American Journal of Cardiology最新文献

Aortic regurgitation (AR) has long been an underdiagnosed and underestimated valvular heart disease. Nevertheless, large cohort studies demonstrated that the prevalence of clinically relevant AR ranges from 1.6% to 4.5% in individuals aged ≥ 65 years. Despite a markedly increased mortality risk, AR was often treated conservatively, especially in patients considered unsuitable for surgery. Early attempts to treat AR patients with conventional transcatheter devices led to unsatisfactory results, mainly due to elevated rates of valve migration or embolization, and relevant paravalvular regurgitation. Recently, dedicated transcatheter heart valves, such as the JenaValve Trilogy System and the J-Valve, have been introduced and indicated high procedural success rates and improved clinical outcomes. However, both interventional and surgical treatment of AR are associated with increased need for pacemaker implantation, follow-up data is scarce, and referring physicians are often unaware of novel dedicated devices. Awareness needs to be spread to provide optimal treatment for AR patients with increased surgical risk.

Aims: Non-dilated left ventricular cardiomyopathy (NDLVC) has emerged as a new entity within the spectrum of non-ischemic cardiomyopathies, characterized by impaired left ventricular (LV) systolic function in the absence of LV dilatation. This study aimed to compare baseline differences in characteristics between NDLVC and dilated cardiomyopathy (DCM), and to identify predictors of heart failure (HF) and sustained ventricular arrhythmias (VA) (VT/VF) hospitalization within the NDLVC subgroup.

Methods: Patients with both DCM and NDLVC were eligible in this prospective observational cohort, with diagnostic classification being performed via cardiac magnetic resonance (CMR)-derived volumes. Univariable and multivariable logistic regression models were used to identify differences in baseline characteristics and indices associated with HF and VA hospitalization.

Results: There were 122 patients in the study. [NDLVC (n=60), DCM (n=62)]. Compared to DCM, NDLVC patients had significantly smaller left-ventricular end-diastolic volume index (LVEDVi) (91 vs. 103 mL/m², p=0.015), shorter QRS duration (104 vs. 115 ms, p=0.02), and were more often in NYHA class I (70% vs. 45%, p=0.004). In multivariable models, the NDLVC phenotype was independently associated with late potentials (OR 2.82, 95%CI[1.25,6.69], p=0.015), lower LVEDVi (OR 0.97, 95%CI[0.95,0.99], p=0.005), and shorter QTc (OR 0.98, 95%CI[0.96,0.99], p<0.001). Among NDLVC patients and after a median follow-up of 41 months, 6/60 (10%) experienced HF and 10/60 (17%) VA hospitalization. In multivariable models, HF hospitalization was associated with worse NYHA class (OR 19.9, 95%CI[2.14,108.9] p=0.006), reduced right ventricular ejection fraction (RVEF) (OR 0.81, 95%CI[0.60,0.95] p=0.006), and lower indexed right ventricular end-diastolic volume (RVEDVi) (OR 0.87, 95%CI[0.71,0.98] p=0.014). VA hospitalization was independently associated with premature ventricular complexes >1000/24h (OR=20.1, 95%CI[2.66,336], p=0.002), RVEF≤45% (OR 0.85, 95%CI[0.71,0.96], p=0.008) and prolonged QTc (OR 1.06, 95%CI[1.01,1.12], p=0.005).

Conclusions: In conclusion, NDLVC represents a distinct cardiomyopathy phenotype with preserved LV geometry and favorable functional status compared to DCM, yet a significant subset remains at risk for adverse events, particularly VA. RV dysfunction and arrhythmic burden are key risk markers in NDLVC and warrant focused monitoring.

