Pub Date : 2025-10-01DOI: 10.1001/jamacardio.2025.3276
Sarah Haeger,Nisha Bansal
{"title":"How Cardiovascular Health in Young Adulthood Affects Kidney and Cardiovascular Risk Later in Life-Lifespan Lessons.","authors":"Sarah Haeger,Nisha Bansal","doi":"10.1001/jamacardio.2025.3276","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3276","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"23 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194880","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 : 2025-09-24DOI: 10.1001/jamacardio.2025.3168
Rohan G Reddy,David A Danford,Shelby Kutty
{"title":"Pathway to Risk Stratification in Tricuspid Regurgitation.","authors":"Rohan G Reddy,David A Danford,Shelby Kutty","doi":"10.1001/jamacardio.2025.3168","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3168","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"24 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127144","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}
ImportanceFor the prevention of sudden cardiac death in myotonic dystrophy type 1 (dystrophia myotonica; DM1), professional practice guidelines recommend pacemaker implantation in asymptomatic patients with a PR interval greater than or equal to 240 milliseconds and/or QRS duration greater than or equal to 120 milliseconds on electrocardiogram (ECG), or a His-ventricular (HV) interval greater than or equal to 70 milliseconds during electrophysiological study (EPS), as class IIa indications.ObjectiveTo determine which of these strategies-ECG or EPS based-is more effective in predicting major bradyarrhythmic events (MBAEs).Design, Setting, and ParticipantsThis was a cohort analysis of retrospectively collected longitudinal data from the DM1 Heart Registry. The setting included cardiology and neurology departments of 6 French university hospitals. Study participants were selected from individuals enrolled in the DM1 Heart Registry between 2000 and 2020. The DM1 Heart Registry includes adults with genetically confirmed DM1. Included patients had a history of first EPS after 1999 and no personal history of advanced atrioventricular block or sustained ventricular tachycardia. Study data were analyzed from January to July 2025.ExposuresECG- and EPS-based strategies.Main Outcomes and MeasuresThe primary outcome was MBAEs, defined as sudden cardiac death, resuscitated cardiac arrest, or second-degree type II or complete atrioventricular block.ResultsOf 1778 adults with genetically confirmed DM1 enrolled in the DM1 Heart Registry, a total of 706 patients (mean [SD] age, 42 [13] years; 359 male [51%]) were included in this study. At baseline, 273 patients (38%) had an HV interval greater than or equal to 70 milliseconds, and 232 (32%) met ECG criteria. Over a median (IQR) follow-up of 5.9 (2.3-9.7) years, 99 patients (14%) experienced an MBAE. In multivariable Cox and joint models incorporating baseline and time-varying values of PR and QRS durations, the HV interval was the only variable significantly associated with the incidence of MBAEs (hazard ratio [HR], 1.77; 95% CI, 1.46-2.16; P < .001 and HR, 1.78; 95% CI, 1.40-2.22; P = .001, respectively). Compared with ECG-based criteria, the EPS criterion proved to be a more reliable (HR, 2.89; 95% CI, 1.92-4.34 vs HR, 1.95; 95% CI, 1.31-2.89) and more sensitive (performance index [SE], 68.35% [6.24%] vs 34.76% [6.47%]) predictor of MBAE and accurately reclassified 28.8% of patients with an MBAE. Lowering the threshold to HV greater than or equal to 65 milliseconds further improved sensitivity (performance index [SE], 90.18% [3.85%]) and net reclassification improvement (33.7%; 95% CI, 19.6%-48.2%) for MBAE prediction.Conclusions and RelevanceIn this cohort of patients with DM1, the HV interval outperformed ECG criteria in predicting MBAEs. An HV threshold greater than or equal to 65 milliseconds may enhance risk stratification for prophylactic pacing.
