Pub Date : 2026-01-05DOI: 10.1016/j.amjcard.2025.12.012
Ridhima Goel, Alessandro Spirito, Davide Cao, Samantha Sartori, Birgit Vogel, Angelo Oliva, Joseph Sweeny, Pedro Moreno, Yihan Feng, Amit Hooda, Parasuram Melarcode Krishnamoorthy, Usman Baber, Annapoorna Kini, George D Dangas, Roxana Mehran, Samin Sharma
The impact of complex coronary anatomy on outcomes in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) remains unclear. Patients from a large PCI referral center were labeled as HBR in presence of ≥1 major or ≥2 minor Academic Research Consortium HBR criteria and undergoing complex PCI if they had any of the following: ≥3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, stent length >60 mm, bifurcation lesion with ≥2 stents, PCI of chronic total occlusion, left main, saphenous venous graft or requiring the use of atherectomy. Primary outcomes at 1 year were major adverse cardiac event (MACE), a composite of all-cause death, myocardial infarction or target vessel revascularization, and major bleeding. Of 16,966 patients, 7,295 (43.0%) were HBR with 3,611 (49.5%) undergoing complex PCI and 9,671 (57.0%) were non-HBR with 4,103 (42.4%) undergoing complex PCI. At 1 year, patients with complex PCI had a higher risk of MACE in both HBR (adjusted Hazard Ratio [adj. HR] 1.78, 95% Confidence Interval [95% CI] 1.54 to 2.06) and non-HBR (adj. HR 1.82 95% CI 1.55 to 2.12, respectively, pint 0.64) groups and a higher risk of major bleeding (adj. HR 1.55, 95% CI 1.29 to 1.87 and adj. HR 1.36, 95% CI 1.03 to 1.78, respectively; pint = 0.46), as compared to patients undergoing noncomplex PCI. In conclusion, complex PCI was associated with significantly higher risk of ischemic and bleeding adverse outcomes at 1-year in both HBR and non-HBR patients.
{"title":"Procedural Complexity and Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention.","authors":"Ridhima Goel, Alessandro Spirito, Davide Cao, Samantha Sartori, Birgit Vogel, Angelo Oliva, Joseph Sweeny, Pedro Moreno, Yihan Feng, Amit Hooda, Parasuram Melarcode Krishnamoorthy, Usman Baber, Annapoorna Kini, George D Dangas, Roxana Mehran, Samin Sharma","doi":"10.1016/j.amjcard.2025.12.012","DOIUrl":"10.1016/j.amjcard.2025.12.012","url":null,"abstract":"<p><p>The impact of complex coronary anatomy on outcomes in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) remains unclear. Patients from a large PCI referral center were labeled as HBR in presence of ≥1 major or ≥2 minor Academic Research Consortium HBR criteria and undergoing complex PCI if they had any of the following: ≥3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, stent length >60 mm, bifurcation lesion with ≥2 stents, PCI of chronic total occlusion, left main, saphenous venous graft or requiring the use of atherectomy. Primary outcomes at 1 year were major adverse cardiac event (MACE), a composite of all-cause death, myocardial infarction or target vessel revascularization, and major bleeding. Of 16,966 patients, 7,295 (43.0%) were HBR with 3,611 (49.5%) undergoing complex PCI and 9,671 (57.0%) were non-HBR with 4,103 (42.4%) undergoing complex PCI. At 1 year, patients with complex PCI had a higher risk of MACE in both HBR (adjusted Hazard Ratio [adj. HR] 1.78, 95% Confidence Interval [95% CI] 1.54 to 2.06) and non-HBR (adj. HR 1.82 95% CI 1.55 to 2.12, respectively, p<sub>int</sub> 0.64) groups and a higher risk of major bleeding (adj. HR 1.55, 95% CI 1.29 to 1.87 and adj. HR 1.36, 95% CI 1.03 to 1.78, respectively; p<sub>int</sub> = 0.46), as compared to patients undergoing noncomplex PCI. In conclusion, complex PCI was associated with significantly higher risk of ischemic and bleeding adverse outcomes at 1-year in both HBR and non-HBR patients.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":"43-52"},"PeriodicalIF":2.1,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145916460","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 : 2026-01-03DOI: 10.1016/j.amjcard.2025.12.008
Agustina Alves de Lima MD, María Celeste Carrero MD, PhD, Pablo Guillermo Stutzbach MD, Julio Sanmartino MD, Leonardo Seoane MD, MSc, Mariano Vrancic MD, Juan Pablo Costabel MD, MSc
