American Journal of Cardiology最新文献

{"title":"Right Ventricular-Pulmonary Arterial Uncoupling as a Predictor of Invasive Hemodynamics and Normotensive Shock in Acute Pulmonary Embolism","authors":"Eugene Yuriditsky MD ,&nbsp;Robert S. Zhang MD ,&nbsp;Peter Zhang MD ,&nbsp;Radu Postelnicu MD ,&nbsp;Allison A. Greco MD ,&nbsp;James. M Horowitz MD ,&nbsp;Samuel Bernard MD ,&nbsp;Orly Leiva MD ,&nbsp;Vikramjit Mukherjee MD ,&nbsp;Kerry Hena MD ,&nbsp;Lindsay Elbaum MD ,&nbsp;Carlos L. Alviar MD ,&nbsp;Norma M. Keller MD ,&nbsp;Sripal Bangalore MD, MHA","doi":"10.1016/j.amjcard.2024.10.036","DOIUrl":"10.1016/j.amjcard.2024.10.036","url":null,"abstract":"<div><div>Right ventricular–pulmonary arterial coupling describes the relation between right ventricular contractility and its afterload and is estimated as the ratio of the tricuspid annular plane systolic excursion (TAPSE) to pulmonary arterial systolic pressure (PASP) by way of echocardiography. Whether TAPSE/PASP is reflective of invasive hemodynamics or occult shock in acute pulmonary embolism (PE) is unknown. This was a single-center retrospective study over a 3-year period of consecutive patients with PE who underwent mechanical thrombectomy and simultaneous pulmonary artery catheterization with echocardiograms performed within 24 hours before the procedure.</div><div>A total of 70 patients (81% intermediate risk) had complete invasive hemodynamic profiles and echocardiograms, with TAPSE/PASP calculated. The optimal cutoff for TAPSE/PASP as a predictor of a reduced cardiac index (CI) (CI ≤2.2 L/min/m²) was 0.34 mm/mm Hg, with an area under the curve of 0.97 and sensitivity, specificity, positive predictive value, and negative predictive value of 97.3%, 90.9%, 92.3%, and 96.8%, respectively. Every 0.1 mm/mm Hg decrease in TAPSE/PASP was associated with a 0.24-L/min/m² decrease in the CI. This relation was similar when restricted to intermediate-risk PE. The TAPSE/PASP ratio was predictive of normotensive shock with an odds ratio of 2.63 (95% confidence interval 1.42 to 4.76, p = 0.002) per unit decrease in the ratio.</div><div>In conclusion, in patients with acute PE who underwent mechanical thrombectomy, TAPSE/PASP was a strong predictor of a reduced CI and normotensive shock. This means that noninvasive point-of-care assessment of hemodynamics may have added value in PE risk stratification.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"236 ","pages":"Pages 1-7"},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589961","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":"Surgical Ablation for Atrial Fibrillation: A Lasting Impact on Outcomes after Cardiac Surgery.","authors":"Irsa Hasan, Danny Chu","doi":"10.1016/j.amjcard.2024.10.037","DOIUrl":"10.1016/j.amjcard.2024.10.037","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589964","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":"Echocardiographic Assessment of Cardiac Remodeling According to Obesity Class","authors":"Rahil Prajapati MMASc ,&nbsp;Tingting Qin MD ,&nbsp;Kim A. Connelly MBBS, PhD ,&nbsp;Anas Merdad MBBS ,&nbsp;Chi-Ming Chow MD, MSc ,&nbsp;Howard Leong-Poi MD ,&nbsp;Geraldine Ong MD, MSc","doi":"10.1016/j.amjcard.2024.10.035","DOIUrl":"10.1016/j.amjcard.2024.10.035","url":null,"abstract":"<div><div>Evidence supports the existence of cardiac remodeling in obesity; however, no standard diagnostic criteria has been proposed or validated. This study aimed to identify echocardiographic features of cardiac remodeling according to obesity class and assess the effect of nonsurgical weight loss on cardiac structure and function. A total of 120 patients were divided according to their obesity class (group 1: body mass index [BMI] 18.5 to 24.9, group 2: 25 to 29.9, group 3: 30 to 39.9, and group 4: &gt;40) and underwent cross-sectional transthoracic echocardiography. Echocardiographic parameters of cardiac chamber quantification and function were compared among the 4 groups. Echocardiographic parameters were compared before and after nonsurgical weight loss in a subgroup of patients. Overall, there was an incremental increase in left ventricular (LV), left atrial (LA), and right ventricular dimensions, LV mass (LVM), and LV stroke volume (all p &lt;0.0001) across the obesity classes. There was no