American Journal of Cardiology最新文献

{"title":"Long Term Efficacy and Safety of Cardiac Resynchronization Therapy in Adult Congenital Heart Disease Patients: A Single Center Cohort Study","authors":"Nili Schamroth Pravda MbbCh ,&nbsp;Ilan Richter MD ,&nbsp;Ofir Brem BA ,&nbsp;Daniel Yehuda MD ,&nbsp;Ori Rahat MD ,&nbsp;Hadas Ofek MD ,&nbsp;Shir Tal MD ,&nbsp;Ran Kornowski MD ,&nbsp;Shahar Vig MD ,&nbsp;Kirill Buturlin MD ,&nbsp;Rafael Hirsch MD ,&nbsp;Gregory Golovchiner MD","doi":"10.1016/j.amjcard.2025.01.011","DOIUrl":"10.1016/j.amjcard.2025.01.011","url":null,"abstract":"<div><div>Heart failure constitutes a major cause for morbidity amongst patients with adult congenital heart disease (ACHD). Cardiac resynchronization therapy (CRT) is a recommended therapeutic measure for patients with heart failure. Data on the efficacy and safety of CRT amongst patients with ACHD is limited. This study analyzed data from a retrospective cohort of patients with ACHD and implantation of CRT between 2015 and 2022. The primary outcome was echocardiographic response to CRT, defined as either: (1) an increase in systemic ventricular ejection fraction (EF) of ≥ 5% in patients with baseline EF &lt;50% (therapeutic efficacy) or (2) maintenance of EF in patients with EF ≥ 50% (preventative efficacy). The outcomes were assessed by subgroups of systemic left or right ventricle ventricle. In a cohort of 45 patients, mean age was 54 ± 14 years, 26 patients had a systemic left ventricle (57.8%) and 19 patients had a systemic right ventricle (42.2%). The average follow-up was 5.2 ± 0.5 years. Primary outcome amongst patients with reduced EF at baseline was achieved in 69.0%; and in 92.3% amongst patients with preserved EF at baseline. There was no significant difference in the response to CRT as per systemic left or right ventricle (p = 0.15) or per baseline EF (p = 0.10). Complications occurred in 28.9% of patients. In conclusion, CRT appears to be effective in patients with ACHD in reducing rates of heart failure, regardless of baseline EF or systemic ventricle morphology. The percentage of patients with a safety outcome was relatively high and highlights the need for careful patient selection.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"242 ","pages":"Pages 82-87"},"PeriodicalIF":2.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073495","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":"Use of Nonsteroidal Anti-Inflammatory Drugs for Pericarditis in Pregnancy","authors":"Lisa Serati,&nbsp;Lucia Trotta,&nbsp;Enrica Negro,&nbsp;Antonio Brucato","doi":"10.1016/j.amjcard.2025.01.024","DOIUrl":"10.1016/j.amjcard.2025.01.024","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 75-76"},"PeriodicalIF":2.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063126","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":"Informed Consent and Shared Decision-Making in Modern Medicine: Case-Based Approach, Current Gaps and Practical Proposal","authors":"Giuseppe Tarantini MD, PhD, FESC ,&nbsp;Chiara Fraccaro MD, PhD ,&nbsp;Andrea Porzionato MD, PhD ,&nbsp;Nicolas Van Mieghem MD, PhD ,&nbsp;Hendrik Treede MD, PhD ,&nbsp;Nicolas Shammas MD, FACC ,&nbsp;Molly Szerlip MD, FACP, FACC, FSCAI ,&nbsp;Vinod Thourani MD, FACC ,&nbsp;Gino Gerosa MD ,&nbsp;Alfredo Marchese MD, PhD ,&nbsp;Giuseppe Speziale MD, PhD ,&nbsp;Bertrand Ludes MD, PhD ,&nbsp;Stephen Pollak MD, PhD ,&nbsp;Peter Vanezis MD, PhD ,&nbsp;Santo Davide Ferrara MD, PhD","doi":"10.1016/j.amjcard.2025.01.015","DOIUrl":"10.1016/j.amjcard.2025.01.015","url":null,"abstract":"<div><div>Advances in personalized medicine and Systems Biology have introduced probabilistic models and error discovery to cardiovascular care, aiding disease prevention and procedural planning. However, clinical application faces cultural, technical, and methodological hurdles. Patient autonomy remains essential, with shared decision-making (SDM) gaining importance in managing complex cardiovascular treatment options. Effective SDM relies on collaboration between providers and patients, guided by P5 Medicine principles, which combine psycho-cognitive considerations with