American Journal of Cardiology最新文献

英文中文

Utility of the Euroscore II in Predicting Long-Term Outcomes in a Contemporary Australian Cohort With Complex Coronary Artery Disease. 欧洲评分II在预测当代澳大利亚复杂冠状动脉疾病队列长期预后中的应用

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-12-01 Epub Date: 2025-07-15 DOI: 10.1016/j.amjcard.2025.07.014

Jack Lewis Bradbury, Thalys Sampaio Rodrigues, Manasha Kumarasiri, Oliver Joshua Nilsen, Michael Luc, Matias Benjamin Yudi, Julian Yeoh, David John Clark, James Theuerle, Anoop Ninan Koshy

The EuroSCORE II is a widely used risk stratification tool for estimating perioperative mortality in cardiac surgery. However, its prognostic utility in broader coronary artery disease (CAD) management, including in patients undergoing percutaneous coronary intervention (PCI) or medical therapy, is less well defined. We conducted a retrospective cohort study of patients with complex CAD discussed in a multidisciplinary Heart Team meeting at a tertiary Australian centre (2019-2024). EuroSCORE II was calculated for each patient, with a threshold of ≥2% used to define higher risk. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and all-cause mortality. Associations were assessed using Cox proportional hazards models, ROC analysis, and Kaplan-Meier survival estimates. Overall, 546 patients were included (mean age 67 years, 17% female sex) with a median EuroSCORE II of 1.19% (IQR 0.78-2.03) Final treatment strategies were CABG (65.2%), PCI (12.6%), or medical therapy (19.6%). Over a median follow-up of 3.2 years, 79 patients (14.5%) experienced MACE. EuroSCORE II ≥2% was significantly associated with higher risk of MACE (HR 2.58, 95% CI 1.65-4.05, p < 0.001). Predictive accuracy was limited (AUC 0.66), with an AUC of 0.59, 0.72 and 0.66 for CABG, PCI and medical therapy, respectively. In conclusion, in a contemporary Heart Team setting, EuroSCORE II ≥2% was independently associated with long-term MACE and mortality across treatment strategies. These findings suggest that EuroSCORE II may serve as a pragmatic adjunct to guide risk stratification and treatment planning beyond its traditional surgical context.

EuroSCORE II是一种广泛使用的风险分层工具，用于估计心脏手术围手术期死亡率。然而，在更广泛的冠状动脉疾病（CAD）治疗中，包括经皮冠状动脉介入治疗（PCI）或药物治疗的患者，其预后效用尚不明确。我们对复杂CAD患者进行了一项回顾性队列研究，该研究在澳大利亚三级中心的多学科心脏小组会议上讨论（2019-2024）。计算每位患者的EuroSCORE II，使用≥2%的阈值来定义高风险。主要终点是主要不良心血管事件（MACE）的综合，包括心肌梗死、卒中和全因死亡率。使用Cox比例风险模型、ROC分析和Kaplan-Meier生存估计来评估相关性。总体而言，纳入546例患者（平均年龄67岁，17%为女性），中位EuroSCORE II为1.19% (IQR 0.78-2.03)，最终治疗策略为CABG (65.2%)， PCI（12.6%）或药物治疗（19.6%）。在中位随访3.2年期间，79名患者（14.5%）经历了MACE。EuroSCORE II≥2%与MACE高风险显著相关（HR 2.58, 95% CI 1.65-4.05, p < 0.001）。预测准确性有限（AUC 0.66）， CABG、PCI和内科治疗的AUC分别为0.59、0.72和0.66。总之，在当代心脏团队环境中，EuroSCORE II≥2%与治疗策略的长期MACE和死亡率独立相关。这些发现表明，EuroSCORE II可以作为一种实用的辅助手段，指导风险分层和治疗计划，而不是传统的外科手术。

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引用次数: 0

Optimizing Abdominal Aortic Aneurysm Imaging to Improve Access, Clinical Utility, and Value-Based Medicine 优化腹主动脉瘤成像以改善获取、临床应用和基于价值的医学。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-12-01 DOI: 10.1016/j.amjcard.2025.11.008

