Pub Date : 2026-03-02DOI: 10.1016/j.amjcard.2026.02.055
Milena Dal Witt de Souza, Ana Paula Deluca, Juan Peres de Oliveira, Mrunalini Dandamudi, Pedro Batista, Juliana Giorgi, Caroline de Oliveira Fischer Bacca
Despite advances in device therapy and the emergence of novel treatments, beta-blockers (BBs) remain a commonly prescribed medication in heart failure (HF). However, HF with preserved ejection fraction (HFpEF) is underdiagnosed and undertreated, and the specific role of BB therapy in this population remains controversial. A comprehensive search was conducted on PubMed, Embase, and Cochrane databases to identify studies evaluating the impact of BB use on clinical outcomes in patients with HFpEF. Data were pooled using a random-effects model to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and heterogeneity was assessed using I² statistics. We identified 13 observational studies comprising 442,543 patients, of whom 48.3% were women, with a mean age of 76.0 ± 8.3 years. In pooled analyses, BB use was associated with a lower risk of all-cause mortality (HR 0.81, 95% CI 0.73-0.90, p < 0.001). BB therapy was also associated with lower risks of cardiovascular death (HR 0.76, 95% CI 0.64-0.90, p < 0.01), HF hospitalization (HR 0.88, 95% CI 0.78-1.00, p = 0.05), and the composite outcome of death or HF hospitalization (HR 0.89, 95% CI 0.82-0.98, p = 0.02). In conclusion, in this observational meta-analysis, BB use was associated with lower mortality risk in HFpEF, whereas associations with hospitalization outcomes were heterogeneous. These findings should be interpreted as hypothesis-generating and warrant confirmation in adequately powered randomized trials.
尽管器械治疗和新治疗方法的出现取得了进展，β受体阻滞剂（BBs）仍然是心力衰竭（HF）的常用处方药。然而，保留射血分数（HFpEF）的心衰诊断和治疗不足，BB治疗在这一人群中的具体作用仍存在争议。我们对PubMed、Embase和Cochrane数据库进行了全面的检索，以确定评估BB使用对HFpEF患者临床结果影响的研究。采用随机效应模型合并数据，估计风险比（hr）和95%置信区间（ci），并采用I²统计量评估异质性。我们纳入了13项观察性研究，包括442,543例患者，其中48.3%为女性，平均年龄为76.0±8.3岁。在合并分析中，使用BB与全因死亡风险较低相关（HR 0.81, 95% CI 0.73-0.90, p < 0.001）。BB治疗还与心血管死亡（HR 0.76, 95% CI 0.64-0.90, p < 0.01）、心力衰竭住院（HR 0.88, 95% CI 0.78-1.00, p = 0.05）以及死亡或心力衰竭住院的综合结局（HR 0.89, 95% CI 0.82-0.98, p = 0.02）相关。总之，在这项观察性荟萃分析中，β受体阻滞剂的使用与HFpEF患者较低的死亡风险相关，而与住院结果的关联则是异质性的。这些发现应该被解释为产生假设，并在充分有力的随机试验中得到证实。
{"title":"Revisiting Beta-Blockers in Heart Failure With Preserved Ejection Fraction-A Systematic Review and Meta-analysis.","authors":"Milena Dal Witt de Souza, Ana Paula Deluca, Juan Peres de Oliveira, Mrunalini Dandamudi, Pedro Batista, Juliana Giorgi, Caroline de Oliveira Fischer Bacca","doi":"10.1016/j.amjcard.2026.02.055","DOIUrl":"10.1016/j.amjcard.2026.02.055","url":null,"abstract":"<p><p>Despite advances in device therapy and the emergence of novel treatments, beta-blockers (BBs) remain a commonly prescribed medication in heart failure (HF). However, HF with preserved ejection fraction (HFpEF) is underdiagnosed and undertreated, and the specific role of BB therapy in this population remains controversial. A comprehensive search was conducted on PubMed, Embase, and Cochrane databases to identify studies evaluating the impact of BB use on clinical outcomes in patients with HFpEF. Data were pooled using a random-effects model to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and heterogeneity was assessed using I² statistics. We identified 13 observational studies comprising 442,543 patients, of whom 48.3% were women, with a mean age of 76.0 ± 8.3 years. In pooled analyses, BB use was associated with a lower risk of all-cause mortality (HR 0.81, 95% CI 0.73-0.90, p < 0.001). BB therapy was also associated with lower risks of cardiovascular death (HR 0.76, 95% CI 0.64-0.90, p < 0.01), HF hospitalization (HR 0.88, 95% CI 0.78-1.00, p = 0.05), and the composite outcome of death or HF hospitalization (HR 0.89, 95% CI 0.82-0.98, p = 0.02). In conclusion, in this observational meta-analysis, BB use was associated with lower mortality risk in HFpEF, whereas associations with hospitalization outcomes were heterogeneous. These findings should be interpreted as hypothesis-generating and warrant confirmation in adequately powered randomized trials.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353338","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 : 2026-03-02DOI: 10.1016/j.amjcard.2026.03.005
