American heart journal最新文献

{"title":"Intracoronary stenting and additional results achieved by shockWAVE coronary lithotripsy: design and rationale of ISAR-WAVE trial","authors":"Salvatore Cassese MD, PhD ,&nbsp;Fiorenzo Simonetti MD ,&nbsp;Hector Alfonso Alvarez Covarrubias MD ,&nbsp;Marion Janisch MD ,&nbsp;Michael Joner MD ,&nbsp;Sebastian Kufner MD ,&nbsp;Tobias Lenz MD ,&nbsp;Costanza Pellegrini MD ,&nbsp;Tobias Rheude MD ,&nbsp;Hendrik Sager MD ,&nbsp;Heribert Schunkert MD ,&nbsp;Fabian Starnecker MD ,&nbsp;Felix Voll MD ,&nbsp;Erion Xhepa MD, PhD ,&nbsp;Adnan Kastrati MD ,&nbsp;Thorsten Kessler MD","doi":"10.1016/j.ahj.2024.12.008","DOIUrl":"10.1016/j.ahj.2024.12.008","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous coronary intervention of severely calcified lesions is limited by inadequate stent expansion and poor clinical outcomes. Over the past decade, several devices and techniques have been developed for calcium modification and lesion preparation. Intravascular lithotripsy (IVL) is a novel tool in this context. Although numerous observational studies have been reported on this technique, randomized trials powered for clinical outcomes on the relative merits of IVL in patients with severely calcified lesions are lacking.</div></div><div><h3>Study design and objectives</h3><div>The ISAR-WAVE trial is a multicenter, prospective, randomized, single-blind controlled trial. The aim is to test whether IVL is superior to other calcium-modifying techniques (modified or super high-pressure balloon and atheroablative devices) in <em>de novo</em> severely calcified coronary lesions. The study is planned to enroll 666 patients. The primary endpoint is the composite of major cardiac and cerebrovascular adverse events defined as death, nonfatal myocardial infarction, nonfatal stroke and clinically indicated target vessel revascularization at 12 months. In addition to the individual components of the primary endpoint, secondary endpoints include also safety, quality of life and cost-effectiveness measures.</div></div><div><h3>Conclusions</h3><div>ISAR-WAVE is a multicenter, randomized trial designed to test the hypothesis that a strategy of IVL confers superior clinical performance compared to other calcium-modifying techniques in patients undergoing percutaneous intervention for a <em>de novo</em> severely calcified coronary artery lesion.</div></div><div><h3>Trial registration</h3><div>ClilicalTrial.gov, NCT06369142.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"282 ","pages":"Pages 1-12"},"PeriodicalIF":3.7,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indobufen-based dual antiplatelet therapy in patients with multivessel coronary disease undergoing drug-eluting stent implantation insight from the OPTION trial","authors":"Lili Xu MD ,&nbsp;Huajie Xu MD ,&nbsp;Shujing Wu MD ,&nbsp;Huanyi Zhang MB ,&nbsp;Kang Cheng MD ,&nbsp;Xiaoyan Wang MD ,&nbsp;Manhua Chen MB ,&nbsp;Guangping Li MD ,&nbsp;Jiangnan Huang MD ,&nbsp;Jun Lan MM ,&nbsp;Guanghe Wei MM ,&nbsp;Xin Zhao MD ,&nbsp;Zhiyong Qi MD ,&nbsp;Juying Qian MD ,&nbsp;Hongyi Wu MD ,&nbsp;Junbo Ge MD","doi":"10.1016/j.ahj.2024.12.007","DOIUrl":"10.1016/j.ahj.2024.12.007","url":null,"abstract":"<div><h3>Background</h3><div>It remains unclear whether indobufen-based dual antiplatelet therapy (DAPT) preserves ischemic protection while limiting bleeding risk in patients with multivessel coronary disease (MVD). This study aimed to investigate the efficacy and safety of indobufen-based DAPT in patients with MVD.</div></div><div><h3>Methods</h3><div>Patients in the OPTION trial were stratified based on the presence of MVD. We compared the ischemic and bleeding risks of indobufen-based DAPT (indobufen 100mg twice a day plus clopidogrel 75 mg/d for 12 months) vs conventional DAPT (aspirin 100 mg/d plus clopidogrel 75 mg/d for 12 months) in patients with and without MVD, using landmarks at 6 months and 1-year post-percutaneous coronary intervention (PCI).