American heart journal plus : cardiology research and practice最新文献_第10页

Evaluation of the predictive value of echocardiography parameters for heart transplant rejection: A tissue Doppler imaging observational study 评价超声心动图参数对心脏移植排斥反应的预测价值：组织多普勒成像观察研究

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-01 Epub Date: 2025-10-24 DOI: 10.1016/j.ahjo.2025.100654

Fereshteh Ghaderi , Hoorak Poorzand , Farveh Vakilian , Hedieh Alimi , Leila Bigdelu , Afsoon Fazlinezhad , Amirhossein Rafighdoost , Faeze Keihanian

Introduction

The rate of heart transplantation is increasing worldwide. Due to the limitations of endomyocardial biopsy (EMB), various non-invasive methods have been suggested to assess rejection. Therefore, the aim of this study was to evaluate the predictive value of echocardiographic parameters to determine heart transplant rejection in a sample of Iranian patients.

Methods

This was a cross-sectional study on heart transplant patients with available EMB results. All patients underwent echocardiography at the same day of EMB and prior to biopsy. The association between echocardiographic parameters and rejection was assessed using binary logistic regression.

Results

A total of 67 patients (50, 74.6 % male and 17, 25.4 % female) with the mean age of 39.20 ± 11.39 years were enrolled in this study. Heart transplant rejection was observed in 22 (32.8 %) patients. There was only a significant difference in mitral inflow peak early diastolic velocity (E) and septal time to peak systolic velocity in ejection phase (septal Ts) between rejection and non-rejection groups. Logistic regression revealed a significant association between rejection and septal Ts (p = 0.048, OR = 0.931) and E velocity (p = 0.022, OR = 78.069). Based on ROC curve, the area under the curve for septal Ts and E were 81.9 % and 68.6 %. Moreover, the sensitivity and specificity for septal Ts and E in detection of rejection were 75 %, 69 % and 68 %, 61 %, respectively.

Conclusion

Septal Ts could be used as a valuable echocardiographic parameter for predicting rejection in heart transplant recipients.

在世界范围内，心脏移植的比率正在上升。由于心内膜心肌活检（EMB）的局限性，各种非侵入性方法被建议评估排斥反应。因此，本研究的目的是评估超声心动图参数对伊朗患者心脏移植排斥反应的预测价值。方法对心脏移植患者进行横断面研究，获得EMB结果。所有患者均在EMB当天和活检前接受超声心动图检查。使用二元逻辑回归评估超声心动图参数与排斥反应之间的关系。结果共纳入67例患者（男性50.74.6%，女性17.25.4%），平均年龄39.20±11.39岁。22例（32.8%）患者出现心脏移植排斥反应。排斥反应组和非排斥反应组在二尖瓣流入峰值舒张早期速度(E)和射血期间隔至收缩峰值速度的时间(t)上仅有显著差异。Logistic回归显示排斥反应与鼻中隔t （p = 0.048, OR = 0.931）和E速度（p = 0.022, OR = 78.069）有显著相关性。根据ROC曲线，间隔t和E的曲线下面积分别为81.9%和68.6%。此外，间隔t和间隔E检测排斥反应的敏感性和特异性分别为75%、69%和68%、61%。结论室间隔t值可作为预测心脏移植受者排斥反应的超声心动图参数。

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引用次数: 0

Clinical utility of the exercise optically pumped magnetocardiographic stress test in young adults: an exploratory study 运动光泵心脏磁图应激试验在年轻人中的临床应用：一项探索性研究

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-01 Epub Date: 2025-10-30 DOI: 10.1016/j.ahjo.2025.100661

Lanxin Feng , Xin Zhao , Shuwen Yang , Linqi Liu , Zhao Ma , Huan Zhang , Jianping Xiang , Ming Ding , Chenchen Tu , Xiantao Song , Hongjia Zhang

Background

To assess the clinical feasibility and safety of exercise magnetocardiographic stress test based on optically pumped magnetometers (OPMs).

