Pub Date : 2025-10-22DOI: 10.1016/j.amjcard.2025.10.015
Monika Gawałko MD, PhD , Monika Budnik MD, PhD , Piotr Scisło MD, PhD , Radosław Piątkowski MD, PhD , Beata Uziębło-Życzkowska MD, PhD , Paweł Krzesiński MD, PhD , Katarzyna Starzyk MD, PhD , Beata Wożakowska-Kapłon MD, PhD , Ludmiła Daniłowicz-Szymanowicz MD, PhD , Damian Kaufmann MD, PhD , Maciej Wójcik MD, PhD , Robert Błaszczyk MD, PhD , Konrad Pieszko MD, PhD , Katarzyna Łojewska MD, PhD , Jarosław Hiczkiewicz MD, PhD , Maciej Wybraniec MD, PhD , Katarzyna Mizia-Stec MD, PhD , Katarzyna Kosmalska MD, PhD , Marcin Fijałkowski MD, PhD , Anna Szymańska MD, PhD , Agnieszka Kapłon-Cieślicka MD, PhD
Current guidelines highlight limited evidence on optimal anticoagulation for atrial fibrillation/flutter (AF/AFl) patients with left atrial thrombus (LAT). This study aimed to assess changes in anticoagulation and their association with LAT resolution in AF/AFl patients. Consecutive patients with AF/AFl undergoing transoesophageal echocardiography (TEE) before direct current cardioversion or ablation at 13 cardiology centres were included. Of 3109 patients enrolled, 8.0% (n = 250) had LAT on TEE, with 46% (n = 116) undergoing follow-up TEE, among whom LAT resolved in 55% (n = 64). No statistically significant predictors of LAT resolution were identified. Baseline characteristics were similar across anticoagulation groups, except for higher prevalence of heart failure in dabigatran users. Switching from vitamin K antagonists (VKAs) to non-VKA oral anticoagulants (NOACs) was associated with lower LAT prevalence (15%) compared to remaining on VKA (50%) or switching to low-molecular-weight heparin (75%, p = 0.022). All patients who continued apixaban had persistent LAT at follow-up, while none who switched from apixaban to another NOAC showed LAT (p = 0.033). Other switching strategies showed no statistically significant differences in LAT prevalence during follow-up. In conclusion, LAT resolved in over half of patients who underwent follow-up. LAT resolution may be associated with changes in anticoagulation, but confirmation in randomized trials is needed.
{"title":"Changes in Anticoagulation Treatment and Associated Resolution or Persistence of Left Atrial Thrombus: Insights from LATTEE Registry","authors":"Monika Gawałko MD, PhD , Monika Budnik MD, PhD , Piotr Scisło MD, PhD , Radosław Piątkowski MD, PhD , Beata Uziębło-Życzkowska MD, PhD , Paweł Krzesiński MD, PhD , Katarzyna Starzyk MD, PhD , Beata Wożakowska-Kapłon MD, PhD , Ludmiła Daniłowicz-Szymanowicz MD, PhD , Damian Kaufmann MD, PhD , Maciej Wójcik MD, PhD , Robert Błaszczyk MD, PhD , Konrad Pieszko MD, PhD , Katarzyna Łojewska MD, PhD , Jarosław Hiczkiewicz MD, PhD , Maciej Wybraniec MD, PhD , Katarzyna Mizia-Stec MD, PhD , Katarzyna Kosmalska MD, PhD , Marcin Fijałkowski MD, PhD , Anna Szymańska MD, PhD , Agnieszka Kapłon-Cieślicka MD, PhD","doi":"10.1016/j.amjcard.2025.10.015","DOIUrl":"10.1016/j.amjcard.2025.10.015","url":null,"abstract":"<div><div>Current guidelines highlight limited evidence on optimal anticoagulation for atrial fibrillation/flutter (AF/AFl) patients with left atrial thrombus (LAT). This study aimed to assess changes in anticoagulation and their association with LAT resolution in AF/AFl patients. Consecutive patients with AF/AFl undergoing transoesophageal echocardiography (TEE) before direct current cardioversion or ablation at 13 cardiology centres were included. Of 3109 patients enrolled, 8.0% (n = 250) had LAT on TEE, with 46% (n = 116) undergoing follow-up TEE, among whom LAT resolved in 55% (n = 64). No statistically significant predictors of LAT resolution were identified. Baseline characteristics were similar across anticoagulation groups, except for higher prevalence of heart failure in dabigatran users. Switching from vitamin K antagonists (VKAs) to non-VKA oral anticoagulants (NOACs) was associated with lower LAT prevalence (15%) compared to remaining on VKA (50%) or switching to low-molecular-weight heparin (75%, p = 0.022). All patients who continued apixaban had persistent LAT at follow-up, while none who switched from apixaban to another NOAC showed LAT (p = 0.033). Other switching strategies showed no statistically significant differences in LAT prevalence during follow-up. In conclusion, LAT resolved in over half of patients who underwent follow-up. LAT resolution may be associated with changes in anticoagulation, but confirmation in randomized trials is needed.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 340-345"},"PeriodicalIF":2.1,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367325","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 : 2025-10-22DOI: 10.1016/j.amjcard.2025.10.019
Barbara Zdzierak MD, PhD, Agata Krawczyk-Ożóg MD, PhD, Tomasz Rakowski MD, PhD, Artur Dziewierz MD, PhD
{"title":"The First 10 Minutes: Sex Disparities in Myocardial Infarction Begin at the Door","authors":"Barbara Zdzierak MD, PhD, Agata Krawczyk-Ożóg MD, PhD, Tomasz Rakowski MD, PhD, Artur Dziewierz MD, PhD","doi":"10.1016/j.amjcard.2025.10.019","DOIUrl":"10.1016/j.amjcard.2025.10.019","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 255-256"},"PeriodicalIF":2.1,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353489","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 : 2025-10-22DOI: 10.1016/j.amjcard.2025.10.013
Rita Micaelo Grilo MD , L. Menezes Falcão MD, PhD
Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent subtype of heart failure. It is characterized by a heterogeneous clinical phenotype, a less understood pathophysiology, and multifactorial etiologies. A frequent comorbidity of HFpEF is chronic kidney disease (CKD). The cardiorenal phenotype in HFpEF is growing in prevalence and represents a high-risk clinical population. HFpEF and CKD are interconnected through complex, bidirectional processes involving systemic inflammation, neurohormonal activation, hemodynamic changes, and iron deficiency. These overlapping processes, along with common risk factors, exacerbate disease presentation and progression, contributing to significantly worse outcomes, including higher rates of hospitalization, mortality, and progression to end-stage kidney disease. Historically, treatment options for HFpEF have been limited, but recent studies have identified agents with both cardiovascular and renal benefits. Emerging therapies, such as SGLT2 inhibitors, nonsteroidal MRAs, and GLP-1 receptor agonists, offer a new hope for improving outcomes in the HFpEF cardiorenal population. However, challenges related to diagnosis, volume and potassium management, and barriers such as underdiagnosis and undertreatment still remain. An integrative, multidisciplinary approach is essential for effectively managing patients with both HFpEF and CKD.
{"title":"Heart Failure With Preserved Ejection Fraction and Chronic Kidney Disease: From Pathophysiology to Treatment","authors":"Rita Micaelo Grilo MD , L. Menezes Falcão MD, PhD","doi":"10.1016/j.amjcard.2025.10.013","DOIUrl":"10.1016/j.amjcard.2025.10.013","url":null,"abstract":"<div><div>Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent subtype of heart failure. It is characterized by a heterogeneous clinical phenotype, a less understood pathophysiology, and multifactorial etiologies. A frequent comorbidity of HFpEF is chronic kidney disease (CKD). The cardiorenal phenotype in HFpEF is growing in prevalence and represents a high-risk clinical population. HFpEF and CKD are interconnected through complex, bidirectional processes involving systemic inflammation, neurohormonal activation, hemodynamic changes, and iron deficiency. These overlapping processes, along with common risk factors, exacerbate disease presentation and progression, contributing to significantly worse outcomes, including higher rates of hospitalization, mortality, and progression to end-stage kidney disease. Historically, treatment options for HFpEF have been limited, but recent studies have identified agents with both cardiovascular and renal benefits. Emerging therapies, such as SGLT2 inhibitors, nonsteroidal MRAs, and GLP-1 receptor agonists, offer a new hope for improving outcomes in the HFpEF cardiorenal population. However, challenges related to diagnosis, volume and potassium management, and barriers such as underdiagnosis and undertreatment still remain. An integrative, multidisciplinary approach is essential for effectively managing patients with both HFpEF and CKD.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 287-301"},"PeriodicalIF":2.1,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367328","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 : 2025-10-22DOI: 10.1016/j.amjcard.2025.10.006
Gal Sella MD , Chloe Kharsa MD, MSc , Yasser M. Sammour MD, MSc , Rody G. Bou Chaaya MD , Mangesh Kritya MD , Yueh-Yun Lin PhD, MS , Anshuj Deva MS , Jerrin Philip MD , Muhammad Haisum Maqsood MD , Neal S. Kleiman MD , Alpesh R. Shah MD
This study examined the impact of body mass index (BMI) on procedural and long-term outcomes following percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). While obesity is an established cardiovascular risk factor, an “obesity paradox” has been observed in various cardiac interventions, but contemporary data in CTO PCI are limited. We analyzed 503 consecutive CTO PCI procedures in 453 patients at our institution between January 2018 and December 2023, stratified by BMI into obese (≥30 kg/m², n = 213, 42.4%), overweight (25-29.9 kg/m², n = 194, 38.6%), and healthy weight (18.5-24.9 kg/m², n = 96, 19.1%). The primary endpoint was a composite of in-stent restenosis requiring revascularization, heart failure hospitalization, myocardial infarction, and stroke at a median follow-up of 704 days. Obese patients were younger (median 64.0 vs 67.0 vs 68.5 years, p < 0.001) and less frequently current smokers (8.5% vs 10.3% vs 19.8%, p = 0.012). Technical and procedural success were lower in obese patients (79.8% vs 75.8% vs 92.7% and 79.3% vs 75.3% vs 92.7%, respectively; p = 0.002), while radiation exposure increased significantly with BMI (median air kerma: 2385 vs 1688 vs 1126 mGy, p < 0.001). At follow-up, the composite endpoint occurred in 16.5% vs 12.3% vs 16.3% (p = 0.492), with similar all-cause mortality (3.9% vs 6.4% vs 7.0%, p = 0.425). On multivariable analysis, male sex was associated with lower risk of adverse outcomes (HR 0.53, 95% CI 0.30 to 0.95), while baseline heart failure was associated with higher risk (HR 1.83, 95% CI 1.04 to 3.25). In conclusion, despite significantly lower technical and procedural success rates and higher radiation exposure, obese patients undergoing CTO PCI had comparable long-term outcomes to healthy weight patients, supporting the obesity paradox. These findings suggest that BMI alone should not preclude CTO PCI but mandate enhanced radiation safety protocols and careful patient counseling regarding procedural success expectations.
