American Journal of Cardiology最新文献

{"title":"Mitral Annular Calcification as a Marker of the HFpEF Phenotype: The Interplay of Cardiac Remodeling, Age, and Sex.","authors":"Israel Gotsman, Ruth Shnipper, Donna R Zwas, Andre Keren, Offer Amir, David Leibowitz","doi":"10.1016/j.amjcard.2026.08.023","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.08.023","url":null,"abstract":"<p><p>Mitral annular calcification (MAC) is recognized as a marker of cardiovascular risk. However, the structural and hemodynamic predictors of its presence and severity remain insufficiently defined. We analyzed a large, consecutive cohort of 49,093 individuals undergoing echocardiography at our tertiary medical center, classifying them into three groups: normal annulus (79.5%), MAC (17.3%), or severe MAC (3.2%). Clinical and echocardiographic multivariable logistic regression models were used to identify independent predictors of MAC presence and severity. Age was a significant predictor of MAC and was characterized by a marked age-by-sex interaction, with the prevalence diverging after age 60. Severe MAC was twice as frequent in women aged ≥70 years. Diabetes, hypertension, renal dysfunction, obesity and heart failure with preserved ejection fraction (HFPEF) were significant independent predictors of MAC. After incorporation of structural variables, concentric remodeling and diastolic parameters emerged as significant determinants. Increased absolute and relative wall thickness, smaller left ventricular end diastolic dimension (LVEDD), higher E/e', left atrial enlargement, and elevated pulmonary pressures were significant predictors of the presence of MAC. Among individuals with MAC, severity was associated with age, sex, diabetes, HFPEF, smaller LVEDD, and elevated filling pressures. During 1,786 days of median follow-up, MAC was an independent predictor of mortality (severe MAC: HR 1.29, 95% CI 1.12-1.48, p<0.001). In conclusion, MAC is age and sex-related and is significantly associated with structural features of a diastolic impairment profile. Severe MAC serves as an indicator of cardiac remodeling and may warrant focused management of diastolic dysfunction and systemic metabolic risk.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148885992","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 of Santreva™-ATK Endovascular Revascularization Catheter in Patients with Claudication and Critical Limb-Threatening Ischemia.","authors":"Shalini Sharma, Anand Gupta, Peter Soukas, Mallik Thatipelli, Venkatesh G Ramaiah, Sameh Sayfo, Shirling Tsai, Ashish Pershad, Javier Vasquez, John F Eidt, Subhash Banerjee","doi":"10.1016/j.amjcard.2026.08.031","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.08.031","url":null,"abstract":"<p><strong>Background: </strong>Patients with femoropopliteal (FP) chronic total occlusions (CTOs) presenting with intermittent claudication (IC) and chronic limb threatening ischemia (CLTI) differ in disease severity and lesion complexity. We performed a subgroup analysis of the prospective, multicenter RESTOR-1 trial to evaluate the safety and effectiveness of the Santreva™-ATK Endovascular Revascularization Catheter in these patient populations.</p><p><strong>Objectives: </strong>Compare procedural and short-term clinical course outcomes of the Santreva™-ATK catheter in patients with IC and CLTI enrolled in RESTOR-1 pivotal trial.</p><p><strong>Methods: </strong>74 patients with Rutherford class (RC) 2-5 peripheral artery disease and de novo FP CTOs were stratified into IC (RC 2-3, n=48) and CLTI (RC 4-5, n=26). The primary endpoint was clinical success, defined as successful device-facilitated guidewire placement into the distal true lumen without device-related major adverse events (MAEs). Secondary endpoints included procedural success, intravascular (IVUS)-determined crossing trajectory, and 30-day clinical outcomes.</p><p><strong>Results: </strong>Clinical success was achieved in 89.6% of patients with IC and 84.6% of patients with CLTI, with similarly high technical and procedural success rates between groups. IVUS evaluation was performed in 85.4% (41/48) of patients with IC and 76.9% (20/26) of patients with CLTI. Among patients with documented crossing trajectory, 86.9% (53/61) demonstrated intraplaque crossing and 13.1% (8/61) demonstrated extraplaque crossing. Although patients with CLTI had a numerically higher prevalence of diabetes mellitus and heavily calcified lesions, these differences were not statistically significant, and crossing performance remained comparable between groups.</p><p><strong>Conclusion: </strong>Santreva™-ATK catheter demonstrated high clinical success and an excellent safety profile across the spectrum of FP CTO disease, supporting its use in both IC and CLTI patients.