American Journal of Cardiology最新文献

{"title":"Comparative Outcomes and Cardiac Imaging Features in Light Chain Versus Transthyretin Cardiac Amyloidosis: A Multi-Center Retrospective Cohort Study.","authors":"Hassan Mahmood, Julius Albert Kato","doi":"10.1016/j.amjcard.2025.09.063","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.063","url":null,"abstract":"<p><p>Cardiac amyloidosis, most commonly presenting as immunoglobulin light-chain (AL) and wild-type transthyretin (ATTR-wt) subtypes, has distinct pathophysiological features and prognoses. Accurate differentiation between these forms is critical for patient management. We conducted a multi-center retrospective cohort study of 200 patients (100 AL, 100 ATTR-wt) diagnosed between 2015 and 2022 within the Baptist Health System in the Southern United States. Clinical, biochemical, echocardiographic, and cardiac magnetic resonance imaging data were systematically reviewed. Patients with light-chain amyloidosis were younger, exhibited higher serum proBNP, lower left ventricular ejection fraction, and greater impairment in global longitudinal strain compared with those with transthyretin amyloidosis. Imaging patterns also differed, with subendocardial late gadolinium enhancement predominating in AL and transmural enhancement more frequent in ATTR-wt. Clinically, AL patients experienced substantially higher heart failure hospitalization rates and worse two-year survival. In conclusion, significant demographic, imaging, and outcome differences exist between light-chain and transthyretin cardiac amyloidosis, highlighting the importance of multimodal assessment to guide timely and targeted management strategies.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285471","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":"Aortic Arch Morphology and Cerebrovascular Accidents after Transfemoral Transcatheter Aortic Valve Implantation.","authors":"Laura Baltruskeviciute, Federico Moccetti, Mathias Wolfrum, Lucca Loretz, Stephanie Brunner, Maani Hakimi, Peter Matt, Stefan Toggweiler","doi":"10.1016/j.amjcard.2025.09.066","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.066","url":null,"abstract":"<p><p>Cerebrovascular accidents (CVA) after transcatheter aortic valve implantation (TAVI) remain a major concern. However, the impact of aortic arch morphology has not been investigated in this context. To address this gap, consecutive patients undergoing transfemoral TAVI between March 2009 and January 2025 were analysed. Aortic arch morphology was assessed on pre-procedural computed tomography scans, including measurements of arch angle, presence of calcification and soft plaques. Patients were classified as having an acutely angled (gothic, angle ≤ 138°) aortic arch or a round (romanesque, angle > 138°) arch. The primary endpoint was the occurrence of CVA within 30 days following TAVI. A total of 1248 patients with a mean age of 81 ± 6 years (44% female) were studied. CVA occurred in 38 patients (3.0%) within 30 days. Notably, patients who experienced CVA had a significantly higher prevalence of a round arch (89% vs. 72%, p=0.021) and soft plaques along the outer curvature (45% vs. 26%, p=0.010). Other predictors of CVA included peripheral arterial disease (29% vs. 12%, p=0.002) and implantation of more than one transcatheter heart valve (11% vs. 2%, p<0.001). Interestingly, use of cerebral protection devices did not reduce stroke rates. In conclusion, an acutely angled (gothic) arch was not associated with increased risk for CVA within 30 days after TAVI. Instead, a round arch and soft plaques along the outer curvature were associated with more strokes. Such patients may benefit from careful advancement of the valve catheter when crossing the aortic arch or an alternative (transapical, direct aortic) access route.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278892","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 Between High-Density Lipoprotein Cholesterol and the Risk of Cardiovascular Disorders: A Cohort Study of Healthy Adults.","authors":"Bo Eun Park, Kang-Un Choi, Ji-Yong Choi, Hyungseop Kim, Sojeong Park, Hasung Kim","doi":"10.1016/j.amjcard.2025.10.004","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.10.004","url":null,"abstract":"<p><p>High-density lipoprotein cholesterol (HDL-C) has been considered protective against cardiovascular (CV) disease, but its correlation with reduced CV risk was inconsistent. This retrospective study analyzed the relationship