American Journal of Cardiology最新文献

{"title":"Prevalence, Predictors and Clinical Outcomes of Percutaneous Coronary Intervention For In-Stent Restenosis versus De Novo Coronary Artery Disease","authors":"Millie Watkins MBChB ,&nbsp;Jacob Park MD ,&nbsp;Diem Dinh PhD ,&nbsp;Angela Brennan PhD ,&nbsp;Riley Batchelor MBBS ,&nbsp;Dion Stub PhD ,&nbsp;Christopher Reid PhD ,&nbsp;Anoop N. Koshy PhD ,&nbsp;Jeffrey Lefkovits MD ,&nbsp;Andrew J. Taylor PhD ,&nbsp;Sinjini Biswas PhD ,&nbsp;VCOR investigators","doi":"10.1016/j.amjcard.2025.11.027","DOIUrl":"10.1016/j.amjcard.2025.11.027","url":null,"abstract":"<div><div>In-stent restenosis (ISR) remains a challenging complication following percutaneous coronary intervention (PCI), owing to its complex pathogenesis and multifaceted risk factor profile. We performed a retrospective analysis of all PCI data recorded in the Victorian Cardiac Outcomes Registry (VCOR), from 2013 to 2022, dividing patients into the ISR or de novo-PCI groups based on the intervened lesion. The primary outcome was in hospital mortality, with secondary outcomes including 30-day major adverse cardiovascular events and long-term mortality. Among 104,722 total PCI procedures, 4,935 procedures (4.7%) were for ISR, and 99,787 procedures (95.3%) were for de novo coronary lesions. Patients with ISR were older (mean age 69.0 ± 10.7 years vs. 66.4 ± 11.9 years, p &lt; 0.001) with a higher burden of comorbidities including advanced chronic kidney disease (eGFR less than 31ml/min/1.73m² (4.2% vs. 2.5%, p &lt; 0.001)), peripheral vascular disease (6.3% vs. 3.3%, p &lt; 0.001) and diabetes mellitus (34.8% vs. 22.3%, p &lt; 0.001). Lesion complexity was higher in the ISR group, with more lesions classified as ACC/AHA Type B2 and above (74.8% vs. 59.6%, p &lt; 0.001). Adjunctive imaging devices were more commonly utilized in the ISR group; however, use was generally low (8.4% vs. 2.8%, p &lt; 0.001). In-hospital mortality was lower in the ISR group, whereas 30-day target vessel and lesion revascularization rates were higher (1.3% vs. 0.7%, p &lt; 0.001 and 0.8% vs. 0.4%, p = 0.001 respectively). Long term mortality as assessed over 10 years was higher in the ISR group. In conclusion, compared with de novo PCI, patients undergoing ISR PCI were older with greater comorbidities and lesion complexity. ISR PCI was associated with lower in-hospital mortality but worse long-term survival. These findings provide contemporary, population-based evidence on the evolving clinical profile and outcomes of ISR in routine PCI practice.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 45-51"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877341","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 Performance of Machine Learning and Traditional Risk Scores in Predicting Adverse Events After Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation","authors":"Johny Nicolas MD, MSc ,&nbsp;George Dangas MD, PhD ,&nbsp;Amanda Borrow PhD ,&nbsp;Rüdiger Smolnik MD ,&nbsp;Felix Just PhD ,&nbsp;Cathy Chen MD, MSc ,&nbsp;Krishna Padmanabhan PhD ,&nbsp;Eva-Maria Fronk PhD ,&nbsp;Christian Hengstenberg MD ,&nbsp;Nicolas Van Mieghem MD, PhD ,&nbsp;Martin Unverdorben MD, PhD","doi":"10.1016/j.amjcard.2025.12.002","DOIUrl":"10.1016/j.amjcard.2025.12.002","url":null,"abstract":"<div><div>Patients with atrial fibrillation (AF) following transcatheter aortic valve replacement (TAVR) remain at risk of ischemic stroke (IS) and bleeding. However, traditional risk scores provide modest predictions of IS and bleeding in these patients. We aimed to develop machine learning (ML) models that predict IS, major gastrointestinal bleeding (MGIB), all clinically relevant bleeding (CRB), and net adverse clinical events (NACE) using data from patients in the ENVISAGE-TAVI AF trial. Ten ML algorithms were trained per outcome using nested cross-validation; the best-performing