American Journal of Cardiology最新文献

{"title":"Prognostic Significance of Right Ventricle-Pulmonary Artery Coupling to Risk Stratify Patients Undergoing Transesophageal Echocardiogram For Severe Tricuspid Regurgitation.","authors":"Kartik Gupta, Andrew Chou, Monique Oye, Krishna Modi, Georgi Fram, John Dawdy, Bryan Zweig, Tiberio Frisoli, Pedro E Gonzalez, Pedro S Villablanca, Brian O'Neill, Trevor Szymanski, Alexandra Deporre, James Lee, Sachin Parikh","doi":"10.1016/j.amjcard.2026.04.004","DOIUrl":"10.1016/j.amjcard.2026.04.004","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697169","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":"Clinical Significance of Extreme Left Atrial Enlargement in Atrial Functional Mitral Regurgitation.","authors":"Nahoko Kato, Joji Ito, Tomohiro Kaneko, Naoki Hirose, Masashi Amano, Taiji Okada, Yukio Sato, Yohei Ohno, Masaru Obokata, Kimi Sato, Hiroyuki Watanabe, Kojiro Morita, Tomoko Machino-Ohtsuka, Yukio Abe, Nobuyuki Kagiyama","doi":"10.1016/j.amjcard.2026.03.067","DOIUrl":"10.1016/j.amjcard.2026.03.067","url":null,"abstract":"<p><p>The left atrium (LA) size varies in patients with atrial functional mitral regurgitation (AFMR) and its clinical impact remains unclear. This study aimed to assess the distribution of LA volume index (LAVI) and the impact of LAVI on clinical outcomes in a large cohort of patients with ≥ moderate AFMR. Patients with AFMR diagnosed by transthoracic echocardiography in 2019 were retrospectively enrolled from the REVEAL-AFMR registry. The endpoint was a composite of cardiovascular death and heart failure hospitalization, compared across the LAVI groups. Of the 877 patients (age 78 ± 9 years, 45% male, 81% with atrial fibrillation), the median LAVI was 75 ml/m². LAVIs of < 50, 50 to 99, 100 to 149, 150 to 199, and ≥ 200 ml/m² were observed in 14%, 55%, 18%, 7%, and 6%, respectively. The prevalence of severe MR increased across these LAVI groups (10%, 19%, 38%, 62%, and 66%; p <0.01 for trend), and the prevalence of symptoms also worsened accordingly (56%, 61%, 62%, 82%, and 96%; p <0.01 for trend). During the median follow up of 2.9 years, LAVIs ≥ 200 and 150 to 199 ml/m² were associated with lower event-free survival compared with LAVI < 50 ml/m². LAVI ≥ 150 ml/m² was associated with the adverse event (adjusted hazard ratio 2.14; 95% CI, 1.30 to 3.52; p <0.01), notably independent of severe mitral regurgitation (MR) and atrial fibrillation. In conclusion, larger LA was associated with severe MR and symptoms in patients with AFMR. Extremely enlarged LA with LAVI ≥ 150 ml/m² was observed in 13% and associated with worse outcomes independent of MR severity and atrial fibrillation.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715669","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":"Mortality and Morbidity Benefit After Influenza Vaccination in High Cardiovascular Risk Population: A Systematic Review and Meta-analysis.","authors":"Kaveh Hosseini, Parham Dastjerdi, Reza Yahyavi Sahzabi, Arghavan Alipoor, Mahyar Masanabadi, Parastesh Rezvanian, Yasaman Daryabari, Maede Mehdizadeh, Sanaz Soleimani, Daniel Modin, Kristoffer Grundtvig Skaarup, Tor Biering-Sørensen","doi":"10.1016/j.amjcard.2026.03.040","DOIUrl":"10.1016/j.amjcard.2026.03.040","url":null,"abstract":"<p><p>Influenza infection increases cardiovascular risk in patients with ischemic heart disease (IHD) or heart failure (HF). This updated meta-analysis evaluated the cardiovascular benefits of influenza vaccination in these populations. Two complementary approaches were used: an individual patient data (IPD) meta-analysis for the primary outcome (reconstructed from published Kaplan-Meier curves) and conventional study-level random-effects meta-analyses for all outcomes. Cox models were used to estimate pooled hazard ratios (HRs). Heterogeneity