American heart journal最新文献

{"title":"Clinical and Economic Outcomes in Diagnostic-Naïve Medicare Fee-for-Service Beneficiaries Managed with Alert-Based Ambulatory Cardiac Monitors: the CAMELOT-ALERT Study.","authors":"Pierantonio Russo, Jordan B Strom, Ramaa Nathan, Yang Song, Mostafa Shokoohi, Rod Passman, Matthew R Reynolds, Suneet Mittal","doi":"10.1016/j.ahj.2026.107594","DOIUrl":"https://doi.org/10.1016/j.ahj.2026.107594","url":null,"abstract":"<p><strong>Background: </strong>Ambulatory cardiac monitoring (ACM) is fundamental to arrhythmia evaluation, yet robust comparative evidence among alert-based monitoring strategies is lacking.</p><p><strong>Objective: </strong>To compare diagnostic yield and downstream clinical and economic outcomes among arrhythmia diagnosis-naïve Medicare Fee-For-Service (FFS) beneficiaries receiving mobile cardiac telemetry (MCT) or ambulatory event monitoring (AEM).</p><p><strong>Methods: </strong>Using 100% Medicare FFS claims from 2020 to 2022, this retrospective cohort study included beneficiaries aged 65 years or older, excluding those with prior arrhythmia diagnoses, antiarrhythmic medication use, or rhythm-management procedures. Cohorts were iRhythm MCT, Other MCT, and AEM; inverse probability of treatment weighting (IPTW) balanced baseline characteristics. Outcomes included diagnostic yield at 90 days, retesting at 180 days, and clinical events and costs at one year.</p><p><strong>Results: </strong>Among 441,792 eligible beneficiaries, 17,773 received iRhythm MCT (4%), 368,830 Other MCT (83%), and 55,189 AEM (13%). After IPTW, 90-day diagnostic yield was higher with iRhythm MCT (49.5%) than Other MCT (40%; HR 0.79 [95% CI, 0.77-0.81]) and AEM (39.1%; HR 0.76 [95% CI, 0.74-0.78]). Retesting at 180 days was more frequent with iRhythm MCT (8.8%) than Other MCT (6.3%; HR 0.70 [95% CI, 0.66-0.74]) and AEM (7.2%; HR 0.81 [95% CI, 0.76-0.87]). Pacemaker implantation was more common with iRhythm MCT; no differences were identified in hospitalizations, emergency visits, or heart failure.</p><p><strong>Conclusions: </strong>Diagnostic yield and retesting varied across ACM platforms, though residual confounding cannot be excluded. No differences were identified in outcomes, utilization, or costs. Randomized trials are warranted to determine true differences in platform performance.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"107594"},"PeriodicalIF":3.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-specific coronary outcomes in subacute Kawasaki disease.","authors":"Shigeyuki Kamiya, Hiroya Masuda, Koki Kosami, Masanari Kuwabara, Ryusuke Ae","doi":"10.1016/j.ahj.2026.107593","DOIUrl":"https://doi.org/10.1016/j.ahj.2026.107593","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery (CA) lesions (CALs) are major complications of Kawasaki disease (KD). Studies have reported that coronary outcomes (CAL regression and progression) are associated with age; however, age-stratified data remain limited.</p><p><strong>Methods: </strong>We analyzed data from 129,950 patients with KD in Japan (2011-2022). CALs were classified as CA dilatation, CA aneurysm, or giant CA aneurysm. Coronary outcomes were assessed by comparing echocardiographic findings between baseline and the subacute phase. Patients were stratified into nine 6-month age groups. Restricted cubic splines (RCS) were used to assess non-linear associations between age and coronary outcomes. Multivariable logistic regression analyses assessed age-specific associations using the RCS-identified reference group.</p><p><strong>Results: </strong>Among patients without CALs at initial echocardiography, the 0-6-month group had the highest proportion with subsequent CAL development (2.8%). Among patients with CA dilatation, the 0-6-month group showed the lowest proportion of patients with CA regression (75.5%). RCS analyses identified the 25-30-month group as the most likely to show CA dilatation regression and the least likely to experience CAL progression. Multivariable analysis demonstrated that patients aged 0-6 months were significantly less likely to show CA dilatation regression (adjusted odds ratio [95% confidence interval]: 0.44 [0.30-0.63], reference: 25-30 months) and more likely to experience CAL progression (3.84 [3.03-4.86]).</p><p><strong>Conclusions: </strong>Coronary outcomes differed substantially across age groups; patients aged 0-6 months had the most adverse coronary outcomes. Even without CALs at initial echocardiography, this age group had the highest risk of subsequent CAL development.