Daniel Raskin MD , Sasan Partovi MD , Abraham Levitin MD , Paul Schoenhagen MD, PhD , Sean P. Lyden MD , Gregory Piazza MD , Levester Kirksey MD

Abdominal aortic aneurysm (AAA) care relies on imaging for screening, surveillance, prerepair planning, and postrepair follow-up, yet both overuse and underuse can harm patients and inflate costs. We performed a narrative synthesis of contemporary guidelines and primary studies to outline a value-based pathway that emphasizes clinical safety, equity, and resource stewardship. Evidence supports an ultrasound-first strategy for unrepaired AAAs, targeted 1-time ultrasound screening in at-risk populations, and a single computed tomography angiogram (CTA) before repair to define anatomy and device planning. After endovascular aneurysm repair (EVAR), routine follow-up can be centered on duplex ultrasonography (DUS) ± contrast-enhanced ultrasound (CEUS), reserving computed tomography angiogram (CTA)/MRA for sac growth, suspected endoleak, or complex repairs. Implementation levers include guideline-embedded order sets, automated capture of incidental AAAs, and operational steps that improve access for disadvantaged patients. In conclusion, a risk-adapted, ultrasound-lean imaging strategy preserves outcomes while lowering cumulative radiation exposure, reducing expenditures, and improving access, thereby advancing value-based cardiovascular care.

腹主动脉瘤（AAA）的护理依赖于影像学筛查、监测、修复前计划和修复后随访，然而过度使用和使用不足都会伤害患者并增加费用。我们对当代指南和初步研究进行了叙述性综合，概述了一条以价值为基础的途径，强调临床安全性、公平性和资源管理。有证据支持对未修复的AAAs采用超声优先策略，在高危人群中进行有针对性的一次性超声筛查，并在修复前进行一次计算机断层扫描血管造影（CTA），以确定解剖结构和设备计划。血管内动脉瘤修复（EVAR）后，常规随访可以双工超声（DUS）±造影增强超声（CEUS）为中心，保留CTA/MRA用于囊生长、疑似内漏或复杂修复。实现杠杆包括指南嵌入的订单集、偶然AAAs的自动捕获以及改善弱势患者访问的操作步骤。总之，适应风险的超声精益成像策略在降低累积辐射暴露、减少支出和改善可及性的同时保留了结果，从而推进了基于价值的心血管护理。

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引用次数: 0

Hospitalization Outcomes After Acute Myocardial Infarction in Patients With Prior Thoracic Irradiation 既往胸部放疗患者急性心肌梗死后的住院结果

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-12-01 DOI: 10.1016/j.amjcard.2025.11.010

Sahil Ghay DO , Aren Singh Saini BS , Baneet Kaur DO , Armando A. Vera MD , Derek M. Isrow MD

Thoracic radiation therapy is a cornerstone in the treatment of malignancies such as breast cancer, lung cancer, esophageal cancer, and lymphoma. While its long-term cardiac risks are well known, there is limited data on how prior thoracic irradiation is associated with outcomes in patients hospitalized with acute myocardial infarction (AMI). This study evaluates the association between prior chest irradiation and in-hospital outcomes among patients admitted with AMI. A retrospective cohort study using the National Inpatient Sample (2016–2022) was conducted. Adult AMI admissions were identified via ICD-10 codes and stratified by history of thoracic radiation. Multivariable regression and propensity matching were used to evaluate the association of prior radiation on in-hospital mortality (primary outcome), and secondary outcomes including hospitalization cost, length of stay, and use of intensive interventions. Of 4,353,204 AMI hospitalizations, 5,280 had a history of thoracic radiation. Prior radiation was associated with increased in-hospital mortality (aOR: 1.55, 95% CI 1.06 to 2.27, p = 0.023). There were no significant differences in hospitalization cost (−$6,126, p = 0.196) or length of stay (−0.20 days, p = 0.327). Patients with prior radiation were more likely to have do-not-resuscitate orders (aOR: 2.15, p <0.001) and receive palliative care consultations (aOR: 2.43, p <0.001). Prior thoracic radiation is associated with worse in-hospital survival following AMI, along with greater palliative involvement and end-of-life care decisions. These findings underscore the need for cardio-oncology–informed inpatient care in this high-risk population.

