Pub Date : 2025-12-10DOI: 10.1001/jamacardio.2025.4456
Michael Johannes Schindler,Julia Schoenfeld,Amelie Trommler,Bernhard Haller,David Christopher Nieman,Martin Halle,Johannes Scherr
ImportanceThe effects of long-term repetitive and strenuous exercise loads on the right ventricle and plasma troponin levels are unclear.ObjectiveTo investigate the marathon-induced increase in troponin T and its association with right ventricular remodeling after 10 years of repetitive bouts of strenuous exercise.Design, Setting, and ParticipantsThis was a longitudinal, observational cohort study (the Prospective Follow-Up, Marathon, Long-Term, Inflammation, Cardiovascular System [Pro-MagIC] study) conducted from August to December 2019. Participants were male marathon runners recruited from a single center in Germany.ExposuresRepetitive strenuous exercise training and endurance competitions for 10 years.Main Outcomes and MeasuresCardiac biomarkers and 3-dimensional echocardiography were assessed prerace, immediately, on days 1 and 3 postrace, and at 10-year follow-up.ResultsA total of 152 male runners (mean [SD] age, 43 [3] years) were included in this analysis. Right ventricular ejection fraction declined significantly from the prerace (median, 52.4%; IQR, 50.0%-55.1%) to immediate postrace (median, 47.6%; IQR, 44.7%-51.5%; P < .001) assessment and 1-day postrace (median, 50.7%; IQR, 48.4%-53.0%; P = .001) but recovered at 3-day postrace (median, 51.3%; IQR, 50.4%-53.0%; P = .18); it also recovered to the prerace level even at the 10-year follow-up (median, 51.9%; IQR, 49.6%-54.5%; P = .15). Left ventricular ejection fraction decreased (median, 59.6%; IQR, 55.6%-64.5% to median, 57.6%; IQR, 54.1%-61.6%; P < .001), whereas lateral E/e' ratio, as an index of left ventricular filling pressure, increased (median, 5.1; IQR, 4.3-6.1 to median, 5.4; IQR, 4.5-6.4; P < .001) at the 10-year follow-up. No association of exercise-induced troponin T increase after the marathon with right and left ventricular ejection fraction changes at the 10-year follow-up was detected (Pearson r = -0.10, P = .35 and Pearson r = -0.09, P = .35, respectively).Conclusions and RelevanceResults showed that marathon-induced acute troponin T increase was not associated with right ventricular ejection fraction after 10 years of endurance training and competition. Left ventricular ejection fraction and left ventricular diastolic function changed significantly; however, the values remained within normal limits. These data suggest that repetitive strenuous exercise training and endurance competitions did not induce long-term deterioration of right ventricular function in most recreational male endurance athletes.
长期重复性和剧烈运动负荷对右心室和血浆肌钙蛋白水平的影响尚不清楚。目的探讨10年反复剧烈运动后马拉松诱导的肌钙蛋白T升高及其与右室重构的关系。设计、环境和参与者这是一项纵向、观察性队列研究（前瞻性随访、马拉松、长期、炎症、心血管系统[Pro-MagIC]研究），于2019年8月至12月进行。参与者是从德国的一个中心招募的男性马拉松运动员。10年反复剧烈运动训练和耐力比赛。主要结果和测量心脏生物标志物和三维超声心动图在术前、立即、术后1天和3天以及10年随访时进行评估。结果共纳入152例男性跑步者，平均[SD]年龄43岁。右心室射血分数从术前（中位数，52.4%；IQR, 50.0%-55.1%）到术后立即(中位数，47.6%；IQR, 44.7%-51.5%; P <。001)评估和术后1天(中位数，50.7%；IQR, 48.4%-53.0%; P =。001)，但在3天后恢复（中位数，51.3%；IQR, 50.4%-53.0%; P = 0.18）；即使在10年随访中也恢复到术前水平（中位数为51.9%；IQR为49.6%-54.5%;P = 0.15）。左室射血分数下降(中位数，59.6%；IQR, 55.6%-64.5%；中位数，57.6%；IQR, 54.1%-61.6%; P <。而作为左心室充盈压力指标的侧位E/ E′比值（中位数，5.1；IQR, 4.3-6.1）增加（中位数，5.4；IQR, 4.5-6.4; P < 0.001）。001)。在10年随访中，未发现马拉松后运动诱导的肌钙蛋白T升高与左右心室射血分数变化之间的关联(Pearson r = -0.10, P =。皮尔森r = -0.09, P =。分别为35)。结论和相关性结果显示，马拉松引起的急性肌钙蛋白T升高与10年耐力训练和比赛后的右心室射血分数无关。左室射血分数和左室舒张功能明显改变；然而，这些数值仍在正常范围内。这些数据表明，在大多数娱乐性男性耐力运动员中，重复的剧烈运动训练和耐力比赛不会引起右心室功能的长期恶化。