重要性为预防1型肌强直性营养不良（肌强直性营养不良；DM1）的心源性猝死，专业实践指南建议对无症状的PR间期大于或等于240毫秒和/或心电图QRS持续时间大于或等于120毫秒，或电生理研究（EPS）时HV间期大于或等于70毫秒的患者植入起搏器，作为IIa类适应症。目的确定哪一种策略（ecg或EPS）更有效地预测主要心律失常事件（MBAEs）。设计、环境和参与者：这是一项对DM1心脏登记处回顾性收集的纵向数据的队列分析。设置包括6所法国大学医院的心内科和神经内科。研究参与者是从2000年至2020年间登记在DM1心脏登记处的个人中挑选出来的。DM1心脏登记包括基因证实患有DM1的成年人。纳入的患者1999年后有首次EPS病史，无晚期房室传导阻滞或持续性室性心动过速个人病史。研究数据分析时间为2025年1月至7月。暴露心电图和eps为基础的策略。主要结局和测量主要结局为MBAEs，定义为心源性猝死、复苏性心脏骤停、二级II型或完全房室传导阻滞。结果在DM1心脏登记处登记的1778名遗传确诊DM1的成年人中，共有706名患者（平均[SD]年龄42岁，其中359名男性[51%]）被纳入本研究。在基线时，273例患者（38%）的HV间期大于或等于70毫秒，232例患者（32%）符合ECG标准。在中位（IQR）随访5.9（2.3-9.7）年期间，99名患者（14%）经历了MBAE。在包含基线值和时变PR和QRS持续时间值的多变量Cox和联合模型中，HV间隔是唯一与MBAEs发生率显著相关的变量(风险比[HR]， 1.77; 95% CI, 1.46-2.16; P <。001， HR为1.78；95% ci, 1.40-2.22；p =。001年,分别)。与基于心电图的标准相比，EPS标准被证明是一个更可靠的MBAE预测指标（HR, 2.89; 95% CI, 1.92-4.34 vs HR, 1.95; 95% CI, 1.31-2.89）和更敏感（表现指数[SE]， 68.35% [6.24%] vs 34.76%[6.47%]），并准确地重新分类了28.8%的MBAE患者。将阈值降低到HV大于或等于65毫秒进一步提高了MBAE预测的灵敏度（性能指数[SE]， 90.18%[3.85%]）和净重分类改善（33.7%;95% CI, 19.6%-48.2%）。结论和相关性在这组DM1患者中，HV间期在预测MBAEs方面优于ECG标准。大于或等于65毫秒的HV阈值可能会增加预防性起搏的风险分层。
{"title":"Electrocardiogram vs Electrophysiological Study and Major Conduction Delays in Myotonic Dystrophy Type 1.","authors":"Nicolas Clementy,Fabien Labombarda,François Grolleau,Vincent Algalarrondo,Guillaume Bassez,Henri-Marc Bécane,Anthony Béhin,Françoise Chapon,Mohamed El Hachmi,Abdallah Fayssoil,Bertrand Fontaine,Rodrigue Garcia,Pascal Laforêt,Arnaud Lazarus,Marion Masingue,Armelle Magot,Yann Pereon,Vincent Probst,Leslie Motté,Malika Saadi,Denis Duboc,Tanya Stojkovic,Raphaël Porcher,Karim Wahbi","doi":"10.1001/jamacardio.2025.3055","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3055","url":null,"abstract":"ImportanceFor the prevention of sudden cardiac death in myotonic dystrophy type 1 (dystrophia myotonica; DM1), professional practice guidelines recommend pacemaker implantation in asymptomatic patients with a PR interval greater than or equal to 240 milliseconds and/or QRS duration greater than or equal to 120 milliseconds on electrocardiogram (ECG), or a His-ventricular (HV) interval greater than or equal to 70 milliseconds during electrophysiological study (EPS), as class IIa indications.ObjectiveTo determine which of these strategies-ECG or EPS based-is more effective in predicting major bradyarrhythmic events (MBAEs).Design, Setting, and ParticipantsThis was a cohort analysis of retrospectively collected longitudinal data from the DM1 Heart Registry. The setting included cardiology and neurology departments of 6 French university hospitals. Study participants were selected from individuals enrolled in the DM1 Heart Registry between 2000 and 2020. The DM1 Heart Registry includes adults with genetically confirmed DM1. Included patients had a history of first EPS after 1999 and no personal history of advanced atrioventricular block or sustained ventricular tachycardia. Study data were analyzed from January to July 2025.ExposuresECG- and EPS-based strategies.Main Outcomes and MeasuresThe primary outcome was MBAEs, defined as sudden cardiac death, resuscitated cardiac arrest, or second-degree type II or complete atrioventricular block.ResultsOf 1778 adults with genetically confirmed DM1 enrolled in the DM1 Heart Registry, a total of 706 patients (mean [SD] age, 42 [13] years; 359 male [51%]) were included in this study. At baseline, 273 patients (38%) had an HV interval greater than or equal to 70 milliseconds, and 232 (32%) met ECG criteria. Over a median (IQR) follow-up of 5.9 (2.3-9.7) years, 99 patients (14%) experienced an MBAE. In multivariable Cox and joint models incorporating baseline and time-varying values of PR and QRS durations, the HV interval was the only variable significantly associated with the