Pub Date : 2025-01-15DOI: 10.1161/CIR.0000000000001292
Rina Mauricio, Garima Sharma, Jennifer Lewey, Rose Tompkins, Torie Plowden, Kathryn Rexrode, Mary Canobbio, Jenna Skowronski, Afshan Hameed, Candice Silversides, Harmony Reynolds, Arthur Vaught
The use of assisted reproductive technology (ART) is growing, both to assist individuals with infertility and for fertility preservation. Individuals with cardiovascular disease (CVD), or risk factors for CVD, are increasingly using ART. Thus, knowing how to care for patients undergoing ART is important for the cardiovascular clinician. In this scientific statement, we review the ART process and known short-term and long-term risks associated with ART that can adversely affect patients with CVD. We review current knowledge on risks from ART for specific cardiac conditions and provide a suggested approach to evaluating and counseling patients with CVD contemplating ART as well as suggested management before and during the ART process. Individuals with CVD are at increased risk for pregnancy complications, and management of this unique population has been discussed previously. The focus of this scientific statement is on ART. Therefore, discussions on risk assessment, counseling, and management of individuals with CVD during pregnancy are limited, and established guidelines are referenced.
{"title":"Assessing and Addressing Cardiovascular and Obstetric Risks in Patients Undergoing Assisted Reproductive Technology: A Scientific Statement From the American Heart Association.","authors":"Rina Mauricio, Garima Sharma, Jennifer Lewey, Rose Tompkins, Torie Plowden, Kathryn Rexrode, Mary Canobbio, Jenna Skowronski, Afshan Hameed, Candice Silversides, Harmony Reynolds, Arthur Vaught","doi":"10.1161/CIR.0000000000001292","DOIUrl":"https://doi.org/10.1161/CIR.0000000000001292","url":null,"abstract":"<p><p>The use of assisted reproductive technology (ART) is growing, both to assist individuals with infertility and for fertility preservation. Individuals with cardiovascular disease (CVD), or risk factors for CVD, are increasingly using ART. Thus, knowing how to care for patients undergoing ART is important for the cardiovascular clinician. In this scientific statement, we review the ART process and known short-term and long-term risks associated with ART that can adversely affect patients with CVD. We review current knowledge on risks from ART for specific cardiac conditions and provide a suggested approach to evaluating and counseling patients with CVD contemplating ART as well as suggested management before and during the ART process. Individuals with CVD are at increased risk for pregnancy complications, and management of this unique population has been discussed previously. The focus of this scientific statement is on ART. Therefore, discussions on risk assessment, counseling, and management of individuals with CVD during pregnancy are limited, and established guidelines are referenced.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":35.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14Epub Date: 2025-01-13DOI: 10.1161/CIRCULATIONAHA.124.070797
Antonio Landi, Diana A Gorog, Marco Valgimigli
{"title":"Swinging Pendulum Between Risks and Benefits of Antiplatelet Agents: A Call for Consistency in the Interpretation of Evidence and Guideline Recommendations.","authors":"Antonio Landi, Diana A Gorog, Marco Valgimigli","doi":"10.1161/CIRCULATIONAHA.124.070797","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.070797","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 2","pages":"126-128"},"PeriodicalIF":35.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14Epub Date: 2024-11-08DOI: 10.1161/CIRCULATIONAHA.124.070064
Helga Lillian Gudmundsdottir, Anna Axelsson Raja, Kasper Rossing, Hanne Rasmusen, Martin Snoer, Lars Juel Andersen, Rikke Gottlieb, Alex Hørby Christensen, Henning Bundgaard, Finn Gustafsson, Jens Jakob Thune
