American Journal of Cardiology最新文献

英文中文

Epidemiological Profile and Mortality of Infective Endocarditis Over the Past Decade: A Systematic Review and Meta-Analysis of 133 Studies 过去十年感染性心内膜炎的流行病学概况和死亡率：对 133 项研究的系统回顾和元分析》。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-25 DOI: 10.1016/j.amjcard.2025.02.023

Andreas Tzoumas MD , Marios Sagris MD , Dimitrios Xenos MD , Athina Ntoumaziou MD , Ioannis Kyriakoulis MD , Fotis Kakargias MD , Wasla Liaqat MD , Sanjana Nagraj MBBS , Riya Patel MBBS , Grigorios Korosoglou MD , Dimitris Tousoulis MD, PhD , Konstantinos Tsioufis MD, PhD , Damianos G. Kokkinidis MD , Leonidas Palaiodimos MD

Infective endocarditis (IE) is an increasingly prevalent condition with relatively high mortality, whose epidemiology has become more complex with an aging population, an increased number of comorbidities, and an increasing incidence of health-care associated IE. Epidemiological data on the causative microorganisms of IE, prevalence of involvement of the different cardiac valves, and IE-associated mortality are clinically relevant. Eligible studies were identified through a systematic search of PubMed/MEDLINE database from 2010 to 2020, and a random effects model meta-analysis was conducted. 133 studies comprising 132,584 patients from six continents were included in this systematic review. The most common causative agents were Staphylococci species in 36% of cases, followed by Streptococci species (26%) and Enterococci species (10%). Out of studies that provided further speciation, the predominant species was Staphylococcus aureus with an incidence of 29%, followed by Viridans group Streptococcus (12%). The short-term mortality rate (defined as in-hospital or 30-day mortality) was 17%. The highest mortality was reported in studies from Latin America with a mean mortality rate of 33% and the lowest mortality was reported in studies from Oceania at 13%. The aortic valve was the most commonly affected valve (46%), followed closely by the mitral valve (43%). The prevalence of tricuspid valve IE was 7% and multivalvular IE occurred in 14% of cases. Our study highlights a shift in epidemiological profile of IE over the last decade with S. aureus identified as the most common causative microorganism of IE.

Protocol registration

PROSPERO CRD42024602342.

{"title":"Epidemiological Profile and Mortality of Infective Endocarditis Over the Past Decade: A Systematic Review and Meta-Analysis of 133 Studies","authors":"Andreas Tzoumas MD , Marios Sagris MD , Dimitrios Xenos MD , Athina Ntoumaziou MD , Ioannis Kyriakoulis MD , Fotis Kakargias MD , Wasla Liaqat MD , Sanjana Nagraj MBBS , Riya Patel MBBS , Grigorios Korosoglou MD , Dimitris Tousoulis MD, PhD , Konstantinos Tsioufis MD, PhD , Damianos G. Kokkinidis MD , Leonidas Palaiodimos MD","doi":"10.1016/j.amjcard.2025.02.023","DOIUrl":"10.1016/j.amjcard.2025.02.023","url":null,"abstract":"<div><div>Infective endocarditis (IE) is an increasingly prevalent condition with relatively high mortality, whose epidemiology has become more complex with an aging population, an increased number of comorbidities, and an increasing incidence of health-care associated IE. Epidemiological data on the causative microorganisms of IE, prevalence of involvement of the different cardiac valves, and IE-associated mortality are clinically relevant. Eligible studies were identified through a systematic search of PubMed/MEDLINE database from 2010 to 2020, and a random effects model meta-analysis was conducted. 133 studies comprising 132,584 patients from six continents were included in this systematic review. The most common causative agents were Staphylococci species in 36% of cases, followed by Streptococci species (26%) and Enterococci species (10%). Out of studies that provided further speciation, the predominant species was Staphylococcus aureus with an incidence of 29%, followed by Viridans group Streptococcus (12%). The short-term mortality rate (defined as in-hospital or 30-day mortality) was 17%. The highest mortality was reported in studies from Latin America with a mean mortality rate of 33% and the lowest mortality was reported in studies from Oceania at 13%. The aortic valve was the most commonly affected valve (46%), followed closely by the mitral valve (43%). The prevalence of tricuspid valve IE was 7% and multivalvular IE occurred in 14% of cases. Our study highlights a shift in epidemiological profile of IE over the last decade with S. aureus identified as the most common causative microorganism of IE.</div></div><div><h3>Protocol registration</h3><div>PROSPERO CRD42024602342.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 67-88"},"PeriodicalIF":2.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522403","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}

