Journal of the American Heart Association最新文献

Background: As a noninvasive, low-cost, nonpharmacological procedure with excellent properties of safety, remote ischemic conditioning (RIC) has been demonstrated to prevent recurrence of stroke among patients with ischemic stroke of large artery atherosclerosis origin. We hypothesized that the benefit is attributed to the improvement of collaterals by chronic RIC in this population, and we aimed to explore the influence of chronic RIC on collateral status evaluated by digital subtraction angiography in this population.

Methods: The RICAS (Remote Ischemic Preconditioning on Collaterals of Atherosclerosis Stroke) study is a prospective, randomized, blind end point, multicenter study. Eligible patients with ischemic stroke of anterior circulation caused by large artery atherosclerosis, poor collateral compensation, and more than 1 month of symptom onset, are randomly assigned into experimental and control groups with a ratio of 1:1. The patients in the experiment group will receive treatment with RIC (bilateral upper limbs, for a total procedure time of 50 minutes, twice daily) for 1 year as an adjunct to guideline-based treatment, while patients in the control group only receive guideline-based treatment. A maximum of 300 patients (150 participants per group) are required to test the superiority hypothesis with 80% power (using a 2-sided α=0.05) to detect a 15% difference. Subgroup analyses for the primary end point will be performed on 8 prespecified subgroups by age, sex, ischemic event (acute ischemic stroke ore transient ischemic stroke), tandem lesion, history of hypertension, hypercholesterolemia, diabetes, and myocardial infarction. The primary outcome is the proportion of collateral status improvement, which is defined as an increase of ≥1 point on the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology score, as assessed by digital subtraction angiography at 12 months after randomization. The safety outcomes include RIC-related adverse events.

Conclusions: This study may provide the direct evidence for the potential effect of chronic RIC treatment on the improvement of collateral status.

Registration: URL: https://clinicaltrials.gov. Unique identifier: NCT06170944.

Background: Plasma protein alterations may occur in patients with acute myocardial infarction (AMI). In this study, we investigated the plasma proteomics of patients with first-onset AMI to identify a novel diagnostic target for myocardial infarction.

Methods: Using a case-control design, we recruited 6 patients with first-onset AMI and 6 age- and sex-matched healthy controls. Mass spectrometry was used to analyze their plasma proteomics. Additionally, we enrolled 156 patients with AMI and 232 healthy individuals to validate the differentially expressed proteins using ELISA.

Results: A total of 58 differentially expressed proteins were identified between the 2 groups (P<0.05, fold change ≥2 or ≤1/2), including 36 upregulated and 22 downregulated proteins. Notably, we discovered a clinically significant protein, thymosin β4 (TMSB4), which was subsequently validated by ELISA. Plasma TMSB4 levels were significantly elevated in patients with first-onset AMI compared with the control group (1093 [701-1608] ng/mL versus 421 [245-658] ng/mL; P<0.001). Univariate and multivariate logistic regression analyses indicated that TMSB4 is a risk factor for first-onset AMI. The receiver operating characteristic curve yielded an area under the curve value of 0.849, with an optimal cutoff of 682 ng/mL, sensitivity of 0.808, and specificity of 0.793. A robust correlation was observed between TMSB4 and cardiac troponin I (r=0.9044, P<0.0001), and the κ test yielded a moderate concordance value (κ=0.590 [95% CI, 0.509-0.671]; P<0.001).

Conclusions: TMSB4 holds diagnostic value for first-onset myocardial infarction and may therefore be considered a potential diagnostic marker for infarction.

Registration: URL: https://www.chictr.org.cn/; unique identifier: ChiCTR2300078144.

Background: Although heart failure is a well-known major global public health concern, the general understanding of the clinical status of pediatric heart failure (PHF) is inadequate. Therefore, this study aims to enhance the general understanding of clinical characteristics across different PHF age groups and provide references for improving PHF treatment strategies.

Methods: This multicenter retrospective cohort study involved patients from 20 Chinese provinces, primarily including hospitalized patients (aged ≤18 years) diagnosed with heart failure between January 2013 and December 2022. The study subjects were categorized into 4 groups: neonatal, infant and toddler, young children, and adolescent.

