American Journal of Cardiology最新文献

The safety and efficacy of cangrelor during percutaneous coronary intervention (PCI) in high-bleeding-risk (HBR) acute coronary syndrome (ACS) patients remain unclear. We evaluated the impact of cangrelor on outcomes after PCI in HBR ACS patients. ACS patients with data available to identify HBR status (per 2019 Academic Research Consortium criteria) who underwent PCI at our institution between 2018 and 2023 (n = 2509) were screened. Those presenting with cardiogenic shock or requiring thrombectomy or glycoprotein 2b/3a inhibitors during PCI were excluded (n = 201) and 1007 were categorized as HBR. In-hospital composite ischemic events (inpatient mortality, target vessel revascularization, stent thrombosis, and ischemic stroke) and major bleeding (intracranial hemorrhage, blood transfusion for hemoglobin drop >3g/dl) were compared between cangrelor and noncangrelor groups. The cohort had a mean age of 71.8 years and 54.5% were male. Cangrelor group had fewer chronic comorbidities but presented with higher acuity, with increased rates of ST-elevation (STE-ACS) (33.4% vs 6%, p <0.001), greater new-onset congestive heart failure (CHF) (10.3% vs 3.5%, p <0.001), intra-aortic balloon pump use (11.9% vs 4.4%, p <0.001), and new acute kidney injury (AKI) (10.9% vs 5.7%, p = 0.003). Multivariate analysis adjusting for age, STE-ACS, new onset CHF, and AKI showed similar ischemic (OR [CI]: 1.52 [0.68 to 3.27], p = 0.30) and major bleeding (OR [CI]: 1.65 [0.92 to 2.93], p = 0.09) outcomes among cangrelor and noncangrelor patients. In conclusion, cangrelor use in HBR ACS patients undergoing PCI was not associated with improved outcomes versus oral P2Y12 inhibitors, although similar event rates despite higher acuity in the cangrelor group may suggest potential benefit in select patients without added bleeding risk.

Aortic valve disease is the most common valvular disease and is often seen in the elderly population. Transcatheter aortic valve replacement (TAVR) is a favorable and rapidly evolving intervention. Despite highly effective procedural outcomes, the TAVR population remains at high risk for heart failure and death, and medical therapy after TAVR is understudied. Diabetic medications including GLP-1 receptor agonists (GLP-1 RA) and SGLT2 inhibitors (SGLT2i) have had emerging data suggesting cardioprotective effects. In this study, we aim to evaluate cardiovascular outcomes in post-TAVR patients who are treated with GLP-1 RA, SGLT2i, or both compared to those who are not treated. Using TriNetX, we identified a cohort of patients who underwent a TAVR procedure and then classified them as treated with GLP-1 RA, SGLT2i, both, or none. After propensity matching for demographics, comorbidities, and medications, patient outcomes for all-cause mortality (ACM) and cardiovascular disorders were evaluated using a Kaplan-Meier analysis. Our results showed a decrease in ACM in those who were on GLP-1 RA after TAVR compared to those who were not. There was also a statistically significant decrease in arrhythmia in patients on SGLT2i after TAVR compared to those who were not. When GLP-1 RA and SGLT2i were combined, there was a decrease in ACM, myocardial infarction, acute heart failure, and arrhythmia after TAVR compared to those who were not. In conclusion, these findings further suggest cardioprotective effects of these drugs in patients treated with TAVR. Future trials should further investigate the role of these medications in patients with aortic valve stenosis.

