Journal of the American Heart Association最新文献

Background: Carpal tunnel syndrome (CTS) has been recognized as a potential early manifestation of systemic amyloidosis; however, its prognostic implications for cardiovascular and renal outcomes remain unclear.

Methods: Using the TriNetX global federated research network, we conducted a retrospective cohort study of patients with bilateral CTS between January 2006 and December 2024. Among 221 902 eligible individuals, 2099 had concomitant amyloidosis. After 1:1 propensity score matching for demographics, comorbidities, medications, and laboratory variables, 1957 matched pairs were analyzed. Outcomes included major adverse cardiovascular events, 3-point major adverse cardiovascular events, heart failure, arrhythmia, dialysis initiation, and major adverse kidney events. Cox proportional hazards models and Kaplan-Meier analyses were performed.

Results: Compared with patients with CTS and amyloidosis (reference group), those without amyloidosis had significantly lower risks of major adverse cardiovascular events (adjusted hazard ratio [aHR], 0.41 [95% CI, 0.28-0.59]), 3-point major adverse cardiovascular events (aHR, 0.26 [95% CI, 0.19-0.35]), heart failure (aHR, 0.45 [95% CI, 0.30-0.64]), arrhythmia (aHR, 0.50 [95% CI, 0.35-0.69]), dialysis initiation (aHR, 0.51 [95% CI, 0.37-0.95]), and major adverse kidney events (aHR, 0.28 [95% CI, 0.25-0.99]; all P<0.05). Kaplan-Meier curves demonstrated consistently lower event-free survival in the amyloidosis group. Sensitivity analyses across alternative modeling strategies yielded directionally consistent results. The median diagnostic delay from CTS to amyloidosis was 3.3 years (interquartile range, 1.4-5.7) and was shorter in the posttafamidis era.

Conclusions: Systemic amyloidosis is associated with substantially increased cardiovascular and renal risks among patients with CTS, highlighting the importance of heightened clinical vigilance and earlier recognition.

Background: Left bundle branch area pacing (LBBAP) is considered to be an alternative modality to deliver cardiac resynchronization therapy (CRT). However, left bundle branch pacing and left ventricular septal pacing (LVSP) are characterized as left bundle branch area pacing. The long-term effect of only LVSP in patients with a CRT indication is still unknown.

Methods: Consecutive patients who met the CRT indication were retrospectively included. LVSP was determined during the procedure. New York Heart Association functional class, NT-proBNP (N-terminal pro-B-type natriuretic peptide), and echocardiographic and pacing parameters were assessed at implant and follow-up visit.

Results: A total of 40 consecutive patients with successful LVSP were included for analysis with a mean follow-up period of 29.4±16.2 months. The QRS complex in lead V₁ during LVSP featured a QS pattern (52.5%), Qr/qR pattern (30%), or rsR pattern (17.5%). LVSP significantly shortened QRS duration (from baseline 172.5±16.8 to 135.3±19.8 ms, P<0.001) with V₆ R-wave peak time of 96.4±9.6 ms. Left ventricular ejection fraction mproved from 26.7±7.4% at baseline to 38.8±16.1% (P<0.001) and a decrease in the LV end-diastolic diameter (67.9±9.8 versus 59.7±10.4 mm; P<0.001) during the follow-up. Echocardiographic response and superresponse were observed in 52.5% and 22.5% of patients, respectively. New York Heart Association functional class improved from 2.7±0.4 at baseline to 1.9±0.6 (P<0.01) and NT-proBNP concentration decreased significantly (4544±975 versus 2353±1225 pg/mL; P<0.001). No procedure-related complications occurred during the implantation procedure.

Conclusions: LVSP is clinically feasible and safe in patients undergoing CRT. LVSP appears to be an alternative CRT pacing strategy with suboptimal ventricular resynchronization.

Background: Chronic kidney disease (CKD) is prevalent in patients undergoing percutaneous coronary intervention for chronic total occlusion and is associated with worse outcomes due to impaired renal function. Understanding the outcomes and predictors of adverse events in this population is crucial.

Methods: A retrospective observational study was conducted on patients undergoing chronic total occlusion percutaneous coronary intervention at Houston Methodist DeBakey Heart and Vascular Center (2018-2023). Patients were categorized on the basis of kidney function: CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m²) and non-CKD. The primary end point was procedural success. Secondary end points included 1-year all-cause death; clinically driven target-lesion revascularization at 1 year; target-lesion failure, defined as the composite of heart failure hospitalization, stroke, target-lesion revascularization, and myocardial infarction at 1 year; in-stent restenosis at 1 year, and in-hospital complications.

