Pub Date : 2025-11-01DOI: 10.1001/jamacardio.2025.3337
Astrid Duus Mikkelsen, Rasmus Paulin Beske, Lisette Okkels Jensen, Hans Eiskjær, Norman Mangner, Amin Polzin, Christian Schulze, Carsten Skurk, Peter Nordbeck, Benedikt Schrage, Vasileios Panoulas, Sebastian Zimmer, Andreas Schäfer, Thomas Engstrøm, Lene Holmvang, Martin Frydland, Anders Bo Junker, Henrik Schmidt, Nanna Louise Junker Udesen, Kristian Wachtell, Christian Juhl Terkelsen, Axel Linke, Jesper Kjærgaard, Jacob Eifer Møller, Christian Hassager
Importance: Microaxial flow pump treatment improves survival in selected patients with infarct-related cardiogenic shock; however, treatment carries substantial risks, and benefit may vary by patient subgroup. Systolic blood pressure (SBP) has been proposed as a modifier of the survival benefit.
Objective: To investigate whether SBP at randomization modifies the survival benefit of microaxial flow pump treatment in ST-segment elevation myocardial infarction-related cardiogenic shock.
Design, setting, and participants: This was a post hoc analysis of the Danish-German (DanGer) Shock open-label randomized clinical trial among adult patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock, conducted between 2013 and 2023 at 14 tertiary invasive cardiac centers in Denmark, Germany, and the United Kingdom. Data analysis was performed from January 7 to April 7, 2024.
Intervention: Microaxial flow pump therapy plus standard care vs standard care alone.
Main outcomes and measures: All-cause mortality at 180 days according to randomization SBP.
Results: Of 355 patients included in the DanGer Shock trial, 351 patients had available SBP at randomization (median [IQR] age, 69 [59-76] years; 277 [79%] male). In a dichotomized regression analysis, microaxial flow pump treatment significantly reduced mortality for SBPs lower than 82 mm Hg compared with standard care alone (odds ratio [OR], 0.34; 95% CI, 0.18-0.63; P < .001). This was not evident for higher pressures (OR, 0.96; 95% CI, 0.53-1.70; P = .90; P for interaction = .02). Kaplan-Meier survival analysis and spline regression analysis supported these findings (P for interaction = .02; P for nonlinearity = .01).
Conclusions and relevance: Randomization SBP was associated with the survival benefit of microaxial flow pump treatment, with the most hypotensive patients deriving the largest survival benefit. Early SBP may help identify patients most likely to gain a net benefit from microaxial flow pump treatment. Findings are hypothesis generating.
{"title":"Systolic Blood Pressure and Microaxial Flow Pump-Associated Survival in Infarct-Related Cardiogenic Shock: A Post Hoc Analysis of the DanGer Shock Randomized Clinical Trial.","authors":"Astrid Duus Mikkelsen, Rasmus Paulin Beske, Lisette Okkels Jensen, Hans Eiskjær, Norman Mangner, Amin Polzin, Christian Schulze, Carsten Skurk, Peter Nordbeck, Benedikt Schrage, Vasileios Panoulas, Sebastian Zimmer, Andreas Schäfer, Thomas Engstrøm, Lene Holmvang, Martin Frydland, Anders Bo Junker, Henrik Schmidt, Nanna Louise Junker Udesen, Kristian Wachtell, Christian Juhl Terkelsen, Axel Linke, Jesper Kjærgaard, Jacob Eifer Møller, Christian Hassager","doi":"10.1001/jamacardio.2025.3337","DOIUrl":"10.1001/jamacardio.2025.3337","url":null,"abstract":"<p><strong>Importance: </strong>Microaxial flow pump treatment improves survival in selected patients with infarct-related cardiogenic shock; however, treatment carries substantial risks, and benefit may vary by patient subgroup. Systolic blood pressure (SBP) has been proposed as a modifier of the survival benefit.</p><p><strong>Objective: </strong>To investigate whether SBP at randomization modifies the survival benefit of microaxial flow pump treatment in ST-segment elevation myocardial infarction-related cardiogenic shock.</p><p><strong>Design, setting, and participants: </strong>This was a post hoc analysis of the Danish-German (DanGer) Shock open-label randomized clinical trial among adult patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock, conducted between 2013 and 2023 at 14 tertiary invasive cardiac centers in Denmark, Germany, and the United Kingdom. Data analysis was performed from January 7 to April 7, 2024.</p><p><strong>Intervention: </strong>Microaxial flow pump therapy plus standard care vs standard care alone.</p><p><strong>Main outcomes and measures: </strong>All-cause mortality at 180 days according to randomization SBP.