American Journal of Cardiology最新文献

英文中文

Lipid Management in United States Commercial and Medicare Enrollees With Atherosclerotic Cardiovascular Disease: Treatment Patterns and Low-Density Lipoprotein Cholesterol Control 美国商业和医疗保险登记的动脉粥样硬化性心血管疾病患者的脂质管理：治疗模式和低密度脂蛋白胆固醇控制

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-01-16 DOI: 10.1016/j.amjcard.2024.12.029

Ann Marie Navar MD, PhD , Batul Electricwala PhD , Jasjit K. Multani MPH , Zifan Zhou MS , Chi-Chang Chen PhD, MsPharm , Barnabie C. Agatep MPH , Allison A. Petrilla MPH , Taylor T. Schwartz MPH , Laetitia N'dri PharmD , Joaquim Cristino MSc , Fatima Rodriguez MD, MPH

Lipid-lowering therapy (LLT) is the cornerstone for secondary prevention of atherosclerotic cardiovascular disease (ASCVD); however, many patients exhibit low adherence to therapy and fail to achieve low-density lipoprotein cholesterol (LDL-C) goals. This retrospective cohort study used 2 nationally representative closed administrative claims databases (PharMetrics Plus and Medicare Fee-for-Service Research Identifiable Files) to identify commercial and Medicare enrollees with ASCVD between 2014 and 2019. Patients were stratified by exposure to statin therapy, ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitor monoclonal antibodies (PCSK9i mAb) regimens. Outcomes included LLT adherence (proportion of days covered ≥0.8), persistence, and discontinuation at 12 months. For patients with LDL-C test results, the percentage of patients achieving LDL-C <70 mg/100 ml during follow-up was evaluated. We identified 4.6 million patients with ASCVD (commercial: 945,704; Medicare: 3,659,011), with the majority having ischemic or coronary heart disease. Of these, 66.4% commercial and 71.4% Medicare patients were on at least 1 LLT, including 69.8% commercial and 71.4% Medicare patients on statin therapy, 2.7% commercial and 1.7% Medicare patients on ezetimibe, and 0.2% commercial and 0.04% Medicare patients on a PCSK9i mAb. By 12 months, medication discontinuation was as follows: 30.4% commercial and 34.1% Medicare for statin therapy, 35.5% commercial and 46.1% Medicare for ezetimibe, and 41.5% commercial and 55.8% Medicare for PCSK9i mAb. Approximately half of the treated patients remained adherent after 12 months. Of patients with LDL-C data available (n = 381,160), <20% achieved an LDL-C <70 mg/100 ml. In conclusion, medication discontinuation and low adherence to statin, ezetimibe, and PCSK9i mAb therapies were observed in both populations. Increased efforts are needed to ensure persistence and adherence to LLT in patients with ASCVD to attain LDL-C targets.

降脂治疗（LLT）是动脉粥样硬化性心血管疾病（ASCVD）二级预防的基石，然而许多患者对治疗的依从性较低，未能达到低密度脂蛋白胆固醇（LDL-C）的目标。本回顾性队列研究使用2个具有全国代表性的行政封闭索赔数据库（PharMetrics®Plus和联邦医疗保险按服务收费[FFS]研究可识别文件）来识别2014-2019年期间患有ASCVD的商业(C)和联邦医疗保险(M)入组者。患者通过暴露于他汀类药物、依折麦布和蛋白转化酶枯草杆菌素/ keexin 9型单克隆抗体（PCSK9i mAb）方案进行分层。结果包括LLT依从性（覆盖天数比例[PDC]≥0.8）、持续治疗和12个月停药。对于LDL-C检测结果的患者，达到LDL-C的百分比

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引用次数: 0

Can ChatGPT 4.0 Diagnose Acute Aortic Dissection? Integrating Artificial Intelligence into Medical Diagnostics ChatGPT 4.0能诊断急性主动脉夹层吗？将人工智能整合到医疗诊断中。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-01-16 DOI: 10.1016/j.amjcard.2025.01.010

Aman Goyal MBBS , Muhammad Daoud Tariq MBBS , Areeba Ahsan MBBS , Andrei Brateanu MD

