American Journal of Cardiology最新文献

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Drug-Coated Balloon Versus Newer-Generation Drug-Eluting Stent Following Directional Coronary Atherectomy for Left Main Bifurcation Lesions 药物包被球囊与新一代药物洗脱支架在左主干病变定向冠状动脉粥样硬化切除术后的比较。
IF 2.3 3区 医学
American Journal of Cardiology Pub Date : 2025-06-05 DOI: 10.1016/j.amjcard.2025.05.036
Kota Murai MD, PhD , Kensuke Takagi MD, PhD , Fumiyuki Otsuka MD, PhD , Yoshiyuki Tomishima MD , Takamasa Iwai MD, PhD , Kenichiro Sawada MD, PhD , Hideo Matama MD , Satoshi Honda MD, PhD , Masashi Fujino MD, PhD , Shuichi Yoneda MD, PhD , Kazuhiro Nakao MD, PhD , Yu Kataoka MD, PhD , Yasuhide Asaumi MD, PhD , Kisaki Amemiya MD, PhD , Manabu Matsumoto MD, PhD , Keiko Ohta-Ogo MD, PhD , Yoshihiko Ikeda MD, PhD , Hatsue Ishibashi-Ueda MD, PhD , Kinta Hatakeyama MD, PhD , Teruo Noguchi MD, PhD
{"title":"Drug-Coated Balloon Versus Newer-Generation Drug-Eluting Stent Following Directional Coronary Atherectomy for Left Main Bifurcation Lesions","authors":"Kota Murai MD, PhD ,&nbsp;Kensuke Takagi MD, PhD ,&nbsp;Fumiyuki Otsuka MD, PhD ,&nbsp;Yoshiyuki Tomishima MD ,&nbsp;Takamasa Iwai MD, PhD ,&nbsp;Kenichiro Sawada MD, PhD ,&nbsp;Hideo Matama MD ,&nbsp;Satoshi Honda MD, PhD ,&nbsp;Masashi Fujino MD, PhD ,&nbsp;Shuichi Yoneda MD, PhD ,&nbsp;Kazuhiro Nakao MD, PhD ,&nbsp;Yu Kataoka MD, PhD ,&nbsp;Yasuhide Asaumi MD, PhD ,&nbsp;Kisaki Amemiya MD, PhD ,&nbsp;Manabu Matsumoto MD, PhD ,&nbsp;Keiko Ohta-Ogo MD, PhD ,&nbsp;Yoshihiko Ikeda MD, PhD ,&nbsp;Hatsue Ishibashi-Ueda MD, PhD ,&nbsp;Kinta Hatakeyama MD, PhD ,&nbsp;Teruo Noguchi MD, PhD","doi":"10.1016/j.amjcard.2025.05.036","DOIUrl":"10.1016/j.amjcard.2025.05.036","url":null,"abstract":"<div><div>Directional Coronary Atherectomy (DCA) is a potential treatment option for left main (LM) bifurcation lesions, as it may prevent side branch occlusion and reduce the need for complex stenting. Recent studies have suggested that combining drug-coated balloon (DCB) with DCA can lead to favorable cardiovascular outcomes. However, the comparative efficacy of DCB and current drug-eluting stents (DES) following DCA for LM bifurcation lesions remains unclear. This study aimed to compare the clinical outcomes of DCB and DES following DCA for LM bifurcation lesions. A retrospective analysis was conducted on 109 patients treated with DCA for LM bifurcation lesions from 2016 to 2024. Patients were divided into groups of DCA+DCB (<em>n</em> = 58) and DCA+DES (<em>n</em> = 51). The primary endpoint was ischemia-driven target lesion revascularization (ID-TLR), and the secondary endpoint was target lesion-related myocardial infarction (TLMI). Lesion characteristics were evaluated using quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). Kaplan-Meier analysis revealed higher ID-TLR occurrence at 5 years in the DCA+DCB group than the DCA+DES group (16.4% vs 2.3%, P = 0.027). In contrast, TLMI occurrence was similar (4.7% vs 2.3%, p = 0.667). The DCA+DCB group exhibited greater residual diameter stenosis (24.4% vs 16.3%, p &lt;0.001) on QCA and smaller minimum lumen area (7.33 mm² vs 8.42 mm², p &lt;0.001) and greater residual plaque area (48.9% vs 45.3%, p = 0.027) on IVUS compared to the DCA+DES group. In conclusion, the DCA+DCB strategy was associated with a higher ID-TLR incidence and a smaller luminal gain than DCA+DES. Although DCA+DCB provides a stent-less alternative, long-term monitoring is essential to address its limitations.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"252 ","pages":"Pages 67-76"},"PeriodicalIF":2.3,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245929","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}
引用次数: 0
