Pub Date : 2025-11-26DOI: 10.1016/j.amjcard.2025.11.006
Lauryn E Spinetta, Christopher A Heid
{"title":"One Ring to Rule Them All: A Commentary on \"Impacts of Mitral Annular Calcification on Heart Failure With Preserved Ejection Fraction\".","authors":"Lauryn E Spinetta, Christopher A Heid","doi":"10.1016/j.amjcard.2025.11.006","DOIUrl":"10.1016/j.amjcard.2025.11.006","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1016/j.amjcard.2025.11.005
Ashish H. Shah MD MD-Research , Ole De Backer MD PhD
Bicuspid and unicuspid aortic valves represent the most common congenital aortic valve malformations and pose unique challenges in clinical management across the lifespan. These anomalies are associated with progressive valvular dysfunction and aortopathy, often necessitating early intervention. Multiple publications have described life-long management of aortic stenosis (AS), affecting tricuspid valve. This review outlines the embryologic basis, natural history, and clinical spectrum of uni- and bicuspid aortic valve, highlighting diagnostic strategies, surveillance protocols, and surgical – transcatheter interventions. Emphasis is placed on longitudinal care, including transition from pediatric to adult congenital cardiology, multimodality imaging, and timing of surgical or transcatheter interventions. In conclusion, the article aims to provide a framework for evidence-informed, individualized management of these complex valvulo-aortic disorders.
{"title":"Bicuspid and Unicuspid Aortic Valves: Development, Genetics, and Lifelong Management","authors":"Ashish H. Shah MD MD-Research , Ole De Backer MD PhD","doi":"10.1016/j.amjcard.2025.11.005","DOIUrl":"10.1016/j.amjcard.2025.11.005","url":null,"abstract":"<div><div>Bicuspid and unicuspid aortic valves represent the most common congenital aortic valve malformations and pose unique challenges in clinical management across the lifespan. These anomalies are associated with progressive valvular dysfunction and aortopathy, often necessitating early intervention. Multiple publications have described life-long management of aortic stenosis (AS), affecting tricuspid valve. This review outlines the embryologic basis, natural history, and clinical spectrum of uni- and bicuspid aortic valve, highlighting diagnostic strategies, surveillance protocols, and surgical – transcatheter interventions. Emphasis is placed on longitudinal care, including transition from pediatric to adult congenital cardiology, multimodality imaging, and timing of surgical or transcatheter interventions. In conclusion, the article aims to provide a framework for evidence-informed, individualized management of these complex valvulo-aortic disorders.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"260 ","pages":"Pages 26-35"},"PeriodicalIF":2.1,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1016/j.amjcard.2025.11.013
Ashwin Siby MS , Mehrtash Hashemzadeh MS , Mohammad Reza Movahed MD, PhD,
Mortality in male patients with Takotsubo cardiomyopathy appears to be double that of Women. The goal of this study was to determine whether a higher mortality rate is associated with a higher complication rate in male adults. Using ICD-10 codes for Takotsubo cardiomyopathy, we evaluated differences in the occurrence of complications between Men and women. A total of 199,890 patients were diagnosed with Takotsubo cardiomyopathy, comprising 34,770 male and 195,120 female patients. All major complications are significantly higher in men than in women, despite multivariate adjustment for age and cardiovascular risk factors. Cardiogenic Shock: 9.88% versus 5.98% p <0.001, OR 1.57, 95% confidence interval (CI) 1.43 to 1.73, Atrial Fibrillation: 23.96% versus 20.12%, p <0.001, OR 1.55, 95% CI 1.45 to 1.66, Cardiac Arrest: 5.71% versus 2.94%, p <0.001, OR 1.71, 95% CI 1.51 to 1.94, Congestive Heart Failure: 39.52% versus 35.18% p <0.001, OR 1.23, 95% CI 1.16 to 1.30, Stroke: 7.45% versus 4.94%, p <0.001, OR 1.51, 95% CI 1.36 to 1.68. In conclusion, all major cardiovascular complications are higher in men compared to women with a diagnosis of Takotsubo cardiomyopathy, as a plausible explanation for the higher mortality in men.
