Pub Date : 2025-01-24DOI: 10.1016/j.amjcard.2025.01.013
Asit Das DNB , Shubham Tewary DM , Debdatta Kar DM , Gaurav Lakhani DM , Nur Nabab Mollah DM , Srirupa Mandal MD
A total of 35 patients completed the study. Mean age was 19.8 (±4.2) years, with a male-to-female ratio of 4:3. A total of 25 patients had uncorrected TOF, and 10 had undergone intracardiac repair. After the procedure, patients with uncorrected TOF showed a significant increase in oxygen saturation from 84.7% (±1.4%) to 94.6% (±1.2%). Procedural success was 91.4%, with 3 patients experiencing significant restenosis. No procedural complications were observed. There were no arrhythmic events until the first year of follow-up. At 1-year follow-up, the mean RVOT pressure gradient was significantly decreased, and all patients remained symptom-free. In conclusion, combined balloon pulmonic valvuloplasty and conal artery occlusion is a safe and effective method for alleviating RVOT obstruction in patients with TOF, showing promising intermediate-term outcomes with minimal complications.
{"title":"Right Ventricular Outflow Tract Obstruction: Transcatheter Correction in Tetralogy of Fallot: A Pilot Study","authors":"Asit Das DNB , Shubham Tewary DM , Debdatta Kar DM , Gaurav Lakhani DM , Nur Nabab Mollah DM , Srirupa Mandal MD","doi":"10.1016/j.amjcard.2025.01.013","DOIUrl":"10.1016/j.amjcard.2025.01.013","url":null,"abstract":"<div><div>A total of 35 patients completed the study. Mean age was 19.8 (±4.2) years, with a male-to-female ratio of 4:3. A total of 25 patients had uncorrected TOF, and 10 had undergone intracardiac repair. After the procedure, patients with uncorrected TOF showed a significant increase in oxygen saturation from 84.7% (±1.4%) to 94.6% (±1.2%). Procedural success was 91.4%, with 3 patients experiencing significant restenosis. No procedural complications were observed. There were no arrhythmic events until the first year of follow-up. At 1-year follow-up, the mean RVOT pressure gradient was significantly decreased, and all patients remained symptom-free. In conclusion, combined balloon pulmonic valvuloplasty and conal artery occlusion is a safe and effective method for alleviating RVOT obstruction in patients with TOF, showing promising intermediate-term outcomes with minimal complications.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"242 ","pages":"Pages 32-36"},"PeriodicalIF":2.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045602","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 : 2025-01-24DOI: 10.1016/j.amjcard.2025.01.021
Eric J. Hall MD , Colby R. Ayers MS , Nicholas S. Hendren MD , Christopher Clark BS , Amit Saha MD , Hadi Beaini MD , Isabella L. Alexander BS , Evan P. Gee BS , Ian R. McConnell BA , Emily S. Samson BSA , Roslyn J. Saplicki BA , Christopher S. Grubb MD , Grant Tucker BS , Justin L. Grodin MD, MPH , Jennifer T. Thibodeau MD, MSCS , Mark H. Drazner MD, MSc , Mujeeb Basit MD, MMSc , Maryjane A. Farr MD, MSc , Ann Marie Navar MD, PhD , Sandeep R. Das MD, MPH , James A. de Lemos MD
Data regarding cardiogenic shock (CS) from safety-net hospitals serving socioeconomically-disadvantaged patients are limited. In addition, little is known regarding long-term outcomes and management of heart failure-related CS (HF-CS), a population potentially especially vulnerable to adverse social determinants of health (SDOH). A single-center retrospective cohort study of patients with Stage C, D, or E CS at a public safety-net hospital between 2017 and 2023 was performed. Management and outcomes were compared between patients with HF-CS and myocardial infarction-CS (AMI-CS). The primary outcome was survival through 2 years. The cohort included 378 patients (median age 57y, 44% Black race, 35% Hispanic ethnicity, 81% HF-CS, 19% AMI-CS); 23% received mechanical circulatory support. Thirty-day mortality was lower among patients with HF-CS than AMI-CS (16% vs 28%; HR 0.50 [95% CI 0.30 to 0.84], p = 0.01]). In contrast, mortality from 31 days through 2 years was higher after HF-CS (45% vs 22%, HR 1.94 [1.11 to 3.38], p = 0.02). At long-term follow-up, 53% of survivors were on beta blockers and 32% on no guideline-directed medical therapies. Eighteen patients (5%) received transplant or left ventricular assist device, all of whom had HF-CS and survived through available follow up (median 2.3y [0.9 to 4.0]). In conclusion, in a large safety-net hospital serving a diverse population with adverse SDOH, HF-CS was much more common than AMI-CS, with lower short-term but higher long-term mortality in HF-CS. Use of advanced therapies was low, with favorable survival among patients who received these. These results highlight the importance of expanding access to specialized heart failure care for socially vulnerable patients with CS.
