American heart journal plus : cardiology research and practice最新文献_第5页

Impact of pre-procedural requirements on time to aortic valve replacement: Transcatheter AVR vs surgical AVR 术前要求对主动脉瓣置换术时间的影响：经导管AVR vs手术AVR

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-10 DOI: 10.1016/j.ahjo.2025.100698

Curtiss Stinis , Sean Tunis , Sandra Lauck , Aakriti Gupta , Shannon Murphy , Soumya Chikermane , Seth Clancy , Mark Russo

Background/objective

This study aims to understand the extent that cardiac specialist visits and imaging requirements contribute to the difference in time to Aortic valve replacement (AVR) stratified by approach transcatheter AVR (TAVR) and surgical AVR (SAVR).

Methods

Optum Market Clarity Data was used to identify patients with clinically significant AS (CSAS) who received an AVR between 2016 and 2023 and whose AVR occurred within two years of their CSAS diagnosis. Patient characteristics were measured at baseline; pre-procedural factors, including the number of cardiac specialist visits and imaging events, were measured from CSAS diagnosis to AVR (TAVR vs SAVR). Stepwise generalized linear models were used to assess whether the number of cardiac specialist visits and imaging events contribute to the differences in time to TAVR and SAVR, after adjusting for baseline characteristics.

Results

Of the 14,225 patients in the cohort, 42 % received a TAVR. Compared to the SAVR cohort, the TAVR cohort was, on average, more male, older, sicker, and had more Medicare enrollees. TAVR patients had approximately two times more cardiac specialist visits (3.73 vs 6.37) and imaging events (1.18 vs 2.07) than SAVR patients. Time to TAVR is 65 days longer (RR = 1.77, 1.67–1.87) than SAVR, after adjustment for patient characteristics. This difference reduces to 11 days (RR = 1.12, 1.07–1.17) after accounting cardiac specialist encounters and imaging events.

Discussion

Pre-procedural encounters significantly contribute to the longer time to AVR for TAVR patients. Findings suggest a need for streamlining the pre-procedural process for TAVR to enhance timely care delivery for CSAS patients.

背景/目的本研究旨在了解心脏专科就诊和影像学要求对经导管AVR （TAVR）和外科AVR （SAVR）分层主动脉瓣置换术（AVR）时间差异的影响程度。方法使用soptum市场清晰度数据识别在2016年至2023年期间接受AVR且在CSAS诊断后两年内发生AVR的临床显著性AS （CSAS）患者。在基线时测量患者特征；从CSAS诊断到AVR (TAVR vs SAVR)，测量术前因素，包括心脏专科就诊次数和影像学事件。在调整基线特征后，采用逐步广义线性模型来评估心脏专科就诊次数和影像学事件是否导致TAVR和SAVR的时间差异。结果在14225例患者中，42%的患者接受了TAVR。与SAVR队列相比，TAVR队列平均更多的是男性，年龄更大，病情更重，并且有更多的医疗保险参保者。TAVR患者的心脏专科就诊次数（3.73 vs 6.37）和影像学事件（1.18 vs 2.07）大约是SAVR患者的两倍。调整患者特征后，到达TAVR的时间比到达SAVR的时间长65天（RR = 1.77, 1.67-1.87）。考虑到心脏病专家就诊和影像学事件后，这一差异减少到11天（RR = 1.12, 1.07-1.17）。术前接触显著增加了TAVR患者到AVR的时间。研究结果表明，需要简化TAVR的术前流程，以提高对CSAS患者的及时护理。

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引用次数: 0

Educational innovation in cardiovascular care: Developing a curriculum for women's cardiovascular health 心血管护理方面的教育创新：制定妇女心血管健康课程

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-09 DOI: 10.1016/j.ahjo.2025.100693

Giorgia Borgarelli , Cristiane C. Singulane , Paul Montana , Lucie Lefbom , Hakinya Karra , Kelsey Watts , Kara Harrison , Jennifer M. Choffel , Christopher S. Ennen , Aditya M. Sharma , Kelly E. Wingerter , Victor Soukoulis , Patricia F. Rodriguez-Lozano

Cardiovascular disease (CVD) is the leading cause of death among women in the United States, with significant knowledge gaps in sex-specific care among providers. To address this, we developed and implemented a structured, multidisciplinary women's cardiovascular health (CVH) curriculum within the cardiovascular fellowship program at the University of Virginia. The curriculum focused on women-specific cardiovascular health, including cardio-obstetrics, spontaneous coronary artery dissection (SCAD) and coronary microvascular disease (CMD), and encompassed didactic lectures and unique experiential learning through clinical work, research, and community outreach. This multidisciplinary approach enhances individualized care and prepares trainees to recognize and treat the unique cardiovascular needs of women. Continued development of such curricula is crucial for reducing morbidity and mortality disparities in CVD.