between HDL-C levels and CV outcomes from South Korea's National Health Insurance Service on healthy adults, focusing on conditions such as ischemic heart disease (IHD), stroke, heart failure (HF), and mortality. Cox proportional hazards regression and Kaplan-Meier curves were used for primary (CV death, IHD, stroke) and secondary (plus all-cause mortality and HF) composite endpoints. Covariates included age, sex, body mass index, blood pressure, lipid levels, glucose levels, and medication use. From 2009 to 2022, a total of 810,848 subjects were enrolled and divided into three groups based on HDL-C levels: HDL-C ≤ 40 mg/dL, 40 < HDL-C < 60 mg/dL, and HDL-C ≥ 60 mg/dL. Compared with the reference group (HDL-C, 40-60 mg/dL), individuals with HDL-C ≤ 40 mg/dL had increased risks of all-cause mortality (HR 1.05, 95% CI 1.02-1.08), CV death (HR 1.12, 95% CI 1.05-1.20), ischemic stroke (HR 1.11, 95% CI 1.07-1.15), IHD (HR 1.08, 95% CI 1.06-1.09), and HF (HR 1.09, 95% CI 1.05-1.13). HDL-C ≥ 60 mg/dL was associated with a lower risk of IHD (HR 0.95, 95% CI 0.94-0.96) but a higher risk of hemorrhagic stroke (HR 1.13, 95% CI 1.08-1.19). A U-shaped association was observed for all-cause mortality. In conclusion, higher HDL-C was associated with lower CVD risk but increased hemorrhagic stroke and all-cause mortality, suggesting the need for nuanced HDL-C interpretation.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273322","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 Pulmonary Disease on Clinical Outcomes in Patients Undergoing Mitral Valve Edge-to-Edge Repair.","authors":"Juri Iwata, Masanori Yamamoto, Toshinobu Ryuzaki, Hikaru Tsuruta, Takashige Yamada, Hideyuki Shimizu, Shunsuke Kubo, Yuki Izumi, Mike Saji, Masahiko Asami, Yusuke Enta, Shinichi Shirai, Masaki Izumo, Shingo Mizuno, Yusuke Watanabe, Makoto Amaki, Kazuhisa Kodama, Hisao Otsuki, Toru Naganuma, Hiroki Bota, Masahiro Yamawaki, Hiroshi Ueno, Gaku Nakazawa, Daisuke Hachinohe, Toshiaki Otsuka, Yohei Ohno, Masaki Ieda, Kentaro Hayashida","doi":"10.1016/j.amjcard.2025.10.005","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.10.005","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary diseases (PD) are frequently associated with impaired cardiac function and the presence of mitral and tricuspid regurgitation (MR and TR).</p><p><strong>Objectives: </strong>The study aimed to clarify the impact of PD on clinical outcomes following mitral transcatheter edge-to-edge repair (M-TEER).</p><p><strong>Methods: </strong>Of the 3,764 patients who underwent M-TEER, 3,666 were included in the analysis and stratified according to the absence or presence of PD before the procedure. The primary endpoint was all-cause mortality, evaluated using Kaplan-Meier analysis. Cardiovascular and non-cardiovascular mortality and HFH (HFH) were also assessed during a 4-year follow-up. Moreover, the prognostic impact of TR improvement after M-TEER was evaluated in patients with and without PD.</p><p><strong>Results: </strong>Of the 3,666 patients, 580 (15.8%) had PD, included fewer women, and exhibited greater frailty compared with those without PD. Within a median follow-up of 432 [314-826] days, all-cause mortality did not differ significantly between patients with PD and those without (150 [25.9%] vs. 682 [22.1%], Log rank P=0.331). No significant differences were observed in the incidence of cardiovascular mortality, non-cardiovascular mortality, and HFH between the two groups. When stratified by PD status, residual significant TR after M-TEER was significantly associated with HFH both in patients with PD and without PD.</p><p><strong>Conclusions: </strong>The intermediate-term prognosis after M-TEER was comparable between patients with and without PD. In patients with PD, MR was effectively reduced through minimally invasive M-TEER. However, appropriate management of TR after MTEER may be required to improve outcomes in this population.