{"title":"Patient Characteristics, Management and Long-Term Outcomes of Patients With Cardiogenic Shock at a Large Safety Net Hospital","authors":"Eric J. Hall MD , Colby R. Ayers MS , Nicholas S. Hendren MD , Christopher Clark BS , Amit Saha MD , Hadi Beaini MD , Isabella L. Alexander BS , Evan P. Gee BS , Ian R. McConnell BA , Emily S. Samson BSA , Roslyn J. Saplicki BA , Christopher S. Grubb MD , Grant Tucker BS , Justin L. Grodin MD, MPH , Jennifer T. Thibodeau MD, MSCS , Mark H. Drazner MD, MSc , Mujeeb Basit MD, MMSc , Maryjane A. Farr MD, MSc , Ann Marie Navar MD, PhD , Sandeep R. Das MD, MPH , James A. de Lemos MD","doi":"10.1016/j.amjcard.2025.01.021","DOIUrl":"10.1016/j.amjcard.2025.01.021","url":null,"abstract":"<div><div>Data regarding cardiogenic shock (CS) from safety-net hospitals serving socioeconomically-disadvantaged patients are limited. In addition, little is known regarding long-term outcomes and management of heart failure-related CS (HF-CS), a population potentially especially vulnerable to adverse social determinants of health (SDOH). A single-center retrospective cohort study of patients with Stage C, D, or E CS at a public safety-net hospital between 2017 and 2023 was performed. Management and outcomes were compared between patients with HF-CS and myocardial infarction-CS (AMI-CS). The primary outcome was survival through 2 years. The cohort included 378 patients (median age 57y, 44% Black race, 35% Hispanic ethnicity, 81% HF-CS, 19% AMI-CS); 23% received mechanical circulatory support. Thirty-day mortality was lower among patients with HF-CS than AMI-CS (16% vs 28%; HR 0.50 [95% CI 0.30 to 0.84], p = 0.01]). In contrast, mortality from 31 days through 2 years was higher after HF-CS (45% vs 22%, HR 1.94 [1.11 to 3.38], p = 0.02). At long-term follow-up, 53% of survivors were on beta blockers and 32% on no guideline-directed medical therapies. Eighteen patients (5%) received transplant or left ventricular assist device, all of whom had HF-CS and survived through available follow up (median 2.3y [0.9 to 4.0]). In conclusion, in a large safety-net hospital serving a diverse population with adverse SDOH, HF-CS was much more common than AMI-CS, with lower short-term but higher long-term mortality in HF-CS. Use of advanced therapies was low, with favorable survival among patients who received these. These results highlight the importance of expanding access to specialized heart failure care for socially vulnerable patients with CS.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"242 ","pages":"Pages 10-17"},"PeriodicalIF":2.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045584","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 : 2025-01-23DOI: 10.1016/j.amjcard.2025.01.020
Pavan Reddy, Ilan Merdler, Cheng Zhang, Matteo Cellamare, Itsik Ben-Dor, Nelson Bernardo, Hayder Hashim, Lowell Satler, Toby Rogers, Ron Waksman
The benefit of mechanical circulatory support (MCS) with Impella (Abiomed, Inc, Danvers, MA) for patients undergoing nonemergent, high-risk percutaneous coronary intervention (HR-PCI) is unclear and currently the subject of a large randomized clinical trial (RCT), PROTECT IV. While contemporary registry data from PROTECT III demonstrated improvement of outcomes with Impella when compared with historical data (PROTECT II), there is lack of direct comparison to the HR-PCI cohort that did not receive Impella support. We retrospectively identified patients from our institution meeting PROTECT III inclusion criteria (left ventricular ejection fraction [LVEF] <35% with unprotected left main or last remaining vessel or LVEF <30% undergoing multivessel PCI), and compared this group (NonIMP) to the published outcomes data from the PROTECT III registry (IMP). Baseline differences were balanced using inverse propensity weighting (IPW). The co-primary outcome was major adverse cardiac events (MACE) in-hospital and at 90 days. Secondary outcomes included in-hospital post-PCI complications. We identified 284 high-risk patients who did not receive Impella support; 200 patients had 90-day event ascertainment and were included in IPW analysis, with 504 patients in the IMP group. After calibration, few residual differences remained; patients in the NonIMP group were older (73.4 vs. 69.3, p <0.001) with higher prevalence of coronary artery bypass grafting (65.0% vs. 13.7%, p <0.001). Unprotected left main intervention was performed in 43% of patients in both groups. The primary outcome was not different in-hospital (3.0% vs. 4.8%, p = 0.403), but lower in the NonIMP group at 90 days (7.5% vs. 13.8%, p = 0.033). Peri-procedural vascular complications, bleeding, and transfusion rates were not different between groups. However, acute kidney injury occurred more frequently in the NonIMP group (10.5% vs. 5.4%, p = 0.023). Under identical HR-PCI inclusion criteria for Impella use in PROTECT III, an institutional non-Impella supported HR-PCI cohort demonstrated similar MACE in-hospital but lower MACE at 90 days. There was no signal for peri-procedural harm with Impella use. These results do not support routine usage of Impella for HR-PCI patients. Careful patient selection is critical until a large RCT demonstrates benefits in a broad HR-PCI population.
