American Journal of Cardiology最新文献

{"title":"Interpreting the Outcomes of Crossover Versus Ostial Stenting in the CROSS-ANATOLIA Registry","authors":"Hakan Süygün","doi":"10.1016/j.amjcard.2025.08.065","DOIUrl":"10.1016/j.amjcard.2025.08.065","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"256 ","pages":"Pages 143-144"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005806","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 Anatomical and Physiological Indices of Angiographically Intermediate Left Main Coronary Artery Stenoses","authors":"Zeynep Gizem Demirtakan MD ,&nbsp;Ahmet Tas MD ,&nbsp;Yaren Alan MD ,&nbsp;Alp Ozcan MD ,&nbsp;Mehmet Rasih Sonsöz MD ,&nbsp;Sabahattin Umman MD ,&nbsp;Berrin Umman MD ,&nbsp;Murat Sezer MD","doi":"10.1016/j.amjcard.2025.08.048","DOIUrl":"10.1016/j.amjcard.2025.08.048","url":null,"abstract":"<div><div>Although physiologic evaluation (e.g., fractional flow reserve) of intermediate lesions is well established in other coronary arteries, the left main coronary artery (LMCA) exhibits diagnostic challenges, hindering development of physiology-based decision-making algorithms. The aim of this study is to evaluate the relationship between angiographic stenosis severity (diameter stenosis, DS%), lesion location and morphologic characteristics and gold-standard pressure indices in patients with intermediate LMCA stenosis. We analyzed 34 patients with angiographically intermediate (25%–65%) LMCA stenosis who underwent intravascular ultrasound (IVUS) imaging and pressure wire assessment. Plaque burden, minimal lumen area (MLA), lesion location, and calcification were documented, and their relationships with FFR and iFR were evaluated. The iFR (<em>r</em> = -0.507 p &lt; 0.001) and FFR (<em>r</em> = -0.383 p = 0.002) were only moderately correlated with DS%. FFR (<em>r</em> = 0.835, p &lt; 0.001) and iFR (<em>r</em> = 0.769, p &lt; 0.001) were significantly correlated with MLA. Presence of calcification partially blunted the correlation between structural and functional parameters. The receiver operating characteristic (ROC) curve showed the highest area under the curve (AUC) for FFR in detecting an MLA&lt;6 mm², with a negative predictive value (NPV) of 80% and a positive predictive value (PPV) of 100%. All lesions with an MLA&lt;6mm² (<em>n</em> = 16) had an FFR &lt;0.80 whereas iFR &gt;0.89 deferred 37% of these lesions. In conclusion, angiographic percent stenosis is an unreliable indicator of hemodynamic significance in intermediate LMCA disease; given that iFR has a high false-negative rate for lesions with MLA &lt;6 mm² despite correlating with MLA, FFR may therefore be a more suitable index for evaluating intermediate LMCA stenoses, and further studies should refine cutoffs for nonhyperemic indices and investigate their clinical implications.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 143-150"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005711","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":"Characteristics, Trends, and Outcomes of Heart Donation After Circulatory Death: An Early Analysis of the United Network for Organ Sharing Database","authors":"Ahad Firoz MD ,&nbsp;Imo Ebong MD ,&nbsp;Martin Cadeiras MD ,&nbsp;Shirin Jimenez MD","doi":"10.1016/j.amjcard.2025.08.061","DOIUrl":"10.1016/j.amjcard.2025.08.061","url":null,"abstract":"<div><div>Heart transplantation (HTx) is greatly limited by organ shortage. To address this crisis, donation after circulatory death (DCD) is an emerging alternative to the traditional donation after brain death (DBD). Unfortunately, there is scarce data on HTx outcomes for this donation type, particularly within the United States; our investigation seeks to address this knowledge gap. As part of this study, the UNOS thoracic database was analyzed for first-time, adult, isolated orthotopic HTx recipients between 2019 and 2023. Patients were stratified into 3 groups: DBD, DCD III, and DCD IV. Further subgroup analysis for DCD III donors was conducted based on the procurement method, direct procurement and perfusion (DPP) or normothermic regional perfusion (NRP). After creating the sample cohort, a total of 14,035 HTx recipients were included in our analysis (DBD 86.5%, DCD III 6.9%, DCD IV 6.5%). There was an exponential increase in the number of DCD III cases and HTx centers that offer this donation type during the study period. DCD III recipients had a higher incidence of postoperative dialysis use; otherwise, all 3 groups shared similar rates of postoperative permanent pacemaker placement and stroke, acute rejection, and mortality. Within DCD III recipients, DPP and NRP procurement techniques had similar survival. To conclude, although DCD III was associated with an increased incidence of postoperative dialysis use, both DCD type III and IV had comparable morbidity and survival as the standard of care DBD donors. Overall, our investigation provides encouraging data to support DCD use as a safe option to increase the limited donor pool in the United States.