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886031","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":"Impact of Pre-Existing Psychiatric Disorders on Clinical Outcomes in Takotsubo Cardiomyopathy.","authors":"Gunner Gilbert, Praneeth Ulavala, Aselin Puthenpurail, Jillian Hackney, Andrew Moore, Byron Marciniak, Samantha Robinson, Tarun Cherukuri, Srikanth Vallurupalli, Hanna Jensen","doi":"10.1016/j.amjcard.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.09.001","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886076","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":"Early Low-Density Lipoprotein Cholesterol Target Attainment Is Associated With Fewer Recurrent Cardiovascular Events After Acute Myocardial Infarction: A Real-World Cohort Study.","authors":"Henry C Okoroike, Weili Zheng, Faisal Hasan, Ahmet Oktay","doi":"10.1016/j.amjcard.2026.08.027","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.08.027","url":null,"abstract":"<p><p>Survivors of acute myocardial infarction (AMI) face high risk of recurrent atherosclerotic cardiovascular disease (ASCVD) events within the first year after discharge, yet real-world achievement of guideline-recommended low-density lipoprotein cholesterol (LDL-C) targets <55 mg/dL remains limited. We conducted a retrospective cohort study of 12,815 adults hospitalized with type 1 AMI between January 1, 2015, and December 31, 2024, within the Rush University Health System in Chicago, Illinois, to evaluate the association between LDL-C <55 mg/dL attainment at approximately 6 months post-discharge and recurrent ASCVD events within 12 months. The primary outcome was a composite of non-fatal MI, unstable angina hospitalization, ischemic stroke, or unplanned coronary revascularization. Among 12,810 patients with available follow-up LDL-C data, 999 (7.8%) achieved the <55 mg/dL target. A total of 4,692 patients (36.6%) experienced a recurrent composite event within 12 months, and all-cause mortality at 12 months was 11.8%. The elevated event rate is attributable to the inclusive composite definition and to administrative coding practices in which hospital readmissions are frequently assigned AMI ICD-10 codes in patients with recent MI history, rather than reflecting true adjudicated MI recurrence. In unadjusted analyses, LDL-C goal attainment was paradoxically associated with higher odds of recurrent events (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.59-2.06; p <0.001), consistent with confounding by indication: patients receiving the most intensive lipid-lowering therapy had the highest underlying cardiovascular risk. After multivariable adjustment for age, comorbidities, statin use, and admitting hospital, LDL-C <55 mg/dL attainment was associated with lower odds of recurrent events (adjusted OR 0.84; 95% CI 0.75-0.97; p = 0.007). LDL-C goal attainment was not significantly associated with all-cause mortality at 12 months (adjusted OR 0.91; 95% CI 0.73-1.14; p = 0.41), consistent with published literature requiring longer follow-up to demonstrate a mortality signal. These findings highlight persistent underattainment of guideline-recommended lipid targets and underscore substantial clinical inertia in post-AMI lipid management, with first LDL-C reassessment occurring at a mean of 85 days post-discharge while recurrent events occurred a mean of 49 days after admission. In conclusion, achievement of LDL-C <55 mg/dL within 6 months after AMI is independently associated with a meaningful reduction in recurrent ASCVD events in real-world practice, and the temporal mismatch between early post-discharge risk and delayed lipid assessment underscores the need for proactive, multidisciplinary care models to close this implementation gap.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886065","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":"Palliated but Not Protected: Transfemoral TAVI in Left Atrial Isomerism and Double-Outlet Right Ventricle.","authors":"Anastasios Apostolos, Konstantinos Dimopoulos, Wei Li, Saeed Mirsadraee, Thomas Semple, Tuan-Chen Aw, Robert Smith, Lauren Connolly, Vasileios Panoulas, Ee Ling Heng","doi":"10.1016/j.amjcard.2026.08.026","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.08.026","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878855","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":"Catheter Ablation Versus Antiarrhythmic Drug Therapy in Atrial Fibrillation with Concomitant Tricuspid Regurgitation.","authors":"Md Fahim, Daoud Eldawud, Hamza Hamza, Roy Wang, Peter Khouri, Ola Rewahi, Ahmad Jallad","doi":"10.1016/j.amjcard.2026.08.025","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.08.025","url":null,"abstract":"<p><p>Atrial fibrillation (AF) frequently coexists with tricuspid regurgitation (TR), a combination associated with poor clinical outcomes. Although catheter ablation improves outcomes in select AF populations, its comparative effectiveness versus antiarrhythmic drug (AAD) therapy in patients with concurrent TR remains unclear. We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Adults with AF and TR were stratified by treatment with catheter ablation plus AAD or AAD therapy alone. 