{"title":"Impella versus Non-Impella for Nonemergent High-Risk Percutaneous Coronary Intervention.","authors":"Pavan Reddy, Ilan Merdler, Cheng Zhang, Matteo Cellamare, Itsik Ben-Dor, Nelson Bernardo, Hayder Hashim, Lowell Satler, Toby Rogers, Ron Waksman","doi":"10.1016/j.amjcard.2025.01.020","DOIUrl":"10.1016/j.amjcard.2025.01.020","url":null,"abstract":"<p><p>The benefit of mechanical circulatory support (MCS) with Impella (Abiomed, Inc, Danvers, MA) for patients undergoing nonemergent, high-risk percutaneous coronary intervention (HR-PCI) is unclear and currently the subject of a large randomized clinical trial (RCT), PROTECT IV. While contemporary registry data from PROTECT III demonstrated improvement of outcomes with Impella when compared with historical data (PROTECT II), there is lack of direct comparison to the HR-PCI cohort that did not receive Impella support. We retrospectively identified patients from our institution meeting PROTECT III inclusion criteria (left ventricular ejection fraction [LVEF] <35% with unprotected left main or last remaining vessel or LVEF <30% undergoing multivessel PCI), and compared this group (NonIMP) to the published outcomes data from the PROTECT III registry (IMP). Baseline differences were balanced using inverse propensity weighting (IPW). The co-primary outcome was major adverse cardiac events (MACE) in-hospital and at 90 days. Secondary outcomes included in-hospital post-PCI complications. We identified 284 high-risk patients who did not receive Impella support; 200 patients had 90-day event ascertainment and were included in IPW analysis, with 504 patients in the IMP group. After calibration, few residual differences remained; patients in the NonIMP group were older (73.4 vs. 69.3, p <0.001) with higher prevalence of coronary artery bypass grafting (65.0% vs. 13.7%, p <0.001). Unprotected left main intervention was performed in 43% of patients in both groups. The primary outcome was not different in-hospital (3.0% vs. 4.8%, p = 0.403), but lower in the NonIMP group at 90 days (7.5% vs. 13.8%, p = 0.033). Peri-procedural vascular complications, bleeding, and transfusion rates were not different between groups. However, acute kidney injury occurred more frequently in the NonIMP group (10.5% vs. 5.4%, p = 0.023). Under identical HR-PCI inclusion criteria for Impella use in PROTECT III, an institutional non-Impella supported HR-PCI cohort demonstrated similar MACE in-hospital but lower MACE at 90 days. There was no signal for peri-procedural harm with Impella use. These results do not support routine usage of Impella for HR-PCI patients. Careful patient selection is critical until a large RCT demonstrates benefits in a broad HR-PCI population.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035909","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 : 2025-01-23DOI: 10.1016/j.amjcard.2025.01.016
Chidubem Ezenna MD, BS , Mrinal Murali Krishna MBBS , Meghna Joseph MBBS , Vinicius Pereira , Samia Nadeem MD , Gregory Valania DO , Andrew M. Goldsweig MD, MS
Introduction
Obstructive hypertrophic cardiomyopathy (oHCM) is a genetic disorder characterized by myocardial hypertrophy, which can obstruct left ventricular outflow. Cardiac myosin inhibitors (CMIs) have emerged as a novel therapeutic agent targeting cardiac muscle hypercontractility.
Objective
To compare the efficacy and safety of CMIs mavacamten and aficamten vs. placebo in patients with oHCM.
Methods
We systematically searched PubMed, Scopus, and Cochrane Central databases for randomized controlled trials (RCTs) comparing mavacamten or aficamten to placebo in patients with symptomatic oHCM. Efficacy outcomes included improvement in peak oxygen consumption (pVO2), New York Heart Association functional class (NYHA-FC) improvement of ≥1 class, change in Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS), peak left ventricular outflow tract gradient at rest (rLVOT) and with Valsalva maneuver (vLVOT). Safety outcomes included treatment-emergent adverse events (TEAE), serious adverse events (SAE), and atrial fibrillation (AF). Random effects models generated risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics.
Results
The systematic search identified 5 RCTs including 767 patients (mavacamten 30.4%, aficamten 22.2%, placebo 47.4%) with a median follow-up of 24 weeks. Compared to placebo, CMIs were associated with improvement of ≥1 NYHA-FC (RR 2.33; 95% CI, 1.92-2.82), rLVOT (MD -38.70; 95% CI, [-46.30]-[-31.10]), vLVOT (MD -47.29; 95% CI, [-57.99]-[-36.58]), pVO2 (MD 1.66; 95% CI, 1.14-2.18), and KCCQ-CSS (MD 7.76; 95% CI, 5.63-9.90). Safety outcomes were similar between CMIs and placebo.
Conclusion
CMIs are an effective and safe short-term treatment for symptomatic oHCM. Long-term outcomes require further investigation.