男性Takotsubo心肌病患者的死亡率似乎是女性的两倍。本研究的目的是确定男性成人较高的死亡率是否与较高的并发症发生率相关。使用Takotsubo心肌病的ICD-10编码，我们评估了男性和女性之间并发症发生的差异。共有199,890名患者被诊断为Takotsubo心肌病，其中包括34,770名男性和195,120名女性患者。尽管对年龄和心血管危险因素进行了多变量调整，但男性的所有主要并发症明显高于女性。心源性休克：9.88% vs 5.98% p
{"title":"Higher Mortality in Male Patients with Takotsubo Cardiomyopathy Appears to Be Related to Higher Complication Rates","authors":"Ashwin Siby MS , Mehrtash Hashemzadeh MS , Mohammad Reza Movahed MD, PhD,","doi":"10.1016/j.amjcard.2025.11.013","DOIUrl":"10.1016/j.amjcard.2025.11.013","url":null,"abstract":"<div><div>Mortality in male patients with Takotsubo cardiomyopathy appears to be double that of Women. The goal of this study was to determine whether a higher mortality rate is associated with a higher complication rate in male adults. Using ICD-10 codes for Takotsubo cardiomyopathy, we evaluated differences in the occurrence of complications between Men and women. A total of 199,890 patients were diagnosed with Takotsubo cardiomyopathy, comprising 34,770 male and 195,120 female patients. All major complications are significantly higher in men than in women, despite multivariate adjustment for age and cardiovascular risk factors. Cardiogenic Shock: 9.88% versus 5.98% p <0.001, OR 1.57, 95% confidence interval (CI) 1.43 to 1.73, Atrial Fibrillation: 23.96% versus 20.12%, p <0.001, OR 1.55, 95% CI 1.45 to 1.66, Cardiac Arrest: 5.71% versus 2.94%, p <0.001, OR 1.71, 95% CI 1.51 to 1.94, Congestive Heart Failure: 39.52% versus 35.18% p <0.001, OR 1.23, 95% CI 1.16 to 1.30, Stroke: 7.45% versus 4.94%, p <0.001, OR 1.51, 95% CI 1.36 to 1.68. In conclusion, all major cardiovascular complications are higher in men compared to women with a diagnosis of Takotsubo cardiomyopathy, as a plausible explanation for the higher mortality in men.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"260 ","pages":"Pages 4-9"},"PeriodicalIF":2.1,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-23DOI: 10.1016/j.amjcard.2025.11.009
Dimitrios Strepkos MD, Sandeep Jalli DO, Michaella Alexandrou MD, Pedro E.P. Carvalho MD, Eleni Kladou MD, Nick Williford MD, Bavana V. Rangan BDS, MPH, Konstantinos Voudris MD, PhD, Yader Sandoval MD, Emmanouil S. Brilakis MD, PhD
Artificial intelligence (AI) can augment coronary angiography images to enhance interpretation. We compared two blinded operators' interpretation of chronic total occlusion (CTO) angiograms obtained for retrograde percutaneous coronary intervention (PCI) standard vs. AI-enhanced (AngioWave, Concord, MA) images and assessed the association with septal collateral crossing success. We reviewed 50 retrograde CTO PCI angiograms. The most common (83.7%) target vessel was the right coronary artery and target CTOs had high complexity with high rates of proximal cap ambiguity (55.3%), blunt or no stump (79.2%), moderate or severe calcification (50.0%) and high J-CTO scores (2.96 ± 0.93). Retrograde was the first crossing strategy in 44.0% of lesions and was successful in 80%. Operators assigned lower frequency of corkscrew bends (10.2% vs 20.6%, p=0.035) and septal collateral tortuosity (31.7% vs 51.5%, p=0.004) and higher frequency of CC2 collateral size (6.5% vs 0.0%, p=0.007) to AI-enhanced compared with standard angiograms. The aggregate predicted likelihood of crossing (85% vs 70%, p<0.001, Wilcoxon test: p<0.001) and ease of interpretation (9.00 vs 7.00, p<0.001) were higher in the AI-enhanced angiograms. There was no difference in predictive performance for crossing success in the two groups (AUCAI-enhanced = 0.74 and AUCstandard = 0.73, De Long test: p=0.856). AI-enhanced angiograms were assigned a median 10.7% higher predicted likelihood of success. Compared with standard angiograms, AI-enhanced angiograms allow easier interpretation of angiograms and have similar predictive performance for collateral crossing despite showing lower collateral complexity.