Real-World Outcomes of Leadless Pacemaker Implantation After Transvenous Lead Removal for Infected Cardiac Implantable Electronic Devices in the United States 美国感染心脏植入式电子装置经静脉去铅后无铅起搏器植入的实际结果
IF 2.3 3区 医学
American Journal of Cardiology Pub Date : 2025-06-04 DOI: 10.1016/j.amjcard.2025.05.035
Siddharth Agarwal MD , Harsh P. Patel MD , Zain Ul Abideen Asad MD, MS , Muhammad Bilal Munir MD , Alan Sugrue MBBCh, MSc , Nicholas Y. Tan MD, MS , Freddy Del-Carpio Munoz MD , Deepak Padmanabhan DM , Daniel DeSimone MD , Siva K. Mulpuru MD , Yong-Mei Cha MD , Christopher V. DeSimone MD, PhD , Danesh K. Kella MD , Abhishek Deshmukh MD
{"title":"Real-World Outcomes of Leadless Pacemaker Implantation After Transvenous Lead Removal for Infected Cardiac Implantable Electronic Devices in the United States","authors":"Siddharth Agarwal MD ,&nbsp;Harsh P. Patel MD ,&nbsp;Zain Ul Abideen Asad MD, MS ,&nbsp;Muhammad Bilal Munir MD ,&nbsp;Alan Sugrue MBBCh, MSc ,&nbsp;Nicholas Y. Tan MD, MS ,&nbsp;Freddy Del-Carpio Munoz MD ,&nbsp;Deepak Padmanabhan DM ,&nbsp;Daniel DeSimone MD ,&nbsp;Siva K. Mulpuru MD ,&nbsp;Yong-Mei Cha MD ,&nbsp;Christopher V. DeSimone MD, PhD ,&nbsp;Danesh K. Kella MD ,&nbsp;Abhishek Deshmukh MD","doi":"10.1016/j.amjcard.2025.05.035","DOIUrl":"10.1016/j.amjcard.2025.05.035","url":null,"abstract":"<div><div>Leadless pacemakers (LPMs) have emerged as a promising alternative to transvenous systems, particularly in patients requiring transvenous lead removal (TLR) due to cardiac implantable electronic device (CIED) infections. However, real-world outcomes following LPM implantation in this setting remain understudied. Using the National Readmissions Database from 2016 to 2021, we identified 41,058 adult patients who underwent LPM implantation, of whom 3,244 (7.9%) received the device following TLR for CIED infection. Compared to patients undergoing de novo implantation, those in the post-TLR cohort were younger, had a greater comorbidity burden, and experienced significantly higher rates of device-related complications (3.7% vs. 2.0%; adjusted odds ratio [aOR]: 1.64; 95% confidence interval [CI]: 1.22–2.20; p&lt;0.01), longer hospital stays, and lower rates of discharge to home. Despite these differences, there were no significant disparities in in-hospital mortality (4.5% vs. 4.8%, p=0.59) or 30-day and 180-day readmission rates, including for device-related complications or infective endocarditis. These findings suggest that while LPM implantation following TLR is associated with higher procedural complexity, it remains a viable and safe option in this high-risk population and provides important real-world context to guide clinical decision-making.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"253 ","pages":"Pages 10-13"},"PeriodicalIF":2.3,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232992","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}
引用次数: 0
Computed Tomography Scan Predictors and Prognostic Impact of Combined Pulmonary Hypertension in Patients With Aortic Valve Stenosis undergoing TAVI 主动脉瓣狭窄行TAVI患者合并肺动脉高压的计算机断层扫描预测因素及预后影响。
IF 2.3 3区 医学
American Journal of Cardiology Pub Date : 2025-06-03 DOI: 10.1016/j.amjcard.2025.05.034
Francesco Putortì MD , Tommaso Fabris MD , Michele Strosio MD, Consolato Mesiani MD, Antonio Amadio MD, Simone Tripi MD, Andrea Panza MD, Federico Arturi MD, Samiha Tamanna, Luca Nai Fovino MD, PhD, Francesco Cardaioli MD, Giulia Masiero MD, Chiara Fraccaro MD, PhD, Massimo Napodano MD, PhD, Giuseppe Tarantini MD, PhD
