Tricuspid regurgitation (TR) is related to survival, and right atrial (RA) size and function may play a role. This study aimed to assess the impact of RA function measured by strain (RA strain [RAS]) on outcome and end-organ congestion. We enrolled 134 patients (mean age 73 ± 13 years, 62% women) with any TR grade or etiology and a complete echocardiogram, clinical follow-up, and renal function assessment. The primary end point was a combination of overall mortality and right-sided heart failure hospitalization, and the secondary end point was worsening renal function (WRF). After a median follow-up of 23.5 months (interquartile range 12 to 34 months), the combined end point was reached by 31% of patients. Patients with RAS ≤18% showed lower event-free survival (log-rank p <0.001). In the multivariable analysis, RAS ≤18% (HR 3.1, 95% CI 1.1 to 8.8) and pulmonary artery systolic pressure (PASP) (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1 to 1.05) were independent predictors of the primary end point. Patients with RAS ≤18% and PASP >45 mm Hg had the worst outcome (HR 4.3, 95% CI 2 to 9.5). RAS ≤18% (odds ratio 3.22, 95% CI 1.11 to 9.33) and PASP >45 mm Hg (OR 3.2, 95% CI 1.15 to 8.88) were independent predictors of WRF, adjusting for TR severity, left and right ventricular function, age, gender, diabetes, diuretics, atrial fibrillation. The addition of RAS ≤18% had incremental power over PASP and echocardiographic variables of TR severity and right or left ventricular function to predict WRF (p = 0.026). In conclusion, RA function measured by RAS independently predicts mortality and hospitalizations in patients with TR and independently and incrementally predicts WRF over time.
三尖瓣反流（TR）与生存有关，右心房（RA）的大小和功能可能起作用。我们的目的是评估通过应变（RAS）测量RA功能对结局和终末器官充血的影响。我们招募了134例患者（平均年龄73±13岁，62%为女性），他们有任何TR级别或病因，并进行了完整的超声心动图、临床随访和肾功能评估。主要终点是总死亡率和右侧心力衰竭住院（HFH），次要终点是肾功能恶化（WRF）。中位随访23.5个月（四分位数间隔12-34个月）后，31%的患者达到了联合终点。RAS≤18%的患者无事件生存率较低(LogRank p45 mmHg预后最差（HR 4.3, 95% CI 2-9.5）。RAS≤18% （OR 3.22, 95% CI 1.11-9.33）和PASP bb0 45 mmHg （OR 3.2, 95% CI 1.15-8.88）是WRF调整TR严重程度、左右心室功能、年龄、性别、糖尿病、利尿剂、房颤的独立预测因子。RAS≤18%的增加比PASP和超声心动图变量TR严重程度和左右心室功能预测WRF的能力增加（p=0.026）。总之，RAS测量的RA功能可独立预测TR患者的死亡率和住院率，也可随时间独立且递增地预测WRF。
{"title":"The Impact of Right Atrial Function on Prognosis and Renal Function in Patients With Tricuspid Regurgitation","authors":"Elvin Tafciu MD, Matteo Pilan MD, Bianca Rocca MD, Ilaria Minnucci MD, Caterina Maffeis MD, PhD, Corinna Bergamini MD, PhD, Giovanni Benfari MD, PhD, Flavio L. Ribichini MD","doi":"10.1016/j.amjcard.2025.01.003","DOIUrl":"10.1016/j.amjcard.2025.01.003","url":null,"abstract":"<div><div>Tricuspid regurgitation (TR) is related to survival, and right atrial (RA) size and function may play a role. This study aimed to assess the impact of RA function measured by strain (RA strain [RAS]) on outcome and end-organ congestion. We enrolled 134 patients (mean age 73 ± 13 years, 62% women) with any TR grade or etiology and a complete echocardiogram, clinical follow-up, and renal function assessment. The primary end point was a combination of overall mortality and right-sided heart failure hospitalization, and the secondary end point was worsening renal function (WRF). After a median follow-up of 23.5 months (interquartile range 12 to 34 months), the combined end point was reached by 31% of patients. Patients with RAS ≤18% showed lower event-free survival (log-rank p <0.001). In the multivariable analysis, RAS ≤18% (HR 3.1, 95% CI 1.1 to 8.8) and pulmonary artery systolic pressure (PASP) (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1 to 1.05) were independent predictors of the primary end point. Patients with RAS ≤18% and PASP >45 mm Hg had the worst outcome (HR 4.3, 95% CI 2 to 9.5). RAS ≤18% (odds ratio 3.22, 95% CI 1.11 to 9.33) and PASP >45 mm Hg (OR 3.2, 95% CI 1.15 to 8.88) were independent predictors of WRF, adjusting for TR severity, left and right ventricular function, age, gender, diabetes, diuretics, atrial fibrillation. The addition of RAS ≤18% had incremental power over PASP and echocardiographic variables of TR severity and right or left ventricular function to predict WRF (p = 0.026). In conclusion, RA function measured by RAS independently predicts mortality and hospitalizations in patients with TR and independently and incrementally predicts WRF over time.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 1-8"},"PeriodicalIF":2.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942740","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 : 2025-01-07DOI: 10.1016/j.amjcard.2025.01.004
Jooyeon Lee MD , Young-Guk Ko MD , Seung-Jun Lee MD , Chul-Min Ahn MD , Cheol Woong Yu MD , Jae-Hwan Lee MD , Seung-Whan Lee MD , Young Jin Youn MD , Jong Kwan Park MD , Chang-Hwan Yoon MD , Pil-Ki Min MD , Seung-Hyuk Choi MD , Donghoon Choi MD , K-VIS ELLA Investigators