心血管疾病（CVD）是美国妇女死亡的主要原因，在性别特异性护理提供者之间存在显著的知识差距。为了解决这个问题，我们在弗吉尼亚大学的心血管奖学金项目中开发并实施了一个结构化的、多学科的妇女心血管健康（CVH）课程。课程侧重于妇女特有的心血管健康，包括心脏产科、自发性冠状动脉夹层（SCAD）和冠状动脉微血管疾病（CMD），并包括通过临床工作、研究和社区外展进行的教学讲座和独特的体验式学习。这种多学科方法加强了个性化护理，使受训者能够认识和治疗妇女独特的心血管需求。这类课程的持续发展对于减少心血管疾病发病率和死亡率的差异至关重要。

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引用次数: 0

Predictive value of abnormal coronary computed tomography angiography in patients with Normal single-photon emission computed tomography scan 冠状动脉造影异常对单光子发射ct正常患者的预测价值

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-08 DOI: 10.1016/j.ahjo.2025.100694

Rami M. Abazid , Monerah A. Almohideb , Mohammad A. Barry , Osama Smettie , Naveed Asad , Yasmine T. Sallam , Mohamed Abdelrazek , Cigdem Akincioglu , James Warrington , Jonathan G. Romsa , William C. Vezina

Background

The aim of this study was to assess the prognostic value of abnormal coronary computed tomography angiography (CCTA) in patients with normal single-photon emission computed tomography (SPECT) study.

Methods

We retrospectively enrolled patients with normal SPECT scans and abnormal CCTA studies, who were categorized according to CCTA findings into obstructive with ≥50 %, and non-obstructive CAD <50 % coronary artery stenosis. Major adverse cardiac events (MACE) was defined as cardiovascular death and non-fatal myocardial infarction.

Results

Among 1558 eligible patients, there were 1356 (87.1 %) patients with non-obstructive CAD and 202 (12.9 %) patients with obstructive CAD. Over a median follow-up of 10.4 ± 5.1 years, a total of 87 MACEs were reported. Patients with obstructive CAD were older (67.4 ± 8 vs. 60.3 ± 10 years, p < 0.001), more often male (75.0 % vs. 54.6 %, p < 0.001), and had a higher prevalence of diabetes mellitus (26.7 % vs. 17.2 %, p = 0.008) compared with those with non-obstructive disease. Despite normal SPECT findings, patients with obstructive CAD had significantly higher rates of MACE compared with those with non-obstructive CAD [25/202 (12.4 %) vs. 62/1356 (4.8 %), p < 0.001]. Multivariable Cox regression confirmed age (HR 1.21, p = 0.04), diabetes (HR 1.35, p = 0.03), higher coronary calcium score (HR 1.49, p = 0.01), and the presence of obstructive CAD (HR 2.57, p < 0.001) are independent predictors of mortality.

Conclusion

Obstructive CAD on CCTA is associated with significantly higher long-term risk of MACE in comparison to non-obstructive CAD in patients with normal SPECT.