{"title":"Long-Term Changes in Ventricular Function in Recreational Marathon Runners.","authors":"Michael Johannes Schindler,Julia Schoenfeld,Amelie Trommler,Bernhard Haller,David Christopher Nieman,Martin Halle,Johannes Scherr","doi":"10.1001/jamacardio.2025.4456","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4456","url":null,"abstract":"ImportanceThe effects of long-term repetitive and strenuous exercise loads on the right ventricle and plasma troponin levels are unclear.ObjectiveTo investigate the marathon-induced increase in troponin T and its association with right ventricular remodeling after 10 years of repetitive bouts of strenuous exercise.Design, Setting, and ParticipantsThis was a longitudinal, observational cohort study (the Prospective Follow-Up, Marathon, Long-Term, Inflammation, Cardiovascular System [Pro-MagIC] study) conducted from August to December 2019. Participants were male marathon runners recruited from a single center in Germany.ExposuresRepetitive strenuous exercise training and endurance competitions for 10 years.Main Outcomes and MeasuresCardiac biomarkers and 3-dimensional echocardiography were assessed prerace, immediately, on days 1 and 3 postrace, and at 10-year follow-up.ResultsA total of 152 male runners (mean [SD] age, 43 [3] years) were included in this analysis. Right ventricular ejection fraction declined significantly from the prerace (median, 52.4%; IQR, 50.0%-55.1%) to immediate postrace (median, 47.6%; IQR, 44.7%-51.5%; P < .001) assessment and 1-day postrace (median, 50.7%; IQR, 48.4%-53.0%; P = .001) but recovered at 3-day postrace (median, 51.3%; IQR, 50.4%-53.0%; P = .18); it also recovered to the prerace level even at the 10-year follow-up (median, 51.9%; IQR, 49.6%-54.5%; P = .15). Left ventricular ejection fraction decreased (median, 59.6%; IQR, 55.6%-64.5% to median, 57.6%; IQR, 54.1%-61.6%; P < .001), whereas lateral E/e' ratio, as an index of left ventricular filling pressure, increased (median, 5.1; IQR, 4.3-6.1 to median, 5.4; IQR, 4.5-6.4; P < .001) at the 10-year follow-up. No association of exercise-induced troponin T increase after the marathon with right and left ventricular ejection fraction changes at the 10-year follow-up was detected (Pearson r = -0.10, P = .35 and Pearson r = -0.09, P = .35, respectively).Conclusions and RelevanceResults showed that marathon-induced acute troponin T increase was not associated with right ventricular ejection fraction after 10 years of endurance training and competition. Left ventricular ejection fraction and left ventricular diastolic function changed significantly; however, the values remained within normal limits. These data suggest that repetitive strenuous exercise training and endurance competitions did not induce long-term deterioration of right ventricular function in most recreational male endurance athletes.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"78 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145711089","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 : 2025-12-10DOI: 10.1001/jamacardio.2025.4442
Jonathan W Waks,Marie-France Poulin,John-Ross D Clarke,Duane S Pinto,Andre d'Avila,Patricia Tung,Beatie Ultimo,Kimberly A Guibone,Katherine Kiernan,Alexandra Medline,Alice Haouzi,Bharath Rathakrishnan,Omar Abdel-Razek,Roger J Laham,Alfred E Buxton
ImportanceTranscatheter aortic valve replacement (TAVR) to treat aortic stenosis is complicated by heart block requiring permanent pacemaker implantation in at least 10% of cases.ObjectivesTo better understand mechanisms underlying heart block complicating TAVR and improve prediction of intraprocedural and delayed heart block.Design, Setting, and ParticipantsThis cohort study was conducted at a single academic medical center in Boston, Massachusetts, from May 2021 to January 2024 among all patients undergoing TAVR, except those with preexisting pacemakers. A total of 409 consecutive patients undergoing TAVR were prospectively studied. An electrophysiologic study was performed at the beginning and end of the TAVR procedure. An electrophysiologist monitored the electrocardiogram (ECG) and His bundle recording continuously during the procedure. Patients were followed up for 1 year. Occurrence of high-grade atrioventricular (AV) block was related to ECG and electrophysiological, anatomic, and procedural variables. Data analysis was performed from March 2023 to May 2025.ExposuresAn electrophysiologist monitored the ECG and intracardiac electrograms continuously during the valve implant; patients with preexisting right bundle-branch block (RBBB) or periprocedural conduction abnormalities were discharged