American Journal of Cardiology最新文献

{"title":"Minimally Invasive Direct Coronary Artery Bypass or Percutaneous Coronary Intervention With Drug-Eluting Stents for Isolated Left Anterior Descending Artery Stenosis.","authors":"Gjin Ndrepepa","doi":"10.1016/j.amjcard.2025.05.016","DOIUrl":"10.1016/j.amjcard.2025.05.016","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092394","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":"Indications and Treatment Outcomes of Below-the-Knee Peripheral Artery Interventions in the XLPAD Registry","authors":"Zachary P. Rosol MD ,&nbsp;Sameh Sayfo MD ,&nbsp;David Fernandez-Vazquez MD ,&nbsp;Minseob Jeong MD ,&nbsp;Mufaddal Mamawala MBBS, MPH ,&nbsp;Anand Gupta MBBS, MPH ,&nbsp;Blake M. Bruneman BS ,&nbsp;Sarah G. Weideman BS ,&nbsp;Kennedy S. Adelman BS ,&nbsp;Shirling Tsai MD ,&nbsp;Aravinda Nanjundappa MD ,&nbsp;Hung B. Chu MD, RPVI ,&nbsp;Bertram L. Smith MD ,&nbsp;Bradley R. Grimsley MD ,&nbsp;Stephen E. Hohmann MD ,&nbsp;Javier Vasquez Jr MD ,&nbsp;Chris Metzger MD ,&nbsp;Christopher L. Henry MD ,&nbsp;Mujtaba M. Ali MD ,&nbsp;Timothy A. Mixon MD ,&nbsp;Subhash Banerjee MD","doi":"10.1016/j.amjcard.2025.05.011","DOIUrl":"10.1016/j.amjcard.2025.05.011","url":null,"abstract":"<div><div>There are unresolved questions regarding indications and outcomes of endovascular below-the-knee (BTK) interventions in patients with symptomatic peripheral artery disease (PAD) in real-world clinical practice. We analyzed 884 patients from the multicenter XLPAD registry between 2006 and 2023 with nonstent BTK PAD interventions. Primary outcome: freedom from major adverse limb events (MALE) at 1 year, a composite of all-cause death, major amputation, or clinically driven revascularization. Majority (62.8%) of the BTK interventions were performed for chronic limb threatening ischemia (CLTI), while remaining (37.2%) in patients with intermittent claudication (IC), performed together with an inflow femoropopliteal artery intervention in 58% or involving complex lesion crossings (11.8%). Nearly, 74% were men, mean age 68.0 ± 10.7 years. Mean Rutherford class was 4.65 in CLTI and 2.71 in IC groups. Moderate to severe calcification was present in 25% of cases. Significantly greater number of lesions were treated in the CLTI group (1.84 ± 1.52 vs 2.08 ± 1.61; p = 0.029). Lesion lengths (CLTI: 129.3 ± 85.1 mm vs IC: 115.5 ± 82.5; p = 0.075) were comparable. Nearly, 92% of lesions were treated with balloon angioplasty. Drug-coated balloon use was higher in IC (5% vs 15%, p &lt;0.001), whereas atherectomy use was high in both groups (CLTI: 45.4% vs IC: 49.9%; p = 0.201). Procedural success was similar (CLTI: 92% vs IC: 88.8%; p = 0.098), however 1-year MALE was significantly higher in CLTI patients (30.5% vs 15.8% vs; p &lt;0.0.001), driven by higher all-cause mortality (5.6% vs 2.1% vs; p = 0.014) and major amputations (14% vs 3.7%; p &lt;0.001). Endovascular treatment for BTK PAD is more often performed in patients with CLTI compared with IC, where it is often combined with an inflow artery intervention or complex lesion crossings. Despite similar procedural success, 1-year MALE is significantly higher in CLTI, driven mainly by over a 2-fold increase in all-cause mortality and major amputations.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 38-45"},"PeriodicalIF":2.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092374","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":"Real-World Evidence on Lead Extraction Following Cardiac Implantable Electronic Device (CIED) Infections and Its Association With 1-year Mortality","authors":"Md Shajedur Rahman Shawon DPhil ,&nbsp;Jennifer Yu PhD ,&nbsp;Sean Gomes MRes ,&nbsp;Sze-Yuan Ooi PhD ,&nbsp;Louisa Jorm PhD","doi":"10.1016/j.amjcard.2025.05.015","DOIUrl":"10.1016/j.amjcard.2025.05.015","url":null,"abstract":"<div><div>Complete lead extraction is strongly recommended for managing cardiac implantable electronic device (CIED) infections. However, actual practices and associated patient