American heart journal plus : cardiology research and practice最新文献_第3页

Impact of baseline anemia on outcomes following chronic total occlusion percutaneous coronary intervention 基线贫血对慢性全闭塞经皮冠状动脉介入治疗后预后的影响

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 DOI: 10.1016/j.ahjo.2025.100708

Chloe Kharsa , Gal Sella , Yasser Sammour , Rody G. Bou Chaaya , Mangesh Kritya , Jerrin Philip , Muhammad Hassan Masood Virk , Muhammad Haisum Maqsood , Neal S. Kleiman , Alpesh R. Shah

Background

Anemia is a common comorbidity in patients undergoing percutaneous coronary intervention (PCI) and may signal worse post-procedural outcomes. Its prognostic impact in the context of chronic total occlusion (CTO) PCI remains underexplored.

Objectives

To evaluate procedural and clinical outcomes following CTO PCI in patients with and without anemia using real-world data from a high-volume tertiary care center.

Methods

We conducted a retrospective observational study using data from 504 patients who underwent CTO PCI between January 2018 and December 2023 at Houston Methodist. Patients were stratified by anemia status, defined using World Health Organization hemoglobin thresholds. Primary endpoints included procedural success, one-year all-cause mortality, and target lesion revascularization (TLR). Secondary endpoints included target lesion failure (TLF) and in-hospital complications.

Results

Of the cohort, 163 patients (32.3 %) had anemia. Patients with anemia were older, more often female, and had a greater burden of comorbidities, including CKD and heart failure. Despite similar lesion complexity and procedural success rates (80.4 % vs. 81.5 %; p = 0.79), patients with anemia had higher rates of in-hospital complications and one-year mortality (18.1 % vs. 5.0 %; HR = 4.0, p < 0.001)one-year target lesion failure (HR = 1.9; 95 % CI [1.2–2.9]; p = 0.005). Multivariate analysis identified age, heart failure, anemia and multivessel PCI as independent predictors of mortality at one-year, while CKD, and ISR lesion were predictors of TLF at one-year. The severity of anemia was not independently associated with all-cause mortality.

Conclusion

Pre-procedural anemia is associated with markedly worse in-hospital and long-term outcomes in patients undergoing CTO PCI, despite comparable technical success. These findings highlight anemia as a marker of systemic vulnerability and underscore the need for comprehensive risk stratification and multidisciplinary care in this high-risk population.

背景：在接受经皮冠状动脉介入治疗（PCI）的患者中，贫血是一种常见的合并症，可能预示着更糟糕的术后结果。其在慢性全闭塞（CTO） PCI背景下的预后影响仍未得到充分探讨。目的利用来自高容量三级医疗中心的真实世界数据，评估有或无贫血患者CTO PCI治疗的程序和临床结果。方法：我们对2018年1月至2023年12月在休斯顿卫理公会医院接受CTO PCI治疗的504例患者的数据进行了回顾性观察研究。根据世界卫生组织血红蛋白阈值定义的贫血状态对患者进行分层。主要终点包括手术成功、一年全因死亡率和靶病变血运重建术（TLR）。次要终点包括靶病变失败（TLF）和院内并发症。结果163例（32.3%）患者有贫血。贫血患者年龄较大，多为女性，并且有更大的合并症负担，包括CKD和心力衰竭。尽管病变复杂性和手术成功率相似（80.4% vs. 81.5%; p = 0.79），但贫血患者的住院并发症和一年内死亡率更高（18.1% vs. 5.0%; HR = 4.0, p < 0.001），一年内目标病变失败（HR = 1.9; 95% CI [1.2-2.9]; p = 0.005）。多因素分析发现，年龄、心力衰竭、贫血和多血管PCI是1年死亡率的独立预测因素，而CKD和ISR病变是1年TLF的预测因素。贫血的严重程度与全因死亡率没有独立的相关性。结论CTO PCI患者术前贫血与较差的住院和长期预后相关，尽管技术上取得了相当的成功。这些发现强调了贫血是系统性易感性的标志，并强调了在这一高危人群中进行全面风险分层和多学科护理的必要性。

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引用次数: 0

The role of Id genes on pulmonary hypertension development in left heart failure Id基因在左心衰肺动脉高压发展中的作用

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 DOI: 10.1016/j.ahjo.2025.100692

Christelle Lteif , Paula Wachs , Ravindra K. Sharma , Julio D. Duarte

Objective

To investigate the role of Id genes in the development of pulmonary hypertension (PH) in heart failure (HF) and evaluate genetic variants of the ID genes associated with HF-PH.

Design

Experimental study using an AKR/J mouse model of HF-PH and a genetic association study using the UK Biobank cohort.

Setting

Laboratory animal study and population-based cohort study.

Participants

AKR/J mice with HF-PH and participants with HF from the UK Biobank cohort.

Interventions

Administration of tacrolimus (Id signaling inducer) in the mouse model.

