Pub Date : 2025-03-10DOI: 10.1016/j.ahjo.2025.100524
Ana Florencia Becerra , Udochukwu Amanamba , Jonathan E. Lopez , Noah J. Blaker , David E. Winchester
Cardiogenic shock (CS) is a heterogeneous condition associated with exceptionally high mortality rates, despite significant advances in the field of cardiology. The primary causes of CS are myocardial infarction-related CS (AMI-CS) and acute decompensated heart failure-related CS (ADHF-CS). Management of CS is inherently complex, with the initial focus—irrespective of the underlying etiology—centered on preserving end-organ perfusion. Parenteral vasopressors and inotropes are the cornerstone of therapy to achieve this objective. However, data on the comparative efficacy of different vasoactive agents in CS remain limited, and no single agent has demonstrated clear superiority. Recent progress in the staging and phenotyping of CS has provided a framework for more tailored therapeutic approaches. This review offers a comprehensive and updated summary of current evidence on the use of vasopressors and inotropes in AMI-CS and ADHF-CS, including a discussion of specific scenarios, such as right ventricular CS (RV-CS).
{"title":"The current use of vasoactive agents in cardiogenic shock related to myocardial infarction and acute decompensated heart failure","authors":"Ana Florencia Becerra , Udochukwu Amanamba , Jonathan E. Lopez , Noah J. Blaker , David E. Winchester","doi":"10.1016/j.ahjo.2025.100524","DOIUrl":"10.1016/j.ahjo.2025.100524","url":null,"abstract":"<div><div>Cardiogenic shock (CS) is a heterogeneous condition associated with exceptionally high mortality rates, despite significant advances in the field of cardiology. The primary causes of CS are myocardial infarction-related CS (AMI-CS) and acute decompensated heart failure-related CS (ADHF-CS). Management of CS is inherently complex, with the initial focus—irrespective of the underlying etiology—centered on preserving end-organ perfusion. Parenteral vasopressors and inotropes are the cornerstone of therapy to achieve this objective. However, data on the comparative efficacy of different vasoactive agents in CS remain limited, and no single agent has demonstrated clear superiority. Recent progress in the staging and phenotyping of CS has provided a framework for more tailored therapeutic approaches. This review offers a comprehensive and updated summary of current evidence on the use of vasopressors and inotropes in AMI-CS and ADHF-CS, including a discussion of specific scenarios, such as right ventricular CS (RV-CS).</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100524"},"PeriodicalIF":1.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-08DOI: 10.1016/j.ahjo.2025.100525
Jennifer Trube, Michael Sabina, Aqeel Khanani, Kayla Hernandez, Zoya Khan, Anas Bizanti
Introduction
Inflammation is a key risk factor in cardiovascular diseases, such as atherosclerosis, and has been linked to increased mortality following myocardial infarction. While inflammation promotes tissue repair, sustained inflammation can drive adverse cardiac remodeling, fibrosis, and impaired contractility, resulting in poorer outcomes. This maladaptive remodeling, compounded by oxidative stress, also predisposes patients to cardiovascular diseases. Colchicine has shown anti-inflammatory benefits in cardiovascular disease, but its role in individual diseases remains unclear. This literature review seeks to understand and evaluate the clinical trials evaluating colchicine in cardiovascular treatment.
Methods
A literature search identified randomized controlled trials (RCTs) evaluating colchicine in cardiovascular disease including coronary artery disease, post-myocardial infarction treatment, atrial fibrillation, heart failure, and stroke.
Conclusions
Colchicine has been studied across many cardiovascular conditions including atrial fibrillation (AF), coronary artery disease (CAD), post-myocardial infarction treatment, heart failure (HF) and stroke; however, evidence of its clinical effectiveness remains mixed. While colchicine has shown prfomise in reducing recurrent cardiovascular events in stable CAD, its impact in postoperative AF prevention, acute coronary syndrome (ACS), HF, and stroke prevention is limited.