outcomes in real-world settings are not well documented. This study aims to quantify use of lead extraction among Australian patients with CIED infections. In this retrospective cohort study, we analyzed linked hospital and mortality data from New South Wales (July 2008 to September 2022). We included patients aged ≥18 years diagnosed with CIED infections, identified using diagnosis codes T82.71 (from July 2017 onwards) and T82.7 with relevant supplementary codes prior to July 2017. We quantified the association between lead extraction and 1-year mortality using time-varying Cox proportional hazards regression models. We included 2,339 patients (mean age 72.5 years, 31.5% female) who were hospitalized with CIED infections, of which 24.0% (<em>n</em> = 561) underwent lead extraction within 30 days. The likelihood of lead extraction was higher among those with sepsis, endocarditis, Staphylococcus aureus infection, prior revision/replacement CIED procedures, and patients admitted to private hospitals. In contrast, older patients (aged 75+ years), female patients, and those with chronic kidney disease were less likely to undergo lead extraction. Lead extraction was associated with reduced 1-year mortality rate (adjusted-HR = 0.64, 95% CI: 0.51 to 0.81), with evidence of greater survival benefit in patients with sepsis and lesser benefit in older patients and females. In conclusion, utilization of lead extraction was limited among patients with CIED infections. Lead extraction was linked to significantly reduced mortality rate, highlighting the importance of improving adherence to recommended management for patients with CIED infections.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 54-62"},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085688","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":"Approach to Management of Cardiac Calcified Amorphous Tumor","authors":"Parker Wilson DO ,&nbsp;Priyamvada Pillai MD ,&nbsp;Jacob Reiss MD ,&nbsp;Matthew Zhou MD ,&nbsp;Aldo Rafael MD ,&nbsp;Purav Mody MD","doi":"10.1016/j.amjcard.2025.05.013","DOIUrl":"10.1016/j.amjcard.2025.05.013","url":null,"abstract":"<div><div>A 76-year-old female with a known medical history of treated essential hypertension, hyperlipidemia, and obesity presented to her primary care provider for 2 months of worsening left-sided vision loss. Ophthalmologic evaluation demonstrated a left retinal artery branch occlusion leading to echocardiographic evaluation which revealed a large mobile echodensity on the mitral valve. Given specific clinical features and echocardiographic characteristics, the suspicion was highest for calcified amorphous tumor (CAT). Excision of this mass confirmed the diagnosis of CAT. There is currently clinical equipoise in literature regarding the best treatment strategy for these tumors therefore a multidisciplinary approach should be used to formulate individualized treatment plans.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 34-37"},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085685","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":"Hemodynamic Response to Exercise and Quality of Life in Patients With Hypertrophic Cardiomyopathy Without Left Ventricular Outflow Tract Obstruction","authors":"Helga Lillian Gudmundsdottir MD, PhD ,&nbsp;Anna Axelsson Raja MD, PhD ,&nbsp;Kasper Rossing MD, DMSc ,&nbsp;Hanne Rasmusen MD, PhD ,&nbsp;Martin Snoer MD, PhD ,&nbsp;Lars Juel Andersen MD, PhD ,&nbsp;Rikke Gottlieb PT, MSc ,&nbsp;Alex Hørby Christensen MD, PhD ,&nbsp;Henning Bundgaard MD, PhD, DMSc ,&nbsp;Finn Gustafsson MD, PhD, DMSc ,&nbsp;Jens Jakob Thune MD, PhD","doi":"10.1016/j.amjcard.2025.05.012","DOIUrl":"10.1016/j.amjcard.2025.05.012","url":null,"abstract":"<div><div>In hypertrophic cardiomyopathy (HCM), impaired exercise capacity and quality of life (QoL) are indicative of a poor prognosis irrespective of left ventricular outflow tract (LVOT) obstruction. Exercise limitations are considered a substantial contributor to reduced QoL in HCM