Pub Date : 2025-12-30DOI: 10.1016/j.amjcard.2025.11.026
Jeffrey J. Silbiger MD , Oksana Marchenko MD, PhD , Raveen Bazaz MD , Priya Panday MD , Aviv Alter MD , Pedro Rafael Vieira De Olivera Salerno MD
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.
{"title":"Anomalous Attachment of the Posterior Mitral Annulus to the Crest of the Left Ventricle in Patients With Mitral Annular Disjunction (MAD) and Mitral Valve Prolapse","authors":"Jeffrey J. Silbiger MD , Oksana Marchenko MD, PhD , Raveen Bazaz MD , Priya Panday MD , Aviv Alter MD , Pedro Rafael Vieira De Olivera Salerno MD","doi":"10.1016/j.amjcard.2025.11.026","DOIUrl":"10.1016/j.amjcard.2025.11.026","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"263 ","pages":"Pages 27-32"},"PeriodicalIF":2.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888673","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}
Pub Date : 2025-12-30DOI: 10.1016/j.amjcard.2025.12.009
Bharat Rawlley MB, BS, Kartik Gupta MD
{"title":"Imaging to Rule Out Thrombus Before Ablation","authors":"Bharat Rawlley MB, BS, Kartik Gupta MD","doi":"10.1016/j.amjcard.2025.12.009","DOIUrl":"10.1016/j.amjcard.2025.12.009","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"263 ","pages":"Page 7"},"PeriodicalIF":2.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888842","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}
Pub Date : 2025-12-30DOI: 10.1016/j.amjcard.2025.12.014
Pavitra Kotini-Shah MD , Priscilla Duran-Luciano MD , Mayank Kansal MD , Farrah Nasrollahi MD , Un Jung Lee PhD , Yawen Yuan MS , Maria Octavia Rangel MD, MS , Robert Kaplan PhD , Sonia G. Ponce MD , Sanjiv J. Shah MD , Jianwen Cai PhD , Martin S. Bilsker MD , Min Pu MD , Barry E. Hurwitz PhD , Carlos J. Rodriguez MD, MPH
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.
{"title":"Global Longitudinal Strain Reference Values in the Hispanic/Latino Population: Echocardiographic Study of Latinos (ECHO-SOL)","authors":"Pavitra Kotini-Shah MD , Priscilla Duran-Luciano MD , Mayank Kansal MD , Farrah Nasrollahi MD , Un Jung Lee PhD , Yawen Yuan MS , Maria Octavia Rangel MD, MS , Robert Kaplan PhD , Sonia G. Ponce MD , Sanjiv J. Shah MD , Jianwen Cai PhD , Martin S. Bilsker MD , Min Pu MD , Barry E. Hurwitz PhD , Carlos J. Rodriguez MD, MPH","doi":"10.1016/j.amjcard.2025.12.014","DOIUrl":"10.1016/j.amjcard.2025.12.014","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"261 ","pages":"Pages 41-49"},"PeriodicalIF":2.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888839","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}
Pub Date : 2025-12-30DOI: 10.1016/j.amjcard.2025.12.016
Christian Hengstenberg, Nicolas M Van Mieghem, Rosa Wang, Weiqin Liao, Ling Shi, Shien Guo, Cathy Chen, Xin Ye, George Dangas, Martin Unverdorben
The previous report on patient-reported outcome findings of the ENVISAGE-TAVI atrial fibrillation (AF) (NCT02943785) trial demonstrated improved patient experience for edoxaban versus vitamin K antagonists (VKAs). This post hoc analysis aimed to provide insights on the patient-reported outcome 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 versus 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 to 2.22]) and 12 (WR [95% CI], 2.01 [1.70 to 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.