Primary tumors of the pericardium are exceptionally rare, with primary pericardial mesothelioma (PPM) being the most frequently encountered histological subtype. PPM is an aggressive malignancy with a poor prognosis and a median survival of approximately six months from symptom onset. Due to its nonspecific clinical presentation, diagnosis is often delayed and typically occurs at an advanced stage. We report the case of a 47-year-old woman who presented with recurrent hemorrhagic pericardial effusions and signs of hemodynamic compromise. Histopathological analysis of the resected pericardium confirmed a diagnosis of biphasic pericardial mesothelioma, predominantly epithelioid in subtype. This case highlights the diagnostic challenges and poor outcomes associated with PPM, underscoring the need for heightened clinical suspicion, timely intervention, and further research into effective management strategies
{"title":"Primary Pericardial Mesothelioma: A Rare and Aggressive Malignancy – Case Report and Literature Review","authors":"Agustina Alves de Lima MD, María Celeste Carrero MD, PhD, Pablo Guillermo Stutzbach MD, Julio Sanmartino MD, Leonardo Seoane MD, MSc, Mariano Vrancic MD, Juan Pablo Costabel MD, MSc","doi":"10.1016/j.amjcard.2025.12.008","DOIUrl":"10.1016/j.amjcard.2025.12.008","url":null,"abstract":"<div><div>Primary tumors of the pericardium are exceptionally rare, with primary pericardial mesothelioma (PPM) being the most frequently encountered histological subtype. PPM is an aggressive malignancy with a poor prognosis and a median survival of approximately six months from symptom onset. Due to its nonspecific clinical presentation, diagnosis is often delayed and typically occurs at an advanced stage. We report the case of a 47-year-old woman who presented with recurrent hemorrhagic pericardial effusions and signs of hemodynamic compromise. Histopathological analysis of the resected pericardium confirmed a diagnosis of biphasic pericardial mesothelioma, predominantly epithelioid in subtype. This case highlights the diagnostic challenges and poor outcomes associated with PPM, underscoring the need for heightened clinical suspicion, timely intervention, and further research into effective management strategies</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"263 ","pages":"Pages 22-26"},"PeriodicalIF":2.1,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905373","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}
Thromboaspiration (TA) has been proposed as an adjunct to primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) to reduce thrombus burden. However, its effect on microvascular perfusion remains uncertain, and concerns have been raised about its potential to aggravate microvascular injury. This study aimed to evaluate the impact of TA on microvascular obstruction (MVO) using cardiac magnetic resonance imaging in a large cohort of STEMI patients. We prospectively enrolled 460 STEMI patients treated with primary PCI within 12 hours of symptom onset. TA was performed in 193 patients (42%). Cardiac magnetic resonance was performed at day 6 and 3 months to assess infarct size and MVO. A propensity score-based average treatment effect analysis was used to adjust for baseline differences. Subgroup analyses were conducted according to symptom-to-treatment time, thrombus burden (thrombolysis in myocardial infarction thrombus score), and sex. TA was independently associated with higher MVO incidence (odds ratios [OR] 1.52; 95% confidence intervals [CI]: 1.16 to 1.98; p = 0.0024) and greater MVO extent (standardized mean differences 0.42; 95% CI: 0.02 to 0.72; p = 0.041). The association was particularly significant in patients reperfused beyond 6 hours (OR 3.46; 95% CI: 1.92 to 6.23; p < 0.0001) and those with nonocclusive thrombus (thrombolysis in myocardial infarction thrombus score “1 to 4”) (OR 2.23; 95% CI: 1.29 to 3.85; p = 0.004). Sex-stratified analysis showed increased MVO risk in men (OR 1.52; 95% CI: 1.14 to 2.05; p = 0.005) but not in women. TA during primary PCI was associated with increased occurrence and extent of MVO, particularly in patients with delayed reperfusion or nonocclusive thrombus. These findings reinforce current ESC guidelines against routine TA use and suggest that its application should be restricted to carefully selected patients.