but the relationship between hemodynamic determinants of exercise capacity and QoL in HCM remains unknown. This study assessed the relationship between exercise hemodynamics and QoL in patients with HCM without LVOT obstruction. Patients underwent hemodynamic assessment via right heart catheterization, with measurements taken at rest and during exercise. Patient-reported QoL was assessed using the Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS). Hemodynamic metrics correlating with QoL were identified. Fifty-nine patients were included (27% females, mean age 58 ± 12 years). The cohort demonstrated mild to moderate QoL impairments, with a median overall summary KCCQ score of 83 (IQR: 71 to 95). At rest, QoL correlated with cardiac output (r = 0.3, p = 0.01) and mean pulmonary arterial pressure (r = –0.4, p = 0.003). During mild exercise (25 watts), an inverse correlation was observed between the KCCQ-OSS and left ventricular filling pressure (r = –0.4, p &lt; 0.001), and at peak exercise, a positive correlation was observed between the KCCQ-OSS and cardiac output (r = 0.4, p &lt; 0.001). In multivariate analysis, left ventricular filling pressure measured during mild exercise (β = –0.8, [95% CI: –1.49, –0.09], p = 0.035) emerged as the sole independent hemodynamic predictor of QoL. In conclusion, in patients with HCM without LVOT obstruction, QoL is significantly associated with several hemodynamic parameters, with elevated left ventricular filling pressures during mild exercise emerging as a key determinant.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 63-69"},"PeriodicalIF":2.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085687","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":"Corrigendum to Impella Versus Non-Impella for Nonemergent High-Risk Percutaneous Coronary Intervention The American Journal of Cardiology (2024) Volume 225, 15 August. Pages 4-9. DOI: 10.1016/j.amjcard.2024.05.038","authors":"Pavan Reddy MD ,&nbsp;Ilan Merdler MD, MHA ,&nbsp;Cheng Zhang PhD ,&nbsp;Matteo Cellamare PhD ,&nbsp;Itsik Ben-Dor MD ,&nbsp;Nelson L. Bernardo MD ,&nbsp;Hayder D. Hashim MD ,&nbsp;Lowell F. Satler MD ,&nbsp;Toby Rogers MD, PhD ,&nbsp;Ron Waksman MD","doi":"10.1016/j.amjcard.2025.04.008","DOIUrl":"10.1016/j.amjcard.2025.04.008","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"249 ","pages":"Page 18"},"PeriodicalIF":2.3,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143934897","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":"Outcomes of Percutaneous Coronary Interventions Following Transcatheter Aortic Valve Replacement: Insights From the CathPCI Registry","authors":"Christina Lalani MD ,&nbsp;Ravi K. Sharma MD ,&nbsp;Jonathan Sevilla-Cazes MD ,&nbsp;Kevin Kennedy MS ,&nbsp;Neel M. Butala MD ,&nbsp;Eric A. Secemsky MD, MSc ,&nbsp;Duane Pinto MD ,&nbsp;Marie-France Poulin MD ,&nbsp;Roger Laham MD ,&nbsp;Dhaval Kolte MD, PhD, MPH ,&nbsp;David J. Cohen MD, MSc ,&nbsp;Robert W. Yeh MD, MSc","doi":"10.1016/j.amjcard.2025.05.006","DOIUrl":"10.1016/j.amjcard.2025.05.006","url":null,"abstract":"<div><div>Although transcatheter aortic valve replacement (TAVR) devices can impair coronary access, there are limited real-world data comparing outcomes of percutaneous coronary intervention (PCI) in post-TAVR versus non-TAVR patients. In this study, we compare procedural characteristics and outcomes between patients with versus without a history of TAVR who undergo PCI. We used claims data for the Medicare population to evaluate the incidence of PCI after TAVR between 2011 and 2017. Then, using the CathPCI Registry, we compared PCI outcomes between patients with a history of TAVR versus propensity score-matched non-TAVR patients. Of the 52,780 Medicare patients who underwent TAVR between 2011 and 2017, the incidence of acute myocardial infarction (AMI) was 10.2% and of PCI was 5.1% at 5 years. At 5 years, the incidence of stroke was 5.0% and of death was 64.0%. In the CathPCI Registry, procedural success for PCI was similar between 