</div></div><div><h3>Results</h3><div>Patients with MVD tended to be older and contained a higher prevalence of high-risk features. Compared with patients without MVD, those with MVD were at higher risk for net adverse clinical events and ischemic events. The risk of ischemic events between indobufen-based DAPT vs conventional DAPT was similar either in patients with MVD or without MVD during the first and second 6 months. During the first 6 months, indobufen-based DAPT decreased the risk of bleeding events consistently in patients with and without MVD. Of note, during the second 6 months, indobufen-based DAPT continually decreased the risk of bleeding events in patients with MVD but not in those without MVD.</div></div><div><h3>Conclusions</h3><div>In patients with MVD, indobufen plus clopidogrel DAPT compared to aspirin plus clopidogrel DAPT could reduce the risk of bleeding events while preserving ischemic protection during both the first and second 6 months post-PCI. Indobufen presents an effective option for patients with MVD, especially those at high ischemic risk requiring DAPT beyond 6 months post-PCI.</div></div><div><h3>Trial registration</h3><div>The trial was registered at <span><span>www.chictr.org</span><svg><path></path></svg></span>. A Randomized Controlled Trial of Indobufen vs Aspirin after Coronary Drug-eluting Stent Implantation: the OPTION Trial (ChiCTR-IIR-17013505).</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"282 ","pages":"Pages 21-29"},"PeriodicalIF":3.7,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of rate-adaptive atrial support compared to VDD pacing in cardiac resynchronization therapy recipients: A randomized cross-over study","authors":"Luca Donazzan MD ,&nbsp;Francesca Bulian MD ,&nbsp;Massimiliano Maines MD ,&nbsp;Martin Erckert MD ,&nbsp;Francesco Peruzza MD ,&nbsp;Werner Günther Rauhe MD ,&nbsp;Daniele Giacopelli PhD ,&nbsp;Massimiliano Manfrin MD","doi":"10.1016/j.ahj.2024.12.005","DOIUrl":"10.1016/j.ahj.2024.12.005","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac resynchronization therapy (CRT) is a cornerstone treatment for heart failure, yet the optimal pacing mode remains uncertain. This study investigates the impact of DDDR (rate-adaptive atrial support) versus VDD pacing modes on functional capacity and echocardiographic outcomes in patients with CRT-defibrillators.</div></div><div><h3>Methods</h3><div>In a multicenter, double-blind, crossover trial, 26 sinus rhythm patients undergoing CRT-defibrillator implantation were randomized to DDDR at 60 beats-per-minute or VDD at 30 beats-per-minute. Each pacing mode was maintained for 6 months (period 1), followed by crossover to the alternate programming for additional 6 months (period 2). Distance covered in the 6-minute walk test (6MWT) and echocardiographic parameters were evaluated at baseline and after each period.</div></div><div><h3>Results</h3><div>The proportion of CRT responders was 73% at 6 months and 79% at 12 months. DDDR pacing yielded a median atrial pacing percentage of 55% (interquartile range, 48%-71%). No significant difference was found between DDDR and VDD modes in 6MWT distance (448 m [369-538] vs. 428 m [360-535], <em>P</em> = .71). The sequence of pacing modes was also not significant (<em>P</em> = .17), while the study period (<em>P</em> = .03) and the distance covered at baseline (<em>P</em> &lt; .01) were positively correlated with the distance walked at follow-up. Echocardiographic parameters, including left ventricular ejection fraction and ventricular volumes, showed no significant differences between the pacing modes.</div></div><div><h3>Conclusions</h3><div>In this cohort, rate-adaptive atrial support did not offer any advantage over VDD pacing in terms of functional capacity or echocardiographic response. The findings support the recommendation to maximize intrinsic sinus rhythm sensing in CRT devices.