American Journal of Cardiology最新文献

Artificial Intelligence for Risk Stratification of Acute Pulmonary Embolism: Perspectives on Clinical Needs, Expanding Toolkit, and Pathways Forward. 急性肺栓塞风险分层的人工智能：临床需求，扩展工具包和前进途径的观点。

IF 2.3 3区医学

American Journal of Cardiology Pub Date : 2025-05-26 DOI: 10.1016/j.amjcard.2025.05.025

Stanislav Henkin, Damon Houghton, Andetta Hunsaker, Marco Zuin, Mariana Pfeferman, Alyssa Sato, Gregory Piazza

{"title":"Artificial Intelligence for Risk Stratification of Acute Pulmonary Embolism: Perspectives on Clinical Needs, Expanding Toolkit, and Pathways Forward.","authors":"Stanislav Henkin, Damon Houghton, Andetta Hunsaker, Marco Zuin, Mariana Pfeferman, Alyssa Sato, Gregory Piazza","doi":"10.1016/j.amjcard.2025.05.025","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.05.025","url":null,"abstract":"Despite a significant number of innovations for management of acute pulmonary embolism (PE) over the past decade, PE-related mortality has not decreased as expected. Significant heterogeneity in PE presentations and limitations in contemporary risk stratification approaches are hypothesized to be important drivers of poorer than expected outcomes. Recently, artificial intelligence (AI) has gained attention in cardiovascular medicine, notably in wearable technology, electrocardiography, and cardiovascular imaging. The utility of AI has been studied in PE diagnosis and risk stratification, especially in hospitalized patients and has the potential to predict presence of PE based on electrocardiography and clinical risk factors, decrease time to diagnosis, and improve characterization of PE as acute versus chronic. However, AI systems do not appear to have better accuracy in identification of PE compared with radiologists. Additionally, whether utilization of AI in diagnosis and management of PE will improve clinician workflow and patient outcomes remains unknown. In this review, we critically appraise the literature on AI-based strategies to diagnose and refine risk stratification of acute PE and discuss how integration of AI may move the field of PE forward with the universal goal of improving short- and long-term PE-related outcomes.","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172488","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}

引用次数: 0

Chronic Intravenous Inotropic Support as Bridge to Surgical Therapies in Patients with Sarcoidosis-Related Cardiomyopathy. 慢性静脉肌力支持作为结节病相关心肌病患者手术治疗的桥梁。

IF 2.3 3区医学

American Journal of Cardiology Pub Date : 2025-05-25 DOI: 10.1016/j.amjcard.2025.05.027

Johana Fajardo, Rachel Barish, Francisca Bermudez, Manavotam Singh, Avantika Banerjee, Fatima Hayat, Nana Afari-Armah, Ajay Kadakkal, Tania VoraMD, Anjani Pillarisetty, Raja Zaghlol, Anirudh Rao, Samer S Najjar, Farooq H Sheikh

引用次数: 0

Stroke Prevention in Cancer Patients with Atrial Fibrillation. 癌症心房颤动患者的卒中预防。

IF 2.3 3区医学

American Journal of Cardiology Pub Date : 2025-05-24 DOI: 10.1016/j.amjcard.2025.05.026

Bülent Özlek, Veysel Ozan Tanık, Süleyman Barutçu

引用次数: 0

Reflections on Sheath Type and Closure Approaches in Contemporary TF-TAVI Practice. 当代TF-TAVI实践中鞘式与闭合方式的思考。

IF 2.3 3区医学

American Journal of Cardiology Pub Date : 2025-05-24 DOI: 10.1016/j.amjcard.2025.05.028

Ritesh Kanyal, Mahmood Ahmad

引用次数: 0

Inflammation - still an underestimated player in coronary artery disease. 炎症——在冠状动脉疾病中仍然是一个被低估的角色。

IF 2.3 3区医学

American Journal of Cardiology Pub Date : 2025-05-23 DOI: 10.1016/j.amjcard.2025.05.023

