American Journal of Cardiology最新文献

英文中文

Survival After Endocarditis Surgery Needing Venoarterial Extracorporeal Membrane Oxygenation Support: Results from the Netherlands Heart Registration.

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-13 DOI: 10.1016/j.amjcard.2025.02.005

Floris J Heinen, Sakir Akin, Floris S van den Brink, Khalil Ayan, Henning Hermanns, Michelle D van der Stoel, Marco C Post, Robert J M Klautz, Wilco Tanis

The incidence of venoarterial extracorporeal membrane oxygenation (VA-ECMO) support after cardiac surgery ranges from 0.4% to 3.7%, with in-hospital mortality rates reported at 60%. While the incidence of VA-ECMO after endocarditis (IE) surgery is unknown, these patients may face an even greater mortality risk due to additional IE-related complications. The primary objective of this study is to investigate the incidence and mortality rates of postoperative VA-ECMO following endocarditis surgery. The secondary objective is to compare clinical outcomes and to identify factors associated with in-hospital mortality in patients requiring and not requiring VA-ECMO support. Data were retrieved from the Netherlands Heart Registration. Of 3,468 IE surgeries performed between 2013 and 2022, 49 patients (1.4%) received postoperative VA-ECMO. The in-hospital mortality rate was 49% and the 1-year mortality rate was 60.9%. As expected, this was significantly higher compared to patients not requiring VA-ECMO support (49.0% vs 9.8% and 60.9% vs 15.2% respectively; p <0.001). At baseline, VA-ECMO patients had statistically higher rates of previous valve surgery, peripheral vascular disease and pulmonary hypertension, as well as lower renal and left ventricular functions compared to than patients not requiring VA-ECMO support. In addition, VA-ECMO patients more frequently underwent emergency surgeries and required aortic root surgery and coronary artery bypass grafting more often. While several comorbidities were associated with in-hospital mortality in patients not requiring VA-ECMO, no such associations were observed in VA-ECMO patients. In conclusion, while the incidence of VA-ECMO support after IE surgery is low, it comes with high mortality rates. However, mortality rates do not seem to differ from those reported for non-IE postcardiotomy VA-ECMO patients in current literature, and mortality after VA-ECMO support remains difficult to predict. Based on our data, postcardiotomy VA-ECMO should not be withheld from IE patients because of high-anticipated mortality risk.

{"title":"Survival After Endocarditis Surgery Needing Venoarterial Extracorporeal Membrane Oxygenation Support: Results from the Netherlands Heart Registration.","authors":"Floris J Heinen, Sakir Akin, Floris S van den Brink, Khalil Ayan, Henning Hermanns, Michelle D van der Stoel, Marco C Post, Robert J M Klautz, Wilco Tanis","doi":"10.1016/j.amjcard.2025.02.005","DOIUrl":"10.1016/j.amjcard.2025.02.005","url":null,"abstract":"<p><p>The incidence of venoarterial extracorporeal membrane oxygenation (VA-ECMO) support after cardiac surgery ranges from 0.4% to 3.7%, with in-hospital mortality rates reported at 60%. While the incidence of VA-ECMO after endocarditis (IE) surgery is unknown, these patients may face an even greater mortality risk due to additional IE-related complications. The primary objective of this study is to investigate the incidence and mortality rates of postoperative VA-ECMO following endocarditis surgery. The secondary objective is to compare clinical outcomes and to identify factors associated with in-hospital mortality in patients requiring and not requiring VA-ECMO support. Data were retrieved from the Netherlands Heart Registration. Of 3,468 IE surgeries performed between 2013 and 2022, 49 patients (1.4%) received postoperative VA-ECMO. The in-hospital mortality rate was 49% and the 1-year mortality rate was 60.9%. As expected, this was significantly higher compared to patients not requiring VA-ECMO support (49.0% vs 9.8% and 60.9% vs 15.2% respectively; p <0.001). At baseline, VA-ECMO patients had statistically higher rates of previous valve surgery, peripheral vascular disease and pulmonary hypertension, as well as lower renal and left ventricular functions compared to than patients not requiring VA-ECMO support. In addition, VA-ECMO patients more frequently underwent emergency surgeries and required aortic root surgery and coronary artery bypass grafting more often. While several comorbidities were associated with in-hospital mortality in patients not requiring VA-ECMO, no such associations were observed in VA-ECMO patients. In conclusion, while the incidence of VA-ECMO support after IE surgery is low, it comes with high mortality rates. However, mortality rates do not seem to differ from those reported for non-IE postcardiotomy VA-ECMO patients in current literature, and mortality after VA-ECMO support remains difficult to predict. Based on our data, postcardiotomy VA-ECMO should not be withheld from IE patients because of high-anticipated mortality risk.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Extensive Pericardial Metastasis of Angiosarcoma: Diagnostic Challenge in a Young Case With Effusive Constrictive Pericarditis

