Pub Date : 2025-10-26DOI: 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.
{"title":"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","authors":"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","doi":"10.1016/j.ahjo.2025.100657","DOIUrl":"10.1016/j.ahjo.2025.100657","url":null,"abstract":"<div><h3>Study objective</h3><div>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.</div></div><div><h3>Design</h3><div>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.</div></div><div><h3>Participants</h3><div>The current study included 3222 patients from the National Health and Nutrition Examination Survey with hypertension combined with diabetes mellitus.</div></div><div><h3>Main outcome measures</h3><div>The endpoints of interest were all-cause death, cardiovascular death, and diabetes death.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>Monitoring and maintaining appropriate TyG levels may help reduce the risk of mortality in patients with diabetes and hypertension.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"60 ","pages":"Article 100657"},"PeriodicalIF":1.8,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419184","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}
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。
{"title":"Evaluation of the predictive value of echocardiography parameters for heart transplant rejection: A tissue Doppler imaging observational study","authors":"Fereshteh Ghaderi , Hoorak Poorzand , Farveh Vakilian , Hedieh Alimi , Leila Bigdelu , Afsoon Fazlinezhad , Amirhossein Rafighdoost , Faeze Keihanian","doi":"10.1016/j.ahjo.2025.100654","DOIUrl":"10.1016/j.ahjo.2025.100654","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>p</em> = 0.048, OR = 0.931) and E velocity (<em>p</em> = 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.</div></div><div><h3>Conclusion</h3><div>Septal Ts could be used as a valuable echocardiographic parameter for predicting rejection in heart transplant recipients.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"60 ","pages":"Article 100654"},"PeriodicalIF":1.8,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419185","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}
Pub Date : 2025-10-24DOI: 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.
{"title":"The controversies in the clinical management of β-blockers in acute heart failure induced by rapid atrial fibrillation: A narrative review","authors":"Wenfang Zhu , Jinpeng Xu , Liang Zhang","doi":"10.1016/j.ahjo.2025.100655","DOIUrl":"10.1016/j.ahjo.2025.100655","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"60 ","pages":"Article 100655"},"PeriodicalIF":1.8,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467590","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}
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.
{"title":"Phase-dependent iron dysmetabolism in myocardial ischemia-reperfusion injury: From mechanisms to therapies","authors":"Yilin Huang , Shuang Li , Yuanlin Zeng , Zeyu Zhang","doi":"10.1016/j.ahjo.2025.100653","DOIUrl":"10.1016/j.ahjo.2025.100653","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"60 ","pages":"Article 100653"},"PeriodicalIF":1.8,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145419188","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}
Pub Date : 2025-10-22DOI: 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.
{"title":"Simultaneous carotid ultrasound and transcranial Doppler to detect cholesterol crystal emboli from unstable carotid plaque to the brain","authors":"Fadi Shamoun , Dorothy R. Pathak , Nicholas Campbell , Akanksha Mehla , Mounzer Yassin-Kassab , Jordan Knepper , George S. Abela","doi":"10.1016/j.ahjo.2025.100651","DOIUrl":"10.1016/j.ahjo.2025.100651","url":null,"abstract":"<div><div>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), <em>p</em> ≤ 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.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"60 ","pages":"Article 100651"},"PeriodicalIF":1.8,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365144","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}
Pub Date : 2025-10-22DOI: 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.
{"title":"Surgical treatment of postinfarction thrombosed left ventricle aneurysm formed from coronary artery dissection.","authors":"Olena K. Gogayeva , Oleksandr O. Nudchenko , Mykola L. Rudenko , Anatolii V. Rudenko","doi":"10.1016/j.ahjo.2025.100652","DOIUrl":"10.1016/j.ahjo.2025.100652","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Material and methods</h3><div>ECG, Echo, coronary angiography and cardiac surgery were performed to a 42-year-old military servant with episodes of dyspnea, dizziness and unconsciousness.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"60 ","pages":"Article 100652"},"PeriodicalIF":1.8,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365218","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}
Pub Date : 2025-10-21DOI: 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.
{"title":"Your CT scans are hiding crucial TAVI survival data: Are you looking?","authors":"Marek Kantor , Otakar Jiravsky , Matej Pekar","doi":"10.1016/j.ahjo.2025.100649","DOIUrl":"10.1016/j.ahjo.2025.100649","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"60 ","pages":"Article 100649"},"PeriodicalIF":1.8,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145365067","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}
Pub Date : 2025-10-20DOI: 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}
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.
{"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}
Pub Date : 2025-10-15DOI: 10.1016/j.ahjo.2025.100643
Peter Oro , Aravinthan Vignarajah , Joseph El Dahdah , Nishanthi Vigneswaramoorthy , Yousif Awakeem , Gautam V. Shah
Background
MINOCA accounts for 5 %–15 % of myocardial infarctions and is defined by <50 % coronary stenosis without an alternative diagnosis, with heterogeneous mechanisms that complicate care. Given the role of inflammation and microvascular dysfunction, we evaluated whether colchicine improves outcomes.
Methods
We conducted a retrospective cohort study using TriNetX, a federated health research network of 134 million patients from 102 healthcare organizations. Adults (≥18 years) with a primary diagnosis of acute myocardial infarction (AMI) and no revascularization after cardiac catheterization and without alternative diagnosis of elevated troponin were classified as MINOCA according to AHA criteria. Patients with MINOCA on colchicine (≥1 year of use for any indication) were propensity score matched with patients who were not on colchicine.
