American heart journal plus : cardiology research and practice最新文献_第7页

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 : 2025-10-28 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

Association of the triglyceride–glucose index with all-cause and cause-specific mortality in patients with comorbid hypertension and diabetes: A population-based cohort study 甘油三酯-葡萄糖指数与合并高血压和糖尿病患者的全因和病因特异性死亡率的关联：一项基于人群的队列研究

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-10-26 DOI: 10.1016/j.ahjo.2025.100657

Jiahao Zou , Song Lu , Kaishen Cao , Ruihong He , Xia Feng , Shuang Yang , Wen Liu , Haochen Liu , Zhichao Wang , Ruichun Liao , Jin Chen , Xiaoting Jiang , Xiaoping Peng

Study objective

Although the triglyceride-glucose (TyG) index has been shown to be an independent risk factor for either hypertension or diabetes, its association with the coexistence of both conditions remains unclear. This study aimed to evaluate the association between the TyG index and all-cause and cause-specific mortality among patients with comorbid hypertension and diabetes.

Design

To elucidate the correlation between the TyG index and various modes of death, three multifactorial Cox proportional risk regression models were constructed. Restricted cubic spline curves are utilised to fit dose–response associations with the TyG index and various mortality rates. The effect of the TyG index threshold on different types of mortality was assessed via a two-stage Cox regression model.

Participants

The current study included 3222 patients from the National Health and Nutrition Examination Survey with hypertension combined with diabetes mellitus.

Main outcome measures

The endpoints of interest were all-cause death, cardiovascular death, and diabetes death.

Results

During the median 13.7-year follow-up, 1029 (31.9 %) all-cause deaths were observed, including 308 (9.6 %) cardiovascular deaths and 99 (3.1 %) diabetes deaths. Multivariate Cox proportional risk regression models revealed a positive correlation with TyG for all three outcome deaths. A restricted cubic spline demonstrated that the TyG index was linearly and positively associated with diabetes mortality, with U-shaped associations between cardiovascular mortality and all-cause mortality, with thresholds set at 8.87 and 9.37, respectively.

Conclusions

Monitoring and maintaining appropriate TyG levels may help reduce the risk of mortality in patients with diabetes and hypertension.

研究目的虽然甘油三酯-葡萄糖（TyG）指数已被证明是高血压或糖尿病的独立危险因素，但其与两种疾病共存的关系尚不清楚。本研究旨在评估TyG指数与合并高血压和糖尿病患者的全因死亡率和病因特异性死亡率之间的关系。为了阐明TyG指数与各种死亡方式的相关性，我们构建了3个多因素Cox比例风险回归模型。限制三次样条曲线用于拟合与TyG指数和各种死亡率的剂量-反应关联。通过两阶段Cox回归模型评估TyG指数阈值对不同类型死亡率的影响。本研究纳入3222例高血压合并糖尿病的全国健康与营养调查患者。主要结局指标感兴趣的终点是全因死亡、心血管死亡和糖尿病死亡。结果在中位13.7年的随访期间，观察到1029例（31.9%）全因死亡，包括308例（9.6%）心血管死亡和99例（3.1%）糖尿病死亡。多变量Cox比例风险回归模型显示TyG与所有三种结局死亡呈正相关。限制三次样条曲线显示，TyG指数与糖尿病死亡率呈线性正相关，心血管死亡率与全因死亡率呈u型相关，阈值分别为8.87和9.37。结论监测并维持适当的TyG水平有助于降低糖尿病合并高血压患者的死亡风险。

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引用次数: 0

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 : 2025-10-24 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

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 : 2025-10-24 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

Phase-dependent iron dysmetabolism in myocardial ischemia-reperfusion injury: From mechanisms to therapies 心肌缺血再灌注损伤的相依赖性铁代谢异常：从机制到治疗

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-10-22 DOI: 10.1016/j.ahjo.2025.100653

Yilin Huang , Shuang Li , Yuanlin Zeng , Zeyu Zhang

Myocardial ischemia-reperfusion injury (MIRI) remains a critical clinical challenge, often worsening myocardial damage after reperfusion therapy for acute myocardial infarction (AMI). Phase-dependent dysregulation of iron homeostasis is critically involved in the pathogenesis of MIRI. Ischemia leads to depletion of the labile iron pool (LIP) and iron accumulation in cardiomyocytes, whereas reperfusion leads to iron overload and oxidative stress. These changes destroy cellular homeostasis, triggering ferroptosis and other programmed cell death pathways. Potential therapeutic targets have been identified through molecular mechanisms regulating ferritinophagy, hepcidin modulation, and transferrin receptor 1-mediated iron transport. This review summarizes research progress in these phase-specific changes in iron metabolism during myocardial ischemia and reperfusion, emphasizing their roles in oxidative stress and cell damage. Potential therapeutic strategies integrate the correction of dysregulated homeostasis into clinical trials using drugs that target AMI and MIRI, offering perspectives for the development of novel treatments.