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273462","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 Hemostatic Agents on Radial Artery Compression Methods Following Transradial Procedures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Carlos De Melo Neto, Mariana Kondo Obara, Denise Filippini, Miguel Godeiro Fernandez, Dilson Pimentel Junior, Milena Monteiro Mastra, Enrico Prajiante Bertolino, Grace Carvajal Mulatti","doi":"10.1016/j.amjcard.2025.09.058","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.058","url":null,"abstract":"<p><p>Radial artery hemostasis in patients undergoing transradial procedures can be achieved through various compression methods, including manual or mechanical devices, with or without the use of hemostatic agents, and may involve patent hemostasis or concomitant ulnar compression. Previous findings suggest that radial artery compression should be maintained for 120 minutes post-procedure. However, the optimal compression method and the efficiency of hemostatic agents remain uncertain. Therefore, we decided to perform a systematic review and meta-analysis evaluating the efficacy of radial artery compression with adjunctive hemostatic agents versus compression without hemostatic agents on patients following transradial procedures. The systematic search was conducted using PubMed, Embase, and Cochrane Central databases. The outcomes evaluated were: time to achieve hemostasis (TAH), failure to achieve hemostasis (FAH), 24-hour radial artery occlusion (24-RAO), and hematoma occurrence. We performed subgroup analyses separating manual and mechanical compression with hemostatic agents. 13 randomized controlled trials were included, comprising 6,588 patients. 2,924 (44.4%) patients underwent compression with hemostatic agents, and 3,664 (55.6%) underwent compression without hemostatic agents. The statistical analysis indicated that hemostatic agents were associated with a significantly reduced TAH (MD -86.59 min; 95% CI -106.88 to -66.30; p < 0.01) compared to compressions without hemostatic agents. No statistical difference was found between the methods regarding 24-RAO, FAH, and hematoma occurrence. However, subgroup analyses revealed that, in the manual compression with hemostatic agents subgroup, 24-RAO was also significantly reduced (RR 0.46; 95% CI 0.27 to 0.78). In conclusion, this meta-analysis of randomized controlled trials reveals that compression with hemostatic agents, compared to compressions without hemostatic agents, can reduce TAH without compromising the occurrence of hematomas for patients following transradial procedures. 24-RAO was also less frequent in patients who underwent manual compression with hemostatic agents.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273551","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 and Patient Perceived Symptoms With Iso-Osmolar and Low Osmolar Contrast Used During Lower Extremity Peripheral Artery Intervention.","authors":"Minseob Jeong, Anand Gupta, Sameh Sayfo, Zachary P Rosol, R Tyler Miller, Shirling Tsai, Sarah G Weideman, Kennedy S Adelman, Harsh J Chauhan, Hima P Patel, David Fernandez-Vazquez, Subhash Banerjee","doi":"10.1016/j.amjcard.2025.09.061","DOIUrl":"10.1016/j.amjcard.2025.09.061","url":null,"abstract":"<p><p>Real-world data comparing iso-osmolar contrast media (IOCM) and low-osmolar contrast media (LOCM) during lower extremity (LE) peripheral artery interventions (PAI), particularly with respect to patient-reported symptoms during procedures and clinical outcomes, remain limited. A total of 440 patients undergoing LE PAI with either IOCM (Iodixanol) or LOCM (Iohexol) were retrospectively analyzed from the multicenter core laboratory adjudicated Excellence in peripheral artery disease (XLPAD) Registry (NCT01904851; 2020 to 2023). In addition, a prospective cohort of 60 patients was enrolled to assess intraprocedural symptoms using a 0 to 10 scale for pain, heaviness, tingling, and burning sensations. The primary endpoint was the 1-year incidence of major adverse limb events (MALE), a composite of all-cause mortality, repeat revascularization, major amputation, myocardial infarction, or stroke. Secondary outcomes included 30-day periprocedural complications, patient-reported symptoms, and the need for repeated digital subtraction angiograms (DSA) due to limb movement. An exploratory analysis including 40 additional retrospectively enrolled patients to the prospective cohort further evaluated DSA repetition rates. Finally, a mixed-effects logistic regression with institution as random effect and patient factors as fixed effect was used to access factors affecting choice of IOCM vs LOCM. Of the 440 patients, 244 (55.5%) received IOCM and 196 (45.5%) LOCM. The mean age was 67.8 ± 10.4 years. IOCM was more frequently used in patients with advanced limb-threatening ischemia (45.1% vs 36.7%, p = 0.077), severe calcification (19.3% vs 10.2%, p = 0.009), and diffuse arterial disease (41.0% vs 9.2%, p <0.001). Technical (95.5% vs 96.9%, p = 0.4) and