with an ECG monitor.Main Outcome and MeasuresThe primary outcome was Mobitz type II or complete heart block.ResultsA total of 409 consecutive patients were enrolled, among whom median (IQR) age was 78.5 (73.1-83.5) years and 182 patients (44.5%) were female. Forty patients (9.7%) developed heart block requiring permanent pacemakers: block developed during the TAVR procedure in 15 patients and after TAVR in 25. Block was persistent in all patients developing block during the TAVR but paroxysmal in 20 of 25 patients with post-TAVR block. Block localized to the AV node during TAVR in 6 cases (all resolved) and in 3 patients (7.5%) with delayed block. In the remaining 9 patients that developed intraprocedural block and 22 patients developing postprocedural block, the block was infranodal. Preexisting RBBB was the only ECG or electrophysiological predictor for intraprocedural block, but preexisting RBBB did not predict postprocedural block. The best predictors of delayed heart block were His-ventricular interval of 80 milliseconds or longer at the end of the implant procedure, PR interval longer than 300 milliseconds, and AV Wenckebach cycle length of 500 milliseconds or longer post-TAVR.Conclusions and RelevanceIn this cohort study, the characteristics and mechanisms causing AV block during TAVR differed from delayed block. Both AV nodal and infranodal block contributed to heart block accompanying TAVR procedures.
{"title":"Mechanisms Underlying Alterations in Cardiac Conduction After Transcatheter Aortic Valve Replacement.","authors":"Jonathan W Waks,Marie-France Poulin,John-Ross D Clarke,Duane S Pinto,Andre d'Avila,Patricia Tung,Beatie Ultimo,Kimberly A Guibone,Katherine Kiernan,Alexandra Medline,Alice Haouzi,Bharath Rathakrishnan,Omar Abdel-Razek,Roger J Laham,Alfred E Buxton","doi":"10.1001/jamacardio.2025.4442","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4442","url":null,"abstract":"ImportanceTranscatheter aortic valve replacement (TAVR) to treat aortic stenosis is complicated by heart block requiring permanent pacemaker implantation in at least 10% of cases.ObjectivesTo better understand mechanisms underlying heart block complicating TAVR and improve prediction of intraprocedural and delayed heart block.Design, Setting, and ParticipantsThis cohort study was conducted at a single academic medical center in Boston, Massachusetts, from May 2021 to January 2024 among all patients undergoing TAVR, except those with preexisting pacemakers. A total of 409 consecutive patients undergoing TAVR were prospectively studied. An electrophysiologic study was performed at the beginning and end of the TAVR procedure. An electrophysiologist monitored the electrocardiogram (ECG) and His bundle recording continuously during the procedure. Patients were followed up for 1 year. Occurrence of high-grade atrioventricular (AV) block was related to ECG and electrophysiological, anatomic, and procedural variables. Data analysis was performed from March 2023 to May 2025.ExposuresAn electrophysiologist monitored the ECG and intracardiac electrograms continuously during the valve implant; patients with preexisting right bundle-branch block (RBBB) or periprocedural conduction abnormalities were discharged with an ECG monitor.Main Outcome and MeasuresThe primary outcome was Mobitz type II or complete heart block.ResultsA total of 409 consecutive patients were enrolled, among whom median (IQR) age was 78.5 (73.1-83.5) years and 182 patients (44.5%) were female. Forty patients (9.7%) developed heart block requiring permanent pacemakers: block developed during the TAVR procedure in 15 patients and after TAVR in 25. Block was persistent in all patients developing block during the TAVR but paroxysmal in 20 of 25 patients with post-TAVR block. Block localized to the AV node during TAVR in 6 cases (all resolved) and in 3 patients (7.5%) with delayed block. In the remaining 9 patients that developed intraprocedural block and 22 patients developing postprocedural block, the block was infranodal. Preexisting RBBB was the only ECG or electrophysiological predictor for intraprocedural block, but preexisting RBBB did not predict postprocedural block. The best predictors of delayed heart block were His-ventricular interval of 80 milliseconds or longer at the end of the implant procedure, PR interval longer than 300 milliseconds, and AV Wenckebach cycle length of 500 milliseconds or longer post-TAVR.Conclusions and RelevanceIn this cohort study, the characteristics and mechanisms causing AV block during TAVR differed from delayed block. Both AV nodal and infranodal block contributed to heart block accompanying TAVR procedures.