predictive, personalized, preventive, and participatory care. Here we propose a 3-step methodological proposal for implementing SDM and enhancing consent acquisition in cardiovascular care. The approach emphasizes personalized patient engagement and the need for clear, comprehensive consent processes. It identifies and addresses significant gaps in current practices, including the complexity of consent language, information dispersion, and the specific needs of vulnerable populations. Issues of Medical Responsibility and/or Liability may raise in the case of absence of consent acquisition or invalid consent due to insufficient/incorrect information. The International Guidelines on Medico-Legal Methods of Ascertainment and Evaluation Criteria are reported. In conclusion, the paper proposes practical solutions, including the use of artificial intelligence (AI) to enhance decision-making and patient counseling, and strategies to ensure that consent processes are both thorough and legally sound and respectful to the individual's autonomy.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 77-83"},"PeriodicalIF":2.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051366","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":"Right Ventricular Outflow Tract Obstruction: Transcatheter Correction in Tetralogy of Fallot: A Pilot Study","authors":"Asit Das DNB ,&nbsp;Shubham Tewary DM ,&nbsp;Debdatta Kar DM ,&nbsp;Gaurav Lakhani DM ,&nbsp;Nur Nabab Mollah DM ,&nbsp;Srirupa Mandal MD","doi":"10.1016/j.amjcard.2025.01.013","DOIUrl":"10.1016/j.amjcard.2025.01.013","url":null,"abstract":"<div><div>A total of 35 patients completed the study. Mean age was 19.8 (±4.2) years, with a male-to-female ratio of 4:3. A total of 25 patients had uncorrected TOF, and 10 had undergone intracardiac repair. After the procedure, patients with uncorrected TOF showed a significant increase in oxygen saturation from 84.7% (±1.4%) to 94.6% (±1.2%). Procedural success was 91.4%, with 3 patients experiencing significant restenosis. No procedural complications were observed. There were no arrhythmic events until the first year of follow-up. At 1-year follow-up, the mean RVOT pressure gradient was significantly decreased, and all patients remained symptom-free. In conclusion, combined balloon pulmonic valvuloplasty and conal artery occlusion is a safe and effective method for alleviating RVOT obstruction in patients with TOF, showing promising intermediate-term outcomes with minimal complications.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"242 ","pages":"Pages 32-36"},"PeriodicalIF":2.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045602","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":"Patient Characteristics, Management and Long-Term Outcomes of Patients With Cardiogenic Shock at a Large Safety Net Hospital","authors":"Eric J. Hall MD ,&nbsp;Colby R. Ayers MS ,&nbsp;Nicholas S. Hendren MD ,&nbsp;Christopher Clark BS ,&nbsp;Amit Saha MD ,&nbsp;Hadi Beaini MD ,&nbsp;Isabella L. Alexander BS ,&nbsp;Evan P. Gee BS ,&nbsp;Ian R. McConnell BA ,&nbsp;Emily S. Samson BSA ,&nbsp;Roslyn J. Saplicki BA ,&nbsp;Christopher S. Grubb MD ,&nbsp;Grant Tucker BS ,&nbsp;Justin L. Grodin MD, MPH ,&nbsp;Jennifer T. Thibodeau MD, MSCS ,&nbsp;Mark H. Drazner MD, MSc ,&nbsp;Mujeeb Basit MD, MMSc ,&nbsp;Maryjane A. Farr MD, MSc ,&nbsp;Ann Marie Navar MD, PhD ,&nbsp;Sandeep R. Das MD, MPH ,&nbsp;James A. de Lemos MD","doi":"10.1016/j.amjcard.2025.01.021","DOIUrl":"10.1016/j.amjcard.2025.01.021","url":null,"abstract":"<div><div>Data regarding cardiogenic shock (CS) from safety-net hospitals serving socioeconomically-disadvantaged patients are limited. In addition, little is known regarding long-term outcomes and management of heart failure-related CS (HF-CS), a population potentially especially vulnerable to adverse social determinants of health (SDOH). A single-center retrospective cohort study of patients with Stage C, D, or E CS at a public safety-net hospital between 2017 and 2023 was performed. Management and outcomes were compared between patients with HF-CS and myocardial infarction-CS (AMI-CS). The primary outcome was survival