American Journal of Cardiology最新文献

{"title":"Precision Risk Stratification in Atrial Fibrillation: Evaluating Machine Learning Models for Bleeding Prediction and Clinical Integration","authors":"Onur Akgün, Murat Akdoğan, Ahmet Ardahanlı, İsa Ardahanlı","doi":"10.1016/j.amjcard.2025.03.015","DOIUrl":"10.1016/j.amjcard.2025.03.015","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"246 ","pages":"Pages 14-15"},"PeriodicalIF":2.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668899","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":"Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock in a Jehovah's Witness Patient","authors":"Masashi Azuma BSE ,&nbsp;Suyog Mokashi MD ,&nbsp;Mohammed Abul Kashem MD, PhD ,&nbsp;Brian O'Murchu MD ,&nbsp;Yoshiya Toyoda MD, PhD ,&nbsp;Roh Yanagida MD, PhD, FACS","doi":"10.1016/j.amjcard.2025.03.014","DOIUrl":"10.1016/j.amjcard.2025.03.014","url":null,"abstract":"<div><div>Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) may support hemodynamics of patients experiencing cardiogenic shock refractory to medical management. We present a 62-year-old Jehovah's Witness female with a history of smoking, obstructive sleep apnea, and anemia presenting with acute myocardial infarction and ensuing cardiogenic shock that required V-A ECMO support due to persistent hemodynamic instability and hypoxemia. Meticulous care to blood saving strategies were employed contributing to the successful management of the patient. These strategies included minimizing frequency of laboratory testing, use of micro-pediatric tubes, meticulous tissue handling to minimize blood loss during decannulation and administration of supplementary agents (vitamin B12, folic acid, iron, and erythropoietin) in consideration with the ethical concerns of the patients and their family. During the patient's hospital stay, their hemoglobin decreased from 14.6 mg/dL to as low as 7.6 mg/dL 3 days after decannulation. To our knowledge, this is the third reported case of V-A ECMO support in a Jehovah's Witness patient and the first reported critical care case. In conclusion, employing a bloodless strategy and adhering to recommended practices can yield positive outcomes for patients who do not accept blood transfusions requiring V-A ECMO.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"246 ","pages":"Pages 43-46"},"PeriodicalIF":2.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668901","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 Mitral Valve Repair Versus Replacement in Infective Endocarditis: A 16-Year Meta-Analysis of Time-to-Event Data From Over 4000 Patients","authors":"Giuseppe Comentale MD, PhD ,&nbsp;Armia Ahmadi-Hadad ,&nbsp;Harvey James Moldon ,&nbsp;Andreina Carbone MD ,&nbsp;Rachele Manzo MD ,&nbsp;Concetta Calanni Macchio MD ,&nbsp;Anna Damiano MD ,&nbsp;Eduardo Bossone MD, PhD ,&nbsp;Giovanni Esposito MD, PhD ,&nbsp;Emanuele Pilato MD, PhD","doi":"10.1016/j.amjcard.2025.03.004","DOIUrl":"10.1016/j.amjcard.2025.03.004","url":null,"abstract":"<div><div>Mitral valve (MV) repair for infective endocarditis (IE) has proven to be a good and safe option, but current trends favor replacement; the available data, in addition, don't allow to reach a general consensus on the preferred first-line approach. The present metanalysis, aimed to compare short- and long-term outcomes between MV repair (MVRep) and MV replacement (MVR) in patients with IE. A search of PubMed was conducted on 30th August 2024, yielding 120 results. (PROSPERO CRD: CRD42023490612). Four additional suitable studies were identified and added from Embase and Medline (via Ovid). Statistical analyses were performed using RStudio, SPSS, and RevMan. Pseudoindividual patient data were extracted from Kaplan-Meier curves by converting the graphical plots into raw data coordinates through WebPlotDigitizer. A total of 21 studies were eligible for inclusion. The 16-year reconstructed analysis revealed that patients undergoing MVRep have higher survival compared to the MVR group (HR: 1.41, 95% Cl: 1.30<strong>–</strong>1.53, p &lt; 0.001). Moreover, IE recurrence was significantly lower in MVRep (95% CI, RR:0.46, 12 = 41%, p = 0.03). Reoperation rates, however, were similar between MVRep and MVR (95% CI, RR: 0.78, 12 = 0%, p = 0.27). In-hospital mortality was similar between the groups (95% CI, RR:0.40, 12 = 34%, p = 0.07). In conclusion, MV repair should be favored over replacement in IE when there is no evidence of local extension of the infections and if valve leaflets have not degenerated. This approach is associated with improved overall survival and a reduced risk of IE recurrence, making it particularly advantageous for younger patients.