1:1 propensity score matching was performed, yielding 13,293 patients per group. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes were stroke, incident heart failure, and right heart strain. Time-to-event analyses were performed using Kaplan-Meier methods with Cox regression as sensitivity analyses. Competing-risk analyses were performed using Fine-Gray models. Over a mean follow-up of 2.60 years, catheter ablation with background AAD use was associated with a 24.8% reduction in MACE (HR 0.752 [0.701, 0.808]), along with reductions in stroke (HR 0.848 [0.788, 0.913]), heart failure (HR 0.803 [0.757, 0.852]), and right heart strain (HR 0.812 [0.761, 0.867]) compared with sole AAD therapy (all p<0.001). Findings were consistent across Cox sensitivity analyses and competing-risk models. In conclusion, among patients with AF and concomitant TR, catheter ablation with background AAD therapy was associated with lower risks of cardiovascular outcomes and survival compared with sole AAD therapy. These findings support catheter ablation as a favorable rhythm-control strategy in this high-risk population.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878736","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":"Interpreting Real-World Cardiovascular Outcomes With GLP-1 Receptor Agonists.","authors":"Usman Ali Akbar, Sudarshan Balla","doi":"10.1016/j.amjcard.2026.08.028","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.08.028","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878758","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":"The Art of Anticoagulation in Frail Older Adults with Atrial Fibrillation.","authors":"José Manuel Andreu-Cayuelas, Francisco Buendía-Santiago, Antonio Meseguer-Hernández, Irene González-Fernández, Juan Antonio Castillo-Moreno","doi":"10.1016/j.amjcard.2026.08.030","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.08.030","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878833","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":"Coronary Revascularization of Ischemic Territories Improves Myocardial Perfusion, Increases Submaximal Aerobic Capacity and Reduces Exercise-Induced Angina in Patients with Chronic Coronary Syndrome.","authors":"Henrik Mosén, Anna Székely, Katarina Steding-Ehrenborg, Shahnaz Akil Engblom, Fredrik Hedeer, Håkan Arheden, David Erlinge, Henrik Engblom","doi":"10.1016/j.amjcard.2026.08.024","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.08.024","url":null,"abstract":"<p><p>Chronic coronary syndrome (CCS) is associated with reduced stress perfusion, a predictor of adverse cardiovascular outcome. To what extent myocardial perfusion is related to cardiorespiratory fitness is not completely known. The aim was to investigate if change in myocardial perfusion correlates to change in aerobic capacity after revascularization. Sixty-two patients with suspected or established CCS underwent cardiopulmonary exercise testing (CPET) and [¹³N]NH₃ positron emission tomography (PET) before and after elective invasive coronary angiography. Thirty-six patients were revascularized and 26 were not. The angiographer was blinded to the results from CPET and PET. Myocardial perfusion was defined as decreased when below 2 ml/min/g and as myocardial perfusion reserve (MPR) < 2. Change in oxygen uptake at submaximal effort (VO₂ at AT) correlated positively to change in MPR in revascularized patients (r=0.36, p=0.04), but not in conservatively treated patients (r=0.03, p=0.90). Change in VO₂peak, however, did not correlate to change in myocardial perfusion in any of the groups. Myocardial perfusion at stress and MPR increased significantly after revascularization, when baseline perfusion was decreased (P=0.01 stress and P=0.001 MPR, respectively). Furthermore, the number of patients with exercise-induced angina decreased significantly for the revascularized patients (42% (14/33) at baseline vs 3% (1/33) at follow-up, p<0.001) whereas half of the conservatively treated patients still had exercise-induced angina at follow-up (42% (10/24) at baseline vs 21% (5/24) at follow-up, p=0.12). In conclusion, change in myocardial perfusion correlates with change in submaximal aerobic capacity after revascularization and revascularization reduces exercise-induced angina.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863553","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":"Does a Null Association Truly Exclude Renal Risk After CTO PCI?","authors":"Ahmet Güner","doi":"10.1016/j.amjcard.2026.08.020","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.08.020","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787138","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}