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 83-88"},"PeriodicalIF":2.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999406","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":"A Phase 1b Randomized Clinical Trial of AZD5642 and Dapagliflozin in Patients With Heart Failure and Moderate Renal Impairment","authors":"Macarena Paz Quintana-Hayashi PhD ,&nbsp;Kathleen Connolly PhD ,&nbsp;Peter Greasley PhD ,&nbsp;Melanie Chan MS ,&nbsp;Masood Sadaat MD ,&nbsp;Sara Svedlund MD, PhD ,&nbsp;Jaya Birgitte Rosenmeier MD, PhD","doi":"10.1016/j.amjcard.2025.08.046","DOIUrl":"10.1016/j.amjcard.2025.08.046","url":null,"abstract":"<div><div>AZD5462 is the first oral selective relaxin/insulin-like family peptide receptor 1 agonist in clinical development. The aim of this mechanistic study is to investigate the renal effects of AZD5462 when administered on top of the sodium–glucose cotransporter 2 inhibitor dapagliflozin in participants with heart failure and moderate renal impairment. AURORA is a phase 1b, placebo-controlled, double-blind, 2-centre study of AZD5462 on top of dapagliflozin as standard of care in 2 arms. Approximately 40 participants with heart failure with ejection fraction ≤50% and moderate renal impairment (estimated glomerular filtration rate of 30–60 mL/min/1.73 m², inclusive) will be randomized 1:1 to AZD5462 or placebo tablets for a treatment period of 4 weeks. All participants will be standardized to 10 mg dapagliflozin prior to AZD5462 administration, and dapagliflozin as standard of care will continue until the end of the follow-up period. The objectives of the study are to evaluate the renal and haemodynamic effects of AZD5462 compared with placebo on top of dapagliflozin on natriuresis, albuminuria, haematocrit, fluid balance, cardiorenal biomarkers, and systemic hemodynamics. The safety and tolerability of AZD5462 will be further evaluated compared with placebo on top of dapagliflozin. AURORA is a phase 1b pharmacodynamic, pharmacokinetic, and safety study of AZD5462 on top of dapagliflozin in patients with heart failure and renal impairment.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 49-53"},"PeriodicalIF":2.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999431","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":"Association of Maternal Cardiac Disease and Echocardiographic Parameters With Neonatal Outcomes","authors":"Yamini Krishnamurthy MD ,&nbsp;Stephanie E Purisch MD ,&nbsp;Pierre Elias MD ,&nbsp;Timothy J Poterucha MD ,&nbsp;Jennifer Haythe MD ,&nbsp;Marlon Rosenbaum MD ,&nbsp;Matthew J Lewis MD, MPH","doi":"10.1016/j.amjcard.2025.08.049","DOIUrl":"10.1016/j.amjcard.2025.08.049","url":null,"abstract":"<div><div>Women with cardiac disease have worse neonatal outcomes compared to women without cardiac disease; risk factors are not well-defined. We hypothesized that structural heart disease, as assessed by echocardiography, is a noninvasive metric for abnormal hemodynamics and an unfavorable maternal-fetal environment. We assessed the association between echocardiographic markers of structural heart disease in women with cardiac disease and a primary endpoint of adverse neonatal outcomes operationalized as neonates with small-for-gestational-age birth weight, preterm delivery, neonatal intensive care unit/transition care unit admission, or neonatal/fatal demise. Women with cardiac disease who delivered at a tertiary care center between 2014 and 2022 were included. Echocardiographic parameters and neonatal outcomes were collected. A subgroup analysis was performed among women with congenital heart disease (CHD). Among 1,108 women, maternal diagnoses of pulmonary hypertension (OR 5.7, 95% CI 1.8–18.6), hypertensive disease (OR 3.8, 95% CI 2.4–6.2), CHD (OR 2.2, 95% CI 1.3–3.8), and cardiomyopathy (OR 2.0, 95% CI 1.1–3.8) were associated with the primary endpoint. Peak tricuspid regurgitation velocity was associated with the primary endpoint (OR 1.9, 95% CI 1.2–3.1). Biventricular function and severity of valvular disease were not associated with the primary endpoint in the total study population and in the CHD subgroup. In conclusion, maternal cardiac diagnosis is associated with adverse neonatal outcomes. Structural heart disease as assessed by echocardiography was not predictive of adverse neonatal outcomes. Large-scale studies are needed to identify drivers of adverse neonatal outcomes in women with cardiac disease.