Anant D Butala, Shane Nanayakkara, Rozanne Johnston, Ellen Gardner, Elisha Gartner, Sonny Palmer, Samer Noaman, Nay M Htun, David M Kaye, Antony S Walton, Dion Stub
Stroke is a serious complication following transcatheter aortic valve implantation, associated with increased disability and mortality. Despite this, there is a lack of patient-level data examining stroke in contemporary, lower-risk transcatheter aortic valve implantation (TAVI) populations and limited literature exploring the temporal evolution in stroke incidence among real-world cohorts. We aimed to assess the incidence, predictors, and outcomes of stroke in a modern group of TAVI patients across the clinical risk spectrum. We performed a retrospective analysis of prospectively collected data from 2014 to 2025, included in an Australian multicenter registry. Stroke and other outcome measures were defined in accordance with the Valve Academic Research Consortium-3 guidelines. Of 3,823 patients, median age 82 (interquartile range [IQR]: 77, 86), 60% male, and median STS score 3.3 (2.0, 5.3), 54 (1.4%) patients experienced a stroke before hospital discharge. Stroke incidence did not reduce across the study period (2014 to 2017: 0.8% vs 2018 to 2021: 1.4% vs 2022 to 2025: 1.5%, ptrend = 0.651). Independent predictors of stroke were previous radiotherapy (adjusted odds ratio [aOR]: 2.8, 95% CI 1.1 to 7.3, p = 0.033), use of a self-expanding valve (aOR: 2.9, 95% CI 1.4 to 6.1, p = 0.004), and nonfemoral access (aOR 3.6, 95% CI 1.1 to 12.2, p = 0.040). Post-TAVI stroke was a strong predictor of 12-month all-cause mortality in Cox proportional hazards regression modelling (adjusted hazard ratio: 7.8, 95% CI 3.9 to 15.7, p < 0.001). In conclusion, stroke remains an uncommon but serious TAVI complication in contemporary practice. Despite demographic and procedural evolution, there was no reduction in stroke incidence across the study period. Further research investigating novel strategies for stroke prevention is required.
卒中是经导管主动脉瓣植入术后的严重并发症，与残疾和死亡率增加有关。尽管如此，在当代低风险TAVI人群中，仍缺乏患者水平的卒中检查数据，并且在现实世界队列中探索卒中发病率的时间演变的文献有限。我们的目的是评估跨临床风险谱的现代TAVI患者卒中的发生率、预测因素和结局。我们对2014年至2025年澳大利亚多中心登记的前瞻性收集数据进行了回顾性分析。卒中和其他结局指标根据瓣膜学术研究联盟-3指南定义。3823例患者中，中位年龄82岁（IQR: 77,86）， 60%为男性，STS中位评分3.3(2.0,5.3)，54例（1.4%）患者在出院前发生过卒中。卒中发病率在整个研究期间没有降低（2014-2017年：0.8% vs 2018-2021年：1.4% vs 2022-2025年：1.5%，p趋势=0.651）。卒中的独立预测因素是既往放疗（调整优势比[aOR]: 2.8, 95% CI 1.1-7.3, p=0.033）、使用自扩张瓣膜（aOR: 2.9, 95% CI 1.4-6.1, p=0.004）和非股动脉通路（aOR 3.6, 95% CI 1.1-12.2, p=0.040）。在Cox比例风险回归模型中，tavi后卒中是12个月全因死亡率的一个强有力的预测因子(校正风险比：7.8,95% CI 3.9-15.7, p
{"title":"Incidence, Predictors, and Outcomes of Stroke Following Transcatheter Aortic Valve Implantation: A Multicenter Australian Experience.","authors":"Anant D Butala, Shane Nanayakkara, Rozanne Johnston, Ellen Gardner, Elisha Gartner, Sonny Palmer, Samer Noaman, Nay M Htun, David M Kaye, Antony S Walton, Dion Stub","doi":"10.1016/j.amjcard.2026.03.005","DOIUrl":"10.1016/j.amjcard.2026.03.005","url":null,"abstract":"<p><p>Stroke is a serious complication following transcatheter aortic valve implantation, associated with increased disability and mortality. Despite this, there is a lack of patient-level data examining stroke in contemporary, lower-risk transcatheter aortic valve implantation (TAVI) populations and limited literature exploring the temporal evolution in stroke incidence among real-world cohorts. We aimed to assess the