American Journal of Cardiology最新文献_第5页

Transcatheter Aortic Valve Replacement in Patients With Extra-Large Aortic Annuli: Insights From a Large Cohort 特大主动脉环患者的经导管主动脉瓣置换术：来自大队列的见解。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-12-29 DOI: 10.1016/j.amjcard.2025.12.015

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

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。

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引用次数: 0

Renal Artery Stent Procedural Trends and Disparities in a National Cohort 肾动脉支架手术在全国队列中的趋势和差异。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-12-29 DOI: 10.1016/j.amjcard.2025.12.011

Jason Gusdorf MD , William B. Earle MD , Siling Li MSc , Anna Krawisz MD , Stephen P. Juraschek MD, PhD , Jennifer L. Cluett MD , Brett J. Carroll MD , Eric A. Secemsky MD, MSc

Atherosclerotic renal artery stenosis (RAS) affects nearly 7% of adults over age 65 and is associated with increased cardiovascular and renal morbidity. Although early observational studies suggested benefit from renal artery stenting, subsequent randomized trials failed to show improvement in major clinical endpoints, contributing to substantial declines in procedural use. To characterize contemporary practice, we conducted a retrospective cohort study of Medicare beneficiaries older than 65 years who underwent renal artery stenting for atherosclerotic RAS between 2016 and 2020. Using Medicare claims data, we evaluated baseline characteristics, temporal utilization, and postprocedural outcomes, stratified by race, geographic region, and dual Medicare–Medicaid enrollment status. Among 19,130 patients, the mean age was 76.0 years (±6.4), 59.2% were female, and 90.3% were White; 84.2% had chronic kidney disease and 48.7% had heart failure. Procedural rates declined by 41.1% over the study period. Compared with White patients, Black patients had higher adjusted risks of hypertensive crisis hospitalization (aHR 1.45, 95% CI, 1.24–1.70) and dialysis initiation (aHR 1.78, 95% CI, 1.39–2.27); patients of Other races also had greater risk of dialysis initiation (aHR 1.98, 95% CI, 1.50–2.63). Patients in the South experienced higher unadjusted cardiovascular event rates (50.0%) but similar adjusted mortality compared with those in the Northeast (aHR 1.09, 95% CI, 0.98–1.21). Dual enrollment was associated with increased all-cause mortality (aHR 1.31, 95% CI, 1.20–1.43). In conclusion, renal artery stenting rates continued to decline in recent years, and contemporary recipients constitute an older, comorbid population with substantial cardiovascular risk. Outcomes differed markedly by race, socioeconomic status, and geography, highlighting the need for improved risk stratification and prospective evaluation of stenting in high-risk cohorts.

动脉粥样硬化性肾动脉狭窄（RAS）影响近7%的65岁以上成年人，并与心血管和肾脏发病率增加相关。尽管早期观察性研究表明肾动脉支架置入有益，但随后的随机试验未能显示主要临床终点的改善，导致程序性使用大幅下降。为了描述当代实践特征，我们对2016年至2020年期间接受动脉粥样硬化性RAS肾动脉支架植入术的65岁以上医疗保险受益人进行了回顾性队列研究。使用医疗保险索赔数据，我们评估了基线特征、时间利用率和手术后结果，并按种族、地理区域和双重医疗保险-医疗补助登记状态分层。19130例患者中，平均年龄76.0岁（±6.4岁），女性59.2%，白人90.3%；84.2%有慢性肾脏疾病，48.7%有心力衰竭。在研究期间，手术率下降了41.1%。与白人患者相比，黑人患者高血压危重住院（aHR 1.45, 95% CI 1.24-1.70）和开始透析（aHR 1.78, 95% CI 1.39-2.27）的调整风险更高；其他种族的患者开始透析的风险也更高（aHR 1.98, 95% CI 1.50-2.63）。南方患者的未调整心血管事件发生率较高（50.0%），但与东北部患者的调整死亡率相似（aHR 1.09, 95% CI 0.98-1.21）。双组入组与全因死亡率增加相关（aHR 1.31, 95% CI 1.20-1.43）。总之，肾动脉支架置入率近年来持续下降，当代受者构成了一个年龄较大、合并症的人群，具有很大的心血管风险。结果因种族、社会经济地位和地理位置的不同而有显著差异，这突出了在高风险队列中改进风险分层和支架置入前瞻性评估的必要性。

