American Journal of Cardiology最新文献

Habitual aerobic exercise is associated with left atrial (LA) enlargement which may increase risk of atrial fibrillation. Patients with LVH and increased LV stiffness may be more predisposed to LA remodeling due to higher LA pressures during exercise. We tested the hypothesis 1 year of aerobic exercise training would increase LA size to a greater extent in patients with LVH than controls. Adults with LVH (n=53) enriched for increased cardiac risk and LV stiffness and control (CON) subjects (n=58) were randomized to one year of high intensity aerobic exercise (ex) or yoga control. LA and LV volumes were measured using 3D echo. Of 111 participants, 83 had complete data available (LVH: 18 exercisers, 10 yoga; CON: 29 exercisers, 26 yoga). Baseline LA volume indices were similar between groups (LVH: 19.8 ± 4.4 mL/m² vs CON: 18.8 ± 4.1 mL/m²; p=0.33). After 1 year, the effects of exercise (p=0.003) and LVH (p=0.001) were each associated with increased LA volume index. More subjects in the LVH/exercise group (33.3%) increased LA size > 5 mL/m² and LA/LV volume ratios > 0.1 compared to the other groups (10% LVH/yoga, 3.4% CON/ex, 3.8% CON/yoga; Chi square p=0.006). In conclusion, 1 year of aerobic training resulted in higher LA volumes in subjects with LVH and LV stiffness compared to healthy subjects. The increase in LA size was greater than changes in LV size suggesting chronic aerobic training in may preferentially affect LA remodeling in subjects with LVH and LV stiffness.

Diuretic resistance (DR) is common among patients admitted with acute heart failure (AHF) and can be estimated by BAN-ADHF scores. Among 317 consecutive patients hospitalized for AHF, BAN-ADHF scores were compared with metrics of DR and composite endpoint of all-cause mortality, HF hospitalization, LVAD, or heart transplantation. The BAN-ADHF score was incorporated into a diuretic dosing calculator and retroactively applied to a patient's diuretic dose to categorize them as adequately dosed or under-dosed (inadequate). The primary outcome studied was attaining >3 L of urine output within the first 24 hours of admission. The median BAN-ADHF score was 9 (IQR of 7-13). A higher BAN-ADHF score was associated with greater DR based on weight loss and urine output (all p<0.001). The highest quartile (Q4) had fewer patients achieve the admission urinary output goal (15% vs 32%, p = 0.004) and lower total urine output (2,009 mL vs 2,559 mL, p=0.029) compared with the first three quartiles. In time-to-event analysis, Q4 of BAN-ADHF score was associated with increased risk of the primary composite endpoint (HR 2.07, 95%CI 1.41-3.04). Compared to those below the calculator's recommended dose, patients receiving loop diuretics at goal doses (37.7% of cohort) had greater 24-hour UOP (3,050 vs. 2,050 mL), likelihood of UOP goal (45% vs. 19%), and weight loss at discharge (8.95 kg vs. 5.94 kg; all p <0.001). In conclusion, BAN-ADHF score correlated with diuretic resistance and prognosis, and may capture the risk of DR compared traditional measures like CKD or NT-proBNP.

Endovascular operators experience elevated rates of occupational orthopedic injuries and persistent radiation exposure with current lead shielding. Novel shielding systems eliminate the need to wear lead aprons while also mitigating occupational radiation exposure, but real-world evidence of their efficacy remains needed. This study evaluated consecutive endovascular procedures requiring fluoroscopy at U.S. and international institutions following installation of a commercially available portable shielding system consisting of interlocking radiation-attenuating acrylic and soft shielding components. Live dosimeters were placed at the left shoulder of the main and assistant operators for quantification of radiation exposure. In total, 1,712 endovascular procedures performed by 671 operators at 153 sites (19% non-U.S.). In 1,712 (99.4%), radiation exposure was recorded. A majority of procedures (83.6%) were coronary interventions including diagnostic angiography (43.8%), non-chronic total occlusion PCI (27.6%), and chronic total occlusion PCI (6.7%). Median fluoroscopy time was 7.7 mins (IQR 3.9-15.3 min), and median radiation exposure to the main operator and first assistant was 2 μSv and 1 μSv. This was comparable to historical measurements of under-lead radiation exposure. In conclusion, the Rampart system effectively reduced radiation exposure in real-world practice, enabling a safe lead-free procedure lab.