</p><p><strong>Results: </strong>Of 355 patients included in the DanGer Shock trial, 351 patients had available SBP at randomization (median [IQR] age, 69 [59-76] years; 277 [79%] male). In a dichotomized regression analysis, microaxial flow pump treatment significantly reduced mortality for SBPs lower than 82 mm Hg compared with standard care alone (odds ratio [OR], 0.34; 95% CI, 0.18-0.63; P < .001). This was not evident for higher pressures (OR, 0.96; 95% CI, 0.53-1.70; P = .90; P for interaction = .02). Kaplan-Meier survival analysis and spline regression analysis supported these findings (P for interaction = .02; P for nonlinearity = .01).</p><p><strong>Conclusions and relevance: </strong>Randomization SBP was associated with the survival benefit of microaxial flow pump treatment, with the most hypotensive patients deriving the largest survival benefit. Early SBP may help identify patients most likely to gain a net benefit from microaxial flow pump treatment. Findings are hypothesis generating.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT01633502.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"1157-1165"},"PeriodicalIF":14.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954739","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 : 2025-10-29DOI: 10.1001/jamacardio.2025.4053
Daniel J Rader,Sarah Schmidt
{"title":"Should Familial Hypercholesterolemia Be Included in Newborn Screening?","authors":"Daniel J Rader,Sarah Schmidt","doi":"10.1001/jamacardio.2025.4053","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4053","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"26 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145381140","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 : 2025-10-29DOI: 10.1001/jamacardio.2025.4047
Amy L Peterson,Vanessa Horner,Michael R Lasarev,Xiao Zhang,Stephen E Humphries,Robert D Steiner,Megan Benoy,Jessica Tumolo,Patrice K Held,Xiangqiang Shao
ImportanceNewborn screening for familial hypercholesterolemia (FH) would dramatically increase the diagnosis of a common, potentially fatal but highly treatable genetic condition in newborns and relatives.ObjectiveTo report the results of genetic testing of residual newborn screening dried blood spots (DBS) with biomarkers suggesting high risk for FH as an initial step toward development of multitier newborn screening for FH.Design, Setting, and ParticipantsA cross-sectional study design from July 2021 to July 2022 was used to test residual DBS from newborns with sample collection between 24 and 72 hours of life for total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B. Principal component analysis identified biomarker combinations that accounted for the greatest variance. Mahalanobis distance was calculated to generalize the idea of a standardized z score of a single variable to several correlated variables; approximately 8% of samples with the greatest positive Mahalanobis distance were selected for genetic FH testing. The study included a population-based screening for newborns in Wisconsin. Study data were analyzed from July 2022 to June 2024.ExposuresNewborn residual DBS were tested for total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B, with a subset tested for pathogenic variants in 8 genes associated with FH.Main Outcomes and MeasuresPrevalence of pathogenic variants for FH in a population-based sample of newborn screening DBS.ResultsOf 59 927 total newborns, DBS samples were obtained from 10 004 newborns (mean [SD] age, 27.8 [5.6] hours; 5142 male [51.4%]). From 10 004 specimens tested, principal component analysis demonstrated the combination of low-density lipoprotein cholesterol and apolipoprotein B accounted for the greatest variance, and 768 specimens were selected for genetic testing. A pathogenic variant for FH was found in 16 samples yielding a population-based prevalence of 1 in 625 (1.6 per 1000; 95% CI, 0.91-2.60 per 1000) newborns. Pathogenic variants were distributed throughout the entire range of Mahalanobis scores selected for genetic testing.Conclusions and RelevanceThis cross-sectional study found that screening newborns for FH using first-tier biochemical testing with reflex second-tier genetic testing was feasible and, in this population, identified 1 in 625 newborns with FH. Further refinement and validation are needed before implementation in newborn screening. Routine newborn screening for FH would substantially increase diagnosis of this common, potentially fatal, yet readily treatable condition while providing opportunities for cascade screening.