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引用次数: 0

Transcatheter Aortic Valve Replacement for Aortic Regurgitation: A Case-Based Review. 经导管主动脉瓣置换术治疗主动脉瓣返流：一项基于病例的回顾。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-12-28 DOI: 10.1016/j.amjcard.2025.12.006

Lucas Uchoa de Assis, Andrea Mariani, Antigone Kostea, Rutger-Jan Nuis, Joost Daemen, Nicolas M Van Mieghem

Aortic regurgitation (AR) is the third most common valvular heart disease and its prevalence increases with age. Surgical aortic valve replacement remains the standard treatment but is often deferred due to perceived high surgical risk and frailty, leaving nearly one‑third of patients with severe AR untreated. Transcatheter aortic valve replacement (TAVR) offers a less invasive alternative, but off-label use of transcatheter valves designed for aortic stenosis has been limited by anchoring difficulties, valve embolization, and residual regurgitation. Dedicated devices have addressed these challenges with tailored anchoring mechanisms and demonstrated improved procedural success. This case-based review explores the evolving role of TAVR for AR through 3 patient vignettes that highlight practical considerations for device selection, anchoring strategies, and complication management. While outcomes with dedicated systems are encouraging, further research should establish TAVR in AR treatment. In parallel, device iterations are required to curtail procedure-induced conduction disturbances and broaden anatomical eligibility.

主动脉瓣反流（AR）是第三大最常见的瓣膜性心脏病，其患病率随着年龄的增长而增加。手术主动脉瓣置换术仍然是标准的治疗方法，但由于手术风险高和身体虚弱，手术常常被推迟，导致近三分之一的严重AR患者未得到治疗。经导管主动脉瓣置换术（TAVR）提供了一种侵入性较小的替代方法，但经导管瓣膜在标签外用于主动脉瓣狭窄的治疗受到锚定困难、瓣膜栓塞和残余返流的限制。专用设备通过量身定制的锚定机制解决了这些挑战，并证明了改进的手术成功率。这篇基于病例的综述通过三个患者的小故事探讨了TAVR在AR中的作用，这些小故事强调了设备选择、锚定策略和并发症管理方面的实际考虑。虽然专用系统的结果令人鼓舞，但进一步的研究应该确定TAVR在AR治疗中的作用。同时，设备迭代需要减少程序引起的传导干扰和扩大解剖资格。

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引用次数: 0

Cardiac Rehabilitation for Coronary Artery Disease: Gaps, Digital Models, and the Future of Personalized Prevention 冠心病的心脏康复：差距、数字模型和个性化预防的未来。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-12-28 DOI: 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.

心血管疾病是全球发病率和死亡率的主要原因，冠状动脉疾病是导致过早死亡的主要原因。心脏康复（CR）是综合锻炼、危险因素调整和教育的二级预防的基石。CR降低了全因死亡率、复发性缺血事件，并改善了生活质量。然而，参与率仍然不理想，妇女、老年人、少数民族和社会经济弱势群体未充分利用CR。我们研究了传统的基于中心的CR （CBCR）模式、基于家庭的CR和混合模式。通过利用远程医疗、移动医疗和可穿戴生物传感器，CR的远程递送显示出与传统CBCR相当的功效。人工智能的整合为通过持续的生理监测和运动处方来个性化CR提供了机会。总之，从卫生系统的角度来看，CR仍然具有成本效益，但患者层面的可负担性和公平获取需要有针对性的政策、财政和适应文化的干预措施，以确保个性化和公平地提供二级预防。