was explored using subgroup, sensitivity, and meta-regression analyses, and study quality was assessed with RoB 2 and ROBINS-I. Twenty-three studies (7 RCTs, 16 observational; n = 1,137,377) met inclusion criteria. Influenza vaccination significantly reduced all-cause mortality (HR = 0.72; 95% CI: 0.63 to 0.82) and cardiovascular mortality (HR = 0.77; 95% CI: 0.67 to 0.89). Vaccinated patients also had a lower risk of MI (HR = 0.81; 95% CI: 0.78 to 0.83), whereas effects on stroke (HR = 0.88; 95% CI: 0.68 to 1.14) and MACE (HR = 0.81; 95% CI: 0.57 to 1.15) were not significant. Reconstructed individual data (n = 22,443) demonstrated a 38% mortality reduction (HR = 0.62; 95% CI: 0.57 to 0.67), with the greatest benefit in the first four months postvaccination. Effects were consistent across age, disease type, study design, and follow-up duration. In conclusion, Influenza vaccination markedly lowers mortality and provides cardiovascular protection in patients with IHD or HF, supporting annual vaccination as an effective secondary prevention strategy.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637949","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":"Post-TAVR Bleeding in Atrial Fibrillation Patients Treated With Apixaban or Rivaroxaban.","authors":"Olivier Morel, Antonin Trimaille, Mickael Guglieri, Benjamin Marchandot, Thibault Lenormand, Amandine Granier, Adrien Carmona, Anne Bernard, Laurence Jesel, Laurent Fauchier","doi":"10.1016/j.amjcard.2026.03.033","DOIUrl":"10.1016/j.amjcard.2026.03.033","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621573","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":"Impella Protected Percutaneous Coronary Intervention Outcomes Compared With Intra-aortic Balloon Pump: A Contemporary View.","authors":"Vasileios Panoulas, Theodore Schreiber, Stelios Tsintzos, Chantal E Holy, Ali Almedhychy, Jeff Wayne Moses, William O'Neill","doi":"10.1016/j.amjcard.2026.03.060","DOIUrl":"10.1016/j.amjcard.2026.03.060","url":null,"abstract":"<p><p>Traditional cardiovascular trials combine adverse events into composites, ignoring the clinical importance and weight of endpoints. The win ratio (WR) is a contemporary statistical technique overcoming these limitations. We aimed to evaluate outcomes of high-risk percutaneous coronary intervention supported with Impella versus intra-aortic balloon pump, by pooling data from the PROTECT-II and PROTECT-III studies, using the WR. All patients from PROTECT-II RCT (P-II) and patients from PROTECT-III (P-III) who met P-II inclusion/exclusion criteria were pooled. The WR was based on independently adjudicated major adverse cardiac and cerebrovascular events at 90 days with following hierarchy: (1) mortality; (2) stroke; (3) spontaneous myocardial infarction; (4) rehospitalization; and (5) peri-procedural myocardial infarction. All major adverse cardiac and cerebrovascular events were analyzed as time-to-event outcomes, except peri-procedural myocardial infarction (binary endpoint). Sub-analyzes included: (1) complex cases: patients with atherectomy or unprotected left main or chronic total occlusion, (2) all patients excluding firsts from P-II (learning cases); and (3) Impella P-II and P-III cohorts separately. Win statistics (WR, net benefit, and win odds) were calculated. The primary analysis (719 Impella and 211 intra-aortic balloon pump-supported PCI) yielded a WR of 1.691 in favor of Impella (1.314 to 2.176, p < 0.001), with net benefit of 0.166 (0.084 to 0.247, p < 0.001) and win odds of 1.398 (1.187 to 1.645, p < 0.001). The WR, net benefit and win odds for complex cases remained statistically significant in favor of Impella. Excluding first patients resulted in increased win statistics compared to primary analysis. In conclusion, pooled WR analyzes from P-II and P-III studies demonstrated improved high risk PCI outcomes up to 90 days with Impella compared to intra-aortic balloon pump.