Methods

Subjects without previous cardiovascular disease were enrolled in this study. All subjects underwent exercise electrocardiographic stress test (EST) and both rest and stress OPM-based magnetocardiography (MCG).

Results

A total of 26 healthy subjects finally enrolled in this study. None of the subjects reported chest pain, dyspnea or any other discomfort during the test. The mean interval between the completion of EST and the initiation of OPM-based MCG signal acquisition was 60.3 ± 8.4 s. One subject observed obvious deflection of magnetic field (Unstable-MCG group) during stress OPM-based MCG, whereas 25 subjects did not (Stable-MCG group). In Stable-MCG group, the rest and stress magnetocardiographic parameters were phenotypically similar (P > 0.05).

Conclusion

We demonstrated an innovative diagnostic technology with broad potential application value for diagnosing myocardial ischemia and assessed its clinical feasibility and safety. This is a critical step toward making the examination widely used in clinical practice.

背景：评价基于光泵磁强计（OPMs）的运动心电图应力测试的临床可行性和安全性。方法既往无心血管疾病的受试者加入本研究。所有受试者都进行了运动心电图压力测试（EST）和基于休息和压力opm的心脏磁图（MCG）。结果26名健康受试者最终入组。在测试过程中，没有受试者报告胸痛、呼吸困难或任何其他不适。EST完成与基于opm的MCG信号采集开始的平均间隔时间为60.3±8.4 s。1名受试者（不稳定MCG组）在应力OPM-based MCG过程中观察到明显的磁场偏转，25名受试者（稳定MCG组）在应力OPM-based MCG过程中观察到明显的磁场偏转。在稳定- mcg组，休息和应激时的心磁图参数表型相似（P > 0.05）。结论展示了一种具有广泛潜在应用价值的心肌缺血诊断技术，并对其临床可行性和安全性进行了评价。这是使该检查广泛应用于临床实践的关键一步。

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引用次数: 0

Prevalence and mortality rate of heart failure across demographic groups in the United States: 2001–2020 2001-2020年美国人口群体中心力衰竭的患病率和死亡率

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-01 Epub Date: 2025-10-28 DOI: 10.1016/j.ahjo.2025.100658

Maria Alva , Sarahfaye Dolman , Slaven Sikirica , Paul Kolm , Katherine Andrade , Zugui Zhang , William S. Weintraub

Background

Heart failure (HF) is a serious, difficult-to-diagnose condition. Tracking its evolving burden using survey data is key to developing strategies to reduce its impact.

Methods

We use NHANES and CDC-WONDER to determine prevalence and death rates in the U.S. population between 2001 and 2020 across age, sex, and race/ethnicity. We also estimated a crude mortality-to-prevalence ratio (proxy CFR)as a descriptive measure of lethality across demographic groups.

Results

Age-adjusted HF prevalence rates for both males and females increased from 2001 to 2020, with males consistently having higher rates. By 2020, the age-adjusted mortality rate was 32.08 per 100,000 males and 25.69 per 100,000 females. HF prevalence increased across all racial groups (from 1.73 % to 1.92 %, 2.47 % to 2.8 %, and 3.68 % to 4.14 % for Hispanic, White, and Black, respectively). Non-Hispanic Blacks showed a steeper rise in both crude and age-adjusted mortality rates from 2001 to 2020, while the proxy CFR for non-Hispanic Whites remained highest among all groups both in 2001 (23.95/2.47 = 9.70) and in 2020 (29.29/2.80 = 10.46).

Conclusions

We observe rising trends in both prevalence and mortality across all groups. While the absolute burden is highest in Whites, the increase in HF rates among Blacks and the higher mortality rates in males highlight the need for targeted interventions. The findings underscore the importance of continued surveillance and considering multiple metrics (absolute numbers, rates within groups, and proxy CFR) to address HF's burden in diverse populations.