背景：胸部放射治疗是乳腺癌、肺癌、食管癌和淋巴瘤等恶性肿瘤治疗的基础。虽然其长期心脏风险是众所周知的，但关于先前胸部照射与急性心肌梗死（AMI）住院患者预后的关系的数据有限。目的：本研究评估AMI患者既往胸部照射与住院预后的关系。方法：采用2016-2022年全国住院患者样本进行回顾性队列研究。通过ICD-10编码确定成人AMI入院，并根据胸部放疗史进行分层。使用多变量回归和倾向匹配来评估既往放疗与住院死亡率（主要结局）和次要结局（包括住院费用、住院时间和强化干预措施的使用）之间的关系。结果：在4,353,204例AMI住院患者中，5,280例有胸部放疗史。既往放疗与住院死亡率增加相关（aOR: 1.55, 95% CI: 1.06-2.27, p = 0.023）。住院费用（- 6126美元，p = 0.196）或住院时间（-0.20天，p = 0.327）无显著差异。既往放疗的患者更有可能获得不复苏命令（aOR: 2.15, p < 0.001）和接受姑息治疗咨询（aOR: 2.43, p < 0.001）。结论：先前的胸部放疗与AMI后较差的住院生存率相关，同时也与更多的姑息治疗和临终关怀决定相关。这些发现强调了在这一高危人群中进行心脏肿瘤学知情住院治疗的必要性。

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引用次数: 0

TriNetX Methodology Concerns in a Retrospective Study of Sodium-Glucose Cotransporter-2 Inhibitors in Transthyretin Amyloid Cardiomyopathy. TriNetX方法涉及转甲状腺素淀粉样心肌病钠-葡萄糖共转运蛋白-2抑制剂的回顾性研究。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-12-01 Epub Date: 2025-07-21 DOI: 10.1016/j.amjcard.2025.07.019

Chien-An Hsieh, Joshua Wang

引用次数: 0

Intravascular Lithotripsy in Diabetic Patients Undergoing Percutaneous Coronary Intervention: Long-Term Outcomes from the BENELUX Registry 经皮冠状动脉介入治疗的糖尿病患者血管内碎石术：来自比荷卢注册中心的长期结果

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-27 DOI: 10.1016/j.amjcard.2025.11.007

Akshay A.S. Phagu MD , Martijn J.H. van Oort MSc , Federico Oliveri MD , Brian O. Bingen MD, PhD , Valeria Paradies MD , Gianluca Mincione MD , Bimmer E.P.M. Claessen MD, PhD , Aukelien C. Dimitriu-Leen MD, PhD , Tessel N. Vossenberg MD , Joelle Kefer MD, PhD , Alessandro Mandurino-Mirizzi MD , Marios Sagris MD, PhD , Frank van der Kley MD, PhD , J. Wouter Jukema MD, PhD , Ibtihal Al Amri MD, PhD , Jose M. Montero-Cabezas MD, PhD

Diabetes mellitus (DM) is associated with increased coronary calcification and adverse outcomes after percutaneous coronary intervention (PCI), yet the performance of intravascular lithotripsy (IVL) in this high-risk population remains insufficiently defined. This study, conducted within the all-comers BENELUX-IVL registry, evaluated the safety and efficacy of IVL-assisted PCI in patients with and without DM. The primary endpoint was major adverse cardiovascular events (MACE) at 1 and 2 years, defined as cardiovascular death, nonfatal myocardial infarction, or clinically driven target vessel revascularization. Secondary endpoints included procedural outcomes, complications, and all-cause mortality. A total of 574 patients were included, of whom 193 (33.6%) had DM and 381 (66.4%) did not. Procedural (87.0% vs 89.5%; p = 0.381) and device success (95.3% vs 97.9%; p = 0.087) were similar between groups. Post-PCI minimum lumen diameter (2.80 ± 0.59 vs 2.95 ± 0.70 mm; p = 0.027) and area (6.0 [4.80 to 7.75] vs 6.6 [4.98 to 8.90] mm²; p = 0.045) were smaller in patients with DM. Thirty-day MACE was higher among diabetics (3.1% vs 0.3%; p = 0.007), whereas 1- and 2-year MACE and mortality rates were comparable. Diabetes was not independently associated with mortality (adjusted OR 1.51; p = 0.17). In conclusion, IVL-assisted PCI is safe and effective in diabetic patients, with long-term outcomes comparable to those without diabetes, although the higher early MACE risk, particularly in type 1 DM, warrants careful procedural planning and follow-up.