incidence, predictors, and outcomes of stroke in a modern group of TAVI patients across the clinical risk spectrum. We performed a retrospective analysis of prospectively collected data from 2014 to 2025, included in an Australian multicenter registry. Stroke and other outcome measures were defined in accordance with the Valve Academic Research Consortium-3 guidelines. Of 3,823 patients, median age 82 (interquartile range [IQR]: 77, 86), 60% male, and median STS score 3.3 (2.0, 5.3), 54 (1.4%) patients experienced a stroke before hospital discharge. Stroke incidence did not reduce across the study period (2014 to 2017: 0.8% vs 2018 to 2021: 1.4% vs 2022 to 2025: 1.5%, p<sub>trend</sub> = 0.651). Independent predictors of stroke were previous radiotherapy (adjusted odds ratio [aOR]: 2.8, 95% CI 1.1 to 7.3, p = 0.033), use of a self-expanding valve (aOR: 2.9, 95% CI 1.4 to 6.1, p = 0.004), and nonfemoral access (aOR 3.6, 95% CI 1.1 to 12.2, p = 0.040). Post-TAVI stroke was a strong predictor of 12-month all-cause mortality in Cox proportional hazards regression modelling (adjusted hazard ratio: 7.8, 95% CI 3.9 to 15.7, p < 0.001). In conclusion, stroke remains an uncommon but serious TAVI complication in contemporary practice. Despite demographic and procedural evolution, there was no reduction in stroke incidence across the study period. Further research investigating novel strategies for stroke prevention is required.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353386","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":"2026-03-01","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 : 2026-03-01Epub 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":"2026-03-01","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}
Pub Date : 2026-03-01DOI: 10.1016/j.amjcard.2026.02.048
Mohammad As Sayaideh, Nagaraj Sanchitha Honganur, Celestine Odigwe, Brent Ruiz, Alexis Parks, Mohammed Elzeneini, Bassam Omar, Kevin DeAndrade, Nasser Lakkis
Patients with prior coronary artery bypass grafting frequently require repeat revascularization because of progressive native coronary artery disease and saphenous vein graft degeneration. Observational studies have consistently reported worse procedural and long-term outcomes with saphenous vein graft percutaneous coronary intervention (PCI) compared with native-vessel PCI.1-6 This has shaped guideline recommendations that favor native-vessel revascularization when feasible.7,8 However, these comparisons are inherently confounded, as vein graft intervention is often selected when the native vessel is not technically amenable to PCI. PROCTOR is the first randomized trial to compare native vessel versus saphenous vein graft PCI after bypass surgery, enrolling patients only after heart-team confirmation that both targets were clinically appropriate and technically feasible.9,10 The trial was terminated early after enrollment of 220 of 584 planned patients and reported only 1-year outcomes. Consequently, PROCTOR provides randomized evidence in a highly selected population characterized by favorable graft anatomy and complex native coronary disease, including a high prevalence of chronic total occlusions. In this review, we integrate the PROCTOR findings with contemporary registry data and mechanistic studies, highlighting how graft morphology and native lesion complexity modulate early procedural risk and long-term durability. We further propose an anatomy-driven framework for target-vessel selection following bypass surgery. In conclusion, PROCTOR should be interpreted as hypothesis-generating randomized evidence that refines-rather than supplants-the native-first paradigm by identifying clinical and anatomic scenarios in which carefully selected saphenous vein graft intervention may confer lower early hazard, while longer-term durability remains uncertain.