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-13 DOI: 10.1016/j.amjcard.2025.02.008

Tatsunori Takahashi MD , Debbie Lin Teodorescu MD , Wyleen Kniola MD , Daniel Luthringer MD , Siddharth Singh MD

A 32-year-old healthy man developed a small pericardial effusion following a motor vehicle accident, which progressed to cardiac tamponade and bilateral pleural effusions over 2 months. Pericardiocentesis drained 1.5 L of hemorrhagic, lymphocyte-predominant exudative fluid, leading to symptomatic improvement and close outpatient follow-up for suspected postcardiac injury syndrome. However, he was readmitted 1.5 months later with recurrent effusions, mediastinal lymphadenopathy, and enlarging hepatic lesions, but without elevated inflammatory markers. Extensive analyses of various fluids, including expert-reviewed cytology and immunostaining, were inconclusive. Despite conservative management, worsening respiratory failure and persistent high chest tube output necessitated venovenous extracorporeal membrane oxygenation. Suspected constrictive pericarditis on transthoracic echocardiography led to the patient's transfer to our quaternary-care hospital for evaluation for pericardiectomy. However, pericardiectomy was deferred due to his unstable respiratory status. Despite intensive care, he eventually died of multiorgan failure 7 months after his initial presentation. Autopsy revealed high-grade hepatic angiosarcoma metastatic to lungs and pericardium with diffuse invasion into the myocardium. This case highlights the importance of cautious interpretation of negative cytology results in patients with recurrent hemorrhagic pericardial effusion, especially without elevated inflammatory markers. When clinical exclusion of pericardial malignancy is challenging, early multidisciplinary consideration of pericardial biopsy may be considered to enhance the diagnostic yield and guide management.

{"title":"Extensive Pericardial Metastasis of Angiosarcoma: Diagnostic Challenge in a Young Case With Effusive Constrictive Pericarditis","authors":"Tatsunori Takahashi MD , Debbie Lin Teodorescu MD , Wyleen Kniola MD , Daniel Luthringer MD , Siddharth Singh MD","doi":"10.1016/j.amjcard.2025.02.008","DOIUrl":"10.1016/j.amjcard.2025.02.008","url":null,"abstract":"<div><div>A 32-year-old healthy man developed a small pericardial effusion following a motor vehicle accident, which progressed to cardiac tamponade and bilateral pleural effusions over 2 months. Pericardiocentesis drained 1.5 L of hemorrhagic, lymphocyte-predominant exudative fluid, leading to symptomatic improvement and close outpatient follow-up for suspected postcardiac injury syndrome. However, he was readmitted 1.5 months later with recurrent effusions, mediastinal lymphadenopathy, and enlarging hepatic lesions, but without elevated inflammatory markers. Extensive analyses of various fluids, including expert-reviewed cytology and immunostaining, were inconclusive. Despite conservative management, worsening respiratory failure and persistent high chest tube output necessitated venovenous extracorporeal membrane oxygenation. Suspected constrictive pericarditis on transthoracic echocardiography led to the patient's transfer to our quaternary-care hospital for evaluation for pericardiectomy. However, pericardiectomy was deferred due to his unstable respiratory status. Despite intensive care, he eventually died of multiorgan failure 7 months after his initial presentation. Autopsy revealed high-grade hepatic angiosarcoma metastatic to lungs and pericardium with diffuse invasion into the myocardium. This case highlights the importance of cautious interpretation of negative cytology results in patients with recurrent hemorrhagic pericardial effusion, especially without elevated inflammatory markers. When clinical exclusion of pericardial malignancy is challenging, early multidisciplinary consideration of pericardial biopsy may be considered to enhance the diagnostic yield and guide management.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"243 ","pages":"Pages 40-44"},"PeriodicalIF":2.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Fellowship-Trained, Board-Certified Adult Congenital Heart Disease Interventionalist: Time to Reach for the Stars