incidence of MBAEs (hazard ratio [HR], 1.77; 95% CI, 1.46-2.16; P < .001 and HR, 1.78; 95% CI, 1.40-2.22; P = .001, respectively). Compared with ECG-based criteria, the EPS criterion proved to be a more reliable (HR, 2.89; 95% CI, 1.92-4.34 vs HR, 1.95; 95% CI, 1.31-2.89) and more sensitive (performance index [SE], 68.35% [6.24%] vs 34.76% [6.47%]) predictor of MBAE and accurately reclassified 28.8% of patients with an MBAE. Lowering the threshold to HV greater than or equal to 65 milliseconds further improved sensitivity (performance index [SE], 90.18% [3.85%]) and net reclassification improvement (33.7%; 95% CI, 19.6%-48.2%) for MBAE prediction.Conclusions and RelevanceIn this cohort of patients with DM1, the HV interval outperformed ECG criteria in predicting MBAEs. An HV threshold greater than or equal to 65 milliseconds may enhance risk stratification for prophylactic pacing.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"21 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127168","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 : 2025-09-24DOI: 10.1001/jamacardio.2025.3224
Maxwell C Braasch,Sophia R Pyeatte,June He,Mehran Rahimi,Alexander A Brescia,Puja Kachroo,Harold G Roberts,Nathan Frogge,Nishath Quader,Marc A Sintek,Alan Zajarias,Nicholas Kouchoukos,Tsuyoshi Kaneko
ImportanceTranscatheter aortic valve replacement (TAVR) reintervention is performed by either redo TAVR or TAVR explant. There is insufficient data on contemporary TAVR reintervention procedural incidence and volume.ObjectiveTo evaluate contemporary procedural volumes of redo TAVR and TAVR explant.Design, Setting, and ParticipantsThis retrospective analysis of redo TAVR and TAVR explant annual incidence and procedural volume was performed from January 2012 to June 2024. For comprehensive assessment of aortic valve replacement, analysis of SAVR reintervention annual incidence and procedural volume was also performed. Data were obtained through the US Centers for Medicare & Medicaid Services Virtual Research Data Center. Patients with prior TAVR or SAVR who underwent subsequent TAVR or SAVR were included.ExposuresPatients who underwent a TAVR after TAVR defined the redo TAVR group, while patients who underwent SAVR after TAVR defined the TAVR explant group. Patients who underwent a TAVR after SAVR defined the valve-in-valve (ViV) TAVR group, while patients who underwent SAVR after SAVR defined the redo SAVR group. Analysis of annual incidences and procedural volumes of all groups at different time intervals was conducted.Main Outcomes and MeasuresThe primary outcome was annual incidence and procedural volume of both redo TAVR and TAVR explant. The secondary outcome was annual incidence and procedural volume of both ViV TAVR and redo SAVR.ResultsOf 410 720 total TAVRs from 2012 to 2024, 2374 redo TAVRs and 1346 TAVR explants were identified. Of 299 780 total SAVRs from 2012 to 2024, 5044 ViV-TAVRs and 4202 redo SAVRs were identified. Since 2020, there have been 1518 redo TAVRs and 1007 TAVR explants. The annual incidence of TAVR reintervention has changed from 0.17% in 2019 to 0.28% in 2023. Although the most common time interval for redo TAVR after index TAVR was within 3 months (410 of 2374 [17.3%]) and for TAVR explant after index TAVR was 1 to 2 years (259 of 1346 [19.2%]), redo TAVR was the predominant procedure beyond 5 years from the index TAVR (725 of 819 [88.5%]).Conclusions and RelevanceIn this study, annual volumes of both redo TAVR and TAVR explant continued to increase, particularly in recent years. Redo TAVR is frequently performed over 5 years from the index TAVR. Future analysis to determine the appropriate TAVR reintervention strategy for individual patients is needed.