心衰（HF）是一种严重且难以诊断的疾病。利用调查数据跟踪其不断变化的负担是制定减少其影响的战略的关键。方法：我们使用NHANES和CDC-WONDER来确定2001年至2020年间美国人口中不同年龄、性别和种族/民族的患病率和死亡率。我们还估计了粗死亡率与患病率比（代理CFR）作为人口群体死亡率的描述性度量。结果2001年至2020年，男性和女性经年龄调整的心衰患病率均有所上升，男性的患病率始终较高。到2020年，男性年龄调整死亡率为32.08 / 10万，女性为25.69 / 10万。HF患病率在所有种族群体中均有所增加（西班牙裔、白人和黑人分别从1.73%增至1.92%、2.47%增至2.8%、3.68%增至4.14%）。从2001年到2020年，非西班牙裔黑人的粗死亡率和年龄调整死亡率都急剧上升，而非西班牙裔白人的代理CFR在2001年（23.95/2.47 = 9.70）和2020年（29.29/2.80 = 10.46）在所有群体中都保持最高。结论：我们观察到所有人群的患病率和死亡率都呈上升趋势。虽然白人的绝对负担最高，但黑人HF发病率的增加和男性较高的死亡率突出表明需要有针对性的干预措施。研究结果强调了持续监测和考虑多种指标（绝对数字、组内发病率和代理CFR）以解决不同人群心衰负担的重要性。

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引用次数: 0

Addressing maternal cardiovascular risk: The impact of lactation, adverse pregnancy outcomes, and racial disparities 解决产妇心血管风险：哺乳的影响，不良妊娠结局，和种族差异

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-01 Epub Date: 2025-10-30 DOI: 10.1016/j.ahjo.2025.100646

Monica Rodriguez , Michele L. McCarroll , Caroline Marrs , Kamala P. Tamirisa

Pregnancy functions as a cardiopulmonary stress test, revealing underlying cardiovascular disease (CVD) or heightening future CVD risk following adverse pregnancy outcomes (APOs). Studies consistently demonstrate strong associations between APOs, higher mortality rates, and increased risk of cardiometabolic diseases in women from racial and ethnic underrepresented groups (UREG). Social determinants of health, particularly in UREGs, contribute to increasing allostatic load, potentially driving poorer pregnancy outcomes. Breastfeeding has a protective effect on allostatic load and is linked to improved maternal cardiometabolic health. In the United States, UREGs have lower rates of breastfeeding initiation, retention, and duration—potentially influenced by both cultural factors and systemic biases within healthcare. Interventions must extend beyond healthcare settings to engage key stakeholders, including community leaders and families, to create sustainable change and reduce disparities. As maternal CVD prevalence rises among UREG populations, a collaborative, multidisciplinary approach to improving breastfeeding rates is essential to improving maternal and infant health outcomes.

妊娠可作为心肺压力测试，揭示潜在心血管疾病（CVD）或增加不良妊娠结局（apo）后未来心血管疾病的风险。研究一致表明，在种族和民族代表性不足群体（UREG）的妇女中，apo、较高的死亡率和心脏代谢疾病风险增加之间存在强烈关联。健康的社会决定因素，特别是在ureg中，有助于增加适应负荷，可能导致较差的妊娠结局。母乳喂养对适应负荷有保护作用，并与改善母亲的心脏代谢健康有关。在美国，ureg的母乳喂养开始、保持和持续时间的比例较低，这可能受到文化因素和医疗保健系统偏见的影响。干预措施必须延伸到医疗保健环境之外，让包括社区领导人和家庭在内的关键利益攸关方参与进来，以创造可持续的变革并减少差距。随着孕产妇心血管疾病患病率在泌尿系人群中上升，采用多学科合作方法提高母乳喂养率对于改善孕产妇和婴儿健康结果至关重要。

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引用次数: 0

APOE ε4 and ischemic heart disease in American Indian/Indigenous tribal Elders 美洲印第安人/土著部落长者的APOE ε4与缺血性心脏病

