American Journal of Cardiology最新文献

{"title":"Home-Based Exercise and Patient-Reported Outcome Measures in Peripheral Artery Disease: The LITE Randomized Clinical Trial","authors":"Mary O. Whipple PhD, RN ,&nbsp;Shujun Xu MS ,&nbsp;Dongxue Zhang MS ,&nbsp;Jack M. Guralnik MD, PhD ,&nbsp;Bonnie Spring PhD ,&nbsp;Lu Tian ScD ,&nbsp;Diane Treat-Jacobson PhD, RN ,&nbsp;Lihui Zhao PhD ,&nbsp;Michael H. Criqui MD, MPH ,&nbsp;Mary M. McDermott MD","doi":"10.1016/j.amjcard.2025.02.027","DOIUrl":"10.1016/j.amjcard.2025.02.027","url":null,"abstract":"<div><div>In patients with peripheral artery disease (PAD), we evaluated the effects of 12 months of walking exercise at a pace inducing ischemic leg symptoms (high intensity) on the attainment of meaningful improvement in patient-reported outcome measures (PROMs) and 6-minute walk, compared to walking exercise at a comfortable pace (low intensity) and a nonexercise control. Participants completed the 6-minute walk test (6MWT) to evaluate objective walking ability. PROMs included the Walking Impairment Questionnaire (WIQ) distance and speed scores (range 0 to 100, 100-best, minimal clinically important difference (MCID) = 15 and 11, respectively). 240 participants (61.7% Black, 48.3% female) participated. High intensity exercise increased 6MWT compared to control (+44.8 meters (95% CI:21.7,68.0) and compared to low-intensity exercise (+37.6 meters [95% CI:18.6,56.5]). Low intensity exercise had no significant benefit compared to control (+7.3 meters [95% CI:-16.3,30.9]). High intensity significantly increased attainment of the MCID for the 6MWT compared to low intensity (OR:2.43 [95% CI:1.35,4.38]) and compared to control (OR:5.22 [95% CI:2.32,11.76]). Compared to control, high intensity exercise significantly increased the odds of attaining an MCID for the WIQ distance score (OR:2.30 [95% CI:1.05,5.04]) and WIQ speed score (OR:2.94 [95% CI:1.27,6.83]). Compared to low intensity, high intensity did not significantly increase the odds of attaining an MCID for the WIQ distance (OR:0.93 [95% CI:0.53,1.66]) or the WIQ speed score (OR:1.31 [95% CI:0.71,2.43]). In conclusion, in people with PAD, high intensity walking exercise increased the odds of meaningful improvement in PROMs compared to control, but not compared to low-intensity exercise. Despite this, high intensity exercise improved 6MWT more than the low intensity exercise and nonexercise control groups (NCT02538900).</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 41-47"},"PeriodicalIF":2.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531172","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":"Brugada Syndrome in Sports Cardiology: An Expert Opinion Statement of the Italian Society of Sports Cardiology (SICSport)","authors":"Antonio Scarà MD ,&nbsp;Luigi Sciarra ,&nbsp;Antonio Dello Russo ,&nbsp;Elena Cavarretta ,&nbsp;Zefferino Palamà MD ,&nbsp;Alessandro Zorzi ,&nbsp;Francesco Brancati ,&nbsp;Paolo Compagnucci PhD ,&nbsp;Michela Casella ,&nbsp;Valeria Novelli PhD ,&nbsp;Giampiero Patrizi MD ,&nbsp;Pietro Delise MD","doi":"10.1016/j.amjcard.2025.02.031","DOIUrl":"10.1016/j.amjcard.2025.02.031","url":null,"abstract":"<div><div>Brugada syndrome (BrS) is a genetic disorder marked by a characteristic electrocardiogram (ECG) pattern of ST-segment elevation and T-wave inversion in right precordial leads, which is associated with an increased risk of ventricular fibrillation in the absence of structural heart disease. Despite advancements in understanding its epidemiology, pathophysiology, and treatment, there is considerable variability in how sports cardiologists approach BrS. This expert opinion by the Italian Society of Sports Cardiology (SICSPORT) aim to review the current definition, diagnosis, epidemiology, genetics, risk stratification, and treatment of BrS and provide guidance for sport eligibility provides guidance for sports doctors and cardiologists in assessing competitive sports eligibility in athletes with BrS. A multiparametric approach to diagnosis and risk stratification is recommended, noting that the presence of a Brugada ECG pattern (BrP) does not confirm a BrS diagnosis. The risk of sudden cardiac death (SCD) is low in asymptomatic individuals with type 1 BrP, especially those with a drug-induced pattern. Pharmacological testing is not required for type 2 or 3 patterns without other risk factors. Low-risk individuals do not require therapy, while intermediate or high-risk patients may need pharmacological treatment, ICD implantation, or ablation. Asymptomatic individuals with type 2 or 3 BrP, no family history of SCD, and no other risk factors may be eligible for competitive sports, as well as asymptomatic type 1 BrP without risk factors and negative electrophysiological study. Conversely, sports eligibility should be denied in patients with BrS who have a history of syncope or cardiac arrest (high-risk subjects), regardless of ICD presence.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 9-17"},"PeriodicalIF":2.3,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531173","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":"Epidemiological Profile and Mortality of Infective Endocarditis Over the Past Decade: A Systematic Review and Meta-Analysis of 133 Studies","authors":"Andreas Tzoumas MD ,&nbsp;Marios Sagris MD ,&nbsp;Dimitrios Xenos MD ,&nbsp;Athina Ntoumaziou MD ,&nbsp;Ioannis Kyriakoulis MD ,&nbsp;Fotis Kakargias MD ,&nbsp;Wasla Liaqat MD ,&nbsp;Sanjana Nagraj MBBS ,&nbsp;Riya Patel MBBS ,&nbsp;Grigorios Korosoglou MD ,&nbsp;Dimitris Tousoulis MD, PhD ,&nbsp;Konstantinos Tsioufis MD, PhD ,&nbsp;Damianos G. Kokkinidis MD ,&nbsp;Leonidas Palaiodimos MD","doi":"10.1016/j.amjcard.2025.02.023","DOIUrl":"10.1016/j.amjcard.2025.02.023","url":null,"abstract":"<div><div>Infective endocarditis (IE) is an increasingly prevalent condition with relatively high mortality, whose epidemiology has become more complex with an aging population, an increased number of comorbidities, and an increasing incidence of health-care associated IE. Epidemiological data on the causative microorganisms of IE, prevalence of involvement of the different cardiac valves, and IE-associated mortality are clinically relevant. Eligible studies were identified through a systematic search of PubMed/MEDLINE database from 2010 to 2020, and a random effects model meta-analysis was conducted. 133 studies comprising 132,584 patients from six continents were included in this systematic review. The most common causative agents were Staphylococci species in 36% of cases, followed by Streptococci species (26%) and Enterococci species (10%). Out of studies that provided further speciation, the predominant species was Staphylococcus aureus with an incidence of 29%, followed by Viridans group Streptococcus (12%). The short-term mortality rate (defined as in-hospital or 30-day mortality) was 17%. The highest mortality was reported in studies from Latin America with a mean mortality rate of 33% and the lowest mortality was reported in studies from Oceania at 13%. The aortic valve was the most commonly affected valve (46%), followed closely by the mitral valve (43%). The prevalence of tricuspid valve IE was 7% and multivalvular IE occurred in 14% of cases. Our study highlights a shift in epidemiological profile of IE over the last decade with S. aureus identified as the most common causative microorganism of IE.</div></div><div><h3>Protocol registration</h3><div>PROSPERO CRD42024602342.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 67-88"},"PeriodicalIF":2.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522403","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":"Chronic Total Occlusion Percutaneous Coronary Intervention: The Present and the Future","authors":"Emmanouil S. Brilakis MD, PhD","doi":"10.1016/j.amjcard.2025.02.022","DOIUrl":"10.1016/j.amjcard.2025.02.022","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"246 ","pages":"Pages 1-2"},"PeriodicalIF":2.