引用次数: 0

Chronic Total Occlusion Percutaneous Coronary Intervention: The Present and the Future 社论

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-25 DOI: 10.1016/j.amjcard.2025.02.022

Emmanouil S. Brilakis MD, PhD

引用次数: 0

Machine Learning Predicts Bleeding Risk in Atrial Fibrillation Patients on Direct Oral Anticoagulant

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-25 DOI: 10.1016/j.amjcard.2025.02.030

Rahul Chaudhary , Mehdi Nourelahi , Floyd W. Thoma , Walid F. Gellad , Wei-Hsuan Lo-Ciganic , Rohit Chaudhary , Anahita Dua , Kevin P. Bliden , Paul A. Gurbel , Matthew D. Neal , Sandeep Jain , Aditya Bhonsale , Suresh R. Mulukutla , Yanshan Wang , Matthew E. Harinstein , Samir Saba , Shyam Visweswaran

Predicting major bleeding in nonvalvular atrial fibrillation (AF) patients on direct oral anticoagulants (DOACs) is crucial for personalized care. Alternatives like left atrial appendage closure devices lower stroke risk with fewer nonprocedural bleeds. This study compares machine learning (ML) models with conventional bleeding risk scores (HAS-BLED, ORBIT, and ATRIA) for predicting bleeding events requiring hospitalization in AF patients on DOACs at their index cardiologist visit. This retrospective cohort study used electronic health records from 2010 to 2022 at the University of Pittsburgh Medical Center. It included 24,468 nonvalvular AF patients (age ≥18) on DOACs, excluding those with prior significant bleeding or warfarin use. The primary outcome was hospitalization for bleeding within one year, with follow-up at one, two, and five years. ML algorithms (logistic regression, classification trees, random forest, XGBoost, k-nearest neighbor, naïve Bayes) were compared for performance. Of 24,468 patients, 553 (2.3%) had bleeding within one year, 829 (3.5%) within two years, and 1,292 (5.8%) within five years. ML models outperformed HAS-BLED, ATRIA, and ORBIT in 1-year predictions. The random forest model achieved an AUC of 0.76 (0.70 to 0.81), G-Mean of 0.67, and net reclassification index of 0.14 compared to HAS-BLED's AUC of 0.57 (p < 0.001). ML models showed superior results across all timepoints and for hemorrhagic stroke. SHAP analysis identified new risk factors, including BMI, cholesterol profile, and insurance type. In conclusion, ML models demonstrated improved performance to conventional bleeding risk scores and uncovered novel risk factors, offering potential for more personalized bleeding risk assessment in AF patients on DOACs.

{"title":"Machine Learning Predicts Bleeding Risk in Atrial Fibrillation Patients on Direct Oral Anticoagulant","authors":"Rahul Chaudhary , Mehdi Nourelahi , Floyd W. Thoma , Walid F. Gellad , Wei-Hsuan Lo-Ciganic , Rohit Chaudhary , Anahita Dua , Kevin P. Bliden , Paul A. Gurbel , Matthew D. Neal , Sandeep Jain , Aditya Bhonsale , Suresh R. Mulukutla , Yanshan Wang , Matthew E. Harinstein , Samir Saba , Shyam Visweswaran","doi":"10.1016/j.amjcard.2025.02.030","DOIUrl":"10.1016/j.amjcard.2025.02.030","url":null,"abstract":"<div><div>Predicting major bleeding in nonvalvular atrial fibrillation (AF) patients on direct oral anticoagulants (DOACs) is crucial for personalized care. Alternatives like left atrial appendage closure devices lower stroke risk with fewer nonprocedural bleeds. This study compares machine learning (ML) models with conventional bleeding risk scores (HAS-BLED, ORBIT, and ATRIA) for predicting bleeding events requiring hospitalization in AF patients on DOACs at their index cardiologist visit. This retrospective cohort study used electronic health records from 2010 to 2022 at the University of Pittsburgh Medical Center. It included 24,468 nonvalvular AF patients (age ≥18) on DOACs, excluding those with prior significant bleeding or warfarin use. The primary outcome was hospitalization for bleeding within one year, with follow-up at one, two, and five years. ML algorithms (logistic regression, classification trees, random forest, XGBoost, k-nearest neighbor, naïve Bayes) were compared for performance. Of 24,468 patients, 553 (2.3%) had bleeding within one year, 829 (3.5%) within two years, and 1,292 (5.8%) within five years. ML models outperformed HAS-BLED, ATRIA, and ORBIT in 1-year predictions. The random forest model achieved an AUC of 0.76 (0.70 to 0.81), G-Mean of 0.67, and net reclassification index of 0.14 compared to HAS-BLED's AUC of 0.57 (p < 0.001). ML models showed superior results across all timepoints and for hemorrhagic stroke. SHAP analysis identified new risk factors, including BMI, cholesterol profile, and insurance type. In conclusion, ML models demonstrated improved performance to conventional bleeding risk scores and uncovered novel risk factors, offering potential for more personalized bleeding risk assessment in AF patients on DOACs.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 58-66"},"PeriodicalIF":2.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522409","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}