人工智能（AI）可以增强冠状动脉造影图像以增强解释。我们比较了两名盲法操作人员对逆行经皮冠状动脉介入治疗（PCI）标准和人工智能增强（AngioWave, Concord， MA）图像获得的慢性全闭塞（CTO）血管造影的解释，并评估了与间隔侧支穿越成功的关系。我们回顾了50张逆行CTO PCI血管造影。最常见的靶血管为右冠状动脉（83.7%），靶血管复杂性高，近端冠状动脉模糊率高（55.3%），钝或无残端（79.2%），中度或重度钙化（50.0%），J-CTO评分高（2.96±0.93）。逆行是44.0%病变的第一个交叉策略，80%的病变成功。与标准血管造影相比，操作者认为人工智能增强的螺旋状弯曲（10.2%对20.6%,p=0.035）和间隔侧支扭曲（31.7%对51.5%,p=0.004）的频率较低，CC2侧支大小的频率较高（6.5%对0.0%,p=0.007）。人工智能增强血管造影的总体预测交叉可能性（85% vs 70%, p<0.001， Wilcoxon检验：p<；0.001）和易解释性（9.00 vs 7.00, p<0.001）更高。两组对杂交成功的预测性能无差异（AUCAI-enhanced = 0.74, AUCstandard = 0.73， De Long检验：p=0.856）。人工智能增强血管造影的成功率中位数高出10.7%。与标准血管造影相比，人工智能增强血管造影可以更容易地解释血管造影，并且在侧枝交叉方面具有相似的预测性能，尽管侧枝复杂性较低。
{"title":"AngioWave Artificial Intelligence-Assisted Analysis of Septal Collaterals for Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention","authors":"Dimitrios Strepkos MD, Sandeep Jalli DO, Michaella Alexandrou MD, Pedro E.P. Carvalho MD, Eleni Kladou MD, Nick Williford MD, Bavana V. Rangan BDS, MPH, Konstantinos Voudris MD, PhD, Yader Sandoval MD, Emmanouil S. Brilakis MD, PhD","doi":"10.1016/j.amjcard.2025.11.009","DOIUrl":"10.1016/j.amjcard.2025.11.009","url":null,"abstract":"<div><div>Artificial intelligence (AI) can augment coronary angiography images to enhance interpretation. We compared two blinded operators' interpretation of chronic total occlusion (CTO) angiograms obtained for retrograde percutaneous coronary intervention (PCI) standard vs. AI-enhanced (AngioWave, Concord, MA) images and assessed the association with septal collateral crossing success. We reviewed 50 retrograde CTO PCI angiograms. The most common (83.7%) target vessel was the right coronary artery and target CTOs had high complexity with high rates of proximal cap ambiguity (55.3%), blunt or no stump (79.2%), moderate or severe calcification (50.0%) and high J-CTO scores (2.96 ± 0.93). Retrograde was the first crossing strategy in 44.0% of lesions and was successful in 80%. Operators assigned lower frequency of corkscrew bends (10.2% vs 20.6%, p=0.035) and septal collateral tortuosity (31.7% vs 51.5%, p=0.004) and higher frequency of CC2 collateral size (6.5% vs 0.0%, p=0.007) to AI-enhanced compared with standard angiograms. The aggregate predicted likelihood of crossing (85% vs 70%, <em>p</em><0.001, Wilcoxon test: <em>p</em><0.001) and ease of interpretation (9.00 vs 7.00, <em>p</em><0.001) were higher in the AI-enhanced angiograms. There was no difference in predictive performance for crossing success in the two groups (AUCAI-enhanced = 0.74 and AUCstandard = 0.73, De Long test: <em>p</em>=0.856). AI-enhanced angiograms were assigned a median 10.7% higher predicted likelihood of success. Compared with standard angiograms, AI-enhanced angiograms allow easier interpretation of angiograms and have similar predictive performance for collateral crossing despite showing lower collateral complexity.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"260 ","pages":"Pages 1-3"},"PeriodicalIF":2.1,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-21DOI: 10.1016/j.amjcard.2025.10.029
Milica Vukićević MD , Mandeep R. Mehra MD, MSc , Robert F. Padera MD, PhD , Ameesh Isath MD
Hydroxychloroquine (HCQ) cardiotoxicity is increasingly recognized, yet progressive conduction system disease remains underappreciated and may represent a lethal phenotype. We report a 67-year-old female on chronic HCQ who developed progressive conduction abnormalities culminating in cardiogenic shock and sudden death despite initial stabilization with isolated atrial pacing. Autopsy revealed extensive sinoatrial and atrioventricular nodal lysosomal toxicity and fibrosis confirming irreversible conduction injury. This case highlights the lysosomal basis of HCQ toxicity and reframes conduction disease as a primary, irreversible manifestation. Vigilant ECG surveillance and early consideration of dual-chamber pacing may prevent catastrophic outcomes in patients on chronic HCQ therapy.