{"title":"Computed Tomography Scan Predictors and Prognostic Impact of Combined Pulmonary Hypertension in Patients With Aortic Valve Stenosis undergoing TAVI","authors":"Francesco Putortì MD ,&nbsp;Tommaso Fabris MD ,&nbsp;Michele Strosio MD,&nbsp;Consolato Mesiani MD,&nbsp;Antonio Amadio MD,&nbsp;Simone Tripi MD,&nbsp;Andrea Panza MD,&nbsp;Federico Arturi MD,&nbsp;Samiha Tamanna,&nbsp;Luca Nai Fovino MD, PhD,&nbsp;Francesco Cardaioli MD,&nbsp;Giulia Masiero MD,&nbsp;Chiara Fraccaro MD, PhD,&nbsp;Massimo Napodano MD, PhD,&nbsp;Giuseppe Tarantini MD, PhD","doi":"10.1016/j.amjcard.2025.05.034","DOIUrl":"10.1016/j.amjcard.2025.05.034","url":null,"abstract":"<div><div>Precapillary (PrPH) and combined pre and postcapillary pulmonary hypertension (CoPH) increase all-cause and cardiovascular mortality risk in patients undergoing TAVI for severe symptomatic aortic stenosis. Since pulmonary artery (PA) diameter adapts to increased pulmonary artery pressure, this study evaluates the correlation between CT-derived main PA (MPA), right PA (RPA), left PA (LPA) diameters, and the MPA/ascending aorta (AA) ratio with PH subtypes defined by right heart catheterization (RHC), as well as their prognostic impact. This retrospective study includes all consecutive patients undergoing TAVR between June 2007 to December 2022 with pre-TAVI RHC and ECG-gated CT scans. The primary endpoint was all-cause mortality. Mean follow-up time was 5 years. Among 638 consecutive patients, 329 (51%) had normal mPAP, while 309 (49%) had PH. Of these, 143 (46%) had isolated postcapillary PH (IpcPH), and 166 (54%) had CoPH. Patients with PrPH were excluded. CoPH patients had higher PAP than both IpcPH and no-PH groups. In univariable and multivariable analysis, MPA, MPA index (MPAi), RPA, RPA index (RPAi), MPA/AA, MPAi/AA, and RPA/LPA correlated with PH, while MPA, MPAi, RPA, RPAi, MPA/AA, and MPAi/AA were associated with CoPH. The best AUC for PH discrimination was MPAi (AUC = 0.71, cutoff = 16 mm/m², sensitivity = 66%, specificity = 72%), while MPA/AA best discriminated CoPH (AUC = 0.73, cutoff = 0.88, sensitivity = 67%, specificity = 72%). Patients with PA/AA &lt;0.88 had significantly lower 5-year mortality after TAVI than those with PA/AA ≥0.88 (log-rank p = 0.046, HR 1.39). In conclusion, Increase in MPA/AA CT-derived ratio is predictive of Combined PH, highlighting patients who could benefit from a RHC in term of CV stratification before TAVI.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"253 ","pages":"Pages 14-22"},"PeriodicalIF":2.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232991","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}
引用次数: 0
Bridging Gaps in LDL-C Management: Utilization of Lipid-Lowering Therapies, Gender Disparities, and the Impact of Cardiology Visits on Secondary Prevention 缩小LDL-C管理的差距:降脂疗法的使用,性别差异,以及心脏病学就诊对二级预防的影响。
IF 2.3 3区 医学
American Journal of Cardiology Pub Date : 2025-06-02 DOI: 10.1016/j.amjcard.2025.05.029
Surik Sedrakyan MD , Bilawal Nadeem MD , Diane Gaughran CCRP , Ana Sinauridze MD , Ann Georgy MD , Hurley Sally MBA , Uyen Lam MD
{"title":"Bridging Gaps in LDL-C Management: Utilization of Lipid-Lowering Therapies, Gender Disparities, and the Impact of Cardiology Visits on Secondary Prevention","authors":"Surik Sedrakyan MD ,&nbsp;Bilawal Nadeem MD ,&nbsp;Diane Gaughran CCRP ,&nbsp;Ana Sinauridze MD ,&nbsp;Ann Georgy MD ,&nbsp;Hurley Sally MBA ,&nbsp;Uyen Lam MD","doi":"10.1016/j.amjcard.2025.05.029","DOIUrl":"10.1016/j.amjcard.2025.05.029","url":null,"abstract":"<div><div>Effective lipid control is essential for secondary cardiovascular prevention, with an LDL-C target of &lt;70 mg/dL recommended for high-risk patients. While novel lipid-lowering therapies have expanded treatment options, their real-world use and impact on LDL-C control remain uncertain. This retrospective cohort study included 19,108 patients with coronary artery disease across 7 hospitals in Massachusetts from January 2019 to March 2024. We evaluated the use of novel therapies, sex disparities in LDL-C goal