{"title":"The Efficacy and Safety of Cardiac Myosin Inhibitors Versus Placebo in Patients With Symptomatic Obstructive Hypertrophic Cardiomyopathy: A Meta-Analysis of Randomized Controlled Trials","authors":"Chidubem Ezenna MD, BS , Mrinal Murali Krishna MBBS , Meghna Joseph MBBS , Vinicius Pereira , Samia Nadeem MD , Gregory Valania DO , Andrew M. Goldsweig MD, MS","doi":"10.1016/j.amjcard.2025.01.016","DOIUrl":"10.1016/j.amjcard.2025.01.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Obstructive hypertrophic cardiomyopathy (oHCM) is a genetic disorder characterized by myocardial hypertrophy, which can obstruct left ventricular outflow. Cardiac myosin inhibitors (CMIs) have emerged as a novel therapeutic agent targeting cardiac muscle hypercontractility.</div></div><div><h3>Objective</h3><div>To compare the efficacy and safety of CMIs mavacamten and aficamten vs. placebo in patients with oHCM.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Scopus, and Cochrane Central databases for randomized controlled trials (RCTs) comparing mavacamten or aficamten to placebo in patients with symptomatic oHCM. Efficacy outcomes included improvement in peak oxygen consumption (pVO2), New York Heart Association functional class (NYHA-FC) improvement of ≥1 class, change in Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS), peak left ventricular outflow tract gradient at rest (rLVOT) and with Valsalva maneuver (vLVOT). Safety outcomes included treatment-emergent adverse events (TEAE), serious adverse events (SAE), and atrial fibrillation (AF). Random effects models generated risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I<sup>2</sup> statistics.</div></div><div><h3>Results</h3><div>The systematic search identified 5 RCTs including 767 patients (mavacamten 30.4%, aficamten 22.2%, placebo 47.4%) with a median follow-up of 24 weeks. Compared to placebo, CMIs were associated with improvement of ≥1 NYHA-FC (RR 2.33; 95% CI, 1.92-2.82), rLVOT (MD -38.70; 95% CI, [-46.30]-[-31.10]), vLVOT (MD -47.29; 95% CI, [-57.99]-[-36.58]), pVO2 (MD 1.66; 95% CI, 1.14-2.18), and KCCQ-CSS (MD 7.76; 95% CI, 5.63-9.90). Safety outcomes were similar between CMIs and placebo.</div></div><div><h3>Conclusion</h3><div>CMIs are an effective and safe short-term treatment for symptomatic oHCM. Long-term outcomes require further investigation.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 52-60"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035927","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}
A dual-therapy sirolimus-eluting and CD34+ antibody–coated Combo Stent (DTS) has been developed to enhance endothelization and capture endothelial progenitor cells; however, vessel responses following DTS implantation remain unclear. Therefore, we evaluated early- and mid-term intravascular characteristics of DTS using intravascular imaging modalities. This multicenter, prospective, observational study enrolled 88 patients (95 lesions) who underwent DTS (43 patients, 48 lesions) or sirolimus-eluting Orsiro stent (SES, 45 patients, 47 lesions) implantation. Serial optical coherence tomography (OCT) and coronary angioscopy (CAS) findings were compared between the groups at 1 and 12 months.The OCT findings were similar between the DTS and SES groups at 1 month, including the covered strut rate (84.21 ± 9.50% versus 80.56 ± 17.68%, p = 0.27). CAS findings were also comparable despite a more severe yellow coloration observed in the DTS group (p = 0.006). At 12 months, OCT findings revealed that the covered and adequate strut coverage (≥40 μm) rates were significantly higher (99.27 ± 0.95% versus 95.46 ± 5.56%, p <0.001 and 88.90 ± 10.15% versus 72.96 ± 16.48%, p <0.001) and neointimal thickness was significantly thicker (152.16 ± 70.31 versus 84.39 ± 29.80 μm, p <0.001) in DTS than in SES. The malapposed strut rate was significantly higher in SES than in DTS (0.04 ± 0.18% versus 0.82 ± 1.87%, p = 0.018). CAS revealed that the yellow coloration (p = 0.049) and subclinical intrastent thrombus (p = 0.019) were less severe in DTS than in SES at 12 months. In conclusion, DTS provided better advantages regarding strut coverage and plaque stabilization compared to SES. However, given the observational nature of this study, further randomized controlled trials are needed to confirm these findings.