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 76-82"},"PeriodicalIF":2.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999403","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 Clinical Impact of Intravascular Imaging-Guided Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients with High Thrombus Burden","authors":"Jinhwan Jo MD ,&nbsp;Hyun Sung Joh MD ,&nbsp;Hyun Kuk Kim MD, PhD ,&nbsp;Ju Han Kim MD, PhD ,&nbsp;Young Joon Hong MD, PhD ,&nbsp;Young Keun Ahn MD, PhD ,&nbsp;Myung Ho Jeong MD, PhD ,&nbsp;Seung Ho Hur MD, PhD ,&nbsp;Doo-Il Kim MD, PhD ,&nbsp;Kiyuk Chang MD, PhD ,&nbsp;Hun Sik Park MD, PhD ,&nbsp;Jang-Whan Bae MD, PhD ,&nbsp;Jin-Ok Jeong MD, PhD ,&nbsp;Yong Hwan Park MD, PhD ,&nbsp;Kyeong Ho Yun MD, PhD ,&nbsp;Chang-Hwan Yoon MD, PhD ,&nbsp;Yisik Kim MD, PhD ,&nbsp;Jin-Yong Hwang MD, PhD ,&nbsp;Hyo-Soo Kim MD, PhD ,&nbsp;Woochan Kwon MD ,&nbsp;Joo Myung Lee MD, MPH, PhD","doi":"10.1016/j.amjcard.2025.08.064","DOIUrl":"10.1016/j.amjcard.2025.08.064","url":null,"abstract":"<div><div>Despite the established clinical efficacy following intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) than angiography-guided PCI, evidence regarding prognostic benefits of IVI-guided PCI in acute myocardial infarction (AMI) patients with high thrombus burden remains limited. Using the nationwide registries of KAMIR-NIH and KAMIR-V, we evaluated the prognostic impact of IVI-guided PCI in AMI patients with high thrombus burden. A total of 4,074 patients with AMI and TIMI thrombus grades 4 or 5 who underwent aspiration thrombectomy were selected, of whom 892 patients (21.9%) received IVI-guided PCI and 3,182 patients (78.1%) received angiography-guided PCI. Primary outcome was major adverse cardiovascular event (MACE, a composite of all-cause death, MI, repeat revascularization, and stent thrombosis). Major secondary efficacy outcome was cardiac death and safety outcome was stroke at 3 years. During the median 3 years of follow-up, the risk of MACE was significantly lower in the IVI-guided PCI group than in the angiography-guided PCI group (12.9% vs 16.3%; adjusted HR, 0.80; 95% CI, 0.65 to 0.98; p = 0.035), mainly driven by a lower risk of all-cause death (5.7% vs 10.0%; adjusted HR, 0.65; 95% CI, 0.48 to 0.89; p = 0.007). IVI-guided PCI also showed lower risk of cardiac death compared with angiography-guided PCI (3.8% vs 7.0%; adjusted HR, 0.65; 95% CI, 0.44 to 0.95; p = 0.025). There was no significant difference in the risk of stroke between the groups. In this hypothesis generating study, IVI-guided PCI was associated with a lower risk of MACE and cardiac death than angiography-guided PCI in AMI patients with high thrombus burden.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 54-62"},"PeriodicalIF":2.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999467","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":"Increasing Rate of Unfilled Training Positions in the Advanced Heart Failure and Transplant Cardiology Match","authors":"Jason Silvestre MD ,&nbsp;Ahmed Brgdar MD ,&nbsp;Jay Chen MD ,&nbsp;Thomas G Di Salvo MD","doi":"10.1016/j.amjcard.2025.08.047","DOIUrl":"10.1016/j.amjcard.2025.08.047","url":null,"abstract":"<div><div>Advanced Heart Failure and Transplant Cardiology (AHFTC) is a vital subspecialty addressing the growing burden of heart failure and the increasing need for advanced therapies such as mechanical circulatory support and heart transplantation. Despite rising clinical demand, interest in AHFTC fellowship training appears to be declining. This study evaluated trends in applicants, training positions, match rates, and unfilled positions in the AHFTC match from 2020 to 2025. We performed a national, cross-sectional analysis of all AHFTC fellowship applicants during this period. Primary outcomes included the annual number of applicants and training positions, match rates, and the percentage of unfilled positions. Temporal trends were