model (highest F1 score) was validated on a 25% holdout set. Model performance was compared with logistic regression models using CHA₂DS₂-VA or HAS-BLED. Among 1,377 patients, 41 had an IS, 83 had MGIB, 375 had CRB, and 255 experienced NACE. The predictive abilities of a linear discriminant analysis algorithm for IS (F1 score = 0.08) and CHA₂DS₂-VA (F1 score = 0.09) were similarly low, but numerically better than HAS-BLED (F1 score = 0.05). Prediction of MGIB was similarly low for a logistic-lasso algorithm (F1 score = 0.11), CHA₂DS₂-VA (F1 score = 0.09), and HAS-BLED (F1 score = 0.12). For CRB, the predictive performance of a Naïve Bayes algorithm (F1 score = 0.39) was similar to CHA₂DS₂-VA (F1 score = 0.38) and HAS-BLED (F1 score = 0.41). The predictive ability of a logistic regression algorithm for NACE (F1 score = 0.33) was numerically better than CHA₂DS₂-VA (F1 score = 0.22) or HAS-BLED (F1 score = 0.27). In conclusion, ML offered similar predictive ability to established risk scores for thromboembolic and bleeding outcomes among TAVR patients with AF.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 91-97"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773355","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":"Evaluating the Accessibility of Transcatheter and Surgical Aortic Valve Replacement Across the US Via Driving-Times","authors":"Sohum Kapadia BS ,&nbsp;Miles Shen MD ,&nbsp;Jonathan Hanna MD ,&nbsp;Kevin Wheelock MD ,&nbsp;Aline F. Pedroso PhD ,&nbsp;Amit Vora MD, MPH ,&nbsp;Lovedeep S. Dhingra MBBS ,&nbsp;Arya Aminorroaya MD, MPH ,&nbsp;Rohan Khera MD, MS","doi":"10.1016/j.amjcard.2025.12.007","DOIUrl":"10.1016/j.amjcard.2025.12.007","url":null,"abstract":"<div><div>While transcatheter aortic valve replacement (TAVR) is a rapidly expanding minimally invasive alternative to surgical aortic valve replacement (SAVR), its access might be limited due to proximity to a TAVR center. Among Medicare beneficiaries, real-world driving times from residential zip codes to TAVR and SAVR center zip codes were computed using the Google Distance Matrix Application Programming Interface. Zip code-level sociodemographic correlates of driving times more than 1 hour to TAVR and SAVR centers were computed using generalized linear mixed-effects models. Of 29,089 US residential zip codes, 407 (1.4%) had a TAVR center and 639 (2.2%) a SAVR center. The median driving time to the nearest zip code with a TAVR center (59 min [IQR, 30–96]) was longer compared with SAVR center (44 min [IQR, 24–73]), and driving times were longer in Western and Southern regions compared with the Northeast. A higher proportion of beneficiaries drive over 1 hour to nearest TAVR center (24.3%) compared with SAVR center (13.1%). Zip codes with a higher median age, a higher ratio of Hispanic to White individuals, and outside metropolitan areas were more likely to have driving times longer than 1 hour to the nearest TAVR centers. In conclusion, access to TAVR is consistently lower compared with SAVR centers, particularly in the Western and Southern US. The geographic barrier to access care, particularly among socioeconomically disadvantaged rural communities, requires evaluating the selection process for sites that provide care.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 61-67"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877395","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":"Cardiac Rehabilitation for Coronary Artery Disease: Gaps, Digital Models, and the Future of Personalized Prevention","authors":"Harroop Bola MBBS ,&nbsp;Amar Rai MBBS ,&nbsp;Rahul Penumaka MBBS ,&nbsp;Edagul Ulucay DPhil ,&nbsp;Eleanor Levin MD ,&nbsp;David Maron MD","doi":"10.1016/j.amjcard.2025.12.013","DOIUrl":"10.1016/j.amjcard.2025.12.013","url":null,"abstract":"<div><div>Cardiovascular disease is the leading cause of global morbidity and mortality, with