{"title":"Patient-Reported Outcomes Using Win Ratio Analysis: A Post Hoc Analysis from the Randomized ENVISAGE-TAVI AF Trial.","authors":"Christian Hengstenberg, Nicolas M Van Mieghem, Rosa Wang, Weiqin Liao, Ling Shi, Shien Guo, Cathy Chen, Xin Ye, George Dangas, Martin Unverdorben","doi":"10.1016/j.amjcard.2025.12.016","DOIUrl":"10.1016/j.amjcard.2025.12.016","url":null,"abstract":"<p><p>The previous report on patient-reported outcome findings of the ENVISAGE-TAVI atrial fibrillation (AF) (NCT02943785) trial demonstrated improved patient experience for edoxaban versus vitamin K antagonists (VKAs). This post hoc analysis aimed to provide insights on the patient-reported outcome 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 versus 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 to 2.22]) and 12 (WR [95% CI], 2.01 [1.70 to 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.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":"63-68"},"PeriodicalIF":2.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888809","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}
Pub Date : 2025-12-30DOI: 10.1016/j.amjcard.2025.11.025
Vinh H. Le MD , Katherine S. Wilkinson MS , Suzanne E. Judd PhD , Elsayed Z. Soliman MD, MS, MSc , Hyacinth I. Hyacinth PhD, MPH, MBBS , Melissa J. Smith PhD , Nels C. Olson PhD, MPH , Mary Cushman MD, MSc
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.
{"title":"Atrial Fibrillation and Risk of Incident Cognitive Impairment: The REasons for Geographic and Racial Differences in Stroke Study","authors":"Vinh H. Le MD , Katherine S. Wilkinson MS , Suzanne E. Judd PhD , Elsayed Z. Soliman MD, MS, MSc , Hyacinth I. Hyacinth PhD, MPH, MBBS , Melissa J. Smith PhD , Nels C. Olson PhD, MPH , Mary Cushman MD, MSc","doi":"10.1016/j.amjcard.2025.11.025","DOIUrl":"10.1016/j.amjcard.2025.11.025","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 28-34"},"PeriodicalIF":2.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888756","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}
Pub Date : 2025-12-30DOI: 10.1016/j.amjcard.2025.11.028
Chirag Vasavda MD, PhD , Beatrix B. Thompson BA , Steven R. Tahan MD , Christopher Iriarte MD
A 65-year-old man with a history of coronary artery disease, myocardial infarction, hypertension, hypereosinophilic syndrome, and chronic hepatitis B presented with a pruritic, generalized rash 3 weeks after initiating amlodipine for refractory hypertension. Physical examination demonstrated widespread indurated pink-red papules coalescing into plaques over the trunk, extremities, face, and scalp. Laboratory evaluation, including complete blood count, metabolic panel, and peripheral flow cytometry, was unremarkable. A skin biopsy revealed vacuolar interface change with a perivascular lymphocytic and granulomatous infiltrate containing eosinophils, consistent with an interstitial granulomatous drug reaction (IGDR). Amlodipine was discontinued and he was initiated on high-dose systemic and high-potency topical corticosteroids. Within 1 week, he experienced significant improvement in pruritus and had not developed any new lesions. Prednisone was successfully tapered without recrudescence of his rash. IGDR is an uncommon hypersensitivity reaction that is most associated with broadly prescribed cardiovascular medications such as calcium channel blockers (CCB) and statins. IGDR rests along a spectrum of reactive granulomatous dermatitides that are triggered by medications, autoimmune diseases, malignancies, or other underlying conditions. Recognition of IGDR by history, exam, and pathology is important for cardiologists and other prescribing clinicians, as its clinical presentation differs from more common drug exanthems as it can develop weeks to months after starting a CCB and can persist long after it is withdrawn. This case underscores the importance of maintaining vigilance for drug eruptions in patients presenting with new rashes while on antihypertensive therapy.