{"title":"Genetic Diagnosis of Familial Hypercholesterolemia in Residual Newborn Dried Blood Spots.","authors":"Amy L Peterson,Vanessa Horner,Michael R Lasarev,Xiao Zhang,Stephen E Humphries,Robert D Steiner,Megan Benoy,Jessica Tumolo,Patrice K Held,Xiangqiang Shao","doi":"10.1001/jamacardio.2025.4047","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4047","url":null,"abstract":"ImportanceNewborn screening for familial hypercholesterolemia (FH) would dramatically increase the diagnosis of a common, potentially fatal but highly treatable genetic condition in newborns and relatives.ObjectiveTo report the results of genetic testing of residual newborn screening dried blood spots (DBS) with biomarkers suggesting high risk for FH as an initial step toward development of multitier newborn screening for FH.Design, Setting, and ParticipantsA cross-sectional study design from July 2021 to July 2022 was used to test residual DBS from newborns with sample collection between 24 and 72 hours of life for total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B. Principal component analysis identified biomarker combinations that accounted for the greatest variance. Mahalanobis distance was calculated to generalize the idea of a standardized z score of a single variable to several correlated variables; approximately 8% of samples with the greatest positive Mahalanobis distance were selected for genetic FH testing. The study included a population-based screening for newborns in Wisconsin. Study data were analyzed from July 2022 to June 2024.ExposuresNewborn residual DBS were tested for total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B, with a subset tested for pathogenic variants in 8 genes associated with FH.Main Outcomes and MeasuresPrevalence of pathogenic variants for FH in a population-based sample of newborn screening DBS.ResultsOf 59 927 total newborns, DBS samples were obtained from 10 004 newborns (mean [SD] age, 27.8 [5.6] hours; 5142 male [51.4%]). From 10 004 specimens tested, principal component analysis demonstrated the combination of low-density lipoprotein cholesterol and apolipoprotein B accounted for the greatest variance, and 768 specimens were selected for genetic testing. A pathogenic variant for FH was found in 16 samples yielding a population-based prevalence of 1 in 625 (1.6 per 1000; 95% CI, 0.91-2.60 per 1000) newborns. Pathogenic variants were distributed throughout the entire range of Mahalanobis scores selected for genetic testing.Conclusions and RelevanceThis cross-sectional study found that screening newborns for FH using first-tier biochemical testing with reflex second-tier genetic testing was feasible and, in this population, identified 1 in 625 newborns with FH. Further refinement and validation are needed before implementation in newborn screening. Routine newborn screening for FH would substantially increase diagnosis of this common, potentially fatal, yet readily treatable condition while providing opportunities for cascade screening.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"23 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145381145","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 : 2025-10-29DOI: 10.1001/jamacardio.2025.4007
Rajeev K Pathak,Adrian D Elliott,Dennis H Lau,Melissa E Middeldorp,Dominik Linz,John L Fitzgerald,Aashray Gupta,Jonathan P Ariyaratnam,Varun Malik,Jean Jacques Noubiap,Walter P Abhayaratna,Jonathan M Kalman,Prashanthan Sanders
ImportanceAtrial fibrillation (AF) ablation outcomes demonstrate attrition over time. Although observational studies have reported reduced arrhythmia recurrence after AF ablation with aggressive lifestyle and risk factor modification, evidence from randomized clinical trials is lacking.ObjectiveTo determine the impact of risk factor and weight management on AF ablation rhythm outcomes.Design, Setting, and ParticipantsThis was an open-label, multicenter, randomized clinical trial with 12-month follow-up conducted from July 2014 to September 2018. The setting included 3 sites in Adelaide, South Australia. Included in the analysis were consecutive patients with nonpermanent symptomatic AF undergoing first-time catheter ablation with a body mass index (BMI) greater than or equal to 27 (calculated as weight in kilograms divided by height in meters squared) and 1 or more additional cardiometabolic risk factors. Data were analyzed from September 2023 to August 2024.InterventionsPatients were randomized 1:1 to lifestyle and risk factor management (LRFM) or usual care (UC) at catheter ablation. The LRFM group was treated in a structured, physician-led tailored clinic to reduce modifiable risk factors. The UC group was given information on management of risk factors by their treating physician but were not enrolled into the risk factor modification clinic. Both groups received guideline-directed care for management of AF by a team blinded to randomization. Pulmonary vein isolation was undertaken in each patient with additional