American Journal of Cardiology最新文献

{"title":"Guiding Early Management in Severe Mitral Stenosis with Extensive Mitral Annular Calcification: A Transseptal ViMAC Case","authors":"Tommaso Fabris MD,&nbsp;Michele Strosio MD,&nbsp;Francesco Putortì MD,&nbsp;Consolato Mesiani MD,&nbsp;Antonio Amadio MD,&nbsp;Simone Tripi MD,&nbsp;Andrea Panza MD,&nbsp;Giuseppe Tarantini MD, PhD","doi":"10.1016/j.amjcard.2025.08.033","DOIUrl":"10.1016/j.amjcard.2025.08.033","url":null,"abstract":"<div><div>Mitral annular calcification (MAC) related mitral stenosis (MS) presents a significant therapeutic challenge, especially in patients considered high-risk or inoperable. Transcatheter mitral valve replacement (TMVR) has emerged as an alternative, but the procedure remains technically demanding due to anatomical complexities and the risk of complications. We report the case of a 72-year-old man with severe MAC and MS, who successfully underwent TMVR using a 29 mm Edwards Sapien 3 valve. A key innovation in this case was the implementation of a novel balloon-assisted trackability assessment to optimize the trajectory of the delivery system. Prior to septostomy, a noncompliant balloon was positioned and inflated at the mitral level, enabling real-time evaluation of coaxial alignment and confirming the feasibility of advancing the prosthesis along the intended path. Once optimal trajectory was verified, the same balloon was used to perform the septostomy, ensuring accurate and controlled passage of the delivery system, and ultimately facilitating precise implantation. At 3-year follow-up, the patient remained asymptomatic with a well-functioning valve and stable hemodynamics. This case highlights the value of preseptostomy balloon-based trackability assessment as a simple yet highly effective technique to enhance procedural precision in TMVR for MAC.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 21-23"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939132","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":"Radial Versus Femoral Access for Percutaneous Coronary Intervention in Patients With Chronic Coronary Disease","authors":"Garry W. Hamilton MBBS ,&nbsp;Diem T. Dinh PhD ,&nbsp;Julian Yeoh MBBS ,&nbsp;Angela L. Brennan RN ,&nbsp;Matias B. Yudi MBBS, PhD ,&nbsp;Christopher M. Reid BA, MSc, PhD ,&nbsp;Dion Stub MBBS, PhD ,&nbsp;William Chan MBBS, PhD ,&nbsp;Melanie Freeman MBBS ,&nbsp;Andrew Ajani MBBS, MD ,&nbsp;Omar Farouque MBBS, PhD ,&nbsp;David J. Clark MBBS ,&nbsp;Melbourne Interventional Group Registry","doi":"10.1016/j.amjcard.2025.08.038","DOIUrl":"10.1016/j.amjcard.2025.08.038","url":null,"abstract":"<div><div>Guidelines recommend trans-radial access (TRA) for all percutaneous coronary intervention (PCI). However, no randomized trials have shown a lower mortality when compared to the femoral approach in chronic coronary disease and femoral access may be preferred in certain situations. Consecutive eligible patients in a multi-center registry between 2014 – 2020 were included. Clinical characteristics and outcomes were compared between those who underwent radial versus femoral access. The main outcomes were major bleeding and 5-year mortality. Of the 6,158 patients included, 3,784 (61.4%) had TRA and 2,374 (38.6%) femoral access. TRA predominated from 2016. The femoral group had higher rates of diabetes mellitus, renal dysfunction and prior stroke. Trans-femoral procedures were more complex with higher rates of ACC/AHA type B2/C lesions, chronic total occlusions, left main PCI, use of adjuvants including rotational atherectomy, and lower procedural success rates. Major bleeding was higher in the femoral group (radial 0.4% vs femoral 0.8%, p = 0.039), however femoral access did not predict major bleeding (OR 1.68, 95% CI 0.74 to 3.82). There was no difference in 5-year mortality (radial 20.3% vs femoral 21%, p = 0.65). In conclusion, TRA predominates in contemporary PCI for CCD. The femoral group had higher procedural complexity and risk with a higher incidence of peri‑procedural major bleeding. Nonetheless, femoral access did not predict major bleeding and there was no difference in 5-year mortality as compared to TRA. In the absence of a contemporary randomized trial, the femoral approach appears reasonable if clinically preferred in patients with chronic coronary disease undergoing PCI.