American Journal of Cardiology最新文献

{"title":"Peripheral Venous Pressure-Guided Decongestive Therapy in Heart Failure 2 (PERIPHERAL-HF2)","authors":"Kartal Emre Aslanger MD ,&nbsp;Funda Özlem Pamuk MD ,&nbsp;Yaser İslamoğlu MD ,&nbsp;Yelda Saltan Özateş MD ,&nbsp;Doğan İliş MD ,&nbsp;Esra Dönmez MD ,&nbsp;Sevgi Özcan MD ,&nbsp;Ezgi Çamlı Babayiğit MD ,&nbsp;Mevlüt Demir MD ,&nbsp;Taner Şen MD ,&nbsp;Özlem Yıldırımtürk MD ,&nbsp;on behalf of PERIPHERAL-HF2 Investigators","doi":"10.1016/j.amjcard.2025.01.018","DOIUrl":"10.1016/j.amjcard.2025.01.018","url":null,"abstract":"<div><div>Congestive symptoms are the primary cause of hospitalizations in heart failure (HF), and diuretics remain the cornerstone of their management. However, clinical practice varies widely due to a lack of a reliable measure of congestion guiding diuretic use. Consequently, many HF patients are discharged prematurely without adequate decongestion, leading to increased readmissions and mortality. Peripheral venous pressure (PVP) has emerged as a promising noninvasive measure of vascular congestion. This study will enroll 650 patients aged 18-99 years admitted with de novo or acutely decompensated chronic HF. In the standard care arm, diuretic dosing and discharge decisions will be at the physician's discretion. In the PVP-guided arm, the goal is to maintain a PVP of &lt;9 mmHg, with diuretic dosing adjusted based on daily PVP changes and urine output. The primary outcome is a composite of all-cause mortality, hospitalizations, and emergency department visits, with secondary outcomes including cardiovascular mortality and HF-related readmissions. We hypothesize that PVP-guided diuretic therapy will provide more precise and effective decongestion than standard care, reducing rehospitalizations and mortality. In conclusion, this study will offer valuable insights into the relationship between diuretic therapy, vascular congestion, and cardiac and renal outcomes.</div><div>Trial registration: ClinicalTrials.gov Identifier: NCT06495892</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 37-42"},"PeriodicalIF":2.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035922","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 Left Main and Nonleft Main Percutaneous Coronary Intervention from the Excellence in Coronary Artery Disease (XLCAD) Registry","authors":"Robert C. Stoler MD ,&nbsp;Minseob Jeong MD ,&nbsp;Talha Akram BS ,&nbsp;Alec Monhollen BS ,&nbsp;David Fernandez Vazquez MD ,&nbsp;Mufaddal Mamawala MBBS, MPH ,&nbsp;Trenton A. Witt BA ,&nbsp;Blake Bruneman BS ,&nbsp;Sarah Weideman BS ,&nbsp;Kennedy S. Adelman BS ,&nbsp;Shalini Sharma BS ,&nbsp;Yumna Furqan BS ,&nbsp;Zachary P. Rosol MD ,&nbsp;Ronak Rengarajan MD ,&nbsp;Jeffrey M. Schussler MD ,&nbsp;Ravi C. Vallabhan MD ,&nbsp;Yashasvi Chugh MD ,&nbsp;Dong-Hi Anthony Yoon MD ,&nbsp;Georges A. Feghali MD ,&nbsp;Carlos E. Velasco MD ,&nbsp;Subhash Banerjee MD","doi":"10.1016/j.amjcard.2025.01.008","DOIUrl":"10.1016/j.amjcard.2025.01.008","url":null,"abstract":"<div><h3>Background</h3><div>There are limited comparative data on real-world outcomes of patients undergoing percutaneous coronary intervention (PCI) of the left main (LM) and non-LM coronary arteries.</div></div><div><h3>Methods</h3><div>Total 873 consecutive patients undergoing LM PCI (n = 256) and non-LM PCI (n = 617) were enrolled between September 2019-March 2023 in the Excellence in Coronary Artery Disease (XLCAD) Registry. Primary outcome was 1-year incidence of major adverse cardiovascular events (MACE), a composite of all-cause death, nonfatal myocardial infarction, clinically driven repeat revascularization and ischemic stroke. The secondary outcome was periprocedural (≤30 days) events.