ablation considered at the discretion of the electrophysiologist.Main Outcomes and MeasuresProportion of patients free from AF in the 12-month period after ablation.ResultsOf 122 participants (mean [SD] age, 60 [10] years; 82 male [67%]; mean [SD] BMI, 33 [5]), 62 were randomized to LRFM, and 60 were randomized to UC. Primary end point at 12 months after ablation was observed in 38 patients (61.3%) in the LRFM group and 24 (40%) in the control group (P = .03). The hazard for recurrent arrhythmia over 12 months was 0.53 (95% CI, 0.32-0.89) for LRFM vs UC. AF symptom severity was significantly improved in the LRFM group compared with the UC group (mean difference, -2.0; 95% CI, -3.7 to -0.3). Patients in the LRFM group achieved a significantly improved risk factor profile compared with those in the UC group (mean difference, body weight, -9.0 kg; 95% CI, -11.1 to -6.8 kg and waist circumference, -7.0 cm; 95% CI, -9.4 to -4.5 cm were lower at 12 months in the LRFM group; systolic BP was lower at 12 months in the LRFM group, -10.8 mm Hg; 95% CI, -16.1 to -5.5 mm Hg, although there was no difference in diastolic BP, -3.5 mm Hg; 95% CI, -7.2 to 0.2 mm Hg).Conclusions and RelevanceAmong patients with AF, elevated BMI, and 1 or more additional cardiometabolic risk factors, aggressive risk factor management reduced arrhythmia recurrence over the 12-month period after catheter ablation. These findings demonstrate the importance of LRFM for the
{"title":"Aggressive Risk Factor Reduction Study for Atrial Fibrillation Implications for Ablation Outcomes: The ARREST-AF Randomized Clinical Trial.","authors":"Rajeev K Pathak,Adrian D Elliott,Dennis H Lau,Melissa E Middeldorp,Dominik Linz,John L Fitzgerald,Aashray Gupta,Jonathan P Ariyaratnam,Varun Malik,Jean Jacques Noubiap,Walter P Abhayaratna,Jonathan M Kalman,Prashanthan Sanders","doi":"10.1001/jamacardio.2025.4007","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4007","url":null,"abstract":"ImportanceAtrial fibrillation (AF) ablation outcomes demonstrate attrition over time. Although observational studies have reported reduced arrhythmia recurrence after AF ablation with aggressive lifestyle and risk factor modification, evidence from randomized clinical trials is lacking.ObjectiveTo determine the impact of risk factor and weight management on AF ablation rhythm outcomes.Design, Setting, and ParticipantsThis was an open-label, multicenter, randomized clinical trial with 12-month follow-up conducted from July 2014 to September 2018. The setting included 3 sites in Adelaide, South Australia. Included in the analysis were consecutive patients with nonpermanent symptomatic AF undergoing first-time catheter ablation with a body mass index (BMI) greater than or equal to 27 (calculated as weight in kilograms divided by height in meters squared) and 1 or more additional cardiometabolic risk factors. Data were analyzed from September 2023 to August 2024.InterventionsPatients were randomized 1:1 to lifestyle and risk factor management (LRFM) or usual care (UC) at catheter ablation. The LRFM group was treated in a structured, physician-led tailored clinic to reduce modifiable risk factors. The UC group was given information on management of risk factors by their treating physician but were not enrolled into the risk factor modification clinic. Both groups received guideline-directed care for management of AF by a team blinded to randomization. Pulmonary vein isolation was undertaken in each patient with additional ablation considered at the discretion of the electrophysiologist.Main Outcomes and MeasuresProportion of patients free from AF in the 12-month period after ablation.ResultsOf 122 participants (mean [SD] age, 60 [10] years; 82 male [67%]; mean [SD] BMI, 33 [5]), 62 were randomized to LRFM, and 60 were randomized to UC. Primary end point at 12 months after ablation was observed in 38 patients (61.3%) in the LRFM group and 24 (40%) in the control group (P = .03). The hazard for recurrent arrhythmia over 12 months was 0.53 (95% CI, 0.32-0.89) for LRFM vs UC. AF symptom severity was significantly improved in the LRFM group compared with the UC group (mean difference, -2.0; 95% CI, -3.7 to -0.3). Patients in the LRFM group achieved a significantly improved risk factor profile compared with those in the UC group (mean difference, body weight, -9.0 kg; 95% CI, -11.1 to -6.8 kg and waist circumference, -7.0 cm; 95% CI, -9.4 to -4.5 cm were lower at 12 months in the LRFM group; systolic BP was lower at 12 months in the LRFM group, -10.8 mm Hg; 95% CI, -16.1 to -5.5 mm Hg, although there was no difference in diastolic BP, -3.5 mm Hg; 95% CI, -7.2 to 0.2 mm Hg).Conclusions and RelevanceAmong patients with AF, elevated BMI, and 1 or more additional cardiometabolic risk factors, aggressive risk factor management reduced arrhythmia recurrence over the 12-month period after catheter ablation. These findings demonstrate the importance of LRFM for the","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"54 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145381107","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 : 2025-10-22DOI: 10.1001/jamacardio.2025.3932
