Journal of the American Heart Association最新文献

Background: Most intracerebral hemorrhages (ICH) are caused by 1 of 2 cerebral small vessel diseases (cSVDs): arteriolosclerosis and cerebral amyloid angiopathy (CAA). Hypertension is a major risk factor for ICH, but its contribution to the hemorrhagic manifestations of these arteriopathies remains uncertain. We investigated associations between a cardiac structural biomarker of systemic hypertension (left ventricular mass [LVM]) and cSVD neuroimaging phenotype in patients with ICH.

Methods: We assessed brain magnetic resonance imaging and echocardiography cross-sectional data from patients with symptomatic hemorrhagic cSVD, including macroscopic ICH, convexity subarachnoid hemorrhage, or cognitive impairment. We compared LVM in patients with possible or probable CAA, mixed pattern cSVD, or arteriolosclerosis. We used linear regression models to investigate associations between LVM, patient characteristics, and SVD.

Results: We included 216 patients (104 with CAA, 91 with mixed pattern cSVD, and 21 with arteriolosclerosis). Patients with CAA had a significantly lower mean LVM (148.8±44.9 g) compared with those with mixed pattern cSVD or arteriolosclerosis (172.8±59.3 g) (P<0.001). Across all SVD classifications, LVM progressively increased: CAA (148.8±44.9 g), mixed pattern cSVD (168.7±55.3 g), and arteriolosclerosis (190.8±72.9 g). In a multivariable linear regression model adjusted for age, sex, and hypertension, LVM was independently associated with CAA (adjusted mean difference in LVM, 14.6 [95% CI, 1.7-27.4] g higher for mixed pattern cSVD or arteriolosclerosis compared with CAA, P=0.026).

Conclusions: Our findings suggest cardiac structure relates to the neuroimaging phenotype of symptomatic hemorrhagic cSVD, including ICH. This is relevant to the classification, understanding, and prevention of hemorrhagic cSVD.

Background: Accurate cardiac output (CO) measurements during exercise are essential for the diagnosis of exercise pulmonary hypertension (PH), exercise precapillary PH, and exercise postcapillary PH. The purpose of this study is to compare performance of thermodilution CO to gold-standard direct Fick CO (dfCO) at rest and exercise.

Methods: A single-center prospective cohort study of patients undergoing invasive cardiopulmonary exercise test over a 3-year period. For the primary outcome, we predicted CO at each stage of exercise and recovery using generalized additive modeling. In secondary analysis, we assessed mean differences in CO across exercise stages and Bland-Altman analysis at rest and peak exercise. Finally, we assessed the impact in classification of exercise PH, exercise precapillary PH, and exercise postcapillary PH between the 2 CO methods.

Results: A total of 302 patients were included. In the primary analysis, the generalized additive model smooth term was significantly different between thermodilution and dfCO (P<0.001), with thermodilution underestimating dfCO at rest and overestimating dfCO at max exercise. Wide limits of agreement were noted between thermodilution and dfCO, particularly at peak exercise (-0.08 (-4.5 to +4.35) L/min). The classification of exercise PH, exercise precapillary PH, and exercise postcapillary PH was not significantly different between CO methods (4, 3, and 1 patient misclassified by thermodilution, respectively). CO reserve using thermodilution was overestimated compared with dfCO (96.66% versus 88.45%, P<0.001).

Conclusions: There are differences and wide limits of agreement between thermodilution and dfCO both at rest and during exercise. Sequential measurement of thermodilution during exercise with computing of mPAP/CO and PAWP/CO slopes, reduced the clinical impact of the differences in the diagnosis of exercise PH or exercise postcapillary PH.

Background: Low fruit intake is a global risk factor for cardiometabolic diseases. This study sought to investigate vascular and metabolic effects of increasing total and select fruit intake in adults with prediabetes.

Methods: This randomized, 2-arm parallel, partially controlled feeding study provided participants (n=82, aged 45±15 years, 30±6 kg/m²) weekly diets (1500 [women] or 1750 kcal/d [men]) incorporating 1 avocado and 1 cup of mango (avocado-mango diet) daily for 8 weeks or energy-matched low-fat, low-fiber foods (control diet). Flow-mediated vasodilation was the primary end point. Central and brachial blood pressure; pulse-wave velocity; metabolic, inflammatory, and kidney function markers; and dietary intake were secondary end points. Change (Δ) data were analyzed by mixed model ANCOVA or Wilcoxon rank-sum test, and postprandial and dietary intake data by repeated-measures ANOVA using SAS 9.4 (SAS Institute, Cary, NC).

Results: Changes in percentage of flow-mediated vasodilation were significantly different between interventions (effect, -2.11±0.77%; P=0.008), increasing ≈1% on the avocado-mango diet and decreasing on the control diet, as were changes in central and brachial diastolic blood pressure (P=0.07 and P=0.03, respectively), specifically in men. Other end points were generally not different between diets (P>0.05), although select lipids and kidney markers were marginally different (P<0.1). Total fruit, dietary fiber, vitamin C, and monounsaturated fat intake significantly increased during the avocado-mango diet compared with the control diet (P<0.05).