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"18 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145711109","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 : 2025-12-10DOI: 10.1001/jamacardio.2025.4453
Harpreet S Bhatia,Anurag Mehta
{"title":"Lipoprotein(a) Elevation for Refining Risk Stratification With the PREVENT Equations-Reply.","authors":"Harpreet S Bhatia,Anurag Mehta","doi":"10.1001/jamacardio.2025.4453","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4453","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"26 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145711108","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 : 2025-12-10DOI: 10.1001/jamacardio.2025.4491
Paul M Ridker,Florian M M Baeres,Anders Hveplund,Mads M D Engelmann,G Kees Hovingh,A Michael Lincoff,Nikolaus Marx,Ann Marie Navar,Naveed Sattar,Katherine Tuttle,Vlado Perkovic
ImportanceCardiovascular inflammation is a major determinant of atherosclerotic disease, and inhibition of the central signaling cytokine, interleukin 6 (IL-6), is a promising target for intervention. Patients with chronic kidney disease (CKD) commonly have plasma elevations of inflammatory biomarkers, such as high-sensitivity C-reactive protein (hsCRP) and IL-6, and are at high risk for life-threatening atherosclerotic events as well as loss of kidney function and might therefore benefit from IL-6 inhibition.ObservationsThe Ziltivekimab Cardiovascular Outcomes Trial (ZEUS; NCT05021835) will determine the safety and efficacy of IL-6 inhibition with ziltivekimab among patients with atherosclerotic cardiovascular disease (ASCVD), CKD, and systemic inflammation. ZEUS is a multinational, double-blind, placebo-controlled, event-driven, randomized clinical trial inclusive of 6376 participants with ASCVD, CKD, and an hsCRP level greater than or equal to 2 mg/L who were randomized in a 1:1 fashion to receive either ziltivekimab, 15 mg, administered subcutaneously every month or matching placebo. At randomization, mean age was 69.5 years, 27.5% were female, 92.0% had hypertension, 65.7% had diabetes, and 41.3% had heart failure. At baseline, the mean estimated glomerular filtration rate (eGFR) was 44.5 mL/min/1.73 m2, mean low-density lipoprotein cholesterol level was 77.7 mg/dL, median hsCRP level was 4.5 mg/L, and median IL-6 level was 4.9 pg/mL. At enrollment, sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists were being used by 36.8% and 11.3% of the cohort, respectively. The primary outcome is 3-point major adverse cardiovascular events. Secondary cardiovascular outcomes include (1) an expanded major adverse cardiovascular event outcome including hospitalization for unstable angina requiring urgent coronary revascularization, (2) hospitalizations for heart failure or urgent heart failure visits or cardiovascular death, and (3) all-cause mortality. The secondary kidney outcome is a composite of greater than 40% decline in eGFR, eGFR less than 15 mL/min/1.73 m2, dialysis, kidney transplant, death from kidney disease, or cardiovascular death.Conclusions and RelevanceThe ZEUS randomized clinical trial will formally test the hypothesis that IL-6 inhibition with ziltivekimab will lower incident cardiovascular event rates and potentially slow kidney decline among participants with known ASCVD, CKD, and elevated hsCRP. If successful, the ZEUS trial would provide a fully novel approach for prevention of myocardial infarction, stroke, cardiovascular death, and kidney function decline among high-risk patients with CKD.
