American Journal of Cardiology最新文献

{"title":"Fitness and Mortality Outcomes Associated With Supramaximal Peak Heart Rate on Treadmill Exercise Stress Testing","authors":"Parth S. Patel MD ,&nbsp;Samuel Heller Jr. BA ,&nbsp;Kathryn F. Larson MD ,&nbsp;Nadia M. Elfessi PA-C ,&nbsp;Nora Sydo MD, PhD ,&nbsp;Karina Gonzalez Carta MD, MS ,&nbsp;Nasir Hussain MD ,&nbsp;Thomas G. Allison PhD, MPH ,&nbsp;Darrell B. Newman MD","doi":"10.1016/j.amjcard.2025.05.004","DOIUrl":"10.1016/j.amjcard.2025.05.004","url":null,"abstract":"<div><div>Inability to reach age-predicted peak heart rate (APPHR) on treadmill exercise testing (TMET) is associated with lower fitness and increased mortality. The significance of a “supramaximal” heart rate (≥105% of APPHR) is poorly understood; as such, we sought to investigate this relationship. We queried the Mayo Stress database from 1993 to 2010 for patients &gt;30 years old without cardiovascular disease and not on antichronotropic therapy. Patients were stratified into groups based on APPHR: &lt;75%, 75% to 84%, 85% to 94%, 95% to 104%, and ≥105%, with 105% to 114% and ≥115% subgroups. Functional aerobic capacity (FAC) was assessed by ANOVA and all-cause mortality by cox hazard regression; we adjusted for confounders. In total, 18,961 patients were included; 1150 (6.1%) died. 2,144 (11.3%) of patients achieved submaximal APPHR (&lt;85%), 2,917 achieved supramaximal APPHR (≥105%). Patients with submaximal APPHR had significantly lower FAC: 76.4% (p &lt;0.0001) [&lt;75%], 83.5% (p &lt;0.0001) [≥75% to &lt;85%]. Those with supramaximal APPHR had significantly higher FAC: 102.0% (p &lt;0.0001). Patients with submaximal APPHR had significantly higher mortality risks: &lt;75% (adjusted HR 2.36 [1.83 to 3.04], p &lt;0.0001) and ≥75 to &lt;85% (adjusted HR 1.93 [1.62 to 2.31], p &lt;0.0001). Those with supramaximal APPHR, after adjustment for cardiac risk factors and resting heart rate, had significantly lower mortality risk (adjusted HR 0.83 [0.70 to 0.99], p = 0.0414). In conclusion, supramaximal heart rate on TMET was associated with significantly higher FAC and lower all-cause mortality risk.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"250 ","pages":"Pages 54-60"},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962254","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":"Interpreting Lipid Biomarkers in Cardiac Allograft Vasculopathy","authors":"Victorious-Benedicta Olamona,&nbsp;Mahmood Ahmad MD","doi":"10.1016/j.amjcard.2025.05.001","DOIUrl":"10.1016/j.amjcard.2025.05.001","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Page 9"},"PeriodicalIF":2.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957231","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":"Pacemaker Prediction Following Trans-aortic Valvular Intervention-Do Risk Scores Help?","authors":"Leonard Ilkhanoff, Brett D Atwater","doi":"10.1016/j.amjcard.2025.04.026","DOIUrl":"10.1016/j.amjcard.2025.04.026","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956446","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":"Incidence and Risk of Heart Failure in Patients With Coronary Heart Disease and Stroke: A Population-Based Cohort Study","authors":"Xiaofei Liu MS ,&nbsp;Peng Shen MD ,&nbsp;Yi Chen MS ,&nbsp;Yexiang Sun MPH ,&nbsp;Qi Chen MPH ,&nbsp;Hongbo Lin MD ,&nbsp;Xun Tang PhD, MHS ,&nbsp;Pei Gao PhD","doi":"10.1016/j.amjcard.2025.04.028","DOIUrl":"10.1016/j.amjcard.2025.04.028","url":null,"abstract":"<div><div>Heart failure (HF) is a major global health issue, with coronary heart disease (CHD) and stroke being risk factors with different mechanisms. The risk of HF in stroke patients remain poorly characterized despite the potential contributions of \"stroke-heart syndrome.\" This study aimed to evaluate HF incidence and risk factors across different cardiovascular disease (CVD) subtypes in a large population-based Chinese cohort. This study included 13,258 CVD patients, i.e. 3,470 patients with CHD (including 610 with myocardial infarction [MI]) and 10,048 with total stroke (comprising 8,631 ischemic and 1,515 hemorrhagic stroke), and 66,290 age- and sex-matched controls without CVD (1:5 ratio). The primary outcome was new-onset HF. Cumulative incidence functions were estimated with non-HF death as a competing event, stratified by CVD subtypes. Cox proportional hazard models were used to assess the risk factors of HF and compare relative hazard ratio (HR) between CHD and stroke patients. The 10-year cumulative incidence of HF was 25.3% in patients with CHD (24.6% in MI patients), 13.5% in stroke patients (14.7% and 7.3% for ischemic and hemorrhagic stroke, respectively), and 6.9% in controls. Hypertension (81.8% in CHD, 81.0% in stroke) significantly increased HF risk compared to those without it (incidence rate ratio: 1.74, 95% CI: 1.41 to 2.12 for stroke; 1.42, 95% CI: 1.12 to 1.78 for CHD). Obesity showed a stronger association with HF in stroke patients than in CHD patients (HR: 1.43, 95%CI: 1.15 to 1.78 vs 0.94, 95%CI: 0.69 to 1.28, ratio of HRs: 1.67, 95% CI: 1.14 to 2.42). Other significant risk factors in both CHD and stroke patients include older age, male sex, former smoking, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease. In conclusion, heart failure incidence varies by CVD subtypes, with the highest risk rates in CHD and MI patients, followed by stroke. Hypertension and obesity notably increase HF risk for stroke patients. Tailored risk management strategies are needed, considering the differential impact of risk factors across CVD subtypes.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"250 ","pages":"Pages 70-78"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963529","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 Influence of Height on Occupational Radiation Exposure of Interventional Cardiologists During Selective Coronary Angiography Using a Radial Artery Approach","authors":"Richard Casazza MAS ,&nbsp;Bilal Malik MD ,&nbsp;Arsalan Hashmi ,&nbsp;Joshua Fogel Phd ,&nbsp;Enrico Montagna RT ,&nbsp;Darren Gibson RT ,&nbsp;Andres Palacio RT ,&nbsp;Habiba Beginyazova RT ,&nbsp;Robert Frankel MD ,&nbsp;Jacob Shani MD","doi":"10.1016/j.amjcard.2025.04.027","DOIUrl":"10.1016/j.amjcard.2025.04.027","url":null,"abstract":"<div><div>Radiation exposure is one of the most adverse occupational hazards faced by interventional cardiologists. Operator height can influence operator radiation exposure. This single-center retrospective study (<em>n</em> = 534) assessed the cumulative radiation (CR) exposure in μSv and normalized radiation exposure (CR/DAP) using three different ranges of height (short, regular, and tall) of the primary operator at four anatomical locations when using a radial artery approach. A multivariate linear regression analyses for cumulative operator radiation dose found that tall operator height had significantly lesser values than regular operator height for the thorax (p &lt;0.001), abdomen (p = 0.01), left eye (p &lt;0.001), and right eye (p &lt;0.001). Short operator height did not significantly differ from regular operator height. Multivariate linear regression analyses for normalized operator radiation dose found that tall operator height had significantly lesser values than regular operator height for the thorax (p &lt;0.001), abdomen (p = 0.01), left eye (p &lt;0.001), and right eye (p = 0.002). Short operator height did not significantly differ from regular operator height. In conclusion, there was an association of lower operator radiation dose in the thorax, abdomen, left eye, and right eye for tall operators as compared to regular height operators. We recommend regular height operators be exceedingly vigilant with their personal radiation protection techniques. Furthermore, these same protection techniques should be considered with patients that have a higher likelihood of generating greater dose-area-products.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 1-8"},"PeriodicalIF":2.3,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961354","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":"Factors Associated with the Uncoupling of Perceived and Achieved Exercise Capacity in Patients Undergoing Cardiopulmonary Exercise Testing","authors":"Kaivalya Dandamudi MD ,&nbsp;Adarsh Mallepally BS ,&nbsp;Teymur Zavar BS ,&nbsp;Justin M. Canada PhD ,&nbsp;Ross Arena PhD ,&nbsp;Inna Tchoukina MD ,&nbsp;Cory R. Trankle MD","doi":"10.1016/j.amjcard.2025.04.029","DOIUrl":"10.1016/j.amjcard.2025.04.029","url":null,"abstract":"<div><div>An objective of the Duke Activity Status Index (DASI) is to standardize assessments of exertional intolerance. However, patient factors associated with inaccurate assessments of exercise capacity with this tool are not well described. Patients who completed the DASI in preparation for a treadmill cardiopulmonary exercise test (CPET) at our institution from 2022 to 2023 were analyzed. Metabolic equivalents of task (METs) were calculated from the DASI score and measured from CPET. Clinical characteristics were compared using Chi square or Mann-Whitney U tests between those who overestimated versus underestimated exercise capacity via the DASI. Correlations were assessed with a Spearman test, and a binary logistic regression model was fit to the clinical characteristics to identify patient characteristics associated with overestimating METs with the DASI. Overall, 512 patients were included in the current study, and the majority (419 [82%]) overestimated exercise capacity via the DASI. DASI-predicted METs had moderate correlation with CPET-achieved METs (Spearman’s rho = +0.620, p &lt;0.001). Patients who overestimated exercise capacity by DASI were more likely to be older, female sex, Black race, on beta blockers, of higher body mass index, and with cardiac comorbidities. The regression model (Χ² = 87.6, p &lt;0.001, Nagelkerke R² = 0.259) found older age, female sex, diagnosis of heart failure, and congenital heart disease most strongly associated with overestimating exercise capacity (all p ≤0.002). In conclusion, a majority of patients referred for CPET overestimate exercise capacity by DASI score, particularly those with older age, female sex, heart failure, and congenital heart disease.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"250 ","pages":"Pages 48-53"},"PeriodicalIF":2.3,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957750","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":"Safety and Effectiveness of the High-Sensitivity HEART Pathway Safely Across Age Groups in Patients With Suspected Acute Coronary Syndrome","authors":"Michael Supples MD, MPH ,&nbsp;Simon Smits BS ,&nbsp;Akalya Villenthi MS ,&nbsp;Anna C. Snavely PhD ,&nbsp;Nicklaus P. Ashburn MD, MS ,&nbsp;Simon A. Mahler MD, MS","doi":"10.1016/j.amjcard.2025.04.022","DOIUrl":"10.1016/j.amjcard.2025.04.022","url":null,"abstract":"<div><div>The high-sensitivity HEART Pathway (hs-HP) is a risk stratification algorithm for Emergency Department (ED) patients with chest pain. However, its diagnostic performance across age subgroups is unknown. We conducted a subgroup analysis of the 5-site hs-HP implementation study. Pre-implementation (1/2019-4/2020) the traditional HEART Pathway was used with contemporary troponins. Postimplementation (11/2020-2/2022) the hs-HP was used with high-sensitivity troponins to risk-stratify patients into rule-out, observation, and rule-in groups. Patients were classified as young (aged: 18 to 45), middle-aged (46 to 64), or older (≥65). Effectiveness and safety outcomes included 30-day hospitalizations and 30-day all-cause mortality or myocardial infarction (MI), respectively. Multivariable logistic regression was used to compare outcomes pre- vs. postimplementation within age subgroups. The 26,126 patients accrued (12,317 pre- and 13,809 postimplementation) were 35.3% non-White and 52.7% female. Postimplementation, hospitalizations decreased 18.1% among the older patients (70.6% vs. 52.5%; aOR 0.47, 95% CI, 0.42 to 0.52), 18.2% in middle-aged (50.0% vs. 31.8%; aOR 0.48, 95% CI, 0.44 to 0.52), and 7.5% among young patients (20.1% vs. 7.6%; aOR 0.69, 95% CI, 0.59 to 0.76). In older patients, 30-day death or MI occurred in 12.9% (497/3,861) postimplementation vs. 13.5% (482/3,571) preimplementation (aOR 1.02; 95% CI, 0.89 to 1.18). In middle-aged patients, 7.0% (382/5,495) had 30-day death or MI postimplementation vs. 7.5% (395/5,257) preimplementation (aOR 1.01; 95% CI, 0.87-1.18). Finally, 30-day death or MI occurred in 1.5% (66/4,453) of young patients postimplementation vs. 2.0% (71/3,489) preimplementation (aOR 1.01; 95% CI 0.69 to 1.48). In conclusion, the hs-HP significantly reduced hospitalizations across all age groups of patients with chest pain, without increasing 30-day adverse events.