Acute aortic dissection (AD) is a critical condition characterized by high mortality and frequent misdiagnoses, primarily due to symptom overlap with other medical pathologies. This study explores the diagnostic utility of ChatGPT 4.0, an artificial intelligence model developed by OpenAI, in identifying acute AD from patients’ presentations and general physical examination findings documented in published case reports. A systematic search was conducted on the PubMed database using the search term “acute aortic dissection,” applying filters for articles published within the past year and categorized as case reports. The primary symptoms and physical examination details from each case were inputted into ChatGPT 4.0, which was prompted to generate three differential diagnoses and one main provisional diagnosis based on the case presentation. The search yielded a total of 163 results, from which 10 case reports were randomly selected. The patient demographics across all 10 case reports demonstrated an age range of 29 to 82 years, with equal gender distribution (5 males, 5 females) and hypertension as the most prevalent baseline comorbidity. ChatGPT 4.0 accurately identified acute AD as one of the top three differential diagnoses in all selected cases and identified acute AD as the provisional diagnosis in five of the 10 cases. In conclusion, while ChatGPT 4.0 demonstrates potential in suggesting acute AD as a differential diagnosis based on clinical data, its role should be considered supportive rather than definitive. Based on our findings, it could serve as an early, cost-effective, and quick screening tool, helping physicians adopt a “think aorta” approach.

急性主动脉夹层（AD）是一种病死率高、误诊率高的危重疾病，主要是由于其症状与其他医学病理重叠。本研究探讨了ChatGPT 4.0 （OpenAI开发的一种人工智能模型）在从已发表病例报告中记录的患者表现和一般体检结果中识别急性AD方面的诊断效用。在PubMed数据库中使用搜索词“急性主动脉夹层”进行了系统搜索，对过去一年内发表的文章进行了过滤，并将其归类为病例报告。将每个病例的主要症状和体检细节输入到ChatGPT 4.0中，根据病例表现提示生成3个鉴别诊断和1个主要临时诊断。搜索产生了163个结果，从中随机选择了10个病例报告。所有10例病例报告的患者人口统计数据显示年龄范围为29至82岁，性别分布均匀（5男5女），高血压是最普遍的基线合并症。ChatGPT 4.0准确地将急性AD确定为所有入选病例的前三大鉴别诊断之一，并在10例病例中有5例将急性AD确定为临时诊断。综上所述，虽然ChatGPT 4.0显示了基于临床数据的急性AD鉴别诊断的潜力，但其作用应被视为支持性而不是决定性的。根据我们的发现，它可以作为一种早期、经济、快速的筛查工具，帮助医生采用“思考主动脉”的方法。

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引用次数: 0

Evaluating Patients With Chest Pain Using the Recalibrated HEART Score and a Single High Sensitive Cardiac Troponin Measurement 使用重新校准的 HEART 评分和单次高灵敏度心肌肌钙蛋白测量对胸痛患者进行评估。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-01-15 DOI: 10.1016/j.amjcard.2024.09.016

Vernon V.S. Bonarjee MD, PhD

引用次数: 0

Epinephrine for Refractory No-Reflow During Percutaneous Coronary Interventions 肾上腺素用于经皮冠状动脉介入治疗过程中的难治性无血流。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-01-15 DOI: 10.1016/j.amjcard.2024.08.023

Fernando Alfonso MD , Josep Gómez-Lara MD , Fernando Rivero MD

引用次数: 0

Effects of Novel Antidiabetic Agents on Contrast-Associated Acute Kidney Injury in Diabetic Patients Undergoing Percutaneous Coronary Intervention 新型降糖药对经皮冠状动脉介入治疗的糖尿病患者造影剂相关急性肾损伤的影响。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-01-11 DOI: 10.1016/j.amjcard.2025.01.007

Annunziata Nusca MD, PhD , Maria Pia Di Bitonto MD , Agostino Spanò MD , Federico Bernardini MD , Fabio Mangiacapra MD, PhD , Elisabetta Ricottini MD, PhD , Rosetta Melfi MD , Sara Giannone MD , Gian Paolo Ussia MD , Francesco Grigioni MD, PhD