本研究的目的是评估异常冠状动脉ct血管造影（CCTA）对正常单光子发射计算机断层扫描（SPECT）患者的预后价值。方法回顾性纳入SPECT扫描正常和CCTA检查异常的患者，根据CCTA检查结果将患者分为阻塞性（≥50%）和非阻塞性（≥50%）冠状动脉狭窄。主要心脏不良事件（MACE）定义为心血管死亡和非致死性心肌梗死。结果1558例符合条件的患者中，非梗阻性CAD患者1356例（87.1%），梗阻性CAD患者202例（12.9%）。在中位随访10.4±5.1年期间，共报告了87例mace。梗阻性CAD患者年龄较大（67.4±8岁对60.3±10岁，p < 0.001），男性居多（75.0%对54.6%,p < 0.001），糖尿病患病率较高（26.7%对17.2%,p = 0.008）。尽管SPECT表现正常，但阻塞性CAD患者的MACE发生率明显高于非阻塞性CAD患者[25/202（12.4%）比62/1356 (4.8%),p < 0.001]。多变量Cox回归证实，年龄（HR 1.21, p = 0.04）、糖尿病（HR 1.35, p = 0.03）、较高的冠状动脉钙评分（HR 1.49, p = 0.01）和阻塞性CAD的存在（HR 2.57, p < 0.001）是死亡率的独立预测因素。结论与SPECT正常的非阻塞性CAD患者相比，CCTA上的阻塞性CAD与MACE的长期风险显著升高相关。

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引用次数: 0

The ‘obesity paradox’ in patients undergoing transcatheter aortic valve implantation. A specialized narrative review 经导管主动脉瓣植入患者的“肥胖悖论”。专门的叙事性评论

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-08 DOI: 10.1016/j.ahjo.2025.100695

Johao Escobar , Iqra Riaz , Muzamil Khawaja , Hafeez Ul Hassan Virk , Joshua Hahn , Fu'’ad Al-Azzam , Zhen Wang , Mahboob Alam , Markus Strauss , Chayakrit Krittanawong

Obesity has long been identified as a noteworthy risk factor for cardiovascular diseases, including aortic stenosis. Nevertheless, an unexplained phenomenon known as the obesity paradox has arisen in the context of transcatheter aortic valve implantation (TAVI), inquiring conventional beliefs. The obesity paradox refers to better clinical outcomes observed in obese individuals undergoing TAVI. These include reduced all-cause mortality, lower rates of procedural complications, and improved long-term survival rates compared to their lean counterparts. Several theories have been proposed to explain the obesity paradox in TAVI. One of the most popular is the adipose tissue-mediated cardioprotective effect hypothesis. It is known that adipose tissue could offer both protective and harmful effects on the cardiovascular system. These effects can be linked to the adipose tissue's distribution, extension, and intrinsic biological characteristics. Obesity has been associated with adipose tissue malfunction, leading to proinflammatory and deleterious effects on the cardiovascular system. As opposed to what is believed, it is suggested that a healthy obese phenotype might be facilitated by exercise, leading to outstanding cardiovascular benefits. A healthy obese phenotype is also associated with a secretome profile that has unique adipose tissue features like adequate fat storage and formation of lipid droplets, a significant capacity for adipogenesis, minimal extracellular matrix fibrosis, potential for angiogenesis, adipocyte browning, and limited infiltration or activation of macrophages. This article is presented as a specialized narrative review, synthesizing current evidence on the relationship between obesity and outcomes in patients undergoing TAVI.

长期以来，肥胖一直被认为是心血管疾病（包括主动脉狭窄）的一个值得注意的危险因素。然而，在经导管主动脉瓣植入（TAVI）的背景下，出现了一种无法解释的肥胖悖论现象，质疑传统观念。肥胖悖论指的是在接受TAVI的肥胖个体中观察到更好的临床结果。这包括降低了全因死亡率，降低了手术并发症的发生率，并提高了长期生存率。人们提出了几种理论来解释TAVI中的肥胖悖论。其中最流行的是脂肪组织介导的心脏保护作用假说。众所周知，脂肪组织对心血管系统既有保护作用，也有有害作用。这些影响可能与脂肪组织的分布、延伸和内在生物学特性有关。肥胖与脂肪组织功能障碍有关，导致对心血管系统的促炎和有害影响。与人们所认为的相反，有人认为，健康的肥胖表型可能是通过运动促进的，从而对心血管有显著的好处。健康的肥胖表型还与具有独特脂肪组织特征的分泌组相关，如充足的脂肪储存和脂滴的形成，显著的脂肪生成能力，最小的细胞外基质纤维化，血管生成的潜力，脂肪细胞褐变，以及有限的巨噬细胞浸润或激活。本文是一篇专门的叙述性综述，综合了目前关于肥胖与TAVI患者预后之间关系的证据。

