American Journal of Cardiology最新文献

{"title":"Impact of a VAD Optimization Clinic on Medication Utilization and Clinical Outcomes Following Left Ventricular Assist Device Implantation.","authors":"Scott W Lundgren, Theresa Diederich, Elizabeth Lyden, Jill Nohl, Windy Alonso, Bunny Pozehl, Adam F Burdorf","doi":"10.1016/j.amjcard.2026.05.007","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.05.007","url":null,"abstract":"<p><p>Guidance on use of neurohormonal antagonists (NHA) following left ventricular assist device (LVAD) implantation remains scant despite studies showing use may reduce morbidity and mortality. We evaluated the impact of a 12-week clinic designed to optimize NHA post-LVAD on medication use and outcomes. A multidisciplinary clinic enrolled patients post-implantation. The clinic consisted of 6 visits and included medication optimization and nutrition and pharmacy counseling. Not enrolled patients served as the comparison group. 44 patients completed VAD optimization clinic, the comparison group included 71 patients. Enrolled patients averaged 56.1 (±11.4) years of age, 14 (31.8%) were female, 42 (95.5%) patients were HeartMate 3, and average time to enrollment was 46 (±20) days post-implant. At the end of OPTIMIZE, there was a significant improvement in quadruple NHA utilization compared to controls. Fewer patients in our optimization group experienced recurrent (2 or more) hospitalizations within 6 months of LVAD implant compared to controls (p=0.02). There was a trend towards reduction in RV failure (p=0.09) and 2-year mortality (p=0.12) in those that completed OPTIMIZE clinic. An optimization clinic post-LVAD improves NHA use and may lead to improved outcomes. Randomized, fully powered studies are needed to better understand how NHA optimization influences post-LVAD outcomes.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855655","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":"Long-Term Clopidogrel versus Aspirin Monotherapy After Drug-Eluting Stent Implantation: A Nationwide Real-World Comparative Study.","authors":"Eun Jin Park, Dong Oh Kang, Jong-Seok Lee, Jungkuk Lee, Yong-Hyun Kim, Sang Yup Lim, Jeong-Cheon Ahn, Woo-Hyuk Song, Sunwon Kim","doi":"10.1016/j.amjcard.2026.05.003","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.05.003","url":null,"abstract":"<p><p>Lifelong antiplatelet maintenance therapy is required after drug-eluting stent (DES) implantation. Although recent randomized studies have suggested potential benefits of clopidogrel monotherapy over aspirin, evidence from unselected real-world populations remains limited. Using a randomly sampled 20% representative cohort from the Korean National Health Insurance Service database, we identified patients who underwent PCI with DES between 2002 and 2018. Among patients who remained event-free for 3 years after PCI, thereby defining a stable late chronic maintenance phase, treatment groups were defined by the prescribed antiplatelet agent within 30 days before event or censoring. After 1:1 propensity score matching, 18,168 patients were analyzed. The primary endpoint was a composite of all-cause death, myocardial infarction (MI), ischemic stroke, and major bleeding during follow-up of up to 10 years. Secondary endpoints comprised two composite outcomes: an ischemic composite (MI, repeated revascularization, ischemic stroke, and cardiovascular death) and a hemorrhagic composite (intracranial hemorrhage and major bleeding). The primary composite endpoint did not differ between clopidogrel and aspirin groups (adjusted hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.94-1.09; P=0.85). Ischemic and hemorrhagic composite outcomes were also comparable (adjusted HR 0.94 [0.84-1.05] and 1.03 [0.92-1.14], respectively). No significant differences were observed in individual endpoints except for MI (adjusted HR 0.71 [0.58-0.87]; P=0.001), favoring clopidogrel. In conclusion, in this nationwide real-world cohort of event-free survivors three years after DES PCI, aspirin and clopidogrel showed comparable long-term efficacy and safety during the chronic maintenance phase over 10 years of follow-up, without broad net clinical advantage of either strategy.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855702","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":"Glucagon-Like Peptide-1 Receptor Agonists and Cardiovascular Outcomes in Patients With Atherosclerotic Cardiovascular Disease and Obesity Without Diabetes.","authors":"Usman Ali Akbar, Avilash Mondal, Mounica Vorla, Waleed Alruwaili, Jordan Lacoste, Harshith Thyagaturu, Nouman Shafique, Sana Shakeel, Amro Taha, Sudarshan Balla","doi":"10.1016/j.amjcard.2026.05.004","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.05.004","url":null,"abstract":"<p><p>The Semaglutide Effects on Cardiovascular Outcomes in People With Overweight or Obesity (SELECT) trial demonstrated cardiovascular benefits of semaglutide in patients with obesity without diabetes; however, the real-world effect across multiple GLP-1 receptor agonist (GLP-1 RA) agents in patients with established atherosclerotic cardiovascular disease (ASCVD) and overweight or obesity without diabetes mellitus remains unknown. We conducted a target trial emulation using data from the TriNetX US Collaborative Network (January 1, 2010-December 1, 2025) in adults aged ≥45 years with established ASCVD (history of myocardial infarction, stroke, or coronary or peripheral revascularization), BMI ≥27 kg/m², and without type 2 diabetes. New initiation of any GLP-1 RA (liraglutide, semaglutide, dulaglutide, or