Recurrent tricuspid regurgitation (TR) following transcatheter edge-to-edge repair (TEER) has not been thoroughly investigated. We aimed to examine the predictive factors and mid-term outcomes of recurrent TR following successful TEER. Procedural success was defined as the reduction of TR grade to ≤2+, assessed at discharge. Recurrence of TR was defined as TR grade 3+ or worse at one year after initially successful TEER. The primary endpoint of this study was the composite of all-cause mortality and heart failure (HF) hospitalization at 2 years-follow up. Among 163 T-TEER patients with a reduction in TR to ≤2+, 37 patients developed recurrent TR within the first 12 months (76% females, mean age 75.5 ± 8.3 years). Fractional area change (odds ratio, 1.05; P=0.013), residual TR2+ (odds ratio, 5.08; P=0.002) and primary TR etiology (odds ratio, 3.45, P=0.043) were independent predictors of recurrent TR. Over a median follow-up of 18.4 months, the primary endpoint occurred in 11 (13.5%) and 17 (20.7%) of patients in the non-recurrent and recurrent TR groups, respectively, with a hazard ratio of 2.39 (1.09-5.26, P=0.030). In the survival analysis, there was a strong tendency toward higher rates of freedom from the primary endpoint in non-recurrent TR patients (84.5% vs. 73.2%; P=0.066), mainly driven by lower rates of HF hospitalization (79.8% vs. 65.2%; log-rank P=0.048) compared to patients with recurrent TR. In conclusion, recurrent TR was associated with worse outcomes. Right ventricular fractional area change, residual TR and primary TR were independent predictors for recurrent TR.

Sudden cardiac death (SCD) is the leading medical cause of death in young athletes. Male African American basketball players (MABP) appear to be at particularly high risk for SCD. Despite increasing screening and preventative efforts, the incidence of SCD remains elevated in this population. This study aimed to characterize cardiac screening findings, including symptoms, family history, physical exam, and electrocardiogram (ECG) abnormalities in MABP compared to other young athletes undergoing cardiac screening. We secondarily examined referral patterns based on screening results between the two groups. This retrospective study analyzed deidentified data from 8,303 individuals in the HeartBytes National Youth Cardiac Registry who underwent cardiac screening between 2015-2023, including 200 MABP. Screening components, ECG findings, and outcomes were compared between the MABP and non-MABP. Of 8,303 individuals screened, 200 MABP were identified. MABP were found to have higher rates of chest pain during exercise (10.0% vs. 4.8%, p<0.001), easily tiring with exercise (13.0% vs. 7.0%, p=0.003), and heart murmurs (8.9% vs. 4.4%, p=0.008) when compared to the rest of the population screened. ECG abnormalities, including T-wave inversions (4.0% vs. 0.8%, p<0.001), ST-segment depressions (0.5% vs. 0.05%, p=0.01), and nonspecific ST-T wave changes (2.0% vs. 0.4%, p<0.001), were more prevalent in MABP. However, positive screening rates leading to referral to a cardiologist were similar (3.5% vs. 3.2%, p=0.842) in MABP and the rest of the screened population. In conclusion, MABP exhibited higher rates of concerning cardiac screening findings compared to non-MABP, highlighting the need for further investigation into optimizing screening strategies and determining appropriate follow-up in this high-risk group.

Percutaneous coronary intervention (PCI) is an established alternative to coronary artery bypass grafting for the treatment of select patients with unprotected left main (LM) coronary artery disease (CAD). This study evaluates the safety and clinical impact of treating additional coronary arteries during LM-PCI. Consecutive patients undergoing PCI with drug-eluting stents for unprotected LM-CAD between 2010 and 2021 at The Mount Sinai Hospital, New York, USA were eligible for inclusion. Patients were stratified based on whether they underwent treatment of the LM complex alone or had concomitant PCI to an additional vessel outside the LM complex. The primary outcome was major adverse cardiovascular events (MACE), a composite of death, myocardial infarction, or stroke, at one year following PCI. Among 869 consecutive patients (mean age 70.9, 33.0% female, 27.9 mean SYNTAX score) undergoing LM-PCI, 479 (55.1%) underwent treatment of the LM complex alone, and 390 (44.9%) had concomitant PCI of an additional non-LM vessel. Compared with LM complex PCI only, there were no significant differences in the rate of MACE at one year [HR 12.0% vs. 13.3%; HR: 0.95; 95% CI (0.62 - 1.44), p = 0.797], even after adjustment for potential confounders [HR 12.0% vs. 13.3%; HR: 0.87; 95% CI (0.56 - 1.36), p = 0.550]. In conclusion, in a large, real-world cohort of patients undergoing unprotected LM-PCI, treatment of an additional non-LM vessel did not increase the risk of MACE at 1 year compared to LM complex PCI alone.