Calcified coronary lesions (CCL) remain a major challenge in percutaneous coronary intervention, often limiting stent expansion and worsening long-term outcomes. Conventional calcium modification techniques such as specialty balloons or atherectomy may fail to adequately address heavily calcified lesions and are associated with procedural risks. Intravascular lithotripsy (IVL) has become an established calcium-modification strategy that uses acoustic pressure waves to fracture calcium while minimizing vessel trauma. This review summarizes evidence from pivotal trials and real-world experience demonstrating the safety and feasibility of IVL across a broad spectrum of lesion morphologies, including eccentric calcium, calcified nodules, and complex subsets such as left main disease. Comparative analyses with other calcium-modification modalities are presented, along with an imaging-guided, morphology-driven algorithm to inform contemporary device selection in routine practice. In conclusion, while IVL offers a safe and effective approach to lesion preparation, important limitations remain, including the lack of randomized comparative data and cost considerations, and ongoing trials are expected to further define its role, with current evidence supporting IVL as an important tool in the contemporary management of calcified coronary lesions.

Risk stratification in individuals with Brugada electrocardiographic pattern (BrECG) remains challenging. The dST-Tiso ECG criterion, defined as an interval between the onset of coved ST-segment elevation and its return to the isoelectric line >300 ms, has been validated as a predictor of ventricular arrhythmia (VA) inducibility during programmed ventricular stimulation. We aimed to assess the association between this criterion and the arrhythmic risk during follow-up. Consecutive patients with BrECG were prospectively enrolled. The dST-Tiso interval was measured during a manifest type 1 BrECG (spontaneous or drug-induced). The primary endpoint was a composite of sudden cardiac death or documented VA, either symptomatic or treated with appropriate implantable cardioverter-defibrillator therapy. The cohort included 281 patients (median age 42 years; 64% male; 10% spontaneous type 1; 23% VA-inducible). Among them, 197 (70%) had a negative and 84 (30%) a positive dST-Tiso criterion. Over a median follow-up of 3.2 years, 11 patients (3.9%) reached the primary endpoint: 1 sudden cardiac death, 5 implantable cardioverter-defibrillator-treated VA, and 5 self-terminating VA episodes. All events occurred in patients with positive dST-Tiso (log-rank p <0.001). Within this group, 5 patients had spontaneous and 6 drug-induced type 1 BrECG; 7 had inducible and 4 noninducible VA. As a continuous variable, the dST-Tiso was also associated with events (hazard ratio per ms: 1.02; 95% confidence interval [95% CI] 1.01 to 1.03; p <0.001). In conclusion, individuals with BrECG and a negative dST-Tiso criterion had a very low risk of arrhythmic events. This ECG marker may enhance multiparametric risk stratification.

Hypertrophic cardiomyopathy (HCM) is a genetic myocardial disease. In 20% to 30% of patients, a disease-causing variant can be identified and may also be present in relatives. Individuals carrying a pathogenic variant (G+) without left ventricular hypertrophy (LVH) are classified as genotype-positive/phenotype-negative (G+/P-). Their risk of developing LVH or HCM-related events remains uncertain. The aim of the article is to describe the clinical course of G+/P- individuals during long-term follow-up. G+/P- individuals were recruited from relatives of HCM patients at a tertiary center. All underwent clinical assessment, electrocardiography (ECG), and transthoracic echocardiography (TTE). Phenotype-negative status was defined as maximal left ventricular wall thickness (MLVWT) <13 mm. HCM was diagnosed when MLVWT ≥13 mm was observed without hypertension or other hemodynamic causes. Genetic testing used targeted Sanger sequencing, with variants classified per ACMG/AMP criteria. Thirty-four individuals were classified as G+/P-; the mean age was 31.7 ± 14.8 years, and 27% were men. Variants occurred in MYBPC3 (76%) and MYH7 (24%). Most were asymptomatic (85%), and 71% had a normal ECG. Mean follow-up was 6.6 ± 3.7 years, with complete ECG and TTE data in 88%. MLVWT increased from 9.6 ± 1.6 mm to 10.7 ± 3.3 mm (p = 0.01), while other echocardiographic parameters and ECG findings remained stable. Nine individuals (26%) developed LVH after a mean of 5.1 ± 4.1 years. One patient developed nonsustained ventricular tachycardia and received a primary prevention implantable cardioverter-defibrillator. In conclusion, G+/P- individuals were young and largely asymptomatic, yet 26% progressed to HCM. These results support regular TTE and ECG surveillance to enable early identification of disease progression and guide risk stratification.