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 63-68"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939409","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":"Predictors of the Need for Pacemaker After Transcatheter Tricuspid Valve Replacement: An Early Experience","authors":"Michael Albosta MD,&nbsp;Mackram Eleid MD,&nbsp;Abhishek Deshmukh MD","doi":"10.1016/j.amjcard.2025.08.037","DOIUrl":"10.1016/j.amjcard.2025.08.037","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 9-11"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939285","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":"Efficacy and Safety of Different Combinations of Add-on Diuretic Therapy in Acute Heart Failure: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials","authors":"Andrew Sephien MD ,&nbsp;Julia G Girgis BS ,&nbsp;Tea Reljic MPH ,&nbsp;Denisse Camille Dayto MD ,&nbsp;Joanna M. Joly MD ,&nbsp;Jason N. Katz MD, MHS ,&nbsp;Jose A. Tallaj MD ,&nbsp;Rosario A. Colombo MD ,&nbsp;Athanasios Tsalatsanis PhD ,&nbsp;Ambuj Kumar MD, MPH","doi":"10.1016/j.amjcard.2025.08.041","DOIUrl":"10.1016/j.amjcard.2025.08.041","url":null,"abstract":"<div><div>Patients hospitalized with acute heart failure (HF) may experience diuretic resistance and require an add-on agent despite increasing loop diuretic dosage. While randomized controlled trials (RCTs) have compared add-on therapy to loop diuretics only, sparse literature exists on direct comparisons between various add-on therapies. We performed a systematic review and network meta-analysis of RCTs to assess the efficacy and safety of different diuretic add-on therapies in patients hospitalized with acute HF. Any RCT evaluating the effect of add-on diuretic therapy in patients hospitalized with acute HF was eligible for inclusion. A systematic search of EMBASE and PubMed was conducted until March 29, 2024. The primary outcome was the hospital length of stay. Data was pooled using a random-effects model for direct comparisons. A network meta-analysis using frequentist methods was performed under random-effects multiple treatment comparisons. We assessed ranking probability using the surface under the cumulative ranking curve (SUCRA) method. Of the 1,103 references, 29 RCTs enrolling 8,362 patients met the eligibility and were included. For the direct comparisons, there was no significant difference in hospital length of stay (MD -0.42, 95% CI= -0.87,0.02). Ranking probability based on SUCRA indicated that acetazolamide had the highest likelihood of being the best treatment for shorter hospital length of stay (SUCRA, 0.89), followed by SGLT2i (SUCRA, 0.70). The certainty of estimates for all outcomes ranged from moderate to very low.</div><div>In conclusion, the efficacy of add-on therapy was associated with reduced hospital length of stay. Albeit uncertain, the results from NMA provide initial evidence suggesting there may be optimal treatment strategies to decongest patients with HF to achieve and maintain euvolemia. However, well-designed direct comparison RCTs are needed to increase the certainty of the estimates. Protocol registered in PROSPERO (CRD42023476669).</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 27-34"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939180","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":"Additional Insights into Real-World Disparities in Lipid-Lowering Therapy Utilization: A Critical Methodological Appraisal","authors":"Kunal Mahajan MD,&nbsp;Jai Bharat Sharma MD,&nbsp;Surender Himral MD","doi":"10.1016/j.amjcard.2025.08.039","DOIUrl":"10.1016/j.amjcard.2025.08.039","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 19-20"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939041","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":"Incidence of Elevated Cardiac Biomarkers in Patients Presenting to the Emergency Department With Allergic Symptoms: Implications for the Diagnosis of Kounis Syndrome","authors":"Maria Anastasopoulou MD, MSc ,&nbsp;Antonios Karanasos MD, PhD ,&nbsp;Katerina Grafanaki MD, PhD ,&nbsp;Georgios Almpanis MD, PhD ,&nbsp;Nikolaos Koutsogiannis MD ,&nbsp;Virginia Mplani MD, PhD ,&nbsp;Christina Papadionysiou MD ,&nbsp;Nicholas G. Kounis MD ,&nbsp;Sophia Georgiou MD, PhD ,&nbsp;Periklis Davlouros MD, PhD","doi":"10.1016/j.amjcard.2025.08.036","DOIUrl":"10.1016/j.amjcard.2025.08.036","url":null,"abstract":"<div><div>Noninfectious, allergic reactions affect many individuals and can range from mild to life-threatening. Kounis syndrome, an acute coronary syndrome triggered by allergic reactions, represents an association between allergies and myocardial ischemia. However, the significance of elevated cardiac biomarkers, particularly high-sensitivity