引用次数: 0

Treating and Preventing Acute Coronary Syndromes in Kidney Transplant Recipients.

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-22 DOI: 10.1016/j.amjcard.2025.02.012

Craig R Narins

引用次数: 0

Prospective Comparison of Temporal Myocardial Function in Men Versus Women After Anterior ST-Elevation Myocardial Infarction With Timely Reperfusion

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-21 DOI: 10.1016/j.amjcard.2025.02.015

Sandeep Jha MD , Aaron Shekka Espinosa MD , Linnea Molander MD , Angela Poller MSc , Valentyna Sevastianova MD, PhD , Koen Simons PhD , Julia Baranowska MD , Thorsteinn Gudmundsson MD , Emanuele Bobbio MD , Rickard Zeijlon MD, PhD , Carlo Pirazzi MD, PhD , Andreas Martinsson MD, PhD , Tomas Mellberg MD, PhD , Petronella Torild RN , Joakim Sundstrom MD , Erik Axel Andersson PhD , Sigurdur Thorleifsson MD , Sabin Salahuddin MD , Ahmed Elmahdy MD , Tetiana Pylova MD, PhD , Bjorn Redfors MD, PhD

Compared to men, women have been reported to have increased morbidity and mortality after ST-elevation myocardial infarction (STEMI); but sex differences in cardiac function in the acute and subacute phases of STEMI are incompletely understood. The objective of this study was to prospectively compare changes in cardiac function over the acute and subacute phases after anterior STEMI with timely reperfusion in women versus men. The Stunning in Takotsubo versus Acute Myocardial Infarction (STAMI) study (NCT04448639) prospectively enrolled 105 men and 41 women with anterior STEMI. Echocardiography and blood sampling were performed within 4 hours of admission and at 1, 2, 3, 7, 14, and 30 days after admission. The primary outcome was akinesia recovery, defined as the difference in the percentage of akinesia observed at baseline versus follow-up. Secondary outcomes included wall motion score index (WMSI), left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Mixed effects linear regression or zero-inflated tobit models with random intercepts were used to model echocardiographic parameters over time. Baseline patient characteristics were similar in both groups. The difference between women and men in akinesia recovery at 30 days was 8.3% (95% credible interval 0.8%, 15.5%). The covariate-adjusted posterior probability that akinesia recovery and WMSI improvement at 30 days are greater in women than men were 96.0% and 99.0% respectively. Similar but less pronounced trends towards greater improvement in women than men were observed for LVEF and GLS. In conclusion, cardiac dysfunction recovered to a greater extent in women than in men after anterior STEMI with timely reperfusion.