<p><strong>Background: </strong>Patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction commonly experience reduced exercise capacity. Physical training improves exercise capacity in these patients, but whether the underlying effects of exercise are a result of central hemodynamic or peripheral improvement is unclear. This study assessed whether exercise training reduces left ventricular filling pressure measured during exercise in patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction.</p><p><strong>Methods: </strong>Between March 2019 and June 2022, patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction were randomly assigned (1:1) to a 12-week (3 h/wk) supervised, moderate-intensity exercise training program or continued usual activity. The primary outcome was the change in invasively measured pulmonary capillary wedge pressure during mild exercise (25 W) from baseline to week 12. Pressure tracings were analyzed offline by a blinded investigator. Secondary outcomes included changes in peak oxygen consumption, cardiac index, quality of life, echocardiographic indices of diastolic function, and natriuretic peptides.</p><p><strong>Results: </strong>Of 59 patients randomized (mean age, 58.1 [12.2] years; 27% women), 51 (86%) completed all follow-up assessments. At week 12, the change in 25-W pulmonary capillary wedge pressure was -2.8 (6.8) mm Hg in the exercise group, compared with +1.2 (4.9) mm Hg in the usual-activity group (between-group difference, 4.0 mm Hg [95% CI, 0.7-7.3]; <i>P</i>=0.018). Peak oxygen consumption improved by +1.8 (2.0) mL·kg⁻¹·min⁻¹ in the exercise group versus -0.3 (3.1) mL·kg⁻¹·min⁻¹ in the usual-activity group (<i>P</i>=0.005). Exercise training improved the ventilatory efficiency (V<sub>E</sub>/VCO<sub>2</sub>) slope compared with usual activity (between-group difference, 2.0 [95% CI, 0.6-3.5]; <i>P</i>=0.006). Peak cardiac index improved by +0.38 (1.38) L·min⁻¹·m⁻² in exercise versus -0.85 (1.20) L·min⁻¹·m⁻² in the usual-activity group (<i>P</i>=0.002). Change in overall Kansas City Cardiomyopathy Questionnaire score was similar between groups. However, the change in physical limitation scores (+8.4 [12.0] points in exercise versus +0.7 [6.8] points in usual-activity group; <i>P</i>=0.034) and quality-of-life scores (+8.7 [18.0] points in exercise versus 0.7 [4.0] points in usual-activity group; <i>P</i>=0.01) differed significantly. There were no significant changes in diastolic function assessed by echocardiography or in natriuretic peptides.</p><p><strong>Conclusions: </strong>In patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction, a 12-week moderate-intensity exercise training program resulted in reduced left ventricular filling pressures at mild exertion and improved exercise performance.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov;
{"title":"Exercise Training in Patients With Hypertrophic Cardiomyopathy Without Left Ventricular Outflow Tract Obstruction: A Randomized Clinical Trial.","authors":"Helga Lillian Gudmundsdottir, Anna Axelsson Raja, Kasper Rossing, Hanne Rasmusen, Martin Snoer, Lars Juel Andersen, Rikke Gottlieb, Alex Hørby Christensen, Henning Bundgaard, Finn Gustafsson, Jens Jakob Thune","doi":"10.1161/CIRCULATIONAHA.124.070064","DOIUrl":"10.1161/CIRCULATIONAHA.124.070064","url":null,"abstract":"<p><strong>Background: </strong>Patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction commonly experience reduced exercise capacity. Physical training improves exercise capacity in these patients, but whether the underlying effects of exercise are a result of central hemodynamic or peripheral improvement is unclear. This study assessed whether exercise training reduces left ventricular filling pressure measured during exercise in patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction.</p><p><strong>Methods: </strong>Between March 2019 and June 2022, patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction were randomly assigned (1:1) to a 12-week (3 h/wk) supervised, moderate-intensity exercise training program or continued usual activity. The primary outcome was the change in invasively measured pulmonary capillary wedge pressure during mild exercise (25 W) from baseline to week 12. Pressure tracings were analyzed offline by a blinded investigator. Secondary outcomes included changes in peak oxygen consumption, cardiac index, quality of life, echocardiographic indices of diastolic function, and natriuretic peptides.