American Journal of Cardiology最新文献

{"title":"Interpreting the Clinical Impact of Proximal Optimization Technique in Provisional Bifurcation PCI Beyond Overall Treatment Effects.","authors":"Ezgi Gültekin Güner, Kaan Gökçe, Ali Öztürk, Adnan Özel, Ahmet Güner","doi":"10.1016/j.amjcard.2026.08.013","DOIUrl":"10.1016/j.amjcard.2026.08.013","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761296","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":"Reducing Unnecessary Preoperative Cardiology Referral and Cost in Patients Undergoing Bariatric Surgery.","authors":"Andrew Deak, Lauren E Tragesser, Kaitlyn D Ibrahim, Rohit Soans, Abdullah Haddad, Raj Dalsania, V Jon Eddy, Liti Zhang, Anika Ross, Joseph McComb, Martin G Keane, Sezgin Ciftci, Isaac R Whitman","doi":"10.1016/j.amjcard.2026.08.010","DOIUrl":"10.1016/j.amjcard.2026.08.010","url":null,"abstract":"<p><p>Candidates for metabolic and bariatric surgery (MBS) are at increased risk for cardiovascular disease (CVD), which may increase surgical risk. Currently, there are no society guidelines indicating which patients are appropriate for preoperative cardiac risk stratification. We hypothesized that applying a standardized surgical risk calculator with a novel referral algorithm to stratify patients for preoperative cardiac risk stratification would decrease unnecessary referrals and cost to patients and the healthcare system. All patients undergoing MBS at our institution between 2014 and 2023 were identified. Baseline patient characteristics, referrals to cardiology, subsequent cardiac testing ordered, and surgical outcomes were measured. Revised Cardiac Risk Index (RCRI) score was retrospectively calculated for each patient and grouped as low versus increased risk (RCRI score of 0 vs ≥1). Deriving a novel scoring system (RCRI score, ever smoker, age ≥65, and/or METS ≤4) and imputing this retrospective referral algorithm using this score to guide cardiology referral, we calculated how the referral pattern would be affected and the resultant change in costs. Postoperative cardiac complications were assessed as defined by myocardial infarctions, cardiac arrests, stroke, or cardiovascular death. A total of 1,528 patients underwent MBS during the study period, of which 56% (n = 852) were referred to cardiology preoperatively. Those referred were older, had more hypertension, hyperlipidemia, and diabetes, were ever smokers, had heart failure and atrial fibrillation, and were more likely to have BMI >50 kg/m². Of those patients with an RCRI score of 0, 45% (n = 435) underwent further cardiac testing. Strictly applying our standardized referral algorithm, of the 852 patients referred to cardiology, 30% (n = 255) were referred despite being low risk. Based on Medicare reimbursement for Level 4 outpatient consults and unnecessary testing, this would have resulted in a savings of approximately $28,000. There were no postoperative cardiac complications. In conclusion, among candidates for bariatric surgery, a novel referral algorithm based on RCRI and other CVD risk factors may reduce unnecessary preoperative cardiology referrals, with resultant reduction in resource utilization and overall cost savings.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757539","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":"Aldosterone Dysregulation in Essential Hypertension.","authors":"Javed Butler, Kendall Hammonds, Muhammad Sameer Arshad, Francesco Fioretti, Monica Bennett, Jason Ettlinger, Abiy Agiro, Shan Luan, Courtney Shaver, Elisa Priest, Muhammad Shahzeb Khan","doi":"10.1016/j.amjcard.2026.08.005","DOIUrl":"10.1016/j.amjcard.2026.08.005","url":null,"abstract":"<p><p>Aldosterone dysregulation is an important contributor to suboptimal blood pressure control in essential hypertension. A retrospective study was conducted using electronic health record data from Baylor Scott and White Health. Adults ≥ 18 years with essential hypertension who underwent at least 1 measurement of serum aldosterone and plasma renin between January 1, 2022 and October 31, 2024 were included. Aldosterone dysregulation was defined as aldosterone-to-renin ratio (ARR) >10 using plasma renin activity (PRA) or ARR > 