Contrast-associated acute kidney injury (CA-AKI) remains a serious complication after percutaneous coronary revascularization (PCI), with limited effective preventive strategies especially for diabetic patients. This study aimed to assess the effects of novel antidiabetic agents (NAD), i.e., glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium-glucose transporter-2 inhibitors (SGLT2i), and dipeptidyl peptidase-4 inhibitors (DPP4i), on the occurrence of this outcome in diabetic patients undergoing PCI. We enrolled 293 consecutive diabetic patients receiving NAD at the time of PCI (NAD group) and paired them with 293 diabetic individuals undergoing revascularization who were not on NAD (no-NAD group), matched according to age and sex. CA-AKI was defined as an increase in serum creatinine (SCr) ≥0.3 mg/dl or >50% from baseline within 48 to 72 hours after contrast exposure. A propensity score-adjusted logistic regression analysis was performed to account for potential selection bias. NAD treatment was associated with a significantly reduced incidence of CA-AKI than standard glucose-lowering therapies (4.1 vs. 8.5%, p = 0.023). Furthermore, patients using SGLT2i and GLP-1RAs exhibited a lower incidence of CA-AKI compared to those taking DPP4i. Both multivariate and propensity-score-adjusted regression analyses identified NAD therapy as an independent predictor of CA-AKI (OR 0.45, 95% CI 0.22–0.98, p = 0.040 and OR 0.48, 95% CI 0.23–0.98, p = 0.045). In conclusion, this study is the first to explore the potential benefit of all three NAD classes on CA-AKI incidence. The use of these agents is associated with a lower incidence of renal damage in diabetic patients undergoing PCI, with the greatest benefit observed with SGLT2i and GLP-1RAs use.

造影剂相关急性肾损伤（CA-AKI）仍然是经皮冠状动脉血管重建术（PCI）后的一个严重并发症，有效的预防策略有限，特别是对糖尿病患者。本研究旨在评估新型降糖药（NAD），即胰高血糖素样肽-1受体激动剂（GLP-1RAs）、钠-葡萄糖转运蛋白-2抑制剂（SGLT2i）和二肽基肽酶-4抑制剂（DPP4i）对接受PCI的糖尿病患者发生这一结局的影响。我们招募了293例在PCI时连续接受NAD治疗的糖尿病患者（NAD组），并将他们与293例未接受NAD治疗的接受血运重建术的糖尿病患者（非NAD组）进行配对，根据年龄和性别进行匹配。CA-AKI被定义为在造影剂暴露后48-72小时内血清肌酐（SCr）比基线增加≥0.3 mg/dl或>50%。进行倾向评分调整逻辑回归分析，以解释潜在的选择偏差。与标准降糖治疗相比，NAD治疗与CA-AKI发生率显著降低相关（4.1 vs 8.5%, p=0.023）。此外，与服用DPP4i的患者相比，使用SGLT2i和GLP-1RAs的患者表现出更低的CA-AKI发生率。多变量和倾向评分调整回归分析均确定NAD治疗是CA-AKI的独立预测因子（OR 0.45, 95% CI 0.22-0.98, p=0.040; OR 0.48, 95% CI 0.23-0.98, p=0.045）。总之，本研究首次探讨了所有三种NAD类型对CA-AKI发病率的潜在益处。在接受PCI治疗的糖尿病患者中，使用这些药物与较低的肾损害发生率相关，使用SGLT2i和GLP-1RAs的益处最大。

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引用次数: 0

Arrhythmogenic Right Ventricular Cardiomyopathy: The Importance of Biventricular Strain in Risk-Stratification 致心律失常性右室心肌病：双心室应变在危险分层中的重要性。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-01-11 DOI: 10.1016/j.amjcard.2025.01.006

Aileen Paula Chua MD , Dorien Laenens MD , Camille Sarrazyn MD , Maria Pilar Lopez-Santi MD , Takeru Nabeta MD , Rinchyenkhand Myagmardorj MD , Marianne Bootsma MD, PhD , Daniela Q.C.M. Barge-Schaapveld MD, PhD , Jeroen J. Bax MD, PhD , Nina Ajmone Marsan MD, PhD

Despite arrhythmogenic right ventricular cardiomyopathy (ARVC) being predominantly a right ventricular (RV) disease, concomitant left ventricular (LV) involvement has been recognized. ARVC is diagnosed by the RV-centric 2010 Task Force Criteria(TFC) using routine echocardiography, but previous studies have suggested that strain imaging may be more sensitive to detect RV and LV dysfunction. No data however are available regarding the additional value of combining biventricular strain for risk stratification. This study aims to assess the prognostic value of both LV global longitudinal strain (GLS) and RV free wall strain (FWLS) in patients with ARVC. To accomplish this, 204 patients who met the TFC for the ARVC spectrum were included. Patients (age 41 ± 17 years,55% men) were divided into impaired(n = 33), discordant (RV or LV impaired, n = 70), and normal (n = 101) strain groups based on a value of ≥18% for both ventricles. During a follow-up of 87 [24–136] months, 57 (28%) experienced the composite outcome of all-cause mortality, arrhythmic events, implantable cardioverter defibrillator therapy and heart failure events, and a significant difference in event-free survival was observed (p <0.001) between the 3 groups. In the multivariable analysis, the strain groups remained associated with outcomes (p = 0.014) after adjusting for age, sex, history of syncope and definite ARVC diagnosis. A subanalysis including only definite and borderline diagnosed ARVC confirmed that the strain groups were independently predictive of the endpoint (p = 0.023). In conclusion, biventricular involvement by strain analysis may help risk stratification in ARVC patients, with the worst outcomes of patients with both RV and LV impaired strain.

