Journal of the American Heart Association最新文献

Background: We examined the associations between metabolic dysfunction-associated steatotic liver disease (MASLD) and cerebral small-vessel disease burden manifested on magnetic resonance images in a population of Chinese individuals undergoing a healthy checkup.

Methods: In this cross-sectional study, 7679 participants (aged ≥18 years) with brain magnetic resonance imaging data from Hunan Province, China, were enrolled between 2017 and 2023. The cerebral small-vessel disease burden was measured using markers on magnetic resonance images, including total white matter hyperintensity (WMH), 4 WMH spatial patterns (deep WMH, periventricular, juxtacortical WMH, and juxtaventricular WMH), lacunes, cerebral microbleeds, and enlarged perivascular space. Multiple linear and ordinal/binary logistic regression models were used for liver-brain associations, and separate models were created for subgroup analyses. The role of cardiovascular metabolism-related mediators was estimated using mediation analysis.

Results: MASLD was significantly associated with a greater volume of total WMH (including 2 unique spatial patterns: deep WMH and periventricular WMH) and a greater burden of lacunes. The relationships between MASLD and cerebral microbleeds or enlarged perivascular space were not significant. Stratified analyses revealed that the liver-brain association (MASLD and total WMH volume or lacunar lesions) was affected by hypertension (P-interaction <0.05). Moreover, blood pressure had the greatest mediating effect among cardiovascular metabolic risks. The mediation proportions with SBP and DBP were 11.67% and 12.67%, respectively, for total WMH volume and 12.37% and 10.87%, respectively, for lacunes.

Conclusions: Our study revealed a close link between MASLD and cerebral small-vessel disease in terms of neuroimaging features. Individuals with MASLD, especially those accompanied by hypertension, should be encouraged to undergo screening for cerebral small-vessel disease risk to facilitate the prediction of brain aging burden.

Background: Although use of electronic cigarettes (e-cigarettes) is increasing, its cardiovascular impact remains uncertain, especially among stroke survivors. We compared the incidence of major cardiovascular events in stroke survivors according to cigarette/e-cigarette use.

Methods: We conducted a retrospective cohort study of Korean men with acute stroke who underwent national health checkups within 3 years of the index stroke (2018-2022). The patients were categorized into 4 groups based on their cigarette/e-cigarette use status: nonusers, combustible cigarette users, dual users (both combustible cigarettes and e-cigarettes), and e-cigarette-only users. The primary outcome was a composite of recurrent stroke and myocardial infarction. Multivariable Cox models estimated hazard ratios (HRs) across groups.

Results: Of the 115 240 men with stroke, 89 326 (77.5%) were nonusers, 23 688 (20.6%) were combustible cigarette users, 1498 (1.3%) were dual users, and 728 (0.7%) were e-cigarette-only users. During a mean follow-up of 2.61±1.46 years, 6722 patients suffered primary outcome events (ischemic stroke: 4799; hemorrhagic stroke: 1165; myocardial infarction: 758). Compared with nonusers, the risk of the primary outcome was higher in the combustible cigarette group (HR, 1.35 [95% CI, 1.27-1.43]) and dual users (HR, 1.27 [95% CI, 1.01-1.60]), whereas e-cigarette-only users showed a nonsignificant elevation (HR, 1.11 [95% CI, 0.77-1.59]).

Conclusions: Among Korean male stroke survivors, combustible cigarette use and dual use were associated with higher risk of recurrent stroke or myocardial infarction, whereas e-cigarette-only use was not significantly different from nonuse. Further research is warranted to clarify the long-term cardiovascular effects of e-cigarette use among stroke survivors.

Background: Individuals who experience hypertensive disorders of pregnancy (HDPs) are at increased risk for downstream pregnancy-related complications, yet the variability in this risk among Asian American, Native Hawaiian, and Pacific Islander individuals remains understudied. This study investigated the risk for 5 HDP outcomes-chronic hypertension, chronic hypertension with superimposed preeclampsia, gestational hypertension, preeclampsia, and severe preeclampsia or eclampsia-among 15 disaggregated Asian American, Native Hawaiian, and Pacific Islander subgroups and assessed maternal characteristics that may be driving differences.