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"246 ","pages":"Pages 33-42"},"PeriodicalIF":2.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661839","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":"Diastolic Stress Echocardiography Using the Six-Minute Walk Test in Asymptomatic Patients With Aortic Stenosis","authors":"Ryutaro Oda MD,&nbsp;Masaki Izumo MD, PhD,&nbsp;Daisuke Miyahara MD,&nbsp;Mitsuki Yamaga MD,&nbsp;Tatsuro Shoji MD,&nbsp;Risako Murata MD,&nbsp;Taishi Okuno MD,&nbsp;Yukio Sato MD, PhD,&nbsp;Shingo Kuwata MD, PhD,&nbsp;Yoshihiro J. Akashi MD, PhD","doi":"10.1016/j.amjcard.2025.03.006","DOIUrl":"10.1016/j.amjcard.2025.03.006","url":null,"abstract":"<div><div>Diastolic stress echocardiography is useful in patients with heart failure with preserved ejection fraction (EF); however, its utility in asymptomatic patients with aortic stenosis (AS) remains unexplored. We investigated the value of diastolic stress echocardiography using a 6-minute walk test (6-MWT) in elderly AS patients. This retrospective observational study included 96 consecutive asymptomatic patients (82 years, 39.6% male) with at least moderate AS (mean pressure gradient (MPG) ≥ 20 mm Hg or aortic valve area &lt; 1.5 cm²) and preserved left ventricular EF. All underwent diastolic stress echocardiography using the 6-MWT. Patients were classified into a post-exercise impaired relaxation pattern (pIR) and a post-exercise pseudo-normalised/restrictive pattern (pPN) groups, based on transmitral flow velocity post-6-MWT. The primary endpoint was the time to first occurrence of the composite endpoint (all-cause mortality, aortic valve replacement due to AS-related symptoms, and hospitalization for heart failure).22 patients (23%) changed from baseline IR pattern at rest to the pPN pattern after the 6-MWT.The pPN group demonstrated lower %predicted walking distance than the pIR group. Additionally, the pPN group exhibited greater dyspnea after the 6-MWT. During a median follow-up of 536 days (interquartile range, 106–720 days), 46 patients experienced AS-related events. Multivariable Cox regression analysis indicated that the pPN group was independently associated with increased event risk (hazard ratio: 5.37, <em>p</em> &lt; 0.001). In conclusion, this study suggests that the diastolic stress echocardiography using the 6-MWT is useful for risk stratification in asymptomatic elderly AS patients.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"246 ","pages":"Pages 71-79"},"PeriodicalIF":2.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661844","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":"Outcomes of Primary Percutaneous Intervention for ST-Segment Elevation Myocardial Infarction With Versus Without Spontaneous Coronary Artery Dissection","authors":"Abhishek Chaturvedi MD ,&nbsp;Hector M. Garcia-Garcia MD, PhD ,&nbsp;Matteo Cellamare PhD ,&nbsp;Parul Chandrika MD ,&nbsp;Waiel Abusnina MD ,&nbsp;Cheng Zhang PhD ,&nbsp;Ron Waksman MD","doi":"10.1016/j.amjcard.2025.02.026","DOIUrl":"10.1016/j.amjcard.2025.02.026","url":null,"abstract":"<div><div>Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, but there is no clear consensus on the choice and timing of revascularization strategy. Recent data from outside the United States suggested similar inpatient mortality after primary percutaneous coronary interventions (PPCI) in patients presenting with ST-elevation myocardial infarction (STEMI) secondary to SCAD versus non-SCAD. Utilizing similar methodologies in a contemporary US cohort, we found that SCAD patients had higher inpatient mortality after PPCI for STEMI compared with non-SCAD patients. We also found that the SCAD group had prolonged hospitalization and hospitalization costs compared with on-SCAD patients. Furthermore, these trends have not changed over the past 5 years. Our findings reiterate the need for continued discussion and research on the role and timing of PPCI in SCAD-STEMI patients in well-designed prospective cohorts.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"246 ","pages":"Pages 30-32"},"PeriodicalIF":2.