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-01 Epub Date: 2025-11-04 DOI: 10.1016/j.ahjo.2025.100662

Rene Labounek , Matti J. Matheson , Ashley J. Petersen , Adam Hansen , Adam D. Block , Corey Strong Jr , Annamarie Hill , Meghan Kremer , Ann J. Robertson , Valmiki Maharaj , Kamakshi Lakshminaryan , Danni Li , J. Neil Henderson , Igor Nestrasil , Christophe Lenglet , William G. Mantyh

Objective

American Indian/Indigenous (AI) populations have the highest rate of ischemic heart disease (IHD) of any racial or ethnic group in the United States. While modifiable cardiovascular risk factors represent a well-established source of elevated IHD in AI, little is known regarding genetic IHD influences, in particular APOE ε4, which has an ancestry-dependent prevalence and effect on human disease. We sought to quantify the prevalence and association between APOE ε4 and IHD in AI communities.

Methods

We performed a cross-sectional, community-based study including tribal Elders (ages >54 years) at the Bois Forte Band of Chippewa in the state of Minnesota. We collected data pertaining to demographics, cardiovascular risk factors, APOE ε4 genotype, and ischemic heart disease (defined as history of myocardial infarction, coronary artery bypass graft, angiogram showing coronary artery disease, percutaneous transluminal coronary angioplasty, or thrombolytic therapy).

Findings

One-hundred-eighty-one participants were included. Their median age and interquartile range were 67 (61, 73) years, AI ancestry was 75 % (50 %, 100 %), 126 (70 %) were females, 46 (25 %) were APOE ε4 heterozygous, and 5 (2.8 %) were APOE ε4 homozygous. Each APOE ε4 allele increased the odds of IHD in AI tribal Elders 2.38-fold (95 % CI: 0.94–6.89; p = 0.06), which is comparable to a two-point rise in hemoglobin A1C.

Conclusions

APOE ε4 appears to play an important role in the risk of IHD in AI populations, given its high prevalence and strong association with IHD.

目的美洲印第安人/土著（AI）人口是美国所有种族或民族中缺血性心脏病（IHD）发病率最高的。虽然可改变的心血管危险因素代表了AI中IHD升高的一个公认的来源，但对于遗传性IHD的影响知之甚少，特别是APOE ε4，它具有依赖于祖先的患病率和对人类疾病的影响。我们试图量化APOE ε4和IHD在AI社区的患病率和相关性。方法我们在明尼苏达州Chippewa Bois Forte部落进行了一项以社区为基础的横断面研究，其中包括部落长老（54岁）。我们收集了有关人口统计学、心血管危险因素、APOE ε4基因型和缺血性心脏病（定义为心肌梗死史、冠状动脉搭桥术、血管造影显示冠状动脉疾病、经皮腔内冠状动脉成形术或溶栓治疗）的数据。研究结果共纳入181名参与者。年龄中位数和四分位数范围为67（61,73）岁，AI祖先75%(50%,100%)，女性126 (70%)，APOE ε4杂合46 (25%)，APOE ε4纯合5（2.8%）。每个APOE ε4等位基因使AI部落长者患IHD的几率增加2.38倍（95% CI: 0.94-6.89; p = 0.06），相当于血红蛋白A1C升高2个点。结论鉴于apoe ε4的高流行率和与IHD的强相关性，apoe ε4可能在AI人群IHD发病风险中起重要作用。