Methods: We used infant and fetal vital records linked to maternal hospital discharge records from births to Asian American, Native Hawaiian, and Pacific Islander individuals in California from 2007 to 2019. Modified Poisson regression models estimated risk ratios (RR) for each outcome with sequential adjustments to assess the contributions of maternal sociodemographic and health-related characteristics to variability in risk. The largest subgroup-Chinese individuals-was the reference group.

Results: The cohort included 772 688 individuals. Prevalence of HDPs ranged from 3.7% among Chinese individuals (n=7930) to 13.0% among Guamanian individuals (n=247). All Pacific Islander subgroups and Filipino individuals were consistently at higher risk for HDPs than Chinese individuals, whereas Korean, Vietnamese, and Japanese individuals tended to be at lowest risk. After full adjustment, the highest risk groups had adjusted relative risks 2- to 3-fold higher than Chinese individuals.

Conclusions: The variability in HDP risk observed across Asian American, Native Hawaiian, and Pacific Islander populations further demonstrates the need to study health outcomes in disaggregated subgroups. These findings may help providers identify individuals at high risk for HDPs, enabling prevention, prompt treatment, and reduced adverse maternal health outcomes.

Background: Aortic stenosis (AS) is a progressive disease requiring timely monitoring and intervention. While transthoracic echocardiography remains the diagnostic standard, deep learning-based approaches offer the potential for improved disease tracking. This study examined the longitudinal changes in a previously developed deep learning-derived index for AS continuum (DLi-ASc) and assessed its prognostic association with progression to severe AS.

Methods: We retrospectively analyzed 2373 patients (7371 transthoracic echocardiographies) from 2 tertiary hospitals. DLi-ASc (scaled 0-100), derived from parasternal long-axis and short-axis views, was tracked longitudinally. The median follow-up duration was 42.8 (interquartile range, 22.2-75.7) months.

Results: DLi-ASc increased in parallel with worsening AS stages (P for trend<0.001) and showed strong correlations with aortic valve maximal velocity (Pearson correlation coefficient, 0.69; P<0.001) and mean pressure gradient (Pearson correlation coefficient, 0.66; P<0.001). Higher baseline DLi-ASc was associated with a faster AS progression rate (P for trend<0.001). Additionally, the annualized change in DLi-ASc, estimated using linear mixed-effect models, correlated strongly with the annualized progression of aortic valve maximal velocity (Pearson correlation coefficient, 0.71, P<0.001) and mean pressure gradient (Pearson correlation coefficient, =0.68; P<0.001). In Fine-Gray competing risk models, baseline DLi-ASc was independently associated with progression to severe AS, even after adjustment for aortic valve maximal velocity or mean pressure gradient (hazard ratios per 10-point increase, 2.38 and 2.80, respectively).

Conclusions: DLi-ASc increased in parallel with AS progression and was independently associated with severe AS progression. These findings support its role as a noninvasive imaging-based digital marker for longitudinal AS monitoring and risk stratification.

Background: Atrial fibrillation is associated with heart failure (HF) through a complex cause-and-effect relationship. We performed multiplex screening of plasma proteins in patients with atrial fibrillation to identify biomarkers and pathways associated with hospitalization for HF. Additionally, we aimed to identify potential pathophysiological differences between HF with reduced ejection fraction and HF with preserved ejection fraction at baseline in patients with atrial fibrillation.

Methods: Using a case-cohort design of patients with atrial fibrillation from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, 596 cases with HF hospitalizations during follow-up and 4029 randomly selected controls without HF hospitalization. Plasma obtained at randomization was analyzed with conventional immunoassays and proximity extension assay panels. Biomarker associations with HF hospitalization were evaluated using random survival forest, Boruta, and Cox-regression analyses. Associations between biomarkers and HF subtype were evaluated with Wilcoxon-Mann-Whitney test with Bonferroni-Holm adjustment for multiplicity.

