American Journal of Cardiology最新文献_第8页

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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引用次数: 0

AngioWave Artificial Intelligence-Assisted Analysis of Septal Collaterals for Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention 血管波人工智能辅助分析慢性逆行全闭塞经皮冠状动脉介入治疗中隔侧支。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-23 DOI: 10.1016/j.amjcard.2025.11.009

Dimitrios Strepkos MD, Sandeep Jalli DO, Michaella Alexandrou MD, Pedro E.P. Carvalho MD, Eleni Kladou MD, Nick Williford MD, Bavana V. Rangan BDS, MPH, Konstantinos Voudris MD, PhD, Yader Sandoval MD, Emmanouil S. Brilakis MD, PhD

Artificial intelligence (AI) can augment coronary angiography images to enhance interpretation. We compared two blinded operators' interpretation of chronic total occlusion (CTO) angiograms obtained for retrograde percutaneous coronary intervention (PCI) standard vs. AI-enhanced (AngioWave, Concord, MA) images and assessed the association with septal collateral crossing success. We reviewed 50 retrograde CTO PCI angiograms. The most common (83.7%) target vessel was the right coronary artery and target CTOs had high complexity with high rates of proximal cap ambiguity (55.3%), blunt or no stump (79.2%), moderate or severe calcification (50.0%) and high J-CTO scores (2.96 ± 0.93). Retrograde was the first crossing strategy in 44.0% of lesions and was successful in 80%. Operators assigned lower frequency of corkscrew bends (10.2% vs 20.6%, p=0.035) and septal collateral tortuosity (31.7% vs 51.5%, p=0.004) and higher frequency of CC2 collateral size (6.5% vs 0.0%, p=0.007) to AI-enhanced compared with standard angiograms. The aggregate predicted likelihood of crossing (85% vs 70%, p<0.001, Wilcoxon test: p<0.001) and ease of interpretation (9.00 vs 7.00, p<0.001) were higher in the AI-enhanced angiograms. There was no difference in predictive performance for crossing success in the two groups (AUCAI-enhanced = 0.74 and AUCstandard = 0.73, De Long test: p=0.856). AI-enhanced angiograms were assigned a median 10.7% higher predicted likelihood of success. Compared with standard angiograms, AI-enhanced angiograms allow easier interpretation of angiograms and have similar predictive performance for collateral crossing despite showing lower collateral complexity.

人工智能（AI）可以增强冠状动脉造影图像以增强解释。我们比较了两名盲法操作人员对逆行经皮冠状动脉介入治疗（PCI）标准和人工智能增强（AngioWave, Concord， MA）图像获得的慢性全闭塞（CTO）血管造影的解释，并评估了与间隔侧支穿越成功的关系。我们回顾了50张逆行CTO PCI血管造影。最常见的靶血管为右冠状动脉（83.7%），靶血管复杂性高，近端冠状动脉模糊率高（55.3%），钝或无残端（79.2%），中度或重度钙化（50.0%），J-CTO评分高（2.96±0.93）。逆行是44.0%病变的第一个交叉策略，80%的病变成功。与标准血管造影相比，操作者认为人工智能增强的螺旋状弯曲（10.2%对20.6%,p=0.035）和间隔侧支扭曲（31.7%对51.5%,p=0.004）的频率较低，CC2侧支大小的频率较高（6.5%对0.0%,p=0.007）。人工智能增强血管造影的总体预测交叉可能性（85% vs 70%, p<0.001， Wilcoxon检验：p<；0.001）和易解释性（9.00 vs 7.00, p<0.001）更高。两组对杂交成功的预测性能无差异（AUCAI-enhanced = 0.74, AUCstandard = 0.73， De Long检验：p=0.856）。人工智能增强血管造影的成功率中位数高出10.7%。与标准血管造影相比，人工智能增强血管造影可以更容易地解释血管造影，并且在侧枝交叉方面具有相似的预测性能，尽管侧枝复杂性较低。

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引用次数: 0

Progressive Conduction System Disease in Hydroxychloroquine Cardiotoxicity: A Call for Early Vigilance 羟基氯喹心脏毒性的进行性传导系统疾病：早期警惕的呼吁。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-21 DOI: 10.1016/j.amjcard.2025.10.029

Milica Vukićević MD , Mandeep R. Mehra MD, MSc , Robert F. Padera MD, PhD , Ameesh Isath MD

Hydroxychloroquine (HCQ) cardiotoxicity is increasingly recognized, yet progressive conduction system disease remains underappreciated and may represent a lethal phenotype. We report a 67-year-old female on chronic HCQ who developed progressive conduction abnormalities culminating in cardiogenic shock and sudden death despite initial stabilization with isolated atrial pacing. Autopsy revealed extensive sinoatrial and atrioventricular nodal lysosomal toxicity and fibrosis confirming irreversible conduction injury. This case highlights the lysosomal basis of HCQ toxicity and reframes conduction disease as a primary, irreversible manifestation. Vigilant ECG surveillance and early consideration of dual-chamber pacing may prevent catastrophic outcomes in patients on chronic HCQ therapy.