Wenli Ni,Lina Benson,Petter Ljungman,Federica Nobile,Susanne Breitner,Siqi Zhang,Jeroen de Bont,Lars H Lund,Gianluigi Savarese,Alexandra Schneider,Stefan Agewall
ImportancePatients with heart failure may be particularly susceptible to nonoptimal temperature exposure, but the associations between short-term low and high temperature exposure and mortality in this population remain unclear, especially in Sweden-a high-latitude country where no nationwide study has been conducted.ObjectiveTo investigate the associations between short-term exposure to low and high ambient temperatures and all-cause and cardiovascular mortality among Swedish patients with heart failure.Design, Setting, and ParticipantsThis nationwide, time-stratified case-crossover study was conducted in Sweden among 250 640 patients with heart failure who died from any cause from 2006 to 2021, identified from the Swedish National Patient Register and the Cause of Death Register.ExposureDaily mean ambient temperature was assessed at 1 × 1-km spatial resolution. To account for regional adaptation, temperature exposures were defined using municipality-specific percentiles, with low and high temperatures corresponding to the 2.5th and 97.5th percentiles, respectively.Main Outcomes and MeasuresThe primary outcome was all-cause and cardiovascular mortality among patients with heart failure.ResultsThe mean (SD) age at death among patients with heart failure was 84.3 (9.4) years, with 121 061 female patients (48.3%). Short-term exposure to ambient temperature demonstrated a U-shaped association with both all-cause and cardiovascular mortality. For all-cause mortality, odds ratios (ORs) were 1.130 (95% CI, 1.074-1.189) for low temperatures and 1.054 (95% CI, 1.017-1.093) for high temperatures over the entire study period. For cardiovascular mortality, low temperatures were associated with an OR of 1.160 (95% CI, 1.083-1.242) over the entire study period, and high temperatures with an OR of 1.084 (95% CI, 1.014-1.159) during 2014-2021. The mortality risk associated with high temperatures was more pronounced during the 2014-2021 period compared to 2006-2013. Male patients, those with comorbid diabetes, and diuretic users were more susceptible to low temperatures, whereas high temperature was more strongly associated with mortality in patients with comorbid atrial fibrillation or flutter and those exposed to elevated ozone levels.Conclusions and RelevanceThis nationwide Swedish time-stratified case-crossover study indicates that short-term exposure to both low and high temperatures was associated with increased risk of all-cause and cardiovascular mortality in patients with heart failure. The mortality risk associated with high temperatures appears to be increasing over time, emphasizing the need for adaptation, even in high-latitude regions.
{"title":"Short-Term Exposure to Low and High Temperatures and Mortality Among Patients With Heart Failure in Sweden.","authors":"Wenli Ni,Lina Benson,Petter Ljungman,Federica Nobile,Susanne Breitner,Siqi Zhang,Jeroen de Bont,Lars H Lund,Gianluigi Savarese,Alexandra Schneider,Stefan Agewall","doi":"10.1001/jamacardio.2025.3932","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3932","url":null,"abstract":"ImportancePatients with heart failure may be particularly susceptible to nonoptimal temperature exposure, but the associations between short-term low and high temperature exposure and mortality in this population remain unclear, especially in Sweden-a high-latitude country where no nationwide study has been conducted.ObjectiveTo investigate the associations between short-term exposure to low and high ambient temperatures and all-cause and cardiovascular mortality among Swedish patients with heart failure.Design, Setting, and ParticipantsThis nationwide, time-stratified case-crossover study was conducted in Sweden among 250 640 patients with heart failure who died from any cause from 2006 to 2021, identified from the Swedish National Patient Register and the Cause of Death Register.ExposureDaily mean ambient temperature was assessed at 1 × 1-km spatial resolution. To account for regional adaptation, temperature exposures were defined using municipality-specific percentiles, with low and high temperatures corresponding to the 2.5th and 97.5th percentiles, respectively.Main Outcomes and MeasuresThe primary outcome was all-cause and cardiovascular mortality among patients with heart failure.ResultsThe mean (SD) age at death among patients with heart failure was 84.3 (9.4) years, with 121 061 female patients (48.3%). Short-term exposure to ambient temperature demonstrated a U-shaped association with both all-cause and cardiovascular mortality. For all-cause mortality, odds ratios (ORs) were 1.130 (95% CI, 1.074-1.189) for low temperatures and 1.054 (95% CI, 1.017-1.093) for