{"title":"Comparison of Vessel Responses Following Combined Sirolimus-Eluting and Endothelial Progenitor Cell Stent and Ultra-Thin Sirolimus-Eluting Stent Implantation by Serial Optical Coherence Tomography and Coronary Angioscopy: A Multicenter Observational Study","authors":"Daisuke Nakamura MD , Isamu Mizote MD, PhD , Takayuki Ishihara MD , Yutaka Matsuhiro MD , Shota Okuno MD, PhD , Tatsuya Shiraki MD , Takuya Tsujimura MD , Naotaka Okamoto MD , Naoki Itaya MD , Takaharu Nakayoshi MD , Atsushi Kikuchi MD , Tsutomu Kawai MD , Yuhei Nojima MD, PhD , Mitsuyoshi Takahara MD, PhD , Takashi Morita MD, PhD , Shungo Hikosou MD, PhD , Daisaku Nakatani MD, PhD , Toshiaki Mano MD, PhD , Takahisa Yamada MD, PhD , Takahumi Ueno MD, PhD , Yasushi Sakata MD, PhD","doi":"10.1016/j.amjcard.2025.01.009","DOIUrl":"10.1016/j.amjcard.2025.01.009","url":null,"abstract":"<div><div>A dual-therapy sirolimus-eluting and CD34+ antibody–coated Combo Stent (DTS) has been developed to enhance endothelization and capture endothelial progenitor cells; however, vessel responses following DTS implantation remain unclear. Therefore, we evaluated early- and mid-term intravascular characteristics of DTS using intravascular imaging modalities. This multicenter, prospective, observational study enrolled 88 patients (95 lesions) who underwent DTS (43 patients, 48 lesions) or sirolimus-eluting Orsiro stent (SES, 45 patients, 47 lesions) implantation. Serial optical coherence tomography (OCT) and coronary angioscopy (CAS) findings were compared between the groups at 1 and 12 months.The OCT findings were similar between the DTS and SES groups at 1 month, including the covered strut rate (84.21 ± 9.50% versus 80.56 ± 17.68%, p = 0.27). CAS findings were also comparable despite a more severe yellow coloration observed in the DTS group (p = 0.006). At 12 months, OCT findings revealed that the covered and adequate strut coverage (≥40 μm) rates were significantly higher (99.27 ± 0.95% versus 95.46 ± 5.56%, p <0.001 and 88.90 ± 10.15% versus 72.96 ± 16.48%, p <0.001) and neointimal thickness was significantly thicker (152.16 ± 70.31 versus 84.39 ± 29.80 μm, p <0.001) in DTS than in SES. The malapposed strut rate was significantly higher in SES than in DTS (0.04 ± 0.18% versus 0.82 ± 1.87%, p = 0.018). CAS revealed that the yellow coloration (p = 0.049) and subclinical intrastent thrombus (p = 0.019) were less severe in DTS than in SES at 12 months. In conclusion, DTS provided better advantages regarding strut coverage and plaque stabilization compared to SES. However, given the observational nature of this study, further randomized controlled trials are needed to confirm these findings.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 26-36"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-23DOI: 10.1016/j.amjcard.2025.01.019
Besir Besir MD , Shivabalan Kathavarayan Ramu MD , Maryam Muhammad Ali Majeed-Saidan MD , Judah Rajendran MD , Odette Iskandar MD , Grant Reed MD , Rishi Puri MD , James Yun MD , Serge Harb MD , Rhonda Miyasaka MD , Amar Krishnaswamy MD , Zoran Popovic MD , Samir R. Kapadia MD
This study sought to explore the clinical factors associated with classical low-flow low-gradient (C-LFLG) and normal-flow low-gradient (NFLG) aortic stenosis (AS) compared with high-gradient (HG) AS. We also compared clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) across flow-gradient patterns. Patients with C-LFLG AS have a higher mortality rate after TAVR than those with HG AS. However, what leads to C-LFLG AS and the predictors of mortality in this population remain unclear. In this retrospective, single-center study involving 1,415 patients with severe AS, patients were classified as having (1) HG AS (aortic valve mean gradient [MG] >40 mm Hg), (2) C-LFLG AS (MG <40 mm Hg, stroke volume index <35 ml/m2, left ventricular ejection fraction <50%), and (3) NFLG AS (MG <40 mm Hg, stroke volume index ≥35 ml/m2, left ventricular ejection fraction ≥50%). Logistic regression was used for predictors of C-LFLG AS. Cox regression was used for predictors of mortality in the C-LFLG AS population. Male gender, multiple co-morbidities, and moderate to severe mitral and tricuspid regurgitation correlated with the C-LFLG AS group. Patients with C-LFLG AS had a higher mortality risk compared with patients with HG AS at 2 years after TAVR. Patients with NFLG AS had similar mortality at 1 year, but higher mortality at 2 years after TAVR compared with patients with HG AS. End-stage renal disease, atrial fibrillation, and other co-morbidities were predictors of 2-year mortality in patients with C-LFLG AS. In conclusion, the mortality rate after TAVR was higher among patients with C-LFLG AS than those with HG AS. Male gender and multiple co-morbidities were predictors of C-LFLG AS. Multiple co-morbidities were predictors of mortality among those patients.