cardiac troponin (hs-cTn), in patients presenting to the emergency department (ED) with allergic symptoms remains unclear. This study included consecutive patients who presented to the ED with symptoms of allergic reaction. All patients underwent serial electrocardiography and hs-cTnI testing. Patients with elevated hs-cTnI levels were further evaluated by dobutamine stress echocardiography. When acute coronary syndrome was suspected in an allergic context, coronary angiography was performed. Among the 200 patients studied, 52.5% were male, 5% had diabetes mellitus, and 24% had arterial hypertension. Urticaria was the most common manifestation, occurring in 73.5% of patients. Elevated hs-cTnI levels were detected in 12% of the patients, with 6% diagnosed with Kounis syndrome and the remaining 6% had myocardial injury without ischemia. Myocardial injury was more prevalent among patients with diabetes mellitus, arterial hypertension, dyslipidemia, and smoking history. Among the patients with Kounis syndrome, 8 had coronary disease, while only one with isolated myocardial injury had coronary artery disease. In conclusion, myocardial injury occurred in 12% of patients with allergic ED symptoms, with Kounis syndrome accounting for half of these cases. Elevated cardiac biomarkers during allergic reactions should prompt consideration of Kounis syndrome. Early recognition of this association is essential, particularly in patients with cardiovascular risk factors.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939257","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":"Elusive Barriers: The Challenges of Diagnosing Subaortic Membranes","authors":"Malik Alqawasmi MD ,&nbsp;Karla Almaraz MD ,&nbsp;Jennifer Febbo MD ,&nbsp;Alex Schevchuck MD","doi":"10.1016/j.amjcard.2025.08.034","DOIUrl":"10.1016/j.amjcard.2025.08.034","url":null,"abstract":"<div><div>Subvalvular aortic stenosis (SAS) is a relatively uncommon cause of left ventricular outflow tract (LVOT) obstruction, constituting only 8-20% of cases. Among the etiologies, subaortic membranes (SAoM) are the most prevalent, manifesting in various anatomical forms, including thin discrete membranes, fibromuscular ridges, and diffuse tunnel-like narrowings. While transthoracic echocardiography (TTE) is the primary diagnostic tool, it often presents challenges, particularly in cases where the membrane is not readily visible, and needs further imaging with transesophageal echocardiogram (TEE) or cardiac magnetic resonance imaging (CMR). This case series explores 2 diagnostically challenging instances of SAoM, highlighting the importance of multimodal imaging and the nuances of interpreting these findings. The first case is of a 19-year-old female with congenital aortic stenosis and ESRD presented with worsening dyspnea; initial TTE, TEE, and CMR failed to identify a subaortic membrane, but intra-procedural 3D TEE revealed an oval-shaped membrane, redirecting management from balloon angioplasty to surgical excision. The second is of a 62-year-old female with prior diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) and progressive dyspnea was found on TEE to have a SAoM, contradicting her prior diagnosis; medical therapy was adjusted, and she was referred for surgery. These cases underscore the diagnostic challenges of SAoM, often evading detection on initial TTE and CMR, necessitating advanced techniques like 3D TEE. Misdiagnosis, as seen with HOCM, can lead to years of inappropriate treatment. In conclusion, accurate and early differentiation through expert interpretation of multimodal imaging, particularly TEE, is crucial for guiding proper management and avoiding unnecessary interventions.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"257 ","pages":"Pages 122-126"},"PeriodicalIF":2.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939083","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":"Coronary Artery Disease in Heart Failure With Preserved Ejection Fraction","authors":"Ryohei Ono MD, PhD ,&nbsp;Luiz Menezes Falcão MD, PhD","doi":"10.1016/j.amjcard.2025.08.035","DOIUrl":"10.1016/j.amjcard.2025.08.035","url":null,"abstract":"<div><div>Coronary artery disease (CAD), including both obstructive epicardial coronary artery disease and coronary microvascular dysfunction (CMD), is a common and impactful contributor to heart failure with preserved ejection fraction (HFpEF). CAD is associated with worse outcomes, progressive myocardial remodeling, and transition to reduced ejection fraction. CMD, which is