coronary artery disease representing the primary driver of premature death. Cardiac rehabilitation (CR) is a cornerstone of secondary prevention that integrates exercise, risk factor modification, and education. CR reduces all-cause mortality, recurrent ischemic events, and improves quality of life. Yet, participation remains suboptimal, and CR is underutilized by women, older adults, minorities, and socioeconomically disadvantaged groups. We examine the modalities of CR including traditional center-based CR (CBCR), home-based CR and hybrid models. By leveraging telemedicine, mobile health, and wearable biosensors remote delivery of CR has shown comparable efficacy to traditional CBCR. The integration of artificial intelligence offers opportunities to personalize CR through continuous physiological monitoring and exercise prescriptions. In conclusion, CR remains cost-effective from a health-system perspective, but patient-level affordability and equitable access require targeted policy, financial, and culturally adapted interventions to ensure personalized and equitable delivery of secondary prevention.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 16-27"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861630","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 Aortic Valve Replacement in Patients With Extra-Large Aortic Annuli: Insights From a Large Cohort","authors":"Ziad Arow MD ,&nbsp;Omar Oliva MD ,&nbsp;Laurent Bonfils MD ,&nbsp;Laurent Lepage MD ,&nbsp;Abid Assali MD ,&nbsp;Ranin Hilu MD ,&nbsp;Nicolas Dumonteil MD ,&nbsp;Didier Tchetche MD ,&nbsp;Chiara De Biase MD","doi":"10.1016/j.amjcard.2025.12.015","DOIUrl":"10.1016/j.amjcard.2025.12.015","url":null,"abstract":"<div><div>Patients with large or extra-large aortic annuli pose a particular challenge for Transcatheter aortic valve replacement (TAVR), as clinical outcomes are less favorable than in patients with smaller annuli. This study aimed to evaluate periprocedural and clinical outcomes in patients with large and extra-large annuli undergoing TAVR and to compare results between balloon-expandable (BEVs) and self-expanding valves (SEVs). This study included patients with severe aortic stenosis (AS) and extra-large annuli who underwent TAVR with either BEVs or SEVs. The primary endpoints were periprocedural and clinical outcomes, including device success, rates of moderate or greater paravalvular leak (PVL), permanent pacemaker (PPM) implantation, new Left bundle branch block (LBBB), stroke, and in-hospital and 1-year mortality. Secondary endpoints included safety outcomes and subgroup analyses comparing outcomes between patients with large (annular perimeter &gt;90 mm and an area &gt;660 mm²) and extra-large annuli (perimeter &gt;96 mm and an area &gt;730 mm²). A total of 237 patients underwent TAVR, including 160 with BEVs and 77 with SEVs. The mean annular area and perimeter were 737 ± 76 mm² and 96.1 ± 4.1 mm, respectively, with no significant differences between groups. Overall device success was high, though slightly lower in the SEV group (84% vs. 93%, p = 0.034), a difference that was no longer statistically significant after multivariate analysis (p = 0.234). Moderate or greater PVL occurred more frequently with SEVs (13% vs. 4%, p = 0.016), particularly in patients with extra-large annuli (26% vs. 4%, p = 0.012). One-year mortality was similar between groups (SEV 13% vs. BEV 12%, p = 0.807), and no significant differences were observed in PPM implantation, new LBBB, stroke, or major vascular and bleeding complications. TAVR is feasible and safe in patients with large and extra-large annuli, with higher rates of moderate or greater paravalvular leak observed in SEV patients with extra-large annuli.