attainment, and the influence of outpatient cardiology care and cardiac rehabilitation. Categorical associations were analyzed using chi-square tests, and multivariable logistic regression was conducted to account for confounding variables. In the final cohort, only 50.1% achieved LDL-<em>C</em> &lt;70 mg/dL. Most (74.9%) were on monotherapy, among whom 53.1% met the target. Dual therapy use was low (12.2%). Females were less likely to meet LDL-C goals (OR 0.53, 95% CI 0.49 to 0.58), had higher mean LDL-C (76.9 vs 67.7 mg/dL; p &lt;0.001), and were less likely to be on combination therapy (OR 0.77, 95% CI 0.68 to 0.86). Cardiology visits improved LDL-C goal attainment (OR 1.54, 95% CI 1.41 to 1.67), and cardiac rehabilitation significantly lowered LDL-C (from 89.1–66.1 mg/dL; p &lt;0.001). In conclusion, despite expanded therapeutic options, many patients fail to achieve LDL-C targets, reflecting underutilization of available treatments. Specialist care and cardiac rehabilitation were associated with improved lipid control, but persistent disparities in women highlight the need for more equitable implementation of guideline-based care.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"253 ","pages":"Pages 1-9"},"PeriodicalIF":2.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224043","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}
引用次数: 0
Association of Mechanical Circulatory Support and Cardiac Catheterization Laboratory Procedural Volumes With Outcomes of Cardiogenic Shock 机械循环支持和心导管实验室操作容积与心源性休克结局的关系。
IF 2.3 3区 医学
American Journal of Cardiology Pub Date : 2025-05-30 DOI: 10.1016/j.amjcard.2025.05.031
Kevin Tabibian BS , Amulya Vadlakonda BS , Troy Coaston BS , Sara Sakowitz MPH, MS , Shayan Ebrahimian MS , Pratyaksh K. Srivastava MD , Peyman Benharash MD, MS
{"title":"Association of Mechanical Circulatory Support and Cardiac Catheterization Laboratory Procedural Volumes With Outcomes of Cardiogenic Shock","authors":"Kevin Tabibian BS ,&nbsp;Amulya Vadlakonda BS ,&nbsp;Troy Coaston BS ,&nbsp;Sara Sakowitz MPH, MS ,&nbsp;Shayan Ebrahimian MS ,&nbsp;Pratyaksh K. Srivastava MD ,&nbsp;Peyman Benharash MD, MS","doi":"10.1016/j.amjcard.2025.05.031","DOIUrl":"10.1016/j.amjcard.2025.05.031","url":null,"abstract":"<div><div>Despite advancements in cardiogenic shock (CS) management, mortality remains high. While hospital volume has been linked to reduced mortality across myriad complex procedures, the cross-volume effects of mechanical circulatory support (MCS) and cardiac catheterization laboratory (CCL) procedures on CS patients not receiving these interventions remain unexplored. Using the 2016 to 2022 Nationwide Readmissions Database, we analyzed nonelective adult CS admissions at MCS- and CCL-capable hospitals. Hospitals were stratified into quartiles by annual volumes of MCS (intra-aortic balloon pump, percutaneous ventricular assist device, extracorporeal membrane oxygenation) and CCL procedures (coronary angiography, percutaneous coronary intervention), with the top quartile classified as high-volume (HVH-MCS or HVH<img>CCL). Multivariable logistic and linear regression models were constructed to evaluate the independent association of high-volume status with mortality, complications, and resource utilization. Among 130,822 CS hospitalizations, 48.2% were treated at HVH-MCS and 46.1% at HVH<img>CCL. Unadjusted mortality was lower at HVH-MCS (24.8% vs 30.7%, p &lt;0.001) and HVH<img>CCL (26.6% vs 29.0%, p &lt;0.001). Following adjustment, HVH-MCS remained associated with reduced mortality (Adjusted odds ratio [AOR] 0.87, 95% confidence interval [CI] 0.82 to 0.93), while HVH<img>CCL showed no significant benefit (p = 0.10). HVH-MCS also had lower respiratory (AOR 0.82, 95% CI 0.78 to 0.86) and infectious (AOR 0.85, 95% CI 0.80 to 0.90) complications, but longer hospital stays (β +1.75 days, 95% CI 1.48 to 2.01) and higher costs (+$8,600, 95% CI 7,100 to 10,100). Increasing MCS volume appears independently correlated with improved CS outcomes, highlighting the cross-volume effect of institutional expertise. Contrastingly, CCL volume was not associated with in-hospital mortality, supporting centralization of CS care at high-volume MCS centers.