糖尿病（DM）与冠状动脉钙化增加和经皮冠状动脉介入治疗（PCI）后的不良后果相关，然而血管内碎石（IVL）在这一高危人群中的表现仍不明确。本研究在所有患者的BENELUX-IVL注册表中进行，评估了ivl辅助PCI在有和没有糖尿病患者中的安全性和有效性。主要终点是1年和2年的主要不良心血管事件（MACE），定义为心血管死亡、非致死性心肌梗死或临床驱动的靶血管重建术。次要终点包括手术结果、并发症和全因死亡率。共纳入574例患者，其中193例（33.6%）患有糖尿病，381例（66.4%）未患糖尿病。手术成功率（87.0% vs. 89.5%; p = 0.381）和器械成功率（95.3% vs. 97.9%; p = 0.087）组间相似。DM患者pci术后最小管腔直径（2.80±0.59 vs 2.95±0.70 mm; p = 0.027）和面积（6.0 [4.80-7.75]vs 6.6 [4.98-8.90] mm²；p = 0.045）较小。糖尿病患者30天MACE较高（3.1% vs. 0.3%; p = 0.007），而1年和2年MACE和死亡率相当。糖尿病与死亡率无独立相关性（调整后OR为1.51;p = 0.17）。总之，ivl辅助PCI对糖尿病患者是安全有效的，其长期预后与非糖尿病患者相当，尽管早期MACE风险较高，特别是1型糖尿病，需要仔细的手术计划和随访。

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引用次数: 0

Corrigendum to “Impact of CCTA/FFRCT on Referrals for Invasive Coronary Angiography and Revascularization in a Community-Based Health System” American Journal of Cardiology. 257(2025)16-17 《CCTA/FFRCT对有创冠状动脉造影和社区卫生系统血运重建的影响》美国心脏病杂志257(2025)16-17。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-27 DOI: 10.1016/j.amjcard.2025.09.003

Wesley T. O’Neal MD , Gayatri Acharya MD , Sara Wallace RN, BSN , Merle Prescott RN, BSN, MSc , Aaron Pifer MHA , Jimmy T. Efird PhD, MSc , Thomas Stuckey MD

引用次数: 0

Road Exposure After Cardioverter-Defibrillator Implantation and its Potential Influence on Reported Motor Vehicle Crash Risks 心脏转复除颤器植入后的道路暴露及其对机动车碰撞风险的潜在影响。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-26 DOI: 10.1016/j.amjcard.2025.11.011

John A. Staples MD , Daniel Daly-Grafstein PhD , Mayesha Khan MA , Shannon Erdelyi MSc , Nathaniel M. Hawkins MD , Herbert Chan PhD , Santabhanu Chakrabarti MD , Christian Steinberg MD , Andrew D. Krahn MD , Jeffrey R. Brubacher MD