{"title":"Selective Use of Thromboaspiration in STEMI: CMR Evidence Against Routine Practice","authors":"Tom Bourcier MD , Jeremie Riou MD , Wissam Abi Khalil MD , Thomas Benard MD , Anicet Betard MD , Audrey Camarzana MD , Stéphane Delepine MD, PhD , Serge Willoteaux MD, PhD , Alain Furber MD, PhD , Fabrice Prunier MD, PhD , Loic Biere MD, PhD","doi":"10.1016/j.amjcard.2025.11.024","DOIUrl":"10.1016/j.amjcard.2025.11.024","url":null,"abstract":"<div><div>Thromboaspiration (TA) has been proposed as an adjunct to primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) to reduce thrombus burden. However, its effect on microvascular perfusion remains uncertain, and concerns have been raised about its potential to aggravate microvascular injury. This study aimed to evaluate the impact of TA on microvascular obstruction (MVO) using cardiac magnetic resonance imaging in a large cohort of STEMI patients. We prospectively enrolled 460 STEMI patients treated with primary PCI within 12 hours of symptom onset. TA was performed in 193 patients (42%). Cardiac magnetic resonance was performed at day 6 and 3 months to assess infarct size and MVO. A propensity score-based average treatment effect analysis was used to adjust for baseline differences. Subgroup analyses were conducted according to symptom-to-treatment time, thrombus burden (thrombolysis in myocardial infarction thrombus score), and sex. TA was independently associated with higher MVO incidence (odds ratios [OR] 1.52; 95% confidence intervals [CI]: 1.16 to 1.98; p = 0.0024) and greater MVO extent (standardized mean differences 0.42; 95% CI: 0.02 to 0.72; p = 0.041). The association was particularly significant in patients reperfused beyond 6 hours (OR 3.46; 95% CI: 1.92 to 6.23; p < 0.0001) and those with nonocclusive thrombus (thrombolysis in myocardial infarction thrombus score “1 to 4”) (OR 2.23; 95% CI: 1.29 to 3.85; p = 0.004). Sex-stratified analysis showed increased MVO risk in men (OR 1.52; 95% CI: 1.14 to 2.05; p = 0.005) but not in women. TA during primary PCI was associated with increased occurrence and extent of MVO, particularly in patients with delayed reperfusion or nonocclusive thrombus. These findings reinforce current ESC guidelines against routine TA use and suggest that its application should be restricted to carefully selected patients.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"263 ","pages":"Pages 8-13"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145896066","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 : 2025-12-31DOI: 10.1016/j.amjcard.2025.11.023
Ciro Pollio Benvenuto MD , Domenico Galante MD , Frederik Zimmermann PhD , Andrea Viceré MD , Vincenzo Viccaro MD , Chiara Giuliana MD , Simona Todisco MD , Michele Bellamoli MD , Luca Bettari PhD , Diego Maffeo MD , Francesco Burzotta PhD , Antonio Maria Leone PhD , Andrea Buono MD
Microvascular dysfunction following primary percutaneous coronary intervention (pPCI) is a well-established determinant of adverse outcomes in ST-segment elevation myocardial infarction (STEMI) patients. Although the invasive Index of Microcirculatory Resistance (IMR) has demonstrated prognostic value, its reliance on thermodilution limits its routine applicability. Angiography-derived functional indices, already validated in the epicardial domain, may offer a simplified, non-invasive alternative for microvascular assessment. To evaluate the prognostic performance of the angiography-derived Index of Microcirculatory Resistance (AngioIMR), we retrospectively analyzed 180 consecutive patients undergoing percutaneous coronary intervention (pPCI) for anterior STEMI at Fondazione Poliambulanza, Brescia, between January 1, 2016, and February 1, 2024. AngioIMR was computed using the formula: AngioIMR = MAP × QFR × TFC. The primary endpoint was a composite of all-cause death, target vessel myocardial infarction, or hospitalization for heart failure. The secondary endpoint additionally included hospitalization for angina. Over a 5-years follow-up, primary and secondary endpoints occurred in 16 (8.9%) and 23 (13%) patients, respectively. The optimal AngioIMR cut-off was 43 (AUC 0.800; 95% CI: 0.714–0.887; p <0.001), with sensitivity 87.5%, specificity 63.4%, PPV 18.9%, and NPV 98.1%. The incidence of both the primary and secondary endpoints were significantly higher in patients with AngioIMR ≥ 43: 18.9% versus 1.9% (p <0.001) and 28.4% versus 1.9% (p <0.001), respectively. AngioIMR ≥ 43 was associated with increased risk of adverse outcomes (HR: 9.5; 95% CI: 2.2–42.0; p <0.001), and remained an independent predictor at multivariable analysis. In conclusion, AngioIMR may be a promising tool to stratify prognosis in patients with STEMI.