{"title":"The Obesity Paradox in Chronic Total Occlusion Percutaneous Coronary Intervention: Contemporary Outcomes Across Body Mass Index Categories","authors":"Gal Sella MD , Chloe Kharsa MD, MSc , Yasser M. Sammour MD, MSc , Rody G. Bou Chaaya MD , Mangesh Kritya MD , Yueh-Yun Lin PhD, MS , Anshuj Deva MS , Jerrin Philip MD , Muhammad Haisum Maqsood MD , Neal S. Kleiman MD , Alpesh R. Shah MD","doi":"10.1016/j.amjcard.2025.10.006","DOIUrl":"10.1016/j.amjcard.2025.10.006","url":null,"abstract":"<div><div>This study examined the impact of body mass index (BMI) on procedural and long-term outcomes following percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). While obesity is an established cardiovascular risk factor, an “obesity paradox” has been observed in various cardiac interventions, but contemporary data in CTO PCI are limited. We analyzed 503 consecutive CTO PCI procedures in 453 patients at our institution between January 2018 and December 2023, stratified by BMI into obese (≥30 kg/m², <em>n</em> = 213, 42.4%), overweight (25-29.9 kg/m², <em>n</em> = 194, 38.6%), and healthy weight (18.5-24.9 kg/m², <em>n</em> = 96, 19.1%). The primary endpoint was a composite of in-stent restenosis requiring revascularization, heart failure hospitalization, myocardial infarction, and stroke at a median follow-up of 704 days. Obese patients were younger (median 64.0 vs 67.0 vs 68.5 years, p < 0.001) and less frequently current smokers (8.5% vs 10.3% vs 19.8%, p = 0.012). Technical and procedural success were lower in obese patients (79.8% vs 75.8% vs 92.7% and 79.3% vs 75.3% vs 92.7%, respectively; p = 0.002), while radiation exposure increased significantly with BMI (median air kerma: 2385 vs 1688 vs 1126 mGy, p < 0.001). At follow-up, the composite endpoint occurred in 16.5% vs 12.3% vs 16.3% (p = 0.492), with similar all-cause mortality (3.9% vs 6.4% vs 7.0%, p = 0.425). On multivariable analysis, male sex was associated with lower risk of adverse outcomes (HR 0.53, 95% CI 0.30 to 0.95), while baseline heart failure was associated with higher risk (HR 1.83, 95% CI 1.04 to 3.25). In conclusion, despite significantly lower technical and procedural success rates and higher radiation exposure, obese patients undergoing CTO PCI had comparable long-term outcomes to healthy weight patients, supporting the obesity paradox. These findings suggest that BMI alone should not preclude CTO PCI but mandate enhanced radiation safety protocols and careful patient counseling regarding procedural success expectations.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 309-319"},"PeriodicalIF":2.1,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367352","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 : 2025-10-22DOI: 10.1016/j.amjcard.2025.10.018
Martijn J.H. van Oort MSc , Akshay A.S. Phagu MD , Federico Oliveri MD , Brian O. Bingen MD, PhD , Gianluca Mincione MD , Valeria Paradies 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 , Frank van der Kley MD, PhD , J. Wouter Jukema MD, PhD , Ibtihal Al Amri MD, PhD , Jose M. Montero-Cabezas MD, PhD
Intravascular lithotripsy (IVL) has emerged as a viable treatment option for calcified coronary lesions. This study aimed to identify clinical and procedural factors associated with major adverse cardiovascular events (MACE) following IVL. This retrospective analysis included 583 patients (72.9 ± 9 years, 74% male) treated with IVL for 612 lesions from the multicenter BENELUX-IVL registry (May 2019-December 2024). Kaplan–Meier analysis was performed to evaluate survival probability. Binary logistic regression analysis was performed to identify predictors of MACE, including cardiac death, nonfatal myocardial infarction (MI) or clinically driven target vessel revascularization (TVR) at 1-year follow-up. Patients presented with acute coronary syndrome in 246 cases (42%), while a variety of target lesions was treated, including in-stent lesions (n = 185, 30%), aorta-ostial lesions (n = 148=24%), bifurcation lesions (n = 135, 22%) and chronic total occlusions (CTOs)(n = 45, 7%). MACE occurred in 44 patients (11%) at 1-year and in 53 patients (18%) at 2-years follow-up. Occurrence of procedural complications (p <0.001), CTOs (p = 0.020), in-stent lesions (p = 0.044), post-IVL plaque modification (p = 0.003) and greater postprocedural residual diameter stenosis on fluoroscopy (p = 0.006) were associated with the occurrence of MACE, while MI in the medical history (p = 0.001) was negatively associated with MACE. Following treatment with IVL in a real-world registry, clinical outcomes up to 2-years follow-up were favorable. Procedural complications, CTOs, in-stent lesions, performance of post-IVL plaque modification and greater postprocedural residual diameter stenosis on fluoroscopy were independent risk factors for experiencing MACE at 1-year follow-up. In contrast, a history of MI was associated with a lower risk of MACE.