{"title":"Colchicine therapy in cardiovascular medicine: A literature review","authors":"Jennifer Trube, Michael Sabina, Aqeel Khanani, Kayla Hernandez, Zoya Khan, Anas Bizanti","doi":"10.1016/j.ahjo.2025.100525","DOIUrl":"10.1016/j.ahjo.2025.100525","url":null,"abstract":"<div><h3>Introduction</h3><div>Inflammation is a key risk factor in cardiovascular diseases, such as atherosclerosis, and has been linked to increased mortality following myocardial infarction. While inflammation promotes tissue repair, sustained inflammation can drive adverse cardiac remodeling, fibrosis, and impaired contractility, resulting in poorer outcomes. This maladaptive remodeling, compounded by oxidative stress, also predisposes patients to cardiovascular diseases. Colchicine has shown anti-inflammatory benefits in cardiovascular disease, but its role in individual diseases remains unclear. This literature review seeks to understand and evaluate the clinical trials evaluating colchicine in cardiovascular treatment.</div></div><div><h3>Methods</h3><div>A literature search identified randomized controlled trials (RCTs) evaluating colchicine in cardiovascular disease including coronary artery disease, post-myocardial infarction treatment, atrial fibrillation, heart failure, and stroke.</div></div><div><h3>Conclusions</h3><div>Colchicine has been studied across many cardiovascular conditions including atrial fibrillation (AF), coronary artery disease (CAD), post-myocardial infarction treatment, heart failure (HF) and stroke; however, evidence of its clinical effectiveness remains mixed. While colchicine has shown prfomise in reducing recurrent cardiovascular events in stable CAD, its impact in postoperative AF prevention, acute coronary syndrome (ACS), HF, and stroke prevention is limited.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100525"},"PeriodicalIF":1.3,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-06DOI: 10.1016/j.ahjo.2025.100519
Muhammad Ahmad Qureshi
{"title":"Letter to the Editor: “Accurate diagnosis of ischemic heart disease without exposure to radiation using non-stress unshielded magnetocardiography (MCG)”","authors":"Muhammad Ahmad Qureshi","doi":"10.1016/j.ahjo.2025.100519","DOIUrl":"10.1016/j.ahjo.2025.100519","url":null,"abstract":"","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100519"},"PeriodicalIF":1.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-05DOI: 10.1016/j.ahjo.2025.100523
Gerald V. Naccarelli
{"title":"Is it time to shorten the blanking period after atrial fibrillation ablation procedures?","authors":"Gerald V. Naccarelli","doi":"10.1016/j.ahjo.2025.100523","DOIUrl":"10.1016/j.ahjo.2025.100523","url":null,"abstract":"","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100523"},"PeriodicalIF":1.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-05DOI: 10.1016/j.ahjo.2025.100522
Robert B. Takla
{"title":"Editor's response to letter","authors":"Robert B. Takla","doi":"10.1016/j.ahjo.2025.100522","DOIUrl":"10.1016/j.ahjo.2025.100522","url":null,"abstract":"","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100522"},"PeriodicalIF":1.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute thoracic aortic dissection (ATAD) has a high mortality rate. Factors that contribute to its onset include the environment, genetic factors, and infectious diseases. Recently, the presence of monocytes/macrophages has been suggested to attract inflammatory and immune cells to lesions. This, together with levels of D-dimer, brain natriuretic peptide (BNP), aspartate aminotransferase (AST), and lactate dehydrogenase (LD), may be useful in predicting a prognosis for ATAD. This study examined the relationship between a combination of such laboratory data and prognosis in ATAD.
Design
A single-center retrospective study. The association between early mortality from ATAD and laboratory data was statistically investigated.
Setting
Treatment strategies were at the discretion of each attending physician.
Participants
A total of 118 patients with ATAD (59 early deaths and 59 survivors).
Main outcome measures
The value of D-dimer, BNP, AST, and LD levels, and the peripheral blood monocyte ratio as scores for the early prediction of a prognosis without requiring advanced testing equipment.
Results
The AST/LD, D-dimer, and BNP levels were significantly elevated in those who died prematurely. In contrast, the monocyte ratio in the peripheral blood leukocyte fraction was significantly decreased. The AST/LD, which was associated with cardiac troponin I, was the most significant variable. An average positive value from each test was defined as an acute aortic dissection prognostic score (AAD-PS). The area under the curve on the receiver operating characteristic was 0.895.
Conclusion
In ATAD patients, the AAD-PS may be a potentially new and useful test item for predicting prognosis.
