Real-life data comparing the long-term outcome in patients with different heart diseases carrying an implantable cardioverter defibrillator (ICD) are scarce. This study aimed to compare the long-term risk of the first appropriate ICD intervention and overall survival in patients with ICD and heart disease of different etiologies. Patients with an ICD implanted between January 1, 2010, and December 31, 2022, followed in our center were included. Study outcomes were all-cause mortality and first appropriate ICD intervention. A comparison between ischemic heart disease (IHD) and non-IHD (NIHD) was performed. In NIHD different etiologies of dilated cardiomyopathy (DCM) were analyzed. Overall, 1184 patients (592 IDH; 592 NIHD) were included. During a median follow-up of 53 months all-cause death occurred in 399 patients (34%) whereas first appropriate ICD intervention occurred in 320 (27%). All-cause mortality was significantly higher in IHD vs NIHD patients (60% vs 43%; p <0.0001) but no differences in appropriate ICD intervention rate at 10 years (34% vs 40%; p = 0.125) were observed. In patients with NIHD, a higher 10-year mortality rate was found in valvular heart disease, post-radio/chemotherapy DCM (rctDCM), and hypertensive DCM. Hypertrophic cardiomyopathy, alcoholic DCM, and rctDCM were the least arrhythmic phenotypes in NIHD. Of note, inappropriate interventions in alcoholic DCM and rctDCM were higher than appropriate ones. In conclusion, the rate of ICD-appropriate interventions and mortality is different according to the etiology of heart disease and cardiovascular risk profile; this should be taken into consideration in the prognostic stratification of these patients at the time of implantation.
{"title":"Long-Term Outcomes in ICD: All-Causes Mortality and First Appropriate Intervention in Ischemic and Nonischemic Etiologies","authors":"Marco Cittar MD , Massimo Zecchin MD , Marco Merlo MD , Francesca Piccinin MD , Chiara Baggio MD , Luca Salvatore MD , Fulvia Longaro MD , Cosimo Carriere MD , Anna Fantasia Zorzin MD , Monica Saitta MD , Linda Pagura MD , Giulia Barbati PhD , Gerardina Lardieri MD , Gianfranco Sinagra MD","doi":"10.1016/j.amjcard.2024.09.026","DOIUrl":"10.1016/j.amjcard.2024.09.026","url":null,"abstract":"<div><div>Real-life data comparing the long-term outcome in patients with different heart diseases carrying an implantable cardioverter defibrillator (ICD) are scarce. This study aimed to compare the long-term risk of the first appropriate ICD intervention and overall survival in patients with ICD and heart disease of different etiologies. Patients with an ICD implanted between January 1, 2010, and December 31, 2022, followed in our center were included. Study outcomes were all-cause mortality and first appropriate ICD intervention. A comparison between ischemic heart disease (IHD) and non-IHD (NIHD) was performed. In NIHD different etiologies of dilated cardiomyopathy (DCM) were analyzed. Overall, 1184 patients (592 IDH; 592 NIHD) were included. During a median follow-up of 53 months all-cause death occurred in 399 patients (34%) whereas first appropriate ICD intervention occurred in 320 (27%). All-cause mortality was significantly higher in IHD vs NIHD patients (60% vs 43%; p <0.0001) but no differences in appropriate ICD intervention rate at 10 years (34% vs 40%; p = 0.125) were observed. In patients with NIHD, a higher 10-year mortality rate was found in valvular heart disease, post-radio/chemotherapy DCM (rctDCM), and hypertensive DCM. Hypertrophic cardiomyopathy, alcoholic DCM, and rctDCM were the least arrhythmic phenotypes in NIHD. Of note, inappropriate interventions in alcoholic DCM and rctDCM were higher than appropriate ones. In conclusion, the rate of ICD-appropriate interventions and mortality is different according to the etiology of heart disease and cardiovascular risk profile; this should be taken into consideration in the prognostic stratification of these patients at the time of implantation.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379940","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}