analyzed using linear regression. Between 2020 and 2025, 470 applicants competed for 737 training positions, resulting in an overall fill rate of 58%. Matched fellows included 52% US allopathic and 48% non-US allopathic graduates. The number of training positions per year increased by 10% (115 to 127) while the number of applicants per year decreased by 24% (84 to 64). The applicant-to-position ratio decreased significantly from 0.7 to 0.5 (p &lt; 0.001), and unfilled positions rose from 30% to 52% (p &lt; 0.001). The proportion of applicants matching at their first-choice program increased from 67% to 83% (p &lt; 0.001). These findings highlight a growing mismatch between AHFTC training capacity and applicant interest. To preserve the future workforce needed to address the rising burden of heart failure, efforts are needed to stimulate interest in AHFTC training.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 69-75"},"PeriodicalIF":2.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999459","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":"Representation of Heart Failure Patients According to Age, Sex, and Race in US-Based Exercise Trials: A Systematic Review with Meta-Analysis of Randomized Trials","authors":"George A. Kelley DA, FACSM ,&nbsp;Kristi S. Kelley MEd ,&nbsp;Brian L. Stauffer MD, FACC","doi":"10.1016/j.amjcard.2025.08.060","DOIUrl":"10.1016/j.amjcard.2025.08.060","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 35-37"},"PeriodicalIF":2.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999426","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":"Comparative 3-Year Outcomes of Transcatheter Aortic Valve Replacement in Failed Transcatheter Versus Surgical Valves","authors":"Akiva Rosenzveig MD,&nbsp;Shivabalan Kathavarayan Ramu MBBS,&nbsp;Ankit Agrawal MD,&nbsp;Osamah Badwan MD,&nbsp;Faysal Massad MD,&nbsp;Grant Reed MD, MSc,&nbsp;Rishi Puri MD, PhD,&nbsp;Amar Krishnaswamy MD,&nbsp;Samir Kapadia MD","doi":"10.1016/j.amjcard.2025.08.052","DOIUrl":"10.1016/j.amjcard.2025.08.052","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 38-40"},"PeriodicalIF":2.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999414","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":"Angiotensin Receptor-Neprilysin Inhibitors and Mortality Among Patients With HFrEF","authors":"Henrik Svanström PhD ,&nbsp;George Frederick Mkoma MD, PhD ,&nbsp;Anders Hviid DrMedSci ,&nbsp;Björn Pasternak MD, PhD","doi":"10.1016/j.amjcard.2025.08.063","DOIUrl":"10.1016/j.amjcard.2025.08.063","url":null,"abstract":"<div><div>While trial evidence supports the benefit of angiotensin receptor-neprilysin inhibitor (ARNI) therapy in heart failure with reduced ejection fraction (HFrEF), its effectiveness in routine clinical practice is less explored. This study investigated the relative and absolute effectiveness of ARNI in patients with HFrEF. This nationwide Danish database study included patients with left ventricular ejection fraction (LVEF) ≤40%, 2018 to 2023. Using a prevalent new user design, 2,446 ARNI initiators were matched 1:2 to 4,892 users of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) based on propensity scores, age, LVEF, and NT-proBNP. The primary outcome was all-cause mortality; secondary outcomes were cardiovascular mortality and hospitalization. There were 279 deaths among ARNI initiators (5.6/100 person-years) and 533 among ACE-I/ARB users (6.7/100 person-years), yielding a hazard ratio (HR) of 0.85 (95% CI, 0.74 to 0.98) for all-cause mortality. A significant interaction was observed for recent hospitalization (p = 0.04), with ARNI yielding a lower HR in this group. HRs were otherwise consistent across age, sex, LVEF, NT-proBNP, NYHA class, ischemic heart disease, chronic kidney disease, and type 2 diabetes. The largest absolute mortality reductions were seen in subgroups with recent hospitalization, NYHA class III to IV, and severely elevated NT-proBNP. ARNI was also associated with a lower risk of cardiovascular death (HR, 0.81; 95% CI, 0.65 to 0.99), but not with other secondary outcomes. In this study, ARNI was associated with a 15% reduction in all-cause mortality vs ACE-I/ARB. Patients with advanced or symptomatic heart failure appeared to experience the greatest absolute benefit.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 158-164"},"PeriodicalIF":2.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999441","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}