Endovascular treatment of femoropopliteal artery (FPA) disease with drug-coated balloons (DCBs) may face complications such as arterial recoil, dissection, and residual stenosis. Angiography has limited accuracy for evaluating blood flow through revascularized target lesions. Thus, there is a need for postprocedure hemodynamic assessment in treated limbs. This study aims to explore how postprocedure ankle-brachial index (ABI) influences outcomes following DCB treatment for FPA disease. This study included patients in a multicenter registry (K-VIS ELLA) treated with DCB for FPA disease between January 2006 and August 2021. Optimal postprocedure ABI cutoff for predicting clinically driven target lesion revascularization (TLR) was determined using receiver operating characteristic curve analysis. Independent predictors of TLR were identified using multivariable Cox regression analysis. A total of 654 limbs (514 patients) treated with DCB for FPA were evaluated by ABI at 1-day (median, interquartile range, 1 to 2 days) postprocedure and followed up for a median of 370 days. The optimal immediate postprocedure ABI cutoff value for predicting TLR was 0.72 (area under the curve, 0.68). Significantly improved TLR-free and major adverse limb event-free survival rates were observed with a postprocedure ABI ≥ 0.72 (hazard ratio [HR] = 0.24, 95% confidence intervals [CI] = 0.16 to 0.37, p < 0.001; HR = 0.25, 95% CI = 0.16 to 0.38, p < 0.001, respectively). Independent predictors of TLR were postprocedure ABI < 0.72 (HR 3.76; 95% CI, 2.33 to 6.07; p < 0.001) and presence of anemia (HR 2.01; 95% CI, 1.03 to 3.92; p = 0.041). An immediate postprocedure ABI is a significant predictor of TLR risk following DCB treatment for FPA disease, underscoring the value of hemodynamic assessment in optimizing angioplasty outcomes.
{"title":"Association of Postprocedure Ankle-Brachial Index With Outcomes Following Drug-Coated Balloon Angioplasty in Femoropopliteal Artery Disease","authors":"Jooyeon Lee MD , Young-Guk Ko MD , Seung-Jun Lee MD , Chul-Min Ahn MD , Cheol Woong Yu MD , Jae-Hwan Lee MD , Seung-Whan Lee MD , Young Jin Youn MD , Jong Kwan Park MD , Chang-Hwan Yoon MD , Pil-Ki Min MD , Seung-Hyuk Choi MD , Donghoon Choi MD , K-VIS ELLA Investigators","doi":"10.1016/j.amjcard.2025.01.004","DOIUrl":"10.1016/j.amjcard.2025.01.004","url":null,"abstract":"<div><div>Endovascular treatment of femoropopliteal artery (FPA) disease with drug-coated balloons (DCBs) may face complications such as arterial recoil, dissection, and residual stenosis. Angiography has limited accuracy for evaluating blood flow through revascularized target lesions. Thus, there is a need for postprocedure hemodynamic assessment in treated limbs. This study aims to explore how postprocedure ankle-brachial index (ABI) influences outcomes following DCB treatment for FPA disease. This study included patients in a multicenter registry (K-VIS ELLA) treated with DCB for FPA disease between January 2006 and August 2021. Optimal postprocedure ABI cutoff for predicting clinically driven target lesion revascularization (TLR) was determined using receiver operating characteristic curve analysis. Independent predictors of TLR were identified using multivariable Cox regression analysis. A total of 654 limbs (514 patients) treated with DCB for FPA were evaluated by ABI at 1-day (median, interquartile range, 1 to 2 days) postprocedure and followed up for a median of 370 days. The optimal immediate postprocedure ABI cutoff value for predicting TLR was 0.72 (area under the curve, 0.68). Significantly improved TLR-free and major adverse limb event-free survival rates were observed with a postprocedure ABI ≥ 0.72 (hazard ratio [HR] = 0.24, 95% confidence intervals [CI] = 0.16 to 0.37, p < 0.001; HR = 0.25, 95% CI = 0.16 to 0.38, p < 0.001, respectively). Independent predictors of TLR were postprocedure ABI < 0.72 (HR 3.76; 95% CI, 2.33 to 6.07; p < 0.001) and presence of anemia (HR 2.01; 95% CI, 1.03 to 3.92; p = 0.041). An immediate postprocedure ABI is a significant predictor of TLR risk following DCB treatment for FPA disease, underscoring the value of hemodynamic assessment in optimizing angioplasty outcomes.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"240 ","pages":"Pages 38-45"},"PeriodicalIF":2.