心肌缺血-再灌注损伤（MIRI）是急性心肌梗死（AMI）再灌注治疗后心肌损伤恶化的关键临床挑战。铁稳态的相位依赖性失调在MIRI的发病机制中起关键作用。缺血导致心肌细胞不稳定铁池（LIP）耗竭和铁积累，而再灌注导致铁过载和氧化应激。这些变化破坏细胞内稳态，引发铁下垂和其他程序性细胞死亡途径。通过调节铁蛋白自噬、hepcidin调节和转铁蛋白受体1介导的铁转运的分子机制，已经确定了潜在的治疗靶点。本文综述了心肌缺血再灌注时铁代谢的阶段性变化的研究进展，重点介绍了它们在氧化应激和细胞损伤中的作用。潜在的治疗策略是利用靶向AMI和MIRI的药物将失调的体内平衡的纠正整合到临床试验中，为开发新的治疗方法提供了前景。

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引用次数: 0

Simultaneous carotid ultrasound and transcranial Doppler to detect cholesterol crystal emboli from unstable carotid plaque to the brain 同时使用颈动脉超声和经颅多普勒检测从不稳定的颈动脉斑块到大脑的胆固醇晶体栓塞

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-10-22 DOI: 10.1016/j.ahjo.2025.100651

Fadi Shamoun , Dorothy R. Pathak , Nicholas Campbell , Akanksha Mehla , Mounzer Yassin-Kassab , Jordan Knepper , George S. Abela

Detection of unstable carotid plaques at risk for cholesterol crystal (CC) emboli to the brain causing strokes can be challenging. Although plaques with lumen stenosis of >70 % have been shown to pose a risk for embolism, detection prior to this stage of plaque progression (<70 % stenosis) may identify early instability. One such approach would be to obtain simultaneous carotid ultrasound (CUS) and transcranial Doppler (TCD) that can detect CCs discharged from plaque as a signal of instability. Application of contact pressure as usually applied by the interrogating ultrasound probe over a carotid artery during CUS that can trigger high intensity transient signals (HITS) on TCD could provide insight into plaque instability. To test this hypothesis, we evaluated 23 patients with moderate stenosis (∼50 %) by CUS/TCD to check for instability. Of the patients insonated, 4/21 had evidence of HITS on TCD during CUS and 3 had neurological symptoms. The presence of HITS was observed only for emboli from heterogenous/complex plaques (4/14) 28.6 % (95 % CI: 0.084–0.581), p ≤ 0.05. Moreover, to confirm the role of CCs on HITS, we injected 1 or 5 CCs into the femoral circulation of a rabbit model and demonstrated that even a single crystal could be detected by a HIT on TCD. Detection of CCs by HITS with TCD was highly sensitive for number of injected crystals (1/1, 5/5) and specific (0/0 for whole blood) indicating 100 % accuracy. We propose that this simple and readily feasible approach could be useful to detect unstable carotid plaques at an early stage.

检测不稳定的颈动脉斑块是否有胆固醇结晶（CC）栓塞导致脑卒中的风险是具有挑战性的。虽然70%管腔狭窄的斑块有栓塞的风险，但在斑块进展阶段（狭窄70%）之前的检测可以识别早期的不稳定性。其中一种方法是同时获得颈动脉超声（CUS）和经颅多普勒（TCD），可以检测斑块释放的CCs作为不稳定的信号。在颈动脉造影期间，通常使用超声探头在颈动脉上施加接触压力，可以触发TCD上的高强度瞬态信号（HITS），可以深入了解斑块的不稳定性。为了验证这一假设，我们通过CUS/TCD评估了23例中度狭窄（~ 50%）的患者，以检查不稳定性。在超声检查的患者中，4/21在CUS期间有TCD的HITS证据，3有神经系统症状。只有来自异质/复杂斑块的栓子（4/14）出现HITS (28.6%) (95% CI: 0.084 ~ 0.581), p≤0.05。此外，为了证实CCs在HIT中的作用，我们在兔模型的股循环中注射了1或5个CCs，并证明即使是单晶也可以通过HIT在TCD上检测到。TCD联合HITS检测CCs对注射晶体数（1/ 1,5 /5）高度敏感，对全血具有特异性（0/0），准确度为100%。我们建议，这种简单易行的方法可用于早期检测不稳定的颈动脉斑块。