particularly prevalent in women, impairs myocardial perfusion and energetics. This leads to exercise intolerance and elevated filling pressures. Emerging treatments such as sodium-glucose co-transporter 2 (SGLT2) inhibitors and finerenone offer benefit across HFpEF phenotypes, including those with ischemia. Multimodal diagnostic approaches, such as positron emission tomography, cardiovascular magnetic resonance, Doppler echocardiography, and invasive coronary physiology, are essential to identify CMD and subclinical CAD in appropriate patients. In conclusion, recognizing ischemic phenotypes within HFpEF is critical for risk stratification and therapeutic decision-making. Future studies should focus on phenotype-specific strategies to improve outcomes in this heterogeneous syndrome.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 12-18"},"PeriodicalIF":2.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939035","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":"Managing Migrated Left Atrial Appendage Closure Devices in the Left Ventricle","authors":"Rong Zhang MD,&nbsp;Yudong Peng MD","doi":"10.1016/j.amjcard.2025.08.030","DOIUrl":"10.1016/j.amjcard.2025.08.030","url":null,"abstract":"<div><div>A 59-year-old woman with a pacemaker for paroxysmal atrial fibrillation developed left hemiparesis secondary to occlusion of the right middle cerebral artery. Following hybrid radiofrequency ablation and left atrial appendage occlusion, acute hypotension occurred due to device migration into the left ventricle. Optimal approach selection remains a significant clinical challenge.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"255 ","pages":"Pages 143-145"},"PeriodicalIF":2.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939279","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":"Postoperative Outcomes and Valvular Involvement in Loeys-Dietz Syndrome: A Multicenter Cohort Study of Surgical Risk and Complications","authors":"Hussein Abdul Nabi MD ,&nbsp;Sant Kumar MD ,&nbsp;Luke Dreher MD ,&nbsp;George Bcharah BS ,&nbsp;Nour Odeh MBBS ,&nbsp;Mayar Alatout MBBS ,&nbsp;Yuxiang Wang MD ,&nbsp;Mayowa A. Osundiji MBBS, PhD ,&nbsp;Bryan Barrus MD ,&nbsp;Kristen Sell-Dotin MD ,&nbsp;Chadi Ayoub MD, PhD ,&nbsp;Hicham El Masry MD ,&nbsp;Fadi E. Shamoun MD","doi":"10.1016/j.amjcard.2025.08.032","DOIUrl":"10.1016/j.amjcard.2025.08.032","url":null,"abstract":"<div><div>Loeys-Dietz syndrome (LDS) is a connective tissue disorder characterized by significant vascular and valvular abnormalities; however, perioperative outcomes involving aortic and valvular interventions remain underreported. This study aimed to evaluate surgical interventions and postoperative complications in LDS patients. We retrospectively reviewed 94 patients diagnosed with LDS from 2018 to 2024 across Mayo Clinic sites. Data on surgical procedures, postoperative complications, echocardiographic findings, and arrhythmic events were collected. Valve replacements, valve types, and anticoagulation regimens were analyzed. Categorical variables were reported as frequencies and percentages. Ascending aortic aneurysms were present in 77 patients (81.9%), mitral valve prolapse in 33 (35.1%), mitral regurgitation in 36 (38.3%), and tricuspid valve regurgitation in 37 (39.4%). A total of 61 patients (64.9%) underwent at least 1 cardiovascular surgical procedure, most commonly aortic root surgery in 59 patients (62.8%) and aortic valve repair/replacement in 39 patients (41.5%). The median follow-up period from the first surgery to the last follow-up was 6.1 years (IQR = 9.2 years). Major postoperative complications occurred in 32 patients (52.5%), including severe bleeding in 15 patients (24.6%) and neurological events in 6 patients (9.8%). New-onset arrhythmias were documented in 25 patients (41.0%), primarily atrial fibrillation/flutter in 12 patients (19.7%). Among patients with mechanical valves, 21 of 28 (75%) on warfarin experienced bleeding complications. In conclusion, this study highlights the high burden of both aortic and valvular surgical interventions in LDS patients and the associated postoperative risks, reflecting underlying connective tissue fragility. Tailored perioperative strategies are needed, and future studies incorporating LDS genotyping may improve risk stratification and management.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"257 ","pages":"Pages 110-115"},"PeriodicalIF":2.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939348","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}