1 using plasma renin concentration (PRC). Primary outcomes included uncontrolled hypertension (systolic blood pressure [SBP] ≥130 mmHg) and stage 2 hypertension (SBP ≥ 140 mmHg) based on office SBP obtained closest to and within 1 year following aldosterone measurement. Multivariable logistic regression models were adjusted for diabetes, encounter type, serum potassium, and aldosterone assay type. Among the 9,129 patients (age 58.7 [15.7] years; women 4,720 [51.7%]), aldosterone dysregulation was present in 39.4% patients, and was more prevalent among those with uncontrolled versus controlled hypertension (41.5% vs 31.9%, respectively). Aldosterone dysregulation was associated with uncontrolled hypertension (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.26 to 1.56) and stage 2 hypertension (OR 1.38; 95% CI 1.26 to 1.50) in adjusted analysis. Aldosterone dysregulation was more common in those receiving multiple antihypertensives (44.2% on ≥4 agents, 40.8% on 3, 36.4% on 2, and 33.9% on 1). In conclusion, aldosterone dysregulation is common in patients with essential hypertension and is associated with suboptimal blood pressure control. Currently available treatments may not fully address aldosterone dysregulation.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":"27-35"},"PeriodicalIF":2.5,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700539","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":"Closing the Diagnostic Gap in MINOCA: From Algorithms to Implementation.","authors":"Robert Jay Widmer","doi":"10.1016/j.amjcard.2026.08.002","DOIUrl":"10.1016/j.amjcard.2026.08.002","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697017","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":"Conduction System Pacing and Pacing Induced Cardiomyopathy: Balancing New and Promising Against Old and Reliable.","authors":"Lynda E Rosenfeld","doi":"10.1016/j.amjcard.2026.08.004","DOIUrl":"10.1016/j.amjcard.2026.08.004","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697001","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":"Long-term Outcomes of Renal Function Following CTO PCI: Insights on Contrast Exposure.","authors":"Federica B B Testerini, Francesco Giangiacomi, Carlo Zivelonghi, Benjamin Scott, Carl Convens, Stefan Verheye, Jelle Bernards, Paul Vermeersch, Pierfrancesco Agostoni","doi":"10.1016/j.amjcard.2026.08.001","DOIUrl":"10.1016/j.amjcard.2026.08.001","url":null,"abstract":"<p><p>The impact of contrast volume on long-term renal outcomes after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains uncertain. The causal role of contrast exposure is increasingly questioned, particularly beyond the acute phase. To evaluate the association between procedural contrast volume and long-term renal function deterioration in patients undergoing CTO-PCI. This retrospective cohort study included consecutive patients undergoing CTO-PCI (2019 to 2025) with available baseline and ≥90-day follow-up creatinine. The main endpoint was persistent kidney dysfunction (≥25% decline in estimated glomerular filtration rate (eGFR)). Other relevant endpoints were kidney disease: Improving Global Outcomes (KDIGO) stage progression (≥1 stage), and rapid progression (≥2 stages). Contrast volume was analyzed as a continuous variable and by quartiles. Multivariable regression models and sensitivity analysis (using a ≥40%eGFR decline threshold and baseline chronic kidney disease) were performed. A total of 275 patients were included with a median follow-up of 3.3 years. Renal function significantly declined (median ΔeGFR: -17.0 ml/min/1.73 m²; p< 0.001). Persistent kidney dysfunction occurred in 52.4% of patients, KDIGO stage progression in 60.7% and rapid progression in 12.0% Contrast volume (median 215 mL) was not independently associated with persistent kidney dysfunction (p = 0.267) and no dose-response relationship was observed across quartiles. Findings were consistent across models for ΔeGFR, KDIGO-based, subgroups and sensitivity analyses. Patient-related factors including age, male sex, hypertension, and diabetes emerged as independent predictors of renal decline. Notably, baseline renal function showed an inverse association with progression (p <0.001), suggesting a \"ceiling effect\" in advanced stages. In patients undergoing CTO-PCI, contrast volume is not independently associated with long-term renal deterioration. Persistent kidney dysfunction appears primarily driven by patient-related factors rather than procedural contrast exposure.