high temperatures over the entire study period. For cardiovascular mortality, low temperatures were associated with an OR of 1.160 (95% CI, 1.083-1.242) over the entire study period, and high temperatures with an OR of 1.084 (95% CI, 1.014-1.159) during 2014-2021. The mortality risk associated with high temperatures was more pronounced during the 2014-2021 period compared to 2006-2013. Male patients, those with comorbid diabetes, and diuretic users were more susceptible to low temperatures, whereas high temperature was more strongly associated with mortality in patients with comorbid atrial fibrillation or flutter and those exposed to elevated ozone levels.Conclusions and RelevanceThis nationwide Swedish time-stratified case-crossover study indicates that short-term exposure to both low and high temperatures was associated with increased risk of all-cause and cardiovascular mortality in patients with heart failure. The mortality risk associated with high temperatures appears to be increasing over time, emphasizing the need for adaptation, even in high-latitude regions.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"1 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338755","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}
ImportanceWomen with adverse pregnancy outcomes have higher subsequent cardiovascular risks, but their long-term risk of atrial fibrillation (AF) and potential causality are unclear. A better understanding of such risks is needed to identify women with high risk early in life and guide interventions to prevent AF and its complications.ObjectiveTo determine long-term risks of AF associated with 6 major adverse pregnancy outcomes in a large population-based cohort and assess for familial confounding using cosibling analyses.Design, Setting, and ParticipantsThis national cohort study included all women with a singleton delivery in Sweden between 1973 and 2015. Analyses were conducted between May 23 and August 18, 2025.ExposuresAdverse pregnancy outcomes (preterm delivery, small for gestational age, large for gestational age, preeclampsia, other hypertensive disorders, and gestational diabetes), identified from nationwide birth records.Main Outcome and MeasuresThe primary outcome was AF identified from nationwide inpatient and outpatient diagnoses through 2018. Cox regression was used to compute hazard ratios (HRs) for AF associated with specific adverse pregnancy outcomes, adjusting for other maternal factors. Cosibling analyses assessed for potential confounding by shared familial (genetic and/or environmental) factors.ResultsAmong 2 201 047 women with 54 million person-years of follow-up, 51 173 (2.3%) were diagnosed with AF (median [IQR] age at diagnosis, 63 [56-69] years). All adverse pregnancy outcomes except small for gestational age were associated with long-term increased risks of AF. Within 10 years following delivery, adjusted HRs for AF were significantly elevated only among women with other hypertensive disorders (HR, 1.69; 95% CI, 1.32-2.15), preterm delivery (HR, 1.46; 95% CI, 1.26-1.70), or large for gestational age (HR, 1.16; 95% CI, 1.01-1.32). However, at 30 to 46 years after delivery, adjusted HRs were increased among women with other hypertensive disorders (HR, 1.44; 95% CI, 1.24-1.66), preeclampsia (HR, 1.38; 95% CI, 1.33-1.50), gestational diabetes (HR, 1.19; 95% CI, 1.03-1.37), large for gestational age (HR, 1.17; 95% CI, 1.14-1.21), or preterm delivery (HR, 1.11; 95% CI, 1.07-1.16). These findings were largely unexplained by shared familial factors. Women with multiple adverse pregnancy outcomes had further increases in risk.ConclusionsIn this large national cohort, all adverse pregnancy outcomes except small for gestational age were associated with increased risk for AF up to 46 years later. Women with adverse pregnancy outcomes need early preventive actions and long-term clinical follow-up for timely detection and treatment of cardiovascular disorders related to the development of AF.
{"title":"Adverse Pregnancy Outcomes and Long-Term Risk of Atrial Fibrillation.","authors":"Casey Crump,Jingkai Wei,Jan Sundquist,Kristina Sundquist","doi":"10.1001/jamacardio.2025.3951","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3951","url":null,"abstract":"ImportanceWomen with adverse pregnancy outcomes have higher subsequent cardiovascular risks, but their long-term risk of atrial fibrillation (AF) and potential causality are unclear. A better understanding of such risks is needed to identify women with high risk early in life and guide interventions to prevent AF and its complications.ObjectiveTo determine long-term risks of AF associated with 6 major adverse pregnancy outcomes in a large population-based cohort and assess for familial confounding using cosibling analyses.Design, Setting, and ParticipantsThis national cohort study included all women with a singleton delivery in Sweden between 1973 and 2015. Analyses were conducted between May 23 and August 18, 2025.ExposuresAdverse