American Journal of Cardiology最新文献

{"title":"Transcatheter versus Surgical Aortic Valve Replacement in Low-Risk Patients: Updated Meta-Analysis.","authors":"Tomonari M Shimoda, Yoshihisa Miyamoto, Shinichi Fukuhara, Hiroki A Ueyama, Yosuke Sakurai, Yujiro Yokoyama, Michel Pompeu Sá, Azeem Latib, Roger J Laham, Kaveh Hosseini, Tsuyoshi Kaneko, Toshiki Kuno","doi":"10.1016/j.amjcard.2025.07.008","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.07.008","url":null,"abstract":"<p><p>Background Long-term data are essential for selection between transcatheter (TAVR) and surgical (SAVR) aortic valve replacement in low-risk aortic stenosis (AS) patients. Given the recent randomized controlled trials (RCTs) and mid-term outcomes from existing trials, a reappraisal of the current literature is necessary. Methods We systematically identified RCTs comparing TAVR and SAVR in low risk AS patients. A meta-analysis was performed using the reconstructed time-to-event data from published Kaplan-Meier curves. The outcome of interest was mid-term mortality. A stratified Cox model was used to calculate hazard ratios (HRs). Proportional hazard assumptions were tested, with landmark analysis and restricted mean survival time (RMST) analysis conducted accordingly. Results Seven RCTs including 5,740 patients (TAVR: 2,927; SAVR: 2,813) were included. At 5 years, TAVR was associated with reduced all-cause mortality (HR 0.83; 95% CI 0.70-1.00). Landmark analysis showed a significant survival benefit in the first year (HR 0.75; 95% CI 0.61-0.93), but not thereafter. The RMST analysis at 5 years favored TAVR by 1.01 months (p=0.011). Conclusions In low risk AS patients, TAVR demonstrated an early survival advantage. However, it remains uncertain whether this short-term benefit translates to long-term advantages. Long-term data are necessary to fully inform clinical practice.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635914","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 Psychological Impact of Implantable Cardioverter Defibrillators: A Narrative Review.","authors":"Kavi Gupta, Margo Kaminska, Shyla Gupta, Hamza Waraich, Shaun Malik, Amin Meghdadi, Laura Marcotte, Gustavo H Vazquez, Adrian Baranchuk","doi":"10.1016/j.amjcard.2025.07.007","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.07.007","url":null,"abstract":"<p><p>Implantable cardioverter defibrillators (ICDs) are critical to the prevention of sudden cardiac death caused by life-threatening arrhythmias such as ventricular tachycardia and fibrillation. While their clinical value is well-established, the psychological impact of living with an ICD remains underrecognized. Patients often experience anticipatory anxiety, depression, Post-Traumatic Stress Disorder (PTSD), and reduced quality of life. These challenges can begin before implantation, persist after both appropriate and inappropriate shocks, and be worsened by fears of device malfunction, recalls, or cybersecurity risks. Many patients alter post-implantation behaviours, avoiding physical activity and reporting diminished trust in medical technology. The burden is especially significant in children, alongside those who experience multiple or unnecessary shocks. Despite increased awareness, mental health care remains poorly integrated into cardiology. Cognitive Behavioural Therapy (CBT), structured patient education, and transparent communication around device updates and recalls have shown effectiveness. In conclusion, addressing this gap is essential to improving outcomes and quality of life.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635913","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 Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors in Reducing Repeated Heart Failure Rehospitalizations among Elderly Patients with Acute Decompensated Heart Failure: The ROSES-HF Study.","authors":"Michitaka Amioka, Hiroki Kinoshita, Yuto Fuji, Kazuhiro Nitta, Kenichi Yamane, Tomoki Shokawa, Yukiko Nakano","doi":"10.1016/j.amjcard.2025.07.005","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.07.005","url":null,"abstract":"<p><p>Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown efficacy in reducing heart failure (HF) hospitalizations and cardiovascular mortality in patients with chronic heart