{"title":"Contemporary Incidence and Procedural Volume of Transcatheter Aortic Valve Reintervention.","authors":"Maxwell C Braasch,Sophia R Pyeatte,June He,Mehran Rahimi,Alexander A Brescia,Puja Kachroo,Harold G Roberts,Nathan Frogge,Nishath Quader,Marc A Sintek,Alan Zajarias,Nicholas Kouchoukos,Tsuyoshi Kaneko","doi":"10.1001/jamacardio.2025.3224","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3224","url":null,"abstract":"ImportanceTranscatheter aortic valve replacement (TAVR) reintervention is performed by either redo TAVR or TAVR explant. There is insufficient data on contemporary TAVR reintervention procedural incidence and volume.ObjectiveTo evaluate contemporary procedural volumes of redo TAVR and TAVR explant.Design, Setting, and ParticipantsThis retrospective analysis of redo TAVR and TAVR explant annual incidence and procedural volume was performed from January 2012 to June 2024. For comprehensive assessment of aortic valve replacement, analysis of SAVR reintervention annual incidence and procedural volume was also performed. Data were obtained through the US Centers for Medicare & Medicaid Services Virtual Research Data Center. Patients with prior TAVR or SAVR who underwent subsequent TAVR or SAVR were included.ExposuresPatients who underwent a TAVR after TAVR defined the redo TAVR group, while patients who underwent SAVR after TAVR defined the TAVR explant group. Patients who underwent a TAVR after SAVR defined the valve-in-valve (ViV) TAVR group, while patients who underwent SAVR after SAVR defined the redo SAVR group. Analysis of annual incidences and procedural volumes of all groups at different time intervals was conducted.Main Outcomes and MeasuresThe primary outcome was annual incidence and procedural volume of both redo TAVR and TAVR explant. The secondary outcome was annual incidence and procedural volume of both ViV TAVR and redo SAVR.ResultsOf 410 720 total TAVRs from 2012 to 2024, 2374 redo TAVRs and 1346 TAVR explants were identified. Of 299 780 total SAVRs from 2012 to 2024, 5044 ViV-TAVRs and 4202 redo SAVRs were identified. Since 2020, there have been 1518 redo TAVRs and 1007 TAVR explants. The annual incidence of TAVR reintervention has changed from 0.17% in 2019 to 0.28% in 2023. Although the most common time interval for redo TAVR after index TAVR was within 3 months (410 of 2374 [17.3%]) and for TAVR explant after index TAVR was 1 to 2 years (259 of 1346 [19.2%]), redo TAVR was the predominant procedure beyond 5 years from the index TAVR (725 of 819 [88.5%]).Conclusions and RelevanceIn this study, annual volumes of both redo TAVR and TAVR explant continued to increase, particularly in recent years. Redo TAVR is frequently performed over 5 years from the index TAVR. Future analysis to determine the appropriate TAVR reintervention strategy for individual patients is needed.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"315 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127178","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 : 2025-09-24DOI: 10.1001/jamacardio.2025.3011
Meliksah Arslan,Elizabeth C Fogelson,Jeffrey B Geske
{"title":"Asymptomatic Grade 6 Diastolic Murmur in an Adult.","authors":"Meliksah Arslan,Elizabeth C Fogelson,Jeffrey B Geske","doi":"10.1001/jamacardio.2025.3011","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3011","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"90 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127169","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 : 2025-09-17DOI: 10.1001/jamacardio.2025.3000
Marco J W Götte,Luuk H G A Hopman,Pranav Bhagirath,Michiel J B Kemme,Jules L Nelissen,Katherine Lindborg,Axel J Krafft,Marieke E S Sprengers,Steven A J Chamuleau,Cornelis P Allaart