Conclusions: In adults with prediabetes, daily inclusion of avocado and mango increases fruit consumption, diversifies nutrient composition, and improves vascular function associated with cardiovascular health.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05353790.

Background: The clinical use of coronary artery calcium (CAC) scoring for risk stratification in Japan is limited by the absence of population-specific reference data, as applying Western-derived thresholds is inappropriate because of known ethnic variations. This study aimed to establish the first comprehensive, age- and sex-specific CAC reference values for a healthy Japanese population.

Methods: In this single-center retrospective study, we analyzed data from 4891 asymptomatic Japanese adults (63.2% men; median age, 58 years) without a history of atherosclerotic cardiovascular disease or diabetes. Age- and sex-specific CAC percentile curves were generated using nonparametric regression modeling.

Results: Men exhibited a higher CAC burden than women, with scores increasing with age in both sexes. The relationship between detectable CAC (CAC >0) and age was nonlinear: concave down for men and concave up for women, indicating different progression patterns. Compared with MESA (Multi-Ethnic Study of Atherosclerosis) data, the Japanese cohort had a markedly lower CAC burden than White participants and systematically lower scores than Chinese American women.

Conclusions: This study provides the first large-scale, age- and sex-specific CAC reference values for a healthy Japanese population. The generated percentile curves offer a practical tool for clinicians to immediately assess a patient's CAC burden relative to their peers, underscoring that using foreign-derived thresholds is inappropriate for risk stratification in Japan.

Background: Women are frequently underrepresented in studies investigating atrial fibrillation (AF) ablation. We evaluated the acute efficacy, safety, and mid-term outcomes of de novo paroxysmal AF ablation in female patients using a pentaspline pulsed-field ablation (PFA) versus thermal-based technologies.

Methods: In a cohort of consecutive female patients with paroxysmal AF undergoing de novo pulmonary vein isolation, enrolled in the ATHENA-CHARISMA (Advanced Technologies For Successful Ablation of AF in Clinical Practice - Catheter Ablation of Arrhythmias With High-DensityMapping System in the Real WorldPractice) registries, thermal ablation systems (radiofrequency or cryoablation) were compared to the PFA by means of a propensity score matching (ratio 1:1:1).

Results: One-thousand one female patients (mean age 63±10 years, mean left ventricular ejection fraction 60.8±6%) were included: 376 (37.6%) underwent cryoablation ablation, 342 (34.2%) radiofrequency ablation, and 283 (28.3%) PFA. Propensity score matching yielded 684 patients (228 per group). The PFA group had significantly shorter skin-to-skin time (60 [50-75] minutes) compared with both radiofrequency (120 [90-145] minutes, P<0.001) and cryoablation (75 [60-100] minutes, P<0.001), while fluoroscopy time was similar among groups (15 [11-21] minutes for PFA, 14 [10-20] minutes for cryoablation, P=0.599 versus PFA and 14 [9-20] minutes for radiofrequency, P=0.454 versus PFA). Overall complication rate was 3.4% and it was significantly higher after thermal ablation than PFA (4.6% versus 0.9%, OR, 5.5, 95% CI, 1.3-23.5, P=0.0227). During a median follow-up of 413 [277-589] days, 139 (20.3%) patients experienced AF recurrence. The Kaplan-Meier estimated freedom from AF at 1-year follow-up was 86.8% with PFA, 84.6% with cryoablation, and 83.3% with radiofrequency (log-rank P value: 0.839).

Conclusions: Among this cohort of female patients, de novo paroxysmal AF using a pentaspline PFA system demonstrated significantly shorter procedural times, and a lower complication rate compared with thermal ablation systems. One-year follow-up revealed comparable rates of AF freedom across all ablation modalities.

Registration: ATHENA (Advanced Technologies For Successful Ablation of AF in Clinical Practice). URL: http://clinicaltrials.gov/; Unique identifier: NCT05617456. CHARISMA (Catheter Ablation of Arrhythmias With High-Density Mapping System in the Real World Practice). URL: http://clinicaltrials.gov/; Unique Identifier: NCT03793998.

Background: Fibromuscular dysplasia (FMD) is a non-inflammatory arteriopathy that may result in arterial stenosis, dissection, aneurysm, and tortuosity. Data remain limited on clinical features and outcomes of patients with FMD presenting with spontaneous cervical artery dissection (SCeAD). This study aimed to describe the characteristics and long-term outcomes of this population.

Methods: We conducted a retrospective multicenter cohort study of patients diagnosed with both SCeAD and FMD at three U.S. comprehensive stroke centers (2018-2023). Patients were identified through hospital records and vascular registries. Diagnosis of FMD and SCeAD was confirmed through imaging review by vascular neurologists or cardiologists. Outcomes included recurrent dissections, cardiovascular events (ischemic stroke, transient ischemic attack, myocardial infarction, subarachnoid hemorrhage) and mortality.