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-10 DOI: 10.1016/j.amjcard.2025.02.006

Georges Ephrem MD, MSc

引用次数: 0

Peripheral Venous Pressure-Guided Decongestion: A New Approach Yet to Prove Beneficial.

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-08 DOI: 10.1016/j.amjcard.2025.02.003

Timir K Paul

引用次数: 0

“Diagnosis of Arrhythmogenic Cardiomyopathy in a Young Patient With Recurrent Myocarditis: The Importance of Genetic Testing” "复发性心肌炎年轻患者的心律失常性心肌病诊断：基因检测的重要性"。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-08 DOI: 10.1016/j.amjcard.2025.01.034

Juana Perez Morales , Ana Spaccavento , Marianna Guerchicoff , Lucrecia Burgos , Juan Pablo Costabel , Eugenio Cingolani , Alberto Alves de Lima

Genetic testing for cardiomyopathies has become a pivotal tool in diagnosing conditions with diverse and often overlapping clinical presentations. Arrhythmogenic cardiomyopathy (ACM), which affects approximately 1 in 5000 individuals, is a life-threatening condition associated with life-threatening arrhythmias and sudden cardiac death (SCD). While ACM typically presents with right- or left-sided heart failure, ventricular arrhythmias, or SCD, it can also manifest as acute or recurrent myocarditis. These inflammatory episodes, known as the "hot phase" of ACM, are less common but highly relevant in certain clinical contexts. We present the case of a 20-year-old male with recurrent episodes of acute myocarditis, confirmed by evidence of myocardial inflammation on cardiac magnetic resonance imaging (cMRI). Genetic testing revealed a pathogenic mutation in the desmoplakin (DSP) gene associated with ACM, raising the suspicion that the recurrent myocarditis episodes represent a "hot phase" of this inherited condition. In conclusion, this case underscores the importance of considering ACM in patients with recurrent myocarditis and highlights the role of genetic testing in uncovering underlying etiologies.

{"title":"“Diagnosis of Arrhythmogenic Cardiomyopathy in a Young Patient With Recurrent Myocarditis: The Importance of Genetic Testing”","authors":"Juana Perez Morales , Ana Spaccavento , Marianna Guerchicoff , Lucrecia Burgos , Juan Pablo Costabel , Eugenio Cingolani , Alberto Alves de Lima","doi":"10.1016/j.amjcard.2025.01.034","DOIUrl":"10.1016/j.amjcard.2025.01.034","url":null,"abstract":"<div><div>Genetic testing for cardiomyopathies has become a pivotal tool in diagnosing conditions with diverse and often overlapping clinical presentations. Arrhythmogenic cardiomyopathy (ACM), which affects approximately 1 in 5000 individuals, is a life-threatening condition associated with life-threatening arrhythmias and sudden cardiac death (SCD). While ACM typically presents with right- or left-sided heart failure, ventricular arrhythmias, or SCD, it can also manifest as acute or recurrent myocarditis. These inflammatory episodes, known as the \"hot phase\" of ACM, are less common but highly relevant in certain clinical contexts. We present the case of a 20-year-old male with recurrent episodes of acute myocarditis, confirmed by evidence of myocardial inflammation on cardiac magnetic resonance imaging (cMRI). Genetic testing revealed a pathogenic mutation in the desmoplakin (DSP) gene associated with ACM, raising the suspicion that the recurrent myocarditis episodes represent a \"hot phase\" of this inherited condition. In conclusion, this case underscores the importance of considering ACM in patients with recurrent myocarditis and highlights the role of genetic testing in uncovering underlying etiologies.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"242 ","pages":"Pages 37-40"},"PeriodicalIF":2.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Biomarkers in Chronic Total Occlusions: Guiding Risk, Not Yet Decisions?