ImportanceCatheter ablation is a cornerstone therapy for symptomatic ventricular arrhythmias, yet current techniques rely on fluoroscopy and electroanatomic mapping, which provide limited soft-tissue detail and expose patients and staff to ionizing radiation. Real-time magnetic resonance (MR)-guided ablation may overcome these limitations by enabling direct visualization of cardiac anatomy, substrate, and lesion formation, all within a radiation-free environment.ObjectiveTo demonstrate the technical feasibility and safety of the first-in-human real-time MR-guided radiofrequency ventricular ablation procedure.Design, Setting, and ParticipantThis was a prospective, worldwide-first roll-in case from the ongoing VISABL-VT nonrandomized clinical trial assessing MR-guided radiofrequency ablation of ventricular tachycardia. The procedure and analysis were performed in April 2025 at an academic tertiary care center equipped with a standard 1.5-T MR imaging (MRI) suite and dedicated MR-compatible electrophysiology platform, MR-compatible 12-lead electrocardiographic monitoring and recording system, MR-conditional defibrillator, and real-time catheter tracking integrated with the MRI scanner for synchronized imaging and ablation. The patient was a 73-year-old man with symptomatic, drug-refractory outflow tract premature ventricular complexes (PVCs).InterventionThe ablation was performed under general anesthesia inside the MRI scanner. Intraprocedurally acquired noncontrast 3-dimensional MR angiographic imaging was used to create an anatomical roadmap for the procedure. Real-time catheter tracking and activation mapping were performed using actively tracked diagnostic and ablation catheters. Mapping identified earliest activation first in the posterior septal right ventricular outflow tract, where ablation transiently suppressed PVCs. Ectopy recurred but was ultimately resolved by ablation performed via a retrograde aortic approach in the left coronary cusp. Lesion formation was confirmed via postprocedural MRI.Main Outcomes and MeasuresSuppression of PVCs and presence or absence of procedural complications.ResultsThe procedure was performed under real-time MRI guidance without complications. PVCs were completely suppressed, with no recurrence during 30-minute observation or at 2-month follow-up.ConclusionsThis first-in-human case demonstrates that ventricular ablation can be safely and effectively performed entirely under real-time MR guidance. Further evidence from the VISABL-VT trial will clarify clinical utility and long-term outcomes.
导管消融是治疗症状性室性心律失常的基础疗法，但目前的技术依赖于透视和电解剖定位，这只能提供有限的软组织细节，并使患者和工作人员暴露在电离辐射下。实时磁共振（MR）引导消融可以克服这些限制，使心脏解剖、基底和病变形成的直接可视化，所有这些都在无辐射的环境中。目的探讨磁共振实时射频心室消融技术的可行性和安全性。设计、环境和参与者：这是一项正在进行的VISABL-VT非随机临床试验的前瞻性、全球首例入组病例，该试验评估了磁共振引导下射频消融室性心动过速。手术和分析于2025年4月在一个学术三级医疗中心进行，该中心配备了标准的1.5 t MR成像（MRI）套件和专用的MR兼容电生理平台，MR兼容12导联心电图监测和记录系统，MR条件除颤器，以及与MRI扫描仪集成的实时导管跟踪，用于同步成像和消融。患者是一名73岁男性，有症状，药物难治性流出道室性早搏（PVCs）。介入消融在全身麻醉下在MRI扫描仪内进行。术中获得的非对比三维MR血管造影成像用于创建手术的解剖路线图。使用主动跟踪诊断导管和消融导管进行实时导管跟踪和激活定位。制图首先在右室后间隔流出道发现最早的激活，消融短暂地抑制了室性早搏。异位复发，但最终通过左冠状动脉尖逆行主动脉入路消融解决。术后MRI证实病变形成。主要结果和措施：室性早搏抑制及是否存在手术并发症。结果手术在实时MRI引导下完成，无并发症。室性早搏完全抑制，观察30分钟或随访2个月无复发。结论：这是首例人类病例，表明完全在实时MR引导下，心室消融可以安全有效地进行。VISABL-VT试验的进一步证据将阐明临床效用和长期结果。
{"title":"First-in-Human Real-Time MR-Guided Ventricular Ablation for Idiopathic Outflow Tract Premature Ventricular Complexes.","authors":"Marco J W Götte,Luuk H G A Hopman,Pranav Bhagirath,Michiel J B Kemme,Jules L Nelissen,Katherine Lindborg,Axel J Krafft,Marieke E S Sprengers,Steven A J Chamuleau,Cornelis P Allaart","doi":"10.1001/jamacardio.2025.3000","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3000","url":null,"abstract":"ImportanceCatheter ablation is a cornerstone therapy for symptomatic ventricular arrhythmias, yet current techniques rely on fluoroscopy and electroanatomic mapping, which provide limited soft-tissue detail and expose patients and staff to ionizing radiation. Real-time magnetic resonance (MR)-guided ablation may overcome these limitations by enabling direct visualization of cardiac anatomy, substrate, and lesion formation, all within a radiation-free environment.ObjectiveTo demonstrate the technical feasibility and safety of the first-in-human real-time MR-guided radiofrequency ventricular ablation procedure.Design, Setting, and ParticipantThis was a prospective, worldwide-first roll-in case from the ongoing VISABL-VT nonrandomized clinical trial assessing MR-guided radiofrequency ablation of ventricular tachycardia. The procedure and analysis were performed in April 2025 at an academic tertiary care center equipped with a standard 1.5-T MR imaging (MRI) suite and dedicated MR-compatible electrophysiology platform, MR-compatible 12-lead electrocardiographic monitoring and recording system, MR-conditional defibrillator, and real-time catheter tracking integrated with the MRI scanner for