Tomasz Podolecki, Zbigniew Kalarus, Jacek Kowalczyk

引用次数: 0

Noninvasive right ventricular myocardial work by pressure-strain loop: a new perspective on right ventricular function and cardiac resynchronization therapy. 压力-应变循环无创右室心肌工作：右室功能和心脏再同步化治疗的新视角。

IF 2.3 3区医学

American Journal of Cardiology Pub Date : 2025-05-23 DOI: 10.1016/j.amjcard.2025.05.024

Fangyan Tian, Chunqiang Hu, Wen Liu, Bei Zhang, Haiyan Chen, Xianhong Shu

{"title":"Noninvasive right ventricular myocardial work by pressure-strain loop: a new perspective on right ventricular function and cardiac resynchronization therapy.","authors":"Fangyan Tian, Chunqiang Hu, Wen Liu, Bei Zhang, Haiyan Chen, Xianhong Shu","doi":"10.1016/j.amjcard.2025.05.024","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.05.024","url":null,"abstract":"Background: Myocardial work (MW) by noninvasive pressure-strain loop (PSL) is a novel echocardiographic tool that provides a more precise estimation of right ventricular (RV) performance by accounting for the RV loading conditions. The study sought to investigate the impact of cardiac resynchronization therapy (CRT) on RV function and explore the role of RV MW indices in predicting CRT response.Methods and results: Ninety-one CRT-candidates were prospectively enrolled. left ventricular (LV) MW parameters, RV global longitudinal strain (RV GLS) and RV free wall strain (RV FWS) were obtained. RV MW indices, including RV global work index (RV GWI), RV global constructive work (RV GCW), RV global wasted work (RV GWW), and RV global work efficiency (RV GWE), were measured by PSL analysis. Response to CRT was defined as a reduction in left ventricular end-systolic volume of ≥15% at follow-up. RV GWI significantly increased in responders. CRT caused significant improvements in RV GWI, RV GCW, and RV GWE (P < 0.05). In multivariate analysis, RV GWI (adjusted odds ratio (OR): 1.010; 95% CI: 1.003-1.017; P < 0.05), and LV GCW (adjusted OR: 1.002; 95% CI: 1.000-1.003; P < 0.05) were associated with CRT response. Adding RV GWI to the basal model yielded a significant improvement in continuous net reclassification improvement at 0.284 (p=0.032), while other function parameters failed to improve reclassification.Conclusion: RV MW indices provide a new reference for the quantitative evaluation of RV myocardial performance before and after CRT. Although both RV GWI and LV GCW have prognostic value, RV GWI may better predict the response to CRT.","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141129","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}

引用次数: 0

Five Years After ARC-HBR's Global Introduction: A Prospective Validation Study in Egypt. ARC-HBR全球引入五年后：埃及的前瞻性验证研究。

IF 2.3 3区医学

American Journal of Cardiology Pub Date : 2025-05-23 DOI: 10.1016/j.amjcard.2025.05.022

Nehad El-Amrawy, Salah El-Tahan, Mohamed Sadaka, Amr Kamal

{"title":"Five Years After ARC-HBR's Global Introduction: A Prospective Validation Study in Egypt.","authors":"Nehad El-Amrawy, Salah El-Tahan, Mohamed Sadaka, Amr Kamal","doi":"10.1016/j.amjcard.2025.05.022","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.05.022","url":null,"abstract":"Five years after the global introduction of the ARC-HBR criteria, prospective validation in real-world clinical settings has remained globally lacking. This study aims to prospectively assess the predictive utility of ARC-HBR criteria in an Egyptian percutaneous coronary intervention (PCI) population, describe contemporary bleeding patterns, and establish a regional reference for post-PCI major bleeding outcomes. This single-center study included 1,018 PCI patients treated at Alexandria Main University Hospital between March 2022 and August 2023. High bleeding risk (HBR) was defined as ≥1 major or ≥2 minor ARC-HBR criteria. The primary endpoint was major bleeding (BARC type 3 or 5), including in-hospital, post-discharge, and cumulative events. Secondary endpoints included ARC-HBR prevalence, individual criterion associations with bleeding, and overall predictive performance. HBR patients (44.6%) experienced significantly higher cumulative major bleeding rates (8.4% vs. 3.2%; HR = 2.8, p < 0.001). In-hospital bleeding was low (1.2%) with no significant group difference, while post-discharge bleeding was markedly higher in HBR patients (7.6% vs. 2.4%, p < 0.001). Mild anemia and chronic kidney disease (CKD) were the most common ARC-HBR criteria. Severe CKD, non-deferrable surgery on dual antiplatelet therapy (DAPT), and oral anticoagulation (OAC) were the strongest predictors of bleeding. ARC-HBR demonstrated moderate predictive performance (C-statistic = 0.682). In conclusion, this study provides the first prospective validation of ARC-HBR in Egypt. While ARC-HBR criteria effectively identify HBR patients, persistently high post-discharge and cumulative bleeding rates highlight the need for improved mitigation strategies in real-world, resource-limited healthcare systems.","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141043","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}