</div></div><div><h3>Results</h3><div>Study cohort included 68% men, mean age 71.9 ± 10.3 in LM and 67.2 ± 11.1 years in non-LM PCI groups (p &lt;0.001). LM PCI patients had significantly greater co-morbidities (diabetes mellitus, hyperlipidemia, prior stroke, prior myocardial infarction, prior coronary revascularization, peripheral artery disease, chronic lung and kidney disease and heart failure) compared with non-LM. Acute coronary syndrome indication was the most prevalent (69%). Mechanical circulatory support was employed in 3.1% LM vs 1% non-LM PCI patients (p = 0.026). Mean number of lesions treated were 2.2 ± 1.0 in LM and 1.4 ± 0.6 in non-LM PCI groups (p &lt;0.001). Multivessel PCI was performed in 68.8% LM and 21% non-LM PCI patients (p &lt;0.001). Overall, drug-eluting stent use (96.7%), bifurcation PCI (24.7%) and atherectomy (2.4%) were similar across groups. Technical and procedural success rates were high across groups, however significantly higher in non-LM group. Periprocedural (≤30 days postprocedure) events included mortality in 3.5% LM and 1.5% non-LM PCI (p = 0.334) and MACE 4.7% LM vs 2.4% non-LM PCI (p = 0.080) groups. One-year MACE was significantly higher in LM versus non-LM PCI (12.9% vs 8.4%, respectively; p = 0.043), driven mainly by higher repeat percutaneous revascularization in LM group (12.1% vs 6.2%; p = 0.003). Mortality at 1-year in LM vs non-LM PCI were 10.2% vs 5.8% (p = 0.074).</div></div><div><h3>Conclusion</h3><div>In a real-world experience, LM PCI is performed in patients with significantly greater comorbidities compared with non-LM PCI, with high procedural success. Thirty-day mortality and 1-year MACE are significantly higher in LM group.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 17-25"},"PeriodicalIF":2.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021849","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":"Lipid Management in United States Commercial and Medicare Enrollees With Atherosclerotic Cardiovascular Disease: Treatment Patterns and Low-Density Lipoprotein Cholesterol Control","authors":"Ann Marie Navar MD, PhD ,&nbsp;Batul Electricwala PhD ,&nbsp;Jasjit K. Multani MPH ,&nbsp;Zifan Zhou MS ,&nbsp;Chi-Chang Chen PhD, MsPharm ,&nbsp;Barnabie C. Agatep MPH ,&nbsp;Allison A. Petrilla MPH ,&nbsp;Taylor T. Schwartz MPH ,&nbsp;Laetitia N'dri PharmD ,&nbsp;Joaquim Cristino MSc ,&nbsp;Fatima Rodriguez MD, MPH","doi":"10.1016/j.amjcard.2024.12.029","DOIUrl":"10.1016/j.amjcard.2024.12.029","url":null,"abstract":"<div><div>Lipid-lowering therapy (LLT) is the cornerstone for secondary prevention of atherosclerotic cardiovascular disease (ASCVD); however, many patients exhibit low adherence to therapy and fail to achieve low-density lipoprotein cholesterol (LDL-C) goals. This retrospective cohort study used 2 nationally representative closed administrative claims databases (PharMetrics Plus and Medicare Fee-for-Service Research Identifiable Files) to identify commercial and Medicare enrollees with ASCVD between 2014 and 2019. Patients were stratified by exposure to statin therapy, ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitor monoclonal antibodies (PCSK9i mAb) regimens. Outcomes included LLT adherence (proportion of days covered ≥0.8), persistence, and discontinuation at 12 months. For patients with LDL-C test results, the percentage of patients achieving LDL-C &lt;70 mg/100 ml during follow-up was evaluated. We identified 4.6 million patients with ASCVD (commercial: 945,704; Medicare: 3,659,011), with the majority having ischemic or coronary heart disease. Of these, 66.4% commercial and 71.4% Medicare patients were on at least 1 LLT, including 69.8% commercial and 71.4% Medicare patients on statin therapy, 2.7% commercial and 1.7% Medicare patients on ezetimibe, and 0.2% commercial and 0.04% Medicare patients on a PCSK9i mAb. By 12 months, medication discontinuation was as follows: 30.4% commercial and 34.1% Medicare for statin therapy, 35.5% commercial and 46.1% Medicare for ezetimibe, and 41.5% commercial and 55.8% Medicare for PCSK9i mAb. Approximately half of the treated patients remained adherent after 12 months. Of patients with LDL-C data available (n = 381,160), &lt;20% achieved an LDL-C &lt;70 mg/100 ml. In conclusion, medication discontinuation and low adherence to statin, ezetimibe, and PCSK9i mAb therapies were observed in both populations. Increased efforts are needed to ensure persistence and adherence to LLT in patients with ASCVD to attain LDL-C targets.