{"title":"Outcomes and Predictors of Different Flow-Gradient Patterns of Aortic Stenosis After Transcatheter Aortic Valve Replacement","authors":"Besir Besir MD , Shivabalan Kathavarayan Ramu MD , Maryam Muhammad Ali Majeed-Saidan MD , Judah Rajendran MD , Odette Iskandar MD , Grant Reed MD , Rishi Puri MD , James Yun MD , Serge Harb MD , Rhonda Miyasaka MD , Amar Krishnaswamy MD , Zoran Popovic MD , Samir R. Kapadia MD","doi":"10.1016/j.amjcard.2025.01.019","DOIUrl":"10.1016/j.amjcard.2025.01.019","url":null,"abstract":"<div><div>This study sought to explore the clinical factors associated with classical low-flow low-gradient (C-LFLG) and normal-flow low-gradient (NFLG) aortic stenosis (AS) compared with high-gradient (HG) AS. We also compared clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) across flow-gradient patterns. Patients with C-LFLG AS have a higher mortality rate after TAVR than those with HG AS. However, what leads to C-LFLG AS and the predictors of mortality in this population remain unclear. In this retrospective, single-center study involving 1,415 patients with severe AS, patients were classified as having (1) HG AS (aortic valve mean gradient [MG] >40 mm Hg), (2) C-LFLG AS (MG <40 mm Hg, stroke volume index <35 ml/m<sup>2</sup>, left ventricular ejection fraction <50%), and (3) NFLG AS (MG <40 mm Hg, stroke volume index ≥35 ml/m<sup>2</sup>, left ventricular ejection fraction ≥50%). Logistic regression was used for predictors of C-LFLG AS. Cox regression was used for predictors of mortality in the C-LFLG AS population. Male gender, multiple co-morbidities, and moderate to severe mitral and tricuspid regurgitation correlated with the C-LFLG AS group. Patients with C-LFLG AS had a higher mortality risk compared with patients with HG AS at 2 years after TAVR. Patients with NFLG AS had similar mortality at 1 year, but higher mortality at 2 years after TAVR compared with patients with HG AS. End-stage renal disease, atrial fibrillation, and other co-morbidities were predictors of 2-year mortality in patients with C-LFLG AS. In conclusion, the mortality rate after TAVR was higher among patients with C-LFLG AS than those with HG AS. Male gender and multiple co-morbidities were predictors of C-LFLG AS. Multiple co-morbidities were predictors of mortality among those patients.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"242 ","pages":"Pages 42-52"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035913","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 : 2025-01-23DOI: 10.1016/j.amjcard.2025.01.023
Catalin Loghin
{"title":"Myocardial Strain: A Physiologic Concept Overstretched Into Clinical Relevance?","authors":"Catalin Loghin","doi":"10.1016/j.amjcard.2025.01.023","DOIUrl":"10.1016/j.amjcard.2025.01.023","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035911","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 : 2025-01-22DOI: 10.1016/j.amjcard.2025.01.014
Giulia Alagna, Giancarlo Trimarchi, Alessia Cascone, Alessio Villari, Giulia Cavolina, Francesca Campanella, Antonino Micari, Giovanni Taverna, Giuseppe Andò
Dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y12 inhibitor, is the standard treatment for patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). However, the optimal duration of DAPT remains debated due to the need to balance ischemic event reduction with bleeding risks. This study evaluates the efficacy and safety of ticagrelor monotherapy after short-duration DAPT (1 to 3 months) compared to extended DAPT, focusing on major bleeding and cardiovascular outcomes. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Randomized controlled trials (RCTs) comparing ticagrelor monotherapy after short-duration DAPT to extended DAPT were identified from PubMed, Embase, and the Cochrane Library. Data on major bleeding, major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction, stroke, stent thrombosis, and mortality were analyzed, and risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Five RCTs involving 32,393 patients were included. Ticagrelor monotherapy significantly reduced MACCE (RR: 0.88; 95% CI: 0.77 to 0.99; p = 0.04) and major bleeding (RR: 0.53; 95% CI: 0.37 to 0.77; p = 0.0008) compared to extended DAPT. It also significantly reduced all-cause mortality (RR: 0.82; 95% CI: 0.67 to 0.99; p = 0.04) and cardiovascular death (RR: 0.68; 95% CI: 0.49 to 0.94; p = 0.02). The incidence of myocardial infarction, stent thrombosis, and stroke were similar between the groups. Net adverse clinical events (NACE) were 27% lower with ticagrelor monotherapy (RR: 0.73; 95% CI: 0.63 to 0.85; p <0.0001). In conclusion, ticagrelor monotherapy after short-duration DAPT reduces major bleeding complications without compromising cardiovascular protection. This approach offers a promising strategy to optimize outcomes for PCI patients, particularly those at high bleeding risk. Further studies are needed to refine the optimal DAPT duration in various patient populations, especially those with higher ischemic risk.
{"title":"Effectiveness and Safety of Ticagrelor Monotherapy After Short-Duration Dual Antiplatelet Therapy in PCI Patients: A Systematic Review and Meta-Analysis","authors":"Giulia Alagna, Giancarlo Trimarchi, Alessia Cascone, Alessio Villari, Giulia Cavolina, Francesca Campanella, Antonino Micari, Giovanni Taverna, Giuseppe Andò","doi":"10.1016/j.amjcard.2025.01.014","DOIUrl":"10.1016/j.amjcard.2025.01.014","url":null,"abstract":"<div><div>Dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y12 inhibitor, is the standard treatment for patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). However, the optimal duration of DAPT remains debated due to the need to balance ischemic event reduction with bleeding risks. This study evaluates the efficacy and safety of ticagrelor monotherapy after short-duration DAPT (1 to 3 months) compared to extended DAPT, focusing on major bleeding and cardiovascular outcomes. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Randomized controlled trials (RCTs) comparing ticagrelor monotherapy after short-duration DAPT to extended DAPT were identified from PubMed, Embase, and the Cochrane Library. Data on major bleeding, major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction, stroke, stent thrombosis, and mortality were analyzed, and risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Five RCTs involving 32,393 patients were included. Ticagrelor monotherapy significantly reduced MACCE (RR: 0.88; 95% CI: 0.77 to 0.99; p = 0.04) and major bleeding (RR: 0.53; 95% CI: 0.37 to 0.77; p = 0.0008) compared to extended DAPT. It also significantly reduced all-cause mortality (RR: 0.82; 95% CI: 0.67 to 0.99; p = 0.04) and cardiovascular death (RR: 0.68; 95% CI: 0.49 to 0.94; p = 0.02). The incidence of myocardial infarction, stent thrombosis, and stroke were similar between the groups. Net adverse clinical events (NACE) were 27% lower with ticagrelor monotherapy (RR: 0.73; 95% CI: 0.63 to 0.85; p <0.0001). In conclusion, ticagrelor monotherapy after short-duration DAPT reduces major bleeding complications without compromising cardiovascular protection. This approach offers a promising strategy to optimize outcomes for PCI patients, particularly those at high bleeding risk. Further studies are needed to refine the optimal DAPT duration in various patient populations, especially those with higher ischemic risk.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 69-74"},"PeriodicalIF":2.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Congestive symptoms are the primary cause of hospitalizations in heart failure (HF), and diuretics remain the cornerstone of their management. However, clinical practice varies widely due to a lack of a reliable measure of congestion guiding diuretic use. Consequently, many HF patients are discharged prematurely without adequate decongestion, leading to increased readmissions and mortality. Peripheral venous pressure (PVP) has emerged as a promising noninvasive measure of vascular congestion. This study will enroll 650 patients aged 18-99 years admitted with de novo or acutely decompensated chronic HF. In the standard care arm, diuretic dosing and discharge decisions will be at the physician's discretion. In the PVP-guided arm, the goal is to maintain a PVP of <9 mmHg, with diuretic dosing adjusted based on daily PVP changes and urine output. The primary outcome is a composite of all-cause mortality, hospitalizations, and emergency department visits, with secondary outcomes including cardiovascular mortality and HF-related readmissions. We hypothesize that PVP-guided diuretic therapy will provide more precise and effective decongestion than standard care, reducing rehospitalizations and mortality. In conclusion, this study will offer valuable insights into the relationship between diuretic therapy, vascular congestion, and cardiac and renal outcomes.
{"title":"Peripheral Venous Pressure-Guided Decongestive Therapy in Heart Failure 2 (PERIPHERAL-HF2)","authors":"Kartal Emre Aslanger MD , Funda Özlem Pamuk MD , Yaser İslamoğlu MD , Yelda Saltan Özateş MD , Doğan İliş MD , Esra Dönmez MD , Sevgi Özcan MD , Ezgi Çamlı Babayiğit MD , Mevlüt Demir MD , Taner Şen MD , Özlem Yıldırımtürk MD , on behalf of PERIPHERAL-HF2 Investigators","doi":"10.1016/j.amjcard.2025.01.018","DOIUrl":"10.1016/j.amjcard.2025.01.018","url":null,"abstract":"<div><div>Congestive symptoms are the primary cause of hospitalizations in heart failure (HF), and diuretics remain the cornerstone of their management. However, clinical practice varies widely due to a lack of a reliable measure of congestion guiding diuretic use. Consequently, many HF patients are discharged prematurely without adequate decongestion, leading to increased readmissions and mortality. Peripheral venous pressure (PVP) has emerged as a promising noninvasive measure of vascular congestion. This study will enroll 650 patients aged 18-99 years admitted with de novo or acutely decompensated chronic HF. In the standard care arm, diuretic dosing and discharge decisions will be at the physician's discretion. In the PVP-guided arm, the goal is to maintain a PVP of <9 mmHg, with diuretic dosing adjusted based on daily PVP changes and urine output. The primary outcome is a composite of all-cause mortality, hospitalizations, and emergency department visits, with secondary outcomes including cardiovascular mortality and HF-related readmissions. We hypothesize that PVP-guided diuretic therapy will provide more precise and effective decongestion than standard care, reducing rehospitalizations and mortality. In conclusion, this study will offer valuable insights into the relationship between diuretic therapy, vascular congestion, and cardiac and renal outcomes.</div><div>Trial registration: ClinicalTrials.gov Identifier: NCT06495892</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 37-42"},"PeriodicalIF":2.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035922","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 : 2025-01-20DOI: 10.1016/j.amjcard.2025.01.008
Robert C. Stoler MD , Minseob Jeong MD , Talha Akram BS , Alec Monhollen BS , David Fernandez Vazquez MD , Mufaddal Mamawala MBBS, MPH , Trenton A. Witt BA , Blake Bruneman BS , Sarah Weideman BS , Kennedy S. Adelman BS , Shalini Sharma BS , Yumna Furqan BS , Zachary P. Rosol MD , Ronak Rengarajan MD , Jeffrey M. Schussler MD , Ravi C. Vallabhan MD , Yashasvi Chugh MD , Dong-Hi Anthony Yoon MD , Georges A. Feghali MD , Carlos E. Velasco MD , Subhash Banerjee MD
Background
There are limited comparative data on real-world outcomes of patients undergoing percutaneous coronary intervention (PCI) of the left main (LM) and non-LM coronary arteries.
Methods
Total 873 consecutive patients undergoing LM PCI (n = 256) and non-LM PCI (n = 617) were enrolled between September 2019-March 2023 in the Excellence in Coronary Artery Disease (XLCAD) Registry. Primary outcome was 1-year incidence of major adverse cardiovascular events (MACE), a composite of all-cause death, nonfatal myocardial infarction, clinically driven repeat revascularization and ischemic stroke. The secondary outcome was periprocedural (≤30 days) events.