{"title":"Progressive Conduction System Disease in Hydroxychloroquine Cardiotoxicity: A Call for Early Vigilance","authors":"Milica Vukićević MD , Mandeep R. Mehra MD, MSc , Robert F. Padera MD, PhD , Ameesh Isath MD","doi":"10.1016/j.amjcard.2025.10.029","DOIUrl":"10.1016/j.amjcard.2025.10.029","url":null,"abstract":"<div><div>Hydroxychloroquine (HCQ) cardiotoxicity is increasingly recognized, yet progressive conduction system disease remains underappreciated and may represent a lethal phenotype. We report a 67-year-old female on chronic HCQ who developed progressive conduction abnormalities culminating in cardiogenic shock and sudden death despite initial stabilization with isolated atrial pacing. Autopsy revealed extensive sinoatrial and atrioventricular nodal lysosomal toxicity and fibrosis confirming irreversible conduction injury. This case highlights the lysosomal basis of HCQ toxicity and reframes conduction disease as a primary, irreversible manifestation. Vigilant ECG surveillance and early consideration of dual-chamber pacing may prevent catastrophic outcomes in patients on chronic HCQ therapy.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"259 ","pages":"Pages 233-236"},"PeriodicalIF":2.1,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1016/j.amjcard.2025.10.026
Yu Tang MD , Xue-Chen Qiao MD , Meng-Yun Yan MD , Yue Yin MD , Wei-Ya Li MD , Ying Zhang MD , Tian-Yuan Xiong MD , Yi-Ming Li MD , Jun-Li Li MD , Lin Bai MD , Xin Wei MD , Yuan-Wei Xiang Ou MD , Zhong-Kai Zhu MD , Yi-Jun Yao MD , Qiao Li MD , Yi-Jian Li MD , Fei Chen MD , Jia-Fu Wei MD , Yong Peng MD , Yuan Feng MD , Mao Chen MD, PhD
The clinical impact of transcatheter aortic valve replacement (TAVR) in patients with moderate mixed aortic valve disease (MMAVD)—characterized by the coexistence of moderate aortic stenosis (AS) and aortic regurgitation (AR)—remains unclear, as current evidence primarily focuses on isolated severe AS. This study aimed to compare outcomes of TAVR between patients with MMAVD and those with isolated severe AS. Between January 2019 and June 2024, 848 patients who underwent TAVR at our center were identified for analysis, including 75 with MMAVD and 773 with isolated severe AS. To minimize confounding, 73 MMAVD patients were matched with 264 isolated AS patients using 1:4 propensity score matching for comparative analysis. The primary endpoint was all-cause mortality; secondary endpoints included heart failure rehospitalization, left ventricular (LV) reverse remodeling, and procedural complications. Continuous variables were compared using independent samples t-tests, categorical variables using chi-square or Fisher’s exact tests, and survival using Kaplan–Meier curves with log-rank tests. At baseline, MMAVD patients exhibited greater LV dilation (LV end-diastolic diameter [LVEDD]: 56.07±9.04 vs 50.68±7.70, p < 0.001) and hypertrophy (LV mass index [LVMI]: 163.68±50.17 vs 151.59±44.38, p = 0.026). Post-TAVR, MMAVD showed superior reverse remodeling (ΔLVEDD: −7.18±9.75 vs −2.52±7.64, p < 0.001), though LVEF recovery was comparable (ΔLVEF: 5.47±13.98 vs 6.88±15.20, p = 0.52). Survival rates were similar (log-rank p = 0.370), but MMAVD had higher 1-year heart failure rehospitalization (5.97% vs 0.96%, p = 0.032). In conclusion, TAVR with self-expandable valves yields comparable survival in MMAVD and isolated AS, with more pronounced reverse remodeling in MMAVD despite advanced baseline disease.