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522399","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":"Machine Learning Predicts Bleeding Risk in Atrial Fibrillation Patients on Direct Oral Anticoagulant","authors":"Rahul Chaudhary ,&nbsp;Mehdi Nourelahi ,&nbsp;Floyd W. Thoma ,&nbsp;Walid F. Gellad ,&nbsp;Wei-Hsuan Lo-Ciganic ,&nbsp;Rohit Chaudhary ,&nbsp;Anahita Dua ,&nbsp;Kevin P. Bliden ,&nbsp;Paul A. Gurbel ,&nbsp;Matthew D. Neal ,&nbsp;Sandeep Jain ,&nbsp;Aditya Bhonsale ,&nbsp;Suresh R. Mulukutla ,&nbsp;Yanshan Wang ,&nbsp;Matthew E. Harinstein ,&nbsp;Samir Saba ,&nbsp;Shyam Visweswaran","doi":"10.1016/j.amjcard.2025.02.030","DOIUrl":"10.1016/j.amjcard.2025.02.030","url":null,"abstract":"<div><div>Predicting major bleeding in nonvalvular atrial fibrillation (AF) patients on direct oral anticoagulants (DOACs) is crucial for personalized care. Alternatives like left atrial appendage closure devices lower stroke risk with fewer nonprocedural bleeds. This study compares machine learning (ML) models with conventional bleeding risk scores (HAS-BLED, ORBIT, and ATRIA) for predicting bleeding events requiring hospitalization in AF patients on DOACs at their index cardiologist visit. This retrospective cohort study used electronic health records from 2010 to 2022 at the University of Pittsburgh Medical Center. It included 24,468 nonvalvular AF patients (age ≥18) on DOACs, excluding those with prior significant bleeding or warfarin use. The primary outcome was hospitalization for bleeding within one year, with follow-up at one, two, and five years. ML algorithms (logistic regression, classification trees, random forest, XGBoost, k-nearest neighbor, naïve Bayes) were compared for performance. Of 24,468 patients, 553 (2.3%) had bleeding within one year, 829 (3.5%) within two years, and 1,292 (5.8%) within five years. ML models outperformed HAS-BLED, ATRIA, and ORBIT in 1-year predictions. The random forest model achieved an AUC of 0.76 (0.70 to 0.81), G-Mean of 0.67, and net reclassification index of 0.14 compared to HAS-BLED's AUC of 0.57 (p &lt; 0.001). ML models showed superior results across all timepoints and for hemorrhagic stroke. SHAP analysis identified new risk factors, including BMI, cholesterol profile, and insurance type. In conclusion, ML models demonstrated improved performance to conventional bleeding risk scores and uncovered novel risk factors, offering potential for more personalized bleeding risk assessment in AF patients on DOACs.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 58-66"},"PeriodicalIF":2.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522409","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":"Treating and Preventing Acute Coronary Syndromes in Kidney Transplant Recipients.","authors":"Craig R Narins","doi":"10.1016/j.amjcard.2025.02.012","DOIUrl":"10.1016/j.amjcard.2025.02.012","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490385","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":"Prospective Comparison of Temporal Myocardial Function in Men Versus Women After Anterior ST-Elevation Myocardial Infarction With Timely Reperfusion","authors":"Sandeep Jha MD ,&nbsp;Aaron Shekka Espinosa MD ,&nbsp;Linnea Molander MD ,&nbsp;Angela Poller MSc ,&nbsp;Valentyna Sevastianova MD, PhD ,&nbsp;Koen Simons PhD ,&nbsp;Julia Baranowska MD ,&nbsp;Thorsteinn Gudmundsson MD ,&nbsp;Emanuele Bobbio MD ,&nbsp;Rickard Zeijlon MD, PhD ,&nbsp;Carlo Pirazzi MD, PhD ,&nbsp;Andreas Martinsson MD, PhD ,&nbsp;Tomas Mellberg MD, PhD ,&nbsp;Petronella Torild RN ,&nbsp;Joakim Sundstrom MD ,&nbsp;Erik Axel Andersson PhD ,&nbsp;Sigurdur Thorleifsson MD ,&nbsp;Sabin Salahuddin MD ,&nbsp;Ahmed Elmahdy MD ,&nbsp;Tetiana Pylova MD, PhD ,&nbsp;Bjorn Redfors MD, PhD","doi":"10.1016/j.amjcard.2025.02.015","DOIUrl":"10.1016/j.amjcard.2025.02.015","url":null,"abstract":"<div><div>Compared to men, women have been reported to have increased morbidity and mortality after ST-elevation myocardial infarction (STEMI); but sex differences in cardiac function in the acute and subacute phases of STEMI are incompletely understood. The objective of this study was to prospectively compare changes in cardiac function over the acute and subacute phases after anterior STEMI with timely reperfusion in women versus men. The Stunning in Takotsubo versus Acute Myocardial Infarction (STAMI) study (NCT04448639) prospectively enrolled 105 men and 41 women with anterior STEMI. Echocardiography and blood sampling were performed within 4 hours of admission and at 1, 2, 3, 7, 14, and 30 days after admission. The primary