尽管心律失常性右室心肌病（ARVC）主要是一种右室（RV）疾病，但也已认识到伴有左室（LV）受累。ARVC是由以RV为中心的2010年工作组标准（TFC）使用常规超声心动图诊断的，但先前的研究表明，应变成像可能对检测左室和左室功能障碍更敏感。然而，没有关于联合双心室应变对风险分层的附加价值的数据。本研究旨在评估左室总纵向应变（GLS）和左室游离壁应变（FWLS）在ARVC患者中的预后价值。为了实现这一目标，我们纳入了204名符合ARVC谱TFC标准的患者。患者（年龄41±17岁，男性55%）根据双心室≥18%的值分为受损组（n=33）、不协调组（右室或左室受损，n=70）和正常组（n=101）。在87个月的随访中[24-136]，57例（28%）患者经历了全因死亡、心律失常事件、植入式心律转复除颤器治疗和心力衰竭事件的复合结局，观察到无事件生存率的显著差异(p

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引用次数: 0

Impact of Exercise on Atrial Functional Mitral Regurgitation and Its Determinants: An Exercise Echocardiographic Study 运动对心房功能性二尖瓣反流的影响及其影响因素。运动超声心动图研究。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-01-10 DOI: 10.1016/j.amjcard.2024.12.033

Stephanie De Schutter MD , Eline Van Damme MD , Galathea Van Hout MD , Lobke L. Pype MD , Andreas B. Gevaert MD, PhD , Emeline M. Van Craenenbroeck MD, PhD , Marc J. Claeys MD, PhD , Caroline M. Van De Heyning MD, PhD

Atrial functional mitral regurgitation (AFMR) is a distinct form of mitral regurgitation in patients with atrial fibrillation and heart failure with preserved ejection fraction. Its pathophysiology remains elusive, and data on exercise-related AFMR are scarce. We sought to investigate the impact of acute exercise on AFMR severity and to identify its determinants. In total, 47 patients with heart failure with preserved ejection fraction (n = 39) and/or atrial fibrillation (n = 22) were enrolled. We assessed AFMR severity, mitral annular dimensions, left atrial size, AFMR severity, and parameters of systolic and diastolic function at rest and during maximal exercise by echocardiography. An increase in AFMR severity of ≥1 grade was observed in 20 patients (43%) during exercise and was associated with impaired progression of peak mitral annulus systolic velocity and increased systolic mitral annular diameter during exercise, whereas the systolic annular diameter decreased in patients without AFMR progression. Furthermore, patients with ≥ moderate AFMR during exercise (n = 19, 40%) had lower peak mitral annulus systolic velocity, greater systolic mitral annular diameters, reduced tricuspid annular plane systolic excursion, and more severe tricuspid regurgitation than patients with ≤ mild MR during exercise. In conclusion, AFMR is a dynamic condition which may worsen during exercise. Deterioration of AFMR during exercise was associated with impaired longitudinal left ventricular contractile reserve and greater mitral annular dimensions. Because impaired left ventricular longitudinal function may influence mitral annular dynamics, this attributes to the hypothesis that AFMR results from mitral annulus area/leaflet area imbalance caused by annular dilation and impaired mitral annular dynamics.

心房功能性二尖瓣反流（AFMR）是房颤和心力衰竭患者保留射血分数（HFpEF）的一种独特形式的MR。其病理生理学仍然难以捉摸，与运动相关的AFMR数据也很少。我们试图调查急性运动对AFMR严重程度的影响，并确定其决定因素。共有47例HFpEF （n=39）和/或心房颤动（n=22）患者入组。我们通过超声心动图评估AFMR严重程度、二尖瓣环尺寸、左心房大小、AFMR严重程度以及静息和最大运动时的收缩和舒张功能参数。20例患者（43%）在运动期间观察到AFMR≥1级的严重程度增加，并且与运动期间二尖瓣收缩速度峰值（Med S'）的进展受损和收缩二尖瓣环直径增加有关，而没有AFMR进展的患者收缩环直径减小。此外，运动时发生≥中度AFMR的患者(n=19；40%)在运动期间，与≤轻度MR患者相比，Med S'较低，收缩二尖瓣环直径较大，三尖瓣环平面收缩漂移减少，三尖瓣反流更严重。总之，AFMR是一种动态疾病，在运动过程中可能会恶化。运动期间AFMR的恶化与左心室纵向收缩储备受损和二尖瓣环尺寸增大有关。由于左心室纵向功能受损可能影响二尖瓣环动力学，这归因于二尖瓣环扩张和二尖瓣环动力学受损导致的二尖瓣环面积/小叶面积失衡的假设。