{"title":"Clinical and Technical Predictors of Adverse Cardiovascular Events Following Coronary Lithotripsy in the BENELUX-IVL Registry","authors":"Martijn J.H. van Oort MSc , Akshay A.S. Phagu MD , Federico Oliveri MD , Brian O. Bingen MD, PhD , Gianluca Mincione MD , Valeria Paradies 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 , Frank van der Kley MD, PhD , J. Wouter Jukema MD, PhD , Ibtihal Al Amri MD, PhD , Jose M. Montero-Cabezas MD, PhD","doi":"10.1016/j.amjcard.2025.10.018","DOIUrl":"10.1016/j.amjcard.2025.10.018","url":null,"abstract":"<div><div>Intravascular lithotripsy (IVL) has emerged as a viable treatment option for calcified coronary lesions. This study aimed to identify clinical and procedural factors associated with major adverse cardiovascular events (MACE) following IVL. This retrospective analysis included 583 patients (72.9 ± 9 years, 74% male) treated with IVL for 612 lesions from the multicenter BENELUX-IVL registry (May 2019-December 2024). Kaplan–Meier analysis was performed to evaluate survival probability. Binary logistic regression analysis was performed to identify predictors of MACE, including cardiac death, nonfatal myocardial infarction (MI) or clinically driven target vessel revascularization (TVR) at 1-year follow-up. Patients presented with acute coronary syndrome in 246 cases (42%), while a variety of target lesions was treated, including in-stent lesions (<em>n</em> = 185, 30%), aorta-ostial lesions (<em>n</em> = 148=24%), bifurcation lesions (<em>n</em> = 135, 22%) and chronic total occlusions (CTOs)(<em>n</em> = 45, 7%). MACE occurred in 44 patients (11%) at 1-year and in 53 patients (18%) at 2-years follow-up. Occurrence of procedural complications (p <0.001), CTOs (p = 0.020), in-stent lesions (p = 0.044), post-IVL plaque modification (p = 0.003) and greater postprocedural residual diameter stenosis on fluoroscopy (p = 0.006) were associated with the occurrence of MACE, while MI in the medical history (p = 0.001) was negatively associated with MACE. Following treatment with IVL in a real-world registry, clinical outcomes up to 2-years follow-up were favorable. Procedural complications, CTOs, in-stent lesions, performance of post-IVL plaque modification and greater postprocedural residual diameter stenosis on fluoroscopy were independent risk factors for experiencing MACE at 1-year follow-up. In contrast, a history of MI was associated with a lower risk of MACE.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 261-267"},"PeriodicalIF":2.1,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367371","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 : 2025-10-17DOI: 10.1016/j.amjcard.2025.10.007
Julio Echarte-Morales MD , Juan Torrado MD, PhD , Andrea Scotti MD , Matteo Sturla MD , Pier Pasquale Leone MD , Guillaume Bonnet MD , Augustin Coisne MD, PhD , Sebastian Ludwig MD , Diego Barzallo MD , Elie Flatow DO , Manaf Assafin MD , Tadahisa Sugiura MD , Juan F. Granada MD , Ulrich P. Jorde MD , Carlos J. Rodriguez MD, MPH , Leandro Slipczuk MD, PhD , Mario J. Garcia MD , Rodrigo Estevez Loureiro MD, PhD , Edwin C. Ho MD , Azeem Latib MD
Atrial secondary tricuspid regurgitation (A-STR) and ventricular secondary tricuspid regurgitation (V-STR) have unique physiological and anatomical differences, but long-term outcomes based on TR etiology remain poorly understood. This study aimed to assess the characteristics and outcomes of severe A-STR and V-STR. Adults diagnosed with severe secondary TR between January 2017 and December 2019 in a quaternary-care health system were included. TR was classified into left-sided V-STR (left-sided cardiac diseases), right-sided V-STR (pulmonary/vascular diseases), and A-STR (atrial pathology). The primary endpoint was to assess survival at follow-up. Incidence of heart failure (HF) hospitalizations and cardiovascular mortality were secondary endpoints. Among 1,037 patients with STR, 125 (12.0%) had A-STR, 737 (71.1%) left-sided V-STR, and 175 (16.9%) right-sided V-STR. Survival was significantly higher for A-STR compared to left and right-sided V-STR (46.9% vs 30.6% vs 22.0%, log-rank p = 0.042, respectively). At multivariable Cox regression analysis, left and right-sided V-STR were independently associated with worse survival compared to A-STR (HR: 1.439, p = 0.039 and HR: 1.816, p = 0.001, respectively). A-STR patients also experienced lower rates of HF hospitalizations and cardiovascular mortality. A-STR was associated with better survival and fewer HF hospitalizations than V-STR groups, with right-sided V-STR being the strongest independent predictor of all-cause mortality.
