Pub Date : 2025-02-26DOI: 10.1001/jamacardio.2024.5699
Sarah C Hull, Joseph J Fins
{"title":"Balancing Concerns-AI and Moral Agency in Medicine-Reply.","authors":"Sarah C Hull, Joseph J Fins","doi":"10.1001/jamacardio.2024.5699","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.5699","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501389","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 : 2025-02-26DOI: 10.1001/jamacardio.2024.5696
Somogy Varga, Asbjørn Steglich-Petersen
{"title":"Balancing Concerns-AI and Moral Agency in Medicine.","authors":"Somogy Varga, Asbjørn Steglich-Petersen","doi":"10.1001/jamacardio.2024.5696","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.5696","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501387","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 : 2025-02-19DOI: 10.1001/jamacardio.2024.5670
Caïa Crooijmans, Tijn P J Jansen, Joan G Meeder, Janneke Woudstra, Martijn Meuwissen, Annemiek M J De Vos, Valeria Paradies, Els G M Olde Bijvank, Patty Winkler, Nicola S Vos, Karin Arkenbout, Pier Woudstra, Martin G Stoel, Tim P Van de Hoef, Stijn C H Van den Oord, Jos W M G Widdershoven, Wouter Remkes, Aysun Cetinyurek-Yavuz, Hester M Den Ruijter, N Charlotte Onland-Moret, Eric Boersma, Marcel A M Beijk, Yolande Appelman, Jan J Piek, Regina E Konst, Angela H E M Maas, Niels Van Royen, Aukelien C Dimitriu-Leen, Suzette E Elias-Smale, Peter Damman
Importance: Patients with angina and no obstructive coronary artery disease frequently have coronary vasomotor dysfunction as underlying pathophysiological mechanism, comprising epicardial spasm, microvascular spasm, and/or microcirculatory dysfunction. These endotypes can be diagnosed by invasive coronary function testing which has previously shown to be safe in tertiary and expert centers.
Objective: To determine the prevalence of vasomotor dysfunction in patients with angina and no obstructive coronary artery disease who were clinically referred for a coronary function test (CFT); and assess safety and feasibility of a CFT.
Design, setting, and participants: This quality improvement study was performed using the Netherlands Registry of Invasive Coronary Vasomotor Function Testing (NL-CFT), a prospective, observational registry, in 15 participating hospitals (2 tertiary and 13 nontertiary). Patients with angina and no obstructive coronary artery disease who were referred for a clinically indicated CFT between December 2020 and January 2024 were included.
Main outcomes and measures: A complete CFT consisted of acetylcholine spasm provocation testing and assessment of microcirculatory function. Prevalence of different endotypes based on test results and overall safety were assessed.
Results: Among a total of 1207 patients included, 978 (81%) were female; and the mean (SD) age was 60 (10) years. The prevalence of coronary vasomotor dysfunction was very high (78%). There were 11 (0.9%) major and 10 (0.8%) minor complications reported. Of them, 3 major and all minor were definitely related to the coronary function test. No procedural death, myocardial infarction, or stroke was observed. No differences were found in the occurrence of complications between tertiary and nontertiary centers.
Conclusions and relevance: This study found that a CFT was feasible and safe to perform in both tertiary and nontertiary centers with a high diagnostic yield.
{"title":"Safety, Feasibility, and Diagnostic Yield of Invasive Coronary Function Testing: Netherlands Registry of Invasive Coronary Vasomotor Function Testing.","authors":"Caïa Crooijmans, Tijn P J Jansen, Joan G Meeder, Janneke Woudstra, Martijn Meuwissen, Annemiek M J De Vos, Valeria Paradies, Els G M Olde Bijvank, Patty Winkler, Nicola S Vos, Karin Arkenbout, Pier Woudstra, Martin G Stoel, Tim P Van de Hoef, Stijn C H Van den Oord, Jos W M G Widdershoven, Wouter Remkes, Aysun Cetinyurek-Yavuz, Hester M Den Ruijter, N Charlotte Onland-Moret, Eric Boersma, Marcel A M Beijk, Yolande Appelman, Jan J Piek, Regina E Konst, Angela H E M Maas, Niels Van Royen, Aukelien C Dimitriu-Leen, Suzette E Elias-Smale, Peter Damman","doi":"10.1001/jamacardio.2024.5670","DOIUrl":"10.1001/jamacardio.2024.5670","url":null,"abstract":"<p><strong>Importance: </strong>Patients with angina and no obstructive coronary artery disease frequently have coronary vasomotor dysfunction as underlying pathophysiological mechanism, comprising epicardial spasm, microvascular spasm, and/or microcirculatory dysfunction. These endotypes can be diagnosed by invasive coronary function testing which has previously shown to be safe in tertiary and expert centers.</p><p><strong>Objective: </strong>To determine the prevalence of vasomotor dysfunction in patients with angina and no obstructive coronary artery disease who were clinically referred for a coronary function test (CFT); and assess safety and feasibility of a CFT.