exenatide) was compared with no GLP-1 RA use. The primary outcome was all-cause mortality; secondary outcomes were acute myocardial infarction, stroke, and heart failure hospitalization over 5 years, analyzed using Cox proportional hazards and Fine-Gray subdistribution hazard models to account for the competing risk of death. Among 14,844 propensity-matched patients without diabetes (7,422 per group; median age 63 [IQR 55-71] years; 64% women), GLP-1 RA use was associated with lower all-cause mortality (HR 0.68; 95% CI 0.53-0.88; P=.003), acute myocardial infarction (sHR 0.63; 95% CI 0.41-0.98; P=.040), and heart failure hospitalization (sHR 0.61; 95% CI 0.39-0.95; P=.028); no significant association was observed for stroke (sHR 0.76; 95% CI 0.52-1.10; P=.146). Findings were consistent in landmark and age subgroup analyses; a sensitivity analysis including patients with diabetes (N=31,910 matched pairs) showed similar associations. In conclusion, these real-world findings are broadly directionally consistent with the SELECT trial and provide complementary observational evidence across multiple GLP-1 RA agents in patients with established ASCVD and overweight or obesity without diabetes mellitus, though causal inference cannot be established from observational data alone.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855686","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":"Transcatheter Tricuspid Valve Intervention Versus Optimal Medical Therapy in Symptomatic Tricuspid Regurgitation: A Systematic Review and Meta-Analysis of Randomized and Observational Studies.","authors":"Akshat Banga, Vikas Bansal, Sawai Singh Rathore, Ashish Yadav, Hritvik Jain, Siddharth Misra, Ankit Agrawal, Sarju Ganatra, Kapil Yadav, Prakash Deedwania, Ravi Dhingra, Andrew M Goldsweig, Sourbha S Dani","doi":"10.1016/j.amjcard.2026.04.053","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.04.053","url":null,"abstract":"<p><strong>Background: </strong>Severe symptomatic tricuspid regurgitation (TR) is associated with a poor prognosis, and many patients are ineligible for surgical intervention. Transcatheter tricuspid valve intervention (TTVI) has emerged as a less invasive alternative, but its impact on clinical outcomes compared with optimal medical therapy (OMT) remains uncertain.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies comparing TTVI (transcatheter edge-to-edge repair or valve replacement) with OMT. Databases were searched from inception through December 31, 2025. Outcomes included all-cause and cardiovascular mortality, heart failure (HF) hospitalization, myocardial infarction, stroke, bleeding, and new permanent pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) implantation. Random-effects models were used to calculate pooled odds ratios (ORs).</p><p><strong>Results: </strong>Thirteen studies encompassing 6732 patients (3240 TTVI; 3492 OMT) were included. In pooled analyses of randomized and observational studies, TTVI was associated with a significant reduction in all-cause mortality compared with OMT (OR 0.70; p=0.009). However, this benefit was not observed in an RCT-only analysis. No significant differences were noted in cardiovascular mortality, HF hospitalization, myocardial infarction, severe bleeding, or stroke. A non-significant trend toward increased PPM/ICD implantation (p=0.06) was primarily driven by valve replacement devices.</p><p><strong>Conclusions: </strong>In symptomatic TR, TTVI was associated with reduced all-cause mortality in pooled analyses incorporating both randomized and observational data; however, this benefit was not confirmed in RCT-only analyses, likely reflecting residual confounding in non-randomized studies which may overestimate treatment effects. These findings support TTVI as an effective therapeutic option for appropriately selected high-risk patients.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855716","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":"Obesity-Related Hypertension: An Emerging Clinical Phenotype.","authors":"Guido Grassi, Dagmara Hering, C Venkata S Ram, Giuseppe Mancia","doi":"10.1016/j.amjcard.2026.05.002","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.05.002","url":null,"abstract":"<p><p>Obesity represents a pandemic, independent and modifiable cardiovascular risk factor, distinct from other well-known risk factors such as hypertension, hypercholesterolemia, and diabetes mellitus. The impact of this condition on cardiovascular outcomes is remarkably potentiated when obesity is associated with hypertension. These include the development and progression of left ventricular hypertrophy, endothelial dysfunction, sympathetic activation to the heart and peripheral vessels, impaired arterial distensibility, pro-atherogenic vascular alterations and kidney dysfunction and failure. On the clinical ground these alterations favor the development and progression of cardiovascular complications, such as coronary artery disease, chronic heart failure, life-threatening cardiac arrhythmias cerebrovascular disease and sleep apnea syndrome. In conclusion, the present paper will provide a comprehensive in-depth pathophysiological background, clinical consequences and therapeutic implications of the obesity-related hypertensive phenotype.