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov Identifier: NCT06592690.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"281 ","pages":"Pages 149-156"},"PeriodicalIF":3.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863122","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":"Association between adverse birth outcomes and long-term risk of premature cardiovascular disease and mortality in a contemporary population-based cohort of 502,383 pregnant women","authors":"Padma Kaul PhD ,&nbsp;Olesya Barrett PhD ,&nbsp;Anamaria Savu PhD ,&nbsp;Vichy Liyanage PhD ,&nbsp;Sandra T. Davidge PhD ,&nbsp;Christy-Lynn M. Cooke MD, PhD","doi":"10.1016/j.ahj.2024.12.002","DOIUrl":"10.1016/j.ahj.2024.12.002","url":null,"abstract":"<div><h3>Background</h3><div>Relatively few studies have examined the association between the entire spectrum of adverse birth outcomes [stillbirth, preterm birth (PTB), term births that are low birth weight (LBW) or high birth weight (HBW)] and long-term risk of CVD in the mother. Our objective was to examine the association between birth outcomes and risk of premature CVD or death in a contemporary cohort of pregnant women.</div></div><div><h3>Methods</h3><div>We conducted a retrospective population-based cohort study of women in Alberta, Canada, between 01/01/2005 and 01/01/2023. The primary endpoint was a composite of CVD-related hospitalization, CVD-related emergency department visit, or death. Cox proportional hazard modelling was used to examine the independent association between birth outcomes and the risk of CVD or death in the mother, after accounting for other socio-demographic, clinical and pregnancy-related complications.</div></div><div><h3>Results</h3><div>Among 502,383 mothers, 0.51% had stillbirth, 7.11% had PTB, 86.11% had normal birth weight (NBW), 2.11% had LBW, and 4.15% had HBW. During a median follow-up of 3612 days (∼10 years), compared the NBW group, the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for maternal CVD or death associated with stillbirth was 1.63 (1.33, 1.99); 1.45 (1.36, 1.55) for PTB; 1.22 (1.06, 1.41) for LBW, and 1.13 (1.03, 1.23) for HBW. In addition to birth outcomes, pre-existing diabetes (aHR: 1.61, 95% CI: 1.47, 1.76), gestational hypertension (aHR: 1.47, 95% CI: 1.38, 1.57), and pre-existing hypertension (aHR: 3.28, 95% CI: 2.66, 4.04) carried a higher risk for premature CVD and death in the mother.</div></div><div><h3>Conclusions</h3><div>Adverse birth outcomes of stillbirth and preterm birth, and to a lesser degree term births that result in LBW or HBW, are markers of increased risk of premature CVD and death in the mother. Coordinated effort between obstetricians, family physicians, and cardiologists are needed to design and implement effective risk reduction programs tailored for these high-risk women.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"282 ","pages":"Pages 13-20"},"PeriodicalIF":3.7,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deferral of routine percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation: Rationale and design of the PRO-TAVI trial","authors":"Hugo M. Aarts MD ,&nbsp;Kimberley I. Hemelrijk MD ,&nbsp;Gijs M. Broeze MSc ,&nbsp;Dirk Jan van Ginkel MD ,&nbsp;Geert A.A. Versteeg MD ,&nbsp;Daniel C. Overduin MD ,&nbsp;Jan G. Tijssen PhD ,&nbsp;Marcel A.M. Beijk MD, PhD ,&nbsp;Jan Baan MD, PhD ,&nbsp;Marije M. Vis MD, PhD ,&nbsp;Jorrit S. Lemkes MD, PhD ,&nbsp;Robbert J. de Winter MD, PhD ,&nbsp;Michael G. Dickinson MD, PhD ,&nbsp;Adriaan O. Kraaijeveld MD, PhD ,&nbsp;Mostafa M. Mokhles MD, PhD ,&nbsp;Thomas C. Dessing MD ,&nbsp;Maik J. Grundeken MD, PhD ,&nbsp;Bimmer E.P.M. Claessen MD, PhD ,&nbsp;Pim A.L. Tonino MD, PhD ,&nbsp;Carl E. Schotborgh MD ,&nbsp;Michiel Voskuil MD, PhD","doi":"10.1016/j.ahj.2024.12.003","DOIUrl":"10.1016/j.ahj.2024.12.003","url":null,"abstract":"<div><h3>Background</h3><div>Concomitant coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). The optimal treatment strategy for CAD is a topic of debate. An initial conservative strategy for CAD in patients undergoing TAVI may be favorable as multiple studies have failed to show an evident beneficial effect of percutaneous coronary intervention (PCI) on mortality after TAVI. However, more randomized, controlled trials are warranted.