Main outcome measures

Tissue-specific gene expression of Id1, Id2, and Id3 in HF-PH mice; severity of HF-PH after tacrolimus treatment; associations of single nucleotide polymorphisms of ID1, ID2, and ID3 with PH development and mortality in participants with HF.

Results

Id1 was upregulated in the left ventricle (Fold Change (FC) = 1.65; P = 3.0 × 10⁻⁴) of HF-PH mice. In adipose tissue, Id1 and Id3 were downregulated (FC = 0.33; P = 5.2 × 10⁻³ and FC = 0.50; P = 0.01, respectively), while Id2 was upregulated (FC = 1.78; P = 7 × 10⁻⁴). Tacrolimus worsened PH and diastolic dysfunction, upregulating only Id2 in adipose tissue. In the clinical cohort, rs7425561 and rs10174593 (expression quantitative loci for ID2) trended toward reduced risk of PH in HF and all-cause mortality in participants with HF-PH.

Conclusion

The results suggest ID1, ID2, and ID3 are involved in HF-PH pathogenesis, but more research is needed to characterize their exact role.

目的探讨Id基因在心力衰竭（HF）肺动脉高压（PH）发生中的作用，并评价与HF-PH相关的Id基因的遗传变异。设计：使用AKR/J小鼠模型进行HF-PH的实验研究，并使用UK Biobank队列进行遗传关联研究。实验动物研究和基于人群的队列研究。参与者：来自UK Biobank队列的HF- ph的sakr /J小鼠和HF的参与者。干预措施：他克莫司（Id信号诱导剂）在小鼠模型中的应用。主要结果测量：在HF-PH小鼠中Id1、Id2和Id3的组织特异性基因表达；他克莫司治疗后HF-PH的严重程度；ID1、ID2和ID3单核苷酸多态性与HF患者PH发展和死亡率的关系结果左心室sid1表达上调(Fold Change (FC) = 1.65；P = 3.0 × 10−4)。在脂肪组织中，Id1和Id3表达下调（FC = 0.33, P = 5.2 × 10−3,FC = 0.50, P = 0.01）， Id2表达上调（FC = 1.78, P = 7 × 10−4）。他克莫司恶化PH和舒张功能障碍，仅上调脂肪组织中的Id2。在临床队列中，rs7425561和rs10174593 （ID2的表达定量位点）倾向于降低HF-PH患者的PH风险和全因死亡率。结论ID1、ID2和ID3参与了HF-PH的发病机制，但其具体作用尚需进一步研究。

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引用次数: 0

Mortality trends in heart failure and colon cancer: Insights into gender, ethnic, and regional disparities in the United States (1999–2020) 心力衰竭和结肠癌的死亡率趋势：对美国性别、种族和地区差异的见解（1999-2020）

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 DOI: 10.1016/j.ahjo.2025.100699

Hafsah Alim Ur Rahman , Nimrah Iqbal , Muhammad Ahmed Ali Fahim , Fayza Salman , Syed Hassan Ahmed , Omama Asim , Taha Mansoor , Muhammad Zain Farooq , Muhammad Sohaib Asghar

Background

Heart failure (HF) and colorectal cancer (CRC) are major public health concerns among the aging population in the United States. This study aimed to investigate temporal, regional, urbanization and racial trends in mortality among adults with HF and CRC aged ≥65 years.

Methods

Mortality data were sourced from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, utilizing ICD-10 codes to identify deaths related to colon cancer and heart failure from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated, along with Annual Percentage Changes (APCs) and their respective 95 % confidence intervals (CIs).

Results

The AAMRs remained relatively stable between 1999 (8.5) and 2004 (7.3) (APC: −2.61; 95 % CI: −3.86, 0.09). From 2004 to 2009, a significant decline to 5.0 was observed (APC: −7.08; 95 % CI: −9.28, −3.58). Subsequently, the rates stabilized by 2015 (3.8) (APC: −4.84; 95 % CI: −6.58 to 2.04) but demonstrated a modest increase to 4.4 by 2020 (APC: 2.55; 95 % CI: 0.08 to 8.19). Mortality rates were consistently higher among males (6.7 vs. 4.5 for females) and varied across racial/ethnic groups, with Non-Hispanic (NH) Whites (5.7) and NH Black/African Americans (5.4) exhibiting the highest rates, while Hispanics (2.8) and NH Asians/Pacific Islanders (2.3) had the lowest. Regional disparities showed that the Midwest had the highest AAMRs (6.5) followed by the Northeast (5.4), West (5.2), and South (4.8). Additionally, non-metropolitan areas exhibited significantly higher rates than metropolitan areas (7.1 vs. 5.0, respectively). The states in the 90th percentile for AAMRs were West Virginia, Mississippi, South Dakota, Nebraska, and North Dakota.