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 1-5"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877372","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":"Renal Artery Stent Procedural Trends and Disparities in a National Cohort","authors":"Jason Gusdorf MD ,&nbsp;William B. Earle MD ,&nbsp;Siling Li MSc ,&nbsp;Anna Krawisz MD ,&nbsp;Stephen P. Juraschek MD, PhD ,&nbsp;Jennifer L. Cluett MD ,&nbsp;Brett J. Carroll MD ,&nbsp;Eric A. Secemsky MD, MSc","doi":"10.1016/j.amjcard.2025.12.011","DOIUrl":"10.1016/j.amjcard.2025.12.011","url":null,"abstract":"<div><div>Atherosclerotic renal artery stenosis (RAS) affects nearly 7% of adults over age 65 and is associated with increased cardiovascular and renal morbidity. Although early observational studies suggested benefit from renal artery stenting, subsequent randomized trials failed to show improvement in major clinical endpoints, contributing to substantial declines in procedural use. To characterize contemporary practice, we conducted a retrospective cohort study of Medicare beneficiaries older than 65 years who underwent renal artery stenting for atherosclerotic RAS between 2016 and 2020. Using Medicare claims data, we evaluated baseline characteristics, temporal utilization, and postprocedural outcomes, stratified by race, geographic region, and dual Medicare–Medicaid enrollment status. Among 19,130 patients, the mean age was 76.0 years (±6.4), 59.2% were female, and 90.3% were White; 84.2% had chronic kidney disease and 48.7% had heart failure. Procedural rates declined by 41.1% over the study period. Compared with White patients, Black patients had higher adjusted risks of hypertensive crisis hospitalization (aHR 1.45, 95% CI, 1.24–1.70) and dialysis initiation (aHR 1.78, 95% CI, 1.39–2.27); patients of Other races also had greater risk of dialysis initiation (aHR 1.98, 95% CI, 1.50–2.63). Patients in the South experienced higher unadjusted cardiovascular event rates (50.0%) but similar adjusted mortality compared with those in the Northeast (aHR 1.09, 95% CI, 0.98–1.21). Dual enrollment was associated with increased all-cause mortality (aHR 1.31, 95% CI, 1.20–1.43). In conclusion, renal artery stenting rates continued to decline in recent years, and contemporary recipients constitute an older, comorbid population with substantial cardiovascular risk. Outcomes differed markedly by race, socioeconomic status, and geography, highlighting the need for improved risk stratification and prospective evaluation of stenting in high-risk cohorts.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 52-60"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877375","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":"Dynamic Changes in Right Ventricular-Pulmonary Arterial Coupling During Acute Heart Failure Hospitalization: Prognostic Implications","authors":"Vasileios Anastasiou MD, MSc ,&nbsp;Evdoxia Stavropoulou MD, MSc ,&nbsp;Emmanouela Peteinidou MD, MSc ,&nbsp;Anastasia Nikolaidou MD, MSc ,&nbsp;Stylianos Daios MD, MSc ,&nbsp;Emmanouil Fardoulis MD, MSc ,&nbsp;Theodoros Karamitsos MD, PhD ,&nbsp;George Giannakoulas MD, PhD ,&nbsp;Katerina Κ. Naka MD, PhD ,&nbsp;Victoria Delgado MD, PhD ,&nbsp;Antonios Ziakas MD, PhD ,&nbsp;Vasileios Kamperidis MD, MSc, PhD","doi":"10.1016/j.amjcard.2025.12.010","DOIUrl":"10.1016/j.amjcard.2025.12.010","url":null,"abstract":"<div><div>Right ventricular (RV) - pulmonary arterial (PA) uncoupling is an important predictor of outcomes in heart failure (HF), yet it may change substantially during hospitalization for acute HF. This study sought to investigate the dynamic changes in RV-PA uncoupling during acute HF hospitalization and their prognostic significance. Tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio was measured in consecutive hospitalized acute HF patients using echocardiography on admission and at discharge. TAPSE/PASP &lt;0.36 mm/mmHg was considered as RV-PA uncoupling. Patients were divided into 3 groups; RV-PA coupling on admission and discharge, RV-PA