羟基氯喹（HCQ）的心脏毒性越来越被认识到，但进行性传导系统疾病仍未得到充分认识，可能代表一种致命的表型。我们报告了一位67岁的慢性HCQ女性患者，她发展为进行性传导异常，最终导致心源性休克和猝死，尽管最初通过孤立心房起搏稳定。尸检显示广泛的窦房和房室结溶酶体毒性和纤维化证实不可逆的传导损伤。本病例强调了HCQ毒性的溶酶体基础，并将传导疾病作为主要的、不可逆的表现。警惕的心电图监测和早期考虑双室起搏可以预防慢性HCQ治疗患者的灾难性后果。

引用次数: 0

Outcomes of Transcatheter Aortic Valve Replacement in Patients With Moderate Mixed Aortic Valve Disease 中度混合性主动脉瓣疾病患者经导管主动脉瓣置换术的疗效。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-19 DOI: 10.1016/j.amjcard.2025.10.026

Yu Tang MD , Xue-Chen Qiao MD , Meng-Yun Yan MD , Yue Yin MD , Wei-Ya Li MD , Ying Zhang MD , Tian-Yuan Xiong MD , Yi-Ming Li MD , Jun-Li Li MD , Lin Bai MD , Xin Wei MD , Yuan-Wei Xiang Ou MD , Zhong-Kai Zhu MD , Yi-Jun Yao MD , Qiao Li MD , Yi-Jian Li MD , Fei Chen MD , Jia-Fu Wei MD , Yong Peng MD , Yuan Feng MD , Mao Chen MD, PhD

The clinical impact of transcatheter aortic valve replacement (TAVR) in patients with moderate mixed aortic valve disease (MMAVD)—characterized by the coexistence of moderate aortic stenosis (AS) and aortic regurgitation (AR)—remains unclear, as current evidence primarily focuses on isolated severe AS. This study aimed to compare outcomes of TAVR between patients with MMAVD and those with isolated severe AS. Between January 2019 and June 2024, 848 patients who underwent TAVR at our center were identified for analysis, including 75 with MMAVD and 773 with isolated severe AS. To minimize confounding, 73 MMAVD patients were matched with 264 isolated AS patients using 1:4 propensity score matching for comparative analysis. The primary endpoint was all-cause mortality; secondary endpoints included heart failure rehospitalization, left ventricular (LV) reverse remodeling, and procedural complications. Continuous variables were compared using independent samples t-tests, categorical variables using chi-square or Fisher’s exact tests, and survival using Kaplan–Meier curves with log-rank tests. At baseline, MMAVD patients exhibited greater LV dilation (LV end-diastolic diameter [LVEDD]: 56.07±9.04 vs 50.68±7.70, p < 0.001) and hypertrophy (LV mass index [LVMI]: 163.68±50.17 vs 151.59±44.38, p = 0.026). Post-TAVR, MMAVD showed superior reverse remodeling (ΔLVEDD: −7.18±9.75 vs −2.52±7.64, p < 0.001), though LVEF recovery was comparable (ΔLVEF: 5.47±13.98 vs 6.88±15.20, p = 0.52). Survival rates were similar (log-rank p = 0.370), but MMAVD had higher 1-year heart failure rehospitalization (5.97% vs 0.96%, p = 0.032). In conclusion, TAVR with self-expandable valves yields comparable survival in MMAVD and isolated AS, with more pronounced reverse remodeling in MMAVD despite advanced baseline disease.