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"107593"},"PeriodicalIF":3.4,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes associated with recurrent compared to first-time myocardial infarction.","authors":"Daniel Mølager Christensen, Caroline Hartwell Garred, Morten Malmborg, Caroline Sindet-Pedersen, Deewa Zahir, Nina Nouhravesh, Emil Fosbøl, Kieran F Docherty, Jawad H Butt, John Jv McMurray, Mark C Petrie, Marc A Pfeffer, Lars Køber, Morten Schou","doi":"10.1016/j.ahj.2026.107592","DOIUrl":"https://doi.org/10.1016/j.ahj.2026.107592","url":null,"abstract":"<p><strong>Background: </strong>Patients with recurrent myocardial infarction (MI) are a heterogenous group with high comorbidity burden, risk of complex coronary disease, and at risk of poor outcomes. However, contemporary comparative data are lacking.</p><p><strong>Methods: </strong>Consecutive patients with recurrent MI (defined as a new hospital admission for MI >28 days following a first-time MI) in Denmark between 2015 and 2022 were identified through the nationwide registries and matched 1:1 on age and sex to patients with first-time MI. The primary outcome was a composite of all-cause mortality, hospitalization for heart failure (HHF), and further recurrent MI. Standardized risks with 95% confidence intervals (CI) were estimated using cause-specific Cox regression models with first-time MI serving as the reference group.</p><p><strong>Results: </strong>A total of 8,397 patients with recurrent MI and 8,397 with first-time MI were included (median age 73, 70.7% male). Patients with recurrent MI had more comorbidities. For the primary composite outcome, patients with recurrent MI had a standardized 1-year risk of 24.0% versus 17.2% among those with first MI (standardized risk ratio [sRR] 1.39 [95% CI: 1.34-1.44]). They also had higher risks of: all-cause mortality, 14.6% versus 11.3% (sRR 1.29 [1.24-1.35]); HHF, 6.6% versus 6.0% (sRR 1.11 [1.00-1.21]), and recurrent MI 6.7% versus 2.2% (sRR 3.01 [2.71-3.45]). Use of guideline-recommended treatments post-dicharge was high, albeit lower than for first-time MI: percutaneous coronary intervention (53.7% versus 64.3%, p<0.001), lipid-lowering treatment (78.1% versus 83.2%, p<0.001), and P2Y12 inhibitor (77.3% versus 82.6%, p<0.001).</p><p><strong>Conclusion: </strong>Recurrent MI is associated with a higher risk of all-cause mortality, HHF, and further recurrent MI compared with first-time MI.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"107592"},"PeriodicalIF":3.4,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiorespiratory Fitness in Children with Surgically Corrected Congenital Heart Disease: Exercise Testing Profiles and Biventricular Function.","authors":"S D Haas, A E van der Hulst, A P Widyanti, J van Schuppen, J Oosterlaan, J G van den Aardweg, A D J Ten Harkel, I M Kuipers, N A Blom","doi":"10.1016/j.ahj.2026.107590","DOIUrl":"https://doi.org/10.1016/j.ahj.2026.107590","url":null,"abstract":"<p><strong>Aims: </strong>Children with surgically corrected congenital heart disease (CHD) often exhibit reduced cardiorespiratory fitness, reflected by impaired maximal oxygen uptake (V̇O₂max). Although exercise limitation is multifactorial, the relative contributions of cardiovascular, ventilatory, and gas exchange abnormalities remain unclear. This study aims to characterize exercise impairments in children with CHD using cardiopulmonary exercise testing (CPET) and cardiac imaging.</p><p><strong>Methods: </strong>Children with surgically corrected biventricular CHD were prospectively recruited. CPET parameters were expressed as percentages of predicted (%pred) for age and sex, and biventricular function was evaluated by echocardiography and cardiac magnetic resonance imaging. Regression analyses examined associations between V̇O₂max, exercise parameters, and imaging-derived cardiac function.</p><p><strong>Results: </strong>In total, 100 consecutive children with CHD were included. V̇O₂max (73.9±14.2%pred) and anaerobic threshold (V̇O₂AT; 74.7±16.6%pred) showed the greatest deviation from normal. CPET demonstrated cardiovascular (oxygen pulse [O₂pulse], maximal heart rate [HRmax]), ventilatory (maximal ventilation), and gas exchange impairments (ventilatory inefficiency). Imaging showed reduced systolic function, particularly left ventricular global longitudinal strain (GLS; -17.5±2.5%) and tricuspid annular plane systolic excursion (TAPSE; 13.1mm, IQR 11.0-15.4). V̇O₂AT, HRmax, GLS, and TAPSE independently predicted V̇O₂max (R²=68.1%; p<0.001), with V̇O₂AT strongest predictor.