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942593","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) encompasses a spectrum of coronary artery diseases, including unstable angina, non-ST segment elevation myocardial infarction, and ST-segment elevation MI. At present, ACS is a major cause of mortality and morbidity in the community. The diagnosis of ACS is of critical importance for guiding appropriate therapeutic strategies, although this can be onerous if the standard presenting manifestations are lacking. While high-sensitivity cardiac troponin (hs-cTn) is a proven biomarker of ACS, additional markers to support the clinical diagnosis could be valuable. Since nitrate metabolism is crucial to the vasomotion of coronary arteries, in this study, we compared the plasma nitrate levels in consecutive patients with ACS and healthy volunteers. Systemic hemodynamic parameters were also compared between the groups. The pulse wave velocity of individuals with ACS was higher than that in healthy volunteers, thereby verifying the association between coronary artery disease and a loss of vascular elasticity in the circulatory system. Notably, median plasma nitrate levels were significantly higher in patients with ACS compared to healthy volunteers. Although plasma nitrate levels seem to be higher in patients with ACS, whether this finding is incidental, contributory, or a consequential factor in the pathogenesis of ACS remains to be determined.
{"title":"Elevated Plasma Nitrate Levels in Patients with Acute Coronary Syndrome","authors":"C. Venkata S. Ram MD, MACP, FACC, FAHA , Ferid Murad MD, PhD , A. Sreenivas Kumar MD, DM, FACC , Baby Shalini Muppalla MBBS, MD , Asma Niloufer MBBS, MD , Praveen Gajjela MSc , Gokul Reddy Mandala MD, DM, FACC , Ramakrishna Janapati MBBS, MD, DM (NIMS) , Sanjeeva Kumar E MD, DM","doi":"10.1016/j.amjcard.2025.01.002","DOIUrl":"10.1016/j.amjcard.2025.01.002","url":null,"abstract":"<div><div>Acute coronary syndrome (ACS) encompasses a spectrum of coronary artery diseases, including unstable angina, non-ST segment elevation myocardial infarction, and ST-segment elevation MI. At present, ACS is a major cause of mortality and morbidity in the community. The diagnosis of ACS is of critical importance for guiding appropriate therapeutic strategies, although this can be onerous if the standard presenting manifestations are lacking. While high-sensitivity cardiac troponin (hs-cTn) is a proven biomarker of ACS, additional markers to support the clinical diagnosis could be valuable. Since nitrate metabolism is crucial to the vasomotion of coronary arteries, in this study, we compared the plasma nitrate levels in consecutive patients with ACS and healthy volunteers. Systemic hemodynamic parameters were also compared between the groups. The pulse wave velocity of individuals with ACS was higher than that in healthy volunteers, thereby verifying the association between coronary artery disease and a loss of vascular elasticity in the circulatory system. Notably, median plasma nitrate levels were significantly higher in patients with ACS compared to healthy volunteers. Although plasma nitrate levels seem to be higher in patients with ACS, whether this finding is incidental, contributory, or a consequential factor in the pathogenesis of ACS remains to be determined.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"240 ","pages":"Pages 68-70"},"PeriodicalIF":2.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942659","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 : 2025-01-06DOI: 10.1016/j.amjcard.2024.12.037
Srikanth Adusumalli MBBS, FRACP , Cian P. McCarthy MB, BCh, BAO, SM , Craig A. Magaret MS , Rhonda F. Rhyne MBA , Farouc A. Jaffer MD, PhD , James L. Januzzi MD
There are limited tools available to predict the long-term prognosis of persons with coronary chronic total occlusions (CTO). A previously described blood biomarker panel to predict cardiovascular (CV) events was evaluated in patients with CTO. From 1,251 patients in the CASABLANCA study, 241 participants with a CTO were followed for an average of 4 years for occurrence of major adverse CV events (MACE, CV death, nonfatal myocardial infarction or stroke) and CV death/heart failure (HF) hospitalization. Results of a biomarker panel (kidney injury molecule-1, N-terminal pro-B-type natriuretic peptide, osteopontin, and tissue inhibitor of metalloproteinase-1) from baseline samples were expressed as low-, medium-, and high-risk. By 4 years, a total of 67 (27.8%) MACE and 56 (23.2%) CV death/HF hospitalization events occurred. The C-statistic of the panel for MACE through 4 years was 0.79 (p < 0.001). Considering the low-risk group as referent, the hazard ratio (HR) of MACE by 4 years was 6.65 (95% confidence interval [CI]: 2.98 to 14.8) and 12.4 (95% CI:5.17 to 29.6) for the medium and high-risk groups (both p < 0.001). The C-statistic for CVD/HF hospitalization by 4 years was 0.84 (p < 0.001). Compared to the low-risk score group, the medium and high-risk groups had HR of 5.61 (95% CI: 2.33 to 13.5) and 15.6 (95% CI: 6.18, 39.2; both p value <0.001). In conclusion, a multiple biomarker panel assisted in discriminating a broad range of risk for adverse outcomes in patients with coronary CTO. These results may have implications for risk stratification, patient care and could have a role for clinical trial enrichment.