{"title":"A Rapid Drug-Induced Granulomatous Dermatitis to Amlodipine","authors":"Chirag Vasavda MD, PhD , Beatrix B. Thompson BA , Steven R. Tahan MD , Christopher Iriarte MD","doi":"10.1016/j.amjcard.2025.11.028","DOIUrl":"10.1016/j.amjcard.2025.11.028","url":null,"abstract":"<div><div>A 65-year-old man with a history of coronary artery disease, myocardial infarction, hypertension, hypereosinophilic syndrome, and chronic hepatitis B presented with a pruritic, generalized rash 3 weeks after initiating amlodipine for refractory hypertension. Physical examination demonstrated widespread indurated pink-red papules coalescing into plaques over the trunk, extremities, face, and scalp. Laboratory evaluation, including complete blood count, metabolic panel, and peripheral flow cytometry, was unremarkable. A skin biopsy revealed vacuolar interface change with a perivascular lymphocytic and granulomatous infiltrate containing eosinophils, consistent with an interstitial granulomatous drug reaction (IGDR). Amlodipine was discontinued and he was initiated on high-dose systemic and high-potency topical corticosteroids. Within 1 week, he experienced significant improvement in pruritus and had not developed any new lesions. Prednisone was successfully tapered without recrudescence of his rash. IGDR is an uncommon hypersensitivity reaction that is most associated with broadly prescribed cardiovascular medications such as calcium channel blockers (CCB) and statins. IGDR rests along a spectrum of reactive granulomatous dermatitides that are triggered by medications, autoimmune diseases, malignancies, or other underlying conditions. Recognition of IGDR by history, exam, and pathology is important for cardiologists and other prescribing clinicians, as its clinical presentation differs from more common drug exanthems as it can develop weeks to months after starting a CCB and can persist long after it is withdrawn. This case underscores the importance of maintaining vigilance for drug eruptions in patients presenting with new rashes while on antihypertensive therapy.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"261 ","pages":"Pages 23-26"},"PeriodicalIF":2.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888623","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}
Pub Date : 2025-12-30DOI: 10.1016/j.amjcard.2025.12.019
Xander Jacquemyn MD , Ganduboina Rohit MBBS , Michel Pompeu Sá MD, PhD , Johannes Bonatti MD , Irsa Hasan MD , Takuya Ogami MD , Tom Verbelen MD, PhD , Peter Verbrugghe MD, PhD , Filip Rega MD, PhD , Ibrahim Sultan MD
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.
三尖瓣反流（TR）在接受退行性二尖瓣反流（DMR）手术的患者中很常见，并与不良结局相关。伴随三尖瓣成形术（TA）在二尖瓣修复（MVr）中的作用仍然存在争议。为了解决这个问题，我们对截至2024年11月发表的随机和观察性研究进行了系统回顾和荟萃分析，比较了DMR患者的孤立MVr与MVr合并TA （CRD42024627505）。使用Cox脆弱性模型分析重建Kaplan-Meier事件时间数据，以评估患者的生存、TR进展和永久起搏器（PPM）植入情况。敏感性分析包括随机或倾向匹配的队列。共分析了5项研究，包括3123名患者。孤立MVr和合并TA的早期（1年）和长期（长达15年）生存率相当（97.3% vs 96.9%, HR: 1.25, 95% CI: 0.76-2.08, p=0.381; 72.2% vs 79.7%, HR: 1.28, 95% CI: 0.96-1.72, p=0.092）。合并TA可显著降低≥中度TR进展的风险（HR: 0.34, 95% CI: 0.17-0.70, p=0.003）。然而，在围手术期，TA植入PPM更高（7.4% vs 1.1%, HR 5.76, 95% CI 3.13-10.59），并在2年后保持升高。敏感性分析证实了这些发现。总之，在接受MVr治疗DMR的患者中，伴随TA有效地阻止了TR进展而不影响生存，但与PPM植入增加有关。这些结果支持基于患者和疾病特异性风险因素的选择性、指导性TA治疗方法。
{"title":"Concomitant Tricuspid Annuloplasty During Degenerative Mitral Valve Repair: A Systematic Review and Meta-Analysis","authors":"Xander Jacquemyn MD , Ganduboina Rohit MBBS , Michel Pompeu Sá MD, PhD , Johannes Bonatti MD , Irsa Hasan MD , Takuya Ogami MD , Tom Verbelen MD, PhD , Peter Verbrugghe MD, PhD , Filip Rega MD, PhD , Ibrahim Sultan MD","doi":"10.1016/j.amjcard.2025.12.019","DOIUrl":"10.1016/j.amjcard.2025.12.019","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 68-74"},"PeriodicalIF":2.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888746","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}
Pub Date : 2025-12-30DOI: 10.1016/j.amjcard.2025.12.018
Darren Kong DO , Matthew Capustin MD , Matthew Ho MD , James Choi MD , David Lee Stern MD , Michael Hadley MD , Dennis Finkielstein MD
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.