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618228","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":"Effectiveness and Safety of Apixaban Versus Warfarin in Atrial Fibrillation Patients with Malignancy: A Propensity-Matched Analysis","authors":"Siddharth P. Agrawal MD ,&nbsp;Ritu Tated MBBS, MPH ,&nbsp;Hritvik Jain MBBS ,&nbsp;Kriti Soni MD ,&nbsp;Dhruvi K. Joshi MBBS ,&nbsp;Pragyat Futela MD ,&nbsp;Maharshi Raval MD ,&nbsp;Vikas Aggarwal MD ,&nbsp;Abhishek Deshmukh MD ,&nbsp;Saraschandra Vallabhajosyula MD, MSc","doi":"10.1016/j.amjcard.2026.01.006","DOIUrl":"10.1016/j.amjcard.2026.01.006","url":null,"abstract":"<div><div>Patients with atrial fibrillation and malignancy have increased risks of thromboembolism and bleeding. Evidence comparing apixaban and warfarin in this group remains limited. We aimed to compare effectiveness and safety of apixaban versus warfarin in patients with atrial fibrillation and active malignancy using real-world data from a large multinational cohort. This retrospective cohort study used the TriNetX Global Collaborative Network, de-identified records from 146 healthcare organizations between December 1, 2012, and May 1, 2025. Atrial fibrillation patients with malignancy receiving apixaban or warfarin were matched 1:1 using propensity scores across 74 clinical variables. Outcomes were assessed at 3 months, 6 months, 1 year, and 5 years. Primary endpoints included all-cause mortality, stroke, pulmonary embolism, deep vein thrombosis, gastrointestinal bleeding and intracranial hemorrhage. In this 12.5-year period, 41,764 matched pairs of patients were analyzed. Compared to the warfarin cohort, the apixaban cohort demonstrated lower all-cause mortality at 3 months (OR: 1.05, 95% CI: 1.00–1.10), 6 months (OR: 1.05, 95% CI: 1.01–1.09), 1 year (OR: 1.06, 95% CI: 1.03–1.10), and 5 years (OR: 1.17, 95% CI: 1.13–1.20; all p &lt;0.05). Stroke rates were comparable between groups, while pulmonary embolism, deep vein thrombosis, gastrointestinal bleeding and intracranial hemorrhage were noted less frequent with apixaban. Kaplan–Meier analyses showed early and sustained differences in survival and bleeding outcomes. In conclusion, in atrial fibrillation patients with cancer, apixaban was associated with lower mortality and major bleeding without increasing stroke risk compared to warfarin.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"264 ","pages":"Pages 14-20"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002850","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 Suitability of Patients for Transcatheter Tricuspid Valve Replacement","authors":"Tyler Andrews DO ,&nbsp;Ritik Patel BS ,&nbsp;Muhtasim Jaigirdar MD ,&nbsp;PedroEngel Gonzalez MD ,&nbsp;Dimitrios Apostolou MD ,&nbsp;James Lee MD ,&nbsp;John Dawdy MD ,&nbsp;Bryan Zweig MD ,&nbsp;Raed Alnajjar MD ,&nbsp;Tiberio M. Frisoli MD ,&nbsp;Pedro Villablanca MD ,&nbsp;Brian P. O’Neill MD","doi":"10.1016/j.amjcard.2026.01.002","DOIUrl":"10.1016/j.amjcard.2026.01.002","url":null,"abstract":"<div><div>Transcatheter tricuspid valve replacement (TTVR) has shown therapeutic promise for patients with severe tricuspid regurgitation (TR). However, some patients may not be eligible due to anatomic limitations. We sought to describe the outcomes of patients who were referred for transcatheter tricuspid valve intervention (TTVI) and were ineligible for TTVR. This was a single-center, retrospective study of 251 patients referred for TTVI from February 2024 to August 2025. All patients were considered by a multidisciplinary heart team and assessed for feasibility of commercial tricuspid valve repair or replacement, with a strategy to proceed with replacement if anatomically feasible. Data