{"title":"APOE ε4 and ischemic heart disease in American Indian/Indigenous tribal Elders","authors":"Rene Labounek , Matti J. Matheson , Ashley J. Petersen , Adam Hansen , Adam D. Block , Corey Strong Jr , Annamarie Hill , Meghan Kremer , Ann J. Robertson , Valmiki Maharaj , Kamakshi Lakshminaryan , Danni Li , J. Neil Henderson , Igor Nestrasil , Christophe Lenglet , William G. Mantyh","doi":"10.1016/j.ahjo.2025.100662","DOIUrl":"10.1016/j.ahjo.2025.100662","url":null,"abstract":"<div><h3>Objective</h3><div>American Indian/Indigenous (AI) populations have the highest rate of ischemic heart disease (IHD) of any racial or ethnic group in the United States. While modifiable cardiovascular risk factors represent a well-established source of elevated IHD in AI, little is known regarding genetic IHD influences, in particular <em>APOE ε4</em>, which has an ancestry-dependent prevalence and effect on human disease. We sought to quantify the prevalence and association between <em>APOE ε4</em> and IHD in AI communities.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional, community-based study including tribal Elders (ages >54 years) at the Bois Forte Band of Chippewa in the state of Minnesota. We collected data pertaining to demographics, cardiovascular risk factors, <em>APOE ε4</em> genotype, and ischemic heart disease (defined as history of myocardial infarction, coronary artery bypass graft, angiogram showing coronary artery disease, percutaneous transluminal coronary angioplasty, or thrombolytic therapy).</div></div><div><h3>Findings</h3><div>One-hundred-eighty-one participants were included. Their median age and interquartile range were 67 (61, 73) years, AI ancestry was 75 % (50 %, 100 %), 126 (70 %) were females, 46 (25 %) were <em>APOE ε4</em> heterozygous, and 5 (2.8 %) were <em>APOE ε4</em> homozygous. Each <em>APOE ε4</em> allele increased the odds of IHD in AI tribal Elders 2.38-fold (95 % CI: 0.94–6.89; <em>p</em> = 0.06), which is comparable to a two-point rise in hemoglobin A1C.</div></div><div><h3>Conclusions</h3><div><em>APOE ε4</em> appears to play an important role in the risk of IHD in AI populations, given its high prevalence and strong association with IHD.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"60 ","pages":"Article 100662"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cognition and coronary events: A narrative overview of neurocognitive impairment in ACS patients 认知和冠状动脉事件：ACS患者神经认知障碍的叙述性概述

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-01 Epub Date: 2025-11-03 DOI: 10.1016/j.ahjo.2025.100666

Umaimah Batool Mirza , Faareah Mansoor , Umna Fnu , Summiya Riaz , Mehar Zaka , Ahmed Asad Raza , Abedin Samadi

Neurocognitive dysfunction is a common but often overlooked complication in patients with Acute Coronary Syndrome (ACS). This narrative review aims to provide a comprehensive synthesis of current evidence on the prevalence, mechanisms, clinical assessment, and management strategies of cognitive impairment in ACS patients. We highlight how neurocognitive deficits including memory loss, reduced attention, and executive dysfunction arise from cerebral hypoperfusion, systemic inflammation, microvascular injury, and post-infarct metabolic stress. These deficits arise from mechanisms including cerebral hypoperfusion, systemic inflammation, microvascular injury, and post-infarct metabolic stress. Such impairments are associated with poorer clinical outcomes, decreased treatment adherence, and increased mortality.

Routine cognitive assessment remains absent from standard ACS management, despite the availability of effective tools such as the Montreal Cognitive Assessment (MoCA), which can detect subtle cognitive deficits early in hospitalization. Integrating cognitive screening into clinical protocols enables timely interventions and better patient stratification. Management strategies should combine pharmacological treatment of cardiovascular risk factors with non-pharmacological interventions such as cognitive rehabilitation, mental health support, and lifestyle modification. Multidisciplinary collaboration between cardiology, neurology, psychology, and rehabilitation specialists is essential to address both cardiac and cognitive recovery.

By integrating findings from clinical and epidemiological studies, this review underscores the need for routine cognitive screening, multidisciplinary care, and innovative interventions such as telemedicine to improve patient outcomes. Recognizing cognitive health as an integral part of ACS management offers a more holistic, patient-centered approach to recovery.