outcome was akinesia recovery, defined as the difference in the percentage of akinesia observed at baseline versus follow-up. Secondary outcomes included wall motion score index (WMSI), left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Mixed effects linear regression or zero-inflated tobit models with random intercepts were used to model echocardiographic parameters over time. Baseline patient characteristics were similar in both groups. The difference between women and men in akinesia recovery at 30 days was 8.3% (95% credible interval 0.8%, 15.5%). The covariate-adjusted posterior probability that akinesia recovery and WMSI improvement at 30 days are greater in women than men were 96.0% and 99.0% respectively. Similar but less pronounced trends towards greater improvement in women than men were observed for LVEF and GLS. In conclusion, cardiac dysfunction recovered to a greater extent in women than in men after anterior STEMI with timely reperfusion.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 48-57"},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482090","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":"The Relationship Between Syncope and Cardiac Index in Acute Pulmonary Embolism","authors":"Peter Zhang MD ,&nbsp;Robert S. Zhang MD ,&nbsp;Eugene Yuriditsky MD ,&nbsp;Kevin Chen MD, MS ,&nbsp;Vincent Li BS ,&nbsp;Lindsay Elbaum MD ,&nbsp;Norma Keller MD ,&nbsp;Allison A. Greco MD ,&nbsp;Vikramjit Mukherjee MD ,&nbsp;Radu Postelnicu MD ,&nbsp;Kerry Hena MD ,&nbsp;James M. Horowitz MD ,&nbsp;Carlos L. Alviar MD ,&nbsp;Sripal Bangalore MD, MHA","doi":"10.1016/j.amjcard.2025.02.017","DOIUrl":"10.1016/j.amjcard.2025.02.017","url":null,"abstract":"<div><div>The relationship between syncope and invasive hemodynamics in patients with pulmonary embolism (PE) remains unknown. The objective of this study was to assess the ability of syncope, as a single clinical variable, to predict a low cardiac index in patients with acute PE. This retrospective study included patients with acute intermediate- and high-risk PE who underwent catheter-based therapies between October 2020 and June 2024. The primary outcome was whether syncope at hospital presentation was a predictor of low cardiac index (≤2.2 L/min/m²) in patients with acute intermediate or high risk PE. Secondary outcomes included 30-day mortality, hemodynamic instability, 90-day readmission rates, other invasive hemodynamic parameters, intensive care unit (ICU) length of stay (LOS), and hospital LOS. Regression analyses were used to evaluate the association between cardiac index and syncope. A total of 132 patients (86% intermediate- and 14% high-risk) were included in the study, with 27 (20%) presenting with syncope. Among the 114 intermediate-risk patients, 24 (21%) presented with syncope. In all-comers, there was no significant difference between groups at baseline. Within the intermediate-only subgroup, there were no significant differences between groups at baseline, except that the syncope group was older (62.6 ± 14.9 vs 56.1 ± 13.9, p = 0.048, Table 2) and had significantly higher troponin elevation at presentation (684.3 ± 1361.8ng/L vs 195.6 ± 278.1ng/L, p = 0.003, Table 2). In all-comers, there was no difference in rates of low cardiac index (63% vs 59%, p = 0.71) or mPAP (33.9 ± 8.6 vs 32.7 ± 9.6 mm Hg, p = 0.57) between patients who presented with and without syncope. Similarly, among intermediate-risk patients, there was also no difference in the rates of low cardiac index (67% vs 57%, p = 0.38) or mPAP (34.0 ± 9.2 vs 33.1 ± 9.8 mmHg, p = 0.69) between patients with and without syncope. There was no difference in clinical outcomes between those who presented with and without syncope. In conclusion, in patients with acute PE, syncope was not associated with a low cardiac index or higher mPAP.