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引用次数: 0

Oxidized low-density lipoprotein cholesterol and plaque vulnerability 氧化低密度脂蛋白胆固醇与斑块易损性

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-05 DOI: 10.1016/j.ahjo.2025.100691

Jun Goto , Daisuke Kinoshita , Yoichiro Otaki , Seisei Ra , Hiroe Ono , Takafumi Mito , Taku Shikama , Shingo Tachibana , Shigehiko Kato , Tetsu Watanabe , Ik-Kyung Jang , Masafumi Watanabe

Background

The oxidation of low-density lipoprotein cholesterol (LDL-C) plays a critical role in plaque inflammation and the subsequent high-risk plaque formation. However, the relationship between LDL-C oxidation and plaque morphology in patients with diabetes mellitus (DM) has not been systematically studied. The study aimed to investigate the association between LDL-C oxidation and plaque morphology assessed using optical coherence tomography (OCT).

Methods

A total of 138 patients with chronic coronary syndrome who underwent OCT were analyzed. Malondialdehyde-modified LDL-C (MDA-LDL), a representative form of oxidized LDL-C, was measured. Levels of LDL-C oxidation were assessed using the ratio of MDA-LDL to LDL-C ratio. Plaque morphology was assessed by OCT at the target lesions.

Results

Patients were divided into three groups according to the tertiles of LDL-C oxidation levels. Lipid index and macrophage grade were significantly higher in patients with higher levels of LDL-C oxidation in patients with DM (low vs. moderate vs. high; lipid index: 714 vs. 1226 vs. 2217, p for trend = 0.040; macrophage grade: 2 vs. 7 vs. 13, p for trend = 0.009). In contrast, no association was found in patients without DM (low vs. moderate vs. high; lipid index: 1109 vs. 1181 vs. 1436, p for trend = 0.633; macrophage grade: 8 vs. 5 vs. 8, p for trend = 0.748). Those associations remained significant even after adjusting for confounders in patients with DM but not in those without.

Conclusions

The levels of LDL-C oxidation were associated with plaque vulnerability, especially in patients with DM.

低密度脂蛋白胆固醇（LDL-C）的氧化在斑块炎症和随后的高风险斑块形成中起着关键作用。然而，糖尿病（DM）患者LDL-C氧化与斑块形态之间的关系尚未有系统的研究。该研究旨在通过光学相干断层扫描（OCT）评估LDL-C氧化与斑块形态之间的关系。方法对138例慢性冠脉综合征患者行OCT检查的临床资料进行分析。测定氧化LDL-C的代表形式丙二醛修饰LDL-C （MDA-LDL）。用MDA-LDL与LDL-C比值评估LDL-C氧化水平。在靶病变处用OCT评估斑块形态。结果根据LDL-C氧化水平分位数将患者分为三组。DM患者LDL-C氧化水平越高，脂质指数和巨噬细胞等级越高（低、中、高；脂质指数：714、1226、2217，p趋势= 0.040；巨噬细胞等级：2、7、13，p趋势= 0.009）。相比之下，非糖尿病患者无相关性（低、中、高；脂质指数：1109、1181、1436，p为趋势= 0.633；巨噬细胞分级：8、5、8，p为趋势= 0.748）。即使在糖尿病患者中调整混杂因素后，这些相关性仍然显著，而在非糖尿病患者中则没有。结论LDL-C氧化水平与斑块易感性相关，尤其是在糖尿病患者中。