Many individuals transiently reduce their road exposure (kilometers or hours of driving per month) after receiving an implantable cardioverter-defibrillator (ICD). This markedly influences interpretation of monthly crash risks, but very few studies describe real-world road exposure after ICD implantation. We obtained 18 years of population-based health and driving data for drivers undergoing ICD implantation in British Columbia, Canada. We estimated drivers’ monthly "road exposure relative to baseline" (RERB) after ICD implantation (0 = complete cessation of driving; 1 = road exposure unchanged), using clinical data to infer the duration of compulsory driving restrictions, and using published data to account for incomplete adherence to restrictions and voluntary reductions in road exposure by month since implantation. We then used estimated RERB to calculate exposure-adjusted crash risks. Among 3,454 primary prevention ICD recipients, RERB-adjusted crash rate in the first month after implantation was not significantly different than among matched controls (mean recipient RERB = 0.29; adjusted incidence rate ratio [aIRR] = 2.22, 95% CI 0.72 to 6.87), but sensitivity analyses suggested that crash rate adjusted for a plausible lower-bound RERB estimate was ∼5-fold higher than among controls. Among 3,070 secondary prevention ICD recipients, RERB-adjusted crash rate in the first 6 months after implantation was not significantly different than among matched controls (mean recipient RERB = 0.50; aIRR = 1.11, 95% CI 0.77 to 1.61), but sensitivity analyses indicated that crash rate in the first 3 months after implantation adjusted for a plausible lower-bound RERB estimate was ∼2-fold higher than among controls. In conclusion, the substantial transient reductions in road exposure after ICD implantation should inform interpretation of monthly crash risks.

许多人在接受植入式心脏转复除颤器（ICD）后，短暂地减少了他们的道路暴露（每月驾驶公里或小时）。这明显影响了对每月碰撞风险的解释，但很少有研究描述ICD植入后现实世界的道路暴露。我们获得了加拿大不列颠哥伦比亚省接受ICD植入的司机18年的基于人群的健康和驾驶数据。我们估计了ICD植入后司机每月“相对于基线的道路暴露”（RERB）（0=完全停止驾驶；1=道路暴露不变），使用临床数据推断强制驾驶限制的持续时间，并使用公开的数据来解释不完全遵守限制和自植入以来每月自愿减少道路暴露。然后，我们使用估计的RERB来计算暴露调整后的崩溃风险。在3454名一级预防ICD受者中，植入后第一个月经RERB调整的碰撞率与匹配对照组无显著差异（平均受者RERB=0.29；调整后发病率比[aIRR]=2.22, 95%CI 0.72-6.87），但敏感性分析表明，经合理的RERB下界估计调整后的碰撞率比对照组高约5倍。在3070名二级预防ICD受者中，植入后前6个月经RERB调整的碰撞率与匹配对照组没有显著差异（平均受者RERB=0.50; aIRR=1.11, 95%CI 0.77-1.61），但敏感性分析表明，植入后前3个月的碰撞率调整为合理的低边界RERB估计值，比对照组高约2倍。综上所述，ICD植入后道路暴露量的短暂大幅减少应该为月度碰撞风险的解释提供依据。

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引用次数: 0

One Ring to Rule Them All: A Commentary on “Impacts of Mitral Annular Calcification on Heart Failure With Preserved Ejection Fraction” 一环统治一切：关于“二尖瓣环钙化对保留射血分数的心力衰竭的影响”的评论。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-26 DOI: 10.1016/j.amjcard.2025.11.006

Lauryn E. Spinetta BA , Christopher A. Heid MD

引用次数: 0

Bicuspid and Unicuspid Aortic Valves: Development, Genetics, and Lifelong Management 二尖瓣和单尖瓣主动脉瓣：发育、遗传和终身管理。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-25 DOI: 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.

双尖瓣和单尖瓣主动脉瓣是最常见的先天性主动脉瓣畸形，在整个生命周期的临床管理中提出了独特的挑战。这些异常与进行性瓣膜功能障碍和主动脉病变有关，通常需要早期干预。许多出版物描述了影响三尖瓣的主动脉瓣狭窄（AS）的终身管理。本文综述了单尖瓣和二尖瓣主动脉瓣的胚胎学基础、自然史和临床谱，重点介绍了诊断策略、监测方案和经导管手术干预。重点放在纵向护理，包括从儿科到成人先天性心脏病学的过渡，多模态成像，以及手术或经导管干预的时机。总之，本文旨在为这些复杂的瓣膜-主动脉疾病的循证、个体化治疗提供一个框架。

引用次数: 0

Higher Mortality in Male Patients with Takotsubo Cardiomyopathy Appears to Be Related to Higher Complication Rates Takotsubo心肌病男性患者较高的死亡率似乎与较高的并发症发生率有关。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-25 DOI: 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

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