{"title":"Multiple Biomarkers to Predict Major Adverse Cardiovascular Events in Patients With Coronary Chronic Total Occlusions","authors":"Srikanth Adusumalli MBBS, FRACP , Cian P. McCarthy MB, BCh, BAO, SM , Craig A. Magaret MS , Rhonda F. Rhyne MBA , Farouc A. Jaffer MD, PhD , James L. Januzzi MD","doi":"10.1016/j.amjcard.2024.12.037","DOIUrl":"10.1016/j.amjcard.2024.12.037","url":null,"abstract":"<div><div>There are limited tools available to predict the long-term prognosis of persons with coronary chronic total occlusions (CTO). A previously described blood biomarker panel to predict cardiovascular (CV) events was evaluated in patients with CTO. From 1,251 patients in the CASABLANCA study, 241 participants with a CTO were followed for an average of 4 years for occurrence of major adverse CV events (MACE, CV death, nonfatal myocardial infarction or stroke) and CV death/heart failure (HF) hospitalization. Results of a biomarker panel (kidney injury molecule-1, N-terminal pro-B-type natriuretic peptide, osteopontin, and tissue inhibitor of metalloproteinase-1) from baseline samples were expressed as low-, medium-, and high-risk. By 4 years, a total of 67 (27.8%) MACE and 56 (23.2%) CV death/HF hospitalization events occurred. The C-statistic of the panel for MACE through 4 years was 0.79 (p < 0.001). Considering the low-risk group as referent, the hazard ratio (HR) of MACE by 4 years was 6.65 (95% confidence interval [CI]: 2.98 to 14.8) and 12.4 (95% CI:5.17 to 29.6) for the medium and high-risk groups (both p < 0.001). The C-statistic for CVD/HF hospitalization by 4 years was 0.84 (p < 0.001). Compared to the low-risk score group, the medium and high-risk groups had HR of 5.61 (95% CI: 2.33 to 13.5) and 15.6 (95% CI: 6.18, 39.2; both p value <0.001). In conclusion, a multiple biomarker panel assisted in discriminating a broad range of risk for adverse outcomes in patients with coronary CTO. These results may have implications for risk stratification, patient care and could have a role for clinical trial enrichment.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"242 ","pages":"Pages 25-31"},"PeriodicalIF":2.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942736","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 : 2025-01-03DOI: 10.1016/j.amjcard.2024.12.036
Mehmet Eren MD, Yalcin Velibey MD
{"title":"Postcardiac Injury Syndrome Following Transcatheter Aortic Valve Implantation: A Brief Report and Review","authors":"Mehmet Eren MD, Yalcin Velibey MD","doi":"10.1016/j.amjcard.2024.12.036","DOIUrl":"10.1016/j.amjcard.2024.12.036","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"240 ","pages":"Pages 46-49"},"PeriodicalIF":2.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930609","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 : 2025-01-03DOI: 10.1016/j.amjcard.2024.12.034
Jasninder S. Dhaliwal MD , Mokshad Gaonkar MS , Nirav Patel MD, MSPH , Naman S. Shetty MD , Peng Li PhD , Nehal Vekariya MS , Rajat Kalra MBChB , Garima Arora MD , Pankaj Arora MD
The Pooled Cohort Equations (PCEs), developed by the American Heart Association (AHA) and American College of Cardiology, have been widely used since 2013 to estimate 10-year atherosclerotic cardiovascular disease (ASCVD) risk and guide statin therapy. Recently, the AHA introduced the Predicting Risk of CVD EVENTs (PREVENT) equations to improve ASCVD risk estimation. However, the effect of using PREVENT instead of PCEs on risk classification and statin eligibility remains unclear. This retrospective cohort study analyzed 261,303 UK Biobank participants, aged 40 to 69 years, who were free from cardiovascular disease and not on statin therapy. The PCEs and the base PREVENT equations were used to estimate 10-year ASCVD risk, categorize risk levels, and determine statin eligibility based on a common risk threshold of 7.5%. The median 10-year ASCVD risk was 5.2% (2.2%, 10.6%) using the PCEs and 3.5% (1.8%, 5.8%) with the PREVENT equations. The PREVENT equations classified 14.0% of participants as high-risk (ASCVD risk >7.5%), compared to 36.9% classified by PCEs. Among participants classified as intermediate-risk by PCEs, 75.3% were reclassified as low-risk by PREVENT. The proportion of individuals eligible for statin use by the PREVENT equation was 19.9%, and by the PCEs was 40.7%. The corresponding difference was 20.8% (95% confidence intervals [CI]: 20.6% to 20.9%). More men (33.0% [95% CI: 32.7% to 33.3%]) than women (11.5% [95% CI: 11.3% to 11.7%]) and more individuals in the older age group (60 to 69 years: 34.0% [95% CI: 33.7% to34.3%]) than in the younger age group (40 to 49 years: 3.5% [95% CI: 3.3% to 3.6%]) would not be recommended for statin consideration with the PREVENT equations. In conclusion, based on the common risk threshold of 7.5%, replacing the PCEs with the base PREVENT equation would reduce statin eligibility in the UK Biobank participants by ∼20%, especially among men and older adults.