Results
The primary composite outcome defined as AMI recurrence, all-cause mortality, cerebrovascular events, and all-cause hospitalizations, was significantly lower with colchicine (HR 0.839, 95 % CI 0.750–0.938, p < 0.001). Secondary outcomes of AMI recurrence (HR 0.749, 95 % CI 0.646–0.867, p < 0.001) and all-cause mortality (HR 0.518, 95 % CI 0.312–0.862, p < 0.001) were significantly lower in the colchicine group. Heart failure events (HR 0.861, 95 % CI 0.723–1.026, p > 0.05) and all-cause hospitalizations (HR 0.892, 95 % CI 0.779–1.020, p = 0.764) showed a trend toward lower rates with colchicine, which was not statistically significant. There was no difference in cerebrovascular events between the two groups (HR 1.364, 95 % CI 0.638–2.914, p = 0.820).
Conclusions
In this large real-world cohort, there was a trend toward reduced cardiovascular outcomes in patients with MINOCA who were on colchicine. These findings support further prospective evaluation of colchicine in this understudied population.
Meeting presentation
A portion of this work was presented as a poster at the 2025 American College of Cardiology Annual Scientific Session (Abstract #1047–113) on March 29, 2025, but the full manuscript and supplementary material remain unpublished. All authors have reviewed and approved the submission and report no conflicts of interest.
背景：minoca占心肌梗死的5% - 15%，50%的冠状动脉狭窄没有其他诊断，其不同的机制使护理复杂化。考虑到炎症和微血管功能障碍的作用，我们评估了秋水仙碱是否能改善预后。方法我们使用TriNetX进行了一项回顾性队列研究，TriNetX是一个来自102个医疗机构的1.34亿患者的联邦卫生研究网络。根据AHA标准，原发性急性心肌梗死（AMI）且心导管置管后无血运重建且无肌钙蛋白升高替代诊断的成人（≥18岁）被归类为MINOCA。使用秋水仙碱的MINOCA患者（任何适应症使用≥1年）倾向评分与未使用秋水仙碱的患者相匹配。结果秋水仙碱组AMI复发、全因死亡率、脑血管事件和全因住院的主要综合指标显著降低（HR 0.839, 95% CI 0.750-0.938, p < 0.001）。秋水仙碱组AMI复发的次要结局（HR 0.749, 95% CI 0.646-0.867, p < 0.001）和全因死亡率（HR 0.518, 95% CI 0.312-0.862, p < 0.001）显著降低。心力衰竭事件（HR 0.861, 95% CI 0.723-1.026, p > 0.05）和全因住院率（HR 0.892, 95% CI 0.779-1.020, p = 0.764）均显示秋水仙碱降低的趋势，差异无统计学意义。两组患者脑血管事件发生率无差异（HR 1.364, 95% CI 0.638-2.914, p = 0.820）。结论：在这个庞大的现实世界队列中，使用秋水仙碱的MINOCA患者心血管结局有降低的趋势。这些发现支持秋水仙碱在这一未充分研究人群中的进一步前瞻性评价。在2025年3月29日的2025年美国心脏病学会年度科学会议（摘要# 1047-113）上，本研究的一部分以海报的形式发表，但完整的手稿和补充材料仍未发表。所有作者都审阅并批准了稿件，报告无利益冲突。
{"title":"Colchicine and cardiovascular outcomes in MINOCA: A retrospective cohort study","authors":"Peter Oro , Aravinthan Vignarajah , Joseph El Dahdah , Nishanthi Vigneswaramoorthy , Yousif Awakeem , Gautam V. Shah","doi":"10.1016/j.ahjo.2025.100643","DOIUrl":"10.1016/j.ahjo.2025.100643","url":null,"abstract":"<div><h3>Background</h3><div>MINOCA accounts for 5 %–15 % of myocardial infarctions and is defined by <50 % coronary stenosis without an alternative diagnosis, with heterogeneous mechanisms that complicate care. Given the role of inflammation and microvascular dysfunction, we evaluated whether colchicine improves outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using TriNetX, a federated health research network of 134 million patients from 102 healthcare organizations. Adults (≥18 years) with a primary diagnosis of acute myocardial infarction (AMI) and no revascularization after cardiac catheterization and without alternative diagnosis of elevated troponin were classified as MINOCA according to AHA criteria. Patients with MINOCA on colchicine (≥1 year of use for any indication) were propensity score matched with patients who were not on colchicine.</div></div><div><h3>Results</h3><div>The primary composite outcome defined as AMI recurrence, all-cause mortality, cerebrovascular events, and all-cause hospitalizations, was significantly lower with colchicine (HR 0.839, 95 % CI 0.750–0.938, <em>p</em> < 0.001). Secondary outcomes of AMI recurrence (HR 0.749, 95 % CI 0.646–0.867, <em>p</em> < 0.001) and all-cause mortality (HR 0.518, 95 % CI 0.312–0.862, p < 0.001) were significantly lower in the colchicine group. Heart failure events (HR 0.861, 95 % CI 0.723–1.026, <em>p</em> > 0.05) and all-cause hospitalizations (HR 0.892, 95 % CI 0.779–1.020, <em>p</em> = 0.764) showed a trend toward lower rates with colchicine, which was not statistically significant. There was no difference in cerebrovascular events between the two groups (HR 1.364, 95 % CI 0.638–2.914, <em>p</em> = 0.820).</div></div><div><h3>Conclusions</h3><div>In this large real-world cohort, there was a trend toward reduced cardiovascular outcomes in patients with MINOCA who were on colchicine. These findings support further prospective evaluation of colchicine in this understudied population.</div></div><div><h3>Meeting presentation</h3><div>A portion of this work was presented as a poster at the 2025 American College of Cardiology Annual Scientific Session (Abstract #1047–113) on March 29, 2025, but the full manuscript and supplementary material remain unpublished. All authors have reviewed and approved the submission and report no conflicts of interest.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"60 ","pages":"Article 100643"},"PeriodicalIF":1.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324649","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}
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