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引用次数: 0

Surgical treatment of postinfarction thrombosed left ventricle aneurysm formed from coronary artery dissection. 冠状动脉夹层形成的梗死后血栓性左心室动脉瘤的外科治疗。

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-10-22 DOI: 10.1016/j.ahjo.2025.100652

Olena K. Gogayeva , Oleksandr O. Nudchenko , Mykola L. Rudenko , Anatolii V. Rudenko

Background

Spontaneous coronary artery dissection (SCAD) may lead to acute myocardial infarction (MI), delayed treatment might develop such life-threatening complication as left ventricle aneurysm (LVA) with further embolization due to the presence of a thrombus in the aneurysmal sac.

Material and methods

ECG, Echo, coronary angiography and cardiac surgery were performed to a 42-year-old military servant with episodes of dyspnea, dizziness and unconsciousness.

Results

There were a signs of postinfarction LVA on ECG. Echo study confirmed LVA with moderate decrease of LV ejection fraction (EF) 35 % and floating thrombus. Coronary angio findings were as following: stenosis of LAD up to 50 %, LCX 60 % with spiral dissection of the LAD. We performed CABG, resection of LVA with thrombectomy on-pump. Patient was discharged on 8th postoperative day. In 15 months after surgery ECHO revealed a recurrent thrombosis of LV apex (LV EF 45 %) that is characterized by increased mobility and heterogeneous structure. Ultrasound exam of lower extremities arteries revealed two thrombotic occlusions: one of the right posterior tibial artery in the middle segment, and another of the left anterior tibial artery in the distal segment. Reoperation was performed on-pump (13 min fibrillation and 98 min perfusion time). Patient was discharged on 6th day after surgery.

Conclusion

Our clinical case demonstrates successful surgical treatment of patient with thrombosed LVA, which appeared after MI due to the coronary artery dissection. Uncontrolled anticoagulation therapy was one of the reasons for recurrent LV thrombosis with low extremities arteries embolization which required on-pump redo cardiac surgery.

背景：自发性冠状动脉夹层（SCAD）可导致急性心肌梗死（MI），延迟治疗可能导致危及生命的并发症，如左心室动脉瘤（LVA），并因动脉瘤囊内存在血栓而进一步栓塞。材料与方法对1例42岁伴有呼吸困难、头晕、意识不清的军人进行心电图、超声、冠状动脉造影及心脏手术检查。结果心电图有梗死后LVA征象。超声检查证实左室血栓，左室射血分数（EF）中度下降35%，并有漂浮血栓。冠状动脉造影结果如下：LAD狭窄高达50%，LCX 60%伴LAD螺旋夹层。我们进行了冠状动脉搭桥、左室静脉切除术和泵上血栓切除术。患者于术后第8天出院。术后15个月，超声显示左室尖部复发性血栓形成（左室EF 45%），其特点是活动性增加和结构不均匀。下肢动脉超声检查发现两处血栓性闭塞：右侧胫骨后动脉位于中段，左侧胫骨前动脉位于远段。再手术进行无泵（13分钟颤动和98分钟灌注时间）。患者于术后第6天出院。结论本病例对心肌梗死后因冠状动脉剥离导致的左心室血栓形成患者进行了成功的手术治疗。不加控制的抗凝治疗是左室血栓复发并下肢动脉栓塞的原因之一，这需要在泵上重做心脏手术。

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引用次数: 0

Your CT scans are hiding crucial TAVI survival data: Are you looking? 你的CT扫描隐藏了重要的TAVI生存数据：你在看吗？

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-10-21 DOI: 10.1016/j.ahjo.2025.100649

