American heart journal最新文献

Background: Ventricular arrhythmias and sudden cardiac death (SCD) are common in adults with congenitally corrected transposition of great arteries (cc-TGA). The purpose of this study was to describe the outcomes after implantable cardioverter-defibrillator (ICD) implantation in adults with cc-TGA.

Method: Retrospective cohort study of adults with cc-TGA who underwent ICD implantation at Mayo Clinic (2003-2024). Indications for ICD implantation were classified as primary versus secondary prevention. Study outcomes were appropriate and inappropriate ICD shocks. Exploratory outcomes were device-related complications and mortality.

Results: Of 278 patients, 87 (31%) underwent ICD implantation (age 45±15 years, 59% males; primary prevention [N=67, 77%], secondary prevention [N=20, 23%]). Overall, 14 (16%) patients received appropriate ICD shock. The annual incidence of appropriate ICD shock was 3.7% per year and was lower in the primary versus secondary prevention groups (1.9% versus 8.2% per year, p=0.006). Overall, 11 (13%) patients received inappropriate ICD shock, yielding annual incidence of 3.5% per year. This was similar between the 2 groups. Apart from ICD implantation for secondary prevention, none of the conventional risk factors were associated with an appropriate ICD shock. All-cause mortality was high (31%) among the cohort, but none of the patients experienced SCD.

Conclusions: We observed a high rate of appropriate ICD shock, especially in the secondary prevention group. However, risk stratification of ICD implantation for primary prevention remains challenging. The absence of SCD (despite a high prevalence of all-cause mortality) suggest that ICD implantation may provide a survival benefit.

Background: Despite evidence supporting low-density lipoprotein cholesterol (LDL-C) reduction below 70 mg/dL after a major acute coronary event (MACE), many patients fail to reach this target.

Methods: Retrospective cohort study (baseline 2012-2022) with follow-up through 12/31/2024 (median follow-up: 5.1 years). Participants were 47,416 adults with non-fatal myocardial infarction and/or coronary revascularization discharged on lipid-lowering therapy. Main exposures were LDL-C levels within 1-year post-event and annually for 10 years. Outcomes were incident ASCVD events (myocardial infarction, revascularization, ischemic stroke, CHD death) and composite CVD events (ASCVD, heart failure, peripheral vascular disease, CVD death).

Results: The cohort's mean (SD) age was 66 (12) years; 72% were male, and 58% white. In year 1, 12% lacked LDL-C testing; this rose from 44% in year 2 to 64% in year 10. Target LDL-C attainment was 67% in year 1 and 57-60% in years 2-10. Women and African American patients had lower target attainment. There was a clear upward trend of improved target control over time (58% in 2012, 77% in 2022). Comorbidities, cardiac rehabilitation participation, and adherence to lipid lowering therapy were associated with improved LDL-C control. Achieving LDL-C <70 mg/dL was associated with lower risk of ASCVD (HR 0.79, 95% CI 0.77-0.82) and composite CVD (HR 0.84, 95% CI 0.82-0.87); both p<0.001. Numbers needed to treat (NNT) to prevent one ASCVD or composite CVD event were 19.7 and 26.3, respectively.

Conclusions: Significant gaps exist in LDL-C monitoring and treatment goal attainment post-MACE. Notable disparities by sex and race/ethnicity were observed. Failure to meet LDL-C targets was associated with a significant increase in ASCVD and CVD risk.

Invasive coronary function testing (ICFT) is the gold standard for diagnosing coronary microvascular dysfunction (CMD) and is predominantly performed in the left anterior descending coronary artery (LAD). We analyzed a prospective registry of 231 patients with angina and no obstructive coronary artery disease (ANOCA) who underwent consecutive ICFT using the Doppler method in both the proximal LAD and the left circumflex (LCx) arteries for assessment of coronary flow reserve (CFR). ICFT with multivessel CFR assessment that included the LCx in addition to the LAD identified an additional 10% of patients with CMD (CFR<2.5) that would have been missed by LAD assessment only.

Background: Chronic total occlusion percutaneous coronary intervention (CTO-PCI) is a high-risk procedure where reliable risk prediction is essential. We compared the performance of two risk models (Blue Cross Blue Shield of Michigan Cardiovascular Consortium [BMC2] and Prospective Global Registry for the Study of Chronic Total Occlusion Intervention [PROGRESS-CTO]) for the prediction of in-hospital outcomes after CTO-PCI.

Methods: We retrospectively analysed 1,157 CTO-PCI procedures performed at a single tertiary center between 2019 and 2023. Primary endpoint was in-hospital mortality. Discrimination was assessed with the area under the curve (AUC) method and calibration with calibration plots. Model accuracy was further quantified by the Brier score.

Results: Major adverse cardiac and cerebrovascular events (MACCE) occurred in 3.0% (n=35), and mortality in 1.0% (n=11). The BMC2 score outperformed PROGRESS-CTO for mortality prediction (AUC 0.96 vs 0.71; p<0.001). BMC2 achieved excellent prediction for acute kidney injury (AUC 0.93), dialysis (0.91), and stroke (0.84), while PROGRESS-CTO provided moderate accuracy for periprocedural myocardial infarction, pericardiocentesis (both AUC 0.71), coronary perforation (AUC 0.72) and MACCE (AUC 0.62). Calibration plots indicated better calibration for the PROGRESS-CTO model, while both models showed low overall prediction error (Brier score).

Conclusions: In CTO-PCI, BMC2 offers superior performance for in-hospital mortality prediction. Their complementary features suggest BMC2 as a powerful, data-demanding, and patient-focused tool, while PROGRESS-CTO as an easy-to-calculate, procedure-oriented model.

Background: Endoscopic mitral valve surgery (MVS) has evolved at specialized centers aiming to reduce surgical trauma and improve recovery. The aim of this study was to monitor the evolution and temporal changes of endoscopic MVS at our institution.

Methods: Between 2012 and 2022, a total of 1.037 consecutive patients underwent endoscopic MVS and were categorized into an initial- (2012-2017; n=487) and a late-group (2018-2022; n=550). Data was retrospectively analyzed.

Results: Patient age increased during the study period from 56.0(47.0-64.2) to 61.0(55.0-68.0)years (p trend=0.0275). The prevalence of coronary artery disease (9.3vs.17.1%;p<0.001) and endocarditis (2.1vs.6.0%;p=0.0026) differed between groups. Median STS PROM score increased from 0.3(0.3-0.5) to 0.4(0.3-0.9) (p trend<0.001). MV repair was performed in 92.7%. Concomitant procedures, e.g., closure of left atrial appendage (21.0%), atrial ablation (19.2%) or tricuspid valve repair (6.7%) increased significantly over time (p trend<0.01). Nevertheless, median bypass and cross-clamp times decreased (p trend<0.001). Median postoperative ventilation time was 5.0(3.3-7.0)hours and decreased during the study-period (p trend<0.001). Length of intensive care unit and in-hospital stay were 2.0(1.0-3.0) and 7.0(6.0-9.0)days, respectively. At 30 days, overall mortality was 0.6% excluding patients with endocarditis. After 5 years re-operation rate was 2.5% and overall survival was 94.0%. During a maximum follow up of 11.2 years, reoperation rate was 5.0%, whereas overall survival was 88.5%.

Conclusions: In the present analysis, evolution of endoscopic MVS from isolated procedures in young, low-risk patients with simple MV pathology to combined procedures in older patients with complex MV disease, was demonstrated. Despite increasing surgical risk, complexity of MV disease as well as an increasing rate of concomitant procedures, perioperative outcome remained favorable over time, resulting in promising mid- to long-term results.