Conclusion

Although there was an overall decline in mortality rates during the study period, disparities remained evident, with higher mortality observed among males, non-Hispanic Whites, residents of the Midwest, and individuals in non-metropolitan areas. This highlights the need for targeted public health intervention.

背景心力衰竭（HF）和结直肠癌（CRC）是美国老龄化人口中主要的公共卫生问题。本研究旨在调查年龄≥65岁的HF和CRC成人死亡率的时间、地区、城市化和种族趋势。方法死亡率数据来自疾病控制和预防中心流行病学研究广泛在线数据（CDC WONDER）数据库，利用ICD-10代码识别1999年至2020年与结肠癌和心力衰竭相关的死亡。计算每10万人的年龄调整死亡率（AAMRs），以及年百分比变化（APCs）及其各自的95%置信区间（ci）。结果aamr在1999年（8.5）~ 2004年（7.3）之间保持相对稳定（APC: - 2.61; 95% CI: - 3.86, 0.09）。从2004年到2009年，观察到显著下降到5.0 （APC: - 7.08; 95% CI: - 9.28, - 3.58）。随后，该比率在2015年稳定下来（3.8）（APC: - 4.84; 95% CI: - 6.58至2.04），但在2020年小幅上升至4.4 （APC: 2.55; 95% CI: 0.08至8.19）。男性死亡率一贯较高（6.7比4.5），不同种族/族裔群体的死亡率不同，非西班牙裔（NH）白人（5.7）和NH黑人/非洲裔美国人（5.4）的死亡率最高，而西班牙裔（2.8）和NH亚洲人/太平洋岛民（2.3）的死亡率最低。从地区差异来看，中西部地区的aamr最高（6.5），其次是东北部（5.4）、西部（5.2）、南部（4.8）。此外，非大都市地区的自杀率明显高于大都市地区（分别为7.1比5.0）。aamr排名第90百分位的州是西弗吉尼亚州、密西西比州、南达科他州、内布拉斯加州和北达科他州。结论：尽管在研究期间死亡率总体下降，但差异仍然明显，男性、非西班牙裔白人、中西部居民和非大都市地区的个体死亡率较高。这突出了有针对性的公共卫生干预的必要性。

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引用次数: 0

Coronary artery disease in patients undergoing transcatheter aortic valve replacement: Current evidence and future directions 经导管主动脉瓣置换术患者的冠状动脉疾病：目前的证据和未来的方向

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-31 DOI: 10.1016/j.ahjo.2025.100710

Bahaa El Deen Wehbeh , Moied Al Sakan , Jamil Francis , Rachad Ghazal , Samir Alam , Fadi Sawaya

Coronary artery disease (CAD) coexists frequently with aortic stenosis (AS), and the optimal management of CAD in patients undergoing transcatheter aortic valve replacement (TAVR) remains incompletely defined due to limited and heterogeneous evidence. This review aims to integrate the current evidence on the epidemiology and shared pathophysiology of CAD and AS, summarize the diagnostic algorithms for CAD in the TAVR population, and evaluates revascularization strategies with a focus on the timing of percutaneous coronary intervention relative to valve replacement. Current evidence suggests that while routine PCI in TAVR candidates for stable CAD may offer limited benefit, revascularization in patients with complex CAD or high anatomical burden may improve outcomes. This review further characterizes the incidence, proposed mechanisms, and prognostic significance of post-TAVR coronary events and outlines emerging strategies to optimize ischemic and procedural outcomes in this high-risk cohort.

冠状动脉疾病（CAD）经常与主动脉瓣狭窄（AS）共存，由于证据有限和不均匀，经导管主动脉瓣置换术（TAVR）患者CAD的最佳处理仍未完全确定。本综述旨在整合CAD和AS的流行病学和共同病理生理学的现有证据，总结TAVR人群中CAD的诊断算法，并评估血运重建策略，重点是相对于瓣膜置换术的经皮冠状动脉介入治疗的时机。目前的证据表明，在TAVR候选的稳定型CAD患者中，常规PCI可能提供有限的益处，而在复杂CAD患者或高解剖负担患者中，血运重建术可能改善结果。这篇综述进一步描述了tavr后冠状动脉事件的发生率、可能的机制和预后意义，并概述了优化这一高危人群的缺血性和程序性结局的新策略。

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引用次数: 0

Coronary artery calcium score of zero does not rule out obstructive CAD in young adults 冠状动脉钙评分为零并不排除年轻人阻塞性CAD的可能性

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-29 DOI: 10.1016/j.ahjo.2025.100707

O. Smettei , R.M. Abazid , J.G. Romsa , C. Akincioglu , J.C. Warrington , T.B. Alshaar , P.J. Teefy , S. De , N. Tzemos , R. Zareardalan , M. Badreddine , Y. Bureau , W.C. Vezina

Purpose

Young adults are more likely to have non-calcified coronary plaques. Purpose to assess the predictive value of a zero-coronary artery calcium (CAC) score in young adults and to determine which clinical characteristics are associated with obstructive coronary heart disease.