{"title":"Native Coronary Artery Versus Saphenous Vein Graft Percutaneous Coronary Intervention After Coronary Artery Bypass Grafting: A Contemporary Synthesis.","authors":"Mohammad As Sayaideh, Nagaraj Sanchitha Honganur, Celestine Odigwe, Brent Ruiz, Alexis Parks, Mohammed Elzeneini, Bassam Omar, Kevin DeAndrade, Nasser Lakkis","doi":"10.1016/j.amjcard.2026.02.048","DOIUrl":"10.1016/j.amjcard.2026.02.048","url":null,"abstract":"<p><p>Patients with prior coronary artery bypass grafting frequently require repeat revascularization because of progressive native coronary artery disease and saphenous vein graft degeneration. Observational studies have consistently reported worse procedural and long-term outcomes with saphenous vein graft percutaneous coronary intervention (PCI) compared with native-vessel PCI.<sup>1-6</sup> This has shaped guideline recommendations that favor native-vessel revascularization when feasible.<sup>7</sup><sup>,</sup><sup>8</sup> However, these comparisons are inherently confounded, as vein graft intervention is often selected when the native vessel is not technically amenable to PCI. PROCTOR is the first randomized trial to compare native vessel versus saphenous vein graft PCI after bypass surgery, enrolling patients only after heart-team confirmation that both targets were clinically appropriate and technically feasible.<sup>9</sup><sup>,</sup><sup>10</sup> The trial was terminated early after enrollment of 220 of 584 planned patients and reported only 1-year outcomes. Consequently, PROCTOR provides randomized evidence in a highly selected population characterized by favorable graft anatomy and complex native coronary disease, including a high prevalence of chronic total occlusions. In this review, we integrate the PROCTOR findings with contemporary registry data and mechanistic studies, highlighting how graft morphology and native lesion complexity modulate early procedural risk and long-term durability. We further propose an anatomy-driven framework for target-vessel selection following bypass surgery. In conclusion, PROCTOR should be interpreted as hypothesis-generating randomized evidence that refines-rather than supplants-the native-first paradigm by identifying clinical and anatomic scenarios in which carefully selected saphenous vein graft intervention may confer lower early hazard, while longer-term durability remains uncertain.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347092","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 : 2026-03-01Epub Date: 2025-12-15DOI: 10.1016/j.amjcard.2025.12.002
Johny Nicolas MD, MSc , George Dangas MD, PhD , Amanda Borrow PhD , Rüdiger Smolnik MD , Felix Just PhD , Cathy Chen MD, MSc , Krishna Padmanabhan PhD , Eva-Maria Fronk PhD , Christian Hengstenberg MD , Nicolas Van Mieghem MD, PhD , Martin Unverdorben MD, PhD
Patients with atrial fibrillation (AF) following transcatheter aortic valve replacement (TAVR) remain at risk of ischemic stroke (IS) and bleeding. However, traditional risk scores provide modest predictions of IS and bleeding in these patients. We aimed to develop machine learning (ML) models that predict IS, major gastrointestinal bleeding (MGIB), all clinically relevant bleeding (CRB), and net adverse clinical events (NACE) using data from patients in the ENVISAGE-TAVI AF trial. Ten ML algorithms were trained per outcome using nested cross-validation; the best-performing model (highest F1 score) was validated on a 25% holdout set. Model performance was compared with logistic regression models using CHA₂DS₂-VA or HAS-BLED. Among 1,377 patients, 41 had an IS, 83 had MGIB, 375 had CRB, and 255 experienced NACE. The predictive abilities of a linear discriminant analysis algorithm for IS (F1 score = 0.08) and CHA₂DS₂-VA (F1 score = 0.09) were similarly low, but numerically better than HAS-BLED (F1 score = 0.05). Prediction of MGIB was similarly low for a logistic-lasso algorithm (F1 score = 0.11), CHA₂DS₂-VA (F1 score = 0.09), and HAS-BLED (F1 score = 0.12). For CRB, the predictive performance of a Naïve Bayes algorithm (F1 score = 0.39) was similar to CHA₂DS₂-VA (F1 score = 0.38) and HAS-BLED (F1 score = 0.41). The predictive ability of a logistic regression algorithm for NACE (F1 score = 0.33) was numerically better than CHA₂DS₂-VA (F1 score = 0.22) or HAS-BLED (F1 score = 0.27). In conclusion, ML offered similar predictive ability to established risk scores for thromboembolic and bleeding outcomes among TAVR patients with AF.