心房继发性三尖瓣反流（A-STR）和心室继发性三尖瓣反流（V-STR）具有独特的生理和解剖差异，但基于TR病因的长期预后仍知之甚少。本研究旨在评估严重A-S和V-STR的特征和结局。纳入了2017年1月至2019年12月在四级保健卫生系统中诊断为严重继发性TR的成年人。TR分为左侧V-STR（左侧心脏疾病）、右侧V-STR（肺/血管疾病）和A-STR（心房病理）。主要终点是评估随访时的生存率。心力衰竭（HF）住院率和心血管死亡率是次要终点。在1037例STR患者中，125例（12%）为A-STR， 737例（71.1%）为左侧V-STR， 175例（16.9%）为右侧V-STR。与左侧和右侧V-STR相比，A-STR的生存率显著更高（46.9% vs. 30.6% vs. 22.0%， log-rank p分别=0.042）。在多变量Cox回归分析中，与A-STR相比，左侧和右侧V-STR与较差的生存率独立相关（HR: 1.439, p=0.039和HR: 1.816, p=0.001）。A-STR患者的HF住院率和心血管死亡率也较低。与V-STR组相比，A-STR组生存率更高，心衰住院率更低，右侧V-STR是全因死亡率最强的独立预测因子。
{"title":"Natural History of Atrial versus Ventricular Secondary Tricuspid Regurgitation: Insights From The Bronx-Valve Registry","authors":"Julio Echarte-Morales MD , Juan Torrado MD, PhD , Andrea Scotti MD , Matteo Sturla MD , Pier Pasquale Leone MD , Guillaume Bonnet MD , Augustin Coisne MD, PhD , Sebastian Ludwig MD , Diego Barzallo MD , Elie Flatow DO , Manaf Assafin MD , Tadahisa Sugiura MD , Juan F. Granada MD , Ulrich P. Jorde MD , Carlos J. Rodriguez MD, MPH , Leandro Slipczuk MD, PhD , Mario J. Garcia MD , Rodrigo Estevez Loureiro MD, PhD , Edwin C. Ho MD , Azeem Latib MD","doi":"10.1016/j.amjcard.2025.10.007","DOIUrl":"10.1016/j.amjcard.2025.10.007","url":null,"abstract":"<div><div>Atrial secondary tricuspid regurgitation (A-STR) and ventricular secondary tricuspid regurgitation (V-STR) have unique physiological and anatomical differences, but long-term outcomes based on TR etiology remain poorly understood. This study aimed to assess the characteristics and outcomes of severe A-STR and V-STR. Adults diagnosed with severe secondary TR between January 2017 and December 2019 in a quaternary-care health system were included. TR was classified into left-sided V-STR (left-sided cardiac diseases), right-sided V-STR (pulmonary/vascular diseases), and A-STR (atrial pathology). The primary endpoint was to assess survival at follow-up. Incidence of heart failure (HF) hospitalizations and cardiovascular mortality were secondary endpoints. Among 1,037 patients with STR, 125 (12.0%) had A-STR, 737 (71.1%) left-sided V-STR, and 175 (16.9%) right-sided V-STR. Survival was significantly higher for A-STR compared to left and right-sided V-STR (46.9% vs 30.6% vs 22.0%, log-rank p = 0.042, respectively). At multivariable Cox regression analysis, left and right-sided V-STR were independently associated with worse survival compared to A-STR (HR: 1.439, p = 0.039 and HR: 1.816, p = 0.001, respectively). A-STR patients also experienced lower rates of HF hospitalizations and cardiovascular mortality. A-STR was associated with better survival and fewer HF hospitalizations than V-STR groups, with right-sided V-STR being the strongest independent predictor of all-cause mortality.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 330-339"},"PeriodicalIF":2.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328192","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 : 2025-10-17DOI: 10.1016/j.amjcard.2025.10.012
Alexander Marschall MD, PhD , Marcos García-Guimarães MD, PhD , Ricardo Sanz-Ruiz MD, PhD , Manel Sabaté MD, PhD , Maite Velazquez-Martín MD, PhD , Gabriela Veiga MD, PhD , Ainhoa Pérez-Guerrero MD, PhD , Pablo Avanzas MD, PhD , Carlos Cortés MD, PhD , Fernando Macaya MD, PhD , Soledad Ojeda MD, PhD , Marcelo Jimenez-Kockar MD, PhD , Gerard Roura MD, PhD , Belen Cid MD, PhD , Teresa Bastante MD , David del Val MD, PhD , Fernando Alfonso MD, PhD
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), historically linked to pregnancy but increasingly associated with emotional and physical stressors. The prognostic impact of these precipitating factors remains unclear. This study aimed to evaluate their clinical and prognostic relevance in a large, nationwide prospective SCAD cohort. The prospective Spanish SCAD Registry (RN-DCE) included 388 patients from 34 centers since 2015. Coronary angiograms were centrally reviewed, and patients were categorized based on the presence and type of precipitating factor (emotional or physical). Major adverse cardiovascular and cerebrovascular events (MACCE) including all-cause death, reinfarction, unplanned revascularization, recurrent SCAD, and stroke, were centrally adjudicated. Cox regression models were used to assess associations with in-hospital and long-term outcomes. Precipitating factors were identified in 40% of patients, with emotional triggers more common than physical (26% vs 15%). Patients with triggers were younger (52 (±11.3) vs 55 (±11.8) years, p = 0.046) and had higher rates of depression and anxiety (24% vs 18%, p = 0.078 and 25% vs 13%, p <0.004). Emotional triggers were more frequent among women and strongly associated with psychiatric history. The overall presence of a trigger was not associated with increased MACCE risk (Adjusted HR: 0.90 (0.39–2.10), p = 0.794). However, SCAD events related to the peripartum period or to Valsalva maneuvers were associated with worse short- and long-term outcomes. In conclusion, in this large national cohort, most precipitating factors were not linked to worse prognosis. However, peripartum-related SCAD and events triggered by Valsalva-like maneuvers may indicate higher-risk presentations and warrant closer clinical attention.