Methods

6775 patients were prospectively entered a registry. They all had a CAC. Mean age 63 +/− 18 years. 56.2 % males. 3525 patients underwent coronary CT angiography (CCTA). 3250 patients underwent single photon emission tomography (SPECT). SPECT patients were mainly outpatients. CCTA patients also were almost exclusively outpatients. Thus, the population was generally a low-risk population.

Results

Among the CCTA patients, 1888 had a 0 CAC score. 175/1888 (9 %) had less than 70 % stenosis, while 41/1888 (2.2 %) had ≥70 % stenosis. Patients with ≥70 % stenosis: were younger 45 ± 12 yr versus 59 ± 11 yr, p < 0.001, predominantly males (51.2 % versus 38.8 % p < 0.001), had a slightly greater prevalence of family history of CAD (58.5 % vs 57.9 % p = 0.04), smoking history (68.3 % VS.44.6 % p < 0.001), hypertension (61 % versus 39.2 % p = 0.004), dyslipidemia (56.1 % versus 36.2 % p < 0.001), and obesity (70.7 % VS 11.7 % p < 0.001). 3250 patients had CAC and SPECT. Of these, 1161 had a zero CAC score. Of these 42 patients had significant ischemia >10 % of LV, Patients with ischemia >10 % of LV mass, and they were younger 44 ± 10 yr versus 60 ± 12 yr, p < 0.001, had a slightly greater prevalence of family history of CAD 61 % versus 57 % p = 0.07, smoking history (64.3 % versus 48.5 % p = 0.045), hypertension (69 % versus 45.5 % p = 0.003), obesity 19 % versus 11.7 %, and diabetes (35.7 % versus 14.5 % p < 0.001).

Conclusions

A zero CAC does not rule out significant CAD in young adults with chest pain with CAD risk factors. These patients may need further investigations.

目的年轻人更容易出现非钙化的冠状动脉斑块。目的评估零冠状动脉钙（CAC）评分在年轻人中的预测价值，并确定哪些临床特征与阻塞性冠心病相关。方法对6775例患者进行前瞻性登记。他们都有CAC。平均年龄63±18岁。56.2%为男性。3525例患者行冠状动脉CT血管造影（CCTA）。3250例患者行单光子发射断层扫描（SPECT）。SPECT患者以门诊为主。CCTA患者也几乎完全是门诊患者。因此，该人群总体上属于低风险人群。结果CCTA患者中，1888例患者的CAC评分为0。175/1888（9%）狭窄小于70%，41/1888（2.2%）狭窄≥70%。年轻患者狭窄≥70%:45±12年和59±11年,p & lt; 0.001,主要是男性(51.2%比38.8% p & lt; 0.001),有一个稍微更流行的家族史的CAD (58.5% vs 57.9%, p = 0.04),吸烟史(68.3% VS.44.6 % p & lt; 0.001)、高血压(61%比39.2%,p = 0.004),血脂异常(56.1%比36.2% p & lt; 0.001),和肥胖(70.7% vs 11.7% p & lt; 0.001)。3250例患者行CAC和SPECT检查。其中，1161人的CAC得分为零。42岁的患者明显缺血祝辞LV的10%,缺血患者在LV质量的10%,他们年轻44±60±10年和12年,p & lt; 0.001中,有一个略大的流行CAD家族史的61%比57%,p = 0.07吸烟史(64.3%比48.5%,p = 0.045),高血压(69%比45.5%,p = 0.003),肥胖19%和11.7%,和糖尿病(35.7%比14.5% p & lt; 0.001)。结论：无CAC不能排除有冠心病危险因素胸痛的年轻成人存在明显冠心病的可能性。这些患者可能需要进一步调查。

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引用次数: 0

Association of caffeine levels with myocardial perfusion during pharmacological stress cardiac magnetic resonance imaging 在药物应激心脏磁共振成像期间咖啡因水平与心肌灌注的关系

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-29 DOI: 10.1016/j.ahjo.2025.100709

Ana Iribarren , Okezi Obrutu , Jenna Maughan , Galen Cook-Wiens , C. Noel Bairey Merz , Debiao Li , Daniel S. Berman , Alan C. Kwan , Janet Wei

Background

Caffeine, a nonselective adenosine A2 receptor antagonist, blunts adenosine-induced coronary hyperemia. Despite recommended abstinence before adenosine stress cardiac magnetic resonance imaging (CMRi), residual caffeine may affect myocardial perfusion reserve index (MPRI), a marker of coronary microvascular dysfunction.

Methods

Symptomatic patients without obstructive coronary artery disease underwent adenosine stress-rest CMRi after 48-h abstinence from caffeine and vasoactive medications. Plasma caffeine was measured pre-scan and subjects were categorized into 2 groups according to caffeine levels (<1 mg/L and ≥ 1 mg/L). Hemodynamics, MPRI and splenic switch-off were compared to assess adequate adenosine stress response during imaging.