{"title":"Differences in Statin Eligibility With the Use of Predicting Risk of Cardiovascular Disease EVENTs Versus Pooled Cohort Equations in the UK Biobank","authors":"Jasninder S. Dhaliwal MD , Mokshad Gaonkar MS , Nirav Patel MD, MSPH , Naman S. Shetty MD , Peng Li PhD , Nehal Vekariya MS , Rajat Kalra MBChB , Garima Arora MD , Pankaj Arora MD","doi":"10.1016/j.amjcard.2024.12.034","DOIUrl":"10.1016/j.amjcard.2024.12.034","url":null,"abstract":"<div><div>The Pooled Cohort Equations (PCEs), developed by the American Heart Association (AHA) and American College of Cardiology, have been widely used since 2013 to estimate 10-year atherosclerotic cardiovascular disease (ASCVD) risk and guide statin therapy. Recently, the AHA introduced the Predicting Risk of CVD EVENTs (PREVENT) equations to improve ASCVD risk estimation. However, the effect of using PREVENT instead of PCEs on risk classification and statin eligibility remains unclear. This retrospective cohort study analyzed 261,303 UK Biobank participants, aged 40 to 69 years, who were free from cardiovascular disease and not on statin therapy. The PCEs and the base PREVENT equations were used to estimate 10-year ASCVD risk, categorize risk levels, and determine statin eligibility based on a common risk threshold of 7.5%. The median 10-year ASCVD risk was 5.2% (2.2%, 10.6%) using the PCEs and 3.5% (1.8%, 5.8%) with the PREVENT equations. The PREVENT equations classified 14.0% of participants as high-risk (ASCVD risk >7.5%), compared to 36.9% classified by PCEs. Among participants classified as intermediate-risk by PCEs, 75.3% were reclassified as low-risk by PREVENT. The proportion of individuals eligible for statin use by the PREVENT equation was 19.9%, and by the PCEs was 40.7%. The corresponding difference was 20.8% (95% confidence intervals [CI]: 20.6% to 20.9%). More men (33.0% [95% CI: 32.7% to 33.3%]) than women (11.5% [95% CI: 11.3% to 11.7%]) and more individuals in the older age group (60 to 69 years: 34.0% [95% CI: 33.7% to34.3%]) than in the younger age group (40 to 49 years: 3.5% [95% CI: 3.3% to 3.6%]) would not be recommended for statin consideration with the PREVENT equations. In conclusion, based on the common risk threshold of 7.5%, replacing the PCEs with the base PREVENT equation would reduce statin eligibility in the UK Biobank participants by ∼20%, especially among men and older adults.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"241 ","pages":"Pages 43-51"},"PeriodicalIF":2.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930565","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 : 2025-01-03DOI: 10.1016/j.amjcard.2024.12.035
Cody W. Dorton DO , Kyle A. McCullough MD , Taylor Pickering DO , Jasjit K. Banwait PhD , Sarah Hale CCRC , J. Michael DiMaio MD , Justin M. Schaffer MD
Despite guideline recommendations, transfer rates to high-volume aortic centers (high-VACs) for acute type A aortic dissections (TAAD) remain suboptimal. This may be because the benefit of undergoing surgical repair of TAAD at high-VACs remains poorly quantified. Medicare beneficiaries undergoing surgical repair of TAAD from 1999-2019 were identified. Hospital and surgeon annual aortic case volumes in Medicare beneficiaries were determined. Long-term survival after surgical repair of TAAD at low-volume aortic centers (low-VACs; <6 annual aortic cases), intermediate-volume aortic centers (intermediate-VACs; 6-27 annual aortic cases), and high-VACs (>27 annual aortic cases) was compared. Overlap propensity score weighting adjusted for measured confounding variables. 