神经认知功能障碍是急性冠脉综合征（ACS）患者常见但常被忽视的并发症。本文旨在对ACS患者认知功能障碍的患病率、机制、临床评估和管理策略提供全面的综合证据。我们强调包括记忆丧失、注意力下降和执行功能障碍在内的神经认知缺陷是如何由脑灌注不足、全身炎症、微血管损伤和梗死后代谢应激引起的。这些缺陷的机制包括脑灌注不足、全身炎症、微血管损伤和梗死后代谢应激。这种损伤与较差的临床结果、治疗依从性降低和死亡率增加有关。尽管蒙特利尔认知评估（MoCA）等有效工具可以在住院早期发现细微的认知缺陷，但标准的ACS管理中仍然缺少常规的认知评估。将认知筛查纳入临床方案能够及时干预并更好地对患者进行分层。管理策略应结合心血管危险因素的药物治疗和非药物干预，如认知康复、心理健康支持和生活方式改变。心脏病学、神经学、心理学和康复专家之间的多学科合作对于解决心脏和认知康复至关重要。通过整合临床和流行病学研究结果，本综述强调了常规认知筛查、多学科护理和远程医疗等创新干预措施改善患者预后的必要性。认识到认知健康是ACS管理的一个组成部分，提供了一个更全面的，以患者为中心的康复方法。

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引用次数: 0

The controversies in the clinical management of β-blockers in acute heart failure induced by rapid atrial fibrillation: A narrative review β-受体阻滞剂治疗快速心房颤动所致急性心力衰竭的临床管理争议：综述

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-01 Epub Date: 2025-10-24 DOI: 10.1016/j.ahjo.2025.100655

Wenfang Zhu , Jinpeng Xu , Liang Zhang

Rapid atrial fibrillation (rapid AF) often induces or exacerbates acute heart failure (HF). However, there is controversy regarding whether β-blockers should be used to control the ventricular rate in patients during the acute HF phase. AF management guidelines generally recommend considering the addition of β-blockers when digoxin-like drugs (such as cedilanid) fail to effectively control the ventricular rate. Nevertheless, HF guidelines clearly state that β-blockers should be used with caution during the acute decompensation phase to avoid the negative inotropic effect that may exacerbate the condition. This article systematically reviews the clinical management strategies under this guideline contradiction, including: (1) Different recommendations on ventricular rate control and the use of β-blockers in domestic and international guidelines for AF and HF; (2) A pooled analysis of relevant research evidence; (3) Application strategies of β-blockers (especially short-acting agents esmolol and landiolol) in the acute phase. We focus on discussing the latest research progress and clinical application strategies of esmolol and landiolol in HF induced by rapid AF, evaluate their effectiveness and safety. Although some studies and consensus articles have focused on the management of rapid AF complicated by HF, there is currently a lack of systematic reviews on this issue. Therefore, the writing of this review has important academic value and clinical guiding significance, providing a reference for treatment decisions in this special population.

快速心房颤动（AF）常诱发或加重急性心力衰竭（HF）。然而，关于β受体阻滞剂是否应该用于控制急性心衰期患者的心室率存在争议。房颤管理指南一般建议，当地高辛类药物（如西地兰）不能有效控制心室率时，考虑添加β受体阻滞剂。然而，心衰指南明确指出，β受体阻滞剂在急性失代偿期应谨慎使用，以避免可能加重病情的负性肌力效应。本文系统综述了这一指南矛盾下的临床管理策略，包括：(1)国内外AF和HF指南中对心室率控制和β受体阻滞剂使用的不同建议；(2)相关研究证据的汇总分析；(3) β受体阻滞剂（尤其是短效药物艾司洛尔和兰地洛尔）在急性期的应用策略。重点讨论艾司洛尔和兰地洛尔治疗快速房颤所致心衰的最新研究进展及临床应用策略，评价其有效性和安全性。虽然一些研究和共识文章关注的是快速房颤合并心衰的管理，但目前缺乏对这一问题的系统综述。因此，本综述的撰写具有重要的学术价值和临床指导意义，为这一特殊人群的治疗决策提供参考。