Results

Of 109 patients studied, 15 (14 %) had detectable caffeine level. Other than sex, there were no significant differences between the two groups. Transmyocardial MPRI did not correlate with caffeine level ≥ 1 mg/L (r = 0.12, p = 0.66).

Conclusion

Mildly elevated plasma levels of caffeine did not affect measures of adequacy of response to adenosine during stress CMRi.

咖啡因是一种非选择性腺苷A2受体拮抗剂，可减弱腺苷诱导的冠状动脉充血。尽管建议在进行腺苷应激心脏磁共振成像（CMRi）前戒酒，但残留的咖啡因可能会影响心肌灌注储备指数（MPRI），这是冠状动脉微血管功能障碍的标志。方法对无阻塞性冠状动脉疾病的有症状患者在戒除咖啡因和血管活性药物48小时后进行腺苷应激休止CMRi检查。扫描前测定血浆咖啡因，并根据咖啡因水平将受试者分为两组（≤1mg /L和≥1mg /L）。比较血流动力学、MPRI和脾关闭在成像过程中评估足够的腺苷应激反应。结果109例患者中，15例（14%）检测到咖啡因水平。除了性别之外，两组之间没有显著差异。心肌MPRI与咖啡因水平≥1 mg/L无关（r = 0.12, p = 0.66）。结论轻度升高的血浆咖啡因水平不影响应激CMRi对腺苷反应充分性的测量。

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引用次数: 0

Short dual antiplatelet therapy after PCI with Resolute Onyx drug-eluting stents in high bleeding risk patients: One-year outcomes from a South Asian cohort 在高风险出血患者PCI术后使用Resolute Onyx药物洗脱支架的短期双重抗血小板治疗：来自南亚队列的一年结果

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-29 DOI: 10.1016/j.ahjo.2025.100703

Pankaj Jariwala , Guna Sai Vallapuri , Bharat Kumar Reddy Konda , Sukesh Kumar Jangam

Background

The optimal duration of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) in patients with high bleeding risk (HBR) remains unclear. This study evaluated the safety and efficacy of a shortened DAPT strategy (3-month DAPT followed by ticagrelor monotherapy) in patients with HBR receiving Resolute Onyx zotarolimus-eluting stents (ZES).

Methods

This retrospective observational study was conducted at the Yashoda Hospitals in Hyderabad. A total of 150 HBR patients who underwent PCI with Resolute Onyx ZES between June 2023 and June 2024 were included in the study. All patients received DAPT (aspirin 75 mg + ticagrelor 90 mg BID) for three months, followed by ticagrelor monotherapy for nine months. The primary outcome was a composite of cardiac death or MI from three months to one year. The secondary endpoints included stent thrombosis, target lesion failure (TLF), target lesion revascularization (TLR), stroke, and bleeding events (BARC classification).

Results

The mean age was 75.5 years, and 42.3 % were female. Diabetes was observed in 33.5 % of patients, prior revascularization in 46.4 %, and acute coronary syndrome in 58.3 %. Most lesions were calcified (60.8 %) or complex (88.2 % B2/C lesions). The patients met an average of 1.9 HBR criteria, and 54.6 % met at least two criteria. The primary composite endpoint occurred in 5.7 % of the patients (cardiac death-2.3 %; MI-3.4 %). Definite/probable stent thrombosis occurred in 0.3 %, TLF in 3.0 %, clinically driven TLR in 1.7 %, stroke in 0.6 %, and BARC 1–3 bleeding in 2.1 %. No BARC 3–5 bleeding events were recorded.

Conclusion

In this real-world HBR cohort treated with Resolute Onyx ZES, a strategy of 3-month DAPT followed by ticagrelor monotherapy was associated with low rates of ischemic events and the absence of major bleeding at one year. These findings suggest a favorable safety–efficacy balance for DAPT de-escalation in carefully selected patients; however, this requires confirmation in larger, prospective studies.