Results
Study cohort included 68% men, mean age 71.9 ± 10.3 in LM and 67.2 ± 11.1 years in non-LM PCI groups (p <0.001). LM PCI patients had significantly greater co-morbidities (diabetes mellitus, hyperlipidemia, prior stroke, prior myocardial infarction, prior coronary revascularization, peripheral artery disease, chronic lung and kidney disease and heart failure) compared with non-LM. Acute coronary syndrome indication was the most prevalent (69%). Mechanical circulatory support was employed in 3.1% LM vs 1% non-LM PCI patients (p = 0.026). Mean number of lesions treated were 2.2 ± 1.0 in LM and 1.4 ± 0.6 in non-LM PCI groups (p <0.001). Multivessel PCI was performed in 68.8% LM and 21% non-LM PCI patients (p <0.001). Overall, drug-eluting stent use (96.7%), bifurcation PCI (24.7%) and atherectomy (2.4%) were similar across groups. Technical and procedural success rates were high across groups, however significantly higher in non-LM group. Periprocedural (≤30 days postprocedure) events included mortality in 3.5% LM and 1.5% non-LM PCI (p = 0.334) and MACE 4.7% LM vs 2.4% non-LM PCI (p = 0.080) groups. One-year MACE was significantly higher in LM versus non-LM PCI (12.9% vs 8.4%, respectively; p = 0.043), driven mainly by higher repeat percutaneous revascularization in LM group (12.1% vs 6.2%; p = 0.003). Mortality at 1-year in LM vs non-LM PCI were 10.2% vs 5.8% (p = 0.074).
Conclusion
In a real-world experience, LM PCI is performed in patients with significantly greater comorbidities compared with non-LM PCI, with high procedural success. Thirty-day mortality and 1-year MACE are significantly higher in LM group.
{"title":"Comparative Outcomes of Left Main and Nonleft Main Percutaneous Coronary Intervention from the Excellence in Coronary Artery Disease (XLCAD) Registry","authors":"Robert C. Stoler MD , Minseob Jeong MD , Talha Akram BS , Alec Monhollen BS , David Fernandez Vazquez MD , Mufaddal Mamawala MBBS, MPH , Trenton A. Witt BA , Blake Bruneman BS , Sarah Weideman BS , Kennedy S. Adelman BS , Shalini Sharma BS , Yumna Furqan BS , Zachary P. Rosol MD , Ronak Rengarajan MD , Jeffrey M. Schussler MD , Ravi C. Vallabhan MD , Yashasvi Chugh MD , Dong-Hi Anthony Yoon MD , Georges A. Feghali MD , Carlos E. Velasco MD , Subhash Banerjee MD","doi":"10.1016/j.amjcard.2025.01.008","DOIUrl":"10.1016/j.amjcard.2025.01.008","url":null,"abstract":"<div><h3>Background</h3><div>There are limited comparative data on real-world outcomes of patients undergoing percutaneous coronary intervention (PCI) of the left main (LM) and non-LM coronary arteries.</div></div><div><h3>Methods</h3><div>Total 873 consecutive patients undergoing LM PCI (n = 256) and non-LM PCI (n = 617) were enrolled between September 2019-March 2023 in the Excellence in Coronary Artery Disease (XLCAD) Registry. Primary outcome was 1-year incidence of major adverse cardiovascular events (MACE), a composite of all-cause death, nonfatal myocardial infarction, clinically driven repeat revascularization and ischemic stroke. The secondary outcome was periprocedural (≤30 days) events.</div></div><div><h3>Results</h3><div>Study cohort included 68% men, mean age 71.9 ± 10.3 in LM and 67.2 ± 11.1 years in non-LM PCI groups (p <0.001). LM PCI patients had significantly greater co-morbidities (diabetes mellitus, hyperlipidemia, prior stroke, prior myocardial infarction, prior coronary revascularization, peripheral artery disease, chronic lung and kidney disease and heart failure) compared with non-LM. Acute coronary syndrome indication was the most prevalent (69%). Mechanical circulatory support was employed in 3.1% LM vs 1% non-LM PCI patients (p = 0.026). Mean number of lesions treated were 2.2 ± 1.0 in LM and 1.4 ± 0.6 in non-LM PCI groups (p <0.001). Multivessel PCI was performed in 68.8% LM and 21% non-LM PCI patients (p <0.001). Overall, drug-eluting stent use (96.7%), bifurcation PCI (24.7%) and atherectomy (2.4%) were similar across groups. Technical and procedural success rates were high across groups, however significantly higher in non-LM group. Periprocedural (≤30 days postprocedure) events included mortality in 3.5% LM and 1.5% non-LM PCI (p = 0.334) and MACE 4.7% LM vs 2.4% non-LM PCI (p = 0.080) groups. One-year MACE was significantly higher in LM versus non-LM PCI (12.9% vs 8.4%, respectively; p = 0.043), driven mainly by higher repeat percutaneous revascularization in LM group (12.1% vs 6.2%; p = 0.003). Mortality at 1-year in LM vs non-LM PCI were 10.2% vs 5.8% (p = 0.074).</div></div><div><h3>Conclusion</h3><div>In a real-world experience, LM PCI is performed in patients with significantly greater comorbidities compared with non-LM PCI, with high procedural success. Thirty-day mortality and 1-year MACE are significantly higher in LM group.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 17-25"},"PeriodicalIF":2.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021849","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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