</p><p><strong>Design, setting, and participants: </strong>This quality improvement study was performed using the Netherlands Registry of Invasive Coronary Vasomotor Function Testing (NL-CFT), a prospective, observational registry, in 15 participating hospitals (2 tertiary and 13 nontertiary). Patients with angina and no obstructive coronary artery disease who were referred for a clinically indicated CFT between December 2020 and January 2024 were included.</p><p><strong>Main outcomes and measures: </strong>A complete CFT consisted of acetylcholine spasm provocation testing and assessment of microcirculatory function. Prevalence of different endotypes based on test results and overall safety were assessed.</p><p><strong>Results: </strong>Among a total of 1207 patients included, 978 (81%) were female; and the mean (SD) age was 60 (10) years. The prevalence of coronary vasomotor dysfunction was very high (78%). There were 11 (0.9%) major and 10 (0.8%) minor complications reported. Of them, 3 major and all minor were definitely related to the coronary function test. No procedural death, myocardial infarction, or stroke was observed. No differences were found in the occurrence of complications between tertiary and nontertiary centers.</p><p><strong>Conclusions and relevance: </strong>This study found that a CFT was feasible and safe to perform in both tertiary and nontertiary centers with a high diagnostic yield.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1001/jamacardio.2024.5667
Najah Ali Khan
{"title":"Donning the Hijab-A Cardiology Fellow's Journey With Advocacy and Inclusion.","authors":"Najah Ali Khan","doi":"10.1001/jamacardio.2024.5667","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.5667","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449115","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 : 2025-02-19DOI: 10.1001/jamacardio.2024.5593
Soongu Kwak, Anvesha Singh, Russell J. Everett, Thomas A. Treibel, Jaehyun Lim, Sungho Won, Michelle C. Williams, Krithika Loganathan, Rong Bing, Neil Craig, Trisha Singh, Shruti Joshi, Heesun Lee, Whal Lee, Yong-Jin Kim, Calvin W. L. Chin, Miho Fukui, Tarique Al Musa, Marzia Rigolli, Lionel Tastet, Laura E. Dobson, Stephanie Wiesemann, Vanessa M. Ferreira, Gabriella Captur, Sahmin Lee, Jeanette Schulz-Menger, Erik B. Schelbert, Marie-Annick Clavel, Sung-Ji Park, Costanza Pellegrini, Martin Hadamitzky, Bernhard L. Gerber, David E. Newby, Saul G. Myerson, Phillipe Pibarot, João L. Cavalcante, Gerry P. McCann, John P. Greenwood, James C. Moon, Marc R. Dweck, Seung-Pyo Lee
ImportanceMyocardial fibrosis in aortic stenosis (AS) may exhibit sex differences. However, its prognostic significance in women with AS remains unclear.ObjectiveTo investigate sex differences in myocardial fibrosis assessed by cardiovascular magnetic resonance (CMR) and evaluate its prognostic value in women and men with AS.Design, Setting, and ParticipantsPatients with severe AS who underwent CMR before aortic valve replacement (AVR) were prospectively enrolled from 13 international sites between March 2011 and September 2021. Myocardial fibrosis was evaluated using extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). The main analysis was conducted on patients without obstructive coronary artery disease (CAD), defined as those with no history of myocardial infarction and no concomitant coronary artery bypass grafting. Data were analyzed from December 2023 to February 2024.ExposuresSurgical or transcatheter AVR.Main Outcomes and MeasuresThe primary outcome was post–AVR all-cause mortality and the secondary outcome was cardiovascular mortality.ResultsOf 822 patients, 670 were without obstructive CAD (368 men [55%] and 302 women [45%]). Among these, women and men had a similar age (median, 72 years vs 71 years, respectively), comorbidities, and AS severity. ECV% was similar between sexes; however, women had less LGE (both infarct and noninfarct LGE). After a median follow-up of 3.7 (IQR, 2.1-4.7) years, there were 76 deaths (11.3%), including 29 adjudicated cardiovascular deaths, in patients without obstructive CAD. Increasing ECV% and LGE were associated with higher all-cause and cardiovascular mortality in both sexes. Cox analyses demonstrated that both ECV% and LGE were associated with higher all-cause mortality without significant interaction by sex (women: adjusted hazard ratio [HR], 1.08 per 1% ECV% increase; 95% CI, 1.04-1.12; P &lt; .001; men: adjusted HR, 1.01; 95% CI, 0.96-1.06; P = .66; P for interaction by sex = .09 and women: adjusted HR, 2.49 for the presence of LGE; 95% CI, 1.07-5.80; P = .03; men: adjusted HR, 1.82; 95% CI, 1.00-3.32; P = .04; P for interaction by sex = .68). In the entire population (n = 822), both noninfarct and infarct-related LGE were associated with increased mortality without significant interaction by sex.Conclusions and RelevanceIn this study, patients with severe AS who underwent AVR exhibited similar ECV% between sexes, while women had lower LGE. Increased myocardial fibrosis provided important prognostic value for both sexes.