{"title":"Artificial Intelligence as a Prognostic Tool in Cardiac Amyloidosis: A Review","authors":"Darren Kong DO , Matthew Capustin MD , Matthew Ho MD , James Choi MD , David Lee Stern MD , Michael Hadley MD , Dennis Finkielstein MD","doi":"10.1016/j.amjcard.2025.12.018","DOIUrl":"10.1016/j.amjcard.2025.12.018","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 75-82"},"PeriodicalIF":2.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888777","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}
Pub Date : 2025-12-29DOI: 10.1016/j.amjcard.2025.11.027
Millie Watkins MBChB , Jacob Park MD , Diem Dinh PhD , Angela Brennan PhD , Riley Batchelor MBBS , Dion Stub PhD , Christopher Reid PhD , Anoop N. Koshy PhD , Jeffrey Lefkovits MD , Andrew J. Taylor PhD , Sinjini Biswas PhD , VCOR investigators
In-stent restenosis (ISR) remains a challenging complication following percutaneous coronary intervention (PCI), owing to its complex pathogenesis and multifaceted risk factor profile. We performed a retrospective analysis of all PCI data recorded in the Victorian Cardiac Outcomes Registry (VCOR), from 2013 to 2022, dividing patients into the ISR or de novo-PCI groups based on the intervened lesion. The primary outcome was in hospital mortality, with secondary outcomes including 30-day major adverse cardiovascular events and long-term mortality. Among 104,722 total PCI procedures, 4,935 procedures (4.7%) were for ISR, and 99,787 procedures (95.3%) were for de novo coronary lesions. Patients with ISR were older (mean age 69.0 ± 10.7 years vs. 66.4 ± 11.9 years, p < 0.001) with a higher burden of comorbidities including advanced chronic kidney disease (eGFR less than 31ml/min/1.73m2 (4.2% vs. 2.5%, p < 0.001)), peripheral vascular disease (6.3% vs. 3.3%, p < 0.001) and diabetes mellitus (34.8% vs. 22.3%, p < 0.001). Lesion complexity was higher in the ISR group, with more lesions classified as ACC/AHA Type B2 and above (74.8% vs. 59.6%, p < 0.001). Adjunctive imaging devices were more commonly utilized in the ISR group; however, use was generally low (8.4% vs. 2.8%, p < 0.001). In-hospital mortality was lower in the ISR group, whereas 30-day target vessel and lesion revascularization rates were higher (1.3% vs. 0.7%, p < 0.001 and 0.8% vs. 0.4%, p = 0.001 respectively). Long term mortality as assessed over 10 years was higher in the ISR group. In conclusion, compared with de novo PCI, patients undergoing ISR PCI were older with greater comorbidities and lesion complexity. ISR PCI was associated with lower in-hospital mortality but worse long-term survival. These findings provide contemporary, population-based evidence on the evolving clinical profile and outcomes of ISR in routine PCI practice.