背景：高出血风险（HBR）患者经皮冠状动脉介入治疗（PCI）后双重抗血小板治疗（DAPT）的最佳持续时间尚不清楚。本研究评估了在接受Resolute Onyx佐他莫司洗脱支架（ZES）的HBR患者中，缩短DAPT策略（3个月DAPT后采用替格瑞洛单药治疗）的安全性和有效性。方法回顾性观察研究在海得拉巴Yashoda医院进行。在2023年6月至2024年6月期间，共有150名HBR患者接受了Resolute Onyx ZES的PCI治疗。所有患者接受DAPT（阿司匹林75mg +替格瑞洛90mg BID）治疗3个月，随后接受替格瑞洛单药治疗9个月。主要结局是3个月至1年的心源性死亡或心肌梗死的复合结局。次要终点包括支架血栓形成、靶病变失败（TLF）、靶病变血运重建（TLR）、卒中和出血事件（BARC分类）。结果平均年龄75.5岁，女性占42.3%。糖尿病患者占33.5%，既往血运重建术患者占46.4%，急性冠状动脉综合征患者占58.3%。大多数病变为钙化（60.8%）或复杂（88.2%）B2/C病变。患者平均满足1.9个HBR标准，54.6%的患者至少满足两个标准。主要复合终点发生在5.7%的患者中（心脏死亡- 2.3%;mi - 3.4%）。明确/可能的支架血栓形成发生率为0.3%，TLF发生率为3.0%，临床驱动TLR发生率为1.7%，卒中发生率为0.6%，BARC 1-3出血发生率为2.1%。无BARC 3-5出血事件记录。结论：在这个使用Resolute Onyx ZES治疗的真实HBR队列中，3个月DAPT +替格瑞洛单药治疗的策略与低缺血性事件发生率和一年内无大出血相关。这些发现表明，在精心挑选的患者中，DAPT降级具有良好的安全性和有效性平衡；然而，这需要在更大的前瞻性研究中得到证实。

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引用次数: 0

Can magnetocardiography decrease ED overcrowding, increase hospital bed capacity, and save hospitals money? 心脏磁图能减少急诊科的拥挤，增加医院的床位容量，并节省医院的资金吗？

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-27 DOI: 10.1016/j.ahjo.2025.100705

Margarita E. Pena , Sharon E. Mace , Griffin Bleecker , Kaitlin Kreuser Girard , Praveen Mital , Pawan Suri , Robert E. Takla

Objectives

The objectives of this study are to demonstrate the time and cost savings of magnetocardiography (MCG) compared to other noninvasive cardiac imaging (NCI) tests, specifically in regard to time, number of skilled healthcare personnel (HCP), and cost of skilled HCP, medications and supplies, including contrast agents and radiotracers required to perform each test.

Design

This is a multicenter study comparing the time, skilled HCP, and costs needed to perform MCG and other NCI from four urban and community hospitals.

Outcome measures

Time needed to perform each test, the number of skilled HCP required, and costs for labor, supplies/drugs and contrast agents/radiotracers.

Results

Median time in minutes for obtaining ETT 60, SE 75, DSE 75, MPI-SPECT 225, MPI-PET 180, cMRI 90, and cCTA 75, MCG 15. Median number of skilled HCP required for performing the NCI were ETT 1.5, SE 2.5, DSE 2.5, MPI-SPECT 3.0, MPI-PET 3.0, cMRI 2.5, cCTA 2, and MCG 1. Median skilled HCP and their costs was ETT $71.23, SE $150.43, DSE $153.91, MPI-SPECT $625.18, MPI-PET $403.62, cMRI $95.41, cCTA $138.03, and MCG $8.75.

Conclusion

There is a time, skilled HCP and cost savings by using MCG versus other NCI for the evaluation of chest pain. Further studies are needed to validate MCG as an alternative to other NCI so these benefits can be realized.

本研究的目的是证明与其他无创心脏成像（NCI）测试相比，心脏磁图（MCG）节省的时间和成本，特别是在时间、熟练医护人员（HCP）的数量、熟练医护人员的成本、药物和耗材（包括造影剂和放射性示踪剂）方面。设计：这是一项多中心研究，比较了四家城市和社区医院进行MCG和其他NCI所需的时间、熟练的HCP和成本。结果测量：每次检查所需的时间、所需熟练HCP的数量、人工、用品/药物和造影剂/放射性示踪剂的成本。结果获得ETT 60， SE 75, DSE 75, MPI-SPECT 225, MPI-PET 180, cMRI 90, cCTA 75， MCG 15的中位时间（分钟）。执行NCI所需熟练HCP的中位数为ETT 1.5, SE 2.5, DSE 2.5, MPI-SPECT 3.0, MPI-PET 3.0, cMRI 2.5， cCTA 2和MCG 1。熟练HCP及其费用中位数为ETT 71.23美元，SE 150.43美元，DSE 153.91美元，MPI-SPECT 625.18美元，MPI-PET 403.62美元，cMRI 95.41美元，cCTA 138.03美元，MCG 8.75美元。结论与其他NCI相比，使用MCG评估胸痛有时间、技术和成本节约。需要进一步的研究来验证MCG作为其他NCI的替代方案，以实现这些益处。