{"title":"Sex-Specific Association of Myocardial Fibrosis With Mortality in Patients With Aortic Stenosis","authors":"Soongu Kwak, Anvesha Singh, Russell J. Everett, Thomas A. Treibel, Jaehyun Lim, Sungho Won, Michelle C. Williams, Krithika Loganathan, Rong Bing, Neil Craig, Trisha Singh, Shruti Joshi, Heesun Lee, Whal Lee, Yong-Jin Kim, Calvin W. L. Chin, Miho Fukui, Tarique Al Musa, Marzia Rigolli, Lionel Tastet, Laura E. Dobson, Stephanie Wiesemann, Vanessa M. Ferreira, Gabriella Captur, Sahmin Lee, Jeanette Schulz-Menger, Erik B. Schelbert, Marie-Annick Clavel, Sung-Ji Park, Costanza Pellegrini, Martin Hadamitzky, Bernhard L. Gerber, David E. Newby, Saul G. Myerson, Phillipe Pibarot, João L. Cavalcante, Gerry P. McCann, John P. Greenwood, James C. Moon, Marc R. Dweck, Seung-Pyo Lee","doi":"10.1001/jamacardio.2024.5593","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.5593","url":null,"abstract":"ImportanceMyocardial fibrosis in aortic stenosis (AS) may exhibit sex differences. However, its prognostic significance in women with AS remains unclear.ObjectiveTo investigate sex differences in myocardial fibrosis assessed by cardiovascular magnetic resonance (CMR) and evaluate its prognostic value in women and men with AS.Design, Setting, and ParticipantsPatients with severe AS who underwent CMR before aortic valve replacement (AVR) were prospectively enrolled from 13 international sites between March 2011 and September 2021. Myocardial fibrosis was evaluated using extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). The main analysis was conducted on patients without obstructive coronary artery disease (CAD), defined as those with no history of myocardial infarction and no concomitant coronary artery bypass grafting. Data were analyzed from December 2023 to February 2024.ExposuresSurgical or transcatheter AVR.Main Outcomes and MeasuresThe primary outcome was post–AVR all-cause mortality and the secondary outcome was cardiovascular mortality.ResultsOf 822 patients, 670 were without obstructive CAD (368 men [55%] and 302 women [45%]). Among these, women and men had a similar age (median, 72 years vs 71 years, respectively), comorbidities, and AS severity. ECV% was similar between sexes; however, women had less LGE (both infarct and noninfarct LGE). After a median follow-up of 3.7 (IQR, 2.1-4.7) years, there were 76 deaths (11.3%), including 29 adjudicated cardiovascular deaths, in patients without obstructive CAD. Increasing ECV% and LGE were associated with higher all-cause and cardiovascular mortality in both sexes. Cox analyses demonstrated that both ECV% and LGE were associated with higher all-cause mortality without significant interaction by sex (women: adjusted hazard ratio [HR], 1.08 per 1% ECV% increase; 95% CI, 1.04-1.12; <jats:italic>P</jats:italic> &amp;lt; .001; men: adjusted HR, 1.01; 95% CI, 0.96-1.06; <jats:italic>P</jats:italic> = .66; <jats:italic>P</jats:italic> for interaction by sex = .09 and women: adjusted HR, 2.49 for the presence of LGE; 95% CI, 1.07-5.80; <jats:italic>P</jats:italic> = .03; men: adjusted HR, 1.82; 95% CI, 1.00-3.32; <jats:italic>P</jats:italic> = .04; <jats:italic>P</jats:italic> for interaction by sex = .68). In the entire population (n = 822), both noninfarct and infarct-related LGE were associated with increased mortality without significant interaction by sex.Conclusions and RelevanceIn this study, patients with severe AS who underwent AVR exhibited similar ECV% between sexes, while women had lower LGE. Increased myocardial fibrosis provided important prognostic value for both sexes.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"2 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444017","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 : 2025-02-12DOI: 10.1001/jamacardio.2024.5537
Muhammad Shahzeb Khan, Adeena Jamil, Muteia Shakoor, Stephen J Greene, Gregg C Fonarow, Deepak L Bhatt, J Michael DiMaio, Michael J Mack, Javed Butler
{"title":"Patient Enrollment for Cardiovascular Clinical Trials in the United States.","authors":"Muhammad Shahzeb Khan, Adeena Jamil, Muteia Shakoor, Stephen J Greene, Gregg C Fonarow, Deepak L Bhatt, J Michael DiMaio, Michael J Mack, Javed Butler","doi":"10.1001/jamacardio.2024.5537","DOIUrl":"10.1001/jamacardio.2024.5537","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-12DOI: 10.1001/jamacardio.2024.5648
Brian R. Lindman, Eugene Braunwald, Patricia A. Pellikka
This Viewpoint advocates for prompt aortic valve replacement (rather than clinical surveillance) as the default strategy for patients with asymptomatic severe aortic stenosis.
{"title":"Aortic Valve Replacement for Asymptomatic Severe Aortic Stenosis—The Time Has Come","authors":"Brian R. Lindman, Eugene Braunwald, Patricia A. Pellikka","doi":"10.1001/jamacardio.2024.5648","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.5648","url":null,"abstract":"This Viewpoint advocates for prompt aortic valve replacement (rather than clinical surveillance) as the default strategy for patients with asymptomatic severe aortic stenosis.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"55 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143393113","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