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"242 ","pages":"Pages 1-9"},"PeriodicalIF":2.3,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998703","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":"Can ChatGPT 4.0 Diagnose Acute Aortic Dissection? Integrating Artificial Intelligence into Medical Diagnostics","authors":"Aman Goyal MBBS ,&nbsp;Muhammad Daoud Tariq MBBS ,&nbsp;Areeba Ahsan MBBS ,&nbsp;Andrei Brateanu MD","doi":"10.1016/j.amjcard.2025.01.010","DOIUrl":"10.1016/j.amjcard.2025.01.010","url":null,"abstract":"<div><div>Acute aortic dissection (AD) is a critical condition characterized by high mortality and frequent misdiagnoses, primarily due to symptom overlap with other medical pathologies. This study explores the diagnostic utility of ChatGPT 4.0, an artificial intelligence model developed by OpenAI, in identifying acute AD from patients’ presentations and general physical examination findings documented in published case reports. A systematic search was conducted on the PubMed database using the search term “acute aortic dissection,” applying filters for articles published within the past year and categorized as case reports. The primary symptoms and physical examination details from each case were inputted into ChatGPT 4.0, which was prompted to generate three differential diagnoses and one main provisional diagnosis based on the case presentation. The search yielded a total of 163 results, from which 10 case reports were randomly selected. The patient demographics across all 10 case reports demonstrated an age range of 29 to 82 years, with equal gender distribution (5 males, 5 females) and hypertension as the most prevalent baseline comorbidity. ChatGPT 4.0 accurately identified acute AD as one of the top three differential diagnoses in all selected cases and identified acute AD as the provisional diagnosis in five of the 10 cases. In conclusion, while ChatGPT 4.0 demonstrates potential in suggesting acute AD as a differential diagnosis based on clinical data, its role should be considered supportive rather than definitive. Based on our findings, it could serve as an early, cost-effective, and quick screening tool, helping physicians adopt a “think aorta” approach.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"239 ","pages":"Pages 90-92"},"PeriodicalIF":2.3,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998701","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":"Evaluating Patients With Chest Pain Using the Recalibrated HEART Score and a Single High Sensitive Cardiac Troponin Measurement","authors":"Vernon V.S. Bonarjee MD, PhD","doi":"10.1016/j.amjcard.2024.09.016","DOIUrl":"10.1016/j.amjcard.2024.09.016","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"235 ","pages":"Pages 91-92"},"PeriodicalIF":2.3,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279137","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":"Epinephrine for Refractory No-Reflow During Percutaneous Coronary Interventions","authors":"Fernando Alfonso MD ,&nbsp;Josep Gómez-Lara MD ,&nbsp;Fernando Rivero MD","doi":"10.1016/j.amjcard.2024.08.023","DOIUrl":"10.1016/j.amjcard.2024.08.023","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"235 ","pages":"Pages 88-90"},"PeriodicalIF":2.3,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103587","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":"Effects of Novel Antidiabetic Agents on Contrast-Associated Acute Kidney Injury in Diabetic Patients Undergoing Percutaneous Coronary Intervention","authors":"Annunziata Nusca MD, PhD ,&nbsp;Maria Pia Di Bitonto MD ,&nbsp;Agostino Spanò MD ,&nbsp;Federico Bernardini MD ,&nbsp;Fabio Mangiacapra MD, PhD ,&nbsp;Elisabetta Ricottini MD, PhD ,&nbsp;Rosetta Melfi MD ,&nbsp;Sara Giannone MD ,&nbsp;Gian Paolo Ussia MD ,&nbsp;Francesco Grigioni MD, PhD","doi":"10.1016/j.amjcard.2025.01.007","DOIUrl":"10.1016/j.amjcard.2025.01.007","url":null,"abstract":"<div><div>Contrast-associated acute kidney injury (CA-AKI) remains a serious complication after percutaneous coronary revascularization (PCI), with limited effective preventive strategies especially for diabetic patients. This study aimed to assess the effects of novel antidiabetic agents (NAD), i.e., glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium-glucose transporter-2 inhibitors (SGLT2i), and dipeptidyl peptidase-4 inhibitors (DPP4i), on the occurrence of this outcome in diabetic patients undergoing PCI. We enrolled 293 consecutive diabetic patients receiving NAD at the time of PCI (NAD group) and paired them with 293 diabetic individuals undergoing revascularization who were not on NAD (no-NAD group), matched according to age and sex. CA-AKI was defined as an increase in serum creatinine (SCr) ≥0.3 mg/dl or &gt;50% from baseline within 48 to 72 hours after contrast exposure. A propensity score-adjusted logistic regression analysis was performed to account for potential selection bias. NAD treatment was associated with a significantly reduced incidence of CA-AKI than standard glucose-lowering therapies (4.1 vs. 8.5%, p = 0.023). Furthermore, patients using SGLT2i and GLP-1RAs exhibited a lower incidence of CA-AKI compared to those taking DPP4i. Both multivariate and propensity-score-adjusted regression analyses identified NAD therapy as an independent predictor of CA-AKI (OR 0.45, 95% CI 0.22–0.98, p = 0.040 and OR 0.48, 95% CI 0.23–0.98, p = 0.045). In conclusion, this study is the first to explore the potential benefit of all three NAD classes on CA-AKI incidence. The use of these agents is associated with a lower incidence of renal damage in diabetic patients undergoing PCI, with the greatest benefit observed with SGLT2i and GLP-1RAs use.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"240 ","pages":"Pages 50-56"},"PeriodicalIF":2.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977065","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":"Arrhythmogenic Right Ventricular Cardiomyopathy: The Importance of Biventricular Strain in Risk-Stratification","authors":"Aileen Paula Chua MD ,&nbsp;Dorien Laenens MD ,&nbsp;Camille Sarrazyn MD ,&nbsp;Maria Pilar Lopez-Santi MD ,&nbsp;Takeru Nabeta MD ,&nbsp;Rinchyenkhand Myagmardorj MD ,&nbsp;Marianne Bootsma MD, PhD ,&nbsp;Daniela Q.C.M. Barge-Schaapveld MD, PhD ,&nbsp;Jeroen J. Bax MD, PhD ,&nbsp;Nina Ajmone Marsan MD, PhD","doi":"10.1016/j.amjcard.2025.01.006","DOIUrl":"10.1016/j.amjcard.2025.01.006","url":null,"abstract":"<div><div>Despite arrhythmogenic right ventricular cardiomyopathy (ARVC) being predominantly a right ventricular (RV) disease, concomitant left ventricular (LV) involvement has been recognized. ARVC is diagnosed by the RV-centric 2010 Task Force Criteria(TFC) using routine echocardiography, but previous studies have suggested that strain imaging may be more sensitive to detect RV and LV dysfunction. No data however are available regarding the additional value of combining biventricular strain for risk stratification. This study aims to assess the prognostic value of both LV global longitudinal strain (GLS) and RV free wall strain (FWLS) in patients with ARVC. To accomplish this, 204 patients who met the TFC for the ARVC spectrum were included. Patients (age 41 ± 17 years,55% men) were divided into impaired(n = 33), discordant (RV or LV impaired, n = 70), and normal (n = 101) strain groups based on a value of ≥18% for both ventricles. During a follow-up of 87 [24–136] months, 57 (28%) experienced the composite outcome of all-cause mortality, arrhythmic events, implantable cardioverter defibrillator therapy and heart failure events, and a significant difference in event-free survival was observed (p &lt;0.001) between the 3 groups. In the multivariable analysis, the strain groups remained associated with outcomes (p = 0.014) after adjusting for age, sex, history of syncope and definite ARVC diagnosis. A subanalysis including only definite and borderline diagnosed ARVC confirmed that the strain groups were independently predictive of the endpoint (p = 0.023). In conclusion, biventricular involvement by strain analysis may help risk stratification in ARVC patients, with the worst outcomes of patients with both RV and LV impaired strain.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 61-68"},"PeriodicalIF":2.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977060","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":"Impact of Exercise on Atrial Functional Mitral Regurgitation and Its Determinants: An Exercise Echocardiographic Study","authors":"Stephanie De Schutter MD ,&nbsp;Eline Van Damme MD ,&nbsp;Galathea Van Hout MD ,&nbsp;Lobke L. Pype MD ,&nbsp;Andreas B. Gevaert MD, PhD ,&nbsp;Emeline M. Van Craenenbroeck MD, PhD ,&nbsp;Marc J. Claeys MD, PhD ,&nbsp;Caroline M. Van De Heyning MD, PhD","doi":"10.1016/j.amjcard.2024.12.033","DOIUrl":"10.1016/j.amjcard.2024.12.033","url":null,"abstract":"<div><div>Atrial functional mitral regurgitation (AFMR) is a distinct form of mitral regurgitation in patients with atrial fibrillation and heart failure with preserved ejection fraction. Its pathophysiology