The relations between degrees of chronic kidney disease (CKD) and congestive heart failure (CHF) events after percutaneous coronary intervention (PCI) are not well characterized. We sought to determine the relation between different stages of CKD and acute CHF events, including HF and cardiogenic shock (CS), and the impact of CKD stages on all-cause mortality after PCI. Patients who underwent PCI from 2009 to 2017 were identified from our institution's National Cardiovascular Disease Registry CathPCI Database. Patients were stratified by CKD stage 1 (estimated glomerular filtration rate [eGFR] ≥90 ml/min/1.73 m2), 2 (60 to 89), 3a (45 to 59), 3b (30 to 44), 4 (16 to 29), 5 (≤15), and current dialysis. The primary end point was composite HF events defined as acute HF or CS within 30 days after PCI, or in-hospital mortality, stratified by CKD and analyzed by multivariable regression after screening with univariate analysis (p <0.05 entry criteria). Patients with CKD stage 3a or worse had more composite HF events, with an increase in all components, compared with patients with CKD stages 1 to 2 (p <0.0001 for all comparisons). After multivariable adjustment, CKD stages 3a to 5 remained independent predictors of composite HF or in-hospital mortality events. eGFR remained a strong predictor of acute HF events after multivariable adjustment, with a model including eGFR and baseline and procedural characteristics achieving excellent discriminatory ability with area under the curve 0.92. In conclusion, baseline eGFR is a strong, independent predictor of acute HF events after PCI. CKD stages 3a to 5 independently predict HF events including HF decompensation and CS and are predictors of in-hospital mortality after PCI. Patients with baseline CKD may benefit from targeted interventions to limit acute HF events after PCI.
{"title":"Chronic Kidney Disease Predisposes to Acute Congestive Heart Failure, Cardiogenic Shock, and Mortality in Patients Undergoing Percutaneous Coronary Intervention","authors":"Meghana Iyer BS , Khaled Ziada MD , Leslie Cho MD , Jacqueline Tamis-Holland MD , Umesh Khot MD , Amar Krishnaswamy MD , Rishi Puri MD, PhD , Samir Kapadia MD , Grant W. Reed MD, MSc","doi":"10.1016/j.amjcard.2024.09.025","DOIUrl":"10.1016/j.amjcard.2024.09.025","url":null,"abstract":"<div><div>The relations between degrees of chronic kidney disease (CKD) and congestive heart failure (CHF) events after percutaneous coronary intervention (PCI) are not well characterized. We sought to determine the relation between different stages of CKD and acute CHF events, including HF and cardiogenic shock (CS), and the impact of CKD stages on all-cause mortality after PCI. Patients who underwent PCI from 2009 to 2017 were identified from our institution's National Cardiovascular Disease Registry CathPCI Database. Patients were stratified by CKD stage 1 (estimated glomerular filtration rate [eGFR] ≥90 ml/min/1.73 m<sup>2</sup>), 2 (60 to 89), 3a (45 to 59), 3b (30 to 44), 4 (16 to 29), 5 (≤15), and current dialysis. The primary end point was composite HF events defined as acute HF or CS within 30 days after PCI, or in-hospital mortality, stratified by CKD and analyzed by multivariable regression after screening with univariate analysis (p <0.05 entry criteria). Patients with CKD stage 3a or worse had more composite HF events, with an increase in all components, compared with patients with CKD stages 1 to 2 (p <0.0001 for all comparisons). After multivariable adjustment, CKD stages 3a to 5 remained independent predictors of composite HF or in-hospital mortality events. eGFR remained a strong predictor of acute HF events after multivariable adjustment, with a model including eGFR and baseline and procedural characteristics achieving excellent discriminatory ability with area under the curve 0.92. In conclusion, baseline eGFR is a strong, independent predictor of acute HF events after PCI. CKD stages 3a to 5 independently predict HF events including HF decompensation and CS and are predictors of in-hospital mortality after PCI. Patients with baseline CKD may benefit from targeted interventions to limit acute HF events after PCI.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379939","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 : 2024-10-05DOI: 10.1016/j.amjcard.2024.09.028