{"title":"Can magnetocardiography decrease ED overcrowding, increase hospital bed capacity, and save hospitals money?","authors":"Margarita E. Pena , Sharon E. Mace , Griffin Bleecker , Kaitlin Kreuser Girard , Praveen Mital , Pawan Suri , Robert E. Takla","doi":"10.1016/j.ahjo.2025.100705","DOIUrl":"10.1016/j.ahjo.2025.100705","url":null,"abstract":"<div><h3>Objectives</h3><div>The objectives of this study are to demonstrate the time and cost savings of magnetocardiography (MCG) compared to other noninvasive cardiac imaging (NCI) tests, specifically in regard to time, number of skilled healthcare personnel (HCP), and cost of skilled HCP, medications and supplies, including contrast agents and radiotracers required to perform each test.</div></div><div><h3>Design</h3><div>This is a multicenter study comparing the time, skilled HCP, and costs needed to perform MCG and other NCI from four urban and community hospitals.</div></div><div><h3>Outcome measures</h3><div>Time needed to perform each test, the number of skilled HCP required, and costs for labor, supplies/drugs and contrast agents/radiotracers.</div></div><div><h3>Results</h3><div>Median time in minutes for obtaining ETT 60, SE 75, DSE 75, MPI-SPECT 225, MPI-PET 180, cMRI 90, and cCTA 75, MCG 15. Median number of skilled HCP required for performing the NCI were ETT 1.5, SE 2.5, DSE 2.5, MPI-SPECT 3.0, MPI-PET 3.0, cMRI 2.5, cCTA 2, and MCG 1. Median skilled HCP and their costs was ETT $71.23, SE $150.43, DSE $153.91, MPI-SPECT $625.18, MPI-PET $403.62, cMRI $95.41, cCTA $138.03, and MCG $8.75.</div></div><div><h3>Conclusion</h3><div>There is a time, skilled HCP and cost savings by using MCG versus other NCI for the evaluation of chest pain. Further studies are needed to validate MCG as an alternative to other NCI so these benefits can be realized.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"62 ","pages":"Article 100705"},"PeriodicalIF":1.8,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023768","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

Beta-blocker therapy after myocardial infarction with preserved LVEF (≥50%): a systematic review and Bayesian meta-analysis with time-to-event reconstruction 保留LVEF（≥50%）的心肌梗死后β受体阻滞剂治疗：一项系统评价和贝叶斯荟萃分析

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-25 DOI: 10.1016/j.ahjo.2025.100706

Ali Saad Al-Shammari , Yousif Hameed Kurmasha , M Rafiqul Islam , Bara M. Hammadeh , Nabeel Ibraheem Khaleel , Belal Mohamed Hamed , Haider Altaii , Nihar Jena , Jennifer Gerdes , George Sokos , Ramesh Daggubati , Yasar Sattar , Marwan Refaat

Background

The role of β-blockers in MI with preserved LVEF (≥50%) remains unclear. This Bayesian meta-analysis assessed their effect on mortality and major cardiovascular outcomes.

Methods

A systematic search was performed in PubMed, Embase, and Scopus from database inception to September 2025 for studies assessing BB use in post-MI patients with preserved LVEF. All-cause mortality was the primary outcome. A Bayesian random-effects model was applied using the bayesmeta package in RStudio, with effect sizes expressed as risk ratios (RRs) and 95% credible intervals (CrIs). Between-study heterogeneity was assessed through posterior τ estimates. Time-to-event outcomes were analyzed using reconstructed individual patient data from published Kaplan-Meier curves.

Results

Six studies, including 17,068 patients, met the inclusion criteria. BB therapy was associated with a posterior risk ratio (RR 0.79; 95% CrI 0.55–1.06) suggesting a possible reduction in all-cause mortality; however, the credible interval included the null, indicating uncertainty in the magnitude or direction of effect. The posterior estimates for cardiovascular death (RR 0.84; 95% CrI 0.55–1.23), stroke (RR 0.92; 95% CrI 0.58–1.49), myocardial infarction (RR 1.04; 95% CrI 0.80–1.40), heart failure (RR 0.84; 95% CrI 0.55–1.23), MACE (RR 1.09; 95% CrI 0.76–1.51), and unplanned revascularization (RR 1.06; 95% CrI 0.75–1.48) also showed wide credible intervals overlapping 1.0, reflecting uncertainty in potential treatment effects. Heterogeneity across outcomes was generally low to moderate. In time-to-event analyses, the frequentist stratified model showed a statistically significant survival benefit with β-blockers (HR 0.87; 95% CI 0.81–0.92), whereas the Bayesian model indicated a similar trend, but the credible interval (HR 0.60; 95% CrI 0.26–1.41) included the null, suggesting no strong evidence of effect.

Conclusion

β-blockers were not associated with a clear reduction in all-cause mortality or other outcomes, as credible intervals included the null. Large, randomized trials are needed to define their long-term role in this population.