引用次数: 0

Prognostic Implications Of High-Sensitivity Cardiac Troponins In Patients With Acute Kidney Injury Without Myocardial Infarction. 高敏感性心肌肌钙蛋白对急性肾损伤无心肌梗死患者的预后影响。

IF 2.3 3区医学

American Journal of Cardiology Pub Date : 2025-05-22 DOI: 10.1016/j.amjcard.2025.05.020

Love Cyon, Erik Kadesjö, Andreas Roos

{"title":"Prognostic Implications Of High-Sensitivity Cardiac Troponins In Patients With Acute Kidney Injury Without Myocardial Infarction.","authors":"Love Cyon, Erik Kadesjö, Andreas Roos","doi":"10.1016/j.amjcard.2025.05.020","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.05.020","url":null,"abstract":"Elevated and dynamic high-sensitivity cardiac troponin T (hs-cTnT) concentrations are often observed in patients with acute kidney injury (AKI) without myocardial infarction (MI), yet their prognostic implications are unknown. This study investigated associations between hs-cTnT measurements and prognosis in patients with AKI in the emergency department (ED). All first visits to 7 EDs during 2010-2017 by patients without MI fulfilling AKI criteria and ≥1 hs-cTnT measured were included. Logistic and Cox regression analyses were applied to estimate short- and long-term risks of mortality and major adverse cardiovascular events (MACE) according to peak hs-cTnT and relative hs-cTnT change (Δhs-cTnT). A total of 12,136 patients were included. In-hospital- and long-term mortality was 15% and 49% (median follow-up: 3.8 years, IQR: 1.3-6.0). Adjusted in-hospital mortality risk increased with higher peak hs-cTnT, being >8-fold (aOR 8.68, 95% CI: 6.85-11.0) in the highest quintile of hs-cTnT, in whom long-term risk of cardiovascular mortality and MACE was 3-fold (HR: 3.01, 95% CI: 2.74-3.31) and 2-fold (HR: 2.12, 95% CI: 2.00-2.24). Associated risks were elevated already at intermediately elevated hs-cTnT and evident in patients with transient AKI and with normalized eGFR at discharge. Patients with the highest Δhs-cTnT experienced an increased short-term mortality risk, but Δhs-cTnT was not associated with long-term mortality and only weakly associated with the risk of MACE. In conclusion, in patients with AKI but without acute MI, peak hs-cTnT are associated with a worse prognosis in both the short and long term, whereas dynamic hs-cTnT changes may have less prognostic significance.","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141113","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}

引用次数: 0

Diagnosis and Management of Phrenic Paralysis Associated Hypoxemia. 膈瘫痪伴低氧血症的诊断与治疗。

IF 2.3 3区医学

American Journal of Cardiology Pub Date : 2025-05-21 DOI: 10.1016/j.amjcard.2025.05.019

Antoine Premachandra, Matthieu Perier, Amandine Richard, Guillaume Tachon, Florent Huang, Benjamin Zuber