</div></div><div><h3>Methods</h3><div>The PeRcutaneous cOronary Intervention before Transcatheter Aortic Valve Implantation (PRO-TAVI) trial is an investigator-initiated, multicenter, open-label, randomized controlled trial comparing TAVI with or without routine preprocedural PCI. A total of 466 patients undergoing TAVI will be randomized in a 1:1 ratio to PCI (reference group) or no PCI (index group). Concomitant CAD is defined as at least 1 stenosis of 70% to 99%, or at least 1 stenosis between 40% and 70% combined with positive physiological measurement in a coronary artery with a minimal diameter of 2.5 mm or bypass graft. The primary endpoint is a composite of all-cause mortality, myocardial infarction, stroke, or type 2 - 4 bleeding at 12 months after randomization, in accordance with Valve Academic Research Consortium-3 criteria. Key secondary endpoints include the individual components of the primary endpoint, revascularization, quality of life and cost-effectiveness. The primary endpoint will be analyzed to assess non-inferiority of deferral of routine PCI in patients undergoing TAVI against the prespecified margin of 11 percentage points.</div></div><div><h3>Conclusion</h3><div>The PeRcutaneous cOronary intervention before Transcatheter Aortic Valve Implantation (PRO-TAVI) trial is designed to investigate the hypothesis that deferral of routine PCI in patients undergoing TAVI is non-inferior to TAVI with preceding PCI.</div></div><div><h3>Clinical trial registration</h3><div>clinicaltrials.gov. Unique identifier NCT05078619</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"281 ","pages":"Pages 133-139"},"PeriodicalIF":3.7,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-level variation in cardiac rehabilitation metrics","authors":"Lisa M. Pollack PhD, MPH, MPT ,&nbsp;Anping Chang MS, MPH ,&nbsp;Michael P. Thompson PhD ,&nbsp;Steven J. Keteyian PhD ,&nbsp;Haley Stolp MPH ,&nbsp;Hilary K. Wall MPH ,&nbsp;Laurence S. Sperling MD ,&nbsp;Sandra L. Jackson PhD, MPH","doi":"10.1016/j.ahj.2024.12.004","DOIUrl":"10.1016/j.ahj.2024.12.004","url":null,"abstract":"<div><h3>Background</h3><div>To inform the delivery of cardiac rehabilitation (CR) care nationwide at the hospital level, we described hospital-level variation in CR metrics, overall and stratified by the hospital's tier of cardiac care provided.</div></div><div><h3>Methods</h3><div>This retrospective cohort analysis used Medicare fee-for-service (FFS) data (2018-2020), Parts A and B, and American Hospital Association (AHA) data (2018). We included beneficiaries with an acute myocardial infarction (AMI), percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG) in 2018, aged ≥65 years, and continuously enrolled in a FFS plan. We calculated hospital-level metrics for hospitals with ≥20 CR-qualifying events, which were identified using diagnostic/procedure codes. Claims for CR were identified by Healthcare Common Procedure Coding System (HCPCS) codes. We used multi-level models to examine patient- and hospital-level factors associated with CR metrics. Hospitals were stratified by tier of cardiac care provided (comprehensive, AMI/PCI, AMI-only care).