Accurate aortic annular sizing is essential for transcatheter aortic valve replacement. While multidetector computed tomography (MDCT) remains the reference standard, three-dimensional transesophageal echocardiography (3D TEE) is frequently used when computed tomography is contraindicated; however, semiautomated 3D TEE is associated with systematic annular underestimation that may lead to prosthesis undersizing. In a prospective single-center cohort of 45 candidates for transcatheter aortic valve replacement undergoing both MDCT and 3D TEE, aortic annular diameter, perimeter, and area were compared using semiautomated 3D TEE, a hybrid approach incorporating manual Flexi-Slice multiplanar reconstruction, and MDCT. Annular underestimation was quantified relative to MDCT, and clinical relevance was assessed by agreement in hypothetical transcatheter heart valve sizing using manufacturer-recommended perimeter-based algorithms. Semiautomated analysis significantly underestimated annular diameter, perimeter, and area compared with multidetector computed tomography (all p <0.001) and resulted in 31% discordance in hypothetical valve sizing. The hybrid approach demonstrated significantly lower annular underestimation and improved agreement with MDCT, reducing valve sizing discordance to 13% and increasing overall agreement from 69% to 87%. Coronary height measurements showed a weak correlation between hybrid 3D TEE and MDCT. In conclusion, although all 3D TEE approaches underestimate aortic annular dimensions compared with MDCT, a hybrid workflow integrating manual Flexi-Slice multiplanar reconstruction significantly reduces underestimation and improves agreement in transcatheter heart valve sizing, providing a clinically valuable alternative for annular assessment when MDCT is unavailable or contraindicated.

Treatment of in-stent restenosis (ISR) is challenging. Drug-coated balloons (DCB) are widely used in this setting to avoid deploying another metal layer to the vessel wall. This first-in-man study sought to assess the safety and efficacy of a novel everolimus-DCB (CVT-DCB) using a new coating formulation and crystalline everolimus in patients with ISR. A total of 51 patients (mean age 69.2 years) with single ISR lesions (≤24 mm in length) were prospectively enrolled at nine sites in Europe. The primary safety endpoint, freedom from target lesion failure at 180 days, was 92.2%, with the lower bound of the 95% CI (81.1%), above the protocol-defined objective performance criterion (65% for conventional balloon angioplasty, p <0.05). The primary efficacy endpoint, in-stent late lumen loss, was 0.40 mm, lower than the protocol-defined objective performance criterion of balloon angioplasty historical control (late lumen loss 0.80 mm, p <0.001). Three-year clinical follow-up was obtained in all (100%) patients. During the first year, 4 patients required ischemia-driven target lesion revascularization. No new episodes of TVF (cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) occurred beyond the first year. The target lesion failure rate at 3 years was 9.8% (95% CI 3.3%-21.4%). The clinical follow-up of this first-in-man study confirms the sustained safety and efficacy of this novel everolimus DCB in patients with ISR. (Clinical Trials Registration: NCT05731700).

Cardiac rehabilitation can improve patient outcomes and reduce the risk of recurrent cardiac events. Virtual home-based programs may support patient access and participation if feasible and effective. Among all eligible patients with a cardiac event (myocardial infarction, coronary artery bypass graft, or percutaneous coronary intervention) between 2016 and 2022, within a multisite integrated delivery system offering a virtual home-based Cardiac Rehabilitation Program, we examined the association between cardiac rehabilitation exposure and return emergency department visits or hospitalizations, major adverse cardiovascular event events, and revascularization during a 1-year period after rehabilitation, using propensity weighted multivariate analyses to balance rehabilitation and nonrehabilitation groups. Among 25,552 eligible patients across 21 medical centers, 7,077 (27.7%) enrolled in home-based virtual cardiac rehabilitation and received three or more intervention encounters. After adjustment, cardiac rehabilitation exposure was associated with a higher risk of all-cause emergency department visits (Adjusted RR: 1.08, 95% confidence interval [CI] 1.05 to 1.12) and a significantly lower risk of hospitalizations (Adjusted RR 0.86, 95% CI 0.81 to 0.90). We found no statistically significant association with major adverse cardiovascular event and revascularization events. Cardiac rehabilitation was, however, associated with a significantly lower rate of 1-year mortality (Adjusted RR 0.68, 95% CI 0.60 to 0.76). In conclusion, virtual home-based cardiac rehabilitation was associated with lower hospitalization and mortality, showing feasibility and effectiveness for improving cardiac outcomes. Further attention may be given to increasing patient engagement, given the relative convenience of a home-based virtual program.