{"title":"Oxidized low-density lipoprotein cholesterol and plaque vulnerability","authors":"Jun Goto , Daisuke Kinoshita , Yoichiro Otaki , Seisei Ra , Hiroe Ono , Takafumi Mito , Taku Shikama , Shingo Tachibana , Shigehiko Kato , Tetsu Watanabe , Ik-Kyung Jang , Masafumi Watanabe","doi":"10.1016/j.ahjo.2025.100691","DOIUrl":"10.1016/j.ahjo.2025.100691","url":null,"abstract":"<div><h3>Background</h3><div>The oxidation of low-density lipoprotein cholesterol (LDL-C) plays a critical role in plaque inflammation and the subsequent high-risk plaque formation. However, the relationship between LDL-C oxidation and plaque morphology in patients with diabetes mellitus (DM) has not been systematically studied. The study aimed to investigate the association between LDL-C oxidation and plaque morphology assessed using optical coherence tomography (OCT).</div></div><div><h3>Methods</h3><div>A total of 138 patients with chronic coronary syndrome who underwent OCT were analyzed. Malondialdehyde-modified LDL-C (MDA-LDL), a representative form of oxidized LDL-C, was measured. Levels of LDL-C oxidation were assessed using the ratio of MDA-LDL to LDL-C ratio. Plaque morphology was assessed by OCT at the target lesions.</div></div><div><h3>Results</h3><div>Patients were divided into three groups according to the tertiles of LDL-C oxidation levels. Lipid index and macrophage grade were significantly higher in patients with higher levels of LDL-C oxidation in patients with DM (low vs. moderate vs. high; lipid index: 714 vs. 1226 vs. 2217, <em>p</em> for trend = 0.040; macrophage grade: 2 vs. 7 vs. 13, <em>p</em> for trend = 0.009). In contrast, no association was found in patients without DM (low vs. moderate vs. high; lipid index: 1109 vs. 1181 vs. 1436, <em>p</em> for trend = 0.633; macrophage grade: 8 vs. 5 vs. 8, <em>p</em> for trend = 0.748). Those associations remained significant even after adjusting for confounders in patients with DM but not in those without.</div></div><div><h3>Conclusions</h3><div>The levels of LDL-C oxidation were associated with plaque vulnerability, especially in patients with DM.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100691"},"PeriodicalIF":1.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736951","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

Obesity burden among heart failure patients in an urban safety net hospital: Implications for GLP-1 agonist therapy 城市安全网医院心力衰竭患者的肥胖负担：GLP-1激动剂治疗的意义

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-02 DOI: 10.1016/j.ahjo.2025.100688

Tracey Yee , Priya Gajjar , Deepa M. Gopal , Matthew Nayor

Introduction

Novel obesity medications (glucagon-like peptide-1 [GLP-1] agonists) show promise for treatment of patients with obesity and heart failure (HF), especially with preserved ejection fraction (HFpEF). However, data are limited regarding the burden of obesity among HF patients in real-world samples.

Methods

We conducted a retrospective electronic medical record-based query of HF patients at a single urban safety net hospital system.

Results

In 1373 patients (mean age 67 ± 14 years, 59 % women) admitted for acute HF (563 [41 %] with HFpEF, 649 [47 %] with reduced ejection fraction, and 161 [12 %] without ejection fraction assessment), up to 64 % met eligibility criteria GLP-1 agonists compared with 42 % of control patients admitted for non-HF diagnoses. This was primarily driven by higher obesity prevalence.

Discussion

The majority of HF patients at an urban safety net hospital are eligible for GLP-1 agonist medications; allocation of these medications to a large patient population represents a major public health challenge.

新型肥胖药物（胰高血糖素样肽-1 [GLP-1]激动剂）有望治疗肥胖和心力衰竭（HF）患者，特别是保留射血分数（HFpEF）的患者。然而，现实世界样本中关于心衰患者肥胖负担的数据有限。方法对单个城市安全网医院系统的心衰患者进行回顾性电子病历查询。结果在1373例急性HF患者（平均年龄67±14岁，59%为女性）中（563例[41%]伴有HFpEF， 649例[47%]伴有射血分数降低，161例[12%]未进行射血分数评估），高达64%的患者符合GLP-1激动剂的合格标准，而非HF诊断的对照组患者为42%。这主要是由较高的肥胖率造成的。大多数城市安全网医院的心衰患者有资格使用GLP-1激动剂药物；向大量患者分配这些药物是一项重大的公共卫生挑战。

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引用次数: 0

Dementia is associated with higher mortality and worse patient-centered outcomes after complex and high-risk coronary artery stenting 在复杂和高风险的冠状动脉支架植入术后，痴呆与更高的死亡率和更差的以患者为中心的结果相关

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-02 DOI: 10.1016/j.ahjo.2025.100689

Khanjan B. Shah , Lingwei Xiang , Samir K. Shah , Rachel R. Adler , Joel S. Weissman

Objectives

The aims of this study were to assess whether dementia status influences outcomes of complex high-risk indicated percutaneous coronary intervention (CHIP-PCI).