{"title":"Prevalence, Predictors and Clinical Outcomes of Percutaneous Coronary Intervention For In-Stent Restenosis versus De Novo Coronary Artery Disease","authors":"Millie Watkins MBChB , Jacob Park MD , Diem Dinh PhD , Angela Brennan PhD , Riley Batchelor MBBS , Dion Stub PhD , Christopher Reid PhD , Anoop N. Koshy PhD , Jeffrey Lefkovits MD , Andrew J. Taylor PhD , Sinjini Biswas PhD , VCOR investigators","doi":"10.1016/j.amjcard.2025.11.027","DOIUrl":"10.1016/j.amjcard.2025.11.027","url":null,"abstract":"<div><div>In-stent restenosis (ISR) remains a challenging complication following percutaneous coronary intervention (PCI), owing to its complex pathogenesis and multifaceted risk factor profile. We performed a retrospective analysis of all PCI data recorded in the Victorian Cardiac Outcomes Registry (VCOR), from 2013 to 2022, dividing patients into the ISR or de novo-PCI groups based on the intervened lesion. The primary outcome was in hospital mortality, with secondary outcomes including 30-day major adverse cardiovascular events and long-term mortality. Among 104,722 total PCI procedures, 4,935 procedures (4.7%) were for ISR, and 99,787 procedures (95.3%) were for de novo coronary lesions. Patients with ISR were older (mean age 69.0 ± 10.7 years vs. 66.4 ± 11.9 years, p < 0.001) with a higher burden of comorbidities including advanced chronic kidney disease (eGFR less than 31ml/min/1.73m<sup>2</sup> (4.2% vs. 2.5%, p < 0.001)), peripheral vascular disease (6.3% vs. 3.3%, p < 0.001) and diabetes mellitus (34.8% vs. 22.3%, p < 0.001). Lesion complexity was higher in the ISR group, with more lesions classified as ACC/AHA Type B2 and above (74.8% vs. 59.6%, p < 0.001). Adjunctive imaging devices were more commonly utilized in the ISR group; however, use was generally low (8.4% vs. 2.8%, p < 0.001). In-hospital mortality was lower in the ISR group, whereas 30-day target vessel and lesion revascularization rates were higher (1.3% vs. 0.7%, p < 0.001 and 0.8% vs. 0.4%, p = 0.001 respectively). Long term mortality as assessed over 10 years was higher in the ISR group. In conclusion, compared with de novo PCI, patients undergoing ISR PCI were older with greater comorbidities and lesion complexity. ISR PCI was associated with lower in-hospital mortality but worse long-term survival. These findings provide contemporary, population-based evidence on the evolving clinical profile and outcomes of ISR in routine PCI practice.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 45-51"},"PeriodicalIF":2.1,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877341","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}
Postoperative atrial fibrillation (POAF) occurs in approximately 5-10% of patients undergoing noncardiac surgery, yet its long-term impact compared to patients without POAF (nPOAF) remains uncertain. This study aimed to assess the incidence of cardiovascular outcomes in patients with new-onset POAF. A systematic search of PubMed, EMBASE, and Scopus up to August 2025 identified studies including adults who developed AF within the first postoperative week. Outcomes analyzed were AF recurrence, cardiac-related hospitalization, stroke, and all-cause mortality. Pooled analyses were performed using random-effects models, reconstructed time-to-event data, and Restricted Mean Survival Time (RMST). A total of 14 studies comprising 3,622,824 patients were included, with 61,305 experiencing POAF. Compared to nPOAF patients, POAF was associated with significantly higher risks of stroke at 1 year (HR 2.34, 95% CI, 1.46-3.21), in-hospital mortality (HR 3.29, 95% CI, 2.90-3.67), and 1-year mortality (HR 1.64, 95% CI, 1.56-1.71). The cumulative incidence of hospitalization or stroke was greater in the POAF group (HR 1.75, 95% CI, 1.18-2.61). Time-to-event analysis showed frequent AF recurrence within days of surgery, with risk persisting over 1 year. RMST analysis indicated that POAF patients experienced hospitalization or stroke an average of 14.77 days earlier than nPOAF patients during follow-up. New-onset POAF after noncardiac surgery is strongly associated with increased risks of stroke, mortality, and recurrent hospitalization. These findings underscore the importance of early recognition and management, and highlight the need for further research into preventive and therapeutic strategies, including the role of anticoagulation.