</p><p><strong>Results: </strong>Of 59 patients randomized (mean age, 58.1 [12.2] years; 27% women), 51 (86%) completed all follow-up assessments. At week 12, the change in 25-W pulmonary capillary wedge pressure was -2.8 (6.8) mm Hg in the exercise group, compared with +1.2 (4.9) mm Hg in the usual-activity group (between-group difference, 4.0 mm Hg [95% CI, 0.7-7.3]; <i>P</i>=0.018). Peak oxygen consumption improved by +1.8 (2.0) mL·kg⁻¹·min⁻¹ in the exercise group versus -0.3 (3.1) mL·kg⁻¹·min⁻¹ in the usual-activity group (<i>P</i>=0.005). Exercise training improved the ventilatory efficiency (V<sub>E</sub>/VCO<sub>2</sub>) slope compared with usual activity (between-group difference, 2.0 [95% CI, 0.6-3.5]; <i>P</i>=0.006). Peak cardiac index improved by +0.38 (1.38) L·min⁻¹·m⁻² in exercise versus -0.85 (1.20) L·min⁻¹·m⁻² in the usual-activity group (<i>P</i>=0.002). Change in overall Kansas City Cardiomyopathy Questionnaire score was similar between groups. However, the change in physical limitation scores (+8.4 [12.0] points in exercise versus +0.7 [6.8] points in usual-activity group; <i>P</i>=0.034) and quality-of-life scores (+8.7 [18.0] points in exercise versus 0.7 [4.0] points in usual-activity group; <i>P</i>=0.01) differed significantly. There were no significant changes in diastolic function assessed by echocardiography or in natriuretic peptides.</p><p><strong>Conclusions: </strong>In patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction, a 12-week moderate-intensity exercise training program resulted in reduced left ventricular filling pressures at mild exertion and improved exercise performance.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov;","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"132-144"},"PeriodicalIF":35.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14Epub Date: 2025-01-13DOI: 10.1161/CIRCULATIONAHA.124.071536
Meiyan Sun, Shufang He, Ji Hu, Ye Zhang
{"title":"Response by Sun et al to Letter Regarding Article, \"Piezo1-Mediated Neurogenic Inflammatory Cascade Exacerbates Ventricular Remodeling After Myocardial Infarction\".","authors":"Meiyan Sun, Shufang He, Ji Hu, Ye Zhang","doi":"10.1161/CIRCULATIONAHA.124.071536","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.071536","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 2","pages":"e23"},"PeriodicalIF":35.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14Epub Date: 2025-01-13DOI: 10.1161/CIRCULATIONAHA.124.072649
James P MacNamara, Michael P Ayers
{"title":"Cardiac Plasticity in Hypertrophic Cardiomyopathy: Exercise as Medicine?","authors":"James P MacNamara, Michael P Ayers","doi":"10.1161/CIRCULATIONAHA.124.072649","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.072649","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 2","pages":"145-148"},"PeriodicalIF":35.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14Epub Date: 2025-01-13DOI: 10.1161/CIRCULATIONAHA.124.073245
Darren K McGuire, James A de Lemos, Joseph A Hill
{"title":"Recognized Outstanding Reviewers for <i>Circulation</i> in 2024.","authors":"Darren K McGuire, James A de Lemos, Joseph A Hill","doi":"10.1161/CIRCULATIONAHA.124.073245","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.073245","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 2","pages":"125"},"PeriodicalIF":35.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14Epub Date: 2024-09-28DOI: 10.1161/CIRCULATIONAHA.124.072055
Muthiah Vaduganathan, Brian L Claggett, Ian J Kulac, Zi Michael Miao, Akshay S Desai, Pardeep S Jhund, Alasdair D Henderson, Meike Brinker, James Lay-Flurrie, Prabhakar Viswanathan, Markus Florian Scheerer, Andrea Lage, Carolyn S P Lam, Michele Senni, Sanjiv J Shah, Adriaan A Voors, Faiez Zannad, Bertram Pitt, John J V McMurray, Scott D Solomon
Background: Patients with heart failure (HF) with mildly reduced or preserved ejection fraction face heightened long-term risks of morbidity and mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and the nonsteroidal mineralocorticoid receptor antagonist finerenone have both been shown to reduce the risk of cardiovascular events in this population, but the effects of their combined use are not known.
Methods: FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure) was a randomized, double-blind, placebo-controlled trial of finerenone in patients with HF and left ventricular ejection fraction ≥40%. Baseline SGLT2i use was a prespecified subgroup. The primary outcome was a composite of total (first and recurrent) worsening HF events and cardiovascular death. We first assessed for evidence of treatment heterogeneity on the basis of baseline SGLT2i use. We further examined SGLT2i uptake during the trial and evaluated the treatment effects of finerenone accounting for baseline and during-trial use of SGLT2i in time-varying analyses.