through 2 years. The cohort included 378 patients (median age 57y, 44% Black race, 35% Hispanic ethnicity, 81% HF-CS, 19% AMI-CS); 23% received mechanical circulatory support. Thirty-day mortality was lower among patients with HF-CS than AMI-CS (16% vs 28%; HR 0.50 [95% CI 0.30 to 0.84], p = 0.01]). In contrast, mortality from 31 days through 2 years was higher after HF-CS (45% vs 22%, HR 1.94 [1.11 to 3.38], p = 0.02). At long-term follow-up, 53% of survivors were on beta blockers and 32% on no guideline-directed medical therapies. Eighteen patients (5%) received transplant or left ventricular assist device, all of whom had HF-CS and survived through available follow up (median 2.3y [0.9 to 4.0]). In conclusion, in a large safety-net hospital serving a diverse population with adverse SDOH, HF-CS was much more common than AMI-CS, with lower short-term but higher long-term mortality in HF-CS. Use of advanced therapies was low, with favorable survival among patients who received these. These results highlight the importance of expanding access to specialized heart failure care for socially vulnerable patients with CS.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"242 ","pages":"Pages 10-17"},"PeriodicalIF":2.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045584","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":"Impella versus Non-Impella for Nonemergent High-Risk Percutaneous Coronary Intervention.","authors":"Pavan Reddy, Ilan Merdler, Cheng Zhang, Matteo Cellamare, Itsik Ben-Dor, Nelson Bernardo, Hayder Hashim, Lowell Satler, Toby Rogers, Ron Waksman","doi":"10.1016/j.amjcard.2025.01.020","DOIUrl":"10.1016/j.amjcard.2025.01.020","url":null,"abstract":"<p><p>The benefit of mechanical circulatory support (MCS) with Impella (Abiomed, Inc, Danvers, MA) for patients undergoing nonemergent, high-risk percutaneous coronary intervention (HR-PCI) is unclear and currently the subject of a large randomized clinical trial (RCT), PROTECT IV. While contemporary registry data from PROTECT III demonstrated improvement of outcomes with Impella when compared with historical data (PROTECT II), there is lack of direct comparison to the HR-PCI cohort that did not receive Impella support. We retrospectively identified patients from our institution meeting PROTECT III inclusion criteria (left ventricular ejection fraction [LVEF] <35% with unprotected left main or last remaining vessel or LVEF <30% undergoing multivessel PCI), and compared this group (NonIMP) to the published outcomes data from the PROTECT III registry (IMP). Baseline differences were balanced using inverse propensity weighting (IPW). The co-primary outcome was major adverse cardiac events (MACE) in-hospital and at 90 days. Secondary outcomes included in-hospital post-PCI complications. We identified 284 high-risk patients who did not receive Impella support; 200 patients had 90-day event ascertainment and were included in IPW analysis, with 504 patients in the IMP group. After calibration, few residual differences remained; patients in the NonIMP group were older (73.4 vs. 69.3, p <0.001) with higher prevalence of coronary artery bypass grafting (65.0% vs. 13.7%, p <0.001). Unprotected left main intervention was performed in 43% of patients in both groups. The primary outcome was not different in-hospital (3.0% vs. 4.8%, p = 0.403), but lower in the NonIMP group at 90 days (7.5% vs. 13.8%, p = 0.033). Peri-procedural vascular complications, bleeding, and transfusion rates were not different between groups. However, acute kidney injury occurred more frequently in the NonIMP group (10.5% vs. 5.4%, p = 0.023). Under identical HR-PCI inclusion criteria for Impella use in PROTECT III, an institutional non-Impella supported HR-PCI cohort demonstrated similar MACE in-hospital but lower MACE at 90 days. There was no signal for peri-procedural harm with Impella use. These results do not support routine usage of Impella for HR-PCI patients. Careful patient selection is critical until a large RCT demonstrates benefits in a broad HR-PCI population.