{"title":"Outcomes of Transcatheter Aortic Valve Replacement in Patients With Moderate Mixed Aortic Valve Disease","authors":"Yu Tang MD , Xue-Chen Qiao MD , Meng-Yun Yan MD , Yue Yin MD , Wei-Ya Li MD , Ying Zhang MD , Tian-Yuan Xiong MD , Yi-Ming Li MD , Jun-Li Li MD , Lin Bai MD , Xin Wei MD , Yuan-Wei Xiang Ou MD , Zhong-Kai Zhu MD , Yi-Jun Yao MD , Qiao Li MD , Yi-Jian Li MD , Fei Chen MD , Jia-Fu Wei MD , Yong Peng MD , Yuan Feng MD , Mao Chen MD, PhD","doi":"10.1016/j.amjcard.2025.10.026","DOIUrl":"10.1016/j.amjcard.2025.10.026","url":null,"abstract":"<div><div>The clinical impact of transcatheter aortic valve replacement (TAVR) in patients with moderate mixed aortic valve disease (MMAVD)—characterized by the coexistence of moderate aortic stenosis (AS) and aortic regurgitation (AR)—remains unclear, as current evidence primarily focuses on isolated severe AS. This study aimed to compare outcomes of TAVR between patients with MMAVD and those with isolated severe AS. Between January 2019 and June 2024, 848 patients who underwent TAVR at our center were identified for analysis, including 75 with MMAVD and 773 with isolated severe AS. To minimize confounding, 73 MMAVD patients were matched with 264 isolated AS patients using 1:4 propensity score matching for comparative analysis. The primary endpoint was all-cause mortality; secondary endpoints included heart failure rehospitalization, left ventricular (LV) reverse remodeling, and procedural complications. Continuous variables were compared using independent samples t-tests, categorical variables using chi-square or Fisher’s exact tests, and survival using Kaplan–Meier curves with log-rank tests. At baseline, MMAVD patients exhibited greater LV dilation (LV end-diastolic diameter [LVEDD]: 56.07±9.04 vs 50.68±7.70, p < 0.001) and hypertrophy (LV mass index [LVMI]: 163.68±50.17 vs 151.59±44.38, p = 0.026). Post-TAVR, MMAVD showed superior reverse remodeling (ΔLVEDD: −7.18±9.75 vs −2.52±7.64, p < 0.001), though LVEF recovery was comparable (ΔLVEF: 5.47±13.98 vs 6.88±15.20, p = 0.52). Survival rates were similar (log-rank p = 0.370), but MMAVD had higher 1-year heart failure rehospitalization (5.97% vs 0.96%, p = 0.032). In conclusion, TAVR with self-expandable valves yields comparable survival in MMAVD and isolated AS, with more pronounced reverse remodeling in MMAVD despite advanced baseline disease.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"259 ","pages":"Pages 265-272"},"PeriodicalIF":2.1,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562487","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}
Acute coronary syndrome (ACS) significantly impacts global morbidity and mortality, traditionally emphasizing left ventricular (LV) dysfunction. However, the prognostic importance of right ventricular (RV) dysfunction remains underexplored. Cardiac magnetic resonance (CMR), the gold standard for RV assessment, enables precise evaluation of ventricular function and structure. We conducted a retrospective cohort study of 268 patients with ACS who underwent CMR between January 2020 and December 2022 at the National Institute of Cardiology Ignacio Chavez. RV dysfunction was defined as RV ejection fraction (RVEF) <50% by CMR. Multivariate logistic regression identified factors associated with RV dysfunction. RV dysfunction occurred in 170 patients (63.4%). Compared to those without RV dysfunction, patients with RV dysfunction were more likely to be male (84% vs 70%, p = 0.011) and smokers (66% vs 51%, p = 0.017). These patients exhibited reduced LV ejection fraction (39% vs 44%, p < 0.001), higher end-systolic and end-diastolic volumes, and reduced RV fractional area change (42% vs 45%, p = 0.004). BMI (OR 1.13, 95% CI 1.04-1.24, p = 0.008) and mitral regurgitation (OR 5.40, 95% CI 1.47–27, p = 0.020) were independently associated with RV dysfunction. Although mortality was higher among patients with RV dysfunction (3.5% vs 1%), it was not statistically significant (p = 0.4). In conclusion RV dysfunction is common in ACS and it is independently associated with increased BMI and mitral regurgitation. CMR evaluation of RV function in ACS patients may be considered to enhance clinical outcomes. Future research should explore targeted therapeutic interventions for RV dysfunction.