15,375 Medicare beneficiaries underwent surgical repair of TAAD from 1999-2019: 4119 (26.8%) at low-VACs, 7193 (46.8%) at intermediate-VACs, and 4063 (26.4%) at high-VACs. Over the study duration, the percentage of patients transferred from an outside medical facility for TAAD increased from 33% in 1999 to 50% in 2019 (Cochran-Armitage p<0.001). Transferred patients comprised 19% of cases performed at low-VACs, 43% at intermediate-VACs, and 64% at high-VACs. Risk-adjusted median survival at high-VACs was 6.6[6.3-7.1] years compared to 4.1[3.6-4.6] years at low-VACs, an advantage of 2.5[1.8-3.0] years. Risk-adjusted median survival at high-VACs was 6.7[6.4-7.1] years compared to 5.2[4.9-5.5] years at intermediate-VACs, an advantage of 1.5[0.9-1.9] years. Survival after surgical repair of TAAD is substantially improved at high-VACs compared to both low-VACs and intermediate-VACs. Although the prevalence of transfer for TAAD has increased since 1999, policy measures aimed at improving transfer rates have the potential to further enhance outcomes in TAAD.
{"title":"Hospital Volume and Long-Term Survival Among Medicare Beneficiaries Undergoing Surgical Repair of Acute Type A Aortic Dissection","authors":"Cody W. Dorton DO , Kyle A. McCullough MD , Taylor Pickering DO , Jasjit K. Banwait PhD , Sarah Hale CCRC , J. Michael DiMaio MD , Justin M. Schaffer MD","doi":"10.1016/j.amjcard.2024.12.035","DOIUrl":"10.1016/j.amjcard.2024.12.035","url":null,"abstract":"<div><div>Despite guideline recommendations, transfer rates to high-volume aortic centers (high-VACs) for acute type A aortic dissections (TAAD) remain suboptimal. This may be because the benefit of undergoing surgical repair of TAAD at high-VACs remains poorly quantified. Medicare beneficiaries undergoing surgical repair of TAAD from 1999-2019 were identified. Hospital and surgeon annual aortic case volumes in Medicare beneficiaries were determined. Long-term survival after surgical repair of TAAD at low-volume aortic centers (low-VACs; <6 annual aortic cases), intermediate-volume aortic centers (intermediate-VACs; 6-27 annual aortic cases), and high-VACs (>27 annual aortic cases) was compared. Overlap propensity score weighting adjusted for measured confounding variables. 15,375 Medicare beneficiaries underwent surgical repair of TAAD from 1999-2019: 4119 (26.8%) at low-VACs, 7193 (46.8%) at intermediate-VACs, and 4063 (26.4%) at high-VACs. Over the study duration, the percentage of patients transferred from an outside medical facility for TAAD increased from 33% in 1999 to 50% in 2019 (Cochran-Armitage p<0.001). Transferred patients comprised 19% of cases performed at low-VACs, 43% at intermediate-VACs, and 64% at high-VACs. Risk-adjusted median survival at high-VACs was 6.6[6.3-7.1] years compared to 4.1[3.6-4.6] years at low-VACs, an advantage of 2.5[1.8-3.0] years. Risk-adjusted median survival at high-VACs was 6.7[6.4-7.1] years compared to 5.2[4.9-5.5] years at intermediate-VACs, an advantage of 1.5[0.9-1.9] years. Survival after surgical repair of TAAD is substantially improved at high-VACs compared to both low-VACs and intermediate-VACs. Although the prevalence of transfer for TAAD has increased since 1999, policy measures aimed at improving transfer rates have the potential to further enhance outcomes in TAAD.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"237 ","pages":"Pages 86-92"},"PeriodicalIF":2.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930607","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 : 2025-01-03DOI: 10.1016/j.amjcard.2024.12.032
Oliver Maier, Dragos-Andrei Duse, Malte Kelm
{"title":"Immediate Versus Staged Complete Revascularization in ST-Segment Elevation Myocardial Infarction: Beyond the Question of Time.","authors":"Oliver Maier, Dragos-Andrei Duse, Malte Kelm","doi":"10.1016/j.amjcard.2024.12.032","DOIUrl":"10.1016/j.amjcard.2024.12.032","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926289","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}