significant difference in LV ejection fraction or right ventricular systolic function, as assessed by tricuspid annular plane systolic excursion; however, there was a significant decrease in global longitudinal strain (BMI 18.5 to 24.9: 22.8 ± 1.7%, BMI 25 to 29.9: 22.0 ± 1.4%, BMI 30 to 39.9: 20.8 ± 1.1%, BMI &gt;40: 20.6 ± 1.3%, p &lt;0.0001) and LA strain (BMI 18.5 to 24.9: 37.7 ± 2.3%, BMI 25 to 29.9: 32.8 ± 2.1%, BMI 30 to 39.9: 31.5 ± 1.8%, BMI &gt;40: 29.0 ± 2.8%, p &lt;0.0001). Allometric height-indexed LV and LA dimensions increased with increasing BMI class (p &lt;0.0001). Echocardiographic parameters did not change significantly after nonsurgical weight loss. In conclusion, echocardiographic features can be described according to obesity class. Allometric height indexation may better reflect cardiac remodeling in obesity than body surface area indexation. Nonsurgical weight loss was not associated with significant changes in cardiac chamber dimensions and function.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"236 ","pages":"Pages 34-41"},"PeriodicalIF":2.3,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589958","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":"Tailored Therapy in Cardiogenic Shock: Case-Based Management Choices","authors":"S. Shiva Patlolla MD ,&nbsp;Amit H. Alam MD ,&nbsp;Jason N. Katz MD ,&nbsp;Shelley A. Hall MD","doi":"10.1016/j.amjcard.2024.10.022","DOIUrl":"10.1016/j.amjcard.2024.10.022","url":null,"abstract":"<div><div>Cardiogenic shock (CS) is a complex, multisystem disorder precipitated by hypoperfusion from cardiac dysfunction. Our current approach to defining and treating CS encompasses all patients under 1 umbrella regardless of phenotype. This has created challenges for clinical trials and patient care owing to the heterogeneity of the patient population with CS. The Society of Coronary Angiography and Interventions shock classification has created a universal language for CS that has been rapidly adopted by researchers and clinicians. Its latest iteration established the 3-axis model incorporating shock severity, risk modifiers, and phenotypes. Phenotypes of CS have unique hemodynamic profiles that require nuanced adjustment approaches. In this study, we discuss representative cases including acute myocardial infarction, acute-on-chronic heart failure, fulminant myocarditis, and right ventricular failure. For each phenotype, specific hemodynamic parameters may help confirm appropriate diagnosis and direct to therapeutic targets signaling stability and recovery. The underlying pathophysiology of each phenotype can also help predict the extent of stabilization with pharmacologic interventions or the need to escalate to mechanical circulatory support. In conclusion, this tailored approach to CS, rather than a 1-size-fits-all approach, could help improve outcomes.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"235 ","pages":"Pages 30-36"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567691","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":"Important Findings for Patients With Previous Coronary Intervention for De Novo and In-Stent Restenosis Indications: A Novel Use of Randomized Trial Data.","authors":"Charles Maynard","doi":"10.1016/j.amjcard.2024.10.028","DOIUrl":"10.1016/j.amjcard.2024.10.028","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567661","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":"Prognostic Value of Incidental Coronary Artery Calcifications in Computed Tomography Pulmonary Angiography for Suspected Pulmonary Embolism","authors":"Marouane Boukhris MD ,&nbsp;Thomas Madelrieux MD ,&nbsp;Guillaume Signoret MD ,&nbsp;Cyrille Boulogne MD ,&nbsp;Paul Gendrin MD ,&nbsp;Aymeric Rouchaud MD, PhD ,&nbsp;Victor Aboyans MD, PhD","doi":"10.1016/j.amjcard.2024.10.020","DOIUrl":"10.1016/j.amjcard.2024.10.020","url":null,"abstract":"<div><div>Computed tomography (CT) has emerged as a noninvasive method to identify coronary artery calcifications (CAC). We sought to investigate the association between opportunistic visual CAC evaluation in patients without known coronary artery disease who underwent CT pulmonary angiography (CTPA) for pulmonary embolism (PE) suspicion, and cardiovascular prognosis. We analyzed data of patients who underwent