{"title":"An acute aortic dissection prognostic score for predicting early in-hospital mortality in acute thoracic aortic dissection","authors":"Satoshi Kimura , Hiroaki Sato , Shohei Shimajiri , Toshiyuki Nakayama","doi":"10.1016/j.ahjo.2025.100521","DOIUrl":"10.1016/j.ahjo.2025.100521","url":null,"abstract":"<div><h3>Study objective</h3><div>Acute thoracic aortic dissection (ATAD) has a high mortality rate. Factors that contribute to its onset include the environment, genetic factors, and infectious diseases. Recently, the presence of monocytes/macrophages has been suggested to attract inflammatory and immune cells to lesions. This, together with levels of D-dimer, brain natriuretic peptide (BNP), aspartate aminotransferase (AST), and lactate dehydrogenase (LD), may be useful in predicting a prognosis for ATAD. This study examined the relationship between a combination of such laboratory data and prognosis in ATAD.</div></div><div><h3>Design</h3><div>A single-center retrospective study. The association between early mortality from ATAD and laboratory data was statistically investigated.</div></div><div><h3>Setting</h3><div>Treatment strategies were at the discretion of each attending physician.</div></div><div><h3>Participants</h3><div>A total of 118 patients with ATAD (59 early deaths and 59 survivors).</div></div><div><h3>Main outcome measures</h3><div>The value of D-dimer, BNP, AST, and LD levels, and the peripheral blood monocyte ratio as scores for the early prediction of a prognosis without requiring advanced testing equipment.</div></div><div><h3>Results</h3><div>The AST/LD, D-dimer, and BNP levels were significantly elevated in those who died prematurely. In contrast, the monocyte ratio in the peripheral blood leukocyte fraction was significantly decreased. The AST/LD, which was associated with cardiac troponin I, was the most significant variable. An average positive value from each test was defined as an acute aortic dissection prognostic score (AAD-PS). The area under the curve on the receiver operating characteristic was 0.895.</div></div><div><h3>Conclusion</h3><div>In ATAD patients, the AAD-PS may be a potentially new and useful test item for predicting prognosis.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100521"},"PeriodicalIF":1.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.ahjo.2025.100518
Celestine Odigwe, Rajasekhar Mulyala, Haijra Malik, Brent Ruiz, Mariam Riad, Mohammad As Sayiadeh, Sanchitha Honganur, Alexis Parks, Mustafeez Ur Rahman, Nasser Lakkis
Semaglutide, a GLP-1 receptor agonist, has emerged as a promising agent in cardiovascular disease management, particularly for patients with obesity and diabetes. Recent studies have demonstrated significant benefits of Semaglutide beyond glycemic control, including reduced major adverse cardiovascular events (MACE), improvements in heart failure symptoms, and weight reduction. Notably, the STEP-HFpEF trial highlighted improved exercise capacity and a reduction in NT-proBNP levels, offering a novel therapeutic pathway for heart failure management. Additionally, Semaglutide has shown anti-inflammatory effects, reducing C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α), thereby mitigating atherosclerotic risks. Moreover, the SELECT trial demonstrated Semaglutide's cardiovascular benefits in non-diabetic, obese patients, suggesting that its effects extend beyond weight loss. These findings represent a potential paradigm shift in cardiovascular risk management, although access and affordability remain key challenges.
{"title":"Emerging role of GLP-1 agonists in cardio-metabolic therapy - Focus on Semaglutide","authors":"Celestine Odigwe, Rajasekhar Mulyala, Haijra Malik, Brent Ruiz, Mariam Riad, Mohammad As Sayiadeh, Sanchitha Honganur, Alexis Parks, Mustafeez Ur Rahman, Nasser Lakkis","doi":"10.1016/j.ahjo.2025.100518","DOIUrl":"10.1016/j.ahjo.2025.100518","url":null,"abstract":"<div><div>Semaglutide, a GLP-1 receptor agonist, has emerged as a promising agent in cardiovascular disease management, particularly for patients with obesity and diabetes. Recent studies have demonstrated significant benefits of Semaglutide beyond glycemic control, including reduced major adverse cardiovascular events (MACE), improvements in heart failure symptoms, and weight reduction. Notably, the STEP-HFpEF trial highlighted improved exercise capacity and a reduction in NT-proBNP levels, offering a novel therapeutic pathway for heart failure management. Additionally, Semaglutide has shown anti-inflammatory effects, reducing C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α), thereby mitigating atherosclerotic risks. Moreover, the SELECT trial demonstrated Semaglutide's cardiovascular benefits in non-diabetic, obese patients, suggesting that its effects extend beyond weight loss. These findings represent a potential paradigm shift in cardiovascular risk management, although access and affordability remain key challenges.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100518"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-28DOI: 10.1016/j.ahjo.2025.100517
Stephanie Jou , Laura P. Gelfman , Karen P. Alexander , R. Sean Morrison , Deepak L. Bhatt , Alan Moskowitz , Emilia Bagiella , Annetine Gelijns , Gregg W. Stone , David J. Cohen , Leslee J. Shaw , Krishna K. Patel
Background
When patients with suspected or known coronary artery disease (CAD) present with new or worsening ischemic symptoms, initial referral to imaging or optimization of guideline directed medical therapy (GDMT) with deferral of testing are both acceptable management approaches.