Ishaque Hameed MD , Khushboo Nusrat MD , Adeena Jamil , Kaneez Fatima MD , Abdul Mannan Khan Minhas MD , Stephen J. Greene MD , Andrew J. Sauer MD , Javed Butler MD, MPH , Muhammad Shahzeb Khan MD, MSc
{"title":"Demographic and Regional Trends of Cardiovascular Disease and Obesity-Related Mortality in the United States From 1999 to 2021","authors":"Ishaque Hameed MD , Khushboo Nusrat MD , Adeena Jamil , Kaneez Fatima MD , Abdul Mannan Khan Minhas MD , Stephen J. Greene MD , Andrew J. Sauer MD , Javed Butler MD, MPH , Muhammad Shahzeb Khan MD, MSc","doi":"10.1016/j.amjcard.2024.09.028","DOIUrl":"10.1016/j.amjcard.2024.09.028","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387329","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 : 2024-10-01DOI: 10.1016/j.amjcard.2024.09.020
Charles S. Roberts MD , Kyle A. McCullough MD
{"title":"Pros and Cons of Classification Systems in Aortic Dissection","authors":"Charles S. Roberts MD , Kyle A. McCullough MD","doi":"10.1016/j.amjcard.2024.09.020","DOIUrl":"10.1016/j.amjcard.2024.09.020","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364003","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 : 2024-09-30DOI: 10.1016/j.amjcard.2024.09.027
Gulmira Kudaiberdieva
{"title":"Regression and Worsening of Tricuspid Regurgitation Following Transvenous Cardiac Implantable Electronic Device Implantation.","authors":"Gulmira Kudaiberdieva","doi":"10.1016/j.amjcard.2024.09.027","DOIUrl":"10.1016/j.amjcard.2024.09.027","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364004","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 : 2024-09-30DOI: 10.1016/j.amjcard.2024.09.022
Andrea Raffaele Munafò MD , Marco Ferlini MD , Ferdinando Varbella MD , Fabrizio Delnevo MD , Martina Solli MD , Daniela Trabattoni MD , Luca Raone MD , Antonio Cardile MD , Paolo Canova MD , Roberta Rossini MD , Dario Celentani MD , Ludovica Maltese MD , Vittorio Taglialatela MD , Simona Pierini MD , Andrea Rognoni MD , Fabrizio Oliva MD , Italo Porto MD , Stefano Carugo MD , Battistina Castiglioni MD , Corrado Lettieri MD , Giuseppe Musumeci MD
In patients with recent acute coronary syndromes (ACS), current guidelines recommend a low-density lipoprotein cholesterol (LDL-C) level <55 mg/100 ml. Despite the widespread use of different potent lipid-lowering therapies (LLT), this goal is not always achieved, often owing to less medication adherence. In this prespecified subanalysis of the JET-Low Density Lipoprotein (JET-LDL) registry, we sought to evaluate the relation between LDL-C targets achievement and LLT adherence in a cohort of patients hospitalized for ACS. The patients’ self-reported medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS) at 3-month follow-up. Depending on the score obtained, the population was divided into 2 groups: high adherence (HA, MMAS ≥6) versus low adherence (LA, MMAS <6). The occurrence of the primary end point (LDL-C reduction >50% from baseline or level <55 mg/100 ml at 1 month) was compared in the 2 groups. A total of 963 patients were included in the present analysis; in 277 cases (28.7%), an MMAS score <6 was reported (LA group), whereas in the remaining 686 (71.3%), the score obtained was ≥6 (HA group). No difference between the 2 groups was observed regarding LDL-C levels at admission and LLT prescribed at discharge. At 1 month, the primary end point occurred in 62.5% of cases, with a statistically significant difference between the 2 groups (LA 60% vs HA 65%, p = 0.034). At multivariate logistic regression analysis, LA was identified as an independent predictor of not achieving the primary end point (odds ratio 0.48, 0.39 to 0.85, p = 0.006). In conclusion, in a real-world cohort of patients with ACS, less medication adherence to LLT was a common event (28.7%), negatively affecting LDL-C goal achievement.