remains elusive, and data on exercise-related AFMR are scarce. We sought to investigate the impact of acute exercise on AFMR severity and to identify its determinants. In total, 47 patients with heart failure with preserved ejection fraction (n = 39) and/or atrial fibrillation (n = 22) were enrolled. We assessed AFMR severity, mitral annular dimensions, left atrial size, AFMR severity, and parameters of systolic and diastolic function at rest and during maximal exercise by echocardiography. An increase in AFMR severity of ≥1 grade was observed in 20 patients (43%) during exercise and was associated with impaired progression of peak mitral annulus systolic velocity and increased systolic mitral annular diameter during exercise, whereas the systolic annular diameter decreased in patients without AFMR progression. Furthermore, patients with ≥ moderate AFMR during exercise (n = 19, 40%) had lower peak mitral annulus systolic velocity, greater systolic mitral annular diameters, reduced tricuspid annular plane systolic excursion, and more severe tricuspid regurgitation than patients with ≤ mild MR during exercise. In conclusion, AFMR is a dynamic condition which may worsen during exercise. Deterioration of AFMR during exercise was associated with impaired longitudinal left ventricular contractile reserve and greater mitral annular dimensions. Because impaired left ventricular longitudinal function may influence mitral annular dynamics, this attributes to the hypothesis that AFMR results from mitral annulus area/leaflet area imbalance caused by annular dilation and impaired mitral annular dynamics.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"240 ","pages":"Pages 57-63"},"PeriodicalIF":2.3,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142968758","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":"Hyperacute Effects of Mitral Transcatheter Edge-to-Edge Repair on Left Ventricular Volumes and Functions","authors":"Mohammad Kassar MD ,&nbsp;Ana Ovsenik MD ,&nbsp;Raouf Madhkour MD ,&nbsp;Noé Corpataux MD ,&nbsp;Athanasios Papadis MD ,&nbsp;George Siontis MD, PhD ,&nbsp;Lukas Hunziker MD ,&nbsp;Stephan Windecker MD ,&nbsp;Fabien Praz MD ,&nbsp;Nicolas Brugger MD","doi":"10.1016/j.amjcard.2024.12.038","DOIUrl":"10.1016/j.amjcard.2024.12.038","url":null,"abstract":"<div><div>Transcatheter edge-to-edge repair (TEER) is an effective intervention for high-risk patients with severe symptomatic mitral regurgitation (MR); however, its acute impact on left ventricular (LV) function has not been well-studied using advanced echocardiographic techniques. This study investigated the immediate effects of TEER on LV volumes and functions and their influence on midterm outcomes, using high-resolution 3-dimensional transesophageal echocardiography. In 80 patients who underwent TEER for severe MR (mean age 79 ± 8 years, 49% with primary MR), LV end-diastolic volume and stroke volume significantly decreased (161 ± 61 to 147 ± 54 ml and 69 ± 18 to 50 ± 15 ml, respectively), whereas end-systolic volume increased (92 ± 60 to 97 ± 45 ml, p &lt;0.0001 for all). Left ventricular ejection fraction (LVEF) (48 ± 16% to 38 ± 14%), global longitudinal strain (16.2 ± 6.8% to 12.8 ± 5.4%), and global circumferential strain (25 ± 10.5% to 18.7 ± 8.5%) deteriorated significantly (p &lt;0.0001 for all). Absolute reductions in LVEF and global circumferential strain were associated with baseline values and afterload reduction, indicated by 3-dimensional vena contracta area decrease (<em>r</em> = 0.47 and <em>r</em> = 0.65, p &lt;0.0001), whereas global longitudinal strain reduction was linked to baseline values and inversely proportional to LV end-diastolic volume (<em>r</em> = 0.63, p &lt;0.0001). Relative LVEF reduction emerged as the strongest predictor of mortality, with a hazard ratio of 1.76 (1.12 to 2.76) per 10% decrease. In conclusion, the acute decrease in LV function after TEER correlates with the degree of MR reduction, with greater impacts observed in circumferential function and patients with higher baseline LVEF. Relative LVEF reduction is a critical echocardiographic predictor of mortality.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 9-16"},"PeriodicalIF":2.3,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969487","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}