pregnancy outcomes (preterm delivery, small for gestational age, large for gestational age, preeclampsia, other hypertensive disorders, and gestational diabetes), identified from nationwide birth records.Main Outcome and MeasuresThe primary outcome was AF identified from nationwide inpatient and outpatient diagnoses through 2018. Cox regression was used to compute hazard ratios (HRs) for AF associated with specific adverse pregnancy outcomes, adjusting for other maternal factors. Cosibling analyses assessed for potential confounding by shared familial (genetic and/or environmental) factors.ResultsAmong 2 201 047 women with 54 million person-years of follow-up, 51 173 (2.3%) were diagnosed with AF (median [IQR] age at diagnosis, 63 [56-69] years). All adverse pregnancy outcomes except small for gestational age were associated with long-term increased risks of AF. Within 10 years following delivery, adjusted HRs for AF were significantly elevated only among women with other hypertensive disorders (HR, 1.69; 95% CI, 1.32-2.15), preterm delivery (HR, 1.46; 95% CI, 1.26-1.70), or large for gestational age (HR, 1.16; 95% CI, 1.01-1.32). However, at 30 to 46 years after delivery, adjusted HRs were increased among women with other hypertensive disorders (HR, 1.44; 95% CI, 1.24-1.66), preeclampsia (HR, 1.38; 95% CI, 1.33-1.50), gestational diabetes (HR, 1.19; 95% CI, 1.03-1.37), large for gestational age (HR, 1.17; 95% CI, 1.14-1.21), or preterm delivery (HR, 1.11; 95% CI, 1.07-1.16). These findings were largely unexplained by shared familial factors. Women with multiple adverse pregnancy outcomes had further increases in risk.ConclusionsIn this large national cohort, all adverse pregnancy outcomes except small for gestational age were associated with increased risk for AF up to 46 years later. Women with adverse pregnancy outcomes need early preventive actions and long-term clinical follow-up for timely detection and treatment of cardiovascular disorders related to the development of AF.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"78 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338734","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 : 2025-10-15DOI: 10.1001/jamacardio.2025.3744
Nicholas Chiu,Peter Libby
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Pub Date : 2025-10-15DOI: 10.1001/jamacardio.2025.3822
Yodying Kaolawanich,David C Wendell,Han W Kim,Enn-Ling Chen,Céleste Chevalier,Piyapat Chunharas,Michele A Parker,Raymond J Kim
ImportancePapillary muscle scarring (papSCAR) can occur without epicardial coronary artery disease, likely due to microvascular dysfunction. Dilated cardiomyopathy (DCM) has been associated with microvascular dysfunction; the prevalence and prognostic significance of papSCAR in patients with DCM are unclear.ObjectiveTo determine the prevalence of papSCAR in patients with DCM and to evaluate if papSCAR is associated with adverse outcomes.Design, Setting, and ParticipantsThis cohort study was conducted among consecutive patients with known or suspected DCM prospectively enrolled at an academic hospital in North Carolina from January 2011 to December 2020. Patients were referred for cardiovascular magnetic resonance (CMR) imaging, and the study protocol included flow-independent dark blood delayed-enhancement (FIDDLE) imaging, which improves the detection of papSCAR. Data were analyzed from January 2022 to December 2022.Main Outcomes and MeasuresThe primary end point was cardiac mortality. Secondary end points included a composite of heart failure events (heart failure death or cardiac transplant) and a composite of arrhythmia events (sudden cardiac death [SCD] or aborted SCD).ResultsThis cohort study included 470 patients (mean [SD] age, 55.3 [14.3] years; 205 female patients [43.6%]). During up to 8 years of follow-up (2082 patient-years), there were 53 cardiac deaths, 49 heart failure events, and 24 arrhythmia events. PapSCAR was present in 137 patients (29.1%), and mean (SD) left ventricular ejection fraction (LVEF) was similar between those with and without papSCAR (30.7% [11.0%] vs 31.4% [10.3%]; P = .52). Patients with papSCAR had a higher rate of cardiac death than those without (19.0% vs 8.1%; hazard ratio [HR], 2.30; 95% CI, 1.34-3.95; P = .002). After adjustment for prespecified variables known to have prognostic value in DCM (age, systolic blood pressure, heart rate, LVEF, and midwall myocardial scar), papSCAR was independently associated with cardiac death (HR, 1.86; 95% CI, 1.07-3.24; P = .03) and provided incremental prognostic value (incremental χ2, 4.68; P = .03). PapSCAR was also independently associated with heart failure events (HR, 2.05; 95% CI, 1.16-3.61; P = .01) and arrhythmia events (HR, 3.41; 95% CI, 1.46-7.94; P = .005).Conclusions and RelevanceIn this single-center cohort study, papSCAR as detected by dark blood delayed-enhancement CMR was present in approximately one-third of patients with DCM and was independently associated with cardiac death.