procedural success (92.6% vs 95.8%, p = 0.2), as well as periprocedural complication rates (4.5% vs 3.6%, p = 0.3), were similar between groups. One-year MALE rates did not differ significantly (p = 0.5). In the prospective cohort, nearly half of patients reported intraprocedural discomfort, with no significant differences in frequency (57.9% vs 46.3%, p = 0.4) or severity (mean pain score: 1.9 ± 2.3vs. 1.8 ± 2.7, p = 0.6) between contrast groups. The need for repeated DSA due to limb motion was numerically lower in the IOCM group (26.3% vs 29.3%, p = 0.076). Patients receiving IOCM experienced significantly shorter postprocedural hospital stays (0 [0, 1.00] vs 1.00 [0, 3.00]; p = 0.001). Institutional preference outweighed other predictors for selecting IOCM over LOCM (variance 13.42, standard deviation 3.663). In real-world practice, IOCM is preferentially used in patients undergoing more complex PAI compared with LOCM, with no difference in 1-year MALE. Institutional practice was the predominant driver for IOCM use. Patient-reported procedural symptoms and the need for repeated DSA were commonly observed and warrant further investigation.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257100","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":"Angiographically-Derived Physiological Assessment of Myocardial Bridging. An Elegant Rationale in Search of Clinical Application.","authors":"Fernando Alfonso, Javier Cuesta, Fernando Rivero","doi":"10.1016/j.amjcard.2025.10.003","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.10.003","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273328","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 Outcomes of Interventions for Femoropopliteal Occlusive Disease in Patients with Chronic Renal Insufficiency from the Multicenter XLPAD Registry.","authors":"Holly Haley, Shirling Tsai, Yulun Liu, David Fernandez Vazquez, Bala Ramanan, John F Eidt, Sameh Sayfo, Zachary Rosol, Dennis Gable, Blake Bruneman, Harsh Chauhan, Minseob Jeong, Subhash Banerjee","doi":"10.1016/j.amjcard.2025.09.065","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.065","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273325","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":"Risk reduction by IMPELLA support in high-risk percutaneous coronary intervention.","authors":"Takashi Ishimatsu, Yoshihiro Fukumoto","doi":"10.1016/j.amjcard.2025.10.001","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.10.001","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273532","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":"Full Heparin Reversal With Protamine After Transcatheter Aortic Valve Replacement: a Systematic Review and Meta-Analysis.","authors":"João Pedro Machado Ribeiro Jacintho Silva, Bruno Viruez Nogueira, Maria Carolina Bortoletto Mussolini, Oscar de Inácio Mendonça Bisneto, Wilton Francisco Gomes","doi":"10.1016/j.amjcard.2025.09.057","DOIUrl":"https://doi.org/10.1016/j.amjcard.2025.09.057","url":null,"abstract":"<p><p>Protamine sulfate is widely used to reverse unfractionated heparin during transfemoral transcatheter aortic valve replacement (TAVR), but the optimal reversal strategy remains uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies comparing full heparin reversal (1 mg protamine per 100 units heparin) with partial or no reversal in transfemoral TAVR. The primary outcome was a composite of all-cause mortality, major bleeding, and major vascular complications, defined according to VARC-3 criteria, while secondary outcomes included each component of the composite and stroke. Five studies (two randomized trials, three cohort studies) involving 3,089 patients were included. Full-dose protamine significantly reduced the composite outcome (RR 0.46, 95% CI 0.36-0.60), driven by reductions in major bleeding (RR 0.41, 95% CI 0.28-0.59) and major vascular complications (RR 0.44, 95% CI 0.30-0.65). No excess risk was observed for all-cause mortality (RR 0.94, 95% CI 0.65-1.36) or stroke (RR 0.67, 95% CI 0.40-1.12). Leave-one-out and subgroup analyses confirmed the robustness of these findings, and no evidence of publication bias was identified. In conclusion, full heparin reversal with protamine during TAVR is associated with lower bleeding and vascular complications without increasing thromboembolic risk, supporting its use as a bleeding-avoidance strategy.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273431","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}