1,309 post-TAVR patients versus 5,236 propensity-score matched patients without prior TAVR. However, post-TAVR patients required greater fluoroscopic time (21.9 vs 17.7 minutes, p &lt;0.001) and had higher rates of post-procedural stroke (0.8% vs 0.4%, p = 0.02) and bleeding (5.1% vs 2.9%, p &lt;0.001). Post-TAVR patients were more likely to have repeat PCI in the 3 years post-PCI (HR: 1.36, 95% C.I: 1.09, 1.70) and had higher rates of stroke (HR: 1.65, C.I.: 1.07 to 2.56, p = 0.023) and death (HR: 1.23, C.I.: 1.11-1.38, p &lt;0.001) compared to non-TAVR patients. In conclusion, in the CathPCI Registry, patients with a history of TAVR appeared to have similar procedural success but longer fluoroscopic times, more frequent post-procedural bleeding and stroke, and a higher likelihood of a repeat PCI compared with matched patients without a history of TAVR.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 18-24"},"PeriodicalIF":2.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962731","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":"Young Adults Undergoing Percutaneous Coronary Intervention for Myocardial Infarction in the United States, 2011 to 2023","authors":"Usman Ali Akbar MD ,&nbsp;Mohamad B. Taha MD ,&nbsp;Hassaan B. Arshad MD ,&nbsp;Kershaw V. Patel MD ,&nbsp;Edo Kaluski MD ,&nbsp;Neal S. Kleiman MD ,&nbsp;Alpesh R. Shah MD ,&nbsp;Safi U. Khan MD, MS","doi":"10.1016/j.amjcard.2025.05.007","DOIUrl":"10.1016/j.amjcard.2025.05.007","url":null,"abstract":"<div><div>The prognostic impact of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in young adults undergoing percutaneous coronary intervention (PCI) remains under explored. We compared the long-term outcomes of young adults undergoing PCI for STEMI and NSTEMI. We used the United States (US) TriNetX database (2011 to 2023), encompassing young adults aged 18 to 50 years hospitalized for myocardial infarction (MI), who received PCI within 24 hours of presentation. We used 1:1 propensity score matching to adjust for baseline differences; cardiovascular outcomes were assessed at 5 years using Cox proportional hazards models. Of 16,209 patients, 53% presented with STEMI and 47% with NSTEMI. After matching, 9,680 patients were analyzed (4,840 in each group). At 5 years, patient with STEMI exhibited higher risk of all-cause mortality [hazard ratio (HR), 1.21 (95% confidence interval, 1.04 to 1.39)], and heart failure (HF) [1.25 (1.12 to 1.41)] compared with those with NSTEMI. There were no significant differences between groups for MI (HR: 0.85 [0.66 to 1.08]), stroke (HR: 1.12 [0.94 to 1.34]), major bleeding (HR: 1.15 [0.99 to 1.29]) and renal replacement therapy ( HR: 0.77 [0.46 to 1.29]). In conclusion, young adults with STEMI undergoing PCI had a higher risk of mortality and HF compared with those with NSTEMI at 5 years. These findings underscore the importance of early and aggressive intervention to mitigate long-term cardiovascular risks in this population.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 85-90"},"PeriodicalIF":2.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952720","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":"Geographic Variation in Cardiometabolic and Lifestyle Risk Factors Across US States, 2011 to 2021","authors":"Rachel K. Gardner MD ,&nbsp;Archana Tale MPH ,&nbsp;Rishi K. Wadhera MD, MPP, MPhil","doi":"10.1016/j.amjcard.2025.05.002","DOIUrl":"10.1016/j.amjcard.2025.05.002","url":null,"abstract":"<div><div>Although cardiovascular death rates vary markedly across US states, little is known about whether state-based inequities in the burden of cardiometabolic and lifestyle risk factors have changed over the past decade. We conducted a serial cross-sectional analysis of US adults using the Behavioral Risk Factor Surveillance System (BRFSS) survey, to evaluate changes in the age- and sex-adjusted prevalence of cardiometabolic risk factors (diabetes, hypertension, hyperlipidemia, and obesity) and lifestyle risk factors (binge alcohol drinking, physical