</div></div><div><h3>Results</h3><div>Across the US, 2,212 hospitals treated individuals aged ≥65 years with a CR-qualifying event in 2018. By tier of cardiac care, 44.4% of hospitals provided comprehensive care, 31.2% provided AMI/PCI care, and 24.4% provided AMI-only care. Across all hospitals, there was substantial variation in CR enrollment (median 19.6%, interquartile range [IQR] = 7.0%, 32.8%). Among hospitals with enrollment (n = 1,866), median time to enrollment was 55.0 days (IQR = 41.0, 71.0), median number of CR sessions was 26.0 (IQR = 23.0, 29.0), and median percent completion was 26.0% (IQR = 10.5%, 41.2%). There was also substantial variation in CR performance metrics among hospitals within each tier of cardiac care (eg, median percent CR enrollment was 30.7% [IQR = 20.7%-41.3%] among comprehensive care hospitals, 18.6% [IQR = 9.5%-27.7%] among AMI/PCI hospitals, and 0.0% [IQR = 0.0%-7.7%] among AMI-only hospitals). In adjusted analyses, characteristics associated with lower odds of CR enrollment included patient-level factors (older age, female sex, non-White race or ethnicity), and hospital-level factors (for-profit ownership, regions other than the Midwest, rural location, medium/large hospital size).</div></div><div><h3>Conclusions</h3><div>This is the first national, hospital-level analysis of CR metrics among Medicare beneficiaries. Substantial variation across hospitals, including peer hospitals within the same tier of cardiac care, indicates opportunities for hospital-level quality improvement strategies to improve CR referral and participation metrics.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"282 ","pages":"Pages 58-69"},"PeriodicalIF":3.7,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827136","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":"The contemporary cardio-obstetrics team: The path to improving maternal outcomes in high-risk patients","authors":"Diana S. Wolfe MD, MPH,&nbsp;Kerly Guerrero MD","doi":"10.1016/j.ahj.2024.12.001","DOIUrl":"10.1016/j.ahj.2024.12.001","url":null,"abstract":"<div><div>The field of Cardio-Obstetrics is focused on mitigating cardiovascular risk among pregnant and post-partum individuals. Due to the complexity of caring for pregnant people with acquired or congenital cardiac disease, patients with these conditions are increasingly managed in multidisciplinary Cardio-Obstetrics teams, which are now considered essential to optimize maternal care in high-risk patients. Cardio-Obstetrics teams are composed of multiple subspecialists and have at least 3 roles: (1) provide preconception counseling and risk stratification to patients with known cardiac disease, (2) organize prenatal and postpartum care for patients who develop or present with cardiac disease during pregnancy, and (3) plan for emergent care for patients whose pregnancy “unmasks” cardiac disease, whether acquired disease or an unknown ACHD. Here we describe our experience at Einstein/Montefiore to aid other institutions in developing their own programs.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"281 ","pages":"Pages 140-148"},"PeriodicalIF":3.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823784","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":"Apolipoprotein B modifies the association between lipoprotein(a) and ASCVD risk","authors":"Yuhui Lai MD ,&nbsp;Shaozhao Zhang PhD ,&nbsp;Yue Guo PhD ,&nbsp;Chaoguang Xu MD ,&nbsp;Mengting Huang MD ,&nbsp;Rongjian Zhan MD ,&nbsp;Menghui Liu PhD ,&nbsp;Zhenyu Xiong PhD ,&nbsp;Yiquan Huang MD ,&nbsp;Xinxue Liao PhD ,&nbsp;Yuedong Ma PhD ,&nbsp;Xiaodong Zhuang PhD ,&nbsp;Jingzhou Jiang PhD ,&nbsp;Xing Wu PhD","doi":"10.1016/j.ahj.2024.11.014","DOIUrl":"10.1016/j.ahj.2024.11.014","url":null,"abstract":"<div><h3>Background</h3><div>Elevated lipoprotein(a) (Lp[a]) and apolipoprotein B (apoB) are individually associated with the risk of atherosclerotic cardiovascular disease (ASCVD). Moreover, previous basic research has implicated the potential interaction between apoB and Lp(a) in the atherogenic process. We aimed to determine whether apoB levels significantly modulate ASCVD risk associated with Lp(a) in a large community-based population without baseline cardiovascular disease.