Background

CHIP-PCI is a type of coronary artery stenting procedure for patients with anatomically complex coronary artery disease and significant medical comorbidities. As the population ages, more patients will require CHIP-PCI including those with Alzheimer's dementia and related dementias (ADRD). Outcomes of CHIP-PCI in patients with ADRD are underexplored.

Methods

We compared outcomes of Medicare fee-for-service (FFS) beneficiaries 66 years or older with and without ADRD who underwent CHIP-PCI from July 1, 2017 to December 31, 2019. The primary clinical outcome was 1-year mortality, and secondary clinical outcomes were complications and readmissions. Patient-centered outcomes were time-at-home ratio and discharge to higher level of care.

Results

8884 patients undergoing CHIP-PCI met study criteria, and 766 (8.6 %) patients carried a diagnosis of ADRD. Patients with ADRD were more likely to be older (81.2 vs 77.5, p < 0.001) and frail (52.1 % vs. 27.3 %, p < 0.001). 1-year mortality was higher among patients with ADRD (OR 1.34, 95 % CI 1.14–1.57) as was 90-day major complications (OR 1.22, 95 % CI 1.03–1.43) and readmissions (OR 1.27, 95 % CI 1.07–1.50). Patients with ADRD were more likely to be discharged to a higher level of care (OR 1.81, 95 % CI 1.48–2.22) and have lower time-at-home ratios (Mean Difference −5.48, 95 % CI −9.24 to −2.45).

Conclusions

Patients with ADRD demonstrate higher 1-year mortality as well as major complications. They demonstrate especially poor time-at-home ratio and risk for discharge to a higher level of care. These data should be used by patients, their families, and physicians to facilitate goal-concordant care.

目的本研究的目的是评估痴呆状态是否影响复杂高危指征经皮冠状动脉介入治疗（CHIP-PCI）的结果。chip - pci是一种冠状动脉支架植入术，适用于解剖结构复杂的冠状动脉疾病和严重的医学合并症患者。随着人口老龄化，更多的患者将需要CHIP-PCI，包括那些患有阿尔茨海默氏痴呆和相关痴呆（ADRD）的患者。CHIP-PCI治疗ADRD患者的疗效尚不明确。方法我们比较了2017年7月1日至2019年12月31日期间接受CHIP-PCI治疗的66岁及以上的医疗保险服务收费（FFS）受益人，有和没有ADRD。主要临床结果为1年死亡率，次要临床结果为并发症和再入院。以患者为中心的结果是在家的时间比和出院到更高的护理水平。结果8884例CHIP-PCI患者符合研究标准，766例（8.6%）患者诊断为ADRD。ADRD患者更可能是老年人（81.2 vs 77.5, p < 0.001）和体弱患者（52.1% vs 27.3%, p < 0.001）。ADRD患者的1年死亡率（OR 1.34, 95% CI 1.14-1.57）高于90天主要并发症（OR 1.22, 95% CI 1.03-1.43）和再入院（OR 1.27, 95% CI 1.07-1.50）。ADRD患者更有可能出院到更高水平的护理（OR为1.81,95% CI为1.48-2.22），并且在家的时间比更低（平均差为5.48,95% CI为9.24 - 2.45）。结论ADRD患者具有较高的1年死亡率和主要并发症。他们在家的时间比例特别低，而且有转到更高级别护理的风险。患者、家属和医生应使用这些数据来促进目标一致的护理。

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引用次数: 0

Cardiac troponin T elevation predicts mortality in hospitalized COVID-19 patients 心脏肌钙蛋白T升高预测住院COVID-19患者的死亡率

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-02 DOI: 10.1016/j.ahjo.2025.100690

Katelyn A. Bruno , R. Scott Wright , Joshua Culberson , Mikolaj A. Wieczorek , David O. Hodge , Patrick W. Johnson , Yomary A. Jimenez , Emily R. Whelan , Jose M. Malavet , Kathryn F. Larson , Jonathon W. Senefeld , Chad C. Wiggins , Stephen A. Klassen , Jacob Ricci , Taimur Sher , Rickey E. Carter , Michael J. Joyner , DeLisa Fairweather , Allan S. Jaffe

Objective

To evaluate if cardiac troponin values predict poor outcomes in COVID-19 patients across the range of patients of different sex and age.