failure, across a range of ejection fractions. However, data on their long-term efficacy in preventing recurrent hospitalization after acute decompensated heart failure (ADHF) in elderly patients are limited. This study aimed to assess the long-term effect of SGLT2i on recurrent HF hospitalization in patients aged ≥75 years following their initial ADHF admission. The ROSES-HF study, a multicenter, prospective observational cohort study, enrolled 415 patients aged ≥75 years hospitalized with ADHF. Patients were divided into those receiving conventional medical therapy (without SGLT2i, n = 206) or SGLT2i therapy (n = 209), initiated at a median of 2.1 days post-admission. The incidence of recurrent HF hospitalization and the composite endpoint of HF hospitalization or cardiovascular death were compared. During a mean follow-up of 22.4 months, HF rehospitalization occurred in 65 patients (31.6%) in the conventional therapy group compared to 43 patients (20.6%) in the SGLT2i group, with a significant difference (log-rank test, p = 0.028). The cumulative annualized HF rehospitalization events were 24.1 per 100 person-years in the conventional therapy group versus 15.7 per 100 person-years in the SGLT2i group (p = 0.007). The composite endpoint of HF rehospitalization or cardiovascular death was observed in 77 patients (37.4%) in the conventional group compared to 49 patients (23.4%) in the SGLT2i group (log-rank test, p = 0.017). In conclusion, initiating SGLT2i in elderly patients post-ADHF reduces recurrent HF rehospitalization, underscoring its therapeutic value in this population.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635912","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":"SGLT2 Inhibitors and Atrial Fibrillation: Interpreting Signal with Precision.","authors":"Rajeev Gupta, Anshul Yadav, Ojus Yadav, Rohit Mody, Neelesh Gupta","doi":"10.1016/j.amjcard.2025.06.036","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.06.036","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574662","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":"Bifurcation Angle and Side-branch Occlusion After Provisional Stenting.","authors":"Kaan Gökçe, Enes Arslan, Ezgi Gültekin Güner, Ahmet Güner, Fatih Uzun","doi":"10.1016/j.amjcard.2025.06.035","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.06.035","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574660","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 Surgical Valve Intervention on In-Hospital Outcomes in Candida Endocarditis: A Seven-Year Analysis.","authors":"Bekure B Siraw, Didien Meyahnwi, Yordanos T Tafesse, Neiberg Lima, Juveriya Yasmeen, Hemraj Paudel, Amha Weldehana, Titilope Olanipekun, Mouaz Oudih, Yonas Gebrecherkos, Mohammed Haroun","doi":"10.1016/j.amjcard.2025.06.019","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.06.019","url":null,"abstract":"<p><p>Candida endocarditis (CE) is a rare but highly lethal infection with limited evidence guiding its management. While surgical valve replacement or repair is often recommended, its impact on in-hospital outcomes remains unclear. We conducted a retrospective cohort study using the National Inpatient Sample (2016-2022) to identify adult admissions with CE. The primary exposure was surgical valve intervention. The primary outcomes were overall and 30-day in-hospital mortality, while the secondary outcomes included length of stay and hospitalization costs. We used multivariable logistic regression, Cox proportional hazards models, and two causal inference methods, propensity score matching (PSM) and inverse probability of treatment weighting (IPTW), to adjust for potential confounding. We identified 1,280 weighted CE hospitalizations, representing 0.77% of infective endocarditis cases. Among them, 228 patients (17.8%) underwent valve intervention, with a median time to surgery of 9.5 days (IQR = 15 days). Overall, in-hospital mortality was 18.8%, significantly lower in those who underwent surgery (8.3% vs. 21.1%; p < 0.001). Valve intervention was associated with reduced mortality across multivariable analysis (AOR 0.28; 95% CI: 0.13-0.55), PSM (OR_PSM 0.31; 95% CI: 0.13-0.66), IPTW (OR_IPTW 0.42; 95% CI: 0.25-0.71), and Cox models (AHR 0.13; 95% CI: 0.07-0.25). However, intervention was also linked to longer hospital stays (β = 1.86; 95% CI: 1.61-2.14) and higher costs (β = 2.10; 95% CI: 1.71-2.61). Surgical valve intervention in patients with CE was associated with significantly lower in-hospital mortality, but at the cost of longer hospital stays and increased resource utilization.