Results: Herein, 2903 hospitalized patients with PHF were included. Significant differences were observed across age groups in clinical characteristics, auxiliary examination results, comorbid diagnoses, and hospitalization outcomes. After adjusting for covariates, the odds of in-hospital death were significantly lower in the infant and toddler (odds ratio [OR], 0.46 [95% CI, 0.25-0.85]), young children (OR, 0.39 [95% CI, 0.18-0.85]), and adolescent (OR, 0.34 [95% CI, 0.13-0.87]) groups compared with the neonatal group. Furthermore, the odds of cardiovascular adverse events were significantly higher in the young children (OR, 1.91 [95% CI, 1.62-2.88]) and adolescent (OR, 2.16 [95% CI, 1.15-4.06]) groups compared with the neonatal group. Additionally, regarding the odds of a bad Ross class, the adolescent group had 1.85 times higher odds (95% CI, 1.11-3.09) compared with the neonatal group, 2.36 times (95% CI, 1.67-3.35) higher odds compared with the infant and toddler group, and 1.45 times (95% CI, 1.05-2.02) higher odds compared with the young children group (P<0.05).

Conclusions: This study emphasizes the importance of age-specific stratification in PHF management, revealing distinct clinical and prognostic differences across various developmental stages.

Registration: URL: https://www.chictr.org.cn. Unique identifier: ChiCTR2300078262.

Background: Coronary microvascular dysfunction has been associated with adverse cardiovascular events following acute myocardial infarction. This study evaluates the role of the angiography-derived index of microcirculatory resistance (angio-IMR) in predicting myocardial damage in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI).

Methods and results: In this post hoc analysis of the CLEVER-ACS (Controlled-Level Everolimus in Acute Coronary Syndromes) trial, the associations between post-PCI angio-IMR of infarct-related coronary arteries (IRAs) and infarct size, microvascular obstruction, and left ventricular ejection fraction at 30 days as assessed by cardiac magnetic resonance were investigated. High post-PCI angio-IMR was defined as ≥40 mm Hg*s . In non-IRAs, angio-IMR was measured before IRA-PCI. A total of 52 IRAs and 94 non-IRAs of 52 patients were analyzed. Post-PCI angio-IMR was 41.5 (interquartile range [IQR], 28.5-55.7) mm Hg*s  in IRAs and pre-PCI angio-IMR was 43.7 (IQR, 31.7-54.0) mm Hg*s in non-IRAs (P=0.70). Patients with high post-PCI angio-IMR (52%) exhibited a larger myocardial infarct size (36.0 [IQR, 23.0-52.5] g versus 14.5 [IQR, 6.50-26.5] g, P<0.001) and a lower left ventricular ejection fraction (46.5% [IQR, 39.5%-49.5%] versus 55.0% [IQR, 48.0%-61.4%], P=0.002) at 30 days as compared with those with low post-PCI angio-IMR values. Post-PCI angio-IMR positively correlated with myocardial infarct size (r=0.45, P=0.001) and extent of microvascular obstruction (r=0.40, P=0.004) at 30 days. Post-PCI angio-IMR predicted myocardial infarct size (area under the curve, 0.78 [IQR, 0.65-0.92]; P=0.001) and extent of microvascular obstruction (area under the curve, 0.74 [IQR, 0.60-0.89]; P=0.009) at 30 days.

Conclusions: In patients with ST-segment-elevation myocardial infarction, post-PCI angio-IMR was identified as independent predictor of myocardial infarct size and extent of microvascular obstruction.

Registration: URL: https://clinicaltrials.gov; Unique Identifier: NCT01529554.

Background: Segregation index (SI) has been associated with worsened health. However, the relationship between SI within health care teams (degree of heterogeneity between teams caring for Black compared with White patients) and cardiovascular care is unclear among adequately insured populations. We sought to assess the relationship between health care team SI, patient race, receipt of care by a cardiologist, 1-year survival, and 30-day readmission rates for Black compared with White patients admitted with heart failure, ischemic heart disease, or valvular heart disease.

Methods: Using Optum's de-identified Clinformatics Data Mart Database (CDM) from 2009 to 2020, generalized linear mixed-effects were used to analyze effects of patient race and SI on receipt of care by a cardiologist, and care by a cardiologist on 1-year survival and 30-day readmission.