原发性经皮冠状动脉介入治疗（pPCI）后微血管功能障碍是st段抬高型心肌梗死（STEMI）患者不良结局的确定因素。尽管侵入性微循环阻力指数（IMR）已被证明具有预后价值，但其对热稀释的依赖限制了其常规适用性。血管造影衍生的功能指数已经在心外膜领域得到验证，可以为微血管评估提供一种简化的、无创的替代方法。为了评估血管造影衍生的微循环阻力指数（AngioIMR）的预后表现，我们回顾性分析了2016年1月1日至2024年2月1日在布雷西亚Poliambulanza基金会连续接受pPCI治疗STEMI的180例患者。血管imr的计算公式为：AngioIMR = MAP × QFR × TFC。主要终点为全因死亡、靶血管心肌梗死或心力衰竭住院。次要终点还包括因心绞痛住院。在5年的随访中，主要和次要终点分别发生在16例（8.9%）和23例（13%）患者中。最佳AngioIMR cut- cut为43 (AUC 0.800; 95% CI: 0.714-0.887; p < 0.001)，敏感性87.5%，特异性63.4%,PPV 18.9%, NPV 98.1%。在AngioIMR≥43的患者中，主要终点和次要终点的发生率均显著较高：分别为18.9% vs. 1.9% （p < 0.001）和28.4% vs. 1.9% （p < 0.001）。AngioIMR≥43与不良结局风险增加相关（HR: 9.5; 95% CI: 2.2-42.0; p < 0.001），并且在多变量分析中仍然是一个独立的预测因子。总之，AngioIMR可能是一种很有前景的STEMI患者预后分层工具。
{"title":"Angiography-Derived Index of Microvascular Resistance in Patients With Anterior ST-Segment Elevation Myocardial Infarction After Successful Primary Percutaneous Coronary Intervention","authors":"Ciro Pollio Benvenuto MD , Domenico Galante MD , Frederik Zimmermann PhD , Andrea Viceré MD , Vincenzo Viccaro MD , Chiara Giuliana MD , Simona Todisco MD , Michele Bellamoli MD , Luca Bettari PhD , Diego Maffeo MD , Francesco Burzotta PhD , Antonio Maria Leone PhD , Andrea Buono MD","doi":"10.1016/j.amjcard.2025.11.023","DOIUrl":"10.1016/j.amjcard.2025.11.023","url":null,"abstract":"<div><div>Microvascular dysfunction following primary percutaneous coronary intervention (pPCI) is a well-established determinant of adverse outcomes in ST-segment elevation myocardial infarction (STEMI) patients. Although the invasive Index of Microcirculatory Resistance (IMR) has demonstrated prognostic value, its reliance on thermodilution limits its routine applicability. Angiography-derived functional indices, already validated in the epicardial domain, may offer a simplified, non-invasive alternative for microvascular assessment. To evaluate the prognostic performance of the angiography-derived Index of Microcirculatory Resistance (AngioIMR), we retrospectively analyzed 180 consecutive patients undergoing percutaneous coronary intervention (pPCI) for anterior STEMI at Fondazione Poliambulanza, Brescia, between January 1, 2016, and February 1, 2024. AngioIMR was computed using the formula: AngioIMR = MAP × QFR × TFC. The primary endpoint was a composite of all-cause death, target vessel myocardial infarction, or hospitalization for heart failure. The secondary endpoint additionally included hospitalization for angina. Over a 5-years follow-up, primary and secondary endpoints occurred in 16 (8.9%) and 23 (13%) patients, respectively. The optimal AngioIMR cut-off was 43 (AUC 0.800; 95% CI: 0.714–0.887; p <0.001), with sensitivity 87.5%, specificity 63.4%, PPV 18.9%, and NPV 98.1%. The incidence of both the primary and secondary endpoints were significantly higher in patients with AngioIMR ≥ 43: 18.9% versus 1.9% (p <0.001) and 28.4% versus 1.9% (p <0.001), respectively. AngioIMR ≥ 43 was associated with increased risk of adverse outcomes (HR: 9.5; 95% CI: 2.2–42.0; p <0.001), and remained an independent predictor at multivariable analysis. In conclusion, AngioIMR may be a promising tool to stratify prognosis in patients with STEMI.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"263 ","pages":"Pages 1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892026","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 : 2025-12-31DOI: 10.1016/j.amjcard.2025.11.019
Batlah Falah MD, MPH , Duzhi Zhao MS , Julia B. Thompson MS , Mir B. Basir DO , Bjorn Redfors MD, PhD , Michael J. Schonning MS, MBS , William W. O’Neill MD , Jason Wollmuth MD