CTPA for suspected PE in 2017 at CHU Dupuytren, Limoges, France. Patients were categorized into 4 groups according to a simple visual ordinal score to assess the extent and severity of CAC on a whole-patient basis: none (grade 0), mild (grade 1), moderate (grade 2), and severe (grade 3). The primary outcome was a composite of cardiovascular mortality, myocardial infarction (MI), or coronary revascularization. The secondary outcomes were all-cause mortality, and an extended composite outcome including cardiovascular mortality, MI, coronary revascularization, ischemic stroke, ischemic peripheral events, and hospitalization for heart failure. A total of 414 patients (mean age 69.7 ± 14.3 years, 42% men, 18.1% PE) were included in the analysis and subdivided according to CAC categories as follows: grade 0 (n = 123; 29.7%), grade 1 (n = 133; 32.1%), grade 2 (n = 79; 19.1%) and grade 3 (n = 79; 19.1%). The mean follow-up was 3.5 ± 2.4 years. After adjustment, the presence of CAC grade 2 to 3 CAC independently predicted the primary outcome (hazard ratio [HR] = 5.30, 95% CI 2.56 to 10.98, p &lt;0.001). CAC grade 2 to 3 were also independent predictors for all-cause mortality (HR = 1.52, 95% CI 1.10 to 2.11, p = 0.011); and the extended composite event (HR = 1.82, 95% CI 1.13 to 2.95, p = 0.014). In conclusion, the opportunistic assessment of CAC in CTPA for suspected PE could provide important mid-term prognostic information, independently from the PE findings.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"235 ","pages":"Pages 44-50"},"PeriodicalIF":2.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563664","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":"Determination of Inoue Balloon Size by Analysis of Mitral Valve Geometry Using Three-Dimensional Transesophageal Echocardiography in Patients With Mitral Stenosis","authors":"Mi-Jin Kim MD ,&nbsp;Yoo-Jin Jung RDCS ,&nbsp;Sun-Hack Lee MD ,&nbsp;Byung Joo Sun MD, PhD ,&nbsp;Sahmin Lee MD, PhD ,&nbsp;Jung-Min Ahn MD, PhD ,&nbsp;Duk-Woo Park MD, PhD ,&nbsp;Dae-Hee Kim MD, PhD ,&nbsp;Duk-Hyun Kang MD, PhD ,&nbsp;Jong-Min Song MD, PhD","doi":"10.1016/j.amjcard.2024.10.031","DOIUrl":"10.1016/j.amjcard.2024.10.031","url":null,"abstract":"<div><div>In percutaneous mitral balloon commissurotomy (PMBC) for patients with mitral stenosis (MS), the size of the balloon has traditionally been determined using a crude method based on the patient's height or body surface area. We aimed to evaluate the clinical value of balloon size selection by quantitatively analyzing mitral valve geometry using 3-dimensional (3D) transesophageal echocardiography. In 184 consecutive patients who underwent PMBC, the geometry of the mitral valve annulus was analyzed during mid-diastole, including the measurement of lateral-medial diameters obtained from dedicated 3D software or from analysis using multiplanar reconstruction images. Patients were categorized into 3 groups: those with successful results after PMBC (SU group), those with residual mitral stenosis (MS group), and those with significant MR (MR group). The SU, MS, and MR groups included 110, 50, and 17 patients, respectively. We compared 3 conventional formulas (formulas 1, 2, and 3) based on the patient's height or body surface area, with 2 new formulas derived from data in the SU group: balloon size = 0.0684 × lateral-medial diameters obtained from dedicated 3D software + 24.309 (formula 4) and 0.061 × lateral-medial diameters obtained from analysis using multiplanar reconstruction images + 24.573 (formula 5). Compared with the calculated balloon sizes using formula 4, the inflated balloon sizes were significantly smaller (−0.78 ± 1.02, p &lt;0.001) in the MS group, whereas they were significantly larger (0.56 ± 1.05, p = 0.04) in the MR group. This pattern was also consistent in formula 5. In conclusion, selecting the Inoue balloon inflation size based on the mitral annulus diameter determined by 3D transesophageal echocardiography might be a reasonable approach.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"235 ","pages":"Pages 51-58"},"PeriodicalIF":2.