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661906","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":"Efficacy and Safety of Glucagon-like Peptide-1 Receptor Agonist Use During the First Trimester in Pregnant Women With Type 2 Diabetes","authors":"Muhammad Hanif MBBS ,&nbsp;Allison G. Hays MD ,&nbsp;Jai S. Nagarajan MBBS ,&nbsp;Shiva P. Sah MBBS ,&nbsp;Ruth S. Weinstock MD PhD ,&nbsp;Cynthia C. Taub MD, MBA","doi":"10.1016/j.amjcard.2025.03.013","DOIUrl":"10.1016/j.amjcard.2025.03.013","url":null,"abstract":"<div><h3>Background</h3><div>Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are a newer class of antidiabetic drugs that have proven beneficial in reducing weight loss and improving cardiometabolic profile. Literature has shown worsened glycemic control and increased risk of cardiovascular outcomes after stopping GLP-1 RAs in the adult type 2 diabetes (T2D) population; however, the effect of exposure to GLP-1 RAs in first-trimester pregnancy, followed by discontinuation, is still unclear.</div></div><div><h3>Objective</h3><div>To evaluate the maternal and fetal clinical outcomes after exposure of GLP-1 RAs in a T2D first-trimester pregnant population.</div></div><div><h3>Methods</h3><div>This retrospective cohort was based on a global database of electronic health records (EHRs) of more than 140 million patients. After propensity score matching (PSM), the study population included 3,652 women with T2D, divided into 2 cohorts based on their exposure to GLP-1 RAs within 1 year before and 1 month after diagnosis of first-trimester pregnancy. Exposure to GLP-1 RAs within 1 year before and 1 month after diagnosis of first-trimester pregnancy in T2D women.</div></div><div><h3>Results</h3><div>In this study of a 3,652 first-trimester T2D population, the average age of the GLP-1 RAs exposed cohort was 36.2 years. The primary outcome of the maternal all-cause mortality rate was comparable in the GLP-1 RAs-exposed first-trimester pregnant cohort compared to the control cohort after 42 weeks of follow-up. Secondary maternal outcomes, i.e., gestational hypertension, preeclampsia, and eclampsia, were also comparable after 42 weeks of follow-up in the women with T2D exposed to GLP-1 RAs during their pregnancy as compared to the control. Similarly, the relative risk of fetal cardiac and kidney anomalies was comparable between the cohorts.</div></div><div><h3>Conclusion</h3><div>In this study, exposure to GLP-1 RAs during the first trimester of pregnancy in T2D.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"246 ","pages":"Pages 10-13"},"PeriodicalIF":2.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661902","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":"Commentary: Aortic Root Enlargement; When Indicated?","authors":"Takashi Murashita","doi":"10.1016/j.amjcard.2025.03.012","DOIUrl":"10.1016/j.amjcard.2025.03.012","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639369","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":"Discordant Diagnostics: A Case Series of iFR and FFR Discrepancies","authors":"Ahmed Kazem DO ,&nbsp;Magdi Zordok MD ,&nbsp;Will Hobbs ,&nbsp;Mohamed Salih MD ,&nbsp;Amr Marawan MD ,&nbsp;Dinesh Apala MD ,&nbsp;Sibi Thomas DO ,&nbsp;Robert J. Widmer MD ,&nbsp;Salman Allana MD ,&nbsp;Srinivasa Potluri MD ,&nbsp;Karim Al-Azizi MD","doi":"10.1016/j.amjcard.2025.02.029","DOIUrl":"10.1016/j.amjcard.2025.02.029","url":null,"abstract":"<div><div>Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are 2 methods used to detect hemodynamically significant lesions and guide revascularization. Discrepancies between FFR and iFR values can complicate revascularization decisions. We present a series of 6 cases with discrepant FFR and iFR results. Among them, 5 were men, 5 had lesions in the right coronary artery, and one had left anterior descending disease, with an average age of 61.7 ± 11.1 years. All patients were iFR negative (mean iFR 0.94 ± 0.02) and FFR positive (mean FFR 0.75 ± 0.04). Consequently, all patients underwent revascularization.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"245 ","pages":"Pages 81-86"},"PeriodicalIF":2.