Results: The biomarkers most strongly and significantly associated with increased risk of HF hospitalization after adjustment for clinical characteristics, renal function, and cardiac biomarkers, and after correction for multiplicity (P≤0.00027), were NT-proBNP (N-terminal pro-B-type natriuretic peptide), BNP (B-type natriuretic peptide), hs-cTnT (high-sensitivity cardiac troponin T), fibroblast growth factor 23, spondin 1, insulin-like growth factor binding protein 7, urokinase-type plasminogen activator receptor, osteopontin, pentraxin-related protein 3, and transferrin receptor protein 1R. Among patients with prevalent HF, 9 biomarkers remained significant after adjustment for multiplicity; NT-proBNP, BNP, hs-cTnT, renin, angiotensin-converting enzyme 2, growth differentiation factor 15, and interleukin-6 levels were higher in HF with reduced ejection fraction, whereas levels of stem cell factor and leptin were higher in HF with preserved ejection fraction (all P<0.05).

Conclusions: Of 268 evaluated biomarkers, this study identified biomarkers representing mechanisms strongly associated with subsequent HF hospitalization. HF with reduced ejection fraction was more strongly associated with cardiorenal dysfunction and inflammation markers, while HF with preserved ejection fraction was associated with adipose metabolism and tissue repair proteins.

Background: To investigate the relationship between circulatory stasis in the left atrial appendage (LAA), as detected by cardiac computed tomography angiography, and atrial fibrillation (AF) recurrence after the initial catheter ablation.

Methods: In this single-center prospective observational study, consecutive patients with nonvalvular AF scheduled for the initial catheter ablation were enrolled from August 2018 to June 2022. The primary end point was AF recurrence (any documented atrial tachyarrhythmia lasting for ≥30 seconds after a 3-month blanking period) during 1 year after catheter ablation.

Results: Among the enrolled 548 patients (mean age 65.3±8.8 years and 64.2% men), 131 (23.9%) were with LAA circulatory stasis. Totally, 525 patients completed the 1-year follow-up. AF recurrence was observed in 39.1% (50/128) of patients with circulatory stasis and 19.4% (77/397) of patients without circulatory stasis. The presence of LAA circulatory stasis was significantly associated with AF recurrence (adjusted hazard ratio [HR], 2.41 [95% CI, 1.57-3.72]). The incorporation of circulatory stasis in the LAA significantly improved the predictive accuracy of conventional scoring systems for AF recurrence, with the areas under the curve increasing from 0.524 to 0.616 (P=0.037) for the APPLE score, from 0.516 to 0.617 (P=0.035) for the CAAP-AF score, and from 0.532 to 0.619 (P=0.001) for the CHA₂DS₂-VASc score.

Conclusions: In patients with nonvalvular AF, circulatory stasis in the LAA could serve as a predictor for AF recurrence following the initial ablation procedure.

Background: Spontaneous coronary artery dissection is a cause of myocardial infarction, which predominantly affects middle-aged women. There are limited data on men with spontaneous coronary artery dissection.

Methods: Information on demographics, presenting characteristics, in-hospital outcomes including major adverse cardiovascular events (composite of myocardial infarction, cerebrovascular accident, or heart failure), length of stay, and discharge medications in men and women were obtained from the multicenter iSCAD (International Spontaneous Coronary Artery Dissection) registry.

Results: Of 1252 patients enrolled from 2019 to 2023, 80 (6.4%) were men. Mean age did not significantly differ between sexes (men, 50.2±10.3 versus women 49.7±10.4; P=0.792). Women reported more emotional stress preceding spontaneous coronary artery dissection (10.2% versus 2.5% men; P=0.025). Men reported more physical stress (22.5% versus 7.7% women; P<0.001), both isometric exertion (12.5% versus 2.4% women; P<0.001) and aerobic exertion (12.5% versus 5.6% women, P<0.013). Chest discomfort was the major symptom, although women reported more non-chest discomfort, shortness of breath, and nausea/vomiting. Men had fewer autoimmune conditions, systemic inflammatory disorders, and fibromuscular dysplasia but more recreational drug use. In-hospital major adverse cardiovascular events did not significantly differ (4.1% men versus 8.5% women; P=0.178). The median length of stay was 3.0 (interquartile range, 3.0-4.0) days for males versus 4.0 (interquartile range, 3.0-5.0) days for women (P=0.003). At discharge, more men were prescribed statins (72.5% men versus 55.3% women; P=0.003) and dual antiplatelet therapy (66.3% men versus 53.7% women) (P=0.049).