The purpose of this study is to determine the site of attachment of the posterior mitral annulus to the left ventricle in patients with mitral annular disjunction (MAD) and mitral valve prolapse (MVP). The posterior annulus normally attaches to the inlet of the left ventricle. Some histological findings suggest that the disjunctive annulus may instead attach anomalously to the left ventricular (LV) crest in patients with MVP. We used cardiac magnetic resonance imaging to determine the site of attachment of the posterior mitral annulus (crest vs inlet) in 25 patients with MVP with MAD (MAD+ group) and 24 patients with MVP without MAD (MAD- group). The site of annular attachment was determined in the 3-chamber view during diastole. Our data demonstrate complete separation in mitral annular attachment site between MAD+ and MAD- groups. All patients in the MAD+ group demonstrated annular attachment to the LV crest, whereas all those in the MAD- group demonstrated annular attachment to the LV inlet (p <0.001). The presence of anomalous annular attachment in MAD+, but not MAD- patients, suggests this anatomic abnormality represents a feature of the MAD phenotype rather than the myxomatous phenotype. Anomalous annular attachment may potentially influence the arrhythmic potential of MAD.

Global longitudinal strain (GLS) is a sensitive measure for detecting early cardiac dysfunction, but prone to variability by age, race/ethnicity, and sex. To date, GLS has not been described in Hispanics/Latinos, nor has GLS been associated with heart failure risk factors. Data from the Echocardiographic-Study of Latinos, a population-based study of Hispanics/Latinos in the United States, was used. A reference healthy sample was used to define the 95th-percentile lower limit of normal GLS value of -14.2% which was applied to the target population to describe the distribution of GLS across age, gender, and Hispanic/Latino background groups. The proportion of normal/abnormal GLS and left ventricular ejection fraction are described, as well as the proportion of abnormal GLS across prevalent heart failure risk factors (hypertension, obesity, and diabetes). Survey statistics and weighted frequencies were used in all analyses. The study sample consisted of 1,818 adult participants (mean age 56.4 years; 42.6% female). The overall ECHO-SOL target population had a mean GLS of -17.6% with 12.1% having prevalent abnormal GLS. GLS was significantly worse in men than women, and abnormal GLS was more prevalent among individuals of Cuban background than any other Hispanic/Latino background group. More than half (56.4%) of individuals with abnormal GLS had values within the normal left ventricular ejection fraction range, and there were worsening GLS values with increasing heart failure risk factor burden (p < 0.01). In conclusion, our study establishes the first Hispanic/Latino-specific GLS reference values, emphasizing the importance of representative populations in the derivation of myocardial deformation thresholds. Abnormal GLS was prevalent among Hispanics/Latinos, and increasing heart failure risk factor burden correlated with worsening GLS, reinforcing the role of risk factors in early cardiovascular risk assessment.

The previous report on patient-reported outcome (PRO) findings of the ENVISAGE-TAVI AF (NCT02943785) trial demonstrated improved patient experience for edoxaban vs vitamin K antagonists (VKAs). This post hoc analysis aimed to provide insights on the PRO findings of ENVISAGE-TAVI AF using a win ratio (WR) approach to understand key drivers of treatment differences. This analysis included patients who received edoxaban or VKAs and had evaluable Perception of Anticoagulant Treatment Questionnaire 2 (PACT-Q2) assessments from ENVISAGE-TAVI AF. The PACT-Q2 assesses treatment convenience (13 items) and satisfaction (7 items). PACT-Q2 data at months 3 and 12 were analyzed using the WR. Patient-to-patient pairs (one from each group) were compared based on predefined outcome rules; a "win," "loss," or "tie" was determined for edoxaban in each pairwise comparison. The WR (95% confidence interval [CI]) for edoxaban was calculated as the total number of pairs with a win divided by that of pairs with a loss. WR >1 indicates a more favorable patient experience for edoxaban vs VKAs. Edoxaban was associated with a higher probability of improved overall treatment convenience and satisfaction compared with VKAs at months 3 (WR [95% CI], 1.87 [1.58-2.22]) and 12 (WR [95% CI], 2.01 [1.70-2.38]). This difference was driven by 18 of 20 PACT-Q2 items, showing a significantly higher probability of meaningfully better outcomes with edoxaban. In conclusion, this WR analysis demonstrated that meaningfully better treatment convenience and satisfaction were more likely with edoxaban than with VKAs in patients with AF after transcatheter aortic valve replacement.