uncoupling on admission that normalized to RV-PA coupling at discharge (normalized RV-PA uncoupling), and RV-PA uncoupling on admission that persisted at discharge (persistent RV-PA uncoupling). The primary endpoint was all-cause mortality and HF rehospitalization. Out of 490 patients (73.4 ± 11.9 years old), 216 (44.1%) had RV-PA coupling, 123 (25.1%) normalized RV-PA uncoupling, and 151 (30.8%) persistent RV-PA uncoupling. After a mean follow-up of 12.0 ± 2.6 months, 186 (38.0%) patients reached the primary endpoint. Significantly worse event-free survival rate was observed for the persistent RV-PA uncoupling patients (RV-PA coupling: 74.1%, normalized RV-PA uncoupling: 71.5%, persistent RV-PA uncoupling: 37.1%, Log-rank p &lt; 0.001). Persistent RV-PA uncoupling status was independently associated with the primary endpoint (hazard ratio 2.78 [95% CI 1.73–4.44]; p &lt; 0.001), and provided incremental prognostic information over a baseline model and RV-PA uncoupling on admission. In conclusion, in hospitalized acute HF patients, persistence of RV-PA uncoupling at discharge is associated with worse 1-year event-free survival. Clinical Trial Registration: <span><span>https://www.clinicaltrials.gov/study/NCT05573997</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 6-15"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861661","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":"Atrial Fibrillation and Risk of Incident Cognitive Impairment: The REasons for Geographic and Racial Differences in Stroke Study","authors":"Vinh H. Le MD ,&nbsp;Katherine S. Wilkinson MS ,&nbsp;Suzanne E. Judd PhD ,&nbsp;Elsayed Z. Soliman MD, MS, MSc ,&nbsp;Hyacinth I. Hyacinth PhD, MPH, MBBS ,&nbsp;Melissa J. Smith PhD ,&nbsp;Nels C. Olson PhD, MPH ,&nbsp;Mary Cushman MD, MSc","doi":"10.1016/j.amjcard.2025.11.025","DOIUrl":"10.1016/j.amjcard.2025.11.025","url":null,"abstract":"<div><div>Atrial fibrillation (AF) and cognitive impairment will each double in prevalence over the next 20 years. Most studies on AF and cognitive disorders have focused on dementia, with less research on cognitive impairment generally. We assessed the association of AF with incident cognitive impairment (ICI) and whether inflammation biomarkers or anticoagulant use attenuated this. The REasons for Geographic and Racial Differences in Stroke (REGARDS) study enrolled 30,239 adults ≥45 years old in 2003-07. Among those without baseline cognitive impairment, ICI was identified by standardized telephone assessments. Hazard ratios (HRs) of ICI were calculated using Cox proportional hazards models. Differences in associations by prevalent stroke, race, and oral anticoagulant use were tested using interaction terms. Among 23,638 participants (mean age 64 years, 56% women, 38% Black), 7% developed ICI over 13 years. AF was associated with ICI among those with prevalent stroke (adjusted HR: 1.69, 95% CI: 1.11–2.56) but not without (HR: 1.05, 95% CI: 0.88–1.27; p interaction = 0.07). The association was not attenuated by anticoagulant use and did not differ by race. Among those with prevalent stroke, there was a small-to-modest attenuation after adjusting for inflammation markers, with the largest attenuation by albumin (15%). In conclusion, in this large cohort, AF was associated with ICI in those with – but not in those without – prevalent stroke. Inflammation biomarkers had modest attenuating effects, and anticoagulation use did not. Results underscore the importance of considering cognitive impairment after stroke in those with AF and identifying underlying causes and preventive treatments.