{"title":"Rationale, Design, and Baseline Clinical Characteristics of the Ziltivekimab Cardiovascular Outcomes Trial: Interleukin-6 Inhibition and Atherosclerotic Event Rate Reduction.","authors":"Paul M Ridker,Florian M M Baeres,Anders Hveplund,Mads M D Engelmann,G Kees Hovingh,A Michael Lincoff,Nikolaus Marx,Ann Marie Navar,Naveed Sattar,Katherine Tuttle,Vlado Perkovic","doi":"10.1001/jamacardio.2025.4491","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4491","url":null,"abstract":"ImportanceCardiovascular inflammation is a major determinant of atherosclerotic disease, and inhibition of the central signaling cytokine, interleukin 6 (IL-6), is a promising target for intervention. Patients with chronic kidney disease (CKD) commonly have plasma elevations of inflammatory biomarkers, such as high-sensitivity C-reactive protein (hsCRP) and IL-6, and are at high risk for life-threatening atherosclerotic events as well as loss of kidney function and might therefore benefit from IL-6 inhibition.ObservationsThe Ziltivekimab Cardiovascular Outcomes Trial (ZEUS; NCT05021835) will determine the safety and efficacy of IL-6 inhibition with ziltivekimab among patients with atherosclerotic cardiovascular disease (ASCVD), CKD, and systemic inflammation. ZEUS is a multinational, double-blind, placebo-controlled, event-driven, randomized clinical trial inclusive of 6376 participants with ASCVD, CKD, and an hsCRP level greater than or equal to 2 mg/L who were randomized in a 1:1 fashion to receive either ziltivekimab, 15 mg, administered subcutaneously every month or matching placebo. At randomization, mean age was 69.5 years, 27.5% were female, 92.0% had hypertension, 65.7% had diabetes, and 41.3% had heart failure. At baseline, the mean estimated glomerular filtration rate (eGFR) was 44.5 mL/min/1.73 m2, mean low-density lipoprotein cholesterol level was 77.7 mg/dL, median hsCRP level was 4.5 mg/L, and median IL-6 level was 4.9 pg/mL. At enrollment, sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists were being used by 36.8% and 11.3% of the cohort, respectively. The primary outcome is 3-point major adverse cardiovascular events. Secondary cardiovascular outcomes include (1) an expanded major adverse cardiovascular event outcome including hospitalization for unstable angina requiring urgent coronary revascularization, (2) hospitalizations for heart failure or urgent heart failure visits or cardiovascular death, and (3) all-cause mortality. The secondary kidney outcome is a composite of greater than 40% decline in eGFR, eGFR less than 15 mL/min/1.73 m2, dialysis, kidney transplant, death from kidney disease, or cardiovascular death.Conclusions and RelevanceThe ZEUS randomized clinical trial will formally test the hypothesis that IL-6 inhibition with ziltivekimab will lower incident cardiovascular event rates and potentially slow kidney decline among participants with known ASCVD, CKD, and elevated hsCRP. If successful, the ZEUS trial would provide a fully novel approach for prevention of myocardial infarction, stroke, cardiovascular death, and kidney function decline among high-risk patients with CKD.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"1 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710956","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}
Importance For patients presenting with symptomatic prosthetic valve thrombosis (PVT) after mechanical heart valve replacement, thrombolytic therapy with alteplase is accepted as a first-line therapeutic alternative. The utility of tenecteplase compared with conventional regimens remains unstudied, to the authors’ knowledge, in this patient population. Objective To assess the relative safety and efficacy of tenecteplase compared with standard infusions of alteplase in patients with PVT. Design, Setting and Participants This was an open-label, parallel-group, non-inferiority randomized clinical trial among consecutive adult patients presenting with obstructive PVT of a mechanical prosthetic valve over the study period from October 2022 to August 2024 to a single tertiary care center in India. Interventions Patients received thrombolytic therapy with a low-dose slow infusion alteplase or weight-based bolus doses of tenecteplase. Main Outcomes and Measures The primary outcomes were to determine the rates of complete thrombolytic success and the incidence of major complications. Results A total of 83 patients (mean [SD] age, 39.6 [12.4] years, 42 male [50.6%]) were randomized to receive alteplase (n = 43) or tenecteplase (n = 40). The rates of the primary efficacy end point (complete thrombolytic success) were significantly higher (risk ratio, 1.18; 95% CI, 1.03-1.39; P = .02 for noninferiority) in the tenecteplase group (39 patients [97.5%]) compared with the alteplase group (35 patients [81.5%]). Additionally, patients treated with tenecteplase had higher rates of complete success with the first administered dose and a shorter duration of hospital stay (median [IQR], 4.1 [3.2-5.1] days vs 6.5 [4.3-9.2] days; P &lt; .001). The rates of major and minor adverse events were similar. Conclusions and Relevance Tenecteplase may be a safe and effective alternative to alteplase in patients presenting with obstructive PVT. Patients treated with tenecteplase in our study had higher rates of complete thrombolytic success and a shorter duration of hospital stay. Furthermore, the relative ease of drug administration with tenecteplase may translate to greater clinical benefit in a real-world setting. Trial Registration Clinical Trials Registry of India: CTRI/2022/10/046127