β受体阻滞剂在LVEF保存（≥50%）的心肌梗死中的作用尚不清楚。本贝叶斯荟萃分析评估了它们对死亡率和主要心血管结局的影响。方法系统检索PubMed， Embase和Scopus数据库，从数据库建立到2025年9月，评估心肌梗死后保留LVEF患者使用BB的研究。全因死亡率是主要结局。使用RStudio中的bayesmeta软件包应用贝叶斯随机效应模型，效应大小表示为风险比（RRs）和95%可信区间（CrIs）。通过后验τ估计评估研究间异质性。使用已发表的Kaplan-Meier曲线重构的个体患者数据分析事件发生时间。结果6项研究，17068例患者符合纳入标准。BB治疗与后置风险比相关（RR 0.79; 95% CrI 0.55-1.06），表明可能降低全因死亡率；然而，可信区间包括零值，表明影响的大小或方向的不确定性。心血管死亡（RR 0.84; 95% CrI 0.55-1.23）、卒中（RR 0.92; 95% CrI 0.58-1.49）、心肌梗死（RR 1.04; 95% CrI 0.80-1.40）、心力衰竭（RR 0.84; 95% CrI 0.55-1.23）、MACE （RR 1.09; 95% CrI 0.76-1.51）和计划外血血重建术（RR 1.06; 95% CrI 0.75-1.48）的后验估计也显示了重叠1.0的宽可信区间，反映了潜在治疗效果的不确定性。结果的异质性一般为低至中等。在时间-事件分析中，频率分层模型显示β-受体阻滞剂具有统计学上显著的生存益处（HR 0.87; 95% CI 0.81-0.92），而贝叶斯模型显示了类似的趋势，但可信区间（HR 0.60; 95% CrI 0.26-1.41）包括零值，表明没有强有力的证据表明效果。结论β受体阻滞剂与全因死亡率或其他结果的明显降低无关，因为可信区间包括零。需要大规模的随机试验来确定它们在这一人群中的长期作用。

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引用次数: 0

Magnetocardiography for noninvasive surveillance of rejection and cardiac allograft vasculopathy in heart transplant recipients 心磁图无创监测心脏移植受者的排斥反应和同种异体心脏移植血管病变

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-23 DOI: 10.1016/j.ahjo.2025.100704

Christian Eskander , Matthew Peters , Dipankar Gupta , Katelyn A. Bruno , Juan R. Vilaro

Heart transplantation is the definitive treatment for end-stage heart failure, yet long-term graft survival is hindered by two major complications: acute/chronic rejection (cellular or antibody mediated) and cardiac allograft vasculopathy (CAV). Standard surveillance is performed to screen for these issues and predominantly consists of cardiac catheterization with hemodynamics, endomyocardial biopsy and invasive coronary angiography, with intravascular ultrasound (IVUS) and coronary flow reserve. The use of IVUS increases the sensitivity for CAV detection. Overall, these procedures have associated morbidities, need anesthesia and have associated patient discomfort and substantial cost. Magnetocardiography (MCG), a noninvasive modality that measures cardiac magnetic fields, has emerged as a potential tool for early detection of complications in post-transplant patients. Unlike electrocardiography, MCG provides spatially resolved data on depolarization and repolarization, independent of body habitus or tissue conductivity. Early studies suggest that MCG can identify electrophysiologic abnormalities associated with both acute rejection and CAV, in some cases preceding histologic or angiographic confirmation. Rejection is reflected by alterations in magnetic dipole strength and repolarization heterogeneity, while CAV correlates with repolarization dispersion indices such as QTc heterogeneity and Magnetic Dispersion Velocity. Despite promising pilot data, MCG remains underutilized, largely due to small study sizes, lack of standardized interpretation, and limited availability of equipment. This review synthesizes the existing evidence, highlights potential advantages and limitations, and outlines future directions for integrating MCG into standard post-transplant surveillance protocols.

心脏移植是终末期心力衰竭的最终治疗方法，但移植的长期存活受到两大并发症的阻碍：急性/慢性排斥反应（细胞或抗体介导）和心脏异体移植血管病变（CAV）。标准的监测是为了筛查这些问题，主要包括心导管血流动力学检查、心内膜活检和侵入性冠状动脉造影，以及血管内超声（IVUS）和冠状动脉血流储备。IVUS的使用提高了CAV检测的灵敏度。总的来说，这些手术有相关的发病率，需要麻醉，并伴有患者不适和大量费用。心脏磁图（MCG）是一种测量心脏磁场的无创方式，已成为移植后患者早期发现并发症的潜在工具。与心电图不同，MCG提供去极化和复极化的空间分辨率数据，不受身体习惯或组织电导率的影响。早期研究表明，在一些病例中，在组织学或血管造影证实之前，MCG可以识别与急性排斥反应和CAV相关的电生理异常。拒流通过磁偶极子强度和复极化非均质性的变化来反映，而CAV则与QTc非均质性和磁色散速度等复极化色散指标相关。尽管试验数据很有前景，但MCG仍未得到充分利用，主要原因是研究规模小，缺乏标准化解释，设备有限。这篇综述综合了现有的证据，强调了潜在的优势和局限性，并概述了将MCG纳入标准移植后监测方案的未来方向。

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引用次数: 0