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"252 ","pages":"Pages 49-55"},"PeriodicalIF":2.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198066","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}
引用次数: 0
Plug- Versus Sutured-Based Vascular Closure Devices for Large Bore Arterial Access: A Systematic Review and Meta-Analysis 用于大口径动脉通路的塞与缝合血管关闭装置:一项系统综述和荟萃分析:塞与缝合血管关闭装置。
IF 2.3 3区 医学
American Journal of Cardiology Pub Date : 2025-05-30 DOI: 10.1016/j.amjcard.2025.05.030
Anastasios Apostolos MD , Konstantinos Konstantinou MD , Nikolaos Ktenopoulos MD , Vasileios Panoulas PhD
{"title":"Plug- Versus Sutured-Based Vascular Closure Devices for Large Bore Arterial Access: A Systematic Review and Meta-Analysis","authors":"Anastasios Apostolos MD ,&nbsp;Konstantinos Konstantinou MD ,&nbsp;Nikolaos Ktenopoulos MD ,&nbsp;Vasileios Panoulas PhD","doi":"10.1016/j.amjcard.2025.05.030","DOIUrl":"10.1016/j.amjcard.2025.05.030","url":null,"abstract":"<div><div>Vascular complications after cardiovascular interventions requiring large-bore arterial access remain frequent and devastating. Whether plug-based vascular closure devices (P-VCD) or sutured-based vascular closure device (S-VCD) are superior in terms of safety and efficacy remains unclear. Aim of our systematic review and meta-analysis was to compare P-VCD with S-VCD. We systematically screened 3 major databases for 2-arm studies comparing P-VCD with S-VCD. Primary endpoint was device success. Secondary endpoints included in-hospital all-cause mortality, major and minor bleeding, major and minor vascular complications, unplanned vascular surgery, endovascular treatment and hospital stay. For categorical variables, we used risk ratios (RRs) with 95% confidence intervals (CIs) and for continuous variables, mean differences or standardized mean differences. A total of 23 studies and 7,584 patients were included in our analysis. No significant differences were observed in device success (RR: 0.98, 95% CI: 0.96 to 1.00, <em>I<sup>2</sup> = 62%</em>), all-cause mortality (RR: 0.60, 95% CI: 0.19 to 1.87), major bleedings (RR: 0.68, 95% CI: 0.44 to 1.07), minor bleedings (RR: 0.83, 95% CI: 0.54 to 1.27), major vascular complications (RR: 0.89, 95% CI: 0.56 to 1.42), minor vascular complication (RR: 1.22, 95% CI: 0.82 to 1.83), endovascular treatment (RR: 1.35, 95% CI: 0.79 to 2.29) or unplanned vascular surgery (RR: 1.12, 95% CI: 0.68 to 1.87). However, hospital length of stay was reduced by 0.2 ± 0.13 days in patients treated with P-VCD. In conclusion, our systematic review and meta-analysis, the largest to date, demonstrated no significant differences between P-VCD and S-VCD, regarding safety or efficacy outcomes, except for a shorter hospital stay associated P-VCD. Further studies are required to validate these results.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"252 ","pages":"Pages 56-66"},"PeriodicalIF":2.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198067","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}
引用次数: 0
Comparative Outcomes of Transcatheter Aortic Valve Replacement and Conservative Management in Patients with Low-Flow, Low-Gradient Aortic Stenosis 更换或不更换:经导管主动脉瓣置换术与保守治疗在低流量、低梯度主动脉瓣狭窄范围内的结果比较
IF 2.3 3区 医学
American Journal of Cardiology Pub Date : 2025-05-28 DOI: 10.1016/j.amjcard.2025.05.018