重要性乳头肌瘢痕（papSCAR）可以在没有心外膜冠状动脉疾病的情况下发生，可能是由于微血管功能障碍。扩张型心肌病（DCM）与微血管功能障碍有关；papSCAR在DCM患者中的患病率和预后意义尚不清楚。目的确定DCM患者papSCAR的患病率，并评估papSCAR是否与不良预后相关。设计、环境和参与者本队列研究于2011年1月至2020年12月在北卡罗来纳州的一家学术医院前瞻性地招募了已知或疑似DCM的连续患者。患者接受心血管磁共振（CMR）成像，研究方案包括血流无关的暗血延迟增强（FIDDLE）成像，这提高了papSCAR的检测。数据分析时间为2022年1月至2022年12月。主要结局和测量：主要终点为心脏死亡率。次要终点包括心力衰竭事件的复合（心力衰竭死亡或心脏移植）和心律失常事件的复合（心源性猝死[SCD]或SCD流产）。结果该队列研究纳入470例患者（平均[SD]年龄55.3[14.3]岁，女性205例[43.6%]）。在长达8年的随访期间（2082例患者年），有53例心脏死亡，49例心力衰竭事件和24例心律失常事件。137例（29.1%）患者存在PapSCAR，有和没有PapSCAR的患者平均左室射血分数（LVEF）相似（30.7% [11.0%]vs 31.4% [10.3%]; P = 0.52）。papSCAR患者的心源性死亡率高于非papSCAR患者（19.0% vs 8.1%；风险比[HR]， 2.30; 95% CI, 1.34-3.95; P = 0.002）。在调整已知对DCM有预后价值的预先指定变量（年龄、收缩压、心率、LVEF和中壁心肌疤痕）后，papSCAR与心源性死亡独立相关(HR, 1.86; 95% CI, 1.07-3.24; P =。03)，并提供增量预后价值（增量χ2, 4.68; P = .03）。PapSCAR也与心力衰竭事件独立相关(HR, 2.05; 95% CI, 1.16-3.61; P =。01)和心律失常事件（HR, 3.41; 95% CI, 1.46-7.94; P = 0.005）。结论和相关性在这项单中心队列研究中，暗血延迟增强CMR检测到的papSCAR存在于大约三分之一的DCM患者中，并且与心源性死亡独立相关。
{"title":"Prognostic Value of Papillary Muscle Scarring in Patients With Dilated Cardiomyopathy.","authors":"Yodying Kaolawanich,David C Wendell,Han W Kim,Enn-Ling Chen,Céleste Chevalier,Piyapat Chunharas,Michele A Parker,Raymond J Kim","doi":"10.1001/jamacardio.2025.3822","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.3822","url":null,"abstract":"ImportancePapillary muscle scarring (papSCAR) can occur without epicardial coronary artery disease, likely due to microvascular dysfunction. Dilated cardiomyopathy (DCM) has been associated with microvascular dysfunction; the prevalence and prognostic significance of papSCAR in patients with DCM are unclear.ObjectiveTo determine the prevalence of papSCAR in patients with DCM and to evaluate if papSCAR is associated with adverse outcomes.Design, Setting, and ParticipantsThis cohort study was conducted among consecutive patients with known or suspected DCM prospectively enrolled at an academic hospital in North Carolina from January 2011 to December 2020. Patients were referred for cardiovascular magnetic resonance (CMR) imaging, and the study protocol included flow-independent dark blood delayed-enhancement (FIDDLE) imaging, which improves the detection of papSCAR. Data were analyzed from January 2022 to December 2022.Main Outcomes and MeasuresThe primary end point was cardiac mortality. Secondary end points included a composite of heart failure events (heart failure death or cardiac transplant) and a composite of arrhythmia events (sudden cardiac death [SCD] or aborted SCD).ResultsThis cohort study included 470 patients (mean [SD] age, 55.3 [14.3] years; 205 female patients [43.6%]). During up to 8 years of follow-up (2082 patient-years), there were 53 cardiac deaths, 49 heart failure events, and 24 arrhythmia events. PapSCAR was present in 137 patients (29.1%), and mean (SD) left ventricular ejection fraction (LVEF) was similar between those with and without papSCAR (30.7% [11.0%] vs 31.4% [10.3%]; P = .52). Patients with papSCAR had a higher rate of cardiac death than those without (19.0% vs 8.1%; hazard ratio [HR], 2.30; 95% CI, 1.34-3.95; P = .002). After adjustment for prespecified variables known to have prognostic value in DCM (age, systolic blood pressure, heart rate, LVEF, and midwall myocardial scar), papSCAR was independently associated with cardiac death (HR, 1.86; 95% CI, 1.07-3.24; P = .03) and provided incremental prognostic value (incremental χ2, 4.68; P = .03). PapSCAR was also independently associated with heart failure events (HR, 2.05; 95% CI, 1.16-3.61; P = .01) and arrhythmia events (HR, 3.41; 95% CI, 1.46-7.94; P = .005).Conclusions and RelevanceIn this single-center cohort study, papSCAR as detected by dark blood delayed-enhancement CMR was present in approximately one-third of patients with DCM and was independently associated with cardiac death.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"4 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288385","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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