经导管主动脉瓣置换术（TAVR）对中度混合性主动脉瓣疾病（MMAVD）患者的临床影响尚不清楚，因为目前的证据主要集中在孤立的严重AS。MMAVD的特征是中度主动脉瓣狭窄（AS）和主动脉瓣反流（AR）并存。本研究旨在比较MMAVD患者和孤立性严重AS患者的TAVR结果。在2019年1月至2024年6月期间，我们中心确定了848例接受TAVR的患者进行分析，其中75例患有MMAVD， 773例患有孤立的严重AS。为了尽量减少混淆，73例MMAVD患者与264例孤立AS患者采用1:4倾向评分匹配进行比较分析。主要终点是全因死亡率；次要终点包括心力衰竭再住院、左心室（LV）反向重构和手术并发症。使用独立样本t检验比较连续变量，使用卡方或Fisher精确检验比较分类变量，使用Kaplan-Meier曲线和log-rank检验比较生存率。在基线时，MMAVD患者表现出更大的左室扩张(左室舒张末期直径[LVEDD]: 56.07±9.04比50.68±7.70,p

{"title":"Outcomes of Transcatheter Aortic Valve Replacement in Patients With Moderate Mixed Aortic Valve Disease","authors":"Yu Tang MD , Xue-Chen Qiao MD , Meng-Yun Yan MD , Yue Yin MD , Wei-Ya Li MD , Ying Zhang MD , Tian-Yuan Xiong MD , Yi-Ming Li MD , Jun-Li Li MD , Lin Bai MD , Xin Wei MD , Yuan-Wei Xiang Ou MD , Zhong-Kai Zhu MD , Yi-Jun Yao MD , Qiao Li MD , Yi-Jian Li MD , Fei Chen MD , Jia-Fu Wei MD , Yong Peng MD , Yuan Feng MD , Mao Chen MD, PhD","doi":"10.1016/j.amjcard.2025.10.026","DOIUrl":"10.1016/j.amjcard.2025.10.026","url":null,"abstract":"<div><div>The clinical impact of transcatheter aortic valve replacement (TAVR) in patients with moderate mixed aortic valve disease (MMAVD)—characterized by the coexistence of moderate aortic stenosis (AS) and aortic regurgitation (AR)—remains unclear, as current evidence primarily focuses on isolated severe AS. This study aimed to compare outcomes of TAVR between patients with MMAVD and those with isolated severe AS. Between January 2019 and June 2024, 848 patients who underwent TAVR at our center were identified for analysis, including 75 with MMAVD and 773 with isolated severe AS. To minimize confounding, 73 MMAVD patients were matched with 264 isolated AS patients using 1:4 propensity score matching for comparative analysis. The primary endpoint was all-cause mortality; secondary endpoints included heart failure rehospitalization, left ventricular (LV) reverse remodeling, and procedural complications. Continuous variables were compared using independent samples t-tests, categorical variables using chi-square or Fisher’s exact tests, and survival using Kaplan–Meier curves with log-rank tests. At baseline, MMAVD patients exhibited greater LV dilation (LV end-diastolic diameter [LVEDD]: 56.07±9.04 vs 50.68±7.70, p < 0.001) and hypertrophy (LV mass index [LVMI]: 163.68±50.17 vs 151.59±44.38, p = 0.026). Post-TAVR, MMAVD showed superior reverse remodeling (ΔLVEDD: −7.18±9.75 vs −2.52±7.64, p < 0.001), though LVEF recovery was comparable (ΔLVEF: 5.47±13.98 vs 6.88±15.20, p = 0.52). Survival rates were similar (log-rank p = 0.370), but MMAVD had higher 1-year heart failure rehospitalization (5.97% vs 0.96%, p = 0.032). In conclusion, TAVR with self-expandable valves yields comparable survival in MMAVD and isolated AS, with more pronounced reverse remodeling in MMAVD despite advanced baseline disease.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"259 ","pages":"Pages 265-272"},"PeriodicalIF":2.1,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Right Ventricular Dysfunction in Acute Coronary Syndrome: Insights From Cardiac Magnetic Resonance Imaging 急性冠状动脉综合征右室功能障碍：心脏磁共振成像的见解。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-16 DOI: 10.1016/j.amjcard.2025.10.028

Mauricio Garcia-Cardenas MD , Pavel Martinez-Dominguez MD , Raul Miranda-Segura MD , Gilberto H. Acosta-Gutiérrez MD , Gabriela Meléndez-Ramírez MD, PhD , Aloha Meave MD , Nilda Espinola-Zavaleta MD, PhD