</div></div><div><h3>Methods</h3><div>Plasma Lp(a) and apoB were measured in the Atherosclerosis Risk in Communities (ARIC) study. Elevated Lp(a) was defined as the highest race-specific quintile, and elevated apoB was defined as ≥89 mg/dl (median value). The modifying effect of apoB on the Lp(a)-related risk of ASCVD and coronary heart disease (CHD) was determined using Cox regression models adjusted for cardiovascular risk factors.</div></div><div><h3>Results</h3><div>Among 12,988 ARIC participants, 3,888 ASCVD events and 1754 CHD events were observed. Elevated apoB (≥89 mg/dl) and elevated Lp(a) (race-specific quintile 5) were independently associated with ASCVD (hazard ratio [HR]: 1.19; 95% CI: 1.08-1.30; P &lt;0.001; HR: 1.27; 95% CI: 1.16-1.40; <em>P</em> &lt; .001, respectively). Lp(a)-by-apoB interaction was noted [Lp(a) (quintile 1-4 or quintile 5) * apoB (&lt;89 or ≥89 mg/dl) = 0.002]. Compared to the concordantly low Lp(a) group, the individuals with high Lp(a) had a greater ASCVD risk only when apoB was elevated (HR: 1.48; 95% CI: 1.34-1.63; <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>In the context of primary prevention, ASCVD risk associated with Lp(a) was observed only when apoB was elevated. The measurement of apoB can further refine and contextualize the ASCVD risk associated with Lp(a).</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"281 ","pages":"Pages 157-167"},"PeriodicalIF":3.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791005","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":"The relationship of diuretics and dietary sodium in patients with heart failure: an analysis of the SODIUM-HF trial","authors":"Kevin Zhou MD ,&nbsp;Wendimagegn Alemayehu PhD ,&nbsp;Sarah Rathwell MSc ,&nbsp;Finlay A. McAlister MD, MSc ,&nbsp;Heather Ross MD, MHSc ,&nbsp;Jorge Escobedo MD ,&nbsp;Clara Saldarriaga MD ,&nbsp;Eloisa Colin-Ramirez PhD ,&nbsp;Peter Macdonald MD ,&nbsp;Joanne Arcand PhD, RD ,&nbsp;Richard Troughton MBChB ,&nbsp;Justin A. Ezekowitz MBBCh, MSc ,&nbsp;SODIUM-HF Investigators","doi":"10.1016/j.ahj.2024.11.019","DOIUrl":"10.1016/j.ahj.2024.11.019","url":null,"abstract":"<div><h3>Background</h3><div>SODIUM-HF was a large clinical trial testing dietary sodium restriction compared to usual care in patients with heart failure that showed no reduction in clinical events. It has been suggested that diuretic doses in response to dietary sodium modification may have influenced the trial results.</div></div><div><h3>Objective</h3><div>We assessed the effects of baseline diuretic dose and diuretic dose changes on clinical outcomes in the SODIUM-HF trial.</div></div><div><h3>Methods</h3><div>Diuretics were converted to furosemide-equivalent diuretic total daily doses. Furosemide dose was treated as a continuous variable and also stratified into 0mg, 1mg to 39mg, 40mg, 41mg to 80mg, and &gt; 80mg daily. The baseline diuretic dose and change in diuretic dose were assessed and correlated with dietary sodium restriction and changes in dietary sodium intake. We then examined the relationship between diuretic dosing and the primary outcomes of SODIUM-HF (cardiovascular-related emergency department visit, cardiovascular-related hospitalization, and all-cause mortality).</div></div><div><h3>Results</h3><div>Of the 806 patients enrolled in the SODIUM-HF trial, 784 had known diuretic status at baseline: 209 patients (26.7%) with 0mg, 134 patients (17%) with 1mg to 39mg, 205 patients (26.1%) with 40mg, 118 patients (15.1%) with 41mg to 80mg, and 118 patients (15.1%) with &gt; 80mg. No correlation was found between dietary sodium intake and diuretic dose, either at baseline or change throughout the study (<em>P &gt; .