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-07 DOI: 10.1016/j.amjcard.2025.01.022

Hannah I Chaudry, Ian C Gilchrist

引用次数: 0

Myocardial Revascularization in Patients With 3 Vessel Coronary Artery Disease and Chronic Kidney Disease: Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-07 DOI: 10.1016/j.amjcard.2025.02.004

Nicholas Fialka MD , Ryaan EL-Andari MD , Jimmy Kang MD , Yongzhe Hong MD, PhD , Finlay A. McAlister MD, MSc , Jayan Nagendran MD, PhD , Jeevan Nagendran MD, PhD

Coronary artery disease (CAD) and chronic kidney disease (CKD) commonly co-exist. Superior outcomes with coronary artery bypass grafting(CABG) compared to percutaneous coronary intervention (PCI) have been identified in patients with 3 vessel CAD (TVD) and CKD but have been limited to mid-term follow-up. Herein, we analyzed the long-term outcomes of patients with TVD and CKD undergoing surgical versus percutaneous revascularization. 1,599 patients with CKD and TVD without STEMI or previous revascularization underwent coronary angiography between 2009 and 2018. The primary outcome was all-cause mortality. Secondary outcomes included rates of readmission for myocardial infarction (MI), stroke, repeat revascularization, and overall rehospitalization. 453 patients were included in the final analysis (PCI 373; CABG 80; median follow-up 9.3 years). All results are presented as CABG versus PCI. The rate of all-cause mortality at the longest follow-up (14.1 years) was significantly lower in patients who underwent CABG (68.9% vs 83.1%, p = 0.039, adjusted Hazard Ratio (aHR) 0.68, 95% confidence interval (CI) 0.47–0.98). Readmission rates for MI (10.2% vs. 28.4%, p = 0.009, aHR 0.37, 95% CI 0.17–0.77) and repeat revascularization (3.1% vs. 24.4%, p < 0.001, aHR 0.09, 95% CI 0.02–0.34) were also lower after CABG than after PCI. No significant difference was observed in the rates of readmission for stroke or all causes. In conclusion, in this retrospective single-center study, we confirmed that the previously described advantages of CABG over PCI in patients with CKD and TVD persist with extended long-term follow-up. CABG should be considered the gold standard approach to revascularization in this patient population.

{"title":"Myocardial Revascularization in Patients With 3 Vessel Coronary Artery Disease and Chronic Kidney Disease: Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention","authors":"Nicholas Fialka MD , Ryaan EL-Andari MD , Jimmy Kang MD , Yongzhe Hong MD, PhD , Finlay A. McAlister MD, MSc , Jayan Nagendran MD, PhD , Jeevan Nagendran MD, PhD","doi":"10.1016/j.amjcard.2025.02.004","DOIUrl":"10.1016/j.amjcard.2025.02.004","url":null,"abstract":"<div><div>Coronary artery disease (CAD) and chronic kidney disease (CKD) commonly co-exist. Superior outcomes with coronary artery bypass grafting(CABG) compared to percutaneous coronary intervention (PCI) have been identified in patients with 3 vessel CAD (TVD) and CKD but have been limited to mid-term follow-up. Herein, we analyzed the long-term outcomes of patients with TVD and CKD undergoing surgical versus percutaneous revascularization. 1,599 patients with CKD and TVD without STEMI or previous revascularization underwent coronary angiography between 2009 and 2018. The primary outcome was all-cause mortality. Secondary outcomes included rates of readmission for myocardial infarction (MI), stroke, repeat revascularization, and overall rehospitalization. 453 patients were included in the final analysis (PCI 373; CABG 80; median follow-up 9.3 years). All results are presented as CABG versus PCI. The rate of all-cause mortality at the longest follow-up (14.1 years) was significantly lower in patients who underwent CABG (68.9% vs 83.1%, p = 0.039, adjusted Hazard Ratio (aHR) 0.68, 95% confidence interval (CI) 0.47–0.98). Readmission rates for MI (10.2% vs. 28.4%, p = 0.009, aHR 0.37, 95% CI 0.17–0.77) and repeat revascularization (3.1% vs. 24.4%, p < 0.001, aHR 0.09, 95% CI 0.02–0.34) were also lower after CABG than after PCI. No significant difference was observed in the rates of readmission for stroke or all causes. In conclusion, in this retrospective single-center study, we confirmed that the previously described advantages of CABG over PCI in patients with CKD and TVD persist with extended long-term follow-up. CABG should be considered the gold standard approach to revascularization in this patient population.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"243 ","pages":"Pages 8-14"},"PeriodicalIF":2.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Exploring Current Diagnosis and Management of Amiodarone-induced Thyrotoxicosis