{"title":"Prospective Comparison of Temporal Myocardial Function in Men Versus Women After Anterior ST-Elevation Myocardial Infarction With Timely Reperfusion","authors":"Sandeep Jha MD , Aaron Shekka Espinosa MD , Linnea Molander MD , Angela Poller MSc , Valentyna Sevastianova MD, PhD , Koen Simons PhD , Julia Baranowska MD , Thorsteinn Gudmundsson MD , Emanuele Bobbio MD , Rickard Zeijlon MD, PhD , Carlo Pirazzi MD, PhD , Andreas Martinsson MD, PhD , Tomas Mellberg MD, PhD , Petronella Torild RN , Joakim Sundstrom MD , Erik Axel Andersson PhD , Sigurdur Thorleifsson MD , Sabin Salahuddin MD , Ahmed Elmahdy MD , Tetiana Pylova MD, PhD , Bjorn Redfors MD, PhD","doi":"10.1016/j.amjcard.2025.02.015","DOIUrl":"10.1016/j.amjcard.2025.02.015","url":null,"abstract":"<div><div>Compared to men, women have been reported to have increased morbidity and mortality after ST-elevation myocardial infarction (STEMI); but sex differences in cardiac function in the acute and subacute phases of STEMI are incompletely understood. The objective of this study was to prospectively compare changes in cardiac function over the acute and subacute phases after anterior STEMI with timely reperfusion in women versus men. The Stunning in Takotsubo versus Acute Myocardial Infarction (STAMI) study (NCT04448639) prospectively enrolled 105 men and 41 women with anterior STEMI. Echocardiography and blood sampling were performed within 4 hours of admission and at 1, 2, 3, 7, 14, and 30 days after admission. The primary outcome was akinesia recovery, defined as the difference in the percentage of akinesia observed at baseline versus follow-up. Secondary outcomes included wall motion score index (WMSI), left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Mixed effects linear regression or zero-inflated tobit models with random intercepts were used to model echocardiographic parameters over time. Baseline patient characteristics were similar in both groups. The difference between women and men in akinesia recovery at 30 days was 8.3% (95% credible interval 0.8%, 15.5%). The covariate-adjusted posterior probability that akinesia recovery and WMSI improvement at 30 days are greater in women than men were 96.0% and 99.0% respectively. Similar but less pronounced trends towards greater improvement in women than men were observed for LVEF and GLS. In conclusion, cardiac dysfunction recovered to a greater extent in women than in men after anterior STEMI with timely reperfusion.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 48-57"},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482090","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}

引用次数: 0

The Relationship Between Syncope and Cardiac Index in Acute Pulmonary Embolism.

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-21 DOI: 10.1016/j.amjcard.2025.02.017

Peter Zhang, Robert S Zhang, Eugene Yuriditsky, Kevin Chen, Vincent Li, Lindsay Elbaum, Norma Keller, Allison A Greco, Vikramjit Mukherjee, Radu Postelnicu, Kerry Hena, James M Horowitz, Carlos L Alviar, Sripal Bangalore

The relationship between syncope and invasive hemodynamics in patients with pulmonary embolism (PE) remains unknown. The objective of this study was to assess the ability of syncope, as a single clinical variable, to predict a low cardiac index in patients with acute PE. This retrospective study included patients with acute intermediate- and high-risk PE who underwent catheter-based therapies between October 2020 and June 2024. The primary outcome was whether syncope at hospital presentation was a predictor of low cardiac index (≤2.2 L/min/m²) in patients with acute intermediate- high risk PE. Secondary outcomes included 30-day mortality, hemodynamic instability, 90-day readmission rates, other invasive hemodynamic parameters, intensive care unit (ICU) length of stay (LOS), and hospital LOS. Regression analyses were used to evaluate the association between cardiac index and syncope. A total of 132 patients (86% intermediate- and 14% high-risk) were included in the study, with 27 (20%) presenting with syncope. Among the 114 intermediate-risk patients, 24 (21%) presented with syncope. In all-comers, there was no significant difference between groups at baseline. Within the intermediate-only subgroup, there were no significant differences between groups at baseline, except that the syncope group was older (62.6 ± 14.9 vs 56.1 ± 13.9, p = 0.048, Table 2) and had significantly higher troponin elevation at presentation (684.3 ± 1361.8ng/L vs 195.6 ± 278.1ng/L, p = 0.003, Table 2). In all-comers, there was no difference in rates of low cardiac index (63% vs 59%, p = 0.71) or mPAP (33.9 ± 8.6 vs 32.7 ± 9.6 mm Hg, p = 0.57) between patients who presented with and without syncope. Similarly, among intermediate-risk patients, there was also no difference in the rates of low cardiac index (67% vs 57%, p = 0.38) or mPAP (34.0 ± 9.2 vs 33.1 ± 9.8 mmHg, p = 0.69) between patients with and without syncope. There was no difference in clinical outcomes between those who presented with and without syncope. In conclusion, in patients with acute PE, syncope was not associated with a low cardiac index or higher mPAP.