</p><p><strong>Conclusions: </strong>Reduced cardiorespiratory fitness in children with surgically corrected CHD encompasses impaired cardiovascular, ventilatory, and gas exchange responses to exercise. Early anaerobic threshold, chronotropic incompetence, and subclinical systolic dysfunction on imaging are associated with reduced maximal exercise capacity, indicating contributions from both cardiac dysfunction and deconditioning. Integrating imaging with CPET may improve differentiation between cardiac and non-cardiac contributors to exercise limitation.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"107590"},"PeriodicalIF":3.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Sensitivity HEART Pathway One-and-Done Troponin Strategy is Safe and Effective.","authors":"Nicklaus P Ashburn, Anna C Snavely, Molly R Ehrig, Aaditya Chandrasekar, Benjamin T Hutchison, Michael W Supples, Simon A Mahler","doi":"10.1016/j.ahj.2026.107588","DOIUrl":"https://doi.org/10.1016/j.ahj.2026.107588","url":null,"abstract":"<p><p>The high-sensitivity History, Electrocardiogram (ECG), Age, Risk factor, and Troponin (HEART) Pathway (hs-HP) includes a \"one-and-done\" strategy where patients with a non-ischemic ECG, no known coronary artery disease, HEAR score ≤3, and chest pain duration >3 hours can be discharged with a single very-low high-sensitivity troponin (hs-cTnI) measure <4 ng/L. We aimed to evaluate the safety and effectiveness of this \"one-and-done\" hs-cTn strategy using a multisite emergency department cohort of patients with acute chest pain (N=12,190). Among these, 13.4% (1,628/12,190) were eligible for the one-and-done strategy, of which 89.6% (1,459/1,628) were discharged from the ED and 0.2% (3/1,628) had all-cause mortality or myocardial infarction at 30 days. Thus, the one-and-done strategy was safe and effective.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"107588"},"PeriodicalIF":3.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Status Relationship to Ischemia and Coronary Artery Disease Severity in the ISCHEMIA Trial.","authors":"Lawrence M Phillips, Philip G Jones, Leslee J Shaw, Daniel B Mark, Daniel S Berman, Raymond Y Kwong, Michael H Picard, Bernard R Chaitman, James K Min, Jelena Celutkiene, Gregg W Stone, Joao Vitola, Nagaraja Moorthy, Philippe Gabriel Steg, Peter Ong, Whady A Hueb, Paulo C Rezende, Judith S Hochman, David J Maron, Harmony R Reynolds, John A Spertus","doi":"10.1016/j.ahj.2026.107586","DOIUrl":"https://doi.org/10.1016/j.ahj.2026.107586","url":null,"abstract":"<p><strong>Background: </strong>The ISCHEMIA trial randomized participants with chronic coronary disease and moderate or severe ischemia by site assessment to an initial invasive strategy plus guideline-directed medical therapy (GDMT) or to an initial conservative strategy of GDMT alone. This secondary analysis examines the association of pre-randomization ischemia severity, from stress testing assessed by a core laboratory, and anatomic severity of coronary artery disease (CAD), assessed by coronary computed tomography angiography (CCTA), with 1-year health status outcomes.</p><p><strong>Methods: </strong>The associations of ischemia and CAD severity with 1-year health status were assessed using proportional odds models, adjusted for age, sex, and baseline health status and stratified by baseline angina; Seattle Angina Questionnaire (SAQ) Angina Frequency [AF] score < 100 (and angina) vs. 100 (no angina).</p><p><strong>Results: </strong>Among 4,558 participants with baseline and 1-year SAQ assessments, 2936 (64.4%) had baseline angina. Among these, ischemia was categorized as no/mild (363), moderate (986) and severe (1587). Among participants reporting angina at baseline, those with severe baseline ischemia had more frequent angina compared with those having less ischemia (SAQ AF, 70.6 vs 73.0, p=0.029). However, the adjusted odds ratio for better 1-year overall health status, assessed by the SAQ Summary Score, was 1.29 (95% CI, CI 1.05-1.59, p=0.007) for participants with severe vs. those with less baseline ischemia. No differences in 1-year health status were observed by CAD severity or in asymptomatic patients categorized by ischemia or CAD severity.</p><p><strong>Conclusions: </strong>Among participants with baseline angina in the ISCHEMIA trial, severe ischemia was independently associated with more frequent angina at baseline and at 1 year, but also with better 1-year overall health status compared with less ischemia. Anatomic CAD severity was not associated with angina severity.