Yash Prakash MD , Lakshay Chopra MD , Carlo Mannina MD , Eileen Galvani MD , Oludamilola Akinmolayemi MD, MPH , Ranbir Singh MD , Edgar Argulian MD , Parasuram Melarcode-Krishnamoorthy MD , George Dangas MD , Jonathan L. Halperin MD , Samin K. Sharma MD , Annapoorna S. Kini MD , Stamatios Lerakis MD, PhD
{"title":"Comparative Outcomes of Transcatheter Aortic Valve Replacement and Conservative Management in Patients with Low-Flow, Low-Gradient Aortic Stenosis","authors":"Yash Prakash MD ,&nbsp;Lakshay Chopra MD ,&nbsp;Carlo Mannina MD ,&nbsp;Eileen Galvani MD ,&nbsp;Oludamilola Akinmolayemi MD, MPH ,&nbsp;Ranbir Singh MD ,&nbsp;Edgar Argulian MD ,&nbsp;Parasuram Melarcode-Krishnamoorthy MD ,&nbsp;George Dangas MD ,&nbsp;Jonathan L. Halperin MD ,&nbsp;Samin K. Sharma MD ,&nbsp;Annapoorna S. Kini MD ,&nbsp;Stamatios Lerakis MD, PhD","doi":"10.1016/j.amjcard.2025.05.018","DOIUrl":"10.1016/j.amjcard.2025.05.018","url":null,"abstract":"<div><div>Transcatheter aortic valve replacement (TAVR) is a standard treatment for severe aortic stenosis (AS), but outcomes vary based on flow state. Low-flow, low-gradient aortic stenosis (LFLG AS) is a heterogenous condition and growing evidence suggests that response to TAVR differs by subtype. However, the generalizability of these studies to U.S. populations remains uncertain. This single-center, US-based retrospective study compared mortality outcomes from TAVR versus conservative management strategies in patients with classical (cLFLG) and paradoxical (pLFLG) LFLG AS. Adults with severe LFLG AS (valve area ≤1.0 cm<sup>2</sup>, stroke volume index ≤35 mL/m<sup>2</sup>, and mean pressure gradient &lt;40 mmHg) evaluated for TAVR between 2019 and 2021 were included. Patients were stratified by subtype (cLFLG: left ventricular ejection fraction [LVEF] &lt;50%; pLFLG: LVEF ≥50%) and treatment strategy (TAVR or conservative management). Of 490 patients included (207 cLFLG, 283 pLFLG), 67% underwent TAVR. Median follow-up was 19 months. TAVR was associated with lower mortality than conservative management (adjusted hazard ratio [HR] 0.47; 95% CI 0.33 to 0.69; p &lt;0.001). In cLFLG AS, TAVR significantly reduced mortality (adjusted HR 0.37; 95% CI 0.23 to 0.60; p &lt;0.001). In pLFLG AS, a nonsignificant trend towards benefit was observed (adjusted HR 0.62; 95% CI 0.33 to 1.15; p = 0.127). Among patients managed conservatively, those with pLFLG AS had lower mortality than cLFLG AS (adjusted HR 0.50; 95% CI 0.25 to 0.99; p = 0.046). In conclusion, TAVR is associated with improved survival in LFLG AS, particularly in patients with cLFLG AS. Comparable outcomes in conservatively managed pLFLG AS patients support a more individualized, phenotype-driven treatment approach.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"252 ","pages":"Pages 30-39"},"PeriodicalIF":2.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179671","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}
引用次数: 0
Artificial Intelligence for Risk Stratification of Acute Pulmonary Embolism: Perspectives on Clinical Needs, Expanding Toolkit, and Pathways Forward 急性肺栓塞风险分层的人工智能:临床需求,扩展工具包和前进途径的观点。
IF 2.3 3区 医学
American Journal of Cardiology Pub Date : 2025-05-26 DOI: 10.1016/j.amjcard.2025.05.025
Stanislav Henkin MD , Damon Houghton MD , Andetta Hunsaker MD , Marco Zuin MD , Mariana Pfeferman MD , Alyssa Sato BA , Gregory Piazza MD, MS