{"title":"Right Ventricular Dysfunction in Acute Coronary Syndrome: Insights From Cardiac Magnetic Resonance Imaging","authors":"Mauricio Garcia-Cardenas MD , Pavel Martinez-Dominguez MD , Raul Miranda-Segura MD , Gilberto H. Acosta-Gutiérrez MD , Gabriela Meléndez-Ramírez MD, PhD , Aloha Meave MD , Nilda Espinola-Zavaleta MD, PhD","doi":"10.1016/j.amjcard.2025.10.028","DOIUrl":"10.1016/j.amjcard.2025.10.028","url":null,"abstract":"<div><div>Acute coronary syndrome (ACS) significantly impacts global morbidity and mortality, traditionally emphasizing left ventricular (LV) dysfunction. However, the prognostic importance of right ventricular (RV) dysfunction remains underexplored. Cardiac magnetic resonance (CMR), the gold standard for RV assessment, enables precise evaluation of ventricular function and structure. We conducted a retrospective cohort study of 268 patients with ACS who underwent CMR between January 2020 and December 2022 at the National Institute of Cardiology Ignacio Chavez. RV dysfunction was defined as RV ejection fraction (RVEF) <50% by CMR. Multivariate logistic regression identified factors associated with RV dysfunction. RV dysfunction occurred in 170 patients (63.4%). Compared to those without RV dysfunction, patients with RV dysfunction were more likely to be male (84% vs 70%, p = 0.011) and smokers (66% vs 51%, p = 0.017). These patients exhibited reduced LV ejection fraction (39% vs 44%, p < 0.001), higher end-systolic and end-diastolic volumes, and reduced RV fractional area change (42% vs 45%, p = 0.004). BMI (OR 1.13, 95% CI 1.04-1.24, p = 0.008) and mitral regurgitation (OR 5.40, 95% CI 1.47–27, p = 0.020) were independently associated with RV dysfunction. Although mortality was higher among patients with RV dysfunction (3.5% vs 1%), it was not statistically significant (p = 0.4). In conclusion RV dysfunction is common in ACS and it is independently associated with increased BMI and mitral regurgitation. CMR evaluation of RV function in ACS patients may be considered to enhance clinical outcomes. Future research should explore targeted therapeutic interventions for RV dysfunction.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"259 ","pages":"Pages 244-249"},"PeriodicalIF":2.1,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145547735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-16DOI: 10.1016/j.amjcard.2025.11.004
Syed A. Hyder MD , Hamid Shirwany MD , Vibhu Parcha MD , J. Emerson Scheinuk MD , Ahmed Saleh MD , Moses Sghayyer MD , Gina C. Josey BS , Usman A. Hasnie MD , Salomon A. Roman Soto MD , Joanna M. Joly MD , Samuel K. McElwee MD , Marc G. Cribbs MD , Stephen Clarkson MD, MSPH
Peripartum cardiomyopathy (PPCM) is a rare but life-threatening condition that occurs in late pregnancy or early postpartum and leads to heart failure with reduced left ventricular ejection fraction (LVEF). A severe complication of PPCM is cardiogenic shock, and its incidence has increased in the recent years. We conducted a retrospective multicenter cohort analysis to evaluate the 180-day clinical outcomes of PPCM complicated by cardiogenic shock (PPCM-CS), with a focus on the role of mechanical circulatory support. We identified 733 patients diagnosed with PPCM-CS between January 2010 and January 2024 using TriNetX, a multi-institutional U.S. health record database. Subgroup analysis evaluated outcomes among patients with no mechanical circulatory support (MCS), those managed with