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引用次数: 0

Hyperacute Effects of Mitral Transcatheter Edge-to-Edge Repair on Left Ventricular Volumes and Functions 二尖瓣经导管边缘到边缘修复对左心室容量和功能的超急性影响。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-01-10 DOI: 10.1016/j.amjcard.2024.12.038

Mohammad Kassar MD , Ana Ovsenik MD , Raouf Madhkour MD , Noé Corpataux MD , Athanasios Papadis MD , George Siontis MD, PhD , Lukas Hunziker MD , Stephan Windecker MD , Fabien Praz MD , Nicolas Brugger MD

Transcatheter edge-to-edge repair (TEER) is an effective intervention for high-risk patients with severe symptomatic mitral regurgitation (MR); however, its acute impact on left ventricular (LV) function has not been well-studied using advanced echocardiographic techniques. This study investigated the immediate effects of TEER on LV volumes and functions and their influence on midterm outcomes, using high-resolution 3-dimensional transesophageal echocardiography. In 80 patients who underwent TEER for severe MR (mean age 79 ± 8 years, 49% with primary MR), LV end-diastolic volume and stroke volume significantly decreased (161 ± 61 to 147 ± 54 ml and 69 ± 18 to 50 ± 15 ml, respectively), whereas end-systolic volume increased (92 ± 60 to 97 ± 45 ml, p <0.0001 for all). Left ventricular ejection fraction (LVEF) (48 ± 16% to 38 ± 14%), global longitudinal strain (16.2 ± 6.8% to 12.8 ± 5.4%), and global circumferential strain (25 ± 10.5% to 18.7 ± 8.5%) deteriorated significantly (p <0.0001 for all). Absolute reductions in LVEF and global circumferential strain were associated with baseline values and afterload reduction, indicated by 3-dimensional vena contracta area decrease (r = 0.47 and r = 0.65, p <0.0001), whereas global longitudinal strain reduction was linked to baseline values and inversely proportional to LV end-diastolic volume (r = 0.63, p <0.0001). Relative LVEF reduction emerged as the strongest predictor of mortality, with a hazard ratio of 1.76 (1.12 to 2.76) per 10% decrease. In conclusion, the acute decrease in LV function after TEER correlates with the degree of MR reduction, with greater impacts observed in circumferential function and patients with higher baseline LVEF. Relative LVEF reduction is a critical echocardiographic predictor of mortality.

经导管边缘到边缘修复（TEER）是治疗严重症状性二尖瓣反流（MR）高危患者的有效干预措施，但其对左心室（LV）功能的急性影响尚未通过先进的超声心动图技术得到很好的研究。本研究利用高分辨率3D经食管超声心动图研究TEER对左室容积和功能的直接影响，以及它们对中期预后的影响。80例重度MR患者（平均年龄79±8岁，原发性MR 49%）行TEER，左室舒张末期容积（LVEDV）和卒中容积显著降低（分别为161±61 ~ 147±54 ml和69±18 ~ 50±15 ml），而收缩末期容积增加(92±60 ~ 97±45 ml；p

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引用次数: 0

Delayed Aortic Dissection After Transcatheter Aortic Valve Replacement for Stenotic Bicuspid Valve 狭窄二尖瓣TAVR术后延迟主动脉夹层。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-01-08 DOI: 10.1016/j.amjcard.2025.01.001

Charles S. Roberts MD , Murad H. Hassan BS , Kyle A. McCullough MD , John B. Eisenga MD

引用次数: 0

Intravascular Ultrasound for Lower Extremity Arterial Interventions: What was Once Peripheral is Now Mainstream. 下肢动脉介入的血管内超声：曾经是次要的，现在是主流。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-01-07 DOI: 10.1016/j.amjcard.2025.01.005

Ramya C Mosarla, Eric A Secemsky

引用次数: 0

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