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引用次数: 0

Dynamic Changes in Right Ventricular-Pulmonary Arterial Coupling During Acute Heart Failure Hospitalization: Prognostic Implications 急性心力衰竭住院期间右心室-肺动脉耦合的动态变化：预后意义。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-12-28 DOI: 10.1016/j.amjcard.2025.12.010

Vasileios Anastasiou MD, MSc , Evdoxia Stavropoulou MD, MSc , Emmanouela Peteinidou MD, MSc , Anastasia Nikolaidou MD, MSc , Stylianos Daios MD, MSc , Emmanouil Fardoulis MD, MSc , Theodoros Karamitsos MD, PhD , George Giannakoulas MD, PhD , Katerina Κ. Naka MD, PhD , Victoria Delgado MD, PhD , Antonios Ziakas MD, PhD , Vasileios Kamperidis MD, MSc, PhD

Right ventricular (RV) - pulmonary arterial (PA) uncoupling is an important predictor of outcomes in heart failure (HF), yet it may change substantially during hospitalization for acute HF. This study sought to investigate the dynamic changes in RV-PA uncoupling during acute HF hospitalization and their prognostic significance. Tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio was measured in consecutive hospitalized acute HF patients using echocardiography on admission and at discharge. TAPSE/PASP <0.36 mm/mmHg was considered as RV-PA uncoupling. Patients were divided into 3 groups; RV-PA coupling on admission and discharge, RV-PA uncoupling on admission that normalized to RV-PA coupling at discharge (normalized RV-PA uncoupling), and RV-PA uncoupling on admission that persisted at discharge (persistent RV-PA uncoupling). The primary endpoint was all-cause mortality and HF rehospitalization. Out of 490 patients (73.4 ± 11.9 years old), 216 (44.1%) had RV-PA coupling, 123 (25.1%) normalized RV-PA uncoupling, and 151 (30.8%) persistent RV-PA uncoupling. After a mean follow-up of 12.0 ± 2.6 months, 186 (38.0%) patients reached the primary endpoint. Significantly worse event-free survival rate was observed for the persistent RV-PA uncoupling patients (RV-PA coupling: 74.1%, normalized RV-PA uncoupling: 71.5%, persistent RV-PA uncoupling: 37.1%, Log-rank p < 0.001). Persistent RV-PA uncoupling status was independently associated with the primary endpoint (hazard ratio 2.78 [95% CI 1.73–4.44]; p < 0.001), and provided incremental prognostic information over a baseline model and RV-PA uncoupling on admission. In conclusion, in hospitalized acute HF patients, persistence of RV-PA uncoupling at discharge is associated with worse 1-year event-free survival. Clinical Trial Registration: https://www.clinicaltrials.gov/study/NCT05573997.

右心室(RV) -肺动脉（PA）解耦是心衰（HF）预后的重要预测指标，但在急性心衰住院期间可能发生重大变化。本研究旨在探讨急性心衰住院期间RV-PA解耦的动态变化及其预后意义。采用超声心动图测量连续住院的急性心力衰竭患者入院和出院时三尖瓣环平面收缩偏移与肺动脉收缩压之比（TAPSE/PASP）。TAPSE / PASP