on demographics, clinical characteristics, and outcomes were collected from medical records. Of 251 patients evaluated, 43 (17.1%) were unsuitable for TTVR. Compared with suitable patients, unsuitable patients were more frequently male (67.4% vs 33.2%, p &lt;0.01) and more likely to have implanted electronic device (53.5% vs 32.2%, p = 0.01) or prior tricuspid interventions (7.9% vs 1.6%, p = 0.03). The leading reason for unsuitability was large annular dimensions (60.5%), followed by leaflet tethering (14.0%) and small annular size (11.6%). Of the unsuitable cohort, 10 patients (23.3%) underwent T-TEER and 33 (76.7%) received medical therapy alone. T-TEER resulted in significant reduction in TR severity (p = 0.034), though 80% had residual moderate or greater TR. In conclusion, this commercial experience, rates of TTVR ineligibility were lower than previously described with large annular dimensions serving as the most frequent exclusion criterion. For those ineligible, T-TEER may provide a feasible approach in appropriately selected patients.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"264 ","pages":"Pages 1-6"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997008","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":"Pregnancy Outcomes in Women with Cardiovascular Disease:A Retrospective Cohort Study from Kaiser Permanente Northern California","authors":"Ekta Partani MD ,&nbsp;Carol Shi MD ,&nbsp;Douglas Stram MS ,&nbsp;Samhita Palakodeti MD ,&nbsp;Marisa McDonald BSN, RN ,&nbsp;Cynthia Triplett MPH, MA ,&nbsp;Jennifer Ting MD ,&nbsp;Megan L. Stephenson MD ,&nbsp;Nikhil Joshi MD ,&nbsp;Seema K. Pursnani MD, MPH","doi":"10.1016/j.amjcard.2026.01.003","DOIUrl":"10.1016/j.amjcard.2026.01.003","url":null,"abstract":"<div><div>Cardiovascular disease (CVD) remains a leading cause of maternal mortality in the United States, comprising 26.5% of pregnancy-related deaths. We sought to evaluate trends in CVD during pregnancy and maternal, obstetric, and fetal outcomes in pregnant women with CVD in the Kaiser Permanente Northern California (KPNC) integrated healthcare system. This retrospective cohort study included adult KPNC members with moderate or greater valvular heart disease, cardiomyopathy, congenital heart disease, or ischemic heart disease during pregnancy from 2010 to 2021. Bivariate analyses and multivariable logistic regression were used to evaluate associations between demographic and clinical risk factors and maternal outcomes in pregnant patients with CVD. Of 320,902 pregnancies, 763 (0.24%) were identified with clinically significant CVD. The prevalence of CVD increased from 0.19% to 0.34% over the decade, predominantly due to an increase in prevalence of women with congenital heart disease. Mean gestational age at delivery was 36.7 weeks with 19.5% experiencing preterm delivery. Cesarean section, pre-eclampsia or eclampsia, and postpartum hemorrhage rates were 29.5%, 20.8%, and 9.7%, respectively. Fetal loss beyond the first trimester occurred in 7.1% pregnancies. Adverse maternal cardiac outcomes occurred in 55 (7.2%) of patients, predominantly driven by congestive heart failure hospitalizations. There were 4 deaths (0.5%) during pregnancy or within 1 year postpartum. Pre-existing CVD (aOR 0.20, p = 0.002) and cardiac medication use (aOR 4.13, p &lt;0.001) were significant predictors of adverse maternal outcomes. Higher left ventricular ejection fraction (aOR 0.95, p = 0.018) was associated with lower odds of adverse maternal outcomes. In conclusion, understanding risk factors for adverse pregnancy outcomes in a diverse, contemporary population of patients with CVD can help refine cardio-obstetric risk assessment and preconception counseling.