{"title":"The Relationship Between Syncope and Cardiac Index in Acute Pulmonary Embolism.","authors":"Peter Zhang, Robert S Zhang, Eugene Yuriditsky, Kevin Chen, Vincent Li, Lindsay Elbaum, Norma Keller, Allison A Greco, Vikramjit Mukherjee, Radu Postelnicu, Kerry Hena, James M Horowitz, Carlos L Alviar, Sripal Bangalore","doi":"10.1016/j.amjcard.2025.02.017","DOIUrl":"10.1016/j.amjcard.2025.02.017","url":null,"abstract":"<p><p>The relationship between syncope and invasive hemodynamics in patients with pulmonary embolism (PE) remains unknown. The objective of this study was to assess the ability of syncope, as a single clinical variable, to predict a low cardiac index in patients with acute PE. This retrospective study included patients with acute intermediate- and high-risk PE who underwent catheter-based therapies between October 2020 and June 2024. The primary outcome was whether syncope at hospital presentation was a predictor of low cardiac index (≤2.2 L/min/m<sup>2</sup>) in patients with acute intermediate- high risk PE. Secondary outcomes included 30-day mortality, hemodynamic instability, 90-day readmission rates, other invasive hemodynamic parameters, intensive care unit (ICU) length of stay (LOS), and hospital LOS. Regression analyses were used to evaluate the association between cardiac index and syncope. A total of 132 patients (86% intermediate- and 14% high-risk) were included in the study, with 27 (20%) presenting with syncope. Among the 114 intermediate-risk patients, 24 (21%) presented with syncope. In all-comers, there was no significant difference between groups at baseline. Within the intermediate-only subgroup, there were no significant differences between groups at baseline, except that the syncope group was older (62.6 ± 14.9 vs 56.1 ± 13.9, p = 0.048, Table 2) and had significantly higher troponin elevation at presentation (684.3 ± 1361.8ng/L vs 195.6 ± 278.1ng/L, p = 0.003, Table 2). In all-comers, there was no difference in rates of low cardiac index (63% vs 59%, p = 0.71) or mPAP (33.9 ± 8.6 vs 32.7 ± 9.6 mm Hg, p = 0.57) between patients who presented with and without syncope. Similarly, among intermediate-risk patients, there was also no difference in the rates of low cardiac index (67% vs 57%, p = 0.38) or mPAP (34.0 ± 9.2 vs 33.1 ± 9.8 mmHg, p = 0.69) between patients with and without syncope. There was no difference in clinical outcomes between those who presented with and without syncope. In conclusion, in patients with acute PE, syncope was not associated with a low cardiac index or higher mPAP.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482091","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}

引用次数: 0

Effects of Year Long Aerobic Exercise on Left Atrial Size in Patients With Left Ventricular Hypertrophy

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-20 DOI: 10.1016/j.amjcard.2025.02.020

Douglas Kyrouac , Nicholas Talbot , James MacNamara , Erin Howden , Michinari Hieda , Christopher Hearon , Tiffany Brazile , Benjamin Levine , Satyam Sarma

Habitual aerobic exercise is associated with left atrial (LA) enlargement which may increase risk of atrial fibrillation. Patients with LVH and increased LV stiffness may be more predisposed to LA remodeling due to higher LA pressures during exercise. We tested the hypothesis 1 year of aerobic exercise training would increase LA size to a greater extent in patients with LVH than controls. Adults with LVH (n = 53) enriched for increased cardiac risk and LV stiffness and control (CON) subjects (n = 58) were randomized to 1 year of high intensity aerobic exercise (ex) or yoga control. LA and LV volumes were measured using 3D echo. Of 111 participants, 83 had complete data available (LVH: 18 exercisers, 10 yoga; CON: 29 exercisers, 26 yoga). Baseline LA volume indices were similar between groups (LVH: 19.8 ± 4.4 mL/m² vs CON: 18.8 ± 4.1 mL/m²; p = 0.33). After 1 year, the effects of exercise (p = 0.003) and LVH (p = 0.001) were each associated with increased LA volume index. More subjects in the LVH/exercise group (33.3%) increased LA size >5 mL/m² and LA/LV volume ratios >0.1 compared to the other groups (10% LVH/yoga, 3.4% CON/ex, 3.8% CON/yoga; Chi square p = 0.006).