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引用次数: 0

Regional differences in characteristics of patients with acute coronary syndromes pre- and during Coronavirus-2019 pandemic 2019冠状病毒大流行前后急性冠状动脉综合征患者特征的地区差异

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-01 Epub Date: 2025-10-14 DOI: 10.1016/j.ahjo.2025.100640

K. Bryniarski , D. Makowicz , P. Kleczynski , M. Nosal , P. Brzychczy , K. Mroz , M. Okarski , J. Twardosz , M. Gasior , J. Legutko

Introduction

Coronavirus-2019 (COVID-19) pandemic placed unprecedented levels of stress on healthcare systems leading to prolonged waiting times and reduced access to emergency medical services. With acute coronary syndrome (ACS) longer delays could mean worsening of the symptoms of admitted patients. Studies exploring ACS in COVID-19 reported either results from one hospital or nation-wide registries and many of them did not report laboratory values. Aim of our study was to compare differences in patients and procedural characteristics before and during COVID-19 period in two hospitals differing mainly in population characteristics.

Methods

Data was gathered in two polish cities – Krakow (2nd biggest city in Poland) and Krosno (smaller city with big rural areas). We have analyzed years 2019 and 2020 and included 448 patients in Krosno and 678 patients in Krakow.

Results

In Krosno during pandemic patients were significantly more often transported from home by emergency medical services as opposed to period before COVID-19 (16.3 % vs. 62.2 %). Killip class at admission in Krosno was higher during pandemic (3.5 % vs. 10.4 % for Killip class 4). Similarly, patients in Krosno in 2020 had significantly higher troponin and NT-proBNP levels. We did not observe any of those differences in Krakow. Procedural characteristics were comparable in both interventional cardiology centers.

Conclusions

Even among the same country large differences in health condition of patients with ACS may be observed between different areas. Those results highlight the need of regional protocols on how to improve patient related factors and accessibility to healthcare system during unprecedented events.

2019冠状病毒（COVID-19）大流行给医疗保健系统带来了前所未有的压力，导致等待时间延长，获得紧急医疗服务的机会减少。对于急性冠脉综合征（ACS），较长的延迟可能意味着入院患者的症状恶化。探索COVID-19中ACS的研究报告的结果要么来自一家医院，要么来自全国范围的登记处，其中许多没有报告实验室值。本研究的目的是比较两家主要人群特征不同的医院在COVID-19之前和期间的患者和程序特征的差异。方法数据收集于波兰两个城市——克拉科夫（波兰第二大城市）和克罗斯诺（农村面积较大的小城市）。我们分析了2019年和2020年，包括克罗斯诺的448名患者和克拉科夫的678名患者。结果大流行期间，克罗斯诺患者通过紧急医疗服务从家中转移的频率明显高于疫情前（16.3% vs. 62.2%）。大流行期间，Krosno的Killip级入学率较高（3.5% vs. Killip 4级10.4%）。同样，2020年克罗斯诺患者的肌钙蛋白和NT-proBNP水平也明显升高。我们在克拉科夫没有观察到任何这些差异。两个介入性心脏病中心的手术特点具有可比性。结论同一国家不同地区ACS患者健康状况存在较大差异。这些结果突出了如何在前所未有的事件中改善患者相关因素和卫生保健系统可及性的区域协议的必要性。

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引用次数: 0

Post-thoracic aortic aneurysm procedural mental wellbeing: A scoping review 胸主动脉瘤后手术心理健康：范围回顾

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-01 Epub Date: 2025-10-15 DOI: 10.1016/j.ahjo.2025.100642

Jasper C. Murphy , Natalie K. Kolba , Ian T. Winkeler , Lichun He , Deborah M. Li , Claire D. Kim , Jonathan D. Price , Thomas V. Bilfinger , Henry J. Tannous , Allison J. McLarty , A. Laurie Shroyer