Methods
In this 12-center study, a 19-item survey exploring preferred management strategy for symptomatic older adults (≥75 years) with or without known CAD, and major patient and clinical factors driving this decision making was administered to clinicians.
Results
There were 96 respondents (70.8 % cardiologists, 20.9 % primary care physicians/geriatricians). Among patients without known CAD, 59 (61.4 %) respondents favored early referral to testing, 6 (6.3 %) opted for initial GDMT and 23 (24.0 %) preferred both. For patients with known CAD, 27 (28.1 %) prioritized initial GDMT optimization, 37 (38.6 %) would refer for early testing and 19.8 % both. Key factors influencing initial preference for GDMT optimization were unoptimized anti-anginal medications, patient preference, increased complication risk, frailty, cognitive impairment and comorbidities. Key factors influencing preference for initial imaging were increasing symptom severity, already optimized GDMT, and electrocardiogram changes. When imaging revealed ischemia, clinicians reported weighing symptom severity, ischemic burden, current medications, comorbidities, frailty, and procedural risks before referring for invasive cardiac angiography.
Conclusion
Both initial GDMT optimization and referral for imaging are frequently used approaches for the symptomatic older patient with suspected or known CAD. The survey highlighted the importance of patient characteristics such as frailty, cognitive impairment, multimorbidity and the gap in clinical guidance on how to optimally manage symptomatic older adults with CAD.
{"title":"Clinical practice patterns among older multimorbid adults presenting with suspected ischemic symptoms: A multi-center survey","authors":"Stephanie Jou , Laura P. Gelfman , Karen P. Alexander , R. Sean Morrison , Deepak L. Bhatt , Alan Moskowitz , Emilia Bagiella , Annetine Gelijns , Gregg W. Stone , David J. Cohen , Leslee J. Shaw , Krishna K. Patel","doi":"10.1016/j.ahjo.2025.100517","DOIUrl":"10.1016/j.ahjo.2025.100517","url":null,"abstract":"<div><h3>Background</h3><div>When patients with suspected or known coronary artery disease (CAD) present with new or worsening ischemic symptoms, initial referral to imaging or optimization of guideline directed medical therapy (GDMT) with deferral of testing are both acceptable management approaches.</div></div><div><h3>Methods</h3><div>In this 12-center study, a 19-item survey exploring preferred management strategy for symptomatic older adults (≥75 years) with or without known CAD, and major patient and clinical factors driving this decision making was administered to clinicians.</div></div><div><h3>Results</h3><div>There were 96 respondents (70.8 % cardiologists, 20.9 % primary care physicians/geriatricians). Among patients without known CAD, 59 (61.4 %) respondents favored early referral to testing, 6 (6.3 %) opted for initial GDMT and 23 (24.0 %) preferred both. For patients with known CAD, 27 (28.1 %) prioritized initial GDMT optimization, 37 (38.6 %) would refer for early testing and 19.8 % both. Key factors influencing initial preference for GDMT optimization were unoptimized anti-anginal medications, patient preference, increased complication risk, frailty, cognitive impairment and comorbidities. Key factors influencing preference for initial imaging were increasing symptom severity, already optimized GDMT, and electrocardiogram changes. When imaging revealed ischemia, clinicians reported weighing symptom severity, ischemic burden, current medications, comorbidities, frailty, and procedural risks before referring for invasive cardiac angiography.</div></div><div><h3>Conclusion</h3><div>Both initial GDMT optimization and referral for imaging are frequently used approaches for the symptomatic older patient with suspected or known CAD. The survey highlighted the importance of patient characteristics such as frailty, cognitive impairment, multimorbidity and the gap in clinical guidance on how to optimally manage symptomatic older adults with CAD.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100517"},"PeriodicalIF":1.3,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-23DOI: 10.1016/j.ahjo.2025.100514
Riccardo Fenici , Marco Picerni , Peter Fenici , Donatella Brisinda
Decades of experimental and clinical studies, along with the most recent clinical trials, have demonstrated the diagnostic potential of magnetocardiography, particularly for the non-invasive early diagnosis of myocardial ischemia. It has also proven to be a valuable clinical tool for monitoring fetal well-being, normal growth, prenatal arrhythmias, and risk markers for sudden death. Such applications have recently received official recognition from Health Canada and the American Heart Association. This unquestionable success, and the additional evidence of magnetocardiography's high sensitivity in diagnosing infiltrative and inflammatory cardiomyopathies, has sparked renewed interest among clinicians.