Results: A total of 492 patients were included, with 176 (35.8%) diagnosed with CKD. Patients with CKD were older and had a higher comorbidity burden. Patients with CKD had more complex disease, with higher rates of multivessel disease and graft vessel stenosis. Procedural success rates were high and similar between the groups (83.0% versus 83.4%). While 1-year all-cause death was comparable, patients with CKD exhibited higher rates of target lesion revascularization (hazard ratio, 2.41 [95% CI, 1.53-3.78]; P<0.001). Procedural complexity was not found as an independent predictor of death or target lesion revascularization.

Conclusions: Although chronic total occlusion percutaneous coronary intervention is associated with higher postprocedural outcomes in patients with CKD, procedural success was comparable between the groups. Further studies are needed to refine postprocedural management strategies.

Background: Understanding the transition from preclinical heart failure to its symptomatic stages, and its associated biomarker and Doppler echocardiographic changes, is crucial for prevention.

Methods: This was a retrospective cohort study using the STOP-HF (St. Vincent's Screening to Prevent Heart Failure) study. Median follow-up was 4.5 (interquartile range [IQR], 4.4-9.8) years. A total of 1425 participants were classified as stage A (at risk) or stage B (asymptomatic structural/functional abnormalities). Serial assessments included BNP (B-type natriuretic peptide), Doppler echocardiography, and cardiologist review. Progression to stage B required significant interval echocardiographic worsening, and regression required significant improvement. BNP levels and patient events between visits were recorded.

Results: At visit 1, 67% (n=959) of individuals were stage A and 33% (n=466) stage B. By visit 2, 22% (n=214) of stage A had progressed to stage B (4.4±0.3 per 100 person-years), while 10% of stage B had progressed to stage C (1.6±0.2 per 100 person-years). Stage A progressors had higher baseline BNP (26.4 [IQR, 12.7-53.2] pg/mL) versus nonprogressors (12.6 [IQR, 6.2-25.1] pg/mL; P<0.001). In stage B, 18% (n=86) regressed to stage A (3.1±0.3 per 100 person-years) with lower baseline BNP (21.6 [IQR, 9.2-52.7] pg/mL) versus progressors to stage C (83 [IQR, 50.7-166] pg/mL) and remainers in stage B (51.1 [IQR, 17.9-85.7] pg/mL) and more favorable Doppler echocardiographic features. Event rates increased with progression and were similar for stage B to stage A regressors and stage A remainers.

Conclusions: Preclinical heart failure exhibits a bidirectional trajectory, with evidence of regression/stability supporting prevention. Incorporating natriuretic peptide screening enhances risk stratification and effectiveness of preventative screening/intervention services.

Background: Clinical studies have shown that aortic arch pulse-wave velocity (PWV_aa), a measure of local aortic stiffness, is a strong independent predictor of subsequent white matter hyperintensity volume and white matter integrity, both associated with cognitive decline, elevated stroke risk, vascular dementia, and neurodegenerative diseases. Total arterial compliance (TAC), a measure of global arterial stiffness, has been recognized as a marker of preclinical vascular disease. This study introduces a smartphone-based method for the noninvasive measurement of PWV_aa and TAC using carotid pressure waveforms acquired via smartphone.

Methods: This method uses intrinsic frequency analysis of smartphone-acquired (iPhone) carotid pressure waveforms to assess PWV_aa and TAC. The method was trained, validated, and blind-tested on a cohort of 132 participants aged 20 to 90 years, including both healthy individuals and those with cardiovascular disease, all of whom underwent cardiac magnetic resonance imaging, tonometry, and iPhone waveform measurements.

Results: In the blind test set, our method achieved Pearson correlations of 0.81 and 0.80 for PWV_aa and TAC, with biases of -0.20 m/s and -0.06 mL/mm Hg and limits of agreement of -4.09 to 3.68 m/s and -0.52 to 0.40 mL/mm Hg, respectively. In the heart failure population, correlations were 0.81 for both, with a PWV_aa a bias of -1.07 m/s and TAC bias of -0.06 mL/mm Hg.

Conclusions: Our smartphone-based method enables accurate assessment of local and global arterial stiffness metrics (PWV_aa and TAC). It offers easy-to-use monitoring of vascular aging and arterial health, with important implications for identifying patients at higher risk of neurodegenerative and cardiovascular diseases.

Registration: URL: clinicaltrials.org; Unique Identifier: NCT02240979.