Marek Kantor , Otakar Jiravsky , Matej Pekar

Transcatheter Aortic Valve Implantation (TAVI) has revolutionized treatment for severe aortic stenosis, but optimal patient selection remains challenging. This commentary highlights findings from our recent systematic review of 14 studies comprising 9692 TAVI patients, which revealed that CT-derived adipose tissue parameters provide valuable prognostic information often overlooked during procedural planning. We found that higher subcutaneous adipose tissue consistently associated with better survival, while adipose tissue quality, measured by CT attenuation, proved equally important. The relationship between adiposity and outcomes appears U-shaped rather than linear, with both extremely low and high adiposity quartiles correlating with worse outcomes, while moderate subcutaneous adiposity provides optimal outcomes by offering metabolic reserves without pathological complications. Notably, fat distribution patterns (VAT:SAT ratio < 1) were associated with better cardiovascular outcomes, underscoring that where fat is stored matters more than total quantity. The obesity-dependent effects of visceral adipose tissue reflect fundamental differences in metabolic physiology: in non-obese patients, modest VAT represents protective energy reserves, while in obese patients, lower VAT indicates relatively better metabolic health within the context of existing obesity. These adipose tissue characteristics are readily available in pre-procedural CT scans already used for anatomical assessment, requiring minimal additional resources while potentially enhancing risk stratification. We present a novel decision algorithm with sex-specific thresholds that enables immediate clinical implementation of these measurements for patient risk stratification. As TAVI indications expand to include both increasingly frail elderly patients and those at intermediate surgical risk, integrating these overlooked adipose tissue parameters into clinical decision-making could improve patient selection and outcomes.

经导管主动脉瓣植入术（TAVI）已经彻底改变了严重主动脉瓣狭窄的治疗方法，但最佳患者选择仍然具有挑战性。这篇评论强调了我们最近对包含9692名TAVI患者的14项研究的系统综述的发现，这些研究表明，ct来源的脂肪组织参数提供了有价值的预后信息，这些信息在手术计划中经常被忽视。我们发现，较高的皮下脂肪组织始终与较好的生存率相关，而通过CT衰减测量的脂肪组织质量也证明同样重要。肥胖与预后之间的关系呈u型而非线性，极低和高肥胖四分位数与较差的结果相关，而中度皮下肥胖通过提供代谢储备而无病理并发症提供最佳结果。值得注意的是，脂肪分布模式（VAT:SAT比率<； 1）与更好的心血管结果相关，强调脂肪储存的位置比总量更重要。内脏脂肪组织的肥胖依赖效应反映了代谢生理学的根本差异：在非肥胖患者中，适度的VAT代表保护性能量储备，而在肥胖患者中，较低的VAT表明在现有肥胖的情况下代谢健康状况相对较好。这些脂肪组织特征很容易在术前CT扫描中获得，已经用于解剖学评估，需要的额外资源很少，但潜在地增强了风险分层。我们提出了一种具有性别特异性阈值的新型决策算法，可以立即在临床实施这些患者风险分层测量。随着TAVI适应症扩大到包括越来越虚弱的老年患者和具有中等手术风险的患者，将这些被忽视的脂肪组织参数纳入临床决策可以改善患者的选择和结果。

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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 : 2025-10-20 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。

{"title":"Impact of intracoronary adenosine on the no-reflow phenomenon: A randomized, triple-blind, placebo-controlled clinical trial","authors":"Fatemeh Baharvand , Mohammadreza Aghajankhah , Shiva Parvaneh , Bahareh Gholami Chaboki , Francesca Maria Di Muro","doi":"10.1016/j.ahjo.2025.100650","DOIUrl":"10.1016/j.ahjo.2025.100650","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Among 240 STEMI patients, adenosine did not significantly reduce angiographic no-reflow compared with placebo (TIMI flow grade ≤ 2: 15 % vs. 19.2 %, <em>p</em> = 0.391). However, adenosine significantly improved left ventricular recovery at 40 days (ΔLVEF: 13.8 ± 7.4 % vs. 12.1 ± 8.4 %, <em>p</em> = 0.043). Multivariable analysis identified diabetes, active smoking, and lower eGFR as independent predictors of no-reflow, while adenosine independently enhanced LVEF recovery.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"60 ","pages":"Article 100650"},"PeriodicalIF":1.8,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365145","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

Association between a reduction in triglyceride levels and risk of cardiovascular events 甘油三酯水平降低与心血管事件风险之间的关系

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2025-10-16 DOI: 10.1016/j.ahjo.2025.100647

Izuki Yamashita , Masanobu Ishii , Tatsuya Tokai , So Ikebe , Yoshinori Yamanouchi , Taishi Nakamura , Kenichi Tsujita

Background

Previous analyses have reported that low triglyceride (TG) levels were associated with a reduced risk of cardiovascular events in a primary prevention cohort. However, it remains unclear whether a reduction in TG levels directly contributes to cardiovascular risk reduction.

Objective

To investigate whether a reduction in TG levels is associated with a decreased risk of cardiovascular events in primary and secondary prevention cohorts.