{"title":"Tenecteplase vs Alteplase in Mechanical Prosthetic Heart Valve Thrombosis","authors":"Gautam Sharma, Krishna Prasad Akkineni, Nayani Makkar, Asmita Shukla, Partha Haldar, Devagourou Velayoudam, Kamal Kamal, Sanjeev Kumar, Nitish Naik, Ambuj Roy, Sandeep Singh, Sandeep Seth, Rohit Bhatia","doi":"10.1001/jamacardio.2025.4369","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4369","url":null,"abstract":"Importance For patients presenting with symptomatic prosthetic valve thrombosis (PVT) after mechanical heart valve replacement, thrombolytic therapy with alteplase is accepted as a first-line therapeutic alternative. The utility of tenecteplase compared with conventional regimens remains unstudied, to the authors’ knowledge, in this patient population. Objective To assess the relative safety and efficacy of tenecteplase compared with standard infusions of alteplase in patients with PVT. Design, Setting and Participants This was an open-label, parallel-group, non-inferiority randomized clinical trial among consecutive adult patients presenting with obstructive PVT of a mechanical prosthetic valve over the study period from October 2022 to August 2024 to a single tertiary care center in India. Interventions Patients received thrombolytic therapy with a low-dose slow infusion alteplase or weight-based bolus doses of tenecteplase. Main Outcomes and Measures The primary outcomes were to determine the rates of complete thrombolytic success and the incidence of major complications. Results A total of 83 patients (mean [SD] age, 39.6 [12.4] years, 42 male [50.6%]) were randomized to receive alteplase (n = 43) or tenecteplase (n = 40). The rates of the primary efficacy end point (complete thrombolytic success) were significantly higher (risk ratio, 1.18; 95% CI, 1.03-1.39; <jats:italic>P</jats:italic> = .02 for noninferiority) in the tenecteplase group (39 patients [97.5%]) compared with the alteplase group (35 patients [81.5%]). Additionally, patients treated with tenecteplase had higher rates of complete success with the first administered dose and a shorter duration of hospital stay (median [IQR], 4.1 [3.2-5.1] days vs 6.5 [4.3-9.2] days; <jats:italic>P</jats:italic> &amp;lt; .001). The rates of major and minor adverse events were similar. Conclusions and Relevance Tenecteplase may be a safe and effective alternative to alteplase in patients presenting with obstructive PVT. Patients treated with tenecteplase in our study had higher rates of complete thrombolytic success and a shorter duration of hospital stay. Furthermore, the relative ease of drug administration with tenecteplase may translate to greater clinical benefit in a real-world setting. Trial Registration Clinical Trials Registry of India: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NzMzMDU=&amp;amp;Enc=&amp;amp;userName=CTRI/2022/10/046127\">CTRI/2022/10/046127</jats:ext-link>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"1 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658247","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 : 2025-12-01DOI: 10.1001/jamacardio.2025.3939
Sanjay Rajagopalan, Robert D Brook, Salil Deo
{"title":"Heart Failure and Nonoptimal Temperatures.","authors":"Sanjay Rajagopalan, Robert D Brook, Salil Deo","doi":"10.1001/jamacardio.2025.3939","DOIUrl":"10.1001/jamacardio.2025.3939","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"1237-1239"},"PeriodicalIF":14.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345170","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 : 2025-12-01DOI: 10.1001/jamacardio.2025.4082
Benjamin D Gallagher
{"title":"Concerns About Diagnosing Hypertension in the Emergency Department.","authors":"Benjamin D Gallagher","doi":"10.1001/jamacardio.2025.4082","DOIUrl":"10.1001/jamacardio.2025.4082","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"1326"},"PeriodicalIF":14.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145444837","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 : 2025-11-26DOI: 10.1001/jamacardio.2025.4345
Sanjay Kaul