Right-sided cardiac catheterization (RHC) is selectively recommended in mitral valve transcatheter edge-to-edge (M-TEER) workup because right ventricle (RV) hemodynamic parameters predict adverse outcomes. This study examines the impact of RV hemodynamics and the prognostic value of the 2022 European Society of Cardiology (ESC) pulmonary hypertension definitions on outcomes after M-TEER. Of 152 patients treated with M-TEER for symptomatic severe mitral regurgitation (MR) between December 2014 and February 2024 at our tertiary center, 71 underwent elective RHC before the procedure. The primary outcomes assessed were all-cause mortality and a composite of heart failure hospitalization and death at the longest available follow-up. In a cohort of 152 mostly male patients (64%) with a median age of 79 years who were treated for symptomatic severe MR, 71 underwent elective RHC. The causes were categorized as degenerative (47%), functional ventricular (41%), and atrial (12%). Pulmonary hypertension (PH) was common, with 74% showing mean pulmonary artery pressure (mPAP) >20 mm Hg and 39% with pulmonary vascular resistance (PVR) >2 Wood Units. Success rates were high, with technical, device, and procedural success at 97%, 88%, and 84%, respectively. At a median follow-up of 681 days, all-cause mortality was 50%, and the composite outcome (death or heart failure hospitalizations) occurred in 61%. Key hemodynamic parameters, including mPAP, PVR, and the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio, were independently linked to mortality risk. Kaplan-Meier analysis found significant associations with mPAP >20 mm Hg and pulmonary capillary wedge pressure >15 mm Hg for long-term mortality, whereas the 2022 ESC PH thresholds showed greater sensitivity, correlating with increased mortality risk. In patients with severe MR who undergo M-TEER, most RV invasive hemodynamic parameters are linked to adverse long-term outcomes, with mPAP, PVR, and the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio identified as independent predictors of mortality. Despite the study's limited sample size, the updated ESC PH definitions enhance prognostic assessment.
{"title":"Impact of Updated Invasive Right Ventricular and Pulmonary Hemodynamics on Long-Term Outcomes in Patients With Mitral Valve Transcatheter Edge-to-Edge Repair","authors":"Giulia Masiero MD , Federico Arturi MD , Elisa Boscolo Soramio MD , Luca Nai Fovino MD, PhD , Tommaso Fabris MD , Francesco Cardaioli MD , Andrea Panza MD , Giulia Lorenzoni MD, PhD , Massimo Napodano MD, PhD , Chiara Fraccaro MD, PhD , Giuseppe Tarantini MD, PhD","doi":"10.1016/j.amjcard.2024.11.010","DOIUrl":"10.1016/j.amjcard.2024.11.010","url":null,"abstract":"<div><div>Right-sided cardiac catheterization (RHC) is selectively recommended in mitral valve transcatheter edge-to-edge <strong>(</strong>M-TEER) workup because right ventricle (RV) hemodynamic parameters predict adverse outcomes. This study examines the impact of RV hemodynamics and the prognostic value of the 2022 European Society of Cardiology (ESC) pulmonary hypertension definitions on outcomes after M-TEER. Of 152 patients treated with M-TEER for symptomatic severe mitral regurgitation (MR) between December 2014 and February 2024 at our tertiary center, 71 underwent elective RHC before the procedure. The primary outcomes assessed were all-cause mortality and a composite of heart failure hospitalization and death at the longest available follow-up. In a cohort of 152 mostly male patients (64%) with a median age of 79 years who were treated for symptomatic severe MR, 71 underwent elective RHC. The causes were categorized as degenerative (47%), functional ventricular (41%), and atrial (12%). Pulmonary hypertension (PH) was common, with 74% showing mean pulmonary artery pressure (mPAP) >20 mm Hg and 39% with pulmonary vascular resistance (PVR) >2 Wood Units. Success rates were high, with technical, device, and procedural success at 97%, 88%, and 84%, respectively. At a median follow-up of 681 days, all-cause mortality was 50%, and the composite outcome (death or heart failure hospitalizations) occurred in 61%. Key hemodynamic parameters, including mPAP, PVR, and the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio, were independently linked to mortality risk. Kaplan-Meier analysis found significant associations with mPAP >20 mm Hg and pulmonary capillary wedge pressure >15 mm Hg for long-term mortality, whereas the 2022 ESC PH thresholds showed greater sensitivity, correlating with increased mortality risk. In patients with severe MR who undergo M-TEER, most RV invasive hemodynamic parameters are linked to adverse long-term outcomes, with mPAP, PVR, and the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio identified as independent predictors of mortality. Despite the study's limited sample size, the updated ESC PH definitions enhance prognostic assessment.