Conclusions: In a large spontaneous coronary artery dissection registry, there were significant sex differences in presentation, baseline medical conditions, and triggers. In-hospital outcomes were similar, but length of stay was longer for women. Men were more often discharged on statins and dual antiplatelet therapy.

Background: American Heart Association and American College of Cardiology guidelines articulate 4 aortic stenosis (AS) stages to highlight its progressive nature, but limited data exist on cardiac alterations in sub-severe stages.

Methods: ARIC (Atherosclerosis Risk in Communities) study participants with protocol echocardiography at Visit 5 (V5; 2011-2013) and free of aortic valve (AV) replacement or cardiovascular disease were classified by ACC/AHA AS stages at V5 and Visit 7 (V7; 2018-2019). AS stage progression was defined as AV replacement or hospitalization, or a higher stage at V7. Associations of AS stage at V5 and AS stage progression from V5 to V7 with cardiac structure and function were assessed using multivariable linear regression. Associations of extra-AV cardiac abnormality categories with AS stage progression were assessed by multivariable logistic regression.

Results: Of 5206 V5 participants (age 75±5 years, 40% men), AS stages A and B at V5 were associated with greater left ventricular wall thickness, mass, and filling pressure measures at both V5 and V7 compared with Stage 0. Among 1562 participants with assessable AS stage at V7, AS stage progression occurred in 370 and was associated with greater worsening of these measures (all P<0.02). The presence of both left ventricular and left atrial extra-AV abnormalities was associated with greater likelihood of AS stage progression (odds ratio 1.7 [95% CI, 1.2-2.6], P=0.009).

Conclusions: Early AS stages are associated with greater left ventricular mass and diastolic dysfunction, and AS stage progression is associated with worsening of these measures. The presence of both left ventricular and left atrial extra-AV abnormalities is associated with a greater likelihood of early AS stage progression.

Background: The decision to perform ascending thoracic aortic aneurysm (ATAA) repair is primarily guided by diameter thresholds, but the optimal timing remains debated. We aimed to analyze ATAA outcomes in a large cohort of veterans.

Methods: Retrospective cohort study of patients with ATAA with diameter≥4.0 cm under surveillance between 1998 and 2024. Outcomes included surgical repair, all-cause mortality, and aortic events. Fine-Gray competing risks regression evaluated the association of baseline diameter with all-cause mortality, adjusting for age, hypertension, smoking, heart failure, and aortic valve phenotype. Results are reported as adjusted subdistribution hazard ratios (aSHRs) with 95% CIs.

Results: We included 764 veterans (98.0% male) with median (interquartile range) age of 75.0 (9.3) years, and ATAA diameter of 4.40 (0.50) cm. Median follow-up was 5.4 (6.2) years. Surgical repair occurred in 86/764 patients (11.3%). Aortic dissection occurred in 2 patients (0.3%), both within the 4.0 to 4.5 cm group. All-cause mortality rates were 2.83 (2.23-3.59), 3.22 (2.47-4.21), 5.82 (3.91-8.67), and 24.6 (12.2-54.1) deaths per 100 person-years for ATAA diameters 4.0 to 4.4, 4.5 to 4.9, 5.0 to 5.4, and ≥5.5 cm, respectively (P<0.001). In multivariable analysis, all-cause mortality was independently associated with increasing ATAA diameter (aSHR, 1.36 per 0.5cm increase [95% CI, 1.14-1.63]; P<0.001) and increasing age (aSHR, 1.07 per year [95% CI, 1.05-1.09]; P<0.001).

Conclusions: ATAA all-cause mortality increases with diameter, with a 7-fold incidence increase in aneurysms ≥5.5 cm. Our findings support the 5.5 cm threshold for prophylactic ATAA repair and emphasize the need for selective intervention in smaller aneurysms.