{"title":"Dynamic Changes in Right Ventricular-Pulmonary Arterial Coupling During Acute Heart Failure Hospitalization: Prognostic Implications","authors":"Vasileios Anastasiou MD, MSc , Evdoxia Stavropoulou MD, MSc , Emmanouela Peteinidou MD, MSc , Anastasia Nikolaidou MD, MSc , Stylianos Daios MD, MSc , Emmanouil Fardoulis MD, MSc , Theodoros Karamitsos MD, PhD , George Giannakoulas MD, PhD , Katerina Κ. Naka MD, PhD , Victoria Delgado MD, PhD , Antonios Ziakas MD, PhD , Vasileios Kamperidis MD, MSc, PhD","doi":"10.1016/j.amjcard.2025.12.010","DOIUrl":"10.1016/j.amjcard.2025.12.010","url":null,"abstract":"<div><div>Right ventricular (RV) - pulmonary arterial (PA) uncoupling is an important predictor of outcomes in heart failure (HF), yet it may change substantially during hospitalization for acute HF. This study sought to investigate the dynamic changes in RV-PA uncoupling during acute HF hospitalization and their prognostic significance. Tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio was measured in consecutive hospitalized acute HF patients using echocardiography on admission and at discharge. TAPSE/PASP <0.36 mm/mmHg was considered as RV-PA uncoupling. Patients were divided into 3 groups; RV-PA coupling on admission and discharge, RV-PA uncoupling on admission that normalized to RV-PA coupling at discharge (normalized RV-PA uncoupling), and RV-PA uncoupling on admission that persisted at discharge (persistent RV-PA uncoupling). The primary endpoint was all-cause mortality and HF rehospitalization. Out of 490 patients (73.4 ± 11.9 years old), 216 (44.1%) had RV-PA coupling, 123 (25.1%) normalized RV-PA uncoupling, and 151 (30.8%) persistent RV-PA uncoupling. After a mean follow-up of 12.0 ± 2.6 months, 186 (38.0%) patients reached the primary endpoint. Significantly worse event-free survival rate was observed for the persistent RV-PA uncoupling patients (RV-PA coupling: 74.1%, normalized RV-PA uncoupling: 71.5%, persistent RV-PA uncoupling: 37.1%, Log-rank p < 0.001). Persistent RV-PA uncoupling status was independently associated with the primary endpoint (hazard ratio 2.78 [95% CI 1.73–4.44]; p < 0.001), and provided incremental prognostic information over a baseline model and RV-PA uncoupling on admission. In conclusion, in hospitalized acute HF patients, persistence of RV-PA uncoupling at discharge is associated with worse 1-year event-free survival. Clinical Trial Registration: <span><span>https://www.clinicaltrials.gov/study/NCT05573997</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"262 ","pages":"Pages 6-15"},"PeriodicalIF":2.1,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861661","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

Comment on “Road Exposure After Cardioverter-Defibrillator Implantation and Its Potential Influence on Reported Motor Vehicle Crash Risks” 对“心脏转复除颤器植入后的道路暴露及其对报告的机动车碰撞风险的潜在影响”的评论。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-12-25 DOI: 10.1016/j.amjcard.2025.12.004

Bhumesh Tyagi MD, Leelabati Toppo MD, Aishwarya Biradar MD

引用次数: 0

Advancing Management of Patients With Lower Extremity Peripheral Artery Disease: A Focused Review and Our Institution’s Approach to Postendovascular Intervention Care 下肢外周动脉疾病患者的先进管理：重点回顾和我院血管内介入后护理方法。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-12-25 DOI: 10.1016/j.amjcard.2025.11.022

Rabih Tabet MD , Iliana S. Hurtado Rendon MD , Golsa Joodi MD , Jose Eduardo Costa Filho MD , Gaelle Romain PhD , Christiany Tapia MD , Kim G. Smolderen PhD , Carlos Mena-Hurtado MD

Peripheral artery disease (PAD) remains one of the leading causes of atherosclerotic cardiovascular diseases affecting millions of people worldwide. Clinical presentation ranges from asymptomatic disease to chronic limb-threatening ischemia, and patients are not only at a higher risk of amputation and limb loss but also at increased risk of cardiovascular events and mortality. Nowadays, many physicians from various specialties are involved in the care of patients with PAD and provide a wide range of vascular interventions and procedures, but to date, there is still a huge discrepancy as to how these patients are managed and followed up after their interventions. This review aims to provide a comprehensive road map for physicians to help them administer a more standardized care covering all aspects of management of patients with PAD in the postintervention phase based on our institution’s best-practice approach.