inactivity, and cigarette smoking) across US states from 2011 to 2021. The study population included 945,160 adults in 2011 and 2021. The age- and sex-adjusted prevalence of diabetes (10.9% [95% CI, 10.7%, 11.0%] to 12.4% [12.2%, 12.6%]), hypertension (32.4% [32.1%, 32.7%] to 33.7% [33.4%, 34.0%]), and obesity (27.5% [27.2%, 27.7%] to 33.1% [32.8%, 33.5%]) increased from 2011 to 2021, while hyperlipidemia decreased (38.5% [38.2%, 38.8%] to 35.5% [35.2%, 35.9%]). State-based inequities in the prevalence of diabetes, hypertension, and obesity widened over this period. Across lifestyle factors, the prevalence of binge alcohol use (18.3% [18.0%, 18.5%] to 15.4% [15.2%, 15.7%]), physical inactivity (25.7% [25.4%, 27.4%] to 24.0% [23.6%, 23.7%]), and cigarette smoking (20.1% [19.8%, 20.3%] to 13.4% [13.2%, 13.7%]) decreased, while state-based inequities across these factors generally narrowed. In conclusion, the prevalence of hypertension, diabetes mellitus, and obesity increased among US adults from 2011 to 2021 while state-based inequities in the prevalence of these risk factors widened. In contrast, binge alcohol drinking, physical inactivity, and cigarette smoking all declined. Our findings suggest an urgent need for targeted strategies to address widening state-based inequities in cardiometabolic risk factors.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 46-53"},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963005","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":"Impact of Annulus Size on Bioprosthetic Valve Failure after Self-Expanding Transcatheter Heart Valves Replacement","authors":"Hirofumi Hioki MD ,&nbsp;Masanori Yamamoto MD ,&nbsp;Tetsuro Shimura MD ,&nbsp;Shinichi Shirai MD ,&nbsp;Kenichi Ishizu MD ,&nbsp;Yohei Ohno MD ,&nbsp;Fumiaki Yashima MD ,&nbsp;Toru Naganuma MD ,&nbsp;Yusuke Watanabe MD ,&nbsp;Futoshi Yamanaka MD ,&nbsp;Gaku Nakazawa MD ,&nbsp;Masahiko Noguchi MD ,&nbsp;Masaki Izumo MD ,&nbsp;Masahiko Asami MD ,&nbsp;Hidetaka Nishina MD ,&nbsp;Yasushi Fuku MD ,&nbsp;Toshiaki Otsuka MD ,&nbsp;Kentaro Hayashida MD ,&nbsp;OCEAN-TAVI Investigators","doi":"10.1016/j.amjcard.2025.05.008","DOIUrl":"10.1016/j.amjcard.2025.05.008","url":null,"abstract":"<div><div>There is limited evidence on the prognosis and long-term valve durability after transcatheter aortic valve replacement (TAVR) in patients with small aortic annulus (SAA) and large aortic annulus (LAA). This analysis was sought to evaluate the impact of annular size differences on patients’ and valve outcomes. A total of 1,211 patients undergoing TAVR using self-expandable transcatheter heart valve (SE-THV) were retrospectively analyzed. The cut-off for SAA was defined as annulus perimeter of &lt; 72 mm. The primary endpoints were all-cause mortality and bioprosthetic valve failure (BVF) between the SAA and LAA groups. As a sub-analysis, the impact of postprocedural mean pressure gradient (mPG) ≥ 20mmHg and severe prosthesis-patient mismatch (PPM) on these outcomes were also evaluated. Of all patients, 60.1% (<em>n</em> = 723) had SAA. At 7 years after TAVR, the SAA group had lower incidence of all-cause mortality (53.7% vs 63.7%, log-rank p = 0.05) and lower event rate of BVF than LAA (1.2% vs 4.6%, p = 0.01 for Gray’s test). Multivariate Cox-regression and Fine-Gray competing risk regression analysis demonstrated the presence of SAA was related to better prognosis (Hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.67 to 0.98) and lower BVF (adjusted subdistribution HR, 0.41; 95% CI, 0.17 to 0.98). There were no impact of postprocedural mPG ≥ 20 mmHg or severe PPM on the difference of mortality and BVF. Further, these results were consistent in the patients with SAAs. In conclusion, SAA had better long-term patients’ prognosis and valve durability after TAVR with SE-THV.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"251 ","pages":"Pages 10-17"},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960056","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}