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-07 DOI: 10.1016/j.amjcard.2025.02.002

Yudi Her Oktaviono MD, PhD , Ali Mustofa BSc , Pandit Bagus Tri Saputra MD , Wynne Widiarti MD , Novia Nurul Faizah MD , Firas Farisi Alkaff MD

Amiodarone, commonly used to treat various types of arrhythmias, can potentially lead to catastrophic adverse effects like amiodarone-induced thyrotoxicosis (AIT). This review offers insights into diagnosing and managing AIT, involving thyroid function tests, imaging techniques, and strategies to prevent cardiac deterioration and reduce mortality. The approach to managing AIT has shifted from focusing on thyrotoxicosis control to a broader strategy that includes preventing heart deterioration, hospitalizations, and reducing mortality. Healthcare professionals should consider the patient's need for amiodarone, side effects, coexisting conditions, and personal perspective. Routine thyroid function monitoring and collaboration across medical specialties are essential for comprehensive AIT management. Effective management of AIT is crucial to diminish mortality and morbidity. Pharmacological treatment can be initiated. Further intervention such as thyroidectomy is recommended, especially in cases where cardiac status is deteriorating and amiodarone continuation is necessary. In conclusion, early diagnosis and timely treatment through interdisciplinary collaboration according to specific individual case are crucial to reduce morbidity and mortality in AIT patients.

{"title":"Exploring Current Diagnosis and Management of Amiodarone-induced Thyrotoxicosis","authors":"Yudi Her Oktaviono MD, PhD , Ali Mustofa BSc , Pandit Bagus Tri Saputra MD , Wynne Widiarti MD , Novia Nurul Faizah MD , Firas Farisi Alkaff MD","doi":"10.1016/j.amjcard.2025.02.002","DOIUrl":"10.1016/j.amjcard.2025.02.002","url":null,"abstract":"<div><div>Amiodarone, commonly used to treat various types of arrhythmias, can potentially lead to catastrophic adverse effects like amiodarone-induced thyrotoxicosis (AIT). This review offers insights into diagnosing and managing AIT, involving thyroid function tests, imaging techniques, and strategies to prevent cardiac deterioration and reduce mortality. The approach to managing AIT has shifted from focusing on thyrotoxicosis control to a broader strategy that includes preventing heart deterioration, hospitalizations, and reducing mortality. Healthcare professionals should consider the patient's need for amiodarone, side effects, coexisting conditions, and personal perspective. Routine thyroid function monitoring and collaboration across medical specialties are essential for comprehensive AIT management. Effective management of AIT is crucial to diminish mortality and morbidity. Pharmacological treatment can be initiated. Further intervention such as thyroidectomy is recommended, especially in cases where cardiac status is deteriorating and amiodarone continuation is necessary. In conclusion, early diagnosis and timely treatment through interdisciplinary collaboration according to specific individual case are crucial to reduce morbidity and mortality in AIT patients.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"242 ","pages":"Pages 75-81"},"PeriodicalIF":2.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of Sodium-Glucose Cotransporter-2 Inhibitors on Cardiovascular Outcomes in Transthyretin Amyloid Cardiomyopathy

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-06 DOI: 10.1016/j.amjcard.2025.01.012

Stefano H. Byer MD, MS , Aravinthasamy Sivamurugan BA , Udhayvir S. Grewal MD , Michael G. Fradley MD , Paari Dominic MD

Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive form of heart failure characterized by restrictive hemodynamics and high morbidity. Tafamidis remains the only approved treatment, but its limited availability underscores the need for alternative therapies. Sodium-glucose co-transporter 2 inhibitors (SGLT2i), shown to improve outcomes in heart failure with preserved ejection fraction (HFpEF), may offer therapeutic benefits in ATTR-CM due to shared pathophysiological mechanisms. A retrospective cohort analysis was conducted using data from the TriNetX Global Research Network. Patients with wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) were divided into 2 groups: those receiving SGLT2i therapy and those not treated with SGLT2i. Propensity score matching balanced 19 baseline characteristics. Clinical outcomes, including heart failure exacerbations, all-cause hospitalizations, acute kidney injury (AKI), and all-cause mortality, were assessed over 5 years. The study included 623 matched patients in each cohort. SGLT2i therapy was associated with significant reductions in heart failure exacerbations (hazard ratio [HR] 0.64, 95% confidence interval [CI]: 0.48 to 0.86, p <0.01), all-cause hospitalizations (HR 0.72, 95% CI: 0.58 to 0.91, p <0.01), and AKI (HR 0.53, 95% CI: 0.35 to 0.79, p <0.01). A trend toward reduced all-cause mortality (HR 0.83, 95% CI: 0.63 to 1.08, p = 0.165) was observed, though not statistically significant. In conclusions, SGLT2 inhibitors demonstrate significant potential to reduce morbidity and healthcare utilization in wt-ATTR-CM patients, with promising trends toward improved survival. These findings highlight SGLT2i as a viable adjunct to existing therapies like tafamidis and warrant further investigation through prospective randomized trials.

{"title":"Impact of Sodium-Glucose Cotransporter-2 Inhibitors on Cardiovascular Outcomes in Transthyretin Amyloid Cardiomyopathy","authors":"Stefano H. Byer MD, MS , Aravinthasamy Sivamurugan BA , Udhayvir S. Grewal MD , Michael G. Fradley MD , Paari Dominic MD","doi":"10.1016/j.amjcard.2025.01.012","DOIUrl":"10.1016/j.amjcard.2025.01.012","url":null,"abstract":"<div><div>Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive form of heart failure characterized by restrictive hemodynamics and high morbidity. Tafamidis remains the only approved treatment, but its limited availability underscores the need for alternative therapies. Sodium-glucose co-transporter 2 inhibitors (SGLT2i), shown to improve outcomes in heart failure with preserved ejection fraction (HFpEF), may offer therapeutic benefits in ATTR-CM due to shared pathophysiological mechanisms. A retrospective cohort analysis was conducted using data from the TriNetX Global Research Network. Patients with wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) were divided into 2 groups: those receiving SGLT2i therapy and those not treated with SGLT2i. Propensity score matching balanced 19 baseline characteristics. Clinical outcomes, including heart failure exacerbations, all-cause hospitalizations, acute kidney injury (AKI), and all-cause mortality, were assessed over 5 years. The study included 623 matched patients in each cohort. SGLT2i therapy was associated with significant reductions in heart failure exacerbations (hazard ratio [HR] 0.64, 95% confidence interval [CI]: 0.48 to 0.86, p <0.01), all-cause hospitalizations (HR 0.72, 95% CI: 0.58 to 0.91, p <0.01), and AKI (HR 0.53, 95% CI: 0.35 to 0.79, p <0.01). A trend toward reduced all-cause mortality (HR 0.83, 95% CI: 0.63 to 1.08, p = 0.165) was observed, though not statistically significant. In conclusions, SGLT2 inhibitors demonstrate significant potential to reduce morbidity and healthcare utilization in wt-ATTR-CM patients, with promising trends toward improved survival. These findings highlight SGLT2i as a viable adjunct to existing therapies like tafamidis and warrant further investigation through prospective randomized trials.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"243 ","pages":"Pages 15-18"},"PeriodicalIF":2.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical Impact of P2Y12 Pretreatment in ST-Segment Elevation Myocardial Infarction: Insights from the SEMPRE (St-Elevation Mestre Pretreatment Registry) Study

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-06 DOI: 10.1016/j.amjcard.2025.02.001

Francesco Gallo MD , Ada Cutolo MD , Antonio Antonucci MD , Gabriele Cordoni MD , Elisabetta Demurtas MD , Andrea Panza MD , Sakis Themistoclakis MD