However, while these aforementioned applications are likely to significantly influence the broader clinical adoption of magnetocardiography, the general focus on these areas has shifted attention away from what we have always regarded as the fundamental strength of contactless cardiac magnetic field mapping: its unique ability to bridge the gap between experimental electrophysiology at the cellular level and non-invasive clinical assessments of human electrophysiology.
This review aims to engage readers by sharing our vision, experience, and several key research milestones, emphasizing the lesser-explored yet significant potential of magnetocardiography. Specifically, it highlights its unique capability to detect electrically silent phenomena that may be critical for the timely and accurate identification of arrhythmogenic focal electrotonic and vortex currents, which can trigger or sustain life-threatening arrhythmias.
{"title":"An advanced vision of magnetocardiography as an unrivalled method for a more comprehensive non-invasive clinical electrophysiological assessment","authors":"Riccardo Fenici , Marco Picerni , Peter Fenici , Donatella Brisinda","doi":"10.1016/j.ahjo.2025.100514","DOIUrl":"10.1016/j.ahjo.2025.100514","url":null,"abstract":"<div><div>Decades of experimental and clinical studies, along with the most recent clinical trials, have demonstrated the diagnostic potential of magnetocardiography, particularly for the non-invasive early diagnosis of myocardial ischemia. It has also proven to be a valuable clinical tool for monitoring fetal well-being, normal growth, prenatal arrhythmias, and risk markers for sudden death. Such applications have recently received official recognition from Health Canada and the American Heart Association. This unquestionable success, and the additional evidence of magnetocardiography's high sensitivity in diagnosing infiltrative and inflammatory cardiomyopathies, has sparked renewed interest among clinicians.</div><div>However, while these aforementioned applications are likely to significantly influence the broader clinical adoption of magnetocardiography, the general focus on these areas has shifted attention away from what we have always regarded as the fundamental strength of contactless cardiac magnetic field mapping: its unique ability to bridge the gap between experimental electrophysiology at the cellular level and non-invasive clinical assessments of human electrophysiology.</div><div>This review aims to engage readers by sharing our vision, experience, and several key research milestones, emphasizing the lesser-explored yet significant potential of magnetocardiography. Specifically, it highlights its unique capability to detect electrically silent phenomena that may be critical for the timely and accurate identification of arrhythmogenic focal electrotonic and vortex currents, which can trigger or sustain life-threatening arrhythmias.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100514"},"PeriodicalIF":1.3,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-22DOI: 10.1016/j.ahjo.2025.100516
Manoj Kumar , Nso Nso , Yehya Khlidj , Shafaqat Ali , Nomesh Kumar , Pramod Kumar Ponna , Steve Attanasio , Wilbert S. Aronow , Javed Butler , Javier Gomez Valencia , Kevin M. Alaxendar , Thomas A. Zelniker , Amit Pursnani , John Preston Erwin , Mark J. Ricciardi , Manan Pareek , Sripal Bangalore , Arman Qamar
Background
The association between cardiovascular disease and advanced liver disease is incompletely understood. To explore this interaction, we compared management, clinical outcomes, readmission rates, and resource utilization in ST-elevation myocardial infarction (STEMI) patients with and without liver disease.
Methods
The Nationwide Readmissions Database (2016–2020) was queried to identify hospitalizations for STEMI. Cohorts were stratified by presence of liver disease. Liver disease was defined as documented diagnosis of liver cirrhosis or liver failure. Multivariable regression model and propensity score matching was used to compare the risk of outcomes.