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633355","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":"Multidimensional Risk Factors for Heart Failure in Hispanic Adults: Findings from the All of Us Research Program","authors":"Qiuhua Shen PhD, APRN, RN ,&nbsp;Lauren Clark MS ,&nbsp;Francisco J. Diaz PhD ,&nbsp;Janet D. Pierce PhD, APRN, CCRN, FAAN","doi":"10.1016/j.amjcard.2025.03.010","DOIUrl":"10.1016/j.amjcard.2025.03.010","url":null,"abstract":"<div><div>Heart failure (HF) is a leading cause of morbidity and mortality in the United States affecting approximately 6.7 million adults. In Hispanic adults, HF is underdiagnosed, leading to an incomplete characterization of the HF risk profiles in this population. Thus, the objective of the study was to investigate the multidimension HF risk factors among Hispanic adults. This cross-sectional study analyzed observational data collected from Hispanic adult participants in the <em>All of Us</em> Research Program. Sociodemographic, lifestyle, environmental, stress, and health care access and utilization data were retrieved from the survey domain. Past medical history was retrieved from the electronic health record domain. Using SAS, logistic regression was performed to identify multidimension risk factors for HF in Hispanic adults. The study subjects consisted of 5,281 Hispanic adults with 72.5% females and 27.5% males. The prevalence of HF was 3.6% (188/5,281). Males had a higher prevalence of HF than females (5.7% vs 2.7%). After adjusting for potential confounders with logistic regression, age (OR = 1.03, 95% CI [1.01, 1.04], p &lt;0.0001), hypertension (OR = 5.75, 95% CI [3.23, 10.24], p &lt;0.0001), heart attack (OR = 11.31, 95% CI [7.71, 16.58], p &lt;0.0001), type 2 diabetes mellitus (OR = 1.45, 95% CI [1.02, 2.06], p = 0.0383), and obesity (OR = 2.32, 95% CI [1.60, 3.36], p &lt;0.0001) were significant risk factors for HF. In conclusion, multidimension risk factors for HF among Hispanic adults were explored in this study. More research is needed to compare these risk factors to other non-Hispanic populations.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"245 ","pages":"Pages 54-61"},"PeriodicalIF":2.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravascular Imaging Improves Clinical Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusions: A Meta-Analysis of Randomized Controlled Trials","authors":"Wilton F. Gomes MD, MSc ,&nbsp;Djinane S. Zerlotto MD ,&nbsp;Patricia Viana MD ,&nbsp;Larissa A. Lucena MD ,&nbsp;Pedro E.P. Carvalho MD ,&nbsp;Pedro F.G. Nicz MD ,&nbsp;Deborah C. Nercolini MD, MSc ,&nbsp;Marcelo H. Ribeiro MD, PhD ,&nbsp;Alexandre S. Quadros MD, MSc ,&nbsp;Ronaldo R.L. Bueno MD, PhD ,&nbsp;Ricardo A. Costa MD, PhD ,&nbsp;Breno A.A. Falcão MD, PhD","doi":"10.1016/j.amjcard.2025.03.011","DOIUrl":"10.1016/j.amjcard.2025.03.011","url":null,"abstract":"<div><div>Clinical data comparing intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) with angiography-guided PCI for chronic total occlusions (CTOs) are limited. This study aimed to compare clinical outcomes of IVI-guided versus angiography-guided PCI in patients with CTOs. A systematic review and meta-analysis were conducted to identify randomized controlled trials (RCTs) comparing IVI-guided with angiography-guided PCI in CTO populations. The primary endpoint was the incidence of major adverse cardiac events (MACE), a composite of death/cardiac death, myocardial infarction (MI), and target-vessel revascularization (TVR). Secondary outcomes included the individual components of MACE. A prespecified subgroup analysis was performed for intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Five RCTs, including 1,296 patients, were analyzed, with 713 (55%) undergoing IVI-guided PCI. Over 1 to 3 years, MACE was significantly lower in the IVI-guided PCI group (7.2% vs 13%; relative risk [RR] 0.55; 95% confidence interval [CI] 0.35 to 0.88; p = 0.012; I² = 31%). In the secondary analysis, TVR incidence was lower in the IVI group (3.1% vs 6.7%; RR 0.52; 95% CI 0.29 to 0.97; p = 0.038). No statistical differences were observed for MI or death/cardiac death. In the IVUS subgroup, MACE was also lower in the IVI-guided PCI group (8.4% vs 14.3%; RR 0.59; 95% CI 0.37 to 0.91; p = 0.019). A trial sequential analysis suggested a low likelihood of type I error. In conclusion, IVI-guided PCI is associated with improved clinical outcomes compared with angiography-guided PCI for the treatment of CTOs.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"245 ","pages":"Pages 62-70"},"PeriodicalIF":2.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623190","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}