Acute coronary syndrome (ACS) significantly impacts global morbidity and mortality, traditionally emphasizing left ventricular (LV) dysfunction. However, the prognostic importance of right ventricular (RV) dysfunction remains underexplored. Cardiac magnetic resonance (CMR), the gold standard for RV assessment, enables precise evaluation of ventricular function and structure. We conducted a retrospective cohort study of 268 patients with ACS who underwent CMR between January 2020 and December 2022 at the National Institute of Cardiology Ignacio Chavez. RV dysfunction was defined as RV ejection fraction (RVEF) <50% by CMR. Multivariate logistic regression identified factors associated with RV dysfunction. RV dysfunction occurred in 170 patients (63.4%). Compared to those without RV dysfunction, patients with RV dysfunction were more likely to be male (84% vs 70%, p = 0.011) and smokers (66% vs 51%, p = 0.017). These patients exhibited reduced LV ejection fraction (39% vs 44%, p < 0.001), higher end-systolic and end-diastolic volumes, and reduced RV fractional area change (42% vs 45%, p = 0.004). BMI (OR 1.13, 95% CI 1.04-1.24, p = 0.008) and mitral regurgitation (OR 5.40, 95% CI 1.47–27, p = 0.020) were independently associated with RV dysfunction. Although mortality was higher among patients with RV dysfunction (3.5% vs 1%), it was not statistically significant (p = 0.4). In conclusion RV dysfunction is common in ACS and it is independently associated with increased BMI and mitral regurgitation. CMR evaluation of RV function in ACS patients may be considered to enhance clinical outcomes. Future research should explore targeted therapeutic interventions for RV dysfunction.

急性冠脉综合征（ACS）显著影响全球发病率和死亡率，传统上强调左心室功能障碍。然而，右心室功能障碍的预后重要性仍未得到充分探讨。心脏磁共振（CMR）是RV评估的金标准，能够精确评估心室功能和结构。我们对2020年1月至2022年12月期间在Ignacio Chavez国家心脏病研究所接受CMR治疗的268名ACS患者进行了回顾性队列研究。右心室功能障碍定义为右心室射血分数（RVEF）。

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引用次数: 0

Clinical Outcomes in Peripartum Cardiomyopathy Complicated by Cardiogenic Shock: A Retrospective Multicenter Cohort Study 围产期心肌病并发心源性休克的临床结局：一项回顾性多中心队列研究。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-16 DOI: 10.1016/j.amjcard.2025.11.004

Syed A. Hyder MD , Hamid Shirwany MD , Vibhu Parcha MD , J. Emerson Scheinuk MD , Ahmed Saleh MD , Moses Sghayyer MD , Gina C. Josey BS , Usman A. Hasnie MD , Salomon A. Roman Soto MD , Joanna M. Joly MD , Samuel K. McElwee MD , Marc G. Cribbs MD , Stephen Clarkson MD, MSPH

Peripartum cardiomyopathy (PPCM) is a rare but life-threatening condition that occurs in late pregnancy or early postpartum and leads to heart failure with reduced left ventricular ejection fraction (LVEF). A severe complication of PPCM is cardiogenic shock, and its incidence has increased in the recent years. We conducted a retrospective multicenter cohort analysis to evaluate the 180-day clinical outcomes of PPCM complicated by cardiogenic shock (PPCM-CS), with a focus on the role of mechanical circulatory support. We identified 733 patients diagnosed with PPCM-CS between January 2010 and January 2024 using TriNetX, a multi-institutional U.S. health record database. Subgroup analysis evaluated outcomes among patients with no mechanical circulatory support (MCS), those managed with intra-aortic balloon pump (IABP) or percutaneous left ventricular assist device (pLVAD), and those supported with extracorporeal membrane oxygenation (ECMO). At 180-day follow-up, all-cause mortality of overall cohort was 15.8%, with higher mortality observed in ECMO (24.1%) and IABP/pLVAD (18.7%) groups. Durable LVAD implantation occurred in 15.0% of the overall cohort, with higher prevalence in ECMO (17.7%) and IABP/pLVAD (29.0%) groups. Heart transplantation was performed in 12.9% of the overall cohort, with higher prevalence in ECMO (19.0%) and IABP/pLVAD (27.1%) patients. Data on outcomes in patients with PPCM complicated by cardiogenic shock remain limited. This study offers insight into the 180-day outcomes in this high-risk population and suggests that, although MCS is associated with higher mortality, it may serve as a viable bridge to advanced therapies.