{"title":"Comparative Performance of Machine Learning and Traditional Risk Scores in Predicting Adverse Events After Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation","authors":"Johny Nicolas MD, MSc , George Dangas MD, PhD , Amanda Borrow PhD , Rüdiger Smolnik MD , Felix Just PhD , Cathy Chen MD, MSc , Krishna Padmanabhan PhD , Eva-Maria Fronk PhD , Christian Hengstenberg MD , Nicolas Van Mieghem MD, PhD , Martin Unverdorben MD, PhD","doi":"10.1016/j.amjcard.2025.12.002","DOIUrl":"10.1016/j.amjcard.2025.12.002","url":null,"abstract":"<div><div>Patients with atrial fibrillation (AF) following transcatheter aortic valve replacement (TAVR) remain at risk of ischemic stroke (IS) and bleeding. However, traditional risk scores provide modest predictions of IS and bleeding in these patients. We aimed to develop machine learning (ML) models that predict IS, major gastrointestinal bleeding (MGIB), all clinically relevant bleeding (CRB), and net adverse clinical events (NACE) using data from patients in the ENVISAGE-TAVI AF trial. Ten ML algorithms were trained per outcome using nested cross-validation; the best-performing model (highest F1 score) was validated on a 25% holdout set. Model performance was compared with logistic regression models using CHA₂DS₂-VA or HAS-BLED. Among 1,377 patients, 41 had an IS, 83 had MGIB, 375 had CRB, and 255 experienced NACE. The predictive abilities of a linear discriminant analysis algorithm for IS (F1 score = 0.08) and CHA₂DS₂-VA (F1 score = 0.09) were similarly low, but numerically better than HAS-BLED (F1 score = 0.05). Prediction of MGIB was similarly low for a logistic-lasso algorithm (F1 score = 0.11), CHA₂DS₂-VA (F1 score = 0.09), and HAS-BLED (F1 score = 0.12). For CRB, the predictive performance of a Naïve Bayes algorithm (F1 score = 0.39) was similar to CHA₂DS₂-VA (F1 score = 0.38) and HAS-BLED (F1 score = 0.41). The predictive ability of a logistic regression algorithm for NACE (F1 score = 0.33) was numerically better than CHA₂DS₂-VA (F1 score = 0.22) or HAS-BLED (F1 score = 0.27). In conclusion, ML offered similar predictive ability to established risk scores for thromboembolic and bleeding outcomes among TAVR patients with AF.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 91-97"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773355","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 : 2026-03-01Epub Date: 2025-12-29DOI: 10.1016/j.amjcard.2025.12.007
Sohum Kapadia BS , Miles Shen MD , Jonathan Hanna MD , Kevin Wheelock MD , Aline F. Pedroso PhD , Amit Vora MD, MPH , Lovedeep S. Dhingra MBBS , Arya Aminorroaya MD, MPH , Rohan Khera MD, MS
While transcatheter aortic valve replacement (TAVR) is a rapidly expanding minimally invasive alternative to surgical aortic valve replacement (SAVR), its access might be limited due to proximity to a TAVR center. Among Medicare beneficiaries, real-world driving times from residential zip codes to TAVR and SAVR center zip codes were computed using the Google Distance Matrix Application Programming Interface. Zip code-level sociodemographic correlates of driving times more than 1 hour to TAVR and SAVR centers were computed using generalized linear mixed-effects models. Of 29,089 US residential zip codes, 407 (1.4%) had a TAVR center and 639 (2.2%) a SAVR center. The median driving time to the nearest zip code with a TAVR center (59 min [IQR, 30–96]) was longer compared with SAVR center (44 min [IQR, 24–73]), and driving times were longer in Western and Southern regions compared with the Northeast. A higher proportion of beneficiaries drive over 1 hour to nearest TAVR center (24.3%) compared with SAVR center (13.1%). Zip codes with a higher median age, a higher ratio of Hispanic to White individuals, and outside metropolitan areas were more likely to have driving times longer than 1 hour to the nearest TAVR centers. In conclusion, access to TAVR is consistently lower compared with SAVR centers, particularly in the Western and Southern US. The geographic barrier to access care, particularly among socioeconomically disadvantaged rural communities, requires evaluating the selection process for sites that provide care.