synchronized imaging and ablation. The patient was a 73-year-old man with symptomatic, drug-refractory outflow tract premature ventricular complexes (PVCs).InterventionThe ablation was performed under general anesthesia inside the MRI scanner. Intraprocedurally acquired noncontrast 3-dimensional MR angiographic imaging was used to create an anatomical roadmap for the procedure. Real-time catheter tracking and activation mapping were performed using actively tracked diagnostic and ablation catheters. Mapping identified earliest activation first in the posterior septal right ventricular outflow tract, where ablation transiently suppressed PVCs. Ectopy recurred but was ultimately resolved by ablation performed via a retrograde aortic approach in the left coronary cusp. Lesion formation was confirmed via postprocedural MRI.Main Outcomes and MeasuresSuppression of PVCs and presence or absence of procedural complications.ResultsThe procedure was performed under real-time MRI guidance without complications. PVCs were completely suppressed, with no recurrence during 30-minute observation or at 2-month follow-up.ConclusionsThis first-in-human case demonstrates that ventricular ablation can be safely and effectively performed entirely under real-time MR guidance. Further evidence from the VISABL-VT trial will clarify clinical utility and long-term outcomes.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"4658 3 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071734","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}
ImportanceSystemic disease burden is well reflected in the retinal microvasculature, but it is not established whether optical coherence tomography angiography (OCTA) parameters can reliably reflect coronary atherosclerosis.ObjectiveTo assess the association of reduced retinal vascular density and subclinical coronary atherosclerosis in asymptomatic individuals.Design, Setting, and ParticipantsThis cross-sectional cohort study included asymptomatic individuals with elevated cardiovascular risk who self-referred for a health screening program involving coronary computed tomography angiography (CTA) at Asan Medical Center in Seoul, South Korea, and subsequently underwent OCTA as part of ophthalmic evaluations. This study was conducted from October 2015 to December 2020, and data analysis was conducted from January 2021 to May 2025.Main Outcomes and MeasuresThe primary outcome was the association between OCTA parameters and coronary CTA parameters.ResultsA total of 1286 eyes from 1286 participants were analyzed (mean [SD] age, 64.2 [9.9] years; 482 female participants [37.5%]). Coronary artery calcium score (CACS), presence of plaque and its subtypes, obstructive coronary artery disease (CAD), severe CAD, segment stenosis score (SSS), and segment involvement score (SIS) were significantly increased across the quartiles of superficial and deep parafoveal vascular density (PFVD). When modeled as continuous variables, superficial capillary plexus (SCP) and deep capillary plexus (DCP) PFVD were the most significant metrics and correlated with CACS, number of coronary vessels involved, SSS, and SIS. The lowest quartile of SCP PFVD was associated with significantly higher odds of obstructive CAD (adjusted odds ratio [aOR], 2.91; 95% CI, 1.83-4.73), severe CAD (aOR, 3.30; 95% CI, 1.55-7.91), and elevated SSS and SIS scores compared to the highest quartile. Similar but attenuated associations were observed for DCP PFVD. Continuous variable analysis for ORs for unit increase supported a linear inverse association between PFVD and CAD burden. Incorporating PFVD into models with cardiovascular risk factors improved area under the curve (AUC) for identifying severe CAD (AUC, 0.79; 95% CI, 0.75-0.82), obstructive CAD (AUC, 0.78; 95% CI, 0.76-0.81), and SSS of 10 or higher (AUC, 0.77; 95% CI, 0.74-0.80), with SCP yielding superior performance over DCP.Conclusions and RelevanceIn this cross-sectional cohort study, reduced retinal PFVD was independently associated with subclinical coronary atherosclerosis in a population with elevated vascular risk. In this context, decreased PFVD may reflect greater subclinical coronary atherosclerotic burden and help identify individuals who could benefit from further coronary evaluation, beyond traditional risk factors.