外周动脉疾病（PAD）仍然是影响全世界数百万人的动脉粥样硬化性心血管疾病的主要原因之一。临床表现从无症状疾病到慢性肢体威胁缺血（CLTI）不等，患者不仅截肢和肢体丧失的风险较高，而且心血管事件和死亡的风险也增加。目前，许多来自不同专业的医生参与到PAD患者的护理中，并提供了广泛的血管干预和手术，但迄今为止，这些患者在干预后的管理和随访方面仍存在巨大差异。本综述旨在为医生提供一个全面的路线图，以帮助他们根据我们机构的最佳实践方法，在干预后阶段管理更标准化的护理，涵盖PAD患者管理的各个方面。

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引用次数: 0

Pulsed-Field Ablation Versus Cryoballoon Ablation for Atrial Fibrillation: A Comparative Analysis 脉冲场消融与低温球囊消融治疗心房颤动的比较分析。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-12-24 DOI: 10.1016/j.amjcard.2025.12.005

Sanchit Duhan MBBS , Narayana Varalakshmi Akula MD , Krishna Prasad Kurpad MD , Bijeta Keisham MBBS , Sanjay S. Mehta MD , Naveed A. Adoni MD , Mbu Mongwa MD

Pulsed-field ablation (PFA) is a nonthermal ablation method for pulmonary-vein isolation to treat atrial fibrillation. Limited data are available to compare PFA with cryoballoon ablation (CBA). We searched PubMed, Cochrane, and Embase for studies comparing PFA and CBA with at least one outcome of interest. Data analysis was performed using Cochrane RevMan 5.4. Dichotomous variables were compared using the Mantel-Haenszel method in a random-effects model to calculate the risk ratio and 95% confidence intervals (CI). Continuous variables were compared using the inverse variance method in a random-effects model to calculate standard mean differences (SMD) and 95% CI. Twenty-one studies comprising 5,222 patients (2,297:PFA, 2,925:CBA) were included. Thirteen studies reported AF recurrence after the blanking period of 3 months, with a lower pooled risk seen in PFA (RR 0.81; 95% CI: 0.70, 0.92). Sixteen studies reported a periprocedural complications rate with a lower pooled risk in PFA than in CBA (RR: 0.67; 95% CI: 0.45, 1.00). Eighteen studies reported procedural time, which was lower with PFA (SMD –0.57; 95% CI: 0.88, –0.26). However, fluoroscopy time was higher with PFA (SMD: 0.26; 95% CI: 0.06, 0.46) (15 studies). Three studies reported an increase in high-sensitivity troponin, with higher levels after PFA (SMD: 2.05; 95% CI: 0.50, 3.61). A greater decrease in heart rate was observed in the PFA group postprocedure (SMD: –0.97; 95% CI: –1.73, –0.21) (4 studies). The use of PFA is associated with lower AF recurrence rates, shorter procedure durations, and a more significant decrease in heart rate compared to CBA. The fluoroscopy times are higher with PFA, and periprocedural complication rates are similar to those with CBA.

脉冲场消融（PFA）是肺静脉隔离治疗心房颤动的一种非热消融方法。比较PFA和低温球囊消融（CBA）的数据有限。我们检索了PubMed， Cochrane和Embase，以比较PFA和CBA至少有一个感兴趣的结果。采用Cochrane RevMan 5.4进行数据分析。采用随机效应模型中的Mantel-Haenszel方法比较二分类变量，计算风险比和95%置信区间（CI）。采用随机效应模型中的反方差法比较连续变量，计算标准均值差（SMD）和95% CI。21项研究包括5222例患者（2297例：PFA， 2925例：CBA）。13项研究报告AF在空白期3个月后复发，PFA患者的总风险较低（RR 0.81; 95% CI 0.70, 0.92）。16项研究报告PFA的围手术期并发症发生率低于CBA （RR 0.67; 95% CI 0.45, 1.00）。18项研究报告了PFA患者的手术时间（SMD -0.57; 95% CI 0.88, -0.26）。然而，PFA组透视时间更长（SMD 0.26; 95% CI 0.06, 0.46）（15项研究）。三项研究报告了高敏感性肌钙蛋白的增加，PFA后水平更高（SMD 2.05; 95% CI 0.50, 3.61）。PFA组术后心率下降幅度更大（SMD -0.97; 95% CI -1.73, -0.21）（4项研究）。与CBA相比，PFA的使用与AF复发率较低、手术时间较短、心率下降更显著相关。PFA的透视次数较高，术中并发症发生率与CBA相似。