自发性冠状动脉剥离（SCAD）是一种罕见的急性冠状动脉综合征（ACS）的原因，历史上与妊娠有关，但越来越多地与情绪和身体压力有关。这些诱发因素的预后影响尚不清楚。本研究旨在评估其在全国大型前瞻性SCAD队列中的临床和预后相关性。自2015年以来，西班牙SCAD前瞻性注册（RN-DCE）包括来自34个中心的388名患者。集中回顾冠状动脉造影，并根据诱发因素（情绪或身体）的存在和类型对患者进行分类。主要不良心脑血管事件（MACCE）包括全因死亡、再梗死、计划外血运重建术、复发性SCAD和卒中，均集中判定。Cox回归模型用于评估与住院和长期预后的关系。40%的患者确定了诱发因素，其中情绪诱发因素比身体诱发因素更常见（26%对15%）。触发因素的患者更年轻（52（±11.3）岁vs 55（±11.8）岁，p=0.046），抑郁和焦虑的发生率更高（24% vs 18%, p=0.078, 25% vs 13%, p=0.046）
{"title":"Clinical and Prognostic Implications of Precipitating Factors in Patients With Spontaneous Coronary Artery Dissection","authors":"Alexander Marschall MD, PhD , Marcos García-Guimarães MD, PhD , Ricardo Sanz-Ruiz MD, PhD , Manel Sabaté MD, PhD , Maite Velazquez-Martín MD, PhD , Gabriela Veiga MD, PhD , Ainhoa Pérez-Guerrero MD, PhD , Pablo Avanzas MD, PhD , Carlos Cortés MD, PhD , Fernando Macaya MD, PhD , Soledad Ojeda MD, PhD , Marcelo Jimenez-Kockar MD, PhD , Gerard Roura MD, PhD , Belen Cid MD, PhD , Teresa Bastante MD , David del Val MD, PhD , Fernando Alfonso MD, PhD","doi":"10.1016/j.amjcard.2025.10.012","DOIUrl":"10.1016/j.amjcard.2025.10.012","url":null,"abstract":"<div><div>Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), historically linked to pregnancy but increasingly associated with emotional and physical stressors. The prognostic impact of these precipitating factors remains unclear. This study aimed to evaluate their clinical and prognostic relevance in a large, nationwide prospective SCAD cohort. The prospective Spanish SCAD Registry (RN-DCE) included 388 patients from 34 centers since 2015. Coronary angiograms were centrally reviewed, and patients were categorized based on the presence and type of precipitating factor (emotional or physical). Major adverse cardiovascular and cerebrovascular events (MACCE) including all-cause death, reinfarction, unplanned revascularization, recurrent SCAD, and stroke, were centrally adjudicated. Cox regression models were used to assess associations with in-hospital and long-term outcomes. Precipitating factors were identified in 40% of patients, with emotional triggers more common than physical (26% vs 15%). Patients with triggers were younger (52 (±11.3) vs 55 (±11.8) years, p = 0.046) and had higher rates of depression and anxiety (24% vs 18%, p = 0.078 and 25% vs 13%, p <0.004). Emotional triggers were more frequent among women and strongly associated with psychiatric history. The overall presence of a trigger was not associated with increased MACCE risk (Adjusted HR: 0.90 (0.39–2.10), p = 0.794). However, SCAD events related to the peripartum period or to Valsalva maneuvers were associated with worse short- and long-term outcomes. In conclusion, in this large national cohort, most precipitating factors were not linked to worse prognosis. However, peripartum-related SCAD and events triggered by Valsalva-like maneuvers may indicate higher-risk presentations and warrant closer clinical attention.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 247-254"},"PeriodicalIF":2.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328173","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 : 2025-10-17DOI: 10.1016/j.amjcard.2025.10.009
Paulomi Gohel MD , William White MD , Karim Jandali Rifai BS , Malek Moumne BS , Samir Saba MD , Haitham Hreibe MD
Cavotricuspid isthmus (CTI) ablation is a highly effective treatment of typical atrial flutter (AFL). The emergence of new-onset atrial fibrillation (AF) following CTI ablation is clinically relevant but limited data exist regarding its predictors. The goal of this study is to investigate predictors of new-onset AF following CTI ablation. Patients who underwent CTI ablation between 2016 and 2022 were included. Baseline variables including left atrial volume index (LAVI), cardiac comorbidities, CHA₂DS₂-VASc score, and medications were collected. The primary outcome was the occurrence of new-onset AF after the index CTI ablation. New AF occurred in 44 (29%) of 153 patients at a median of 264 days. Patients who developed AF were more likely men (p = 0.046), had hypertension (p = 0.014), and higher LAVI (40.6 ± 12.2 vs 34.2 ± 9.5 mL/m², p <0.001). After adjusting for unbalanced covariates in a Cox multivariable model, protective predictors against developing new AF included female sex (HR 0.31, 95% CI 0.12–0.76, p = 0.011) and prior cardiac surgery (HR 0.22, 95% CI 0.07–0.72, p = 0.013) while increased LAVI (HR 1.02, 95% CI 1.00–1.05, p = 0.08) showed a trend towards higher risk of new AF. In conclusion, in this cohort of AF-naive patients undergoing CTI ablation for typical AFL, nearly one-third developed new-onset AF. Independent predictors of developing AF include male sex and no-prior cardiac surgery. These findings have clinical implications to the management of AFL patients, including for the decision to consider performing concomitant AF ablation in patients with higher risk features.