{"title":"Subclinical Coronary Atherosclerosis and Retinal Optical Coherence Tomography Angiography.","authors":"Jee Myung Yang,Dong Hyun Yang,Seung-Whan Lee,Jiehoon Kwak,Yunhan Lee,Yoon Jeon Kim,Joo Yong Lee,Kyung Rim Sung,Young Hee Yoon","doi":"10.1001/jamacardio.2025.3036","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3036","url":null,"abstract":"ImportanceSystemic disease burden is well reflected in the retinal microvasculature, but it is not established whether optical coherence tomography angiography (OCTA) parameters can reliably reflect coronary atherosclerosis.ObjectiveTo assess the association of reduced retinal vascular density and subclinical coronary atherosclerosis in asymptomatic individuals.Design, Setting, and ParticipantsThis cross-sectional cohort study included asymptomatic individuals with elevated cardiovascular risk who self-referred for a health screening program involving coronary computed tomography angiography (CTA) at Asan Medical Center in Seoul, South Korea, and subsequently underwent OCTA as part of ophthalmic evaluations. This study was conducted from October 2015 to December 2020, and data analysis was conducted from January 2021 to May 2025.Main Outcomes and MeasuresThe primary outcome was the association between OCTA parameters and coronary CTA parameters.ResultsA total of 1286 eyes from 1286 participants were analyzed (mean [SD] age, 64.2 [9.9] years; 482 female participants [37.5%]). Coronary artery calcium score (CACS), presence of plaque and its subtypes, obstructive coronary artery disease (CAD), severe CAD, segment stenosis score (SSS), and segment involvement score (SIS) were significantly increased across the quartiles of superficial and deep parafoveal vascular density (PFVD). When modeled as continuous variables, superficial capillary plexus (SCP) and deep capillary plexus (DCP) PFVD were the most significant metrics and correlated with CACS, number of coronary vessels involved, SSS, and SIS. The lowest quartile of SCP PFVD was associated with significantly higher odds of obstructive CAD (adjusted odds ratio [aOR], 2.91; 95% CI, 1.83-4.73), severe CAD (aOR, 3.30; 95% CI, 1.55-7.91), and elevated SSS and SIS scores compared to the highest quartile. Similar but attenuated associations were observed for DCP PFVD. Continuous variable analysis for ORs for unit increase supported a linear inverse association between PFVD and CAD burden. Incorporating PFVD into models with cardiovascular risk factors improved area under the curve (AUC) for identifying severe CAD (AUC, 0.79; 95% CI, 0.75-0.82), obstructive CAD (AUC, 0.78; 95% CI, 0.76-0.81), and SSS of 10 or higher (AUC, 0.77; 95% CI, 0.74-0.80), with SCP yielding superior performance over DCP.Conclusions and RelevanceIn this cross-sectional cohort study, reduced retinal PFVD was independently associated with subclinical coronary atherosclerosis in a population with elevated vascular risk. In this context, decreased PFVD may reflect greater subclinical coronary atherosclerotic burden and help identify individuals who could benefit from further coronary evaluation, beyond traditional risk factors.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"83 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071771","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 : 2025-09-17DOI: 10.1001/jamacardio.2025.3043
Alexis Hure,Roseanne Peel,Catherine D'Este,Walter P Abhayaratna,Andrew Tonkin,Ingrid Hopper,Amanda G Thrift,Christopher Levi,Jonathan Sturm,David Durrheim,Joseph Hung,Tom Briffa,Derek P Chew,Shu Ren,Mark McEvoy,Philip Hansbro,David Newby,Stuart Szwec,Simon Chiu,John Attia
ImportanceAnimal studies and meta-analysis of human observational data suggest that pneumococcal polysaccharide vaccination (PPV) could be protective against atherosclerosis; however, to the authors' knowledge, no randomized clinical trial has been conducted.ObjectiveTo determine whether pneumococcal vaccination (Pneumovax [Merck Sharp & Dohme Corp]) decreases the composite primary outcome of fatal and nonfatal acute coronary syndrome and ischemic stroke in people at increased risk, with an average follow-up of 7 years after immunization.Design, Setting, and ParticipantsThis was a double-blind, placebo-controlled, parallel-arm randomized clinical trial conducted at 6 centers across Australia. Participants were community-dwelling adults 55 to 60 years of age at baseline in 2016 to 2017, with at least 2 risk factors (obesity, hypertension, or hypercholesterolemia) for cardiovascular disease (CVD) but no prior CVD event or indication for early