Results
Among 1,029,608 hospitalizations for STEMI; 45,478 (4.4 %) patients had a history of significant liver disease. Patient with liver disease had higher baseline prevalence of diabetes, chronic kidney disease, anemia, and heart failure. After propensity matching (N = 24,067 in each group), patients with liver disease had higher in-hospital mortality (48.8 % vs 17.3 %, aOR: 6.80 [CI: 6.55–7.06], p < 0.001) and adverse events, including cerebrovascular accidents (6.8 % vs 4.4 %, aOR:1.74 [CI: 1.62–1.86], p < 0.001), cardiac arrest (24.4 % vs 10.3 %, aOR:3.34 [CI: 3.21–3.48], p < 0.001), cardiogenic shock (55.9 % vs 21.1 %, aOR: 6.4 [CI: 6.18–6.64], p < 0.001), mechanical circulatory support requirement (36.2 % vs 14.4 %, aOR: 4.2 [CI: 4.01–4.34], p < 0.001), and major adverse cardiovascular and cerebrovascular events (61.1 % vs 25.3 %, aOR:6.5 [CI: 6.28–6.75], p < 0.001). From 2016 to 2020, in-hospital mortality for STEMI did not change significantly for patients with liver disease (47.4 % to 48.6 % p-trend: 0.826), however percutaneous coronary intervention (PCI) use increased from 43.6 % to 52.2 % (p-trend <0.001).
Conclusion
In STEMI hospitalizations, patients with liver disease have significantly higher mortality, and adverse events as compared with those without liver disease. Despite the increasing use of primary PCI, mortality remains high in STEMI patients with liver disease.
{"title":"Management and outcomes of patients with ST-elevation myocardial infarction and liver disease—Insights from the Nationwide Readmissions Database","authors":"Manoj Kumar , Nso Nso , Yehya Khlidj , Shafaqat Ali , Nomesh Kumar , Pramod Kumar Ponna , Steve Attanasio , Wilbert S. Aronow , Javed Butler , Javier Gomez Valencia , Kevin M. Alaxendar , Thomas A. Zelniker , Amit Pursnani , John Preston Erwin , Mark J. Ricciardi , Manan Pareek , Sripal Bangalore , Arman Qamar","doi":"10.1016/j.ahjo.2025.100516","DOIUrl":"10.1016/j.ahjo.2025.100516","url":null,"abstract":"<div><h3>Background</h3><div>The association between cardiovascular disease and advanced liver disease is incompletely understood. To explore this interaction, we compared management, clinical outcomes, readmission rates, and resource utilization in ST-elevation myocardial infarction (STEMI) patients with and without liver disease.</div></div><div><h3>Methods</h3><div>The Nationwide Readmissions Database (2016–2020) was queried to identify hospitalizations for STEMI. Cohorts were stratified by presence of liver disease. Liver disease was defined as documented diagnosis of liver cirrhosis or liver failure. Multivariable regression model and propensity score matching was used to compare the risk of outcomes.</div></div><div><h3>Results</h3><div>Among 1,029,608 hospitalizations for STEMI; 45,478 (4.4 %) patients had a history of significant liver disease. Patient with liver disease had higher baseline prevalence of diabetes, chronic kidney disease, anemia, and heart failure. After propensity matching (N = 24,067 in each group), patients with liver disease had higher in-hospital mortality (48.8 % vs 17.3 %, aOR: 6.80 [CI: 6.55–7.06], p < 0.001) and adverse events, including cerebrovascular accidents (6.8 % vs 4.4 %, aOR:1.74 [CI: 1.62–1.86], p < 0.001), cardiac arrest (24.4 % vs 10.3 %, aOR:3.34 [CI: 3.21–3.48], p < 0.001), cardiogenic shock (55.9 % vs 21.1 %, aOR: 6.4 [CI: 6.18–6.64], p < 0.001), mechanical circulatory support requirement (36.2 % vs 14.4 %, aOR: 4.2 [CI: 4.01–4.34], p < 0.001), and major adverse cardiovascular and cerebrovascular events (61.1 % vs 25.3 %, aOR:6.5 [CI: 6.28–6.75], p < 0.001). From 2016 to 2020, in-hospital mortality for STEMI did not change significantly for patients with liver disease (47.4 % to 48.6 % p-trend: 0.826), however percutaneous coronary intervention (PCI) use increased from 43.6 % to 52.2 % (p-trend <0.001).</div></div><div><h3>Conclusion</h3><div>In STEMI hospitalizations, patients with liver disease have significantly higher mortality, and adverse events as compared with those without liver disease. Despite the increasing use of primary PCI, mortality remains high in STEMI patients with liver disease.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"52 ","pages":"Article 100516"},"PeriodicalIF":1.3,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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