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy and Safety of Cardiac Myosin Inhibitors Versus Placebo in Patients With Symptomatic Obstructive Hypertrophic Cardiomyopathy: A Meta-Analysis of Randomized Controlled Trials","authors":"Chidubem Ezenna MD, BS ,&nbsp;Mrinal Murali Krishna MBBS ,&nbsp;Meghna Joseph MBBS ,&nbsp;Vinicius Pereira ,&nbsp;Samia Nadeem MD ,&nbsp;Gregory Valania DO ,&nbsp;Andrew M. Goldsweig MD, MS","doi":"10.1016/j.amjcard.2025.01.016","DOIUrl":"10.1016/j.amjcard.2025.01.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Obstructive hypertrophic cardiomyopathy (oHCM) is a genetic disorder characterized by myocardial hypertrophy, which can obstruct left ventricular outflow. Cardiac myosin inhibitors (CMIs) have emerged as a novel therapeutic agent targeting cardiac muscle hypercontractility.</div></div><div><h3>Objective</h3><div>To compare the efficacy and safety of CMIs mavacamten and aficamten vs. placebo in patients with oHCM.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Scopus, and Cochrane Central databases for randomized controlled trials (RCTs) comparing mavacamten or aficamten to placebo in patients with symptomatic oHCM. Efficacy outcomes included improvement in peak oxygen consumption (pVO2), New York Heart Association functional class (NYHA-FC) improvement of ≥1 class, change in Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS), peak left ventricular outflow tract gradient at rest (rLVOT) and with Valsalva maneuver (vLVOT). Safety outcomes included treatment-emergent adverse events (TEAE), serious adverse events (SAE), and atrial fibrillation (AF). Random effects models generated risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics.</div></div><div><h3>Results</h3><div>The systematic search identified 5 RCTs including 767 patients (mavacamten 30.4%, aficamten 22.2%, placebo 47.4%) with a median follow-up of 24 weeks. Compared to placebo, CMIs were associated with improvement of ≥1 NYHA-FC (RR 2.33; 95% CI, 1.92-2.82), rLVOT (MD -38.70; 95% CI, [-46.30]-[-31.10]), vLVOT (MD -47.29; 95% CI, [-57.99]-[-36.58]), pVO2 (MD 1.66; 95% CI, 1.14-2.18), and KCCQ-CSS (MD 7.76; 95% CI, 5.63-9.90). Safety outcomes were similar between CMIs and placebo.</div></div><div><h3>Conclusion</h3><div>CMIs are an effective and safe short-term treatment for symptomatic oHCM. Long-term outcomes require further investigation.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 52-60"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035927","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":"Comparison of Vessel Responses Following Combined Sirolimus-Eluting and Endothelial Progenitor Cell Stent and Ultra-Thin Sirolimus-Eluting Stent Implantation by Serial Optical Coherence Tomography and Coronary Angioscopy: A Multicenter Observational Study","authors":"Daisuke Nakamura MD ,&nbsp;Isamu Mizote MD, PhD ,&nbsp;Takayuki Ishihara MD ,&nbsp;Yutaka Matsuhiro MD ,&nbsp;Shota Okuno MD, PhD ,&nbsp;Tatsuya Shiraki MD ,&nbsp;Takuya Tsujimura MD ,&nbsp;Naotaka Okamoto MD ,&nbsp;Naoki Itaya MD ,&nbsp;Takaharu Nakayoshi MD ,&nbsp;Atsushi Kikuchi MD ,&nbsp;Tsutomu Kawai MD ,&nbsp;Yuhei Nojima MD, PhD ,&nbsp;Mitsuyoshi Takahara MD, PhD ,&nbsp;Takashi Morita MD, PhD ,&nbsp;Shungo Hikosou MD, PhD ,&nbsp;Daisaku Nakatani MD, PhD ,&nbsp;Toshiaki Mano MD, PhD ,&nbsp;Takahisa Yamada MD, PhD ,&nbsp;Takahumi Ueno MD, PhD ,&nbsp;Yasushi Sakata MD, PhD","doi":"10.1016/j.amjcard.2025.01.009","DOIUrl":"10.1016/j.amjcard.2025.01.009","url":null,"abstract":"<div><div>A dual-therapy sirolimus-eluting and CD34+ antibody–coated Combo Stent (DTS) has been developed to enhance endothelization and capture endothelial progenitor cells; however, vessel responses following DTS implantation remain unclear. Therefore, we evaluated early- and mid-term intravascular characteristics of DTS using intravascular imaging modalities. This multicenter, prospective, observational study enrolled 88 patients (95 lesions) who underwent DTS (43 patients, 48 lesions) or sirolimus-eluting Orsiro stent (SES, 45 patients, 47 lesions) implantation. Serial optical coherence tomography (OCT) and coronary angioscopy (CAS) findings were compared between the groups at 1 and 12 months.The OCT findings