</em>05). For the primary outcomes, the 2-year risk of primary outcomes was strongly correlated with diuretic dose at baseline across the overall SODIUM-HF population (<em>P &lt; .</em>001). No significant association was found between the treatment arm and the risk of primary outcomes, within each baseline diuretic dose range or with change in diuretic dose (both <em>P &gt; .</em>05).</div></div><div><h3>Conclusions</h3><div>Although a higher baseline diuretic dose was associated with worse clinical outcomes, no association was found between dietary sodium restriction, baseline or change in diuretic dose and the primary outcomes.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"281 ","pages":"Pages 49-58"},"PeriodicalIF":3.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response of health-related quality of life following pediatric/congenital cardiac catheterization procedures","authors":"Michael L. O'Byrne MD, MSCE ,&nbsp;Priya Sharma PhD ,&nbsp;Jing Huang PhD ,&nbsp;Christopher L. Smith MD, PhD ,&nbsp;Jie Tang MD ,&nbsp;Ryan Callahan MD ,&nbsp;Jonathan B. Edelson MD ,&nbsp;Yoav Dori MD, PhD ,&nbsp;Matthew J. Gillespie MD ,&nbsp;Jonathan J. Rome MD ,&nbsp;Andrew C. Glatz MD, MSCE","doi":"10.1016/j.ahj.2024.11.017","DOIUrl":"10.1016/j.ahj.2024.11.017","url":null,"abstract":"<div><h3>Background</h3><div>Health related quality of life (HRQOL) is a patient-reported metric (PRM) that provides a holistic measure of health that is not addressed in traditional outcome measures. The acute responsiveness of HRQOL after pediatric/congenital cardiac catheterization procedures has not, to our knowledge, been studied.</div></div><div><h3>Methods</h3><div>A single-center prospective cohort study was performed, longitudinally evaluating HRQOL and other PRM in school-age children and adolescents (ages 8-18) undergoing diagnostic and interventional cardiac catheterization procedures prior to their scheduled procedure, and then 1 day, ∼1 month, and ∼3 months after the procedure. Differences between HRQOL at baseline and at 1- and 3-month follow-up were evaluated using paired Student's t-tests.</div></div><div><h3>Results</h3><div>A total of 70 patient-parent/guardian dyads were studied. The participating patients were 13±3 years old, 51% female, and 74% non-Hispanic white, with 54% undergoing a diagnostic procedure. The trajectory of cardiac-specific HRQOL as measured through Pediatric Cardiac Quality of Life Inventory differed for patients undergoing diagnostic and interventional procedures. Following diagnostic procedures, there was no significant change in cardiac-specific HRQOL (<em>P</em> &gt; .05). After interventional procedures, patient-reported cardiac-specific HRQOL increased at both 1-month (4.3±11, <em>P</em> = .04) and 3-months (5.9±11.4, <em>P</em> = .02), though the same changes were not seen in parent/guardian-reported cardiac-specific HRQOL (<em>P</em> &gt; .05). PROMIS measures of physical function, psychological symptoms, and social function were associated with baseline cardiac-specific HRQOL (all <em>P</em> &lt; .05), but no associations were seen between other patient-reported outcomes and baseline HRQOL or change from baseline to 3-month follow-up.</div></div><div><h3>Conclusion</h3><div>Across a range of transcatheter interventional procedures, patient-reported cardiac-specific HRQOL improved in short term follow up, though these changes were not seen in parent/guardian reported measures. Incorporating these patient-centered metrics into evaluation of transcatheter therapies may provide more accurate measures of comparative effectiveness.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"281 ","pages":"Pages 71-83"},"PeriodicalIF":3.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791007","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}