Atrial fibrillation (AF) and cognitive impairment will each double in prevalence over the next 20 years. Most studies on AF and cognitive disorders have focused on dementia, with less research on cognitive impairment generally. We assessed the association of AF with incident cognitive impairment (ICI) and whether inflammation biomarkers or anticoagulant use attenuated this. The reasons for Geographic and Racial Differences in Stroke (REGARDS) study enrolled 30,239 adults ≥45 years old in 2003-07. Among those without baseline cognitive impairment, ICI was identified by standardized telephone assessments. Hazard ratios (HRs) of ICI were calculated using Cox proportional hazards models. Differences in associations by prevalent stroke, race, and oral anticoagulant use were tested using interaction terms. Among 23,638 participants (mean age 64 years, 56% women, 38% Black), 7% developed ICI over 13 years. AF was associated with ICI among those with prevalent stroke (adjusted HR: 1.69, 95% CI: 1.11-2.56) but not without (HR: 1.05, 95% CI: 0.88-1.27; p interaction = 0.07). The association was not attenuated by anticoagulant use and did not differ by race. Among those with prevalent stroke, there was a small-to-modest attenuation after adjusting for inflammation markers, with the largest attenuation by albumin (15%). In conclusion, in this large cohort, AF was associated with ICI in those with - but not in those without - prevalent stroke. Inflammation biomarkers had modest attenuating effects, and anticoagulation use did not. Results underscore the importance of considering cognitive impairment after stroke in those with AF and identifying underlying causes and preventive treatments.

Tricuspid regurgitation (TR) is common among patients undergoing surgery for degenerative mitral regurgitation (DMR) and is associated with adverse outcomes. The role of concomitant tricuspid annuloplasty (TA) during mitral valve repair (MVr) remains controversial. To address this, we performed a systematic review and meta-analysis of randomized and observational studies published up to November 2024, comparing isolated MVr versus MVr with concomitant TA in patients with DMR (CRD42024627505). Reconstructed Kaplan-Meier time-to-event data were analyzed using Cox frailty models to evaluate survival, TR progression, and permanent pacemaker (PPM) implantation. Sensitivity analyses included randomized or propensity-matched cohorts. A total of 5 studies, including 3,123 patients, were analyzed. Early (1-year) and long-term (up to 15 years) survival were comparable between isolated MVr and concomitant TA (97.3% vs. 96.9%, HR: 1.25, 95% CI: 0.76 to 2.08, p = 0.381 and 72.2% vs 79.7%, HR: 1.28, 95% CI: 0.96 to 1.72, p = 0.092, respectively). Concomitant TA significantly reduced the risk of ≥moderate TR progression (HR: 0.34, 95% CI: 0.17 to 0.70, p = 0.003). However, PPM implantation was higher with TA during the perioperative period (7.4% vs 1.1%, HR 5.76, 95% CI 3.13 to 10.59) and remained elevated at 2 years. Sensitivity analyses confirmed these findings. In conclusion, in patients undergoing MVr for DMR, concomitant TA effectively prevents TR progression without compromising survival but is associated with increased PPM implantation. These results support a selective, guideline-directed approach to TA based on patient- and disease-specific risk factors.

Cardiac amyloidosis (CA) poses a significant prognostic challenge due to its varied presentations and frequent delays in identification. While traditional prognosticators, such as cardiac biomarkers and imaging parameters, offer valuable information, there are significant challenges with individualizing prognosis and accounting for its complex and heterogeneous nature. Artificial intelligence (AI) has enhanced the precision across multiple modalities and has emerged as a prognostic tool in cardiac amyloidosis, demonstrated through models that predict disease progression and stratify patient risk, often outperforming or complementing traditional staging systems. Utilizing AI-derived prognostic information ultimately facilitates informed decision-making-including early initiation of treatments, referrals to specialized centers, and planning for advanced therapies-thereby improving patient outcomes in cardiac amyloidosis. This review aims to synthesize the current advancements and applications of artificial intelligence in predicting outcomes and guiding management strategies for cardiac amyloidosis.