Methods

We examined high-sensitivity cardiac troponin T (hs-cTnT) levels in 1050 severely ill hospitalized COVID-19 patients who had hs-cTnT data available and participated in the Expanded Access Program for convalescent plasma study during the first wave (April–August 2020) of the COVID-19 pandemic.

Results

We observed a continuous relationship between hs-cTnT levels and mortality in hospitalized males and females with COVID-19. This finding was present regardless of sex or age.

Conclusion

These data indicate the prognostic ability of hs-cTnT to predict mortality in hospitalized COVID-19 patients across all relevant patient groups.

Clinical Trials registration number: NCT04338360

目的探讨心肌肌钙蛋白值对不同性别和年龄的COVID-19患者预后不良的预测作用。方法我们检测了1050名有hs-cTnT数据的重症住院COVID-19患者的高敏心肌肌钙蛋白T （hs-cTnT）水平，这些患者参加了第一波（2020年4月- 8月）COVID-19大流行期间恢复期血浆研究扩大准入计划。结果我们观察到住院的男性和女性COVID-19患者的hs-cTnT水平与死亡率之间存在连续关系。这一发现与性别和年龄无关。结论这些数据表明hs-cTnT在所有相关患者组中预测住院COVID-19患者死亡率的预后能力。临床试验注册号：NCT04338360

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引用次数: 0

New recommendations for rhythm control—What has changed in the 2023 ACC/AHA/ACCP/HRS and 2024 ESC guidelines for atrial fibrillation, and where does dronedarone fit in? 2023年ACC/AHA/ACCP/HRS和2024年ESC心房颤动指南有何变化？无人机在哪里适用？

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-12-01 DOI: 10.1016/j.ahjo.2025.100645

Gerald V. Naccarelli , Justin Rackley , Giuseppe Boriani

In recent years, the importance of early rhythm control to delay the progression of atrial fibrillation (AF) has been recognized, as have the benefits of catheter ablation and antiarrhythmic drugs (AADs) as first-line therapy for rhythm control. Selecting the most appropriate AAD according to its safety profile as well as individual patient characteristics is of key importance. To inform decision-making, up-to-date guidelines are paramount. The American College of Cardiology (ACC)/American Heart Association (AHA)/American College of Clinical Pharmacy (ACCP)/Heart Rhythm Society (HRS) guidelines for AF were updated in 2023, while the European Society of Cardiology (ESC) guidelines for AF were updated in 2024.

Dronedarone is an AAD indicated in the US to reduce the risk of hospitalization for AF in patients in sinus rhythm with a history of paroxysmal or persistent AF. In Europe, it is indicated for the maintenance of sinus rhythm after successful cardioversion in clinically stable adults with paroxysmal or persistent AF. Since the last major review of the efficacy and safety of dronedarone (published in 2019), multiple real-world evidence (RWE) studies and post hoc analyses of key dronedarone randomized controlled trials have been performed. This review discusses the findings of these RWE studies and post hoc analyses in the context of the 2023 ACC/AHA/ACCP/HRS and 2024 ESC guidelines for AF with a focus on dronedarone as a treatment option for early rhythm control, its use after catheter ablation, and its use in people with heart failure and a mildly reduced or preserved ejection fraction.

近年来，人们认识到早期心律控制对延缓房颤（AF）进展的重要性，以及导管消融和抗心律失常药物（AADs）作为心律控制的一线治疗的益处。根据其安全性和个体患者特征选择最合适的AAD是至关重要的。为了为决策提供信息，最新的指导方针至关重要。美国心脏病学会(ACC)/美国心脏协会(AHA)/美国临床药学院(ACCP)/心律学会（HRS） AF指南于2023年更新，而欧洲心脏病学会（ESC） AF指南于2024年更新。在美国，Dronedarone是一种AAD，用于降低有阵发性或持续性房颤史的窦性心律患者因房颤住院的风险。在欧洲，它被用于临床稳定的阵发性或持续性房颤患者心律转复成功后维持窦性心律。自上一次关于Dronedarone疗效和安全性的重大综述（发表于2019年）以来，多项真实世界证据（RWE）研究和关键无人机随机对照试验的事后分析已经完成。本综述在2023年ACC/AHA/ACCP/HRS和2024年ESC房颤指南的背景下讨论了这些RWE研究的结果和事后分析，重点讨论了drone - edarone作为早期心律控制的治疗选择，其在导管消融后的应用，以及其在心力衰竭和射血分数轻度降低或保留的患者中的应用。