腔尖瓣峡部（CTI）消融是治疗典型心房扑动（AFL）的一种非常有效的方法。CTI消融后新发心房颤动（AF）的出现与临床相关，但有关其预测因素的数据有限。本研究的目的是研究CTI消融后新发房颤的预测因素。纳入了2016年至2022年间接受CTI消融的患者。基线变量包括左房容积指数（LAVI）、心脏合并症、CHA₂DS₂-VASc评分和药物。主要终点是CTI消融后新发房颤的发生情况。153例患者中有44例（29%）发生新的房颤，平均264天。发生房颤的患者中男性（p=0.046）、高血压（p=0.014）和LAVI较高（40.6±12.2 vs. 34.2±9.5 mL/m²，p= 0.05）
{"title":"Incidence and Predictors of Atrial Fibrillation After Cavotricuspid Isthmus Ablation for Typical Atrial Flutter","authors":"Paulomi Gohel MD , William White MD , Karim Jandali Rifai BS , Malek Moumne BS , Samir Saba MD , Haitham Hreibe MD","doi":"10.1016/j.amjcard.2025.10.009","DOIUrl":"10.1016/j.amjcard.2025.10.009","url":null,"abstract":"<div><div>Cavotricuspid isthmus (CTI) ablation is a highly effective treatment of typical atrial flutter (AFL). The emergence of new-onset atrial fibrillation (AF) following CTI ablation is clinically relevant but limited data exist regarding its predictors. The goal of this study is to investigate predictors of new-onset AF following CTI ablation. Patients who underwent CTI ablation between 2016 and 2022 were included. Baseline variables including left atrial volume index (LAVI), cardiac comorbidities, CHA₂DS₂-VASc score, and medications were collected. The primary outcome was the occurrence of new-onset AF after the index CTI ablation. New AF occurred in 44 (29%) of 153 patients at a median of 264 days. Patients who developed AF were more likely men (p = 0.046), had hypertension (p = 0.014), and higher LAVI (40.6 ± 12.2 vs 34.2 ± 9.5 mL/m², p <0.001). After adjusting for unbalanced covariates in a Cox multivariable model, protective predictors against developing new AF included female sex (HR 0.31, 95% CI 0.12–0.76, p = 0.011) and prior cardiac surgery (HR 0.22, 95% CI 0.07–0.72, p = 0.013) while increased LAVI (HR 1.02, 95% CI 1.00–1.05, p = 0.08) showed a trend towards higher risk of new AF. In conclusion, in this cohort of AF-naive patients undergoing CTI ablation for typical AFL, nearly one-third developed new-onset AF. Independent predictors of developing AF include male sex and no-prior cardiac surgery. These findings have clinical implications to the management of AFL patients, including for the decision to consider performing concomitant AF ablation in patients with higher risk features.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 234-238"},"PeriodicalIF":2.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145328183","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}
Eruptive calcified nodules (ECN) represent a distinct and high-risk plaque morphology implicated in the pathogenesis of acute coronary syndrome. While prior studies have reported poor clinical outcomes following percutaneous coronary intervention (PCI) with drug-eluting stents (DES) or drug-coated balloons (DCB) for these lesions, comparative data evaluating the efficacy of DES versus DCB therapy remains unavailable. Among 1,975 patients who underwent optical coherence tomography (OCT)-guided PCI for de novo coronary lesions, 68 patients (75 lesions) were identified with OCT-confirmed ECN. These lesions were retrospectively analyzed and stratified into either the DES group (45 lesions in 41 patients) or the DCB group (30 lesions in 27 patients). The primary endpoint was clinically driven target lesion revascularization (CD-TLR) and cardiac death. Over a median follow-up of 2.1 years, no significant differences were observed between the two groups in CD-TLR (hazard ratio [HR] 1.2, 95% confidence interval [CI] 0.5 to 3.2, p = 0.6) and cardiac death (HR 0.7, 95% CI 0.3 to 1.9, p = 0.5). These findings remained consistent after adjustment for baseline clinical characteristics. In conclusion, this study demonstrated that PCI with either DES or DCB for OCT-identified ECN results in similarly poor clinical outcomes, highlighting the limitations of current PCI devices for these rare, unstable lesions and emphasizing the need for alternative therapies.