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574661","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":"Identification of patients at high bleeding risk after PCI: How can scoring systems help?","authors":"Marc Cohen, Sumit Sohal","doi":"10.1016/j.amjcard.2025.06.031","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.06.031","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144566994","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":"Regional Disparities and Predictors of Intracoronary Imaging Use During Percutaneous Coronary Intervention in the United States.","authors":"Abhishek Chaturvedi, Matteo Cellamare, Beni R Verma, Jason Galo, Zhang Cheng, Parul Chandrika, Waiel Abusnina, Dan Haberman, Lior Lupu, Hayder D Hashim, Ron Waksman, Gary S Mintz","doi":"10.1016/j.amjcard.2025.06.017","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.06.017","url":null,"abstract":"<p><strong>Introduction: </strong>Intracoronary imaging (ICI) guidance improves outcomes after percutaneous coronary intervention (PCI), yet adoption remains slow and can be further compounded by known disparities in cardiovascular care. We examined contemporary trends in ICI use during PCI and associated regional disparities in the United States.</p><p><strong>Methods & results: </strong>Records of patients ≥ 18 years old who underwent PCI between January 1, 2016, and December 31, 2020, were identified using appropriate ICD-10 codes (n=weighted total of 1876970 records). Those with missing region information and those with a history of coronary artery bypass grafting, concomitant cardiogenic shock, and cardiac arrest were excluded. The cohort's mean age was 64.9 years, 33.6% were female, and the majority (74.9%) were White. Between 2016 and 2020, the use of ICI increased from 6.8% to 13.5% (p_trend=0.01), with increase in intravascular ultrasound from 6.5% to 12.9% (p_trend=0.01) and optical coherence tomography from 0.3% to 0.7% (p_trend=0.03). ICI use improved across all four regions over the years, but Southern region had persistently lower rates of ICI use (7.6%), followed by Midwest (8.9%), Northeast (9.9%), and Western (12.6%) regions. Western region was associated with higher [OR (CI): 1.46 (1.29 - 1.66)], while Southern region with lower [OR (CI): 0.86 (0.76, 0.98)] likelihood of ICI use.</p><p><strong>Conclusion: </strong>There is significant regional variation in the use of ICI during PCI across the United States, with a lesser likelihood in Southern and higher likelihood in Western states. Cardiology societies must continue to advocate for and design strategies to facilitate ICI use across all regions.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144566995","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 the First 200 Cases of Single-Operator TEE-Guided Left Atrial Appendage Occlusion (SOLO-CLOSE).","authors":"Hafez Golzarian, Mallory Knous, Anna Kleman, Jamie Saum, Jennifer Koenig, Emily Miller, Maile Miller, Sarah Stechschulte, Andria Utendorf, Jordan Trombley, Denise M Walker, Amy Carder, William Carder, Janelle Fields, Cynthia Hoersten, Sarah Kallay, Andrew Macke, Jennifer Music, Gerri Hempfling, Amanda Laird, Sandeep M Patel","doi":"10.1016/j.amjcard.2025.06.033","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.06.033","url":null,"abstract":"<p><strong>Background: </strong>SOLO-CLOSE is a simplified methodology for left atrial appendage occlusion (LAAO) with the Watchman device consisting of single-operator TEE guidance, nurse-driven conscious sedation, same-day discharge, and deferment of any pre-procedural imaging.</p><p><strong>Objective: </strong>We aim to investigate the efficacy and safety of LAAO with the SOLO-CLOSE methodology.