Results: Among 6001 participants, 817 (13.6%) were treated with an SGLT2i at baseline. During 2.6 years median follow-up, treatment with finerenone similarly reduced the risk of the primary outcome in participants treated with an SGLT2i (rate ratio, 0.83 [95% CI, 0.60-1.16]) and without an SGLT2i at baseline (rate ratio, 0.85 [95% CI, 0.74-0.98]; Pinteraction=0.76). In follow-up, 980 participants initiated SGLT2i, which was less frequent in the finerenone arm compared with placebo (17.7% versus 20.1%; hazard ratio, 0.86 [95% CI, 0.76-0.97]). Time-updated analyses accounting for baseline and subsequent use of SGLT2i did not meaningfully alter the treatment effects of finerenone on the primary end point.
Conclusions: The treatment benefits of the nonsteroidal mineralocorticoid receptor antagonist finerenone were observed irrespective of concomitant use of an SGLT2i. These data suggest that the combined use of SGLT2i and a nonsteroidal mineralocorticoid receptor antagonist may provide additive protection against cardiovascular events in patients with HF with mildly reduced or preserved ejection fraction.
{"title":"Effects of the Nonsteroidal MRA Finerenone With and Without Concomitant SGLT2 Inhibitor Use in Heart Failure.","authors":"Muthiah Vaduganathan, Brian L Claggett, Ian J Kulac, Zi Michael Miao, Akshay S Desai, Pardeep S Jhund, Alasdair D Henderson, Meike Brinker, James Lay-Flurrie, Prabhakar Viswanathan, Markus Florian Scheerer, Andrea Lage, Carolyn S P Lam, Michele Senni, Sanjiv J Shah, Adriaan A Voors, Faiez Zannad, Bertram Pitt, John J V McMurray, Scott D Solomon","doi":"10.1161/CIRCULATIONAHA.124.072055","DOIUrl":"10.1161/CIRCULATIONAHA.124.072055","url":null,"abstract":"<p><strong>Background: </strong>Patients with heart failure (HF) with mildly reduced or preserved ejection fraction face heightened long-term risks of morbidity and mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and the nonsteroidal mineralocorticoid receptor antagonist finerenone have both been shown to reduce the risk of cardiovascular events in this population, but the effects of their combined use are not known.</p><p><strong>Methods: </strong>FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure) was a randomized, double-blind, placebo-controlled trial of finerenone in patients with HF and left ventricular ejection fraction ≥40%. Baseline SGLT2i use was a prespecified subgroup. The primary outcome was a composite of total (first and recurrent) worsening HF events and cardiovascular death. We first assessed for evidence of treatment heterogeneity on the basis of baseline SGLT2i use. We further examined SGLT2i uptake during the trial and evaluated the treatment effects of finerenone accounting for baseline and during-trial use of SGLT2i in time-varying analyses.</p><p><strong>Results: </strong>Among 6001 participants, 817 (13.6%) were treated with an SGLT2i at baseline. During 2.6 years median follow-up, treatment with finerenone similarly reduced the risk of the primary outcome in participants treated with an SGLT2i (rate ratio, 0.83 [95% CI, 0.60-1.16]) and without an SGLT2i at baseline (rate ratio, 0.85 [95% CI, 0.74-0.98]; <i>P</i><sub>interaction</sub>=0.76). In follow-up, 980 participants initiated SGLT2i, which was less frequent in the finerenone arm compared with placebo (17.7% versus 20.1%; hazard ratio, 0.86 [95% CI, 0.76-0.97]). Time-updated analyses accounting for baseline and subsequent use of SGLT2i did not meaningfully alter the treatment effects of finerenone on the primary end point.</p><p><strong>Conclusions: </strong>The treatment benefits of the nonsteroidal mineralocorticoid receptor antagonist finerenone were observed irrespective of concomitant use of an SGLT2i. These data suggest that the combined use of SGLT2i and a nonsteroidal mineralocorticoid receptor antagonist may provide additive protection against cardiovascular events in patients with HF with mildly reduced or preserved ejection fraction.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04435626.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"149-158"},"PeriodicalIF":35.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14Epub Date: 2025-01-13DOI: 10.1161/CIRCULATIONAHA.124.068331
Abdul Wahed Sidiqi, Diana Dad Zada, Nader Ahmad Exeer
{"title":"Global Rounds Afghanistan: A Critical Overview of Cardiovascular Medicine.","authors":"Abdul Wahed Sidiqi, Diana Dad Zada, Nader Ahmad Exeer","doi":"10.1161/CIRCULATIONAHA.124.068331","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.068331","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"151 2","pages":"129-131"},"PeriodicalIF":35.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号