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"250 ","pages":"Pages 38-47"},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952284","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":"Unmasking Nonresponders: Right Ventricular Function as the Missing Link in Transcatheter Mitral Valve Repair Outcomes.","authors":"Rahul Chaudhary, George Chalhoub, Matthew E Harinstein","doi":"10.1016/j.amjcard.2025.04.019","DOIUrl":"10.1016/j.amjcard.2025.04.019","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957549","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 Denervation for Hypertension: From Innovation to Indication","authors":"Raymond R. Townsend MD ,&nbsp;Michael A. Weber MD","doi":"10.1016/j.amjcard.2025.04.011","DOIUrl":"10.1016/j.amjcard.2025.04.011","url":null,"abstract":"<div><div>High blood pressure is a common problem around the world. Although many trials attest to the value of reducing blood pressure with medication and lifestyle changes, current prevalence studies of high blood pressure show a substantial portion of the adult population with uncontrolled high blood pressure. Treatment nonadherence is part of the challenge to achieving blood pressure control and newer approaches to high blood pressure treatment, whether device based, or using agents such as silencing ribonucleic acids, have shown high levels of treatment efficacy and since they are administered in the health care setting, adherence is less of an issue. In this introduction to a special issue of the American Journal of Cardiology we will review the history of hypertension treatment and some current epidemiology highlighting the public health importance of improving blood pressure control to reap the well described benefits of lower blood pressure upon the target organs of hypertension. Subsequent sections of this special issue will focus on aspects of renal denervation, including patient selection, efficacy in blood pressure lowering, measuring success of denervation and procedural guidance for this emerging therapy in the management of uncontrolled hypertension.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"249 ","pages":"Pages 65-67"},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942675","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":"Predictive Value of V̇O2peak in Adult Congenital Heart Disease in Comparison With Heart Failure With Reduced Ejection Fraction","authors":"Andrea Soares MD ,&nbsp;Lauren K. Park PhD ,&nbsp;Emily Mansour MS, MD ,&nbsp;Elena Deych MS ,&nbsp;Alyssa Puritz DPT ,&nbsp;Min Zhao MS ,&nbsp;Chao Cao MPH ,&nbsp;Andrew R. Coggan PhD ,&nbsp;Phillip M. Barger MD ,&nbsp;Randi Foraker PhD, MA, FAHA ,&nbsp;Susan B. Racette PhD ,&nbsp;Linda R. Peterson MD, FACC, FAHA, FASE","doi":"10.1016/j.amjcard.2025.04.020","DOIUrl":"10.1016/j.amjcard.2025.04.020","url":null,"abstract":"<div><div>Peak oxygen consumption (V̇O_2peak) is used to predict outcomes and time to transplantation in patients with heart failure with reduced ejection fraction (HFrEF); V̇O_2peak also has predictive utility in patients with adult congenital heart disease (ACHD). However, the predictive value of a given V̇O_2peak on cardiac events in patients with ACHD compared to HFrEF, especially after adjustment for age and sex, is unclear. Therefore, we performed a longitudinal cohort study comparing patients with ACHD to patients with HFrEF. The cohorts were sex and age matched (±10 years). V̇O_2peak tests were conducted from 1993 to 2012. Cardiac events included death, cardiac transplantation, and LVAD placement. Events were obtained via electronic medical record, SSDI, and phone interview. Cox proportional-hazard regression analyses were used to evaluate relationships of event-free survival with predictor variables. Patients with ACHD (N = 137) and HFrEF (N = 137) had median follow-up times of 19.0 years (14.8 to 21.1) and 14.5 years (13.4 to 15.6), respectively. In multivariable models, Higher V̇O_2peak was associated with lower risk for a cardiac event, independent of age and sex, in both ACHD (HR 0.89, 95% CI 0.83 to 0.96, p = 0.002) and HFrEF (HR 0.86, 95% CI 0.82 to 0.91, p &lt;0.001). Male sex was associated with greater risk of a cardiac event HFrEF (HR 1.90, 95% CI 1.24 to 2.90, p = 0.003) but not in ACHD group. After multivariable adjustment (Beta-blockers, sex, and V̇O_2peak), having ACHD conferred a 71% lower risk of cardiac events compared to a HFrEF diagnosis (HR 0.29, 95% CI 0.18 to 0.47, p &lt;0.001). V̇O_2peak independently predicts event-free survival among adults with ACHD or HFrEF and has clinical utility in outpatient settings. Patients with ACHD have a better prognosis after multivariable adjustment including V̇O_2peak compared to HFrEF.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"249 ","pages":"Pages 29-35"},"PeriodicalIF":2.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935919","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}