</p><p><strong>Methods: </strong>A single-center prospective analysis of 208 consecutive patients undergoing SOLO-CLOSE between December 2020 and January 2024 was performed. The primary efficacy outcome was the rate of significant peri-device (>5 mm) leak at 45-day TEE. The primary safety outcome was a composite of major adverse cardiovascular events (MACE), comprised of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke at 45 days. Procedure times, 7-day all cause readmission, incidents of all-cause death, device-related thrombi, stroke, device embolization, pericardial effusion, and major post-procedure bleeding within 45 days of the index procedure were also collected.</p><p><strong>Results: </strong>The technical success rate was 96.2% (n=200). The mean age was 77 ± 8 years, mean CHA₂D₂SVASc score was 5.2 ± 1.4, mean HAS-BLED score was 3.4 ± 1.0, and mean procedural time was 28 ± 14 minutes. At 45 days, there were no significant peri-device leak (>5 mm). Immediate procedural complications included one (0.5%) esophageal trauma, one (0.5%) pulmonary hemorrhage, one (0.5%) TIA, and one (0.5%) pericardial effusion. MACE occurred in 4 patients (2.0%). The incidences of all-cause mortality, major bleeding, and device related thrombus were 3 (1.5%), 5 (2.5%), and 2 (1.0%), respectively. The 7-day all-cause readmission rate was 3.5%.</p><p><strong>Conclusions: </strong>The SOLO-CLOSE technique has potential to significantly enhance clinical efficiency and cost-effectiveness for LAAO while maintaining comparable procedure-related safety outcomes to that of other closure methodologies.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144566993","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 Left Ventricular Outflow Tract Calcification on Early Outcome in Patient with Bicuspid Aortic Valve Undergoing Transcatheter Aortic Valve Implantation with Self-Expandable and Balloon-Expandable Valve.","authors":"Vincenzo Cesario, Chiara De Biase, Omar Oliva, Alessandro Beneduce, Nicolas Dumonteil, Didier Tchètchè","doi":"10.1016/j.amjcard.2025.06.028","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.06.028","url":null,"abstract":"<p><p>The aim of this study was to assess the impact of left ventricular outflow (LVOT) calcification on early device outcomes in a contemporary patient cohort with bicuspid aortic valve undergoing transcatheter aortic valve implantation (TAVI), and to compare outcomes between balloon-expandable (BE) and self-expandable (SE) prostheses in this population. LVOT calcification is known to be associated with adverse outcomes after TAVI in patient with tricuspid anatomy. However, its impact on patients with bicuspid anatomy remains less explored. Additionally, the differential effect of LVOT calcification on outcomes with BE vs. SE prostheses remains unclear. Pre-TAVI multi-slice computed tomography (MSCT) scans from 198 BAV patients were analyzed to assess the presence and quantification of LVOT calcification. The cohort was divided into LVOT+ (calcium volume >10 mm³) and LVOT- groups (calcium volume < 10 mm³). The amount of LVOT calcification was measured quantitatively from contrast-enhanced CT, using 3mensio Structural Heart software (Pie Medical Imaging). Outcomes were further stratified by valve type (SE vs. BE). The impact of LVOT calcification on 30-day VARC-3 device success, mean trans-prosthetic gradient, and peri-valvular regurgitation (PVR) was assessed using univariate and multivariate regression analysis. LVOT calcification was present in 48.2% of patients. Device success at 30 days was significantly lower in the LVOT+ group (75.8% vs. 90.1%; p=0.007). In subgroup analysis, BE valves showed higher mean trans-prosthetic gradients in LVOT+ patients (12.1±6.3 mmHg) compared to SE valves (10.2±5.8 mmHg, p=0.04). Moderate or greater PVR was more common in SE valves (17.5% vs. 10.2%; p=0.03), especially in LVOT+ patients. On multivariate analysis, LVOT calcification remained an independent predictor of reduced device success (OR 0.237; p=0.005). In conclusion LVOT calcification is highly prevalent in BAV patients undergoing TAVI and it is associated with reduced device success at 30 days. The impact of LVOT calcification differs between valve types, with BE valves exhibiting higher gradients and SE valves showing higher rates of PVR. These findings suggest that LVOT calcium burden should be carefully considered when selecting the type of transcatheter valve.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564295","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}