{"title":"Artificial Intelligence for Risk Stratification of Acute Pulmonary Embolism: Perspectives on Clinical Needs, Expanding Toolkit, and Pathways Forward","authors":"Stanislav Henkin MD ,&nbsp;Damon Houghton MD ,&nbsp;Andetta Hunsaker MD ,&nbsp;Marco Zuin MD ,&nbsp;Mariana Pfeferman MD ,&nbsp;Alyssa Sato BA ,&nbsp;Gregory Piazza MD, MS","doi":"10.1016/j.amjcard.2025.05.025","DOIUrl":"10.1016/j.amjcard.2025.05.025","url":null,"abstract":"<div><div>Despite a significant number of innovations for management of acute pulmonary embolism (PE) over the past decade, PE-related mortality has not decreased as expected. Significant heterogeneity in PE presentations and limitations in contemporary risk stratification approaches are hypothesized to be important drivers of poorer than expected outcomes. Recently, artificial intelligence (AI) has gained attention in cardiovascular medicine, notably in wearable technology, electrocardiography, and cardiovascular imaging. The utility of AI has been studied in PE diagnosis and risk stratification, especially in hospitalized patients and has the potential to predict presence of PE based on electrocardiography and clinical risk factors, decrease time to diagnosis, and improve characterization of PE as acute versus chronic. However, AI systems do not appear to have better accuracy in identification of PE compared with radiologists. Additionally, whether utilization of AI in diagnosis and management of PE will improve clinician workflow and patient outcomes remains unknown. In this review, we critically appraise the literature on AI-based strategies to diagnose and refine risk stratification of acute PE and discuss how integration of AI may move the field of PE forward with the universal goal of improving short- and long-term PE-related outcomes.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"252 ","pages":"Pages 40-48"},"PeriodicalIF":2.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172488","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}
引用次数: 0
Chronic Intravenous Inotropic Support as Bridge to Surgical Therapies in Patients With Sarcoidosis-Related Cardiomyopathy 慢性静脉肌力支持作为结节病相关心肌病患者手术治疗的桥梁。
IF 2.3 3区 医学
American Journal of Cardiology Pub Date : 2025-05-25 DOI: 10.1016/j.amjcard.2025.05.027
Johana Fajardo DNP , Rachel Barish ANP , Francisca Bermudez BS , Manavotam Singh MD , Avantika Banerjee MD , Fatima Hayat MBBS , Nana Afari-armah MD , Ajay Kadakkal MD , Tania Vora MD , Anjani Pillarisetty MD , Raja Zaghlol MD , Anirudh Rao MD , Samer S. Najjar MD , Farooq H. Sheikh MD
{"title":"Chronic Intravenous Inotropic Support as Bridge to Surgical Therapies in Patients With Sarcoidosis-Related Cardiomyopathy","authors":"Johana Fajardo DNP ,&nbsp;Rachel Barish ANP ,&nbsp;Francisca Bermudez BS ,&nbsp;Manavotam Singh MD ,&nbsp;Avantika Banerjee MD ,&nbsp;Fatima Hayat MBBS ,&nbsp;Nana Afari-armah MD ,&nbsp;Ajay Kadakkal MD ,&nbsp;Tania Vora MD ,&nbsp;Anjani Pillarisetty MD ,&nbsp;Raja Zaghlol MD ,&nbsp;Anirudh Rao MD ,&nbsp;Samer S. Najjar MD ,&nbsp;Farooq H. Sheikh MD","doi":"10.1016/j.amjcard.2025.05.027","DOIUrl":"10.1016/j.amjcard.2025.05.027","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"252 ","pages":"Pages 27-29"},"PeriodicalIF":2.3,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155387","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}
引用次数: 0
Stroke Prevention in Cancer Patients With Atrial Fibrillation 癌症心房颤动患者的卒中预防。
IF 2.3 3区 医学
American Journal of Cardiology Pub Date : 2025-05-24 DOI: 10.1016/j.amjcard.2025.05.026
Bülent Özlek MD, Veysel Ozan Tanık MD, Süleyman Barutçu MD
{"title":"Stroke Prevention in Cancer Patients With Atrial Fibrillation","authors":"Bülent Özlek MD,&nbsp;Veysel Ozan Tanık MD,&nbsp;Süleyman Barutçu MD","doi":"10.1016/j.amjcard.2025.05.026","DOIUrl":"10.1016/j.amjcard.2025.05.026","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"252 ","pages":"Pages 1-2"},"PeriodicalIF":2.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148875","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}
引用次数: 0
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