虽然经导管主动脉瓣置换术（TAVR）是外科主动脉瓣置换术（SAVR）的一种快速发展的微创替代方法，但由于靠近TAVR中心，其进入可能受到限制。在医疗保险受益人中，使用谷歌距离矩阵应用程序编程接口计算从住宅邮政编码到TAVR和SAVR中心邮政编码的真实驾驶时间。使用广义线性混合效应模型计算了邮政编码级别到TAVR和SAVR中心的驾驶时间超过一小时的社会人口学相关性。在29,089个美国住宅邮政编码中，407个（1.4%）有TAVR中心，639个（2.2%）有SAVR中心。到最近的有TAVR中心的邮政编码的驾车时间中位数（59 min [IQR, 30-96]）比到最近的SAVR中心的驾车时间中位数（44 min [IQR, 24-73]）要长，西部和南部地区的驾车时间比东北地区长。驱车超过一小时到达最近的TAVR中心的受益人比例（24.3%）高于SAVR中心（13.1%）。邮政编码中年龄中位数较高，西班牙裔与白人的比例较高，以及大都市以外的地区，到最近的TAVR中心的驾驶时间更有可能超过一小时。总之，与SAVR中心相比，TAVR的可及性一直较低，特别是在美国西部和南部。获得医疗服务的地理障碍，特别是在社会经济上处于不利地位的农村社区，需要评估提供医疗服务地点的选择过程。
{"title":"Evaluating the Accessibility of Transcatheter and Surgical Aortic Valve Replacement Across the US Via Driving-Times","authors":"Sohum Kapadia BS , Miles Shen MD , Jonathan Hanna MD , Kevin Wheelock MD , Aline F. Pedroso PhD , Amit Vora MD, MPH , Lovedeep S. Dhingra MBBS , Arya Aminorroaya MD, MPH , Rohan Khera MD, MS","doi":"10.1016/j.amjcard.2025.12.007","DOIUrl":"10.1016/j.amjcard.2025.12.007","url":null,"abstract":"<div><div>While transcatheter aortic valve replacement (TAVR) is a rapidly expanding minimally invasive alternative to surgical aortic valve replacement (SAVR), its access might be limited due to proximity to a TAVR center. Among Medicare beneficiaries, real-world driving times from residential zip codes to TAVR and SAVR center zip codes were computed using the Google Distance Matrix Application Programming Interface. Zip code-level sociodemographic correlates of driving times more than 1 hour to TAVR and SAVR centers were computed using generalized linear mixed-effects models. Of 29,089 US residential zip codes, 407 (1.4%) had a TAVR center and 639 (2.2%) a SAVR center. The median driving time to the nearest zip code with a TAVR center (59 min [IQR, 30–96]) was longer compared with SAVR center (44 min [IQR, 24–73]), and driving times were longer in Western and Southern regions compared with the Northeast. A higher proportion of beneficiaries drive over 1 hour to nearest TAVR center (24.3%) compared with SAVR center (13.1%). Zip codes with a higher median age, a higher ratio of Hispanic to White individuals, and outside metropolitan areas were more likely to have driving times longer than 1 hour to the nearest TAVR centers. In conclusion, access to TAVR is consistently lower compared with SAVR centers, particularly in the Western and Southern US. The geographic barrier to access care, particularly among socioeconomically disadvantaged rural communities, requires evaluating the selection process for sites that provide care.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 61-67"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877395","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 : 2026-03-01DOI: 10.1016/j.amjcard.2026.02.060
Wenbin Lian, Yuangang Qiu
{"title":"Letter to the Editor: A Critical Appraisal of Cardiac Magnetic Resonance Evidence on Thrombus Aspiration in ST-Elevation Myocardial Infarction.","authors":"Wenbin Lian, Yuangang Qiu","doi":"10.1016/j.amjcard.2026.02.060","DOIUrl":"10.1016/j.amjcard.2026.02.060","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343488","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 : 2026-03-01Epub Date: 2025-12-28DOI: 10.1016/j.amjcard.2025.12.013
Harroop Bola MBBS , Amar Rai MBBS , Rahul Penumaka MBBS , Edagul Ulucay DPhil , Eleanor Levin MD , David Maron MD
Cardiovascular disease is the leading cause of global morbidity and mortality, with coronary artery disease representing the primary driver of premature death. Cardiac rehabilitation (CR) is a cornerstone of secondary prevention that integrates exercise, risk factor modification, and education. CR reduces all-cause mortality, recurrent ischemic events, and improves quality of life. Yet, participation remains suboptimal, and CR is underutilized by women, older adults, minorities, and socioeconomically disadvantaged groups. We examine the modalities of CR including traditional center-based CR (CBCR), home-based CR and hybrid models. By leveraging telemedicine, mobile health, and wearable biosensors remote delivery of CR has shown comparable efficacy to traditional CBCR. The integration of artificial intelligence offers opportunities to personalize CR through continuous physiological monitoring and exercise prescriptions. In conclusion, CR remains cost-effective from a health-system perspective, but patient-level affordability and equitable access require targeted policy, financial, and culturally adapted interventions to ensure personalized and equitable delivery of secondary prevention.