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引用次数: 0

Polymorphic Ventricular Tachycardia as a Manifestation of Unilateral Renal Artery Stenosis 多形性室性心动过速是单侧肾动脉狭窄的表现。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-12-24 DOI: 10.1016/j.amjcard.2025.12.003

Uma Sirisha Pusapati MBBS, Sanjai Pattu Valappil DM (Cardiology) , Bharatraj Banavalikar DM (Cardiology) , Soorya Prakash Sundar Rajan MBBS

Renovascular hypertension (RVH) is an under-recognized but potentially reversible cause of secondary hypertension with significant cardiovascular consequences. Excess aldosterone resulting from renin–angiotensin–aldosterone system activation leads to potassium loss, QT-interval prolongation, and increased susceptibility to malignant ventricular arrhythmias. Hypokalemia combined with hypertension-mediated left-ventricular hypertrophy further increases myocardial electrical instability, predisposing to polymorphic ventricular tachycardia (PVT). We report a woman in her fifties who presented with recurrent syncope secondary to PVT associated with severe hypokalemia. Biochemical evaluation revealed elevated plasma renin activity and aldosterone with a low aldosterone-to-renin ratio. Further evaluation with CT angiography demonstrated critical unilateral atherosclerotic renal artery stenosis. Following percutaneous angioplasty and stent placement, blood pressure and serum potassium normalized, and there were no further arrhythmic episodes. This case highlights a rare but clinically important cardiovascular manifestation of unilateral renal artery stenosis presenting as polymorphic ventricular tachycardia. Recognition of hypokalemia-mediated electrophysiological instability as a reversible cause of life-threatening arrhythmia is essential, as timely revascularization can achieve complete clinical resolution.

肾血管性高血压（RVH）是一种未被充分认识但具有潜在可逆性的继发性高血压，具有显著的心血管后果。肾素-血管紧张素-醛固酮系统激活导致的过量醛固酮可导致钾流失、qt间期延长和对恶性室性心律失常的易感性增加。低钾血症合并高血压介导的左心室肥厚进一步增加心肌电不稳定，易发生多形性室性心动过速（PVT）。我们报告了一位50多岁的女性，她出现了继发于PVT的复发性晕厥，并伴有严重的低钾血症。生化评价显示血浆肾素活性和醛固酮升高，醛固酮与肾素之比较低。进一步的CT血管造影显示单侧肾动脉粥样硬化性狭窄。经皮血管成形术和支架置入术后，血压和血钾恢复正常，没有进一步的心律失常发作。本病例突出了一种罕见但临床上重要的单侧肾动脉狭窄的心血管表现，表现为多形性室性心动过速。认识到低钾血症介导的电生理不稳定是危及生命的心律失常的可逆原因是必要的，因为及时的血运重建可以实现完全的临床解决。

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引用次数: 0

Corrigendum to ‘Clinical Characteristics and Prognosis of Acute Heart Failure in Patients with Chronic Obstructive Pulmonary Disease’ [The American Journal of Cardiology 257(2025) Pages 101-109] “慢性阻塞性肺疾病患者急性心力衰竭的临床特征和预后”的更正[The American Journal of Cardiology 257(2025) page 101-109]。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-12-23 DOI: 10.1016/j.amjcard.2025.12.001

Han Xia PhD, Junlei Li PhD, Jianzeng Dong PhD

引用次数: 0