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832439","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":"TAVR in an Underserved Minority Population with Very Severe Aortic Stenosis: The Bronx study.","authors":"Antonella Millin, Pier Pasquale Leone, Matteo Sturla, Daniel Feldman, Tadahisa Sugiura, Leandro Slipczuk, Edwin C Ho, Manaf Assafin, Andrea Scotti, Azeem Latib","doi":"10.1016/j.amjcard.2026.04.051","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.04.051","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832482","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":"Lipoprotein(a) Distribution Across Race/Ethnicity and Association with Mortality Outcomes in NHANES III (1988-1994) with Follow‑Up to 2019.","authors":"Leh Chuan Lim, Mustafa Al-Jarshawi, Nicholas Ws Chew, Thomas Shepherd, Richard Partington, Pierre Sabouret, Ameen Al-Alwany, Kausik K Ray, Mamas A Mamas","doi":"10.1016/j.amjcard.2026.04.063","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.04.063","url":null,"abstract":"<p><p>Lipoprotein(a) [Lp(a)] is a genetically determined and likely causal independent risk factor for cardiovascular outcomes and mortality with levels >50mg/dl considered risk enhancing. Over 90% of variation in levels is genetically determined with levels varying by race/ethnicity. Evidence on whether Lp(a) risk thresholds vary by race/ethnicity and remains inconsistent. This study examines whether the association between Lp(a) and mortality differs by race/ethnicity. We analysed survey-weighted data from a nationally representative muti-ethnic cohort of U.S. adults from NHANES III with mortality follow-up through 2019. Participants were stratified into non-Hispanic White, non-Hispanic Black or Mexican-American. Associations between Lp(a) and mortality outcomes were estimated using multivariable Cox and Fine-Gray competing risk models. Lp(a) were analysed as continuous variables, logarithmically transformed and divided into three groups (<50 mg/dL, 50-75 mg/dL, and >75 mg/dL). A total of 50,519,751 survey-weighted records were included. Mean follow-up was 22.6 years. Median Lp(a) concentrations were higher among non-Hispanic Black participants (36 mg/dL, IQR 22-66) than non-Hispanic White (12 mg/dL, IQR 3-30) and Mexican-American (8 mg/dL, IQR 2-22) participants. Mexican American participants with Lp(a) >75 mg/dL had a higher risk of cardiovascular mortality that persisted after multivariable adjustment (sHR 2.93, 95% CI 1.01-8.56, p-value 0.049). Among non-Hispanic Black participants, higher Lp(a) was linked to all-cause and cardiovascular mortality in unadjusted models but not after adjustment. No significant association was detected in non-Hispanic White participants. In conclusion, Lp(a) distributions and their relationship with clinical outcomes vary by race/ethnicity. Our findings suggest that prognostic thresholds for Lp(a) may differ, supporting the need to define and validate race/ethnicity-specific cut-offs that best predict cardiovascular outcomes and improve risk stratification.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832446","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":"Outcomes of Long-Term Suppressive Antimicrobial Therapy in Patients with TAVR Infective Endocarditis.","authors":"Omneya Kandil, Lindsey Trinchet, Juan M Farina, Pyongsoo Yoon, Bryan Barrus, Frank Downey, Reza Arsanjani, Kristen A Sell-Dottin","doi":"10.1016/j.amjcard.2026.04.062","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.04.062","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832403","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":"Sex and Gender Differences in Atrial Remodeling After Atrial Fibrillation Ablation.","authors":"Anna Vittoria Mattioli","doi":"10.1016/j.amjcard.2026.04.067","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.04.067","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832411","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":"Severe Low Flow Aortic Stenosis with Preserved Ejection Fraction: Latest Diagnostic and Therapeutic Approach.","authors":"Charis Armonis, Konstantinos Triantafyllou, Elektra Papadopoulou, Athanasios Trikas","doi":"10.1016/j.amjcard.2026.04.066","DOIUrl":"https://doi.org/10.1016/j.amjcard.2026.04.066","url":null,"abstract":"<p><p>Paradoxical low-flow, low-gradient aortic stenosis (pLF-LG AS) represents a distinct phenotype of severe aortic stenosis characterized by a reduced aortic valve area with low transvalvular gradients despite preserved left ventricular ejection fraction and reduced forward flow. It is associated with concentric remodeling, impaired longitudinal systolic function, and diastolic dysfunction, resulting in reduced stroke volume and potential underestimation of disease severity. This state-of-the-art review synthesizes evidence from registries, observational studies, randomized trial subgroup analyses, guideline recommendations, and mechanistic investigations. Diagnosis requires an integrative multimodality approach combining Doppler echocardiography, low-dose dobutamine stress echocardiography, and computed tomography-based aortic valve calcium scoring to differentiate true-severe from pseudo-severe disease. In symptomatic patients with confirmed severe pLF-LG AS, aortic valve replacement is associated with improved survival, although the magnitude of clinical benefit remains variable. Transcatheter aortic valve implantation represents an effective treatment option in selected patients; however, phenotype-specific comparative data versus surgical valve replacement remain limited. Overall, pLF-LG AS requires accurate diagnostic confirmation and individualized, Heart Team-guided management to optimize clinical outcomes.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832420","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}