In conclusion, 1 year of aerobic training resulted in higher LA volumes in subjects with LVH and LV stiffness compared to healthy subjects. The increase in LA size was greater than changes in LV size suggesting chronic aerobic training in may preferentially affect LA remodeling in subjects with LVH and LV stiffness.

{"title":"Effects of Year Long Aerobic Exercise on Left Atrial Size in Patients With Left Ventricular Hypertrophy","authors":"Douglas Kyrouac , Nicholas Talbot , James MacNamara , Erin Howden , Michinari Hieda , Christopher Hearon , Tiffany Brazile , Benjamin Levine , Satyam Sarma","doi":"10.1016/j.amjcard.2025.02.020","DOIUrl":"10.1016/j.amjcard.2025.02.020","url":null,"abstract":"<div><div>Habitual aerobic exercise is associated with left atrial (LA) enlargement which may increase risk of atrial fibrillation. Patients with LVH and increased LV stiffness may be more predisposed to LA remodeling due to higher LA pressures during exercise. We tested the hypothesis 1 year of aerobic exercise training would increase LA size to a greater extent in patients with LVH than controls. Adults with LVH (<em>n</em> = 53) enriched for increased cardiac risk and LV stiffness and control (CON) subjects (<em>n</em> = 58) were randomized to 1 year of high intensity aerobic exercise (ex) or yoga control. LA and LV volumes were measured using 3D echo. Of 111 participants, 83 had complete data available (LVH: 18 exercisers, 10 yoga; CON: 29 exercisers, 26 yoga). Baseline LA volume indices were similar between groups (LVH: 19.8 ± 4.4 mL/m<sup>2</sup> vs CON: 18.8 ± 4.1 mL/m<sup>2</sup>; p = 0.33). After 1 year, the effects of exercise (p = 0.003) and LVH (p = 0.001) were each associated with increased LA volume index. More subjects in the LVH/exercise group (33.3%) increased LA size >5 mL/m<sup>2</sup> and LA/LV volume ratios >0.1 compared to the other groups (10% LVH/yoga, 3.4% CON/ex, 3.8% CON/yoga; Chi square p = 0.006).</div><div>In conclusion, 1 year of aerobic training resulted in higher LA volumes in subjects with LVH and LV stiffness compared to healthy subjects. The increase in LA size was greater than changes in LV size suggesting chronic aerobic training in may preferentially affect LA remodeling in subjects with LVH and LV stiffness.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"244 ","pages":"Pages 3-8"},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476195","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}

引用次数: 0

Adequacy of Loop Diuretic Dosing in Treatment of Acute Heart Failure: Insights from the BAN-ADHF Diuretic Resistance Risk Score

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-20 DOI: 10.1016/j.amjcard.2025.02.018

Joseph Mauch MD , Max Puthenpura MD , Pieter Martens MD, MSc, PhD , Timothy Engelman LPN , Justin L Grodin MD, MPH , Matthew W. Segar MD , Ambarish Pandey MD, MS , Wai Hong Wilson Tang MD

Diuretic resistance (DR) is common among patients admitted with acute heart failure (AHF) and can be estimated by BAN-ADHF scores. Among 317 consecutive patients hospitalized for AHF, BAN-ADHF scores were compared with metrics of DR and composite endpoint of all-cause mortality, HF hospitalization, LVAD, or heart transplantation. The BAN-ADHF score was incorporated into a diuretic dosing calculator and retroactively applied to a patient's diuretic dose to categorize them as adequately dosed or under-dosed (inadequate). The primary outcome studied was attaining >3 L of urine output within the first 24 hours of admission. The median BAN-ADHF score was 9 (IQR of 7-13). A higher BAN-ADHF score was associated with greater DR based on weight loss and urine output (all p <0.001). The highest quartile (Q4) had fewer patients achieve the admission urinary output goal (15% vs 32%, p = 0.004) and lower total urine output (2,009 mL vs 2,559 mL, p = 0.029) compared with the first 3 quartiles. In time-to-event analysis, Q4 of BAN-ADHF score was associated with increased risk of the primary composite endpoint (HR 2.07, 95% CI 1.41 to 3.04). Compared to those below the calculator's recommended dose, patients receiving loop diuretics at goal doses (37.7% of cohort) had greater 24-hour UOP (3,050 vs 2,050 mL), likelihood of UOP goal (45% vs 19%), and weight loss at discharge (8.95 kg vs 5.94 kg; all p <0.001). In conclusion, BAN-ADHF score correlated with diuretic resistance and prognosis, and may capture the risk of DR compared traditional measures like CKD or NT-proBNP.