{"title":"Low-Density Lipoprotein Cholesterol Goal Achievement and Self-Reported Medication Adherence: Insights from the JET-LDL Registry","authors":"Andrea Raffaele Munafò MD , Marco Ferlini MD , Ferdinando Varbella MD , Fabrizio Delnevo MD , Martina Solli MD , Daniela Trabattoni MD , Luca Raone MD , Antonio Cardile MD , Paolo Canova MD , Roberta Rossini MD , Dario Celentani MD , Ludovica Maltese MD , Vittorio Taglialatela MD , Simona Pierini MD , Andrea Rognoni MD , Fabrizio Oliva MD , Italo Porto MD , Stefano Carugo MD , Battistina Castiglioni MD , Corrado Lettieri MD , Giuseppe Musumeci MD","doi":"10.1016/j.amjcard.2024.09.022","DOIUrl":"10.1016/j.amjcard.2024.09.022","url":null,"abstract":"<div><div>In patients with recent acute coronary syndromes (ACS), current guidelines recommend a low-density lipoprotein cholesterol (LDL-C) level <55 mg/100 ml. Despite the widespread use of different potent lipid-lowering therapies (LLT), this goal is not always achieved, often owing to less medication adherence. In this prespecified subanalysis of the JET-Low Density Lipoprotein (JET-LDL) registry, we sought to evaluate the relation between LDL-C targets achievement and LLT adherence in a cohort of patients hospitalized for ACS. The patients’ self-reported medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS) at 3-month follow-up. Depending on the score obtained, the population was divided into 2 groups: high adherence (HA, MMAS ≥6) versus low adherence (LA, MMAS <6). The occurrence of the primary end point (LDL-C reduction >50% from baseline or level <55 mg/100 ml at 1 month) was compared in the 2 groups. A total of 963 patients were included in the present analysis; in 277 cases (28.7%), an MMAS score <6 was reported (LA group), whereas in the remaining 686 (71.3%), the score obtained was ≥6 (HA group). No difference between the 2 groups was observed regarding LDL-C levels at admission and LLT prescribed at discharge. At 1 month, the primary end point occurred in 62.5% of cases, with a statistically significant difference between the 2 groups (LA 60% vs HA 65%, p = 0.034). At multivariate logistic regression analysis, LA was identified as an independent predictor of not achieving the primary end point (odds ratio 0.48, 0.39 to 0.85, p = 0.006). In conclusion, in a real-world cohort of patients with ACS, less medication adherence to LLT was a common event (28.7%), negatively affecting LDL-C goal achievement.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364002","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}
Hypertension has been associated with worse outcomes in patients with familial hypercholesterolemia (FH). We aimed to identify the clinical impact of blood pressure management on the development of cardiovascular events. We assessed patients with clinically diagnosed heterozygous FH (n = 1,273, male/female = 614/659) with blood pressure data. We categorized them into 4 groups (group 1: patients without hypertension from baseline to follow-up; group 2: patients without hypertension at baseline but in whom hypertension developed at follow-up; group 3: patients with hypertension at baseline that was well-controlled at follow-up; group 4: patients with hypertension from baseline that was uncontrolled at follow-up). We used Cox proportional hazards models to evaluate factors associated with cardiovascular events, including cardiovascular death and any coronary events. The median follow-up period was 10.9 years. We observed 142 cardiovascular events during the follow-up period and revealed that blood pressure management was significantly associated with cardiovascular event occurrence (hazard ratio [HR] 2.50, 95% confidence interval [CI] 1.30 to 3.70, p <0.001; HR 4.18, 95% CI 2.08 to 6.28, p <0.001; HR 10.96, 95% CI 6.10 to 17.58, p <0.001 in groups 2, 3, and 4, respectively, with group 1 as reference). In conclusion, blood pressure management is crucial in patients with heterozygous FH.