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563762","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 Current State of Physician-Modified Endovascular Grafts in Complex Abdominal Aortic Aneurysms","authors":"Pedro J.F. Neves MD ,&nbsp;John J. Kanitra MD ,&nbsp;Rafael D. Malgor MD, MBA ,&nbsp;Mazin I. Foteh MD","doi":"10.1016/j.amjcard.2024.10.025","DOIUrl":"10.1016/j.amjcard.2024.10.025","url":null,"abstract":"<div><div>Physician-modified endografts (PMEGs) for the treatment of complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms are a viable option. Other endovascular options include custom and off-the-shelf devices for fenestrated and branched endovascular aortic repair, parallel grafts, and in situ laser fenestration. The limitations of these devices include time to development, strict anatomic criteria, and durability regarding parallel grafts. PMEGs fill this void with perioperative and long-term outcomes similar to custom-made devices. Postdissection aneurysms also present a unique role for PMEGs given the added complexity with fixing these aneurysms and have been reported with good outcomes. Lastly, we discuss the approach to preoperative planning and the operative component of PMEGs in this brief review.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"233 ","pages":"Pages 101-105"},"PeriodicalIF":2.3,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543145","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 Influences of Beta blockers and Verapamil on Cardiac Outcomes in Hypertrophic Cardiomyopathy","authors":"Giuseppe Pinto MD ,&nbsp;Mauro Chiarito MD, PhD ,&nbsp;Tania Puscas MD ,&nbsp;Anne Bacher BSc ,&nbsp;Erwan Donal MD, PhD ,&nbsp;Patricia Reant MD, PhD ,&nbsp;Gianluigi Condorelli MD, PhD ,&nbsp;Albert Hagège MD, PhD ,&nbsp;REMY working group of the French Society of Cardiology","doi":"10.1016/j.amjcard.2024.10.029","DOIUrl":"10.1016/j.amjcard.2024.10.029","url":null,"abstract":"<div><div>Guidelines recommend β blockers (BBs) as first-line therapy in symptomatic patients with hypertrophic cardiomyopathy (HCM) and nondihydropyridine calcium channel blockers, particularly, verapamil, as the second-line therapy, despite the absence of comparison trials between those 2 drugs. Because deleterious effects of verapamil have been reported in this setting, the present analysis aimed to evaluate the prognostic impact of BBs and verapamil in a cohort of patients with HCM. From a nationwide cohort of 1,434 patients with a diagnosis of HCM included in the French prospective observational REgistry of hypertrophic cardioMYopathy (REMY), we retrospectively analyzed patients with sarcomeric HCM included in the 3 largest centers and treated either with BBs or verapamil. Patients with a cardiac defibrillator or a pacemaker or who underwent a procedure of atrial fibrillation or septal ablation were excluded. The primary end point was the composite of cardiovascular death, hospitalization for heart failure, and hospitalization for atrial fibrillation. Of 600 patients with HCM, 544 (91%) were treated with BBs and 56 (9%) with verapamil. At inclusion, the 2 groups were comparable concerning the presence/amplitude of obstruction and sudden cardiac death risk factors. At up to 8 years of follow-up (median 3.9 years, interquartile range 2.1 to 5.8), no significant differences were observed in the primary end point (132 [24%] vs 10 [18%] under BBs or verapamil, respectively, hazard ratio 1.84, 95% confidence interval 0.94 to 3.63). In conclusion, in a real-world cohort of low-risk patients with HCM, verapamil therapy was not associated with a higher incidence of adverse events than β-blocker therapy.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"235 ","pages":"Pages 9-15"},"PeriodicalIF":2.3,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543139","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":"Influence of Age on the Impact of a Natriuretic Peptide–Guided Treatment Strategy in Patients With Heart Failure","authors":"Caleb J. Hood ,&nbsp;Anand Gupta ,&nbsp;Nicholas S. Hendren ,&nbsp;Maryjane A. Farr ,&nbsp;Mark H. Drazner ,&nbsp;W.H. Wilson Tang ,&nbsp;Justin L. Grodin","doi":"10.1016/j.amjcard.2024.10.023","DOIUrl":"10.1016/j.amjcard.2024.10.023","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"234 ","pages":"Pages 60-62"},"PeriodicalIF":2.3,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556965","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}