Methods

This retrospective study was conducted with a nationwide health insurance claims database, with medical checkups between January 2005 and August 2020 in Japan. We included patients with baseline TG levels ≥150 mg/dL and classified them into primary or secondary prevention of cardiovascular events. TG levels at one year were used to stratify patients into four groups: low (≤100 mg/dL), normal (100–149 mg/dL), high (150–499 mg/dL), and very high (≥500 mg/dL). The primary outcome was major adverse cardiovascular events (MACE).

Results

In the primary prevention cohort, a reduction TG levels to ≤150 mg/dL was significantly associated with a reduced risk of MACE. No significant association was observed in the secondary prevention cohort. In subgroup analyses stratified by LDL-C target achievement, patients with elevated LDL-C showed a trend toward lower event risk with decreasing TG levels.

Conclusion

A weak association was found between a reduction in TG levels and a reduced risk of cardiovascular events in the primary prevention population. However, prospective, randomized, placebo-controlled, and large cardiovascular outcomes trials are needed to prove that substantial reductions in TG levels correlate with cardiovascular event risk reduction.

背景：先前的分析报道，在一级预防队列中，低甘油三酯（TG）水平与心血管事件风险降低相关。然而，目前尚不清楚TG水平的降低是否直接有助于心血管风险的降低。目的探讨在一级和二级预防队列中，TG水平的降低是否与心血管事件风险的降低相关。方法本回顾性研究是在日本全国健康保险索赔数据库中进行的，并在2005年1月至2020年8月期间进行了医疗检查。我们纳入了基线TG水平≥150mg /dL的患者，并将其分为一级预防或二级预防心血管事件。使用一年的TG水平将患者分为四组：低（≤100 mg/dL）、正常（100 - 149 mg/dL）、高（150-499 mg/dL）和非常高（≥500 mg/dL）。主要终点为主要不良心血管事件（MACE）。结果在一级预防队列中，TG水平降低至≤150 mg/dL与MACE风险降低显著相关。在二级预防队列中未观察到显著相关性。在按LDL-C目标实现程度分层的亚组分析中，LDL-C升高的患者随着TG水平的降低，事件风险降低。结论在初级预防人群中，TG水平的降低与心血管事件风险的降低之间存在弱关联。然而，需要前瞻性、随机、安慰剂对照和大型心血管结局试验来证明TG水平的显著降低与心血管事件风险降低相关。

{"title":"Association between a reduction in triglyceride levels and risk of cardiovascular events","authors":"Izuki Yamashita , Masanobu Ishii , Tatsuya Tokai , So Ikebe , Yoshinori Yamanouchi , Taishi Nakamura , Kenichi Tsujita","doi":"10.1016/j.ahjo.2025.100647","DOIUrl":"10.1016/j.ahjo.2025.100647","url":null,"abstract":"<div><h3>Background</h3><div>Previous analyses have reported that low triglyceride (TG) levels were associated with a reduced risk of cardiovascular events in a primary prevention cohort. However, it remains unclear whether a reduction in TG levels directly contributes to cardiovascular risk reduction.</div></div><div><h3>Objective</h3><div>To investigate whether a reduction in TG levels is associated with a decreased risk of cardiovascular events in primary and secondary prevention cohorts.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted with a nationwide health insurance claims database, with medical checkups between January 2005 and August 2020 in Japan. We included patients with baseline TG levels ≥150 mg/dL and classified them into primary or secondary prevention of cardiovascular events. TG levels at one year were used to stratify patients into four groups: low (≤100 mg/dL), normal (100–149 mg/dL), high (150–499 mg/dL), and very high (≥500 mg/dL). The primary outcome was major adverse cardiovascular events (MACE).</div></div><div><h3>Results</h3><div>In the primary prevention cohort, a reduction TG levels to ≤150 mg/dL was significantly associated with a reduced risk of MACE. No significant association was observed in the secondary prevention cohort. In subgroup analyses stratified by LDL-C target achievement, patients with elevated LDL-C showed a trend toward lower event risk with decreasing TG levels.</div></div><div><h3>Conclusion</h3><div>A weak association was found between a reduction in TG levels and a reduced risk of cardiovascular events in the primary prevention population. However, prospective, randomized, placebo-controlled, and large cardiovascular outcomes trials are needed to prove that substantial reductions in TG levels correlate with cardiovascular event risk reduction.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"60 ","pages":"Article 100647"},"PeriodicalIF":1.8,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324648","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