{"title":"Impact of Blood Pressure Management on Cardiovascular Events in Patients With Familial Hypercholesterolemia","authors":"Hayato Tada MD , Nobuko Kojima MD , Yasuaki Takeji MD , Atsushi Nohara MD , Masa-Aki Kawashiri MD , Masayuki Takamura MD","doi":"10.1016/j.amjcard.2024.09.021","DOIUrl":"10.1016/j.amjcard.2024.09.021","url":null,"abstract":"<div><div>Hypertension has been associated with worse outcomes in patients with familial hypercholesterolemia (FH). We aimed to identify the clinical impact of blood pressure management on the development of cardiovascular events. We assessed patients with clinically diagnosed heterozygous FH (n = 1,273, male/female = 614/659) with blood pressure data. We categorized them into 4 groups (group 1: patients without hypertension from baseline to follow-up; group 2: patients without hypertension at baseline but in whom hypertension developed at follow-up; group 3: patients with hypertension at baseline that was well-controlled at follow-up; group 4: patients with hypertension from baseline that was uncontrolled at follow-up). We used Cox proportional hazards models to evaluate factors associated with cardiovascular events, including cardiovascular death and any coronary events. The median follow-up period was 10.9 years. We observed 142 cardiovascular events during the follow-up period and revealed that blood pressure management was significantly associated with cardiovascular event occurrence (hazard ratio [HR] 2.50, 95% confidence interval [CI] 1.30 to 3.70, p <0.001; HR 4.18, 95% CI 2.08 to 6.28, p <0.001; HR 10.96, 95% CI 6.10 to 17.58, p <0.001 in groups 2, 3, and 4, respectively, with group 1 as reference). In conclusion, blood pressure management is crucial in patients with heterozygous FH.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339448","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 : 2024-09-27DOI: 10.1016/j.amjcard.2024.09.023
Charles S Roberts, Kyle A McCullough
{"title":"Intrapericardial (A) Versus Strictly Extrapericardial (B) Involvement in Aortic Dissection: A Practical Distinction.","authors":"Charles S Roberts, Kyle A McCullough","doi":"10.1016/j.amjcard.2024.09.023","DOIUrl":"10.1016/j.amjcard.2024.09.023","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339449","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 : 2024-09-26DOI: 10.1016/j.amjcard.2024.09.024
Eduard Ródenas-Alesina MD , Jordi Lozano-Torres MD , Pablo Eduardo Tobías-Castillo MD , Clara Badia-Molins MD , Maria Calvo-Barceló MD , Rosa Vila-Olives MD , Guillem Casas-Masnou MD , Aleix Olivella San Emeterio MD , Toni Soriano-Colomé MD , Rubén Fernández-Galera MD , Ana B. Méndez-Fernández MD, PhD , José A. Barrabés MD, PhD , José Rodríguez-Palomares MD, PhD , Ignacio Ferreira-González MD, PhD
Nonischemic dilated cardiomyopathy (NIDCM) is associated with an increased risk of atrial fibrillation (AF) and stroke, especially in patients with high CHA2DS2-VASc. We aimed to identify variables associated with incident AF or stroke using left atrial deformation analysis and its prognostic value added to CHA2DS2-VASc score. Patients with NIDCM and left ventricular ejection fraction <50% in sinus rhythm were included between January 2015 and December 2019. Left atrial volume index (LAVI) and atrial strain were used in combination with the CHA2DS2-VAS score to predict ischemic stroke or incident AF. Proportional hazards Cox regression was used to provide hazard ratios (HRs). There were 338 patients included. After a median follow-up of 3.6 years, the end point occurred in 41 patients (12.1%). LAVI outperformed other echocardiographic parameters, with a significant improvement in risk reclassification compared with CHA2DS2-VASc alone (net reclassification index 0.6, increase in Harrell's C from 0.63 to 0.73, p = 0.003), and remained significant after multivariate adjustment. LAVI was associated with both components of the end point separately. The best cutoff for LAVI was 44 ml/m2. LAVI ≥44 ml/m2 increased the risk of the end point among those with CHA2DS2-VASc ≥3 (HR 6.0, 95% confidence interval 2.6 to 13.5) but not in those with CHA2DS2-VASc <3 (HR 1.2, 95% confidence interval 0.3 to 4.5). Competing risk analysis did not alter the results. In conclusion, LAVI might be used to assess the risk of incident AF or stroke in NIDCM. Patients with LAVI ≥44 ml/m2 and CHA2DS2-VASc ≥3 could be at high risk of AF and stroke and may benefit from more intensive surveillance.
