated with high mortality in Cardiac Intensive Care Unit (CICU) patients. We sought to determine the association of Transthoracic Echocardiography (TTE) parameters with in-hospital mortality in patients admitted to the CICU and found to have PH. We included Mayo Clinic CICU admissions from 2007 to 2018, with a TTE within 1 day of CICU admission demonstrating PH, defined as estimated right ventricular systolic pressure (RVSP) ≥36 mmHg. Logistic regression was used to identify predictors of in-hospital mortality. We included 3085 unique CICU patients with PH by TTE; median age was 73.7 (63.8, 82.4) years, and 1343 (43.5%) were females. Heart failure (65.6%) and respiratory failure (34.0%) were the most common admission diagnoses. The median RVSP was 47 (41, 56) mmHg, and 1314 (42.6%) had RVSP ≥50 mmHg. A total of 337 (10.9%) patients died during hospitalization. The RVSP was higher among in-hospital deaths (51 versus 47 mmHg, p <0.001), reflecting higher right atrial (RA) pressure (14 versus 10 mmHg, p <0.001). In-hospital mortality increased with higher RA pressure and worse Right Ventricle-Pulmonary Artery (RV-PA) coupling, such as a lower tricuspid S' velocity to RVSP ratio (AUC 0.72) or higher pulmonary artery elastance (AUC 0.72). In conclusion, in CICU patients found to have elevated pulmonary pressures, several 2D and Doppler TTE parameters predict in-hospital mortality. Specifically, RA pressure and parameters of RV-PA coupling, had highest association with worse outcomes. Early identification of high-risk hemodynamic parameters may facilitate improved investigation, management, and prognostication.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}