{"title":"T-TEER for Severe Tricuspid Regurgitation in the TRILUMINATE Pivotal Trial.","authors":"Sanjay Kaul","doi":"10.1001/jamacardio.2025.4345","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4345","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"147 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599641","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 : 2025-11-26DOI: 10.1001/jamacardio.2025.4337
Benjamin Salter,Gilbert H L Tang,Rebecca T Hahn,Anuradha Lala,David H Adams,Anita Asgar,Michael A Borger,Neil P Fam,Edwin C Ho,Sahil Khera,Annapoorna S Kini,Azeem Latib,Alex P W Lee,Stamatios Lerakis,Phillipp Lurz,Lucy M Safi,Paul Sorajja,Ralph Stephan von Bardeleben,Fabien Praz,Patrick T O'Gara,Henry M K Wong,Randolph H L Wong,Syed Zaid,Kent C Y So
ImportanceUntreated severe tricuspid regurgitation carries a poor prognosis. We aim to provide a contemporary review of the anatomy, clinical manifestations, and diagnostic and management strategies, including medical, surgical and transcatheter options. By synthesizing current knowledge, this review seeks to equip clinicians with the insights necessary to navigate the complexities of TR treatment.ObservationsTricuspid regurgitation is predominantly secondary to annular dilation and leaflet tethering but can also be associated with cardiac implantable electronic device leads and primary leaflet pathologies. Isolated tricuspid valve surgery is infrequently performed, especially in high surgical risk patients, prompting the emergence of transcatheter treatment options. These advancements are complemented by significant strides in multimodality imaging, including three-dimensional echocardiography, computed tomography, and magnetic resonance imaging, which enhance diagnostic accuracy and procedural planning.Conclusions and RelevanceThe effective management of tricuspid regurgitation necessitates a multidisciplinary approach, integrating input from interventional cardiology, cardiac surgery, heart failure cardiology, imaging, and electrophysiology. Surgical and transcatheter interventions such as tricuspid transcatheter-edge-to-edge repair and transcatheter tricuspid valve replacement have demonstrated favorable early clinical and functional outcomes, but ongoing research is necessary to refine patient selection and improve treatment decision-making. Individualizing treatment plans to optimize health outcomes and quality of life for patients with tricuspid regurgitation is paramount.
{"title":"A Contemporary Look at the Landscape of Treatment of Tricuspid Regurgitation: A Review.","authors":"Benjamin Salter,Gilbert H L Tang,Rebecca T Hahn,Anuradha Lala,David H Adams,Anita Asgar,Michael A Borger,Neil P Fam,Edwin C Ho,Sahil Khera,Annapoorna S Kini,Azeem Latib,Alex P W Lee,Stamatios Lerakis,Phillipp Lurz,Lucy M Safi,Paul Sorajja,Ralph Stephan von Bardeleben,Fabien Praz,Patrick T O'Gara,Henry M K Wong,Randolph H L Wong,Syed Zaid,Kent C Y So","doi":"10.1001/jamacardio.2025.4337","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4337","url":null,"abstract":"ImportanceUntreated severe tricuspid regurgitation carries a poor prognosis. We aim to provide a contemporary review of the anatomy, clinical manifestations, and diagnostic and management strategies, including medical, surgical and transcatheter options. By synthesizing current knowledge, this review seeks to equip clinicians with the insights necessary to navigate the complexities of TR treatment.ObservationsTricuspid regurgitation is predominantly secondary to annular dilation and leaflet tethering but can also be associated with cardiac implantable electronic device leads and primary leaflet pathologies. Isolated tricuspid valve surgery is infrequently performed, especially in high surgical risk patients, prompting the emergence of transcatheter treatment options. These advancements are complemented by significant strides in multimodality imaging, including three-dimensional echocardiography, computed tomography, and magnetic resonance imaging, which enhance diagnostic accuracy and procedural planning.Conclusions and RelevanceThe effective management of tricuspid regurgitation necessitates a multidisciplinary approach, integrating input from interventional cardiology, cardiac surgery, heart failure cardiology, imaging, and electrophysiology. Surgical and transcatheter interventions such as tricuspid transcatheter-edge-to-edge repair and transcatheter tricuspid valve replacement have demonstrated favorable early clinical and functional outcomes, but ongoing research is necessary to refine patient selection and improve treatment decision-making. Individualizing treatment plans to optimize health outcomes and quality of life for patients with tricuspid regurgitation is paramount.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"24 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599642","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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