Results: Among 6572 patients (17.1% Black), the odds of receiving care by a cardiologist were 31.3% less for Black than White patients (adjusted odds ratio 0.687 [95% CI, 0.545-0.872]; P=0.001). However, there was no statistically significant association of SI on receipt of care by a cardiologist (P=0.14). For those seen by a cardiologist, the adjusted odds ratio (Black-to-White) of 1-year survival increased with increasing SI (P=0.02). SI had no statistically significant effect on 30-day readmission (P=0.86).

Conclusions: Among patients hospitalized for heart failure, ischemic heart disease, or valvular heart disease, segregation of health care teams was not associated with receipt of care by cardiologists in Indiana hospitals. When cardiologists were included, the odds of 1-year survival increased for Black versus White patients with increasing segregation of clinicians, and segregation was not associated with 30-day readmission.

Background: Recurrent pulmonary vein stenosis (PVS) following surgical repair of total anomalous pulmonary venous connection is associated with poor prognosis. Preclinical studies have shown that use of an angiotensin receptor blocker can attenuate intimal hyperplasia; notwithstanding, its clinical utility is of uncertain benefit.

Methods: This single-center study included patients undergoing total anomalous pulmonary venous connection repair in 2020 to 2021. Since August 2020, patients have been considered for valsartan therapy early after operation. Contemporaneous participants were subcategorized into study versus control groups based on valsartan exposure. Patients in the control group were treated with the same protocolized algorithm except valsartan administration. The primary end point was postoperative PVS (PPVS) progression.

Results: Overall, 104 patients operated on at a median age of 1.3 months were included (valsartan group: 25 versus control group: 79). The baseline characteristics were similar between the 2 groups. Within a median follow-up of 28.6 months, 27 patients developed PPVS noted by echocardiography and computed tomography angiography, among which 22 with clinical PPVS underwent reoperations. No between-group difference was observed in the incidence of initial PPVS (P=0.80, Cohen's h=0.06 [95% CI, -0.38 to 0.50]) and reoperation (P=0.46, Cohen's h=-0.18[ 95% CI, -0.65 to 0.29]); however, patients in the valsartan group had a significantly lower risk of PPVS progression (P=0.019, Cohen's h=-1.12 [95% CI, -1.66 to -0.57]) and subsequent PPVS progression after reoperation (P=0.011, Cohen's h=-1.71 [95% CI, -2.61 to -0.82]) compared with the control group. PPVS-related death was observed in 9 cases (11.4%) in the control group versus none (0%) in the valsartan group. No adverse event related to valsartan occurred in this series.

Conclusions: Early use of valsartan after total anomalous pulmonary venous connection surgery appears to potentially be a feasible and effective adjunct to reoperation in treating pediatric acquired PVS.

Background: Coronary artery disease is a leading cause of morbidity and mortality in the United States. Coronary artery disease can lead to major complications including myocardial infarction (MI). The association of dietary cholesterol with coronary artery disease remains inconsistent. We examined the relation of dietary cholesterol with the incidence of MI among participants of the Million Veteran Program.

Methods and results: The Million Veteran Program is a prospective cohort database collecting genetic and nongenetic factors influencing chronic diseases. We analyzed data from 180 156 veterans with complete information on relevant dietary intake. The association between dietary cholesterol and MI risk was assessed using both linear and nonlinear models. Statistical significance was determined using the Wald test for linear trends and the likelihood ratio test for nonlinearity, alongside comparisons between high (≥300 mg/d) and low (<300 mg/d) cholesterol intake groups. In this study of 180 156 veterans with mean follow-up of 3.5 years, we observed a linear, dose-response association between dietary cholesterol intake and risk of MI, with every 100-mg/d increment in cholesterol intake associated with a 5% higher MI risk (relative risk [RR], 1.05 [95% CI, 1.02-1.08]). Subjects consuming >300 mg/d of cholesterol had a 15% increased MI risk compared with those consuming less (RR, 1.15 [95% CI, 1.06-1.25]).

Conclusions: We found that dietary cholesterol intake was linearly associated with greater risk of MI. These findings contribute to the growing literature highlighting the impact dietary cholesterol has on cardiovascular health. Reductions in cholesterol intake, which can be achieved by decreasing the intake of meat and eggs, may reduce the risk of incident MI.