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"107586"},"PeriodicalIF":3.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guideline-Directed Medical Therapy and Clinical Outcomes in Adults with Fontan Palliation and Systemic Ventricular Systolic Dysfunction.","authors":"Alexander C Egbe, Samuel Saad, Alaaeldin Hodhod, Rana Rashwan, Ahmed T Abdelhalim, Amr Moustafa, Naser Ammash","doi":"10.1016/j.ahj.2026.107589","DOIUrl":"https://doi.org/10.1016/j.ahj.2026.107589","url":null,"abstract":"<p><strong>Background: </strong>The role of guideline-directed medical therapy (GDMT) in adults with Fontan palliation and systemic ventricular (SV) systolic dysfunction remains uncertain.</p><p><strong>Objectives: </strong>To evaluate the association between GDMT intensity and clinical outcomes, and to assess the impact of GDMT uptitration on SV systolic function and congestion.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adults (≥18 years) with Fontan palliation and SV systolic dysfunction (SV ejection fraction <50%) (2003-2024). GDMT intensity was quantified using a standardized GDMT score. Outcomes were all-cause mortality and cardiovascular adverse events (composite hospitalization, transplantation, or death). Changes in SV systolic function and NT-proBNP were evaluated in patients with serial follow-up. GDMT uptitration was defined as increase in GDMT score between baseline and 1-year encounter.</p><p><strong>Results: </strong>Among 182 patients (age 27±9 years, 61% male), mean GDMT score was 1.71±1.53. Overall, 24% died and 47% experienced cardiovascular events. Higher GDMT score was independently associated with lower mortality (HR 0.68, 95%CI 0.40-0.89, p=0.001) and fewer cardiovascular events (HR 0.74, 95%CI 0.53-0.95, p=0.02). These associations were consistent across subgroups. Among patients with follow-up data, GDMT uptitration was associated with greater improvement in SV ejection fraction (+14% vs +3%, p=0.01), longitudinal strain (+19% vs +9%, p=0.007), and NT-proBNP (-28% vs -15%, p=0.009).</p><p><strong>Conclusions: </strong>In adults with Fontan circulation and SV systolic dysfunction, higher GDMT intensity is associated with improved survival and reduced cardiovascular events. GDMT uptitration is associated with improved ventricular function and reduced congestion, suggesting a potential role for optimized medical therapy in this high-risk population.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"107589"},"PeriodicalIF":3.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of influenza vaccination dosing strategies for cardiovascular protection: a systematic review and network meta-analysis of randomised controlled trials.","authors":"Joshua J Hon, Tadao Aikawa, Tor Biering-Sørensen, Elliot Crouch, Masao Iwagami, Leandro Slipczuk, Alexandros Briasoulis, Jose Wiley, Kaveh Hosseini, Deepak L Bhatt, Toshiki Kuno","doi":"10.1016/j.ahj.2026.107591","DOIUrl":"https://doi.org/10.1016/j.ahj.2026.107591","url":null,"abstract":"<p><strong>Background: </strong>Influenza vaccination is recommended for cardiovascular secondary prevention, but the comparative effectiveness of different dose strategies remains incompletely characterised.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, and CENTRAL for randomised trials comparing high-dose (HD-IIV), double standard-dose, standard-dose (SD-IIV), and no vaccination in adults with established cardiovascular disease. A pairwise meta-analysis (SD-IIV versus no vaccination) and a network meta-analysis comparing all four dosing strategies were performed. The primary endpoint was the trial-reported composite cardiovascular endpoint. Secondary endpoints were all-cause death, cardiovascular death, myocardial infarction, stroke, and heart failure hospitalisation. Risk ratios (RR) were pooled under random-effects models.</p><p><strong>Results: </strong>Ten trials enrolling 131,908 participants were included. In the pairwise analysis, SD-IIV was associated with a significantly lower risk of the composite cardiovascular endpoint (RR, 0.74; 95% confidence interval [CI], 0.61-0.90), all-cause death (0.75; 0.64-0.89), cardiovascular death (0.63; 0.42-0.93), and myocardial infarction (0.76; 0.62-0.94) compared with no vaccination. No significant reductions were observed for stroke (1.06; 0.72-1.54) or heart failure hospitalisation (0.96; 0.60-1.54). In the network meta-analysis, SD-IIV ranked highest across mortality and composite endpoints while HD-IIV ranked highest for heart failure hospitalisation and stroke, though no head-to-head dose comparison reached statistical significance.