{"title":"Risk of Stroke and Incident Atrial Fibrillation in Patients in Sinus Rhythm With Nonischemic Dilated Cardiomyopathy","authors":"Eduard Ródenas-Alesina MD , Jordi Lozano-Torres MD , Pablo Eduardo Tobías-Castillo MD , Clara Badia-Molins MD , Maria Calvo-Barceló MD , Rosa Vila-Olives MD , Guillem Casas-Masnou MD , Aleix Olivella San Emeterio MD , Toni Soriano-Colomé MD , Rubén Fernández-Galera MD , Ana B. Méndez-Fernández MD, PhD , José A. Barrabés MD, PhD , José Rodríguez-Palomares MD, PhD , Ignacio Ferreira-González MD, PhD","doi":"10.1016/j.amjcard.2024.09.024","DOIUrl":"10.1016/j.amjcard.2024.09.024","url":null,"abstract":"<div><div>Nonischemic dilated cardiomyopathy (NIDCM) is associated with an increased risk of atrial fibrillation (AF) and stroke, especially in patients with high CHA<sub>2</sub>DS<sub>2</sub>-VASc. We aimed to identify variables associated with incident AF or stroke using left atrial deformation analysis and its prognostic value added to CHA<sub>2</sub>DS<sub>2</sub>-VASc score. Patients with NIDCM and left ventricular ejection fraction <50% in sinus rhythm were included between January 2015 and December 2019. Left atrial volume index (LAVI) and atrial strain were used in combination with the CHA<sub>2</sub>DS<sub>2</sub>-VAS score to predict ischemic stroke or incident AF. Proportional hazards Cox regression was used to provide hazard ratios (HRs). There were 338 patients included. After a median follow-up of 3.6 years, the end point occurred in 41 patients (12.1%). LAVI outperformed other echocardiographic parameters, with a significant improvement in risk reclassification compared with CHA<sub>2</sub>DS<sub>2</sub>-VASc alone (net reclassification index 0.6, increase in Harrell's C from 0.63 to 0.73, p = 0.003), and remained significant after multivariate adjustment. LAVI was associated with both components of the end point separately. The best cutoff for LAVI was 44 ml/m<sup>2</sup>. LAVI ≥44 ml/m<sup>2</sup> increased the risk of the end point among those with CHA<sub>2</sub>DS<sub>2</sub>-VASc ≥3 (HR 6.0, 95% confidence interval 2.6 to 13.5) but not in those with CHA<sub>2</sub>DS<sub>2</sub>-VASc <3 (HR 1.2, 95% confidence interval 0.3 to 4.5). Competing risk analysis did not alter the results. In conclusion, LAVI might be used to assess the risk of incident AF or stroke in NIDCM. Patients with LAVI ≥44 ml/m<sup>2</sup> and CHA<sub>2</sub>DS<sub>2</sub>-VASc ≥3 could be at high risk of AF and stroke and may benefit from more intensive surveillance.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339451","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 : 2024-09-25DOI: 10.1016/j.amjcard.2024.09.019