{"title":"Cardiac Rehabilitation for Coronary Artery Disease: Gaps, Digital Models, and the Future of Personalized Prevention","authors":"Harroop Bola MBBS , Amar Rai MBBS , Rahul Penumaka MBBS , Edagul Ulucay DPhil , Eleanor Levin MD , David Maron MD","doi":"10.1016/j.amjcard.2025.12.013","DOIUrl":"10.1016/j.amjcard.2025.12.013","url":null,"abstract":"<div><div>Cardiovascular disease is the leading cause of global morbidity and mortality, with coronary artery disease representing the primary driver of premature death. Cardiac rehabilitation (CR) is a cornerstone of secondary prevention that integrates exercise, risk factor modification, and education. CR reduces all-cause mortality, recurrent ischemic events, and improves quality of life. Yet, participation remains suboptimal, and CR is underutilized by women, older adults, minorities, and socioeconomically disadvantaged groups. We examine the modalities of CR including traditional center-based CR (CBCR), home-based CR and hybrid models. By leveraging telemedicine, mobile health, and wearable biosensors remote delivery of CR has shown comparable efficacy to traditional CBCR. The integration of artificial intelligence offers opportunities to personalize CR through continuous physiological monitoring and exercise prescriptions. In conclusion, CR remains cost-effective from a health-system perspective, but patient-level affordability and equitable access require targeted policy, financial, and culturally adapted interventions to ensure personalized and equitable delivery of secondary prevention.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 16-27"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861630","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}
Patients with large or extra-large aortic annuli pose a particular challenge for Transcatheter aortic valve replacement (TAVR), as clinical outcomes are less favorable than in patients with smaller annuli. This study aimed to evaluate periprocedural and clinical outcomes in patients with large and extra-large annuli undergoing TAVR and to compare results between balloon-expandable (BEVs) and self-expanding valves (SEVs). This study included patients with severe aortic stenosis (AS) and extra-large annuli who underwent TAVR with either BEVs or SEVs. The primary endpoints were periprocedural and clinical outcomes, including device success, rates of moderate or greater paravalvular leak (PVL), permanent pacemaker (PPM) implantation, new Left bundle branch block (LBBB), stroke, and in-hospital and 1-year mortality. Secondary endpoints included safety outcomes and subgroup analyses comparing outcomes between patients with large (annular perimeter >90 mm and an area >660 mm²) and extra-large annuli (perimeter >96 mm and an area >730 mm²). A total of 237 patients underwent TAVR, including 160 with BEVs and 77 with SEVs. The mean annular area and perimeter were 737 ± 76 mm² and 96.1 ± 4.1 mm, respectively, with no significant differences between groups. Overall device success was high, though slightly lower in the SEV group (84% vs. 93%, p = 0.034), a difference that was no longer statistically significant after multivariate analysis (p = 0.234). Moderate or greater PVL occurred more frequently with SEVs (13% vs. 4%, p = 0.016), particularly in patients with extra-large annuli (26% vs. 4%, p = 0.012). One-year mortality was similar between groups (SEV 13% vs. BEV 12%, p = 0.807), and no significant differences were observed in PPM implantation, new LBBB, stroke, or major vascular and bleeding complications. TAVR is feasible and safe in patients with large and extra-large annuli, with higher rates of moderate or greater paravalvular leak observed in SEV patients with extra-large annuli.