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"264 ","pages":"Pages 7-13"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997033","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":"Nanotechnology in Cardiology: A New Era of Targeted Therapies and Advanced Diagnostics-A Review.","authors":"Saqib Hussain Hadri, Nida Tareen, Hafsa Javed, Azka Hassan, Maha Naseer, Kabisha Ali, Areesh Sajjad","doi":"10.1016/j.amjcard.2026.03.034","DOIUrl":"10.1016/j.amjcard.2026.03.034","url":null,"abstract":"<p><p>Heart diseases together with circulatory diseases known as cardiovascular diseases maintain their position as the world's leading cause of mortality because these disorders killed about 33% of people during 2021. Medical progress and diagnostic innovation have not addressed the major obstacles within current therapeutic approaches, which involve systemic toxicity together with non-specific drug distribution and invasive medical interventions. The field of nanotechnology delivers beneficial solutions through its capacity to direct medications, along with managing their release mechanisms and improving visualization precision. Therapeutic efficacy gets enhanced with diminished side effects through the application of nanoparticle (NP)-based systems, including polymeric NPs, liposomes, dendrimers, and solid lipid NPs. The field of molecular imaging and regenerative cardiology has experienced advancements through the implementation of novel nanomaterials, including gold NPs, carbon nanotubes, and graphene derivatives. This analysis examines current developments in nanomedicine, which supports cardiovascular disease diagnostics and therapy while demonstrating its ability to revolutionize precise cardiology practices through specific treatments, along with minimally invasive tests and integrated therapeutic systems.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147589402","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":"Anomalous Attachment of the Posterior Mitral Annulus to the Crest of the Left Ventricle in Patients With Mitral Annular Disjunction (MAD) and Mitral Valve Prolapse","authors":"Jeffrey J. Silbiger MD ,&nbsp;Oksana Marchenko MD, PhD ,&nbsp;Raveen Bazaz MD ,&nbsp;Priya Panday MD ,&nbsp;Aviv Alter MD ,&nbsp;Pedro Rafael Vieira De Olivera Salerno MD","doi":"10.1016/j.amjcard.2025.11.026","DOIUrl":"10.1016/j.amjcard.2025.11.026","url":null,"abstract":"<div><div>The purpose of this study is to determine the site of attachment of the posterior mitral annulus to the left ventricle in patients with mitral annular disjunction (MAD) and mitral valve prolapse (MVP). The posterior annulus normally attaches to the inlet of the left ventricle. Some histological findings suggest that the disjunctive annulus may instead attach anomalously to the left ventricular (LV) crest in patients with MVP. We used cardiac magnetic resonance imaging to determine the site of attachment of the posterior mitral annulus (crest vs inlet) in 25 patients with MVP with MAD (MAD+ group) and 24 patients with MVP without MAD (MAD- group). The site of annular attachment was determined in the 3-chamber view during diastole. Our data demonstrate complete separation in mitral annular attachment site between MAD+ and MAD- groups. All patients in the MAD+ group demonstrated annular attachment to the LV crest, whereas all those in the MAD- group demonstrated annular attachment to the LV inlet (p &lt;0.001). The presence of anomalous annular attachment in MAD+, but not MAD- patients, suggests this anatomic abnormality represents a feature of the MAD phenotype rather than the myxomatous phenotype. Anomalous annular attachment may potentially influence the arrhythmic potential of MAD.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"263 ","pages":"Pages 27-32"},"PeriodicalIF":2.1,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888673","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}