引用次数: 0

Impact of intracoronary adenosine on the no-reflow phenomenon: A randomized, triple-blind, placebo-controlled clinical trial 冠状动脉内腺苷对无血流现象的影响：一项随机、三盲、安慰剂对照的临床试验

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-01 Epub Date: 2025-10-20 DOI: 10.1016/j.ahjo.2025.100650

Fatemeh Baharvand , Mohammadreza Aghajankhah , Shiva Parvaneh , Bahareh Gholami Chaboki , Francesca Maria Di Muro

Introduction

The no-reflow phenomenon occurs in 5 % to 50 % of patients with ST-elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PPCI), leading to suboptimal myocardial reperfusion and poor outcomes. Although intracoronary adenosine has shown benefits in studies, its use remains controversial. This analysis aims to evaluate the impact of intracoronary adenosine administration on preventing NRP during PPCI.

Methods

In this randomized, triple-blind, placebo-controlled trial, 240 STEMI patients undergoing PPCI were divided into two cohorts, one receiving a bolus dose of intracoronary adenosine and the other receiving 5 cc of saline as a placebo before stenting. The primary endpoint was the incidence of NRP measured by Thrombolysis in Myocardial Infarction flow grade and frame count. Secondary endpoints included ST-segment resolution after 90 min, left ventricular ejection fraction, and major adverse cardiac events after 40 days.

Results

Among 240 STEMI patients, adenosine did not significantly reduce angiographic no-reflow compared with placebo (TIMI flow grade ≤ 2: 15 % vs. 19.2 %, p = 0.391). However, adenosine significantly improved left ventricular recovery at 40 days (ΔLVEF: 13.8 ± 7.4 % vs. 12.1 ± 8.4 %, p = 0.043). Multivariable analysis identified diabetes, active smoking, and lower eGFR as independent predictors of no-reflow, while adenosine independently enhanced LVEF recovery.

Conclusion

Prophylactic intracoronary adenosine did not significantly reduce angiographic no-reflow in STEMI patients undergoing primary PCI but was associated with greater left ventricular functional recovery at 40 days. These findings suggest a cardioprotective effect of adenosine on the microvasculature and myocardial tissue, supporting its potential role as an adjunctive therapy in STEMI management.

在首次经皮冠状动脉介入治疗（PPCI）期间，5% ~ 50%的st段抬高型心肌梗死（STEMI）患者出现无再流现象，导致心肌再灌注次优，预后较差。尽管研究显示冠状动脉内腺苷有益，但其使用仍存在争议。本分析旨在评估PPCI期间冠状动脉内腺苷对预防NRP的影响。在这项随机、三盲、安慰剂对照试验中，240名接受PPCI的STEMI患者被分为两组，一组在支架植入前接受冠状动脉内腺苷的大剂量注射，另一组接受5cc生理盐水作为安慰剂。主要终点是通过溶栓测量心肌梗死血流等级和帧数的NRP发生率。次要终点包括90分钟后st段分辨率、左室射血分数和40天后主要心脏不良事件。结果在240例STEMI患者中，与安慰剂相比，腺苷没有显著降低血管造影无回流（TIMI血流等级≤2:15% vs. 19.2%, p = 0.391）。然而，腺苷可显著改善40天左心室恢复（ΔLVEF: 13.8±7.4%比12.1±8.4%,p = 0.043）。多变量分析发现糖尿病、主动吸烟和较低的eGFR是无血流再流的独立预测因素，而腺苷独立地增强了LVEF的恢复。结论预防性冠状动脉内腺苷并不能显著降低STEMI患者行首次PCI的血管造影无血流倒流，但与40天左心室功能恢复有关。这些发现表明腺苷对微血管和心肌组织具有心脏保护作用，支持其作为STEMI管理辅助治疗的潜在作用。

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