intra-aortic balloon pump (IABP) or percutaneous left ventricular assist device (pLVAD), and those supported with extracorporeal membrane oxygenation (ECMO). At 180-day follow-up, all-cause mortality of overall cohort was 15.8%, with higher mortality observed in ECMO (24.1%) and IABP/pLVAD (18.7%) groups. Durable LVAD implantation occurred in 15.0% of the overall cohort, with higher prevalence in ECMO (17.7%) and IABP/pLVAD (29.0%) groups. Heart transplantation was performed in 12.9% of the overall cohort, with higher prevalence in ECMO (19.0%) and IABP/pLVAD (27.1%) patients. Data on outcomes in patients with PPCM complicated by cardiogenic shock remain limited. This study offers insight into the 180-day outcomes in this high-risk population and suggests that, although MCS is associated with higher mortality, it may serve as a viable bridge to advanced therapies.
{"title":"Clinical Outcomes in Peripartum Cardiomyopathy Complicated by Cardiogenic Shock: A Retrospective Multicenter Cohort Study","authors":"Syed A. Hyder MD , Hamid Shirwany MD , Vibhu Parcha MD , J. Emerson Scheinuk MD , Ahmed Saleh MD , Moses Sghayyer MD , Gina C. Josey BS , Usman A. Hasnie MD , Salomon A. Roman Soto MD , Joanna M. Joly MD , Samuel K. McElwee MD , Marc G. Cribbs MD , Stephen Clarkson MD, MSPH","doi":"10.1016/j.amjcard.2025.11.004","DOIUrl":"10.1016/j.amjcard.2025.11.004","url":null,"abstract":"<div><div>Peripartum cardiomyopathy (PPCM) is a rare but life-threatening condition that occurs in late pregnancy or early postpartum and leads to heart failure with reduced left ventricular ejection fraction (LVEF). A severe complication of PPCM is cardiogenic shock, and its incidence has increased in the recent years. We conducted a retrospective multicenter cohort analysis to evaluate the 180-day clinical outcomes of PPCM complicated by cardiogenic shock (PPCM-CS), with a focus on the role of mechanical circulatory support. We identified 733 patients diagnosed with PPCM-CS between January 2010 and January 2024 using TriNetX, a multi-institutional U.S. health record database. Subgroup analysis evaluated outcomes among patients with no mechanical circulatory support (MCS), those managed with intra-aortic balloon pump (IABP) or percutaneous left ventricular assist device (pLVAD), and those supported with extracorporeal membrane oxygenation (ECMO). At 180-day follow-up, all-cause mortality of overall cohort was 15.8%, with higher mortality observed in ECMO (24.1%) and IABP/pLVAD (18.7%) groups. Durable LVAD implantation occurred in 15.0% of the overall cohort, with higher prevalence in ECMO (17.7%) and IABP/pLVAD (29.0%) groups. Heart transplantation was performed in 12.9% of the overall cohort, with higher prevalence in ECMO (19.0%) and IABP/pLVAD (27.1%) patients. Data on outcomes in patients with PPCM complicated by cardiogenic shock remain limited. This study offers insight into the 180-day outcomes in this high-risk population and suggests that, although MCS is associated with higher mortality, it may serve as a viable bridge to advanced therapies.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"259 ","pages":"Pages 237-243"},"PeriodicalIF":2.1,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145547746","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}
Echocardiographic evaluation of Aortic valve stenosis (AS) severity relies on aortic valve area and peak jet velocity. In pursuit of improving accuracy, the transaortic flow rate (FR), defined as the ratio of stroke volume to systolic ejection time, has been introduced. However, its prognostic value in AS patients remains a matter of controversy. This study aims to systematically review the predictive value of FR in AS patients and provide quantitative pooled analysis results where applicable. A systematic search was conducted for observational studies on AS patients published up to July 31, 