Early administration of P2Y12 receptor antagonists, in patients admitted with ST-segment elevation myocardial infarction (STEMI) diagnosis, is still debatable. Aim of this observational registry was to describe the clinical impact of a preloading strategy on coronary reperfusion and in-hospital bleeding in a real-world population, compared with patients who did not receive a P2Y12 receptor antagonist. Consecutive patients from January 2016 to April 2021 with STEMI, who underwent emerging coronary angiography in our institution were included. Primary outcomes were: infarct related artery (IRA) patency; definite or probable stent thrombosis (ST) and in-hospital BARC3-5 bleeding. To overcome the limit of the observational nature of the study an inverse-probability-weighting (IPW) analysis has been performed to adjust for baseline differences. A total of 1004 patients were included, 70% of them did not receive a P2Y12 inhibitor, while 301 patients (30%) were pretreated with a P2Y12 inhibitor before coronary angiography. We have not found differences in IRA reperfusion (46.9% vs. 46.8%; p = 0.81), final TIMI 3 flow after PCI (85.6% vs. 84.9%; p = 0.47) and acute or subacute ST (2% vs. 0.7%; p = 0.17). BARC 3-5 bleeding was significantly higher in the P2Y12 inhibitor-pretreated group (7.3% vs. 3.3%; p = 0.005). At multivariate analysis, pretreatment with a P2Y12 inhibitor, before knowing the coronary anatomy, was an independent predictor of hemorrhagic events (adj OR 3.45 [95% CI 1.78 to 6.69]; p <0.001), In STEMI patients, a routine pretreatment strategy with a P2Y12 inhibitor, before the coronary angiography, seems to not impact on reperfusion outcomes, despite a trend toward increased risk of stent thrombosis; on the other hand, it may increase the risk of major bleedings.

{"title":"Clinical Impact of P2Y12 Pretreatment in ST-Segment Elevation Myocardial Infarction: Insights from the SEMPRE (St-Elevation Mestre Pretreatment Registry) Study","authors":"Francesco Gallo MD , Ada Cutolo MD , Antonio Antonucci MD , Gabriele Cordoni MD , Elisabetta Demurtas MD , Andrea Panza MD , Sakis Themistoclakis MD","doi":"10.1016/j.amjcard.2025.02.001","DOIUrl":"10.1016/j.amjcard.2025.02.001","url":null,"abstract":"<div><div>Early administration of P2Y12 receptor antagonists, in patients admitted with ST-segment elevation myocardial infarction (STEMI) diagnosis, is still debatable. Aim of this observational registry was to describe the clinical impact of a preloading strategy on coronary reperfusion and in-hospital bleeding in a real-world population, compared with patients who did not receive a P2Y12 receptor antagonist. Consecutive patients from January 2016 to April 2021 with STEMI, who underwent emerging coronary angiography in our institution were included. Primary outcomes were: infarct related artery (IRA) patency; definite or probable stent thrombosis (ST) and in-hospital BARC3-5 bleeding. To overcome the limit of the observational nature of the study an inverse-probability-weighting (IPW) analysis has been performed to adjust for baseline differences. A total of 1004 patients were included, 70% of them did not receive a P2Y12 inhibitor, while 301 patients (30%) were pretreated with a P2Y12 inhibitor before coronary angiography. We have not found differences in IRA reperfusion (46.9% vs. 46.8%; p = 0.81), final TIMI 3 flow after PCI (85.6% vs. 84.9%; p = 0.47) and acute or subacute ST (2% vs. 0.7%; p = 0.17). BARC 3-5 bleeding was significantly higher in the P2Y12 inhibitor-pretreated group (7.3% vs. 3.3%; p = 0.005). At multivariate analysis, pretreatment with a P2Y12 inhibitor, before knowing the coronary anatomy, was an independent predictor of hemorrhagic events (adj OR 3.45 [95% CI 1.78 to 6.69]; p <0.001), In STEMI patients, a routine pretreatment strategy with a P2Y12 inhibitor, before the coronary angiography, seems to not impact on reperfusion outcomes, despite a trend toward increased risk of stent thrombosis; on the other hand, it may increase the risk of major bleedings.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"243 ","pages":"Pages 1-7"},"PeriodicalIF":2.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

American Journal of Cardiology

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