</p><p><strong>Conclusions: </strong>Influenza vaccination was associated with lower risks of cardiovascular events, all-cause death, cardiovascular death, and myocardial infarction in patients with cardiovascular disease, with mortality benefits concentrated in trials enrolling patients during acute cardiovascular admission. Higher-dose formulations did not demonstrate incremental cardiovascular benefit over standard-dose vaccination, although a directional advantage for HD-IIV against heart failure hospitalisation was observed in a single trial and requires confirmation.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"107591"},"PeriodicalIF":3.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mavacamten monotherapy in obstructive hypertrophic cardiomyopathy: an integrated analysis of phase 3 clinical trials.","authors":"Iacopo Olivotto, Pablo Garcia-Pavia, Zhuang Tian, Anjali T Owens, Neal K Lakdawala, Ganesh Balaratnam, Yue Zhong, Arteid Memaj, Yu Chen Barrett, Milind Desai","doi":"10.1016/j.ahj.2026.107587","DOIUrl":"https://doi.org/10.1016/j.ahj.2026.107587","url":null,"abstract":"<p><p>This study assessed mavacamten monotherapy efficacy and safety in an integrated analysis of four phase 3 studies: EXPLORER-HCM, the EXPLORER cohort of MAVA-LTE, VALOR-HCM and EXPLORER-CN. Mavacamten monotherapy was associated with improvements in left ventricular outflow tract gradients and symptoms in patients with obstructive hypertrophic cardiomyopathy; descriptive comparisons with patients receiving mavacamten plus beta-blockers or calcium-channel blockers suggested broadly similar trends in efficacy and adverse event rates. Reductions in left ventricular ejection fraction from baseline to week 128 of ≤8.8% were observed across treatment groups.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"107587"},"PeriodicalIF":3.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cleaner Air for Lower Cardiometabolic Risk: protocol for a double-blind, randomized, sham-controlled trial of HEPA filtration in adults with prediabetes.","authors":"Sharine Wittkopp, Parsa Asachi, Filipp Kazatsker, Souptik Barua, José O Alemán, Terry Gordon, Robert D Brook, Lorna E Thorpe, Jonathan D Newman","doi":"10.1016/j.ahj.2026.107573","DOIUrl":"https://doi.org/10.1016/j.ahj.2026.107573","url":null,"abstract":"<p><strong>Introduction: </strong>Air pollution is a leading driver of cardiovascular disease with a growing body of literature implicating this in worse glucose homeostasis. Increases in fine particulate matter air pollution (PM_2.5) are associated with increased blood glucose and hemoglobin A1c across the glycemic spectrum from normoglycemia to prediabetes to all forms of diabetes. Despite strong evidence for positive associations of PM_2.5 with dysglycemia, it remains unknown if reducing air pollution exposure through air filtration can affect improvements in glucose. This study aims to test the hypothesis that short-term, in-home air pollution reduction using high efficiency particulate air (HEPA) filtration will improve blood sugar in adults with prediabetes.</p><p><strong>Methods and analysis: </strong>This trial is a randomized, double-blind, sham-controlled trial of the effects of lowering air pollution exposure using HEPA filtration on cardiometabolic health in adults with prediabetes living in the New York City area. Participants will be randomly assigned to use bedroom air cleaners, or sham air cleaners, while measuring PM_2.5 continuously for 1 month. The primary outcomes will be continuous glucose monitoring metrics measured before and after HEPA air filtration. Exploratory outcomes will include insulin resistance measures, serum biomarkers and transcriptomics measured before and after HEPA intervention. We will quantify effects of HEPA filtration with models using treatment arm (true versus sham filtration) as the independent variable. Secondary analyses will model continuous measures of PM_2.5 as the independent variable.</p><p><strong>Ethics and dissemination: </strong>This study has undergone peer review; and the work was supported by Grant 2023-0214 from the Doris Duke Foundation, who had no other role in study design or implementation. The study was registered in ClinicalTrials.gov (NCT05994937) prior to recruitment.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"107573"},"PeriodicalIF":3.4,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}