背景：围产期心肌病（PPCM）是一种罕见但危及生命的疾病，发生在妊娠晚期或产后早期，可导致心力衰竭并降低左心室射血分数（LVEF）。心源性休克是PPCM的一个严重并发症，近年来其发病率有所上升。我们进行了一项回顾性多中心队列分析，以评估PPCM合并心源性休克（PPCM- cs）的180天临床结果，重点关注机械循环支持的作用。方法和结果：2010年1月至2024年1月，我们使用美国多机构健康记录数据库TriNetX确定了733例诊断为PPCM-CS的患者。亚组分析评估了无机械循环支持（MCS）、使用主动脉内球囊泵（IABP）或经皮左心室辅助装置（pLVAD）和体外膜氧合（ECMO）支持的患者的结局。随访180天，全因死亡率为15.8%，其中ECMO组（24.1%）和IABP/pLVAD组（18.7%）死亡率更高。持久LVAD植入发生率为15.0%，ECMO组（17.7%）和IABP/pLVAD组（29.0%）的发生率更高。12.9%的患者接受了心脏移植，其中ECMO患者（19.0%）和IABP/pLVAD患者（27.1%）的发生率更高。结论：PPCM合并心源性休克患者的预后数据仍然有限。这项研究为这一高危人群180天的预后提供了深入的见解，并表明，尽管MCS与较高的死亡率相关，但它可以作为通向先进治疗的可行桥梁。

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引用次数: 0

Prognostic Significance of Echocardiographic Transaortic Flow Rate in Aortic Valve Stenosis: A Systematic Review and Meta-Analysis 超声心动图经主动脉血流率对主动脉瓣狭窄的预后意义：系统回顾和荟萃分析。

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology

Pub Date : 2025-11-16 DOI: 10.1016/j.amjcard.2025.10.027

Hoda Mombeini MD , Mohammad Reza Hatamnejad MD, MPH , Fatemeh Chichagi MD , Mahta Arbabi MD , Parnian Jamshidi MD, MPH , Setayesh Sotoudehnia MD , Maryam Sahafi bandary MD , Moein Piroozkhah MD

Echocardiographic evaluation of Aortic valve stenosis (AS) severity relies on aortic valve area and peak jet velocity. In pursuit of improving accuracy, the transaortic flow rate (FR), defined as the ratio of stroke volume to systolic ejection time, has been introduced. However, its prognostic value in AS patients remains a matter of controversy. This study aims to systematically review the predictive value of FR in AS patients and provide quantitative pooled analysis results where applicable. A systematic search was conducted for observational studies on AS patients published up to July 31, 2025. Studies were included if they assessed the clinical prognostic utility of FR with at least 3 months of follow-up. Pooled estimates and 95% CI for FR's hazard ratio (HR) in each binary outcome were calculated using a random effects model. Twenty-one studies with 10,895 patients underwent descriptive analysis, and 19 eligible studies were included in the meta-analysis. For predicting all-cause mortality, the pooled HR for low FR measured at rest (cut-off value 200–210 mL/s) was 1.31 (95% CI: 1.03–1.60, I²: 66%, p < 0.05). For FR measured during stress echocardiography (cut-off value 250 mL/s), the pooled HR was higher at 1.58 (95% CI: 1.20–1.96, I²: 0%, p < 0.05). However, data in stress echocardiography have been drawn from a smaller number of studies compared to rest FR assessment, and validation in larger studies is warranted. Additionally, every 100 mL/s increase in FR, either at rest or stress, significantly reduced all-cause mortality. In Conclusion, FR is a prognostic marker for all-cause mortality and adverse composite outcomes in AS patients, indicating its potential for risk stratification. Incorporating FR into clinical assessments could help personalize follow-up and monitoring strategies.

Systematic Review Registration: PROSPERO (registration number: CRD42023404048).

超声心动图评价主动脉瓣狭窄（AS）严重程度依赖于主动脉瓣面积和峰值射流速度。为了提高准确性，引入了经主动脉血流率（FR），定义为卒中容积与收缩期射血时间之比。然而，其在AS患者中的预后价值仍存在争议。本研究旨在系统回顾FR在AS患者中的预测价值，并在适用的情况下提供定量汇总分析结果。系统检索了截至2025年7月31日发表的关于AS患者的观察性研究。如果研究评估FR的临床预后效用，随访至少三个月，则纳入研究。使用随机效应模型计算每个二元结局FR风险比（HR）的汇总估计值和95% CI。21项研究10,895例患者进行了描述性分析，19项符合条件的研究纳入了meta分析。对于预测全因死亡率，静息时低FR的合并HR（临界值200-210 mL/s）为1.31 (95% CI: 1.03-1.60, I2: 66%, p2: 0%, p

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引用次数: 0