{"title":"Diagnosis and Management of Phrenic Paralysis Associated Hypoxemia.","authors":"Antoine Premachandra, Matthieu Perier, Amandine Richard, Guillaume Tachon, Florent Huang, Benjamin Zuber","doi":"10.1016/j.amjcard.2025.05.019","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.05.019","url":null,"abstract":"Phrenic nerve paralysis caused by herpes zoster infection is an exceptionally rare condition associated with severe respiratory complications. An even rarer phenomenon is the development of hypoxemia due to a right-to-left shunt through a patent foramen ovale (PFO), triggered by mediastinal shift and redirection of venous flow caused by right diaphragmatic elevation. We report the case of a 74-year-old woman admitted to the intensive care unit with severe hypoxemia refractory to oxygen therapy, requiring mechanical ventilation, following a recent herpes zoster infection affecting the C4 dermatome. Imaging revealed right hemidiaphragm elevation due to phrenic nerve paralysis, leading to mediastinal shift and a right-to-left shunt through a PFO without an interatrial pressure gradient. Transesophageal echocardiography confirmed a massive shunt. Emergency percutaneous PFO closure was performed, resulting in immediate improvement in oxygenation. In this article, the authors provide a framework for navigating the diagnostic reasoning and management of this rare condition. In conclusion, this case emphasizes the importance of considering phrenic nerve paralysis and PFO-related shunting in the differential diagnosis of unexplained hypoxemia, particularly in patients with recent cervical herpes zoster infections. Early screening for diaphragmatic dysfunction and transesophageal echocardiography are essential diagnostic tools, and percutaneous PFO closure offers a safe and effective solution for severe shunt-related hypoxemia.","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132108","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}

引用次数: 0

Implementation of a High-Sensitivity Cardiac Troponin Assay and Diagnostic Protocol for Suspected Acute Coronary Syndrome. 实施高灵敏度心肌肌钙蛋白测定和诊断方案疑似急性冠脉综合征。

IF 2.3 3区医学

American Journal of Cardiology Pub Date : 2025-05-21 DOI: 10.1016/j.amjcard.2025.05.005

Dustin G Mark, Jie Huang, Keane K Lee, Dana R Sax, Dustin W Ballard, David R Vinson, Mary E Reed

{"title":"Implementation of a High-Sensitivity Cardiac Troponin Assay and Diagnostic Protocol for Suspected Acute Coronary Syndrome.","authors":"Dustin G Mark, Jie Huang, Keane K Lee, Dana R Sax, Dustin W Ballard, David R Vinson, Mary E Reed","doi":"10.1016/j.amjcard.2025.05.005","DOIUrl":"10.1016/j.amjcard.2025.05.005","url":null,"abstract":"We assessed if implementation of a high-sensitivity cardiac troponin I (hs-cTnI) assay and 0/2-hour diagnostic protocol for evaluation of suspected acute coronary syndromes was associated with improved resource utilization by retrospectively studying adult emergency department (ED) encounters for chest pain/discomfort at 21 hospitals in an integrated health system. The hs-cTnI assay (Beckman Access) and corresponding 0/2-hour protocol were introduced on November 16, 2022. The preimplementation period was January 1, 2018 to June 30, 2019 (prior to the COVID-19 pandemic) and the postimplementation period was January 1, 2023 to June 30, 2024. Co-primary outcomes were ED disposition and 30-day coronary testing, assessed following adjustment for confounders and within strata of predicted risk. There were 87,647 preimplementation and 97,677 postimplementation encounters with similar demographics (median age 59 years, 55.2% vs 55.5% female) and risk factors (diabetes 26.6% vs 25.8%; chronic kidney disease 13.5% vs 13.6%; coronary revascularization 12.3% vs 10.6%). Adjusted prepost analyses revealed an increase in ED discharges (75.0% vs 78.9%, adjusted difference + 3.9%, 95% CI 3.4% to 4.4%) and a decrease in 30-day coronary testing (36.2% vs 24.1%, adjusted difference-12.1%, 95% CI -12.9% to -11.4%). Notably, results differed by predicted risk strata, with decreased ED discharges and increased 30-day coronary testing among nonlow risk encounters. In conclusion, hs-cTnI assay and protocol implementation was associated with decreased overall resource utilization among ED patients with chest pain, despite increased utilization among nonlow risk encounters. Structured use of hs-cTn assays can improve alignment between risk and resource allocation in this population.","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961256","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}

引用次数: 0