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"234 ","pages":"Pages 99-106"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic limb-threatening ischemia (CLTI), the severest stage of peripheral artery disease, frequently necessitates amputation. In CLTI patients, heart failure with reduced ejection fraction (HFrEF) markedly raises mortality risk, with increased peripheral vascular resistance contributing to this exacerbation. This investigation aimed to assess the impact of major amputation (MA) on the cardiovascular (CV) prognosis in CLTI patients with HFrEF by lowering peripheral vascular resistance. Conducting a retrospective, observational analysis at a single center, a total of 60 patients with CLTI and HFrEF (EF < 50%) who underwent endovascular therapy (EVT) at our institution were assessed. We compared CV outcomes in CLTI patients with HFrEF who received MA (n = 17) to those who did not (n = 43) after undergoing EVT. During the follow-up period, which median 641 (IQR: 245 to 1,734) days post-EVT, a composite primary endpoint of CV death or hospitalization for HF was observed. During the study period, 19 patients (32%) were admitted for HF or died as a consequence of CV events. Kaplan-Meier analysis revealed a significantly reduced incidence of the primary endpoint in the MA cohort (log-rank test: p = 0.035). Adjustments for age and sex showed MA was significantly linked to improved CV prognosis (HR: 0.19; 95% confidence interval: 0.04 to 0.87). A nonsignificant trend toward decreased overall mortality was noted in the MA group, with infections being the predominant cause of death across both groups. In conclusion, in CLTI patients with HFrEF, MA might be linked to reduced CV events, proposing it as a potential definitive strategy for improving CV outcomes in this high-risk population.
{"title":"Cardiovascular Prognosis in Limb Ischemia Patients With Heart Failure and Systolic Dysfunction Following Major Amputation","authors":"Takuma Takada MD, PhD , Eiji Shibahashi MD, PhD , Shun Hasegawa MD , Ayano Yoshida MD, PhD , Makoto Kishihara MD , Shonosuke Watanabe MD , Shota Shirotani MD, PhD , Takuro Abe MD , Masashi Nakao MD, PhD , Junichi Yamaguchi MD, PhD , Kentaro Jujo MD, PhD","doi":"10.1016/j.amjcard.2024.12.031","DOIUrl":"10.1016/j.amjcard.2024.12.031","url":null,"abstract":"<div><div>Chronic limb-threatening ischemia (CLTI), the severest stage of peripheral artery disease, frequently necessitates amputation. In CLTI patients, heart failure with reduced ejection fraction (HFrEF) markedly raises mortality risk, with increased peripheral vascular resistance contributing to this exacerbation. This investigation aimed to assess the impact of major amputation (MA) on the cardiovascular (CV) prognosis in CLTI patients with HFrEF by lowering peripheral vascular resistance. Conducting a retrospective, observational analysis at a single center, a total of 60 patients with CLTI and HFrEF (EF < 50%) who underwent endovascular therapy (EVT) at our institution were assessed. We compared CV outcomes in CLTI patients with HFrEF who received MA (<em>n</em> = 17) to those who did not (<em>n</em> = 43) after undergoing EVT. During the follow-up period, which median 641 (IQR: 245 to 1,734) days post-EVT, a composite primary endpoint of CV death or hospitalization for HF was observed. During the study period, 19 patients (32%) were admitted for HF or died as a consequence of CV events. Kaplan-Meier analysis revealed a significantly reduced incidence of the primary endpoint in the MA cohort (log-rank test: p = 0.035). Adjustments for age and sex showed MA was significantly linked to improved CV prognosis (HR: 0.19; 95% confidence interval: 0.04 to 0.87). A nonsignificant trend toward decreased overall mortality was noted in the MA group, with infections being the predominant cause of death across both groups. In conclusion, in CLTI patients with HFrEF, MA might be linked to reduced CV events, proposing it as a potential definitive strategy for improving CV outcomes in this high-risk population.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"240 ","pages":"Pages 17-23"},"PeriodicalIF":2.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920542","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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