Severe coronary artery calcification (CAC) complicates high-risk percutaneous coronary intervention (HRPCI), particularly in patients with impaired left ventricular function. Atherectomy may facilitate lesion preparation, but its use in high-risk settings is limited. We therefore aimed to assess the impact of CAC severity and atherectomy on outcomes in Impella-supported HRPCI. In the PROTECT III study (NCT04136392), 1,015 of 1,237 patients had data on CAC severity and atherectomy. Patients were grouped as severe CAC without atherectomy (n = 298), severe CAC with atherectomy (n = 326), and no severe CAC (n = 400). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke/TIA, or repeat revascularization) at 30- and 90-days. Secondary endpoints included 1-year mortality, PCI-related complications, and hemodynamic instability. Patients with severe CAC had higher baseline SYNTAX scores and more left main disease. Atherectomy was associated with slightly longer procedural times, but not increased periprocedural complications or hemodynamic instability. At 90 days, MACCE was highest in the untreated severe CAC group (16.1% vs 12.6% vs 9.2%; overall log-rank p = 0.048). One-year mortality was also highest in this group (23.7%; p = 0.02). However, CAC severity and atherectomy use were not independent predictors of outcomes. Sensitivity analysis excluding patients with atherectomy but no severe CAC showed higher mortality risk in untreated severe CAC cases (adjHR: 0.59; overall p = 0.026). In conclusion, Severe CAC is common in patients undergoing Impella-supported HRPCI and is associated with worse outcomes. Atherectomy was safe but its benefit remains uncertain. These findings highlight the prognostic relevance of CAC and the potential role of calcium modification in HRPCI.
{"title":"The Impact of Atherectomy in Severely Calcified Lesions in Impella-Supported High-Risk Percutaneous Coronary Intervention","authors":"Batlah Falah MD, MPH , Duzhi Zhao MS , Julia B. Thompson MS , Mir B. Basir DO , Bjorn Redfors MD, PhD , Michael J. Schonning MS, MBS , William W. O’Neill MD , Jason Wollmuth MD","doi":"10.1016/j.amjcard.2025.11.019","DOIUrl":"10.1016/j.amjcard.2025.11.019","url":null,"abstract":"<div><div>Severe coronary artery calcification (CAC) complicates high-risk percutaneous coronary intervention (HRPCI), particularly in patients with impaired left ventricular function. Atherectomy may facilitate lesion preparation, but its use in high-risk settings is limited. We therefore aimed to assess the impact of CAC severity and atherectomy on outcomes in Impella-supported HRPCI. In the PROTECT III study (NCT04136392), 1,015 of 1,237 patients had data on CAC severity and atherectomy. Patients were grouped as severe CAC without atherectomy (<em>n</em> = 298), severe CAC with atherectomy (<em>n</em> = 326), and no severe CAC (<em>n</em> = 400). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke/TIA, or repeat revascularization) at 30- and 90-days. Secondary endpoints included 1-year mortality, PCI-related complications, and hemodynamic instability. Patients with severe CAC had higher baseline SYNTAX scores and more left main disease. Atherectomy was associated with slightly longer procedural times, but not increased periprocedural complications or hemodynamic instability. At 90 days, MACCE was highest in the untreated severe CAC group (16.1% vs 12.6% vs 9.2%; overall log-rank p = 0.048). One-year mortality was also highest in this group (23.7%; p = 0.02). However, CAC severity and atherectomy use were not independent predictors of outcomes. Sensitivity analysis excluding patients with atherectomy but no severe CAC showed higher mortality risk in untreated severe CAC cases (adjHR: 0.59; overall p = 0.026). In conclusion, Severe CAC is common in patients undergoing Impella-supported HRPCI and is associated with worse outcomes. Atherectomy was safe but its benefit remains uncertain. These findings highlight the prognostic relevance of CAC and the potential role of calcium modification in HRPCI.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"263 ","pages":"Pages 14-21"},"PeriodicalIF":2.1,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892027","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 : 2025-12-31DOI: 10.1016/j.amjcard.2025.11.029
Stephan Nienaber MD , Jonathan Curio MD , Giuseppe Tarantini MD, PhD , Hendrik Wienemann MD , Matti Adam MD
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.