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 28-34"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888756","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":"Concomitant Tricuspid Annuloplasty During Degenerative Mitral Valve Repair: A Systematic Review and Meta-Analysis","authors":"Xander Jacquemyn MD ,&nbsp;Ganduboina Rohit MBBS ,&nbsp;Michel Pompeu Sá MD, PhD ,&nbsp;Johannes Bonatti MD ,&nbsp;Irsa Hasan MD ,&nbsp;Takuya Ogami MD ,&nbsp;Tom Verbelen MD, PhD ,&nbsp;Peter Verbrugghe MD, PhD ,&nbsp;Filip Rega MD, PhD ,&nbsp;Ibrahim Sultan MD","doi":"10.1016/j.amjcard.2025.12.019","DOIUrl":"10.1016/j.amjcard.2025.12.019","url":null,"abstract":"<div><div>Tricuspid regurgitation (TR) is common among patients undergoing surgery for degenerative mitral regurgitation (DMR) and is associated with adverse outcomes. The role of concomitant tricuspid annuloplasty (TA) during mitral valve repair (MVr) remains controversial. To address this, we performed a systematic review and meta-analysis of randomized and observational studies published up to November 2024, comparing isolated MVr versus MVr with concomitant TA in patients with DMR (CRD42024627505). Reconstructed Kaplan–Meier time-to-event data were analyzed using Cox frailty models to evaluate survival, TR progression, and permanent pacemaker (PPM) implantation. Sensitivity analyses included randomized or propensity-matched cohorts. A total of 5 studies, including 3,123 patients, were analyzed. Early (1-year) and long-term (up to 15 years) survival were comparable between isolated MVr and concomitant TA (97.3% vs. 96.9%, HR: 1.25, 95% CI: 0.76 to 2.08, p = 0.381 and 72.2% vs 79.7%, HR: 1.28, 95% CI: 0.96 to 1.72, p = 0.092, respectively). Concomitant TA significantly reduced the risk of ≥moderate TR progression (HR: 0.34, 95% CI: 0.17 to 0.70, p = 0.003). However, PPM implantation was higher with TA during the perioperative period (7.4% vs 1.1%, HR 5.76, 95% CI 3.13 to 10.59) and remained elevated at 2 years. Sensitivity analyses confirmed these findings. In conclusion, in patients undergoing MVr for DMR, concomitant TA effectively prevents TR progression without compromising survival but is associated with increased PPM implantation. These results support a selective, guideline-directed approach to TA based on patient- and disease-specific risk factors.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 68-74"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888746","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":"Artificial Intelligence as a Prognostic Tool in Cardiac Amyloidosis: A Review","authors":"Darren Kong DO ,&nbsp;Matthew Capustin MD ,&nbsp;Matthew Ho MD ,&nbsp;James Choi MD ,&nbsp;David Lee Stern MD ,&nbsp;Michael Hadley MD ,&nbsp;Dennis Finkielstein MD","doi":"10.1016/j.amjcard.2025.12.018","DOIUrl":"10.1016/j.amjcard.2025.12.018","url":null,"abstract":"<div><div>Cardiac amyloidosis (CA) poses a significant prognostic challenge due to its varied presentations and frequent delays in identification. While traditional prognosticators, such as cardiac biomarkers and imaging parameters, offer valuable information, there are significant challenges with individualizing prognosis and accounting for its complex and heterogeneous nature. Artificial intelligence (AI) has enhanced the precision across multiple modalities and has emerged as a prognostic tool in cardiac amyloidosis, demonstrated through models that predict disease progression and stratify patient risk, often outperforming or complementing traditional staging systems. Utilizing AI-derived prognostic information ultimately facilitates informed decision-making—including early initiation of treatments, referrals to specialized centers, and planning for advanced therapies—thereby improving patient outcomes in cardiac amyloidosis. This review aims to synthesize the current advancements and applications of artificial intelligence in predicting outcomes and guiding management strategies for cardiac amyloidosis.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 75-82"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888777","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}