背景：在接受非心脏手术的患者中，术后心房颤动（POAF）发生率约为5-10%，但与无POAF患者（nPOAF）相比，其长期影响仍不确定。本研究旨在评估新发POAF患者心血管结局的发生率。方法：系统检索PubMed， EMBASE和Scopus，直到2025年8月，确定了包括术后第一周内发生房颤的成年人的研究。结果分析为房颤复发、心脏相关住院、卒中和全因死亡率。采用随机效应模型、重建的事件时间数据和限制平均生存时间（RMST）进行合并分析。结果：共纳入14项研究，包括3,622,824例患者，其中61,305例发生POAF。与nPOAF患者相比，POAF患者一年内卒中风险（HR 2.34, 95% CI 1.46-3.21）、住院死亡率（HR 3.29, 95% CI 2.90-3.67）和一年内死亡率（HR 1.64, 95% CI 1.56-1.71）显著升高。POAF组住院或卒中的累积发生率更高（HR 1.75, 95% CI 1.18-2.61）。时间-事件分析显示手术数日内房颤频繁复发，风险持续超过一年。RMST分析显示，在随访期间，POAF患者住院或中风的时间比nPOAF患者平均早14.77天。结论：非心脏手术后新发POAF与卒中、死亡率和复发住院的风险增加密切相关。这些发现强调了早期识别和管理的重要性，并强调了进一步研究预防和治疗策略的必要性，包括抗凝的作用。
{"title":"Postoperative Atrial Fibrillation in Patients Undergoing Non-Cardiac Surgery.","authors":"Khatere Roozbehi, Davood Semirani-Nezhad, Hamidreza Soleimani, Parnian Soltani, Sahar Saeidi, Yasmin Farahvash, Mohammad Nikoohemmat, Pegah Bahiraie, Sima Tayebi, Dhanunjaya Lakkireddy, Jishanth Mattumpuram, Kaveh Hosseini","doi":"10.1016/j.amjcard.2025.10.030","DOIUrl":"10.1016/j.amjcard.2025.10.030","url":null,"abstract":"<p><p>Postoperative atrial fibrillation (POAF) occurs in approximately 5-10% of patients undergoing noncardiac surgery, yet its long-term impact compared to patients without POAF (nPOAF) remains uncertain. This study aimed to assess the incidence of cardiovascular outcomes in patients with new-onset POAF. A systematic search of PubMed, EMBASE, and Scopus up to August 2025 identified studies including adults who developed AF within the first postoperative week. Outcomes analyzed were AF recurrence, cardiac-related hospitalization, stroke, and all-cause mortality. Pooled analyses were performed using random-effects models, reconstructed time-to-event data, and Restricted Mean Survival Time (RMST). A total of 14 studies comprising 3,622,824 patients were included, with 61,305 experiencing POAF. Compared to nPOAF patients, POAF was associated with significantly higher risks of stroke at 1 year (HR 2.34, 95% CI, 1.46-3.21), in-hospital mortality (HR 3.29, 95% CI, 2.90-3.67), and 1-year mortality (HR 1.64, 95% CI, 1.56-1.71). The cumulative incidence of hospitalization or stroke was greater in the POAF group (HR 1.75, 95% CI, 1.18-2.61). Time-to-event analysis showed frequent AF recurrence within days of surgery, with risk persisting over 1 year. RMST analysis indicated that POAF patients experienced hospitalization or stroke an average of 14.77 days earlier than nPOAF patients during follow-up. New-onset POAF after noncardiac surgery is strongly associated with increased risks of stroke, mortality, and recurrent hospitalization. These findings underscore the importance of early recognition and management, and highlight the need for further research into preventive and therapeutic strategies, including the role of anticoagulation.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":"53-62"},"PeriodicalIF":2.1,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877353","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}
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