{"title":"Aortic Regurgitation as the Next Frontier in the TAVR Space","authors":"Stephan Nienaber MD , Jonathan Curio MD , Giuseppe Tarantini MD, PhD , Hendrik Wienemann MD , Matti Adam MD","doi":"10.1016/j.amjcard.2025.11.029","DOIUrl":"10.1016/j.amjcard.2025.11.029","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 83-90"},"PeriodicalIF":2.1,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892072","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.2025.11.026
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}
Nondilated left ventricular cardiomyopathy (NDLVC) has emerged as a new entity within the spectrum of nonischemic 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. Patients with both DCM and NDLVC were eligible in this prospective observational cohort, with diagnostic classification being performed via cardiac magnetic resonance-derived volumes. Univariable and multivariable logistic regression models were used to identify differences in baseline characteristics and indices associated with HF and VA hospitalization. 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 (91 vs 103 ml/m², p = 0.015), shorter QRS duration (104 vs 115 ms, p = 0.02), and were more often in New York Heart Association class I (70% vs 45%, p = 0.004). In multivariable models, the NDLVC phenotype was independently associated with late potentials (odds ratio [OR] 2.82, 95% confidence intervals [CI] [1.25,6.69], p = 0.015), lower left-ventricular end-diastolic volume index (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 New York Heart Association class (OR 19.9, 95% CI [2.14,108.9] p = 0.006), reduced right ventricular ejection fraction (OR 0.81, 95% CI [0.60,0.95] p = 0.006), and lower indexed right-ventricular end-diastolic volume (OR 0.87, 95% CI [0.71,0.98] p = 0.014). VA hospitalization was independently associated with premature ventricular complexes >1,000/24 hours (OR=20.1, 95% CI [2.66,336], p = 0.002), right ventricular ejection fraction ≤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). 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.
{"title":"The Nondilated Left Ventricular Cardiomyopathy Phenotype: Arrhythmic Prognosis and Differences With Dilated Cardiomyopathy","authors":"Nikias Milaras MD , Konstantinos Pamporis MD , Konstantinos Gatzoulis MD, PhD , Paschalis Karakasis MD , Panagiotis Dourvas MD , Nikolaos Ktenopoulos MD , Zoi Sotiriou MD , Alexandros Kasiakogias MD, PhD , Ioannis Leontsinis MD, PhD , Stefanos Archontakis MD, PhD , Charalambos Vlachopoulos MD, PhD , Konstantinos Toutouzas MD, PhD , Konstantinos Tsioufis MD, PhD , Skevos Sideris MD, PhD","doi":"10.1016/j.amjcard.2025.12.017","DOIUrl":"10.1016/j.amjcard.2025.12.017","url":null,"abstract":"<div><div>Nondilated left ventricular cardiomyopathy (NDLVC) has emerged as a new entity within the spectrum of nonischemic 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. Patients with both DCM and NDLVC were eligible in this prospective observational cohort, with diagnostic classification being performed via cardiac magnetic resonance-derived volumes. Univariable and multivariable logistic regression models were used to identify differences in baseline characteristics and indices associated with HF and VA hospitalization. There were 122 patients in the study (NDLVC [<em>n</em> = 60], DCM [<em>n</em> = 62]). Compared to DCM, NDLVC patients had significantly smaller left-ventricular end-diastolic volume index (91 vs 103 ml/m², p = 0.015), shorter QRS duration (104 vs 115 ms, p = 0.02), and were more often in New York Heart Association class I (70% vs 45%, p = 0.004). In multivariable models, the NDLVC phenotype was independently associated with late potentials (odds ratio [OR] 2.82, 95% confidence intervals [CI] [1.25,6.69], p = 0.015), lower left-ventricular end-diastolic volume index (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 New York Heart Association class (OR 19.9, 95% CI [2.14,108.9] p = 0.006), reduced right ventricular ejection fraction (OR 0.81, 95% CI [0.60,0.95] p = 0.006), and lower indexed right-ventricular end-diastolic volume (OR 0.87, 95% CI [0.71,0.98] p = 0.014). VA hospitalization was independently associated with premature ventricular complexes >1,000/24 hours (OR=20.1, 95% CI [2.66,336], p = 0.002), right ventricular ejection fraction ≤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]<strong>,</strong> p = 0.005). 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.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 35-44"},"PeriodicalIF":2.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888805","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}
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