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697022","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":"Outcome-linked Left Internal Mammary Artery to Left Anterior Descending Artery Graft Flow Threshold and Quantitative Flow Ratio-based Low-flow Prediction in Off-pump Coronary Artery Bypass Grafting.","authors":"Zengkun Liu, Dexin Zhang, Fushun Lin, Chenna Lu, Donglin Xu, Zhenbang Qi, Hourong Sun, Xingming Wang, Mengmeng Tang, Weidong Bing, Heng Yang, Lingwei Meng, Xiangjin Kong, Kai Liu, Xinghua Gu","doi":"10.1016/j.amjcard.2026.07.026","DOIUrl":"10.1016/j.amjcard.2026.07.026","url":null,"abstract":"<p><p>Transit-time flow measurement (TTFM) is used during coronary artery bypass grafting (CABG), but outcome-linked thresholds for low left internal mammary artery-left anterior descending artery (LIMA-LAD) mean graft flow (MGF) and preoperative low-flow predictors remain limited. This single-center retrospective study included 282 patients undergoing elective off-pump CABG with LIMA-LAD grafting. Restricted cubic spline and segmented regression examined the association between MGF and peak high-sensitivity cardiac troponin I (hs-cTnI) within 48 hours, and logistic regression evaluated associations with in-hospital major adverse cardiac and cerebrovascular events (MACCE) and developed a preoperative low-flow prediction model. LIMA-LAD MGF showed a nonlinear association with peak hs-cTnI, with an inflection point at 31 ml/min. Flow <31 ml/min was associated with higher hs-cTnI levels and higher adjusted in-hospital MACCE risk in the main model (34 events; adjusted odds ratio [OR] 2.53, 95% confidence interval [CI] 1.21 to 5.44; p = 0.014). In a sensitivity model additionally adjusted for obtuse marginal/left circumflex-territory grafting, the association was attenuated but remained directionally consistent (OR 2.10, 95% CI 0.99 to 4.46; p = 0.053). Higher LAD quantitative flow ratio (QFR) and smaller distal vessel diameter independently predicted low flow. In conclusion, a LIMA-LAD MGF threshold of 31 ml/min was associated with greater perioperative myocardial injury and higher in-hospital event risk, and a QFR-based model may support perioperative risk stratification pending external validation with standardized 30-day outcomes.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":"78-85"},"PeriodicalIF":2.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688325","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":"Relationship Between Admitting Diagnosis, Use of Primary Percutaneous Coronary Intervention, and Survival for Patients Who Develop a STEMI While Hospitalized.","authors":"Grace Lian, Rajiv C Patel, George A Stouffer","doi":"10.1016/j.amjcard.2026.08.003","DOIUrl":"10.1016/j.amjcard.2026.08.003","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":"9-11"},"PeriodicalIF":2.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13484596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688420","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":"Early and Long-Term Outcomes After DOAC Initiation in Hospitalized Patients With Newly Diagnosed Atrial Fibrillation.","authors":"Matthew Cervantes, Tariq Jamal Siddiqi, Anand Gupta, Minseob Jeong, Sagar S Mukhida, Catherine A Raver, Michael D Duncan, Byron Cryer, Subhash Banerjee","doi":"10.1016/j.amjcard.2026.07.032","DOIUrl":"10.1016/j.amjcard.2026.07.032","url":null,"abstract":"<p><p>New-onset atrial fibrillation (AF) is common among acutely hospitalized patients and is associated with increased risks of stroke and mortality. However, anticoagulation in this setting involves a temporal tradeoff between early bleeding during recovery and potential long-term stroke prevention, and data guiding direct oral anticoagulant (DOAC) initiation at discharge remain limited. We conducted a retrospective cohort study of adults with newly diagnosed AF identified between 3 days before hospital admission and hospital discharge within the Baylor Scott & White Health system (July 2020 to June 2024), comparing patients initiated on DOAC therapy at discharge with those who were not. Outcomes included major adverse cardiovascular events (MACE: all-cause death, nonfatal myocardial infarction, or ischemic stroke/transient ischemic attack) and net adverse clinical events (NACE: MACE or major bleeding) at 30 days and 3 years. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), and landmark cumulative incidence analyses assessed temporal trends after discharge. Among 16,641 patients (mean age 75.1 years; 41.8% women), 7,181 (43.2%) were discharged on a DOAC. In adjusted analyses, DOAC use was associated with lower risk of 3-year MACE (HR 0.61, 95% CI 0.58 to 0.65, p < 0.001) and NACE (HR 0.64, 95% CI 0.61 to 0.68, p < 0.001) compared with those not receiving DOAC therapy. Landmark analyses showed consistent reductions in MACE at both 30 days (HR 0.61, 95% CI 0.57 to 0.65) and 3 years (HR 0.68, 95% CI 0.62 to 0.74). Patients treated with DOACs had a lower risk of NACE at both 30 days (HR 0.65, 95% CI 0.61 to 0.69) and 3 years (HR 0.67, 95% CI 0.62 to 0.73). Overall, DOAC initiation at discharge in patients with newly diagnosed AF identified between 3 days before hospital admission and hospital discharge was associated with lower early and long-term ischemic risk, with lower rates of both MACE and NACE observed at 30 days and 3 years, underscoring the need for individualized decision-making regarding anticoagulation during acute hospitalization.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676896","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":"Pulmonary Arterial Hypertension-Targeted Therapy for Pulmonary Hypertension Associated With Left Heart Disease: Bayesian and Frequentist Meta-Analysis of Randomized Controlled Trials.","authors":"Yuko Kiyohara, Taku Sakai, Lina M Freeman, David Katzianer, Matthew T Siuba, Neal Chaisson, Ashish Correa, Maria Giovanna Trivieri, Wai Hong Wilson Tang, Yuichiro Yano, Toshio Naito, Satoshi Miyashita","doi":"10.1016/j.amjcard.2026.07.022","DOIUrl":"10.1016/j.amjcard.2026.07.022","url":null,"abstract":"<p><p>Pulmonary hypertension associated with left heart disease (PH-LHD) is the most prevalent form of pulmonary hypertension. Despite the recent advances in medications for pulmonary artery hypertension (PAH), it remains unclear whether PAH-targeted therapy is effective in patients with PH-LHD. We searched PUBMED and EMBASE through October 1, 2025 for randomized controlled trials comparing PAH-targeted therapy (i.e., endothelin receptor antagonist and phosphodiesterase-5 inhibitor) and placebo for patients with PH-LHD. The primary outcome was all-cause mortality, and secondary outcomes included adverse events and heart failure hospitalization. First, we performed Bayesian random-effects meta-analysis with weakly informative priors, using study-specific effect estimates and standard errors, with subgroup analysis for heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). Additionally, we conducted frequentist meta-analysis. We identified 8 randomized controlled trials in a total of 775 patients. In Bayesian meta-analysis, we estimated the probability that PAH-targeted therapy increased all-cause mortality at 79.9% (risk ratio [RR]: 1.55; 95% credible interval [0.51 to 4.36]) and adverse events at 94.8% (RR: 1.13; 95% credible interval [0.96 to 1.38]), compared with placebo. In the subgroup analysis, no material difference was observed between heart failure with reduced ejection fraction and HFpEF, with HFpEF demonstrating a 62% probability of a smaller risk increase. In frequentist meta-analysis, there was no significant difference in all-cause mortality, while PAH-targeted therapy was associated with significantly increased adverse events, compared with placebo (RR: 1.15; 95% CI 1.04 to 1.28). PAH-targeted therapy was associated with a moderate probability of increased mortality and a high probability of increased adverse events.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700531","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}