Talhat Azemi MD , Fahad Ahmed MD , Immad Sadiq MD , William Lane Duvall MD , Sean McMahon MD , Jeff F. Mather BSc , Sabet W. Hashim MD , Raymond G. McKay MD
There are limited reports on the impact of prosthesis-patient mismatch (PPM) on the regression of left ventricular hypertrophy (LVH) after transcatheter aortic valve replacement (TAVR). We compared the relative effects of supra-annular, self-expanding (SE) versus intra-annular, balloon-expandable (BE) prostheses on TAVR LVH regression. Regression of left ventricular mass index (LVMi) was evaluated in 168 consecutive TAVR patients, including 60 treated with SE valves (Evolut series) and 108 treated with BE valves (Sapien 3). All patients had LVH determined at baseline by echocardiography and had repeat LVMi measurements at a mean follow-up time of 707 ± 528 days. SE patients were more likely female (68.3% vs 46.3%, p = 0.007), but otherwise, the 2 cohorts did not differ with respect to baseline demographics and Society of Thoracic Surgeons risk score. SE patients had a higher effective orifice area indexed to body surface area after TAVR (0.98 ± 0.29 vs 0.86 ± 0.25 cm²/m², p = 0.006), with lower mean aortic valve gradients (9.9 ± 6.5 vs 12.8 ± 5.8 mm Hg, p = 0.003) and a lower prevalence of moderate/severe PPM (33.3% vs 49.1%, p = 0.049). On follow-up, changes in LVMi were similar between the SE and BE groups, with similar absolute changes in LVMi (19.2 ± 26.8 vs 21.9 ± 31.7 g/m2, p = 0.578) and relative LVMi decrease (14.0 ± 19.5 vs 16.2% ± 24.2%, p = 0.547). No difference in LVMi regression was also noted comparing combined SE/BE patients with moderate/severe PPM versus those without PPM. In conclusion, despite differences in effective orifice area indexed to body surface area, mean aortic valve gradient, and PPM after TAVR, the degree of LVH regression during intermediate follow-up did not differ between patients receiving supra-annular SE and intra-annular BE prostheses.
关于假体与患者不匹配（PPM）对经导管主动脉瓣置换术（TAVR）后左室肥厚（LVH）消退的影响，目前报道有限。我们比较了环上自扩张（SE）和环内球囊扩张（BE）假体对 TAVR LVH 消退的相对影响。我们对 168 名连续 TAVR 患者的左心室质量指数（LVMi）回归情况进行了评估，其中包括 60 名接受 SE 瓣膜（Evolut 系列）治疗的患者和 108 名接受 BE 瓣膜（Sapien 3）治疗的患者。所有患者均在基线时通过超声心动图确定了 LVH，并在平均 707±528 天的随访时间内重复测量了 LVMi。SE患者更多是女性（68.3% vs 46.3%，P=0.007），除此之外，两组患者在基线人口统计学和STS风险评分方面没有差异。SE患者在TAVR术后的有效孔面积与体表面积指数（EOAi）更高（0.98±0.29 vs 0.86±0.25 cm²/m²，p=0.006），平均主动脉瓣梯度更低（9.9±6.5 vs 12.8±5.8 mmHg，p=0.003），中度/重度PPM患病率更低（33.3 vs 49.1%，p=0.049）。随访期间，SE 组和 BE 组的 LVMi 变化相似，LVMi 的绝对变化（19.2±26.8 vs. 21.9±31.7g/m2，p=0.578）和相对 LVMi 下降（14.0±19.5 vs. 16.2±24.2%，p=0.547）相似。中度/重度 PPM 的 SE/BE 合并患者与无 PPM 的患者相比，LVMi 回归也无差异。总之，尽管TAVR术后EOAi、平均主动脉瓣梯度和假体-患者不匹配存在差异，但接受环上SE和环内BE假体的患者在中期随访期间的LVH消退程度没有差异。
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