在急性心力衰竭（AHF）住院患者中，利尿剂抵抗（DR）很常见，可以通过 BAN-ADHF 评分来估算。在 317 名连续住院的 AHF 患者中，将 BAN-ADHF 评分与 DR 指标以及全因死亡率、HF 住院、LVAD 或心脏移植的复合终点进行了比较。BAN-ADHF 评分被纳入利尿剂剂量计算器，并追溯到患者的利尿剂剂量，将其分为剂量充足和剂量不足（不足）两类。研究的主要结果是入院后 24 小时内达到大于 3 L 的尿量。BAN-ADHF 评分的中位数为 9（IQR 为 7-13）。根据体重减轻和尿量，BAN-ADHF 分数越高，DR 越大（均 p

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引用次数: 0

Ticagrelor Versus Clopidogrel in Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention for Acute Coronary Syndrome in Chronic Kidney Disease

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-20 DOI: 10.1016/j.amjcard.2025.02.016

Min Choon Tan MD , Aravinthan Vignarajah MD , Tanusha Winson MBBS , Yong Hao Yeo MBBS , Qi Xuan Ang MBBS , Ramzi Ibrahim MD , Justin Z. Lee MD

引用次数: 0

Real-World Reductions in Lead-Free Radiation Exposure with the Rampart System during Endovascular Procedures

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-02-20 DOI: 10.1016/j.amjcard.2025.02.019

Matthew S. Herzig MD , Ajar Kochar MD, MHS , James B. Hermiller MD , Rhian E. Davies DO, MS , William J. Nicholson MD , Hibiki Orui MS , Eric. A. Secemsky MD, MSc

Endovascular operators experience elevated rates of occupational orthopedic injuries and persistent radiation exposure with current lead shielding. Novel shielding systems eliminate the need to wear lead aprons while also mitigating occupational radiation exposure, but real-world evidence of their efficacy remains needed. This study evaluated consecutive endovascular procedures requiring fluoroscopy at U.S. and international institutions following installation of a commercially available portable shielding system consisting of interlocking radiation-attenuating acrylic and soft shielding components. Live dosimeters were placed at the left shoulder of the main and assistant operators for quantification of radiation exposure. In total, 1,712 endovascular procedures performed by 671 operators at 153 sites (19% non-U.S.). In 1,712 (99.4%), radiation exposure was recorded. A majority of procedures (83.6%) were coronary interventions including diagnostic angiography (43.8%), nonchronic total occlusion PCI (27.6%), and chronic total occlusion PCI (6.7%). Median fluoroscopy time was 7.7 mins (IQR 3.9 to 15.3 min), and median radiation exposure to the main operator and first assistant was 2 μSv and 1 μSv. This was comparable to historical measurements of under-lead radiation exposure. In conclusion, the Rampart system effectively reduced radiation exposure in real-world practice, enabling a safe lead-free procedure lab.

血管内手术操作人员的骨科职业损伤率较高，而且在目前的铅屏蔽系统下仍会受到持续的辐射照射。新型屏蔽系统既无需穿戴铅围裙，又可减轻职业辐射暴露，但仍需实际证据证明其功效。这项研究评估了美国和国际机构在安装了市售的便携式屏蔽系统（由互锁的辐射衰减丙烯酸和软屏蔽组件组成）后进行的需要透视的连续血管内手术。在主要操作员和助理操作员的左肩上放置了活体剂量计，以量化辐射暴露量。共有 671 名操作员在 153 个地点（19% 非美国）进行了 1712 例血管内手术。其中有 1712 例（99.4%）记录了辐射暴露。大多数手术（83.6%）是冠状动脉介入治疗，包括诊断性血管造影（43.8%）、非慢性全闭塞PCI（27.6%）和慢性全闭塞PCI（6.7%）。透视时间中位数为 7.7 分钟（IQR 为 3.9-15.3 分钟），主要操作者和第一助手的辐射暴露中位数分别为 2 μSv 和 1 μSv。这与历史测量的铅下辐照度相当。总之，Rampart 系统有效地减少了实际操作中的辐射暴露，实现了安全的无铅手术室。

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