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引用次数: 0

The impact of diabetes on giant negative T-wave amplitude in apical hypertrophic cardiomyopathy patients 糖尿病对根尖肥厚性心肌病患者巨负t波振幅的影响

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-11-27 DOI: 10.1016/j.ahjo.2025.100686

Simin Song , Min Xu , Jinmei Gao , Xiu Feng , Hongqin Huang , Liping Wang

Clinical observations indicate an attenuation of giant negative T-waves (GNTWs) in some patients with apical hypertrophic cardiomyopathy (ApHCM), a condition frequently comorbid with type 2 diabetes mellitus (T2DM). The objective of this study was to examine the effect of T2DM on the GNTWs amplitude in ApHCM. A retrospective cohort of 124 ApHCM patients from Changzhou First People's Hospital (2021–2024) was categorized into T2DM (n = 30) and non-T2DM (n = 94) groups per American Diabetes Association criteria. A comparative analysis of baseline characteristics was conducted using Kruskal-Wallis and χ² tests. The association between T2DM and maximal negative T-wave voltage (Tmax) was assessed via multivariable linear regression, while nonlinear relationships were explored with generalized additive models (GAM). The T2DM subgroup exhibited a higher prevalence of hypertension (83.3 % vs. 60.6 %, p = 0.022) and coronary artery disease (44.8 % vs. 19.4 %, p = 0.006). The T2DM group demonstrated significantly lower absolute magnitude of both R-waves [3.000 (2.118, 3.775) mV vs. 3.625 (2.615, 4.400) mV, p = 0.045] and GNTWs (Tmax) [− 0.600 (−0.700, 0.400) mV vs. −0.750 (−1.100, 0.500) mV, p = 0.016]. Multivariable analysis identified T2DM as an independent predictor of attenuated GNTWs (β = 0.272, p = 0.016). GAM confirmed a significant nonlinear inverse correlation between T2DM and T-wave amplitude (p < 0.05). In conclusion, T2DM is independently associated with lower absolute magnitude of GNTWs in ApHCM, potentially obscuring characteristic electrocardiographic features. It is incumbent upon clinicians to take these diabetes-related confounding effects into account during diagnostic evaluation.

临床观察表明，一些根尖肥厚性心肌病（ApHCM）患者的巨负t波（GNTWs）衰减，这种疾病通常与2型糖尿病（T2DM）合并症。本研究的目的是探讨T2DM对apcm患者GNTWs振幅的影响。根据美国糖尿病协会的标准，对常州市第一人民医院（2021-2024）124例ApHCM患者进行回顾性队列研究，分为T2DM组（n = 30）和非T2DM组（n = 94）。采用Kruskal-Wallis检验和χ2检验对基线特征进行比较分析。通过多变量线性回归评估T2DM与最大负t波电压（Tmax）之间的关系，并使用广义加性模型（GAM）探讨非线性关系。T2DM亚组高血压患病率（83.3%比60.6%,p = 0.022）和冠状动脉疾病患病率（44.8%比19.4%,p = 0.006）较高。T2DM组r波绝对值[3.000 (2.118,3.775)mV vs. 3.625 (2.615, 4.400) mV, p = 0.045]和GNTWs （Tmax）绝对值[- 0.600 (- 0.700,0.400)mV vs. - 0.750 (- 1.100, 0.500) mV, p = 0.016]均显著降低。多变量分析发现T2DM是GNTWs衰减的独立预测因子（β = 0.272, p = 0.016）。GAM证实T2DM与t波振幅呈显著的非线性负相关（p < 0.05）。总之，T2DM与ApHCM中GNTWs的绝对值较低独立相关，这可能会掩盖心电特征。临床医生有责任在诊断评估中考虑这些与糖尿病相关的混杂效应。

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