爆发性钙化结节（ECN）是一种独特的高风险斑块形态，与急性冠状动脉综合征的发病机制有关。虽然先前的研究报告了经皮冠状动脉介入治疗（PCI）使用药物洗脱支架（DES）或药物包被球囊（DCB）治疗这些病变的临床结果较差，但评估DES与DCB治疗效果的比较数据仍然缺乏。在1975名接受光学相干断层扫描（OCT）引导的冠状动脉新发病变PCI治疗的患者中，68名患者（75个病变）被OCT证实为ECN。回顾性分析这些病变并将其分为DES组（41例患者中45个病变）或DCB组（27例患者中30个病变）。主要终点是临床驱动的靶病变血运重建术（CD-TLR）和心源性死亡。在中位随访2.1年期间，两组在CD-TLR（风险比[HR] 1.2； 95%可信区间[CI] 0.5-3.2; p = 0.6）和心源性死亡（HR 0.7; 95% CI 0.3-1.9; p = 0.5）方面无显著差异。在调整基线临床特征后，这些发现保持一致。总之，本研究表明，对于oct识别的ECN，采用DES或DCB进行PCI治疗的临床结果同样很差，突出了目前PCI设备对这些罕见、不稳定病变的局限性，并强调了替代治疗的必要性。
{"title":"Clinical Outcomes Following Percutaneous Coronary Intervention With Drug-Eluting Stents and Drug-Coated Balloons in Lesion With Eruptive Calcified Nodules","authors":"Masahiro Koide MD, PhD , Kan Zen MD, PhD , Tomotsugu Seki MD, MPH, PhD , Kento Fukui MD , Kazuaki Takamatsu MD, PhD , Jun Shiraishi MD, PhD , Satoaki Matoba MD, PhD","doi":"10.1016/j.amjcard.2025.10.010","DOIUrl":"10.1016/j.amjcard.2025.10.010","url":null,"abstract":"<div><div>Eruptive calcified nodules (ECN) represent a distinct and high-risk plaque morphology implicated in the pathogenesis of acute coronary syndrome. While prior studies have reported poor clinical outcomes following percutaneous coronary intervention (PCI) with drug-eluting stents (DES) or drug-coated balloons (DCB) for these lesions, comparative data evaluating the efficacy of DES versus DCB therapy remains unavailable. Among 1,975 patients who underwent optical coherence tomography (OCT)-guided PCI for de novo coronary lesions, 68 patients (75 lesions) were identified with OCT-confirmed ECN. These lesions were retrospectively analyzed and stratified into either the DES group (45 lesions in 41 patients) or the DCB group (30 lesions in 27 patients). The primary endpoint was clinically driven target lesion revascularization (CD-TLR) and cardiac death. Over a median follow-up of 2.1 years, no significant differences were observed between the two groups in CD-TLR (hazard ratio [HR] 1.2, 95% confidence interval [CI] 0.5 to 3.2, p = 0.6) and cardiac death (HR 0.7, 95% CI 0.3 to 1.9, p = 0.5). These findings remained consistent after adjustment for baseline clinical characteristics. In conclusion, this study demonstrated that PCI with either DES or DCB for OCT-identified ECN results in similarly poor clinical outcomes, highlighting the limitations of current PCI devices for these rare, unstable lesions and emphasizing the need for alternative therapies.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"257 ","pages":"Pages 224-230"},"PeriodicalIF":2.1,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318038","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 : 2025-10-16DOI: 10.1016/j.amjcard.2025.10.011
Mihajlo Kovacic MD , Gregor Leibundgut MD , Mihai Cocoi MD , Nenad Bozinovic MD , Giuseppe Colletti MD , Josip Andelo Borovac MD, PhD , Claudiu Ungureanu MD
Chronic total occlusion percutaneous coronary intervention (CTO-PCI) has made significant progress with the retrograde approach, particularly when antegrade techniques are insufficient or not clinically indicated. Despite its advantages, the conventional externalization process carries some notable challenges, including procedural complexity, increased equipment requirements, and elevated risk of rupture of fragile collateral vessels. This article examines the "deep dive rendezvous" or DDR technique that we propose in great detail. This novel interventional solution builds on the previously elaborated rendezvous approaches, however, with the added value of offering an enhanced guidewire support through deep intubation into the retrograde system. By refining the rendezvous technique, we propose DDR (deep dive rendezvous) as a streamlined and effective alternative to conventional externalization. This technique has the potential to reduce risks of procedural complications, preserve collateral vessel integrity, and diminish the need for additional equipment or introduction of complex procedural steps. In conclusion, the versatility of this technique extends to serving as both a primary strategy and a bailout solution, making it a valuable option in cases where conventional externalization is either impractical or unsafe during the retrograde Chronic total occlusion percutaneous coronary intervention (CTO-PCI).
{"title":"Deep Dive Rendezvous as a Novel Alternative Technique for Conventional Externalization in Retrograde Chronic Total Occlusion Interventions","authors":"Mihajlo Kovacic MD , Gregor Leibundgut MD , Mihai Cocoi MD , Nenad Bozinovic MD , Giuseppe Colletti MD , Josip Andelo Borovac MD, PhD , Claudiu Ungureanu MD","doi":"10.1016/j.amjcard.2025.10.011","DOIUrl":"10.1016/j.amjcard.2025.10.011","url":null,"abstract":"<div><div>Chronic total occlusion percutaneous coronary intervention (CTO-PCI) has made significant progress with the retrograde approach, particularly when antegrade techniques are insufficient or not clinically indicated. Despite its advantages, the conventional externalization process carries some notable challenges, including procedural complexity, increased equipment requirements, and elevated risk of rupture of fragile collateral vessels. This article examines the \"deep dive rendezvous\" or DDR technique that we propose in great detail. This novel interventional solution builds on the previously elaborated rendezvous approaches, however, with the added value of offering an enhanced guidewire support through deep intubation into the retrograde system. By refining the rendezvous technique, we propose DDR (deep dive rendezvous) as a streamlined and effective alternative to conventional externalization. This technique has the potential to reduce risks of procedural complications, preserve collateral vessel integrity, and diminish the need for additional equipment or introduction of complex procedural steps. In conclusion, the versatility of this technique extends to serving as both a primary strategy and a bailout solution, making it a valuable option in cases where conventional externalization is either impractical or unsafe during the retrograde Chronic total occlusion percutaneous coronary intervention (CTO-PCI).</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"257 ","pages":"Pages 275-282"},"PeriodicalIF":2.1,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318059","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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