背景：大或特大主动脉环空患者对经导管主动脉瓣置换术（TAVR）提出了特殊的挑战，因为临床结果不如小环空患者好。本研究旨在评估大环空和特大环空患者行TAVR的围术期和临床结果，并比较球囊膨胀性瓣膜（bev）和自膨胀性瓣膜（sev）的结果。方法：本研究纳入了严重主动脉狭窄（AS）和特大环空的患者，他们接受了bev或sev的TAVR。主要终点是围手术期和临床结果，包括器械成功、中度或更严重的瓣旁漏（PVL）、永久性起搏器（PPM）植入、新的左束支阻滞（LBBB）、中风、住院死亡率和1年内死亡率。次要终点包括安全性结果和亚组分析，比较大环空（环周90 mm，面积660 mm²）和超大环空（环周96 mm，面积730 mm²）患者的结果。结果：共237例患者行TAVR，其中bev组160例，sev组77例。平均环面积和周长分别为737 ± 76 mm²和96.1 ± 4.1 mm，组间差异无统计学意义。尽管SEV组的器械成功率略低（84% vs. 93%, p=0.034），但在多变量分析后，这一差异不再具有统计学意义（p=0.234）。中度或更严重的PVL在sev患者中更常见（13% vs. 4%, p = 0.016），特别是在特大环空患者中（26% vs. 4%, p = 0.012）。两组间一年死亡率相似（SEV 13% vs BEV 12%, p = 0.807），在PPM植入、新的LBBB、中风或主要血管和出血并发症方面无显著差异。综上所述：TAVR在大环空和特大环空患者中是可行和安全的，特大环空SEV患者出现中度或较大瓣旁漏的比例较高。
{"title":"Transcatheter Aortic Valve Replacement in Patients With Extra-Large Aortic Annuli: Insights From a Large Cohort","authors":"Ziad Arow MD , Omar Oliva MD , Laurent Bonfils MD , Laurent Lepage MD , Abid Assali MD , Ranin Hilu MD , Nicolas Dumonteil MD , Didier Tchetche MD , Chiara De Biase MD","doi":"10.1016/j.amjcard.2025.12.015","DOIUrl":"10.1016/j.amjcard.2025.12.015","url":null,"abstract":"<div><div>Patients with large or extra-large aortic annuli pose a particular challenge for Transcatheter aortic valve replacement (TAVR), as clinical outcomes are less favorable than in patients with smaller annuli. This study aimed to evaluate periprocedural and clinical outcomes in patients with large and extra-large annuli undergoing TAVR and to compare results between balloon-expandable (BEVs) and self-expanding valves (SEVs). This study included patients with severe aortic stenosis (AS) and extra-large annuli who underwent TAVR with either BEVs or SEVs. The primary endpoints were periprocedural and clinical outcomes, including device success, rates of moderate or greater paravalvular leak (PVL), permanent pacemaker (PPM) implantation, new Left bundle branch block (LBBB), stroke, and in-hospital and 1-year mortality. Secondary endpoints included safety outcomes and subgroup analyses comparing outcomes between patients with large (annular perimeter >90 mm and an area >660 mm²) and extra-large annuli (perimeter >96 mm and an area >730 mm²). A total of 237 patients underwent TAVR, including 160 with BEVs and 77 with SEVs. The mean annular area and perimeter were 737 ± 76 mm² and 96.1 ± 4.1 mm, respectively, with no significant differences between groups. Overall device success was high, though slightly lower in the SEV group (84% vs. 93%, p = 0.034), a difference that was no longer statistically significant after multivariate analysis (p = 0.234). Moderate or greater PVL occurred more frequently with SEVs (13% vs. 4%, p = 0.016), particularly in patients with extra-large annuli (26% vs. 4%, p = 0.012). One-year mortality was similar between groups (SEV 13% vs. BEV 12%, p = 0.807), and no significant differences were observed in PPM implantation, new LBBB, stroke, or major vascular and bleeding complications. TAVR is feasible and safe in patients with large and extra-large annuli, with higher rates of moderate or greater paravalvular leak observed in SEV patients with extra-large annuli.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 1-5"},"PeriodicalIF":2.1,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877372","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号