were similar between the DTS and SES groups at 1 month, including the covered strut rate (84.21 ± 9.50% versus 80.56 ± 17.68%, p = 0.27). CAS findings were also comparable despite a more severe yellow coloration observed in the DTS group (p = 0.006). At 12 months, OCT findings revealed that the covered and adequate strut coverage (≥40 μm) rates were significantly higher (99.27 ± 0.95% versus 95.46 ± 5.56%, p &lt;0.001 and 88.90 ± 10.15% versus 72.96 ± 16.48%, p &lt;0.001) and neointimal thickness was significantly thicker (152.16 ± 70.31 versus 84.39 ± 29.80 μm, p &lt;0.001) in DTS than in SES. The malapposed strut rate was significantly higher in SES than in DTS (0.04 ± 0.18% versus 0.82 ± 1.87%, p = 0.018). CAS revealed that the yellow coloration (p = 0.049) and subclinical intrastent thrombus (p = 0.019) were less severe in DTS than in SES at 12 months. In conclusion, DTS provided better advantages regarding strut coverage and plaque stabilization compared to SES. However, given the observational nature of this study, further randomized controlled trials are needed to confirm these findings.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 26-36"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035813","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":"Outcomes and Predictors of Different Flow-Gradient Patterns of Aortic Stenosis After Transcatheter Aortic Valve Replacement","authors":"Besir Besir MD ,&nbsp;Shivabalan Kathavarayan Ramu MD ,&nbsp;Maryam Muhammad Ali Majeed-Saidan MD ,&nbsp;Judah Rajendran MD ,&nbsp;Odette Iskandar MD ,&nbsp;Grant Reed MD ,&nbsp;Rishi Puri MD ,&nbsp;James Yun MD ,&nbsp;Serge Harb MD ,&nbsp;Rhonda Miyasaka MD ,&nbsp;Amar Krishnaswamy MD ,&nbsp;Zoran Popovic MD ,&nbsp;Samir R. Kapadia MD","doi":"10.1016/j.amjcard.2025.01.019","DOIUrl":"10.1016/j.amjcard.2025.01.019","url":null,"abstract":"<div><div>This study sought to explore the clinical factors associated with classical low-flow low-gradient (C-LFLG) and normal-flow low-gradient (NFLG) aortic stenosis (AS) compared with high-gradient (HG) AS. We also compared clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) across flow-gradient patterns. Patients with C-LFLG AS have a higher mortality rate after TAVR than those with HG AS. However, what leads to C-LFLG AS and the predictors of mortality in this population remain unclear. In this retrospective, single-center study involving 1,415 patients with severe AS, patients were classified as having (1) HG AS (aortic valve mean gradient [MG] &gt;40 mm Hg), (2) C-LFLG AS (MG &lt;40 mm Hg, stroke volume index &lt;35 ml/m², left ventricular ejection fraction &lt;50%), and (3) NFLG AS (MG &lt;40 mm Hg, stroke volume index ≥35 ml/m², left ventricular ejection fraction ≥50%). Logistic regression was used for predictors of C-LFLG AS. Cox regression was used for predictors of mortality in the C-LFLG AS population. Male gender, multiple co-morbidities, and moderate to severe mitral and tricuspid regurgitation correlated with the C-LFLG AS group. Patients with C-LFLG AS had a higher mortality risk compared with patients with HG AS at 2 years after TAVR. Patients with NFLG AS had similar mortality at 1 year, but higher mortality at 2 years after TAVR compared with patients with HG AS. End-stage renal disease, atrial fibrillation, and other co-morbidities were predictors of 2-year mortality in patients with C-LFLG AS. In conclusion, the mortality rate after TAVR was higher among patients with C-LFLG AS than those with HG AS. Male gender and multiple co-morbidities were predictors of C-LFLG AS. Multiple co-morbidities were predictors of mortality among those patients.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"242 ","pages":"Pages 42-52"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035913","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":"Myocardial Strain: A Physiologic Concept Overstretched Into Clinical Relevance?","authors":"Catalin Loghin","doi":"10.1016/j.amjcard.2025.01.023","DOIUrl":"10.1016/j.amjcard.2025.01.023","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035911","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}