2025. Studies were included if they assessed the clinical prognostic utility of FR with at least 3 months of follow-up. Pooled estimates and 95% CI for FR's hazard ratio (HR) in each binary outcome were calculated using a random effects model. Twenty-one studies with 10,895 patients underwent descriptive analysis, and 19 eligible studies were included in the meta-analysis. For predicting all-cause mortality, the pooled HR for low FR measured at rest (cut-off value 200–210 mL/s) was 1.31 (95% CI: 1.03–1.60, I2: 66%, p < 0.05). For FR measured during stress echocardiography (cut-off value 250 mL/s), the pooled HR was higher at 1.58 (95% CI: 1.20–1.96, I2: 0%, p < 0.05). However, data in stress echocardiography have been drawn from a smaller number of studies compared to rest FR assessment, and validation in larger studies is warranted. Additionally, every 100 mL/s increase in FR, either at rest or stress, significantly reduced all-cause mortality. In Conclusion, FR is a prognostic marker for all-cause mortality and adverse composite outcomes in AS patients, indicating its potential for risk stratification. Incorporating FR into clinical assessments could help personalize follow-up and monitoring strategies.
{"title":"Prognostic Significance of Echocardiographic Transaortic Flow Rate in Aortic Valve Stenosis: A Systematic Review and Meta-Analysis","authors":"Hoda Mombeini MD , Mohammad Reza Hatamnejad MD, MPH , Fatemeh Chichagi MD , Mahta Arbabi MD , Parnian Jamshidi MD, MPH , Setayesh Sotoudehnia MD , Maryam Sahafi bandary MD , Moein Piroozkhah MD","doi":"10.1016/j.amjcard.2025.10.027","DOIUrl":"10.1016/j.amjcard.2025.10.027","url":null,"abstract":"<div><div>Echocardiographic evaluation of Aortic valve stenosis (AS) severity relies on aortic valve area and peak jet velocity. In pursuit of improving accuracy, the transaortic flow rate (FR), defined as the ratio of stroke volume to systolic ejection time, has been introduced. However, its prognostic value in AS patients remains a matter of controversy. This study aims to systematically review the predictive value of FR in AS patients and provide quantitative pooled analysis results where applicable. A systematic search was conducted for observational studies on AS patients published up to July 31, 2025. Studies were included if they assessed the clinical prognostic utility of FR with at least 3 months of follow-up. Pooled estimates and 95% CI for FR's hazard ratio (HR) in each binary outcome were calculated using a random effects model. Twenty-one studies with 10,895 patients underwent descriptive analysis, and 19 eligible studies were included in the meta-analysis. For predicting all-cause mortality, the pooled HR for low FR measured at rest (cut-off value 200–210 mL/s) was 1.31 (95% CI: 1.03–1.60, I<sup>2</sup>: 66%, p < 0.05). For FR measured during stress echocardiography (cut-off value 250 mL/s), the pooled HR was higher at 1.58 (95% CI: 1.20–1.96, I<sup>2</sup>: 0%, p < 0.05). However, data in stress echocardiography have been drawn from a smaller number of studies compared to rest FR assessment, and validation in larger studies is warranted. Additionally, every 100 mL/s increase in FR, either at rest or stress, significantly reduced all-cause mortality. In Conclusion, FR is a prognostic marker for all-cause mortality and adverse composite outcomes in AS patients, indicating its potential for risk stratification. Incorporating FR into clinical assessments could help personalize follow-up and monitoring strategies.</div><div>Systematic Review Registration: PROSPERO (registration number: CRD42023404048).</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"259 ","pages":"Pages 250-264"},"PeriodicalIF":2.1,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145547813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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