Results: Among 1,632 patients with SCeAD, 97 (6%) had FMD diagnosis. The cohort was predominantly female (91%) and median age at FMD diagnosis was 50 years(IQR 42-63). Carotid dissections were more frequent than vertebral dissections (86%vs.27%, p<0.001). Multiple dissections occurred in 32 patients (33%): 24 (75%) had bilateral dissections, 4(13%) had recurrent dissections in the same artery, and 7 (22%) had dissections in other vascular beds including the renal, iliac, mesenteric, and coronary arteries. Younger age [OR 0.945; 95%CI 0.908-0.983; p=0.005] and classical FMD "beading" on imaging [OR 3.06; 95%CI 1.28-7.36; p=0.012] were associated with multiple dissections. Aneurysms were detected in 27%, more frequently in patients with multiple dissections [OR 1.66; 95%CI 1.02-2.71;p=0.04]. Most patients were discharged on single (49%) or dual (29%) antiplatelet therapy and 22% received anticoagulation with no significant differences in event rates. Over a mean follow-up of 5±2.5 years, 13% developed recurrent dissections and 28% experienced cardiovascular events. Recurrent dissections were associated with future cardiovascular events [OR11.56; 95%CI 2.22-60.07; p=0.004].

Conclusions: FMD should be considered in patients presenting with SCeAD, particularly middle-aged women with multifocal dissections and no traditional vascular risk factors. There is an increased risk of dissection recurrence, future cardiovascular events and harboring aneurysms. These findings highlight the need for further prospective studies that can guide surveillance and management strategies for this high-risk population.

Background: Subclinical alterations in left ventricular (LV) structure, diastolic function, and metabolic disturbances are associated with coronary heart disease (CHD) risk, but their relationships remained unclear. Large-scale longitudinal metabolomic profiling of LV measures is lacking.

Methods: Using untargeted metabolomics, we quantified 563 fasting plasma metabolites from 1799 American Indian individuals attending 2 exams (~5.5 years apart). We examined associations between metabolites and measures of LV structure (LV mass index, relative wall thickness), and diastolic function (peak early filling velocity to peak late filling velocity, isovolumic relaxation time, and deceleration time) using generalized estimating equation model. Findings were then replicated in an independent biracial cohort. Frailty Cox proportional hazards models were used to examine whether LV-related metabolites are associated with the risk of CHD over a 20-year follow-up. Pathway enrichment analysis was performed to identify relevant metabolic pathways.

Results: We identified 173 metabolites (47 named; q<0.05) associated with LV structure or diastolic function in the SHFS (Strong Heart Family Study), and some metabolites were confirmed in the biracial cohort. Three metabolites were additionally associated with incident CHD. Aspartic acid and palmitoleic acid were associated with lower LV mass index and peak early filling velocity to peak late filling velocity ratio and lower CHD risk (hazard ratios [HRs], 0.75 [95% CI, 0.56-0.99] to 0.81 [95% CI, 0.67-0.99]), whereas isothreonic acid was associated with higher relative wall thickness and higher CHD risk (HR, 1.15 [95% CI, 1.01-1.32]). LV-related metabolites were enriched in arginine biosynthesis, alanine-aspartate-glutamate metabolism, and starch and sucrose metabolism.

Conclusions: We identified metabolomic markers of LV structure and diastolic function, several of which that were independently associated with CHD risk, providing insight into metabolic pathways underlying LV subclinical changes and CHD.

Background: In October 2022, our center implemented a standardized program to promote ventricular recovery in pediatric patients supported with durable ventricular assist devices. We report our experience and outcomes.

Methods: The initiative consists of 4 core components for all patients with ventricular assist devices: (1) cultural shift: routine assessment for ventricular recovery for possible device explant or, in complex congenital heart disease (CHD), for further surgical palliation; (2) reverse remodeling-use of goal-directed medical therapy as tolerated; (3) assessment of recovery: stepwise evaluation by echocardiography, exercise testing, and cardiac catheterization; and (4) multidisciplinary review of patients. This retrospective cohort study includes all patients who underwent durable ventricular assist device implantation between October 2022 and October 2024. Patient characteristics and outcomes are described for those explanted for recovery.

Results: The cohort included 35 patients, 22 (63%) with Berlin Heart EXCOR and 13 (37%) with HeartMate 3. Indications included cardiomyopathy (60%, n=21), CHD (31%, n=11), coronary pathology (6%, n=2), and myocarditis (3%, n=1). Nine patients underwent explant (26% of all patients, 38% of patients without CHD). No patients with CHD met criteria for recovery. Median age of explanted patients was 1 year (interquartile range, 3 months-10 years), and all were discharged postexplant. Median follow-up was 10 months (interquartile range, 5.5-20 months). One patient was relisted for transplant; the others remained outpatient with, at worst, mild ventricular dysfunction.

Conclusions: A standardized approach to ventricular recovery was associated with explant in 26% of patients, exclusively among those without CHD. Short-term postexplant outcomes are encouraging, supporting further study in larger cohorts.