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"246 ","pages":"Pages 3-9"},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482091","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 Year Long Aerobic Exercise on Left Atrial Size in Patients With Left Ventricular Hypertrophy","authors":"Douglas Kyrouac ,&nbsp;Nicholas Talbot ,&nbsp;James MacNamara ,&nbsp;Erin Howden ,&nbsp;Michinari Hieda ,&nbsp;Christopher Hearon ,&nbsp;Tiffany Brazile ,&nbsp;Benjamin Levine ,&nbsp;Satyam Sarma","doi":"10.1016/j.amjcard.2025.02.020","DOIUrl":"10.1016/j.amjcard.2025.02.020","url":null,"abstract":"<div><div>Habitual aerobic exercise is associated with left atrial (LA) enlargement which may increase risk of atrial fibrillation. Patients with LVH and increased LV stiffness may be more predisposed to LA remodeling due to higher LA pressures during exercise. We tested the hypothesis 1 year of aerobic exercise training would increase LA size to a greater extent in patients with LVH than controls. Adults with LVH (<em>n</em> = 53) enriched for increased cardiac risk and LV stiffness and control (CON) subjects (<em>n</em> = 58) were randomized to 1 year of high intensity aerobic exercise (ex) or yoga control. LA and LV volumes were measured using 3D echo. Of 111 participants, 83 had complete data available (LVH: 18 exercisers, 10 yoga; CON: 29 exercisers, 26 yoga). Baseline LA volume indices were similar between groups (LVH: 19.8 ± 4.4 mL/m² vs CON: 18.8 ± 4.1 mL/m²; p = 0.33). After 1 year, the effects of exercise (p = 0.003) and LVH (p = 0.001) were each associated with increased LA volume index. More subjects in the LVH/exercise group (33.3%) increased LA size &gt;5 mL/m² and LA/LV volume ratios &gt;0.1 compared to the other groups (10% LVH/yoga, 3.4% CON/ex, 3.8% CON/yoga; Chi square p = 0.006).</div><div>In conclusion, 1 year of aerobic training resulted in higher LA volumes in subjects with LVH and LV stiffness compared to healthy subjects. The increase in LA size was greater than changes in LV size suggesting chronic aerobic training in may preferentially affect LA remodeling in subjects with LVH and LV stiffness.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 3-8"},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476195","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":"Adequacy of Loop Diuretic Dosing in Treatment of Acute Heart Failure: Insights from the BAN-ADHF Diuretic Resistance Risk Score","authors":"Joseph Mauch MD ,&nbsp;Max Puthenpura MD ,&nbsp;Pieter Martens MD, MSc, PhD ,&nbsp;Timothy Engelman LPN ,&nbsp;Justin L Grodin MD, MPH ,&nbsp;Matthew W. Segar MD ,&nbsp;Ambarish Pandey MD, MS ,&nbsp;Wai Hong Wilson Tang MD","doi":"10.1016/j.amjcard.2025.02.018","DOIUrl":"10.1016/j.amjcard.2025.02.018","url":null,"abstract":"<div><div>Diuretic resistance (DR) is common among patients admitted with acute heart failure (AHF) and can be estimated by BAN-ADHF scores. Among 317 consecutive patients hospitalized for AHF, BAN-ADHF scores were compared with metrics of DR and composite endpoint of all-cause mortality, HF hospitalization, LVAD, or heart transplantation. The BAN-ADHF score was incorporated into a diuretic dosing calculator and retroactively applied to a patient's diuretic dose to categorize them as adequately dosed or under-dosed (inadequate). The primary outcome studied was attaining &gt;3 L of urine output within the first 24 hours of admission. The median BAN-ADHF score was 9 (IQR of 7-13). A higher BAN-ADHF score was associated with greater DR based on weight loss and urine output (all p &lt;0.001). The highest quartile (Q4) had fewer patients achieve the admission urinary output goal (15% vs 32%, p = 0.004) and lower total urine output (2,009 mL vs 2,559 mL, p = 0.029) compared with the first 3 quartiles. In time-to-event analysis, Q4 of BAN-ADHF score was associated with increased risk of the primary composite endpoint (HR 2.07, 95% CI 1.41 to 3.04). Compared to those below the calculator's recommended dose, patients receiving loop diuretics at goal doses (37.7% of cohort) had greater 24-hour UOP (3,050 vs 2,050 mL), likelihood of UOP goal (45% vs 19%), and weight loss at discharge (8.95 kg vs 5.94 kg; all p &lt;0.001). In conclusion, BAN-ADHF score correlated with diuretic resistance and prognosis, and may capture the risk of DR compared traditional measures like CKD or NT-proBNP.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 18-27"},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476193","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}