Patients with nonsyndromic thoracic aortic aneurysm and dissection (nsTAAD) may have systemic arterial involvement, but the distribution and clinical correlates of extrathoracic disease remain poorly defined. We conducted a retrospective cohort study of adults with nsTAAD at Mayo Clinic (2018-2024). Trained reviewers manually confirmed thoracic aortic dilation and all extrathoracic vascular lesions; syndromic, congenital, and fibromuscular dysplasia-related cases were excluded. Cross-sectional imaging availability was abstracted for the head or neck, chest, and abdomen or pelvis. Detection frequencies of nonthoracic aneurysm (nTA-A) were calculated among patients imaged in ≥1 extrathoracic territory, while nonaortic dissection (nTA-D) frequencies used the full cohort denominator. Group differences were assessed using Chi-square or t Tests, and logistic regression identified predictors of nTA-A. Among 3,989 patients (28.6% female), 82.0% had CT or MRI of ≥1 extrathoracic territory. nTA-A was detected in 443/3,270 (13.5%) and increased with age (7.4% at 18-30 years, 8.4% at 31 to 50 years, 18.3% at ≥51 years; p <0.001), with the greatest detection burden in the abdomen or pelvis followed by the head/neck. nTA-D occurred in 136/3,989 (3.4%) and also rose with age (0.7%, 2.2%, 4.9%; p <0.001). Hypertension and hyperlipidemia were independently associated with nTA-A (p ≤0.05). Patients with nTA-A or nTA-D had higher rates of heart failure, myocardial infarction, stroke, and mortality (all p ≤0.01). In conclusion, extrathoracic aneurysms and dissections are common in nsTAAD and increase with age, supporting careful clinical assessment with vigilant symptom monitoring and risk factor optimization, and providing a foundation for future studies to determine when broader vascular evaluation improves longitudinal risk stratification and outcomes.

The obesity epidemic is a major health burden that enhances susceptibility to a broad spectrum of metabolic-associated comorbidities, ranging from fatty liver disease and endocrine dysfunction to traditional risks like type 2 diabetes mellitus and cardiovascular disease. Glucagon-like peptide-1 receptor agonists, including semaglutide, facilitate weight loss alongside glucose metabolism. The dual therapy CagriSema, which combines semaglutide with cagrilintide was developed. We systematically searched MEDLINE (via PubMed), Web of Science, Scopus, and Cochrane Library, from inception to July 2025, for randomized controlled trials (RCTs) comparing CagriSema with semaglutide monotherapy or placebo in patients with obesity. Four RCTs (n = 4,419) were included (CagriSema: 3,055; control: 1,364). Pooled analysis showed that CagriSema significantly reduced percent weight loss (Cohen's d: -1.38; 95% CI: -1.84 to -0.91; I² = 94.8%). CagriSema also resulted in greater absolute weight loss (MD: -11 kg), waist circumference (MD: -9.41 cm), and systolic blood pressure (MD: -7.06 mmHg). Gastrointestinal adverse events were more frequent (RR: 1.32). CagriSema therapy was associated with superior weight reduction compared with semaglutide or placebo. In conclusion, CagriSema achieves greater weight loss than semaglutide or placebo but increases gastrointestinal adverse events, warranting careful tolerability monitoring and longer-term data.