pneumococcal vaccination. Data were analyzed from February 2023 to December 2024 using competing risk proportional hazards regression models, stratified by sex and center.InterventionsParticipants received either 23-valent PPV (PPV23) or placebo (saline).Main Outcomes and MeasuresThe primary outcome was a composite of fatal and nonfatal myocardial infarction or ischemic stroke, ascertained via electronic medical records from emergency department, admitted patient, and mortality data collections using International Statistical Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes.ResultsA total of 4725 participants (mean [SD] age, 58.0 [1.7] years; 2433 male [52%]) were included in this study. There was no significant difference in the primary outcome (58 of 2366 events in the active PPV23 group compared with 64 of 2357 events in the control group, hazard ratio, 0.90; 95% CI, 0.63-1.28; P = .57). Similarly, no significant differences occurred in the exploratory outcomes of all-cause mortality, all-cause hospital presentations, and CVD-related hospital procedures. These results are tempered by the lower than expected event rate leading to low power.Conclusions and RelevanceResults of this randomized clinical trial found that PPV23 did not reduce the rates of fatal and nonfatal acute coronary syndrome and ischemic stroke, although the study was underpowered.Trial RegistrationANZCTR Identifier: ACTRN12615000536561.
{"title":"Prevention of Adverse Cardiovascular Events Using the 23-Valent Pneumococcal Polysaccharide Vaccine: A Randomized Clinical Trial.","authors":"Alexis Hure,Roseanne Peel,Catherine D'Este,Walter P Abhayaratna,Andrew Tonkin,Ingrid Hopper,Amanda G Thrift,Christopher Levi,Jonathan Sturm,David Durrheim,Joseph Hung,Tom Briffa,Derek P Chew,Shu Ren,Mark McEvoy,Philip Hansbro,David Newby,Stuart Szwec,Simon Chiu,John Attia","doi":"10.1001/jamacardio.2025.3043","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3043","url":null,"abstract":"ImportanceAnimal studies and meta-analysis of human observational data suggest that pneumococcal polysaccharide vaccination (PPV) could be protective against atherosclerosis; however, to the authors' knowledge, no randomized clinical trial has been conducted.ObjectiveTo determine whether pneumococcal vaccination (Pneumovax [Merck Sharp & Dohme Corp]) decreases the composite primary outcome of fatal and nonfatal acute coronary syndrome and ischemic stroke in people at increased risk, with an average follow-up of 7 years after immunization.Design, Setting, and ParticipantsThis was a double-blind, placebo-controlled, parallel-arm randomized clinical trial conducted at 6 centers across Australia. Participants were community-dwelling adults 55 to 60 years of age at baseline in 2016 to 2017, with at least 2 risk factors (obesity, hypertension, or hypercholesterolemia) for cardiovascular disease (CVD) but no prior CVD event or indication for early pneumococcal vaccination. Data were analyzed from February 2023 to December 2024 using competing risk proportional hazards regression models, stratified by sex and center.InterventionsParticipants received either 23-valent PPV (PPV23) or placebo (saline).Main Outcomes and MeasuresThe primary outcome was a composite of fatal and nonfatal myocardial infarction or ischemic stroke, ascertained via electronic medical records from emergency department, admitted patient, and mortality data collections using International Statistical Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes.ResultsA total of 4725 participants (mean [SD] age, 58.0 [1.7] years; 2433 male [52%]) were included in this study. There was no significant difference in the primary outcome (58 of 2366 events in the active PPV23 group compared with 64 of 2357 events in the control group, hazard ratio, 0.90; 95% CI, 0.63-1.28; P = .57). Similarly, no significant differences occurred in the exploratory outcomes of all-cause mortality, all-cause hospital presentations, and CVD-related hospital procedures. These results are tempered by the lower than expected event rate leading to low power.Conclusions and